Protein-Losing Enteropathy

Edith Maskell's adventures with a very sick Border Collie and an obscure debilitating disease - not for the faint hearted!

I first came across PROTEIN-LOSING ENTEROPATHY at the end of December 2003 when I woke up one morning to find that my Border Collie, Sally had vomited during the night.

That morning (Sunday) she refused to eat her breakfast which is not that unusual. Whilst Sally is an incurable and notorious scavenger, she always has always had her off days with regard to proper food. I therefore took no notice, thinking "she'll tuck in later".

Her normal diet is actually a wheat free dry food because my other dog, a Labrador cross has sensitivity to wheat and it made sense to have them both on the same food. I only feed them once a day. And the previous day (Saturday) had been no different from any other. Plus she had not scavenged food (to my knowledge) in the garden or from the rubbish bins.

Anyway throughout Sunday, Sally continued to vomit and have diarrhoea which got so bad that when I woke up on the Monday morning, I was greeted with 13 piles of vomit on my living room carpet!! Plus two puddles in the bathroom which did not look healthy at all.

We took her to the vet who prescribed probiotics and digestive enzymes to replace those lost over the previous 24 hours and electrolytes to add to her water for re-hydration.

By Tuesday, Sally was continuing to vomit and have diarrhoea, this time it was particularly worrying as there was clear there was a heavy blood loss going on She looked decidedly sorry for herself. She was also shaking and shivering as though her whole body was in shock. On revisitng the Vet, another blood test was taken and Sally was put on a drip and given an injection to stop the sickness.

The result of the blood test revealed that there was liver damage, a bacterial infection, low blood platelets and a loss of proteins in the blood. The Vet felt that this could have been "something" Sally picked up from a fox in the garden.

Sally stayed on the drip for 3 or 4 days. She was having twice daily injections for the infection and for the sickness. By the end of the first week she had not eaten a morsel and was rapidly losing weight.

The vomit and diarrhoea contained a frightening amount of fresh blood.

The blood test revealed that Sally had severe liver dysfunction. Her blood was dropping and she was still losing proteins. We took her for an Ultra Sound which revealed that all her major organs were OK. There was no sign of anything nasty (tumours). That is not to say there were no tumours; just that they did not show up on the Ultra Sound) but we still did not know from where she was bleeding.

By the end of the second week Sally still had intermittent sickness and diarrhoea but her blood platelet count rose from 26 to 28 and the liver appeared to be functioning OK but she was still losing proteins and was very anaemic.

By the end of the third week, she was starting to eat on an adhoc basis (after a battle of wills) and the sickness had stopped. The diarrhoea was still there but less of a problem and there was no sign of blood.

After consultating with the Pathologist who suggested that Sally was started on a high dose of corticosteroid injections which is known to suppress the immune system and within 24 hours Sally had stopped shaking and shivering but I still could not persuade her to eat and she was literally wasting away. She put on 3 grams on the Monday and by Friday had lost 4.5 grams.

Her recovery has really been very much up and down. Virtually alternating day by day. There were at least 3 occasions when I was convinced that the next breath she took would be her last. She really was poorly.

We were at a loss what to do next.

The Vet suggested that we keep her on the steroid injection for a further 10 days and then do another blood test to check her progress and make a decision about her future at that stage.

Neither of us want to think in the negative, she has managed to survive this long, we, nor Sally can give up now BUT at the end of the day, if she is progressively getting worse and ultimately suffering, then of course we all need to be realistic. We even gave Sally a lecture about the fact that we had done our best and now it was down to her !! She did not seem impressed.

The next day (4 weeks since this all started) she ate her breakfast (breast of chicken) as soon as I put it down for her. A few hours later she ate a whole fillet of fresh salmon!! And, most importantly, managed to retain it all.

All she does is sleep. She is so weak sometimes that she could not even stand to drink from a bowl of water. She does not have the energy to walk up the stairs.

What is PROTEIN-LOSING ENTEROPATHY?

It is an inflammatory bowel disease where the lining of the digestive tract (stomach, small and large intestine) becomes inflamed. This interferes with the normal function of the gut and causes an abnormal loss of blood proteins from the intestines or an inability for the gut to absorb proteins. It is also an immune related disorder which may be the body's response to parasites, bacterial infection, food intolerances, heart, liver and kidney failure and even cancer. It is difficult to pinpoint the cause.

Low levels of proteins can result in accumulation of fluid (lymph) in the abdomen, shins and ankles. Lymph is a fluid which cleanses the blood, if it is blocked and accumulating in other tissues in the body then it will create problems. Abdominal fluid collection will cause inflammation and a disturbance in the digestive tract. Fluid collecting in other tissues is what we know as "oedema". A blockage of lymphatic tissues in the abdomen will over stimulate the intestines and put pressure on the liver and kidneys, thus causing damage and/or dysfunction because they are unable to compensate for the losses.

The loss of proteins into stools will result in bowel habits creating vomiting, diarrhoea, abdominal discomfort and anaemia. Another side effect is the loss of important immunoglobulins which help the body to fight infection. So at a time when the system is seriously in need of some support, the immune system is not able to fight off infection. Not all patients, whether animals or humans with this condition will lose blood in their stools or vomit.

In animals the condition is first usually seen in young adults (Sally is 6 years old), in humans it can strike at any age. Babies can pick up infection across the placenta from the Mother which could trigger this condition.

What caused this disease in Sally ?

Regrettably, we don't know and probably never will. It could be that she did pick up something from a fox (like an infection) or ate something in the garden which poisoned her and the resultant damage left her so depleted that PLE was the outcome OR it could be that the condition is inherited and that it has been lying dormant until now.

When I think back – she often suffered from a very strange gurgling sound in her belly which would go on all night sometimes and into the day. Also, as I said earlier, she often had "off" days with regard to her food. But she certainly never displayed any signs of "illness" which would have prompted me to take her to or even mention it to the Vet.

If Sally survives the next 10 days then it could mean a lifetime of corticosteroids, gradually reducing the dosage and she will eventually need to take it in tablet form, on alternate days. However, I am told that the outcome for Sally must remain guarded.

The most important thing now is to persuade her to eat and put on a bit of weight. Then we'll consider the options. After all this time, both the Vet and I are determined not to lose Sally.

If Sally continues to eat and put on some weight, I can also start to introduce some nutritional supplements and homeopathic remedies. We have tried to syringe liquid food and other medication but she becomes SO stressed that I just refuse to do it any more. Because what I have come to accept is that the smallest measure of stress very quickly brings back the diarrhoea and sickness.

She hardly has the strength to bark but if the postmen comes or if the other dog starts barking then Sally (being Top Dog) wants to chip in with her two penneth but is clearly really struggling with the stress. So keeping her quiet and resting a very important part of her treatment programme.

The other thing which the Vet suggested was medium-chain triglycerides like Coconut Oil. I did try her on this one day but within 12 hours she had a bout of diarrhoea and as one of the side effects of Coconut Oil is vomiting, diarrhoea and anorexia I have decided to wait until she is a bit stronger to introduce it into her diet because I do feel it will help in the longer term. Her diet at the moment is entirely protein. Chicken, Fish, Eggs and some natural yogurt.

I shall be limiting fat intake to the medium chain triglycerides and foods that are high in MCT's because these are far more readily absorbed and help to block the loss of proteins from the intestines. Replacing fat in the diet with medium chain triglycerides (MCT's) can improve fat mal-absorption and nutritional status.

Coconut oil is a medium chain triglyceride and is known to have many health giving properties, among which are its conversion by the body into pregnenolone, (corticosteroid). It is also known to have antioxidant actions as well as the ability to increase metabolism. "Vitamin Research Production : Coconut Oil"

Given the opportunity, I will also be keeping Sally on a gluten/wheat free diet because the proteins in wheat and gluten are known to aggravate the lining of the gut, causing further inflammation and I would not want to exacerbate the condition any further.

The body's way to fight infection (a stressor in the body) is to stimulate the immune system. Since this condition is also exacerbated by ANY stressor, internal or external, then a STIMULATED immune system will only make the symptoms worse. Hence the treatment of cortico-steroids, because they reduce the inflammation, thereby reducing the loss of protein and associated diarrhoea and will also SUPPRESS the immune system.

The only drawback of course, is that this situation will, in the long term, leave the animal (or human) in a very vulnerable position indeed. So I have some reservations about leaving Sally on steroids in the long term and I shall be discussing this with the Vet in due course. I want to support her system with alternatives to drugs ASAP. It is safe to say also that where there is mal-absorption there will be loss of vital fat soluble vitamins and minerals and so I would want to consider supplementation in the short term, if not the long term for protection. In my view, supplementation is important in cases of mal-absorption because the rate of soluble vitamin loss is greater than could be replaced by the small amounts available in food.

Meanwhile the corticosteroids are saving her life. For now, it is impossible to get any oral medication into her as she is so fed up with being fed anything through a syringe and if she suspects that there ANYTHING has been put into her food, she won't touch it. So my approach for the moment is very much, softly, softly.

She is drinking quite a lot of water which is a side effect of the drugs but not excessively and now that she's no longer dehydrated, there is no further need for her to be on a drip.

Regrettably, the condition of Protein-Losing Enteropathy (PLE) can not be cured but so long as we can Sally through the next 10 days, I believe we can manage it with a lot of consideration to dietary factors. Our major goals will be to reduce the loss of proteins and restore normal protein levels and then to get some weight back on her.

I am still shocked at how suddenly Sally went from a normal, healthy, fit and active Border Collie to a very sick dog. It is frustrating not to know what instigated such a shocking illness.

Regrettably, PLE is a very nasty condition but we haven't given up yet. It is down to Sally for the moment. I don't know what has kept her alive so far. I can only think it is her stubborn, strong Border Collie spirit and thank goodness for it.

Sunday, 4 January 2004

© 2004 Bromley Health Management