Choking rabbit-unknown cause(not food related)

Question
QUESTION: I have basically no where else to turn. I have a rabbit who has had several choking or what appear to be choking episodes that at least two of them have not had any food source near by.

She is a REW dwarf, aprox 1.7 lbs. Adopted and is about 2 years old. She's an indoor rabbit and does not go outdoors.

There have been a total of 4 episodes since July of this year. The first I was unaware of what happened and only saw her after when she was wheezing and had some drool dripping. She went to the vet immediately but the vet on call was not as savvy and didn't have any suggestions. The second time it happened I was visiting my family and she may have eaten hay about 2-3 min prior but she had stopped chewing in those minutes and only after a few passed by did she start the drooling. This time I saw her bob her head, almost like a person does when they heave. Looks like a chicken bobbing their head. I grabbed her, tipped her forward to try and get the drool to come out and not have her aspirate it. The third time I heard the same gurgling sounds and found her in the throws of another fit. The bobbing was extremely obvious and there were copious amounts of drool. I grabbed a video for the vet then assisted her by tipping her forward to get as much to drain forward. We went straight to the vet, this time my preferred vet was working and she did a complete exam. She was at a loss because this time there was absolutely no food involved. She was put on an allergy medication, metacam and Panacur. I was also told to get an air purifier for the room. I will mention I also have two rabbit's that are bonded and live in a bedroom to themselves and I foster a rabbit who lives in the kitchen on a different floor. I also have a cat who wants nothing to do with any rabbit. The episodes started well after we all had been living together(except the cat, the first episode happened just before she arrived). I booked her in to have an endoscopy of the mouth and throat to r/o malformation or spurs on the teeth not seen by the oral exam. She also had skull X-ray's. Nothing turned up on the diagnostics and I was told to discontinue the allergy meds because it didn't fit the profile of an asthma attack. We did metacam for two weeks and Panacur for 30 days. That last episode was early October and she hasn't had a fit until today. I heard the noises and grabbed her. This time she was really struggling. She would push her head very far back as she bobbed. I have a baby aspirator and began to suction over her nose and mouth the try and get the drool out. She struggled with me but ultimately gave up and just kept bobbing. The episodes last less than a few minutes and then she has wheezing for several minutes afterwards as she cleans her face up. After about 10 minutes you can't even tell something happened. She will hop around and even beg for treats. Today she did appear more lethargic afterward and wanted to flop over more than she usually does, but she has since eaten a treat, her hay and some pellets. All the drool is completely clear and it appears to be produced in the mouth but she seems to have it come out of her nose after a certain point.

There have been a total of 4 episodes I am aware of which is including today's. Her diet is 1/4 oxbow adult pellets daily(but she usually takes a little over a day to finish it all), romaine lettuce almost every day and unlimited Timothy hay with the occasional treat hay like orchard or botanical. Her treats are oxbow or Martin mills and she is happy to eat those quickly so I have started to soak them slightly to reduce a risk. Our vet is at a loss because there does not seem to be any pattern or cause. If you have any ideas please tell me. We are going in tomorrow to have her looked at and I'd like as much info and literature for them to read up on.

Thank you for your time.

K

ANSWER: Dear Khrystyn

We do hear of choking rabbits from time to time, and the first suspect is always dental problems.  But often, rabbits who choke have teeth with no obvious problems.

The most recent surprise regarding this problem came to me via our House Rabbit Society listserve via one of our educators.  She had a choking rabbit who usually had this problem while eating.  But I would not be surprised if this might help your bunny.

Dr. Gil Stanzione (who works in New York) discovered that the bunny had a very weak/partially paralyzed epiglottis, and could not swallow normally.  He said that he usually sees this problem in older dogs, or ones who have had trauma to the throat/neck, but that it is also sometimes associated with hypothyroidism.

They took blood on the bunny, and her thyroid levels were so low that the machine could barely read them.  Dr. Stanzione put the bunny on half of a tablet of Levocrine daily, and so far (knock wood!) the bunny has had no further seizures or choking episodes.  This was back in September/October 2015, so no one is yet sure whether this is a cure. But it's very promising.

I hope this will help your bunny.  I would start by having bloodwork done to check her thyroid hormone levels.

Good luck!

Dana






---------- FOLLOW-UP ----------

QUESTION: Thank you for your response. Since I sent that message, she had another episode, and this time I actually saw the entire process. She had eaten a bit of hay, then she proceeded to lick her side (shes in the middle of a molt) and stopped abruptly. Kind of looked like she made a hiccup motion, and was making chewing motions with her mouth. It sounded odd, like she was grinding her teeth (but not pain grinding-but not happy grinding either). Her eyes went wide but her pupils stayed small. She proceeded to go into the choking episode, the drool and this time she was in a crisis. She started pushing her head right back, gasping at the air. I tried to use a suction device to remove the drool but was not successful. She was to the point where she was starting to get really weak and limp. She recovered, but took her a good hour before I could actually attempt to move her. I feared any excitement would make her hyperventilate and have more of the liquid aspirated. That episode happened on Saturday night just before midnight. I took her to the emergency vet clinic and she has been there ever since. They have done blood work on her and I will double check they will do thyroid profiles on her. I believe they mentioned that the night I dropped her off, but I was having a melt down so I can't really recall what exactly they check on them. I spoke to a vet this morning, and she is still suggesting that it is a motility issue, and are leaning towards an E.Cuniculi cause for either nerve damage causing the paralysis. I do not know if she is positive for EC, the general assumption is that most rabbits are positive and we treat regardless. I will take your information to the vet this evening when I pick her up. If you have any way of contacting this veterinarian or if my own vets can do so, please let me know. I'd like perhaps even to have them speak just to share ideas as to how I can help Pearl.

-Khrystyn

Answer
Dear Khrystyn,

Holy cow.  How horrible.  I'm glad she's still with us.

If this were my bunny, I would get her home from the emergency clinic ASAP.  If she has another seizure, they will know less there than you do about how to save her.  And here are a few tips.

The Bunny Heimlich:

If the choice is between choking to death and taking a risk, try this.

Hold her firmly from nose to tail between your forearms, with your left arm over her dorsal side and your right arm over her ventral side.  Use a gentle swing motion as shown here:

http://www.vgr1.com/choking/

(This guy actually illustrated an Allexperts answer I gave in 2007, and didn't do too bad a job, though I would have positioned the bunny a little differently).

The pressure of the visceral bumping against the diaphragm can help push liquid or even solids OUT of the trachea so bunny can breathe.  

If you can't do the swing, at least hold bun with her nose pointing downward, body perpendicular to the ground, so that gravity can help her expel the obstruction.  A few quick presses against the diaphragm (upwards from the abdomen to the chest) can help.

I hope she will be home with you soon, and that she suffers no more seizures before you can try the thyroid medication.  This is NOT a typical presentation for E. cuniculi.  But it would not hurt to treat for E. cuniculi as long as you don't neglect the possible thyroid connection.

Sending lots of healing thoughts.


Dana