When Neroli stopped hopping

Published in 'Rabbiting On' magazine, Autumn 2011 

 

Several of my previous rabbits over the past 30 years were lost to problems which could have been tackled given today’s advances in rabbit medicine. So, when Neroli, our nine-and-a-half- year-old Dutch houserabbit suddenly stopped hopping, I was determined not to give up hope, but find out why, and what we could do for her. I researched thoroughly, and, despite the steep learning curve, discovered that it IS possible for a disabled rabbit to have a good quality of life. Without my newly acquired knowledge, I could have panicked, given up hope and missed out on 11 rewarding weeks with Neroli. 

The problem 

Neroli was in excellent health for her age. Although she spent a lot of time resting, she would still leap onto the sofa, race back to her cage for treats, and burrow into the armchair. 

Last Easter, Neroli’s hind legs suddenly weakened. On Maundy Thursday we rushed for the last appointment with our vet, who diagnosed arthritis. On Good Friday she collapsed to one side every few hops, struggled to stand, and found it tricky to clean or climb into her tray without assistance. 

By Easter Saturday we were questioning the diagnosis as her legs had deteriorated rapidly. Although we saw no sign of pain or distress, and no loss of appetite, we wondered if it was fair to keep her alive over Easter. The possibility of giving Panacur (hind leg weakness is one of the symptoms of rabbits affected by E. cuniculi) was recommended. 

Over the weekend I observed keenly, researched intently, and kept a detailed journal. I read about rabbits with hind end paralysis/paresis from fractures, arthritis, spondylosis, slipped discs, spinal infection (spondylitis), and E. cuniculi. We were so anxious but fortunately, Neroli was adapting to moving with two front legs, even grinding happily when basking in the sun. 

When I returned to the vet to request anti-inflammatory drugs after the weekend, Neroli’s hind legs were so lifeless that I was prepared, with my newly found knowledge, to convince him she could have a good quality of life. To my amazement, when he put her on the surgery floor she hopped! The vet still thought it was leg and hip arthritis, and prescribed Metacam ‘as required’. 

Back at home, she hopped back to her cage, into her tray and even scratched her ear. She hopped weakly but still managed to travel around the living room. This miraculous transformation gave us false hope, and lasted for three days. On Friday her legs weakened again, and she returned to lying on her side. We began giving Neroli the Metacam. For a fortnight she could stand if supported, but her back legs gradually lost strength, until she could no longer move them at all. 

In June, eight-and-a-half weeks after her problem appeared, she suddenly lost the use of her front legs. She had been eating well, but gradually her appetite decreased until she was only eating highly selectively. She died peacefully at home, in my arms in early July. She was affectionate and interested in life to the end. She never showed signs of pain or distress. Of course, we were devastated but it was such a rewarding journey that I want to share some of the knowledge I gained along the way. 

Diagnosis: the importance of a rabbit-savvy vet

When Neroli could no longer stand, the vet decided it was not just arthritis (it would have responded to Metacam) or E.Cuniculi (there was no balance problem). He concluded it was probably something ‘very unusual’. Having researched many possibilities, I was dissatisfied with this diagnosis, and lost some confidence in him. 

We decided that there was no valid reason to proceed with diagnostic testing as it would not change the prognosis, treatment, or quality of life for Neroli. An X-ray simply to satisfy our own curiosity would be stressful for Neroli and may have required an anaesthetic or at least sedation, especially if the legs or spine were painful or stiff, and any problem it might reveal was unlikely to be treatable. 

However, eight weeks after Neroli first developed weakness in her legs, through a chance encounter I discovered a locally based rabbit-enthusiastic vet. She encouraged me to consider an X-ray, and was able to perform it without anaesthetic. The X-rays revealed spondylosis of the spine. Although it was not treatable, at least we knew we were doing all we could, managing any pain using the anti-inflammatory drug Metacam. Reassured by her knowledge and love of rabbits, we decided to transfer care of Neroli to this vet. 

Caring for a disabled rabbit

Aiding mobility: 

Many disabled rabbits keep mobile using carts, small skateboards, or slings. Neroli was an elderly, fairly inactive rabbit, not frustrated by her lack of mobility. She probably wouldn’t have adapted to any mobility aid, so we made her comfortable wherever she decided to rest, and carried her to routine resting places.

We cut a large roll of Vet Bed (faux fleece) into squares for her cage and favourite places, to prevent pressure sores and provide grip. When she was still able to pull herself around to find some sunshine or come for a cuddle there was a Vet Bed with some treats waiting to reward her huge effort. 

Some people use baby clothes for their rabbit, or place them on a small pad of material with slippery base to reduce friction on the down hip, but Neroli’s movement wasn’t sufficient to wear off fur or create soreness.  

Accessible food and drink:  

Hay, pellets and vegetables were always left within easy reach of Neroli, and we remembered to bring her treats as she was no longer able to scrabble or nudge our ankles for them! She wouldn’t drink from a bowl, so we frequently offered her bottle.  

Comfortable bedding and toilet:  

A rabbit that cannot sit properly soon becomes soiled – a prime target for flystrike. I covered Neroli’s hind quarters with a towel, whether she was indoors or outside. Unreachable caecotrophs were offered regularly for consumption. 

Urine scald is a big problem in the world of disabled rabbits. At first, I stood Neroli in her litter tray every couple of hours. When her legs were too weak to stand, she started to wet on her bedding so I stopped using the tray. Every other day I washed her bottom under a mixer tap with luke warm water. 

Researching the problem of urine scald revealed that many carers advise using creams to prevent scald and soothe sore skin (eg. Calendula cream, Sudocrem), but Neroli always set about aggressively cleaning it off, pulling out fur and occasionally drawing blood, so I had to abandon that solution. 

The secret to keeping bedding dry seemed to be layering: a material, such as Vet Bed, which wicks the moisture away from the rabbit, with something absorbent underneath. In Neroli’s cage I used litter sandwiched between Vet Bed and newspaper. Outside the cage, I used Vet Bed and newspaper, and placed an open nappy under Neroli’s bottom. I watched carefully before I was happy to leave her unattended with the nappy (as most types of disposables contain dangerous gel granules). Some disabled rabbits wear nappies, or have their bladders expressed but Neroli wouldn’t tolerate either. 

At first, Neroli became distressed when she had an ‘accident’ outside her tray. She was house-trained and had to be convinced she was not in trouble. 

Soon after Neroli lost use of her front limbs, her breathing became laboured. I placed a large cushion and some foam under her vet bed to take pressure off her lungs and the breathing returned to normal within a couple of days.  

Medicine:  

Metacam (Meloxicam) is a non-steroidal anti-inflammatory drug widely used for disabled rabbits, often long-term. However, not all vets are confident in prescribing it as there is not as much scientific research to determine the optimum dosage for rabbits as in dogs and cats, and it is not currently licensed in the UK for use in rabbits. However, anecdotal evidence from online forums indicated that the dose prescribed for Neroli was low and that, because of the rate it is metabolised, it should be split into at least two doses per day, and given with food, to reduce effects on the stomach. 

I was informed that Metacam is palatable to rabbits, so I swapped the syringe for a teaspoon. The importance of keeping Neroli free from pain far outweighed any possible side effects (including kidney damage) so she had Metacam twice daily and never displayed any signs of pain. 

It was also suggested that I could give Litozin Rosehip capsules for arthritis and joint problems. I mixed the contents of a capsule with a small piece of bread and drop of water, which became a much anticipated part of Neroli’s routine. Many rabbits respond well to other alternative medicines, including acupuncture.  

Massage and grooming:  

Neroli’s position twisted her spine and put strain on her front limbs. I spent every evening on the floor massaging her whole body. I cuddled her with my hand under her abdomen to take the weight off her front legs. Sometimes she became so relaxed that she fell asleep in this position. 

I used my little finger to scratch inside Neroli’s ears (too large to cause damage). She liked to lick my finger afterwards!

Quality of life

Is it cruel to keep alive a prey animal that is unable to move? This was a dilemma we struggled with. Of course it is impossible to generalise, but several factors were in Neroli’s favour: she was a sociable, relaxed rabbit, who trusted us; she showed no sign of pain or fear, was still spirited, affectionate, and maintained a healthy appetite (even in her final week, she was still enjoying her favourite treats as I desperately offered things from the garden); as a stay-at-home Mum, I was fortunate to be with Neroli for most of the day. We frequently re-assessed whether she was still enjoying life, and every time we saw that sparkle in her eyes, we knew that she was still enjoying her sweet life with us, her family.

Top Tips

I asked members of the ‘Disabled Rabbits’ forum to offer their Top Tips.

1. Find a rabbit knowledgeable and rabbit-caring vet who is able to help you assess quality of life and who does not default to euthanasia, but who is not afraid to provide an objective view on when the time has come to say goodbye.
2. Seek knowledgeable groups and learning resources, and prepare to launch yourself onto a steep, fast learning curve to assess and acclimatise to your bunny’s changing symptoms and needs.
3. Record all information to help you and your vet meet your bunny's changing health needs (dietary adjustments, environment, skincare of those who become immobile and/or incontinent of urine).
4. Don't panic but take a deep breath: It is easy to worry ourselves into exhaustion. Taking care of a disabled rabbit is stressful, but also rewarding. Remember to remain calm.
5. Enjoy your time with them. We won't be able to take care of them forever. Household chores can wait.