Protein Losing Enteropathy (Ibd) - Dandi Has Relapsed

[greyhndz]

About 8 months ago, Dandi (galgo) was diagnosed with lymphangiectasia, a form of IBD and protein losing enteropathy. This thread explains the situation.

 

He did very well on an ultra-low-fat,hypoallergenic diet until about a month ago, when the diarrhea returned full force. His albumin is now down to a critical level of 1.5 again, and even though his weight is stable, I can see a considerable difference in his condition over the past week. (His albumin was 1.6 last week, and his potassium and calcium were way out of normal range). He has PU PD (large volumes of water going in and coming out) which is flooding into my kitchen, and has several pure liquid stools daily. He's just been more sluggish and isn't playing with his toys as he usually does. He's had progressive hind end weakness -- all resulting from the low albumin. So far, he has not shown evidence of dehydration as was the case last winter. He's eating very well and doesn't have muscle wasting (yet).

 

His diet has been a combination of Purina HA, an ultra-low-fat hypoallergenic kibble which looks like styrofoam. I've had to use z/d canned food to entice him to eat it, but still remain off any potential allergenic triggers. Unfortunately, I neglected to research the protein level, which is considerably higher than desirable, and he was eating a can a day. This may well have been the source of the relapse. After talking with his IM vet, the z/d has been stopped and he's getting a small amount of a low-fat novel protein (venison) mixed in with his HA kibble now. Only a large spoonful/meal, not 1/2 can.

 

We started Dandi on cyclosporine last week, but it will take at least 4-6 weeks before we would expect to see improvement. Since he's deteriorated over the week, he's back on prednisone which I dread. He developed muscle wasting after only a week on pred last time, but we have no choice if we want to keep him stable until the cyclosporine kicks in. He's also taking metronidazole for the next 7 days. My IM vet's first choice was budesonide, but the cost is just too prohibitive. I found a good source of cyclosporine 100mg - 30 days for $89 vs around $400/month for budesonide.

 

You can use your imagination to visualize what the pred is going to do with a dog who's already got PU PD. I'm going to need a canoe to navigate my kitchen. (BTW - Dandi has a dog door to go through, which he will do if I'm down there watching him, but if I'm not, he'll just let go indoors, probably because it's physically difficult for him to make it through the dog door). Or because he's a pickle.

 

I hope he rebounds soon, and that the cyclosporine proves to be the right drug to manage his PLE/IBD. I know anyone who has taken this journey with their IBD dog knows too well the frustration of getting them stabilized, and of finding a way for them to get the nutrition they need without their gut leaking out all the protein.

 

Oh, and did I mention that I'm losing my job as of Aug 31? (yes, again...)

 

[Xan]

Oh man. My heart goes out to you both. I had an IBD girl, and it was a sad and bumpy road all the way to the end. I did find a source for budesonide that was not too out of reach, in Canada, if I recall.

 

Is there any way you can make your dog door easier for him to navigate? I'm grasping at straws here... : I hope you guys can get some relief (and a new job!!) asap!

[tbhounds]

Well crap-I feel your pain! Have you ever tried tylan powder or B-12 injections?

Sorry he's relapsed-sadly it can and does happen-miserable disease. I never could understand why they would make Z/D with a higher fat content.

[galgrey]

Oh no, Jordan! I'm so sorry to see this. Sending good thoughts to you and Dandi.

[Xan]

We also had good luck (for a time) with tylan powder and some relief with vit B injections (helped with appetite, immediately following the injection).

[Guest PA_Greys]

So sorry you are going through this. We just lost our grey to lymphangiectasia and I felt compelled to at least reach out to you since we have been through exactly the same thing. I don't have any advice. Even with prednisone our boy had a very scarey 1.2 albumin level for about six months ... fortunately he had no idea he was sick and did not exhibit symptoms until the very end. We ended up getting a sheet of vinyl to cover the carpet where he would be during the day and trying to split his prednisone so he got the higher dose during the day and the lower dose at night so we might get some sleep. He didn't do well on the HA food and we switched to Royal Canin's low fat digestive ... it was the internist second choice but it worked for him. I know it's hard and I hope your sweet boy stabilizes quickly. I'll be anxiously watching for updates.

Yvonne

[4My2Greys]

Oh Jordan, what a rotten time all around for you. I hope another job opens up soon for you. I know being without one is the last thing you need to worry about on top of Dandi being ill.

[JenniferS]

Jordan, I'm so sorry Dandi has relapsed. It is a nasty, nasty disease. I went through the same thing with Ducky. He did well for a while on the Hill's d/d Venison dry food. He also got weekly B12 injections. I've never heard of cyclosporine, so I don't have any advice on that, but I agree prednisone has some bad side effects. We did have him on a low dose of it toward the end. He was also on Plavix, which was very expensive. As well as a bunch of other meds. I found a support forum that you may find helpful: http://www.savelouie.com/phpBB3/index.php

Good luck!

[FiveRoooooers]

Oh, Jordan. I have no advice, just lots of hugs and support.

[phall]

Oh Jordan,

 

I'm so sorry to hear that Dandi is going through this relapse. No advice here for you, but know that I'm thinking of you both and hoping Dandi is better soon. IBD is terrible.

 

Pat

[3greys2cats]

Oh no Jordan, so sorry to read this, hoping he is better soon, you have been through so much in these last few years, will keep you in my prayers.

[TINMANPDX]

I am not sure if this will help, but thought I would throw it out there ... one of my hounds gives blood every 3 mos at a local emergency vet hospital - the e-vet there makes a TPN solution that is administered via pic line interveinously over a short term period while dogs are recovering from surgery or illness and can't take nutrition in a normal fashion. I wonder if this is an option for you?

Best of luck for you and Dandi.

Tess

[Remolacha]

for Dandi and another for you

[greyhndz]

Oh man. My heart goes out to you both. I had an IBD girl, and it was a sad and bumpy road all the way to the end. I did find a source for budesonide that was not too out of reach, in Canada, if I recall.

 

Is there any way you can make your dog door easier for him to navigate? I'm grasping at straws here... : I hope you guys can get some relief (and a new job!!) asap!

 

 

 

Could you share the pharmacy info so I can check into the pricing for the budesonide?

 

The dog door. Oy. Let me just say that I've been leaving the slider door open so he can get to the deck and down to the yard easily. He still pees on the kitchen floor. Or he'll go through the dog door to the deck to poop, then come inside to pee on the floor. Dandi has "issues" between his ears.

 

Well crap-I feel your pain! Have you ever tried tylan powder or B-12 injections?

Sorry he's relapsed-sadly it can and does happen-miserable disease. I never could understand why they would make Z/D with a higher fat content.

 

Dandi has been on Tylan for years. I really saw a difference for a long time, until his flare last year. He's still on it, but is now on metronidazole for a week in addition to the pred and cyclosporine, and also ranitidine and probiotics which he's been on for many months. He received B-12 injections at the time of his last flare - I'll mention it to Fiona (vet) when he goes back for labs next week.

Edited August 11, 2012 by greyhndz

[greyhndz]

So sorry you are going through this. We just lost our grey to lymphangiectasia and I felt compelled to at least reach out to you since we have been through exactly the same thing. I don't have any advice. Even with prednisone our boy had a very scarey 1.2 albumin level for about six months ... fortunately he had no idea he was sick and did not exhibit symptoms until the very end. We ended up getting a sheet of vinyl to cover the carpet where he would be during the day and trying to split his prednisone so he got the higher dose during the day and the lower dose at night so we might get some sleep. He didn't do well on the HA food and we switched to Royal Canin's low fat digestive ... it was the internist second choice but it worked for him. I know it's hard and I hope your sweet boy stabilizes quickly. I'll be anxiously watching for updates.

Yvonne

 

I'm so glad you posted, and I'm so sorry your pup lost his battle. We were very relieved that he started to show improvement about 2 months after starting the HA, and were hopeful that the diet would be enough to keep him stable. Initially, when he was first put onto the HA, he was also on pred and he didn't care what the kibble tasted like. Then, when he was off steroids, he realized that it was pretty crappy-tasting stuff. Now that I've stopped the z/d and am using just a spoonful of venison, it will keep him interested in the HA but with far less fat.

 

24 hrs on pred and already he looks awful to me, but both my own vet and the IM vet feel strongly that it's the only way to get his albumin up and keep him stable until the cyclosporine kicks in. I know this all sounds way too familiar to you.....

 

Jordan, I'm so sorry Dandi has relapsed. It is a nasty, nasty disease. I went through the same thing with Ducky. He did well for a while on the Hill's d/d Venison dry food. He also got weekly B12 injections. I've never heard of cyclosporine, so I don't have any advice on that, but I agree prednisone has some bad side effects. We did have him on a low dose of it toward the end. He was also on Plavix, which was very expensive. As well as a bunch of other meds. I found a support forum that you may find helpful: http://www.savelouie...hpBB3/index.php

Good luck!

 

Thanks Jennifer! I was fortunate to have found this site last winter. The folks are very supportive and also very knowledgeable, so it's time for me to check in again.

[tbhounds]

Try pricing budesonide at roadrunner and wedgewood pharmacys. I had budesonide compounded for me my by a greyt little local pharmacy . They were very accommodating -Rock Ridge Pharmacy in GlenRock, NJ. Not sure of the current price but, it may be worth giving them a call. If the price is right and they don't ship I would be glad to pick it up and ship it for you.

Honestly, I'm not sure my guy would have survived without the budesonide as long as he did (3yrs before it morphed into adenocarcinoma)----pred did zippo for him.

[Xan]

Budesonide prices: I had to go searching all over heck and back, and ended up finding this post right here on GT! There are lots of other possibilities listed for sources in that thread.

 

Good luck!!

[macoduck]

Fingers crossed for a quick improvement in Dandi and a new job on the horizon for you.