URGENT: Mucus pouring from nose

Question
My rabbit, Elmer, is a neutered male who is a couple of years old and he's a spunky, large Dutch lop. He is an indoor-only rabbit. I have been to a rabbit-savvy vet recommended by the House Rabbit Society and still need help.

About a month ago Elmer's nose was pouring liquid, his mouth was hanging open, his breath sounded raspy to the point that you could hear it across the room, and he was in clear distress - tilting his head up, eyes bulging. In a panic, I looked online and saw that I should tilt him downwards to drain the fluid. I put him in my lap and did so, and my upper leg got covered in what I thought was water. It was mucus. His face (nose area) was drenched in it as well. He seemed fine but I took him to the vet to be sure.

Until this morning he seemed to have a clear bill of health. He'd had no episodes for a month after having been on Baytril  - that I saw, at least. I thought everything was fine. Then, this morning, I was up at about 4AM and decided to check on their hay levels. I did so, and gave him some pellets too (Western Timothy hay and Bunny Basics T pellets since he needs to gain weight; they get a healthy diet.) He seemed fine at first, but then started acting strange. He was hopping around his cage as if he were panicking. I took him out, and his nose was doing the same thing again. I even saw a bubble come out of his nose from the mucus! It poured onto my leg/the carpet when I tilted his head down in my lap. After a few minutes, his nose and the area under it was drenched, and a LOT of mucus had poured out. It was thick and dangling from his nose as it poured out.

He seems okay again -- he's not lethargic at all, but this is the second time the mucus drainage has happened and it's scary. I don't know what to do or what's wrong. I'm terrified that it will happen again, and that he may suffocate.

The vet had said Elmer seemed fine after the last episode, and he ran a lot of tests. He did a culture and nothing unusual grew except for Pasturella, which is why Elmer was put on Baytril the last time. He is NOT on any current medication. He shows no signs of significant nasal discharge until these episodes happen. Then, suddenly he's pouring mucus out of his nose, and both times it has happened he was eating. I have 4 other rabbits and NONE of them are having this problem -- it's ONLY poor Elmer.

The vet is listed on the House Rabbit Society's page, and the vet does seem to know bunnies pretty well. These are also indoor-only rabbits, they get a healthy diet of mostly Western Timothy hay; their cages are cleaned regularly with a mixture of white vinegar and baking soda, then rinsed out with water and dried; they are kept in separate cages, they have CareFresh paper litter, and they always have water available.

Elmer's also been on Fenbendazole -- after another one of my rabbits, Cimmeron (spayed female), tested positive for e. cuniculi exposure, and was showing symptoms. The vet thought dosing all of them would be appropriate. Elmer had been losing weight mysteriously, hence the increase in Bunny Basics T pellets. The other bunny, Cimmeron, is also having a health mystery: she is anemic and losing weight, despite a healthy appetite and spunky attitude.

On May 21st, Cimmeron tested positive for e. cuniculi. I was told .39 is the cutoff for a low result, and that 2.0 a high result. Cimmeron tested at 2.208 for e. cuniculi.

Elmer has been doing better on the wasting front, and has been gaining weight since I increased his pellets. So, I don't know if the weight loss and the respiratory problem are related.

These are the test results thus far for my bunnies:

* Elmer has mostly normal results. He is not anemic.
* But, the normal range for Hematocrit is between 35-50%, and when tested he was at 35%. Redblood cell for rabbits is normal at 5-8, and he was at a 5.
* White blood cell levels normal.
* Normal calcium levels.
* Potassium at 4.1, but 4.3-5.8 is normal.
* Fecal float negative for parasites.
* Nose culture turned up Pasturella, which he had been put on Baytril for.
+ However, the vet felt that Elmer's hematocrit and red blood cell results were a little suspicious due to them being borderline results, because of Cimmeron (the female's) similar but more drastic results.

Cimmeron's results, in case you would like to know them as well, were:

* 29% Hematocrit level on May 7th, but I was told it *should* be 43-59, and that Cimmeron is anemic. It was 28% on May 17th. He suggested "polycrinasia" -- I don't know how to spell that, sorry.
* Reticulaci count - measures cells that have remnants: I was told 5% is normal, but on May 7th she was 1.9%, which is nonregenerative anemia. But then, her May 17th sample went up to 6%, which I was told is regenerative anemia.
* White blood cell levels are normal.
* I was told that high calcium is 7%, but that Cimmeron is at 15.2%.
* I was told that 1.7%-1.83% for *ionized* calcium is the normal range, BUT that she's at 1.9%. He said that this might be a red herring result since it's not really that high, and so it may not have anything to do with what's going on.
* Fecal float was negative for parasites.
* Her X-Ray was normal.

I have no idea what's going on with my bunnies and my vet seems stumped too. They have a re-check this Saturday since they finished their Fenbendazole on June 7th. Cimmeron had also been on Sulfatrimethazole, but finished that on the same day.

Please, if you can, help me solve Elmer's respiratory issue. Any other information about what's going on would be EXTREMELY valued, but what I am most terrified about is the mucus that has randomly gushed from his nose again this morning. He clearly is freaked out when it happens and I desperately want to help him.

Thank you,
Julie

Answer
Dear Julie,

In my experience, this sentence is the clue to the problem:

"Then, suddenly he's pouring mucus out of his nose, and both times it has happened he was eating."

I am afraid that Elmer may be eating a little too enthusiastically, and aspirating his food.  I have seen this happen, and the signs are *exactly* what you describe:  copious, watery mucus pouring from the mouth and nose, and often with a greenish tinge, though the mucus itself is not opaque; it's clear.  I believe that's because it's a combination of mucus from the trachea/bronchi and saliva--the body's emergency defense and flushing mechanism to get the foreign particles out of the airways.

You may have saved his life by holding him nose down to get the mucus out.  I once had to do this with a bunny (his problem was pneumonia, not aspiration) who was basically drowning in his own discharge.  I grabbed a pediatric ear syringe, stuck it into his mouth, and just sucked out bulb after bulb until he could breathe again.  It was horrible, but he did survive that episode.

For emergencies, I'd keep a pediatric ear syringe handy.  And always remember to do the "rabbit Heimlich" just as you did:  hold him with his nose hanging down (strongly and firmly support his back so he doesn't injure himself).  In extreme cases, if he is absolutely unable to breathe because of airway blockage, you might have to do the *real* rabbit Heimlich:  

If the rabbit cannot clear his own airway, then the only way to save his life is with the "rabbit Heimlich maneuver" which is difficult to safely perform.  If this does happen again and Elmer really cannot breathe, you must pick him up and firmly align him between your forearms so that his neck and spine are absolutely immobilized.  Swing your arms upward (rabbit nose pointing to the sky), and then smoothly (not *too* fast) swing them down, being extremely careful not to allow the bunny to hit the floor or slip from your grasp!

Again, it is *vital* to have the neck and back completely immobilized so that the force of the swing doesn't break or dislocate the delicate vertebral column!

The centripetal force generated by the swing will push the bunny's internal organs forward, forcing air out of the lungs, and (hopefully) clearing the rabbit's trachea.  We have had to do this only a couple of times, and it is very traumatic, sometimes requiring 2-3 swings before the bunny can breathe again.

Once the bunny can breathe, it's important to schedule a veterinary appointment as soon as possible, since aspiration pneumonia can result from an episode like this.

I hope Elmer doesn't do this again, but it's unfortunate that he's done it twice. Some rabbits who are very eager eaters have this accident, and some people have said they were able to stop the problem by providing food constantly so that he doesn't gobble things so fast when he gets them.

If he has constant access to hay, that will help, and that's the healthiest way to provide constant food, anyway.

I hope this helps.

Dana