Protein Losing Enteropathy

[Guest KeesMom]

Just wondering if anyone else has experience with this condition with their Grey? Kees has been seeing an internal specialist trying to isolate why he's had watery stools since the end of September. After ultrasound, endoscopy and a variety of tests, we are waiting for confirmation of the last one that will confirm he has protein losing enteropathy (which doc is already pretty sure of and treating accordingly).

 

So sad. He's just six and has lost about 15 pounds. Doc is trying various foods to see which might help firm them up. Kees apparently also has an issue with his pancreas not producing enough enzymes which is also contributing.

 

Sigh. Poor guy. Thanks for any feedback.

 

 

[Guest jurygirl]

 

Here is a link to another thread about Protein Losing Enteropathy that has a lot of good information.

 

http://forum.greytalk.com/index.php?showto...p;hl=BUDESONIDE

 

I hope he feels better soon.

 

 

[Guest zoolaine]

Sunny - non grey - was diagnosed with PLE in July. He has had the ultrasound and endoscopic biopsy showing that his intestines are abnormal but no specific diagnosis. He started out with the venison and potato but I recently switched him to duck and potato as he seemed to not be eating very much and likes the duck better. I also try to give him some extra protein each meal, like ground buffalo or pork or some type of fish. He is currently taking Zantac, SAM-e, metronidazole, L-glutamine, probiotics, budesonide, and azathioprine. And I give him salmon oil too. He still has occasional runny stools - like when he stole half a pound of tuna tooters while I was at work - d'oh. Sunny isn't losing weight and his albumin levels were back in the normal range last vet check, although his total protein is still too low. I was very sad and scared when he was diagosed because they said he would be dead in three months but overall he is doing pretty well and is still my loving, easy going boy. There are several good posts on PLE from about 1-2 months ago. I put Sunny on some of the things Stevie ???? Is taking and seems to be working well. Keep us updated on Kees.

[Guest KeesMom]

Thanks, I checked out the link and found lots of good info.

 

Boy, all the meds sounds familiar; Kees is on the same ones at this time. I'm confident Dr. will be able to stabilize Kees with the right combo of food and meds. We tried the duck and potato (Royal Canin) but Kees ended up vomiting several times so Doc thinks it might still be too rich. He is currently on a veterinary IAMS low-residue formula and doing better....tail wags, eyes are bright, he is alert, and poos are like soft-serve ice cream instead of shooting out his rear like a rocket!

 

I will ask about the Budesonide as that is not one that Doc mentioned.

 

So, a side question, Kees has obviously lost a fair amount of muscle mass. Does this "come back" as he (hopefully) puts on weight? Or is it gone, used up by his body?

 

Thanks for your care and information. Funny how comforting it is just to know you're not the only one going through this...

[Guest ss556]

Sending good thoughts for Kees.

[CaliforniaGreys]

Sending lots of prayers. My little girl has lost a lot of muscle mass due to Cushings. Hers won't come back but it may be different in Kee's case.

[Guest jurygirl]

When Jury had PLE she lost a lot of muscle and it never did come back. She did end up putting her weight back on after we found the right food for her and the right meds.

[ahicks51]

The reports of PLE in the canine are remarkably similar to what happens with ruminants that get Johne's disease, and with humans who get Crohn's. In fact, the treatment regimen prescribed by vets for dogs with PLE is pretty much the same as that for humans with Crohn's- azathioprine, budesonide (or other steroid), Flagyl (metronidazole), fluoroquinolone antibiotics (Cipro for humans), Zantac or other proton pump inhibitors (PPI), and glutamine. In my own case, when I came down with PLE, I was given 'scripts for Flagyl, a PPI, budesonide (as Entocort), mesalazine (an anti-inflammatory), and a B vitamin to rectify the megaloblastic anemia caused by folate deficiency. The drugs made me sick, and I quit them after a month.

 

By that point in time, I was already on a highly specialized diet. The root of the diet is to exclude starch. Overall, the diet vastly reduces the concentration of carbohydrates. The canine equivalent is to feed raw food, or cooked food, with no added grains, starches, or other vegetable matter- or keep it to an absolute minimum- with NO STARCH.

 

In humans, for decades the thought was that the disease is autoimmune or possibly infectious (due to a mycobacterium called MAP, which causes Johne's disease in cattle). And MAP makes sense- if you eat too much like a cow, maybe you (being a human) might get a disease found in ruminants. Back in June I posited that MAP may be responsible for IBD in the canine, and in July out came the first paper confirming my suspicions: researchers in Germany found MAP in canines.

 

With humans, PLE from Crohn's is straightforward:

 

1) Eat too much starch, and bacteria in the gut start to grow too well. Specifically, Klebsiella pneumoniae grows very well with starch.

2) In fact, Kp puts off a specific enzyme to "debranch" amylopectin. This enzyme is called pullulanase.

3) Pullulanase has a protein sequence that- at some point- emulates the structure of collagen.

4) The body's immune system becomes sensitized to the Kp, and starts to attack the products of growth. This includes pullulanase.

5) On its way to destroy pullulanase, the body's immune system "recognizes" collagen, and attacks it.

6) This can cause ankylosing spondylitis, or Crohn's disease. It causes Crohn's when it attacks the collagen of the intestines.

7) Enough damage to the intestines results in malabsorption. The host does not get enough protein, resulting in PLE.

8) Stop eating starch and the disease slowly reverses itself.

 

I have gained back all the muscle I lost. I no longer feel like crap. I feel better than I have in years- predecessing the appearance of my disease by at least 3-4 years. My blood values- much to the surprise of my doctor- have all normalized. He has gone from dire warnings of death to "keep doing whatever it is you're doing." Part of what changed his mind were 10 papers from the refereed scientific literature on the subject, indicating Kp is responsible for Crohn's, and about 7-8 papers on how carbohydrate restriction works on management of the disease. All of this has been done in the absence of prescription medications. This is not supposed to be possible according to the prevailing medical viewpoint. All I did was cut out the carbs.

 

So- with Crohn's, I feel there are two options:

 

1) Lots of drugs for the rest of your life

 

or

 

2) Months (years) of highly restrictive dieting to get rid of the bacteria

 

One gets to the root of the problem. The other just treats the symptoms.

 

Whether this has anything to do with PLE in the canine is speculative, but I humbly submit that from the (relatively few) incidents in which dogs with PLE have been put on a diet free of vegetable matter, many have improved remarkably. I would also wonder aloud whether any animals *fed* raw or cooked diets have ever subsequently developed PLE.

 

I have the Ebringer papers as .pdfs. If anyone is interested, please PM me.

[Guest argolola]

Sending prayers for your little sweetie.

[Charlies_Dad]

Hoping that they find the right food combination for Kees soon. Poor boy.

[MP_the4pack]

Did you have a liver function test done? This is not the same as the routine liver enzyme test that we all get when blood chemistries are drawn.

 

I lost my 5 yr old to liver disease and she had PLE.

[tbhounds]

I second the "liver test". Your vet should run a bile acid test to make sure the liver is functioning and producing protein properly. Please inquire about the Budesonide--really was a lifesaver for my boy!

Feel free to pm me with any questions you have--I'll be glad to share what info I have on this disease.

My boy was given a rather grave initial prognosis and come March he'll be 3 years in "remission" and doing well!!

 

[ahicks51]

My boy was given a rather grave initial prognosis and come March he'll be 3 years in "remission" and doing well!!

 

Whatcha feeding?

[Guest larock]

We lost our Greyhound, Walter, in June to a form of PLE, Lympahngiectasia. We did all the tests, bile, endoscopic biopsy, blood, urine, fecal. He was diagnosed in November and was OK until May. protien levels slowly creeping back but he was still losing weight and lost about 8 lbs in the last 3 weeks of his life.

 

Although this is what Walter suffered from, DH, EVet and I feel there was something else going on, perhaps a fast growing form of cancer that was not initally detected during the biopsy. While PLE is a scary diagnosis I now feel diet and nutrition was more critical than our vets led us to believe and therefore wasn't high on our proirity list. We really tried to save him but did all the wrong things. I now feel that feeding the right food, home cooked, raw, whatever was the key to his survival. We just didn't know enough couldn't find any information on the subject.

 

Given the chance to have a do-over I would run, not walk to the nearest Naturopath (sp?) Vet and get more information on diet, nutrition and suppliments.

 

I wish you the best of success with this endeavor. My thoughts will be with you, I know what you are going through.

 

Lynn

[Trudy]

Ryan's symptoms 1+ years ago were similar to PLE. Still don't know what is wrong with him, but we now just treat symptoms as they appear.

Anyway... enalapril helped with him and our vet also suggested adding Derm Caps as a supplement since they had the correct omega 3 v 6 ratio

 

While he still loses protein much faster than he makes it, his ratio isn't super sky high anymore... just really high.

[Batmom]

He is getting some meds for the pancreatic insufficiency?

 

What is he eating now?

[Guest KeesMom]

Kees is eating IAMS Low-Residue Intestinal canned food at the moment. We also give him cottage cheese, scrambled eggs, and yogurt. We weighed him Tuesday morning and he'd lost 6 pounds since the previous week. Talked to Doc Tues who recommended adding Cyclosporine to the current Pred and every other day Imuran. We also give case Pancrezyme for the deficiency there.

 

Watching to see if we can stem the weight loss..... He still gives tail wags and has bright eyes, which is encouraging.

 

Thanks again for your concern.

[ahicks51]

Kees is eating IAMS Low-Residue Intestinal canned food at the moment.

 

Ingredients

Chicken Broth, Chicken, Chicken Liver, Beef By-Products, Brewers Rice, Whitefish, Corn Grits, Fish Meal (source of Fish Oil), Dried Egg Product, Dried Beet Pulp, Potassium Chloride, Fructooligosaccharides, Calcium Carbonate, Brewers Dried Yeast, DL-Methionine, Monosodium Phosphate, Taurine, Vitamins (Vitamin E Supplement, Niacin, Thiamine Mononitrate [source of Vitamin B1], Calcium Pantothenate, Biotin, Pyridoxine Hydrochloride [source of Vitamin B6], Vitamin B12 Supplement, Riboflavin Supplement [source of Vitamin B2], Folic Acid, Menadione Dimethylpyrimidinol Bisulfite [source of Vitamin K3]), Mannanoligosaccharides, Choline Chloride, Minerals (Zinc Oxide, Manganese Sulfate, Copper Sulfate, Potassium Iodide)

 

Undesirable components are in bold. They seem to be in fairly low concentrations, all factors considered.

 

Imuran is azathioprine, an immunosuppressant; as already noted, this drug is commonly used with Crohn's disease as well as other forms of IBD.

 

Good luck, and keep us appraised.

[tbhounds]

In my dog's case I truly believe that a chicken intolerance brought on his IBD. No poultry in my house! He's currently eating (after trying all of the script diets) OTC Natural Balance Duck and Potato top dressed with raw ground rabbit (meat and bones). We stay away from fat--thats's why the rabbit works so well for us. He's at a point were he can tolerate a small amount of other foods allowing me to add things like low-fat cottage cheese--which he loves! But, never ever will a chicken pass his lips again

 

Edited to add--to the OP---which tests did the vets actually run--Bile acids-TLI?????

Edited December 18, 2008 by tbhounds

[Guest KeesMom]

Yes, since this ordeal started we've run a urinanalysis, bile acids test, VDIC fluid analysis (due to abdominal fluid), Fecal a1 Proteinase inhibitor test, CBC, and TLI/Cobalamine/Folate test.

[Guest greytlady]

I got one boy that was so bad his legs were swollen with edema and his total protein was almost incompatible with life and his albumin wasn't even registering. He was started on a pancreatic enzyme and given a Blue Buffalo diet that was 42% protein and 17% fat. He bounced back over time and is now doing fine. Some stools are still gooey but overall he has gained back his weight and lab values are holding steady.

[Guest KeesMom]

We weighed Kees again on Friday morning.... I was dreading to see the number on the scale. To my surprise he was the same weight as the previous Tuesday, 58.5 pounds. While he is still severely underweight (should be 76-80 lbs.), he had not continued losing the pound per day like the week before, so I am looking at this as a positive thing. Doc added Cyclosporin to the steroid mix (which he had taken for only two days before the weigh-in). I think it may be helping.

 

Kees is wagging his tail more and being more playful; all good signs to me. We'll keep doing what we're doing and see how it goes.

 

By the way, I had also tried Blue Buffalo in trying to get more solid stools well before this recent episode. I don't think any of the many foods we tried are bad, Doc just thinks Kees has a bad case of PLE.

 

Thanks for sharing and listening; I really do appreciate it. We'll continue taking it one day at a time.

[ahicks51]

Wow- that's really good news.

 

Could you recap what you're doing specifically- meds, feeding, etc.?

[Guest KeesMom]

Sure. Kees currently takes 40mp Prednisone 2x daily, 50 mg Imuran every other day, 100 mg Cyclosporine 2x daily, 20mg Omeprazole once daily, and gets a Vit B shot once a week. Doc had him on Pancrezyme but doesn't feel that needs continued.

 

We're feeding him IAMS Veterinary Formula Low-Residue Intestinal Diet canned and dry food, along with scrambled eggs, cottage cheese, yogurt, and Cheerios. He usually gets a can for breakfast and dinner and 2-3 cups of dry once or twice at lunch and before bedtime. We'll substitute a can for the dry feedings occasionally as he prefers that to the dry (go figure )

 

Doc also said we could try chicken, fish, or any other low-fat meat but we haven't yet added that.

Edited December 21, 2008 by KeesMom

[tbhounds]

Isn't your Dr worried about a food intolerance or food allergy? Most dogs displaying IBD symptoms are tried on a hypoallergenic novel protein/carb diet.