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Mitsie - female lop eared rabbit


born: January 17, 2014 (3.5 years old)
neutered: April 9, 2015
average weight 2.4 kg
no known health problems (more info about her life/diet at the bottom of the page)
vaccinated Pestorin Mormyx every 6 months (ended, last shot in February 2016)

Mitsie's diet
- I'm trying to make it is as natural as I can - hay, lots of leaves and herbs from garden (fresh and dried), branches, greens, vegetable, dandelion roots, some fruits, homemade dried fruits and vegetables as a treat, grain free pellets, little flax and hemp seeds (approx. 2 tsp a months).
No store-bought unhealthy treats, no salt or mineral licks.
- she never had a gut problem, never left a caecotrophe.
- since young, she has been drinking a lot, approx. 500 ml a day (+-100ml). She is well litter trained, but she used to pee outside the litter box and spray urine before neutering, then it all stopped. Now after hind limb weakness, I noticed some incontinence and it seems she is drinking a little bit less (around 300ml a day).

Mitsie's life
- she lives in an apartment with a spayed male friend (9 years old), they are bonded, but she is still showing some dominance/aggression sometimes, they have a wooden cage but are free-roam almost all the time (except nights), completely free-roam from March 2017
- they do go outside occasionally, a large terrace available almost every day in summer, and sometime free run around a fenced garden to get them some more exercise

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Friday 13th Jan 2017 - sudden hind limb weakness
she can still walk/run, but she can't sit up on her hind legs; she can't jump onto anything higher; while cleaning her face with front legs, she can't do it with both as usually, one of the front leg needs to be on the ground as a support, she can't clean her ears with her hind left leg (she can't lift it up from the floor very high)

no apathy, no loss of appetite, no significant weight loss, no seizures
still active, running, chasing her buddy, eating as usual


16 Jan 2017
first vet visit for x-rays and a complete blood test incl. EC (blood sample taken while sedated on Isofluran for x-ray)

treatment suggested by vet - NSAID (Meloxidyl) for arthrosis - I refused as they are bad for both liver and kidneys, I wanted to wait for blood test results first

blood test results from 17 Jan 2017: (Creatinine and calcium high)

E. cuniculi test - sadly, only IgG were tested for E. cuniculi and were positive (IFAT 1:1280), IgM were not tested as I wanted - I had worries about EC and her kidnesy since she's been drinking more than average

Lump - she had a lump on her back that came out very dense on the x-ray (please see x-rays below). It was there for several months, under the skin, not attached to the bone, felt like one lump (not two), not growing, looked like lipoma; change in size/shape noticed in Jan 2017, several days before hind limb weakness.


20 Jan 2017
the lumps were surgically removed, then second x-ray taken
histology results of lumps: "lesion are similar to calcinosis circumscripta (mineralisation of soft tissues), some granulomatous inflammations were found around it"
(original report in Czech language JPG)

Note:
- I noticed no change in hind limb weakness after Meloxidyl application (after surgical lump removal); I might assume there is no or little pain involved, looks more like nerve/muscle dysfunction to me
- she has no excess vitamin D intake (I found that calcification and hypercalcaemia may be the result of hypervitaminosis D, due to an excessive intake of vitamin D3)

weight after surgery: 2.31 kg

1st and 2nd x-rays - Mon 16th Jan 2017      
x-ray 1 x-ray 1 - detail x-ray 2 x-ray 2 - detail
high resolution image hi-res image hi-res image hi-res image

 

3rd x-ray - Fri 20th Jan 2017
after the lumps were surgically removed
   
x-ray 3 x-ray 3 - detail x-ray 3 - detail
hi-res image hi-res image hi-res image


Lump removed

hi-res image

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Urine - I wanted to test the urine - sadly, couldn't find anybody to do that, but I think there isn't a large amount of sediment in her urine
her urine is not leaving white stains

I did at least a simple urine test at home several times using Health Mate Vet-11AC strips and Undekaphan strips (for human purpose), pH always 8-9, other results always the same as on the pictures:


high resolution image



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31 Jan 2017
- she is getting worse, she has troubles getting into her litter box, more troubles walking, she's more resting and lying than usual
- as there is still a probability of EC causing all this, I decided to start Panacur treatment (panacur pills, fenbendazole 50 mg daily)


1 Feb 2017
- weird, but she seems to feel much better, not sure whether the Panacur helped so quickly- coincidence? (IgM month later were negative)
- keep searching for a place where to do CT scan (hard to find)
- meanwhile giving her these vitamins and herbs:

From the begining of her sickness I was giving her:
vitamin C (around 50 mg daily)
• yeast beta-glucan (around 50 mg daily)
milk thistle seeds (maybe around 10-15 daily, later lowered, keep searching for pure silyimarin supplement)
dandelion roots (supports the kidneys and acts as a diuretic) and dried leaves (fresh not available in winter)
• tropaeolum (dried leaves, immunity, urinary tract)
• lots of parsley fresh greens and sometimes root
• pumpkin seeds (just few a week) (supposed to be good for kidney and bladder problems)
• little bit of oats (only a tsp daily for first few weeks, reduced later) (supposed to be good for kidney and bladder problems, otherwise she's on a grain free diet)
• little of hemp and flax seeds (approx. 1 tsp/week)


7 Feb 2017
- weight: 2.33 kg
- first batch of ordered herbs and supplements arrived

slowly started adding to her diet:
echinacea dried root (immunity)
folic acid
resveratrol
vitamin B complex (incl. B12)
nettle seeds
• little of dried cranberries and aronia (freeze-dried - no sugar/oil added)

Astragalus (root) and Uva ursi - major herbs for kidneys I found


16 Feb 2017
2nd blood sample taken for new tests including IgM and IgG - IgM came out negative
blood test results:

23 Feb 2017 - rabbit specialist appointment
we drove more than 2 hours early in the morning to Brno to do a CT scan, xrays, and another blood tests
Diagnose:
- kidneys damage confirmed (chronic renal failure) - might have been caused by EC or any other infection or inflammation, her kidneys don’t excrete the calcium properly, as I was thinking, which is the reason of calcification - the vet saw calcification in her kidneys, vertebras, aorta, some cartilage (ear), hypercalcification of bones..
- otitis media checked and excluded
- she also has anemia (kidneys producing less erythropoietin, which leads to less red blood cell production)
- the reason of walking problems is because of spinal cord is under a pressure in the neural tube that is narrowed due to calcification
Prognosis:
- not good - she may live few weeks to few months... no cure possible

I stopped giving her Panacur.

Here are all the result I finally received (sadly after month and a half of asking for them):

medical report in PDF - original text in czech language with brief translation into english

blood test results:
IgM was again tested - I was given no paper from lab with the result, just told it was negative.
Here are hematology and biochemistry results:

x-rays


CT scans

whole DICOM folder with CT images (viewer incl.) can be downloaded here from google drive or here (zip file 332 MB)


treatment suggested by vet - Enalapril 0,6 mg daily + IV fluids 60-150 ml/kg/day (saline or ringer)

She was not given Enalapril nor IV fluids yet - I found that one of the side effects of Enalapril is kidney damage and increased serum creatinine (20%), seemed too risky to me :( and also intravenous fluids – I know it is common but while searching for informaition which solution is better (saline or ringer), I found that IV fluids are also hard on kidneys (not helping always) and the heart too.. that rabbits die after too much fluids... etc.. so I just couldn’t take that risk either (anyway, it is hard to find a vet who could get a cannula in her ear) - I also considered that she drinks a lot by herself.
Might consider enalapril later - studies found:
- folic acid + enalapril combination proved more effective at preventing CKD progression
- enalapril + cordyceps mycelium extract was more effective than either alone or no additional treatment

I increased fresh greens (to increase water intake and reduce calcium concetration) and found herbs that improve blood circulation within kidneys (hawthorn and ginkgo) and reduce blood pressure (hibiscus flower).

Fresh greens that can be bought here in winter and that I was giving her:
- daily - parsley and dill leaves
- few times a week - romaine or little gem lettuce and occasionally wheat grass that I grow for her

 

12 Mar 2017
- weight 2.33 kg
- started to give her Cordyceps (I found doses for rats and mice from 50 to 200 mg/kg/day, I started with around 50 mg/day)
- made herb cookies with herbs she didn't want to eat much, which was most of them ;)
(hawthorn, ginkgo, eleutherococcus, salvia miltiorrhiza, birch leaves and licorice root)
cookies -> herbs were mixed with carrot and beet root, little bit of apple and hay, and dried in food dehydrator at low temperature
some herbs were added as an extract (in glycerin): hawthorn, ginkgo, astragalus, uva ursi

also added:
CoQ10 (ubiquinone + ubiquinol)
B6 and magnesium
vitamin K2 (MK4 + MK7) (might reverse calcification?)
P5P (pyridoxal-5-phosphate)

13 Mar 2017
progress! she managed to jump into a box with herbs, she is jumping back and forths :)

16 Mar 2017
another huge progress - she jumped on the shelves in their home again - it is 30 cm (11 in) high from the ground, she wasn't able to do that since the January :)


I made another lower step for them to jump up and down easily and let them free roam all the time.

10 Apr 2017
- pure Silymarin from iherb arrived, starting giving her around 70 mg daily
- weight 2.30 kg

VIDEO - her progress

19 Apr 2017
4th blood test - probably not the best day for her to give us some blood, vet tried front leg first as the last time.. nothing, just few drops, second leg the same.. back leg finally worked, even though we all tried to calm her down, she was very stressed
blood test results:

 

summer 2017

she is active and happy, running and jumping without problems, just still not standing up on her feet
eating lots of fresh grass and greens, good appetite but sometime picky
continuing with herbs and vitamins supplements
weight - between 2.21 and 2.33 kg
drinking around 300 - 400 ml water a day
continuing incontinence
small lumps on her back (that started to grow again) remained about the same size the whole summer (maybe around 3 mm diameter)

small progress - she is sometimes trying to stand up on her feet while reaching for food :)

I would like to thank Esther van Praag for her remote consultation that helped me a lot, and her article about Mitsie.
She mentioned a possibility of hypothyroidism:

The results obtained for the different biochemical parameters a concomitant increase in the levels of calcium, creatinine, triglycerides and lactate dehydrogenase, may, however, also be the result of a dysfunction of the thyroid and parathyroid glands. Anisocytosis may be one of the signs of anemia, which is confirmed by the latest blood tests. Anemias of all types are observed in individuals suffering from a thyroid dysfunction. Hypothyroidism is also characterized by excessive thirst, which is also the case of Mitsie.
relevant study - Renal impairment resulting from hypothyroidism

 

18 Sep 2017
5th blood test - T3 and T4 tested
T3 ... 71.3 ng/dl
T4 ... 1.2 μg/dl

blood test results:


Laboratory has neither ref. levels for T3 nor was able to give me more information about those levels.
The book "The Laboratory Rabbit, Guinea Pig, Hamster, and Other Rodents" mentions these reference levels for rabbits:
T3 ... 130 - 143 ng/dl
T4 ... 1.7 - 2.4 μg/dl
and this study T4 values: 5.0 ± 0.3 and 2.5 ± 0.4 μg/dl in control and hypothyroid animals, respectively

While searching for levothyroxine dosage I found one interesting study aboud ossification and levothyroxine:
Levothyroxin inhibits heterotopic ossification: an experimental study in rabbits.
They mention amount of 20 μg/kg of levothyroxine orally daily.

questions now:

how low are her levels?
try L-thyroxine? iodine? herbs? kelp?
how much L-thyroxine to start with?

From some studies (rats, rabbits) I'm getting to the L-thyroxine dose of up to 20 μg/kg/day orally
human doses are much smaller: 1 - 1.7 μg/kg/day

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All blood test results compared in a table:

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Herbs and supplements notes

Milk Thistle, Silymarin – helps take ammonia from the blood and protects both the liver and the kidneys; nephron-protective effects; protective against several classes of nephrotoxic drugs (reduce and often prevent the kidney damage caused by these drugs); protective effects on renal tissue (In animal studies, silymarin protected against renal damage due to a wide range of toxins and drugs including cisplatin, doxorubicin, cyclosporine, aminoglycosides, and paracetamol); reduces damage due to diabetic nephropathy as well as decreasing progression, in significant part thanks to enhanced function of the glutathione system; silibinin and silicristin, stimulate regeneration of renal epithelium in vitro
Silymarin doses for rabbits 20-50 mg/kg/day p.o (20-90 seeds), nontoxic and symptom free with the maximum oral doses of 2500 and 5000 mg/kg
I use pure silymarin powder on iherb, silymarin + turmeric on iherb
Parsley – urinary problems; good for the cure of inflammation of bladder & kidneys, diuretic - helps prevent and treat kidney stones
Echinacea root and whole plant - immunity (immune- system balancer)
dried root bought from local herb store, she likes eating it as it is
Dandelion root - supports the kidneys and acts as a diuretic
dried root from my own supply, more bought from local herb store and pet shop, she loves it
Oats – good for kidney and bladder problems (?)
Ttropaeolum
- immunity, urinary tract health
Vitamin C - immunity, helps in stress; form and repair red blood cells, bones and other tissues
(rabbit average doses 50-100mg/kg/day, found up to 2g/kg)
pure ascorbic acid powder, pharmaceutical quality
Beta-glucan - yeast beta-glucan better, immunity support (doses 2 - 50 mg/kg/day)
Pumpkin seeds - supposed to be good for kidney and bladder problems
Uva ursi - excellent herb for bladder infections; one of the best urinary antiseptics; soothing of mucous membranes and the reduction of tissue inflammation; cleanses kidneys; diuretic; increases renal circulation
dried leaves bought from local herb store, low alcohol extract on iherb
Resveratrol - renoprotective; antioxidant and anti-inflammatory potential; can reduce or prevent both kidney and lung injury in septic rats; combats oxidative damage following reperfusion, markedly reducing kidney dysfunction; preventive in diabetic kidney damage; preserving kidney structure and function in rats exposed to ischemia/reperfusion injury
caps on iherb
Astragalus membranaceus - root has been used in traditional Asian medical systems to support patients with chronic renal failure; helpful for diabetic nephropathy; absence of adverse effects; beneficial in patients with diabetic nephropathy for preventing progression as well as raising serum albumin levels; protection of renal tubules from lithotripsy; renal function protection against IgA nephropathy
dried root and alcohol-free extract bought from local herb store
Salvia sp. (species not stated) - Increased GFR; lower renal lipid peroxidation and SCr levels (Salviae radix extract prevents cisplatin-induced acute renal failure in rabbits)
Salvia miltiorrhiza - root is frequently utilized in traditional Asian medical systems for preventing and treating various forms of kidney disease
Hawthorn - leaf, flower, and fruit all contains proanthocyanidins that have ACE inhibiting properties (Yarnell); increases blood flow in smaller vessels, acting much like ACE inhibitor drugs, as it decreases blood pressure; improve blood circulation within kidneys,
leaves bought from herb store, dried fruits are hard to crush, bought alcohol-free extract on iherb
Ginkgo - improve blood circulation within kidneys;
dried leaves easily bought from store, alcohol-free extract on iherb
Licorice - licorice or its various components, notably glycyrrhizin, have nephroprotective effects; decoctions of root have also been shown to improve clearance of immune complexes in rodent models, which might help in cases of CKD
Coenzyme Q10 (CoQ10) fortifies the body’s natural antioxidant capacity and reduces levels of oxygen free radicals, indicating an important defense against CKD;
ubiquinone + ubiquinol
Cordyceps - traditional Tibetan and Chinese herb revered as a kidney tonic; improve kidney function, reduce anemia, and lower blood pressure in CKD patients; lowers serum creatinine; benefit on immune function and kidney function in CKD patients; combining enalapril and cordyceps mycelium extract was more effective than either alone or no additional treatment)
bought local Cordyceps Premium by Natural Medicaments
Magnesium - when you introduce magnesium into a human body calcium dissolves, it becomes more water-soluble.
Stinging nettle seeds - good for renal disease; potential nephroprotective; reduce serum creatinine
Vitamin K2 (MK4 + MK7) - might reverse calcification?
bought MK4 and MK7
P5P (pyridoxal-5-phosphate) on iherb
Folic acid - a daily dose of folic acid may slow the decline of renal function in people with CKD (as well as other B vitamins); folic acid + enalapril combination proved more effective at preventing CKD progression;
organic from Viridian capsules unnecessary or harmful additives
Vitamin B complex (incl. B12) - important for nervous system
B6 - helps the body make protein, which is then used to make cells; also helps make red blood cells;
B6, B12 and folic acid good for anemia
Viridian capsules with B12

Eleutherococcus
Birch leaves

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other herbs and supplements I found and consider:

Cannabidiol - CBD - I've read many articles that medical marijuana is effective with chronic kidney diseases, however THC is not legal in our country, so I only got CBD oil (CBD+CBDA 1:1) and occasionally give her a tiny drop (since March)
Slippery elm (Ulmus fulva) - found this article, iherb capsules
Lespedeza capitata, Baoyuan Dahuang, Lipoic Acid, Reishi... liquid magnesium
?? Infrared Therapy - Keeping the kidneys warm is one of the best treatments for them. Weak kidneys will get wonderful support with infrared therapy. FIR heat expands capillaries, stimulating increased blood flow, aids in regeneration, improved circulation, and oxygenation.

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I would like to especially thank Esther van Praag for her help and her article about Mitsie

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katka@pruskova.com