For descending paralysis, that is indicative of botulism, you can expect paralysis to continue to develop over several days (3 days in our case) and then progressively clear over several more days so the treatment will need to be readjusted as the paralysis changes.
None of the following is intended to replace consultation with a qualified veterinary practitioner. Always discuss treatment and seek prescriptions as needed from your veterinarian.
Onset to stabilization
Veterinary assistance is critical, some causes can be readily identified and treated. Rapid treatment by an experienced rabbit vet can make a profound difference. There are several potentially fatal complications, with paralysis of breathing muscles the most difficult (impossible/impractical) to treat. Other complications include infection and digestive issues, they develop over time and if watched for can be treated.
- The first few hours are stressful for you and your rabbit. With descending paralysis the strong rear leg muscles will have lots of strength. In Ruby's case for a while she was nearly fully paralyzed from the middle of her back up, but her back legs had full function. Half rag doll and half jumping machine; without supervision she would jump around tossing the limp top of her body around, major physical injury seemed a real risk. Sometimes she would land in her water bowl.
Solution We provided soft flooring & area, removed her water bowl, and provided near 24 hour snuggling until she calmed down. Over a couple of days she adjusted to the new reality and was much calmer. Water is offered every 2 hours and if sufficient fluids are not drunk, subcutaneous fluids are given (as prescribed by your vet).
- With loss of the neck muscles Ruby is unable to keep her head upright, when resting her face would usually have the right side on the floor. Rabbits have a somewhat protruding eye ball, that can be easily damaged. Paralysis may include loss of control of the eyelid and/or nictitating membrane.
Solution As well as keeping her as calm as possible and keeping the area clean and soft, we found that a towel folded to a height of about 3/4 inch (2 cm) thick helped to stabilize her head, keeping it better aligned and seemed to provide her increased comfort. She maintained some ability to move (flop) around during the entire event, and would generally reposition herself to continue use of the "pillow". We monitored her eyes to make sure they stayed moist, and for presence of the ability to blink.
- Rabbits need to keep food moving through their digestive track. To complicate matters, we now have a rabbit who has paralysis everywhere, in humans with botulism swallowing issues are common. With rabbits who are not feeling well we will often force feed them to keep the digestive track moving. In this case we have the potential for many complications, if you force feed and the swallowing muscles are paralyzed you can force food into your bunnies lungs and cause aspiration pneumonia this can be fatal. If your bun survives the first few hours of botulism, feeding is the next critical point.
Solution Talk to your vet! Do it soon, a few hours without food is probably OK, but after 12 hours it is getting critical and 24 hours... well, just don't go there. In our case Ruby had acceptable jaw movement, swallowing and appetite. The first 24 hours she had small meals every couple of hours. She had difficulty with hard food like pellets and hay, We mixed critical care with some of her normal pellets and water to make a mush. Sitting cross legged on the floor, with her head draped over my thigh I could raise the bowl to her mouth and she could eat (video). By the third day she was eating 4 or 5 fairly large meals per day, she preferred thicker mush as time progressed. By about the 7th day she refused mushy critical care and pellets. We transitioned her to dry pellets, lettuce and a couple days later added hay back to her diet. I can not stress strongly enough how important every decision here can be, seek the best assistance you can find. Rabbits die from digestive upset, and they die if you fill their lungs with mush. Eating mushy food with a paralyzed head/neck can be messy. Use a towel to protect your lap, and the surrounding area. A warm moist wash cloth can be used to wipe your bunnies head and neck when she is done eating. We found that the area under the chin was most problematic to keep clean.
- Going to the bathroom: Rabbits as a rule have great litter box habits. For anyone who is paralyzed (person of bun) keeping urine and feces from causing harm to the skin is important. Also bed sores are a risk if one position is maintained for too long. While neither is fatal in the short term, they can make life unpleasant and be extremely difficult to treat.
Solution Up to the litter box every two hours. We used several methods to help protect in case of an accident (example) but our primary approach is get to the litter box regularly. The first few nights I slept on the floor with her, and we got up to pee every 2 hours. After the first few days we purchased incontinence pads used by bed bound humans, and moved ruby into our bed (after putting the mattress on the floor,so she would not get hurt if she fell off), continuing the every two hour potty break. She has not wet the be yet. This keeps her clean, dry and keeps her moving to prevent bed sores. Because she has had much less fiber in her diet her her poops are much smaller, they occasionally stick to her fur but have been easy to remove.
Life Goes On
After the first 3 days or so, things stopped getting worse. Now we are on the road to recovery; we have feeding, sleeping, drinking & bathroom covered. In activity is not a natural state for a rabbit (or person) to be in, a body expects to move around to keep. Inactivity leads to it's own complications.
- Loss of appetite, decreased activity, appears to just not be feeling well. You may notice any of these things. Ruby maintained her personality throughout the paralysis. When she seemed to be less than well, we always found something going on.
Solution Monitor health closely, feed specific amounts of food and track your bunnies intake. You are already monitoring fluids, do the same for food in and poop out. If your bun seems unwell get a temperature (work with your vet to get a rectal temperature) a rabbit normally has a temperature of 101-104 °F (38.6–40.1 °C). Antibiotics may be required if there is a fever. Following antibiotics you will want to consider recolonizing your rabbits gut bacteria. Any number of things can cause your bunny to feel a little off. If it not medical it could be her perception of the world, restoring a diet favorite, or modifying her environment to increase the feeling of comfort and/or security may help. Use care in the feeding of treat foods as they can cause problems with gut bacteria.
- Inactivity can cause decreased muscle mass, and decreased range of motion in joints. In the very long term it can also lead to decreased bone density.
Solution When your rabbit is paralyzed to the point that it can not move around it's enviorment well, is not able to stand, walk or hop; it is time for physical therapy. Provide sufficient area for your rabbit to get as much exercise as possible on her own. Once or twice a day provide passive range of motion through each limbs full ability. Your vet can provide more information, but basically spend a few minutes on each limb moving it through all the positions it would see in a normal day for a non-paralyzed rabbit. Using a towel or scarf (maybe with holes for the legs) support your rabbit in a near normal position so her legs just touch the floor. Encourage her to move naturally. Additionally wheel chairs are available, the majority found on the internet are for rabbits with rear leg paralysis, a quadriplegic is going to need a different solution. Each rabbit will be different so working to customize a solution will be important.
- I am not a baby anymore I want to eat real food by myself! About a week after the onset of symptoms, Ruby is recovering, she has adjusted well to the situation. But she wants to eat real food and she wants her independence. The days of sitting in a lap and eating mush are over!
Solution while monitoring for her ability to chew and swallow solid foods. Re-introduce the regular diet, pellets, lettuce, greens. You may have also included canned pumpkin (NOT pumpkin pie filling) to her diet to maintain fiber in her diet when she was not eating hay. You can continue the pumpkin in her diet. Hopefully at this point your rabbit has good control over head and neck, but may still lack the ability to get her body off the ground. We use a towel rolled up and placed under her chest to elevate her so she can reach her food. Video 1, Video 2, Video 3
- Cecotropes are moving again! About 11 days into the event she is passing cecotropes. She has been passing normal poops (but much smaller then normal) all the time. This is the first sign of cecotropes, they are stickier than normal, but look much the same. The first 24 hours or so we don't see her eating them. She can not get into the normal cecotrope eating position yet. They can be messy.
Solution To help make up for the lack of cecotropes in her diet, we have been feeding as much pellets and oat meal (dry rolled oats) as we could get her to eat. For the first 24 hours or so she would not eat the cecotropes even if presented to her. We were not overly concerned as they are aged beyond normal, and she has been on several meds that probably had a negative impact on them. Frequent checking to keep the area free and clear of these uneaten cecotropes and keeping her clean if any stick to her. She is moving around better (but still has significant issues) it seems safe to start letting her sleep alone now (and potentially very yucky if she starts passing cecotropes in bed with us). She still comes to bed for a while in the evening and morning, but back to her own room with, a soft, moisture resistant bed hay and water available all the time. We are still getting up to help her to the litter box every 2 hours, and checking for cecotropes to keep the area clean. She is occasionally turning around and eating the dropped cecotropes, but not consistently. We encourage her to eat them as practical but are not fretting if she does not. She has lost a bit of weight (3.35 kg - 2.80 kg = about 1 pound or 0.5 kg) so we are still encouraging a high food value diet. Continuing Reglan (Metoclopramide) 1 cc, twice daily, every time we skip a dose she slows down on her eating considerably.
- 16 days into the event, and recovery seems to have slowed down over the last few day. Her left rear leg is only working about 10%, it tends to lay straight out beside her. Her right rear seems to the most normal of all her limbs. Her front limbs seem to work ok, except they keep sliding out to the side, so she does not stand up well.
Solution Continuing physical therapy 2 or 3 times per day. Full range of motion to keep joints flexible, muscles & tendons from contracting. Start using an anti slip mat (like to keep throw rugs from sliding) to give her better traction. Instant improvement, with her footing more secure she is able to hold better posture and keep her limbs under herself better. In the picture here the antislip mat is on a towel so any water spills will be contained.
The antislip mat was nearly magical solution, within hours she was moving around much better, we had to remove the exercise mat, and transitioned to just an incontinence pad with the anitslip mat over it. With in 24 hours she was hopping around, nearly normal, still a bit wobbly but a huge improvement. Ruby hopping around video 1 & Ruby hopping around video 2
At day 20 Ruby is nearly fully recovered. She has lost a lot of weight, and has been finicky about what she will eat. Getting her back to her optimal weight and stabilizing there are on the task list now. She lost a lot of muscle and does not have the strength or endurance she had 3 weeks ago before the event. She is able to get in and out of her room (small cage) and use the litter box on her own. She has full 24 hour access to her normal space (master bedroom) now, the mattress and box spring remain on the floor, and she is not quite able to jump up on the bed, herself yet. Physical therapy is now encouraging her to run around the room. Her left rear leg is returned to near normal positioning and usage, but still has a ways to go before reaching 100%. On day 21 she will be taking her last antibiotic (prescribed for elevated temp and listlessness), we will continue the Reglan for at least a few days after that, as we work to regain normal appetite and weight.
After a month Ruby is 99.90% recovered, her left rear leg has been slow to recover fully. It has a tendency to be a bit more forward than it should be as if the ligament were stretched a bit, and have not returned to normal.
At 6 weeks Ruby is 99.95% recovered, Unless you know what to look for, the left rear seems OK. She is back to her pre-event weight and behaving normally. Just a normal happy snuggle bunny.
This ends the journey of recovery for a quadriplegic rabbit. Botulism remains the primary probable cause, see Why can't my rabbit lift it's head?
5 Year update
Ruby is still doing fine. There are no signs of injury or loss of function related to the above. She is about 9 years old now and starting to show some slowness as she ages. Last year she stopped jumping up on the bed.
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