# Protein losing enteropathy



## cd13 (Sep 22, 2009)

Sorry about the length of this post...................

My dog is a two year old miniature schnauzer, in July this year he started getting diarrheoa quite regularly so we took him to the vet (we saw a locum at the time) she suspected colitis and prescribed antibiotics. More or less a day after he started taking the antibiotics he went downhill and started vomiting aswell.

We took him back to the vet (saw our usual one this time) and she gave him a blood test as she thought he seemed quiet but could see nothing else obvious but she also recommened tests on both his urine and faeces.When the blood results came back his protein was alarmingly low (about 21, dogs should have between 54-77 per count) the samples also showed that e had campylobacter and a parasite called giardia. He was given antiobiotics and a powder to treat the campylobacter and giardia and he seemed better for a week or 2, the vet had narrowed the protein loss down to an intestinal problem as no problems had shown up with the liver or kidney function. Shortly after this he developed ascities (fluid in the abdomen and a by product of low protein) at this point he was referred to an animal hospital where he spent 2 days having ultrasound and an endscopy. The vet diagnosed either inflammatory disease or possibly lymphangiectasia and started treating him with prednisolone (20mg) metronizadole (200mg) and atopica (50mg) and roal canin sensitivity control diet.

Initially he responded very well to the treatment and the diarrheoa stopped, he developed the usual side effects of taking pred - increased thirst and urination etc. After several week his protein had gone up to 39, the vet has said that she will only consider lowering the dose of pred when he gets within the normal protein range. On his latest test his protein has gone back down to 32 and I am really concerned about the effects that i think the pred is having on him, he is really lethargic, has a very round abdomen and is also becoming quite weak - he won't attempt to jump up on the sofa which he always used to do. He is so bony and does not seem to have any muscle on him where as before his illness he was a muscly, stocky, springy little dog. 

The vets advice is now to take thing day to day and retest the protein in another month and then we ca decide if his quality of life is acceptable. I would never let him suffer as he is a tremendous dog and the centre of our lives. Before his illness he would have 3 good (3-5 miles) walks a day and did everything with us. I just want to do the best by him.

Just wondering has anyone experience the same or have any advice? I would really appreciate it x.


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## james1 (Sep 21, 2008)

never heard of it sorry, and hope you boy gets better soon  What are you feeding him? As a good kibble I use Orijen which has one of the highest protein levels there are in a kibble, its an expensive food but last the equivilent amount of time as you give them less due to how rich it is. Id look at the food your feeding and see if there is a decent amount of meat in there, less grain the better  But tell your vet you are changing his diet so as not to interfere with any meds


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## cd13 (Sep 22, 2009)

Thankyou for your reply. We are feeding him royal canin sensitivity control diet, it comes in chicken and duck in the 'wet' form - almost like a paste. We also give hi the dry biscuits from this range which are made from blue whiting and tapioca, this was recommended from the vet as it is easily digestable and recommended for dogs with intestianal problems.


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## james1 (Sep 21, 2008)

Just had a look over the wet ingredients list and it seems a solid food, their food is the only thing I could point to if it wasnt getting enough protein... hope he fixes himself soon - maybe he just needs his gut strenghtening which is what i expect the vet is doing for him


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## karen m (Sep 22, 2009)

sorry to hear what you are going through. i have some similarties although not all of them with my dog.

she is a 3 1/2 yr old irish wheaton terrier - had same initial symptoms, chronic diahrea and vomiting, vet would give her some meds, she would initially get better but then it kept getting worse and worse and she was eventually referred to an animal specialist hospital here in NYC where we live.

she had an endoscopy and they diagnosed her with inflammatory bowel disease (mild in the stomach, moderate in the intestines) and possible lympagasemia as well. they were going to start her on predisone as well but said we could first try a strong antibiotic as possibly the current inflammation was due to a bacteria . . the vet did say this probably wasn't likely and we would probably have to do predisone but we tried to antibiotic first and she improved greatly with it - i think it was called baytril and she was on it for 6 wks.

we were lucky that her proteins came back fine although they have told me that she will eventually likely be looking at protein losing enteropathy as well and we have to keep checking her proteins every 6 months.

i know that PLE can also affect the liver - have they given your dog an ultrasound? stella got an ultrasound so they could look at her kidneys . . .

as far as food - she is on hills prescription z/d (wet formula) and has done very well on it - she also had been on royal canine for a while when she first got sick but then the vet specialist wanted her on the z/d . . so not sure if the baytril helped or maybe the food or maybe some combination. you actually have to get a prescription from a vet for the z/d and y.ou can only buy it at a vet's office (at least here in the usa).

also i could be wrong about this - but when the vet was talking to me about the predisone and some of the unpleasant side-effects i believe?? she said they would just be temporary and would go away once the predisone was no longer used . . .maybe once your dog's protein level goes up (hopefully) they will stop the pred and the side effects will go away.??

oh one other thing that it took the vet a few months to tell me and i think was a factor - no treats, rawhide bones, NOTHING else but the food. i felt bad about this but now that my dog has been doing so much better it really doesn't matter - we can deal w/o the bones and treats. the only thing we let her ingest is water and the z/d. make sure you are giving him distilled water as well.

good luck to you.


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## karen m (Sep 22, 2009)

i meant to say that PLE can affect the kidneys - not the liver - sorry - so ultrasound would be to look at the kidneys


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## Roo (May 28, 2009)

cd13 said:


> Sorry about the length of this post...................
> 
> My dog is a two year old miniature schnauzer, in July this year he started getting diarrheoa quite regularly so we took him to the vet (we saw a locum at the time) she suspected colitis and prescribed antibiotics. More or less a day after he started taking the antibiotics he went downhill and started vomiting aswell.
> 
> ...


Well, that has given me more answers than I got from my vet when I went through an identical situation with one of my beloved pets a few years ago. Same symptoms ( out of nowhere ).......scary drop in protein levels. Unfortunately, this particular practice didn't give my little girl any meds.....just a drip........they kept sending her home saying they didn't know the problem. Eventually, after 6 weeks I demanded an endscopy......however my girl by this time was so weak she died on the table. The reason I tell you this is that your vet IS taking this seriously & trying lots of things. I was never given a real diagnosis. Keeping everything crossed for you.


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## cd13 (Sep 22, 2009)

Thanks again for the replies. 

In fairness both my vet and the vet that I saw at the referral hospital have been very good. When he was in hospital he had an ultrasound and they were pretty happy that both his liver and kidney funtion were good, the kidney results were backed up with a urine sample.

The vet did say that when the protein improves then she will gradually start to reduce the steroids, this just doesn't seem to be happening and is so frustrating as we stick to his meds and bland diet religously.

The only thing I comfort myself with is that at least we have tried everything suggested and we can't do anymore. fingers double crossed x.


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## karen m (Sep 22, 2009)

that is all you can do - and try and take it one day at a time - i hope he starts to improve!

best wishes


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## Paul99 (Dec 30, 2009)

Hi. My Doberman mix is going through the exact same thing right now, only the doses are much higher for my 60lb dog -- 300mg Atopica, and weaning him down from 60mg pred, now to 20, as well as the other drugs you mentioned -- and I am watching him waste away. It is awful. Plus, the Atopica has allowed an infection to grow in his leg and we have had to add several antibiotics. I want to reduce his levels more aggressively than the vet wants but I haven't yet. I'm not sure what to do. Have you had success with this treatment?

Thanks and good luck, I hope he is much better by now.


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## FEWill (Sep 2, 2009)

Hi cd13,

Here is an article that I wrote several months ago about PLE

Maybe there is something that might help in it

Thanks,



Protein Losing Enteropathy in dogs, also referred to as PLE in dogs, is a condition in which dogs will have a variety of intestinal diseases that are directly associated with hypoproteinemia, or low protein levels which is caused by a loss, a leakage, or a failure to absorb protein in their stomach.

It can in some cases, be the kiss of death for your dog, it is that serious. 

This life threatening condition in dogs can be controlled in some cases with a specific diet as well as with pharmacologic therapy, and if controlled, the chances of your dog surviving are fair to good in some cases, while the more severe cases will most likely cause the death of your dog. 

In severe cases, some dogs may not respond to any type of therapy, or relapse quite suddenly after initial treatment, and pass as a result of worsening conditions or other complications. 

It is extremely important to note that this is a very, very difficult disease to properly diagnose by your veterinarian, as they must exclude non-intestinal causes of the low protein levels that may be specifically related to the kidneys or the liver. 

Hypoproteinemia, or low protein levels, is a condition where there are low levels of protein in the blood and usually indicate that there is an inadequate diet or an intestinal or renal disorder. 

The driving force behind your dog losing protein in PLE in dogs may be related to either inflammation or erosion causes that are affecting the normal functions of the stomach, or may be caused by some type of a congenital problem or vascular drainage problems. 

Most cases of PLE in dogs have been linked to disruptions or a series of issues that cause problems with your dogs ability to absorb food proteins in the small intestine. In the intestines, mucus from both the small and large intestines will form a barrier, so to speak, that controls movement of fluid and electrolytes. 

However, this lining only provides a small barrier that protects against the loss of protein. 

The major loss of protein from PLE in dogs is caused by either the lining mining blood supply or the area that is between the cells. 

However, the intestinal lining provides only a minor barrier to the loss of plasma proteins from the body. An alteration or a change of this lining by disease or conditions such as PLE in dogs results in the loss of the protein into the intentional lumen, which in turn cases as loss of albumin, a water soluble protein, and globulins, which are serum proteins, both at an equal ratio. 

All this spells vey bad news for your dog if it is not corrected, and the challenge you now face is can it be corrected. 

What makes the situation even worse for you dog, is that most of the ultra low-fat commercialized dog foods that are sold today will contain an increased dietary fiber in them, which is potentially very dangerous to a dog with this condition as the fiber reduces both the availability and the digestions of proteins as well as carbohydrates. 

The symptoms to watch for with this horrible condition will be an initial loss of weight which is actually their muscle wasting away, as well as decreased body fat. Some dogs may stop to vomit or develop diarrhea, but not always. 

Limb swelling and fluid accumulation may also start to formulate in the abdomen, indicating a decrease in serum counts. Other symptoms will include edema, which is any type of an unusual or an abnormal fluid accumulation in any part of the body, and respiratory problems. 

Respiratory problems are especially important to watch for as this is most likely fluid accumulating in the chest and or lungs. 

A diagnosis of this condition will again be very difficult as there are several possibilities to rule out first by your veterinarian that may be caused by hypoproteinemia, such as hepatitis, cancer, or even cirrhosis of the liver. 

Treatment for protein losing enteropathy in your dog will have to be directed at whatever can be determined as the actual underlying cause. 

The first form of treatment will obviously be your dogs diet and feeding them diets that are homemade will be an absolute necessity. The diet must be something that is very easy to digest and ultra low in fat such as white turkey meat combined with either rice or potatoes. 

MCT oil is also highly recommended. MCT oil is a clear, light colored liquid that has no flavor and a very low viscosity, making it easy to digest. When it t is metabolized by your dogs body, it acts as a carbohydrate, which produces the much needed fuel to their body, and is a very quick acting source of energy. 

Fluid forms of therapy may be necessary in some dogs that have experienced either severe vomiting or diarrhea, or both, to replace lost fluids as well as electrolytes, and to help maintain a normal fluid distribution on your pets body. 

Metronidazole, tetracycline or other long term antibiotic therapies may also be required to help control bacterial growth. Supplements of calcium, magnesium, and the fat soluble vitamins A, D, E, and K will be required as your dog is not absorbing these vitamins. In normal circumstances, these fat soluble vitamins are easily stored in your pets liver. 

These minerals and vitamins will be extremely important in conjunction with the diet therapy, but also very important if the diet therapy does not correct the imbalance. 

Protein Losing Enteropathy, or PLE in dogs in your dog will be very difficult to overcome, but it can be done in several cases if caught early, diagnosed properly, and than treated properly, but it certainly will not be easy.


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## haeveymolly (Mar 7, 2009)

Hi, ime so sorry your dog is ill and t.b.h i dont know much about the condition only the muscle wastage which indeed leaves them very weak our first springer had muscle wastage through low protein due to kidney failure which was a secondary condition, he was given a steroid injection every 6 weeks much like the human anabolic steroid, its not a cure i know but helped him get some muscle back i thought he was lathargic because of the d.c.m he had but it was the weakness from having very little muscle.


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## cd13 (Sep 22, 2009)

Thankyou for all the replies.

Unfortunately we had to have Archie pts on December 7th. He had been doing pretty well in the weeks before hand, not really any better and his protein hadn't improved but he was stable.

On the weekend before, he seemed really lethargic and couldn't seem to get comfortable when he lied down, so he was just standing up all the time but you could see how tired he was. He didn't want to walk at all and he was drinking lots and lots of water (about a bowl an hour). When I got home from work on the Monday I phoned our vet who said to bring him up immediately. I knew what was coming as he just seemed different, like he'd given up the fight - he could hardly pick his head up off the sofa. My auntie had sat with him all day and said he hadn't moved, had hardly ate (when he did try something he was sick) and had looked really uncomfortable.


My partner and I then took him to the vets and she said that she could feel odemas (fluid under he skin) all down his back legs and she was concerned about the water he was drinking. She advised that we had him pts as she felt his body was starting to shut down and that he was just wouldn't recover (plus the toll that all the treatment had had on him). In our heart of hearts I had a feeling this was coming so we both agreed to have him pts that evening. I can honesty say that it is the worst decision I have ever had to make but I just couldn't let him suffer, he was far too ill.

We are so devastated at losing him, he was a superb dog who was the centre of lives and couldn't have been more loved. It is such a cruel condition as 6 months ago he was fit and healthy and in the prime of life (as he should have been). I just feel so cheated that this has happened and he's gone. The only comfort that I can take is that we really pursued treatment, tried everything that was offered to us and did our best by him. On that day in the vets I really didn't feel that there was any choice as he was so poorly, I'm just glad that he went sharply down hill rather than being like that for weeks.

I'm really sorry that I don't have any encouraging news to report on the condition but this is only my experience. I'm sure that there are dogs out there who are managing to live with the condition xx.


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## haeveymolly (Mar 7, 2009)

So sorry this has happened, i feel for you as i know how it feels to make that decision its so hard even when you know all has been done we always said when our first was so ill and he was still quite young that we wouldnt keep him alive for us it had to be the best for him but you find yourself doing just that because you hold on to the chance that there might just be something else that can be done.

Take care you did do the right thing.


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## diane cooper (Aug 8, 2018)

FEWill said:


> Hi cd13,
> 
> Here is an article that I wrote several months ago about PLE
> 
> ...


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## diane cooper (Aug 8, 2018)

My dog was diagnosed with pLE 6 months ago. He is on cyclosporine,prednisone and flagyl. My problem is that when put him in the flagyl for up to 6 days, his stools improve, but as soon as I take him off, his diarrhea returns. Any suggestions?


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## MontyMaude (Feb 23, 2012)

diane cooper said:


> My dog was diagnosed with pLE 6 months ago. He is on cyclosporine,prednisone and flagyl. My problem is that when put him in the flagyl for up to 6 days, his stools improve, but as soon as I take him off, his diarrhea returns. Any suggestions?


You might be better staring your own thread as this one is very very old.


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## Jdevito (Oct 28, 2018)

diane cooper said:


> My dog was diagnosed with pLE 6 months ago. He is on cyclosporine,prednisone and flagyl. My problem is that when put him in the flagyl for up to 6 days, his stools improve, but as soon as I take him off, his diarrhea returns. Any suggestions?


Hi diane. Not sure if you're going to see this because I see it's been a few months since you posted. How is your dog doing? Mine was just diagnosed.


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