PLE

[keeperdean]

I have 7 year old male Greyhound. His normal weight is around 80 Lbs. Always a voracious eater.

About 6 weeks ago he started refusing his breakfast. Took him to vet. They did blood work and put him on Pepcid twice a day. Appetite increased for a couple of weeks but then started to do the same thing. Took him back to vet. He had lost 6 lbs. More bloodwork and they suspected a PLE due to low protein and albumin. Referred to IM. Went to IM, had ultrasound and confirmed PLE and an additional 4 lb. weight loss for a total of 10 lbs (mostly muscle mass).

IM changed diet to Hydrolized, a combination of kibble and canned, Prednisone (35mg/day), a probiotic and a blood thinner. This was about 10 days ago. His appetite immediately improved, he can’t get enough of it! His stool are firm, no vomiting, or any other symptoms normally associated with this insidious disease. Hard to tell if he is loosing weight, his profile looks normal except for the muscle mass loss in his shoulders and haunches.

Based on my research, I am assuming the weight/muscle loss is due to the Prednisone and will rectify itself once his system has been stabilized and the dose can be reduced.

I would appreciate any recommendations/comments from people that have experience with PLE.

[FiveRoooooers]

I am sorry about your boy's diagnosis (what is his name!). Definitely the Pred can contribute to muscle loss and increased appetite. GreyTalk doesn't allow for a three-word search but if you search in the H&M forum here for Protein-losing enteropathy you'll find information that will hopefully be helpful. Good luck and please keep us posted.

[keeperdean]

Thank you. His name is Bolt.

[greysmom]

My experience with PLE was not as happy as yours.  Our girl was never able to get it under control, and she passed within a couple months.  I hope your Bolt is luckier.  There is a GT member who kept her dog alive and happy for a couple years post-diagnosis, so I hope she sees this and can offer her advice.

That being said, a couple things don't add up for me in your narrative, and it could be that you left parts out to not make it so long.  If so, my apologies.

As far as I know, the only way to definitively diagnose PLE is through a biopsy of a sample of the intestinal wall.  PLE is not in itself a separate disease, but a result of another primary disease causing protein-carrying fluid to leak through/from the lymphatic system into available cavities in the body.  Bloodwork and ultrasound can point towards PLE, but to find the underlying cause requires more invasive techniques.  Simply having no appetite and losing weight could have many, many causes and to jump right to PLE seems extreme.  Fluid build up and swelling in the abdominal cavity and legs, bloody diarrhea, vomiting, increased heart rate and difficulty breathing from fluid build up in the chest cavity, and yes - thickening of the intestinal walls can all indicate PLE.  In the absence of any of these other symptoms, I would have doubts about him having PLE without a biopsy.

Steroids can and do increase appetite and can cause the severe loss of muscle mass.  The longer he's on the Pred, the worse it will get.  And unfortunately, most dogs on high doses of pred don't ever gain that muscle loss back, and many go back off their food without the drug driving their appetite.  But taking him off may cause the original issues to resurface.  It all depends on what the underlying cause of his inappetence and weight loss was.  If the medical intervention took care of the underlying problem he might be good for now, or relapse down the road, or never have it happen again.  Often an immunosuppressant drug will help ameliorate the underlying problem and keep it a bay longer.

Hopefully this time on a prescription diet with drug support has straightened out whatever was wrong with Bolt's system, and he can go back to being a happy companion for you again!!

[keeperdean]

Greysmom, thank you so much for responding. You are correct in everything you say.  Since we are early in the journey (It’s only been 2 weeks since diagnosis), and he hasn’t experienced any of the horrendous symptoms you noted except some loss of appetite/weight loss, My IM Doctor felt that a endoscopy or biopsy are premature. The ultrasound did identify thickening of the intestinal wall but not why as you stated.

The waiting game has started. He’s tolerating all the meds and eating everything. Weather or not he’s loosing any more weight, I can’t tell but he sure doesn’t look emaciated.

Thanks again for your input.

Edited March 20, 2023 by keeperdean

[cello]

Good morning. I am very sorry to hear that Bolt is not doing well. My Greyhound Lady was diagnosed with PLE around age 8. Our local vet suspected that was what was going on and he sent us to the specialty veterinary practice to see an internal medicine vet. Tests run were blood, ultrasound and a biopsy of her intestinal walls. They took several samples of her intestines and found evidence that confirmed a diagnoses of PLE. Changes in the thickness of her intestinal walls and free fluid in places that it should not have been. Lady was treated initially with high dose steroids and an ultra low fat diet. Eventually we added in an appetite stimulant to help her eating. 

The main thing that I feel and our internal medicine vet felt kept Lady going was the extreme low fat diet. This all took place 6-8 years ago and at that time there were only two ultra low fat kibbles on the market, and Lady hated both of them. Our vet said that this is common as without fat the kibble is tasteless. So I came up with my own diet plan for her. I realized that boneless skinless chicken tenderloins were almost fat free. I also discovered that pasta was high in calories and very low in fat. So Lady began her two year odyssey of eating four cups of pasta and four ounces of cooked chicken breast and one cup of her low fat kibble eat day. Some days were better than others when it came to keeping her eating. We were able to lower the prednisone to a very low maintenance dose that she took three times a week. Lady did quite well on this regime and our vet was extremely pleased, calling her our miracle dog. Eventually after almost two years Lady developed intestinal cancer and we had to let her go.

I hope that you have similar success with your Bolt. PLE is a horrible disease and the end result is unfortunately always the same. However, if you can get a hold of the keeping the symptoms at bay, your boy can potentially have a good life in the short term. 

[keeperdean]

Update on Bolt. Went to IM and had bloodwork done Thursday. Results were promising. His albumin went from 2.2 to 2.7 (within normal range for Greyhound) and his protein level is steady at 5.0 (a little low). Increased diet to compensate for weight loss/prednisone effects. Fingers crossed.

Thanks all for your responses.

Edited March 21, 2023 by keeperdean

[FiveRoooooers]

This sounds encouraging, and that Bolt is eating and tolerating his meds is huge. Keep up the good work and hang in there. Thank you for your updates!

 

[EllenEveBaz]

Keeping all paws crossed for Bolt.