emaciated dog with chronic diarrhoea

RE: emaciated dog with chronic diarrhoea

Thomas Johnson — Wed, 06 Jun 2018 14:30:02 GMT

[quote user="Matt Hilary"]

[quote user="Thomas Johnson"]

I've seen a couple of adult dogs with PLE caused by giardia, one of them was so hypoproteinaemic it had developed ascites. They both made a full recovery after treatment with fenbendazole.

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I hadn't thought it was that pathogenic on its own either in an adult dog. Did you suspect a secondary IBD or all due to Giardia?

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I assumed there must have been some secondary changes for it cause such a severe problem, but as the response to fenbendazole was so good in both cases we didn't get as far as biopsies.

RE: emaciated dog with chronic diarrhoea

Matt Hilary — Wed, 06 Jun 2018 12:14:25 GMT

[quote user="Thomas Johnson"]

I've seen a couple of adult dogs with PLE caused by giardia, one of them was so hypoproteinaemic it had developed ascites. They both made a full recovery after treatment with fenbendazole.

[/quote]

I hadn't thought it was that pathogenic on its own either in an adult dog. Did you suspect a secondary IBD or all due to Giardia?

RE: emaciated dog with chronic diarrhoea

Andrew Kent — Wed, 06 Jun 2018 11:02:36 GMT

[quote user="Thomas Johnson"]I've seen a couple of adult dogs with PLE caused by giardia, one of them was so hypoproteinaemic it had developed ascites. They both made a full recovery after treatment with fenbendazole.[/quote]

Interesting, thanks Thomas, I tend to consider these things unlikely in PLE so a good reminder we shouldn't write it off on that basis.

Andy

RE: emaciated dog with chronic diarrhoea

Martin Atkinson — Wed, 06 Jun 2018 11:02:35 GMT

I had PLE several years ago and 2 months and several intestinal biopsies + cultures later there was no diagnosis. Then I spoke to another vet who said she'd had the same and it was Giardia. So I self treated with a course of metronidazole as you do in these cases and it was better in days.

As a foot note to that; there are 2 recommended dosage regimes for metronidazole in humans: standard dose for a week and a mega dose for 3 days. Given I was going skiing just as the course started and skiing involves apres-ski activity + alcohol doesn't go well with metronidazole I elected for the latter. However shoving 12-13 x 500mg metronidazole tablets down the oesophagus in one go was not pleasant and involved quite a lot of retching! Anyway it worked and I was able to enjoy my skiing week.

RE: emaciated dog with chronic diarrhoea

Thomas Johnson — Wed, 06 Jun 2018 10:23:19 GMT

[quote user="Andrew Kent"]

[quote user="David Mills"]With PLE do people not start preds etc straight away? [/quote]

For me it depends how severe, there are still some dogs who respond to dietary manipulation alone, this was reported in Yorkies with PLE below:

https://onlinelibrary.wiley.com/doi/10.1111/jsap.12625

So if the dog is bright and the protein is not too low I might give diet a week or two before considering immunosuppression.

[/quote]

I've seen a couple of adult dogs with PLE caused by giardia, one of them was so hypoproteinaemic it had developed ascites. They both made a full recovery after treatment with fenbendazole.

RE: emaciated dog with chronic diarrhoea

Andrew Kent — Wed, 06 Jun 2018 09:22:27 GMT

[quote user="David Mills"]With PLE do people not start preds etc straight away? [/quote]

For me it depends how severe, there are still some dogs who respond to dietary manipulation alone, this was reported in Yorkies with PLE below:

https://onlinelibrary.wiley.com/doi/10.1111/jsap.12625

So if the dog is bright and the protein is not too low I might give diet a week or two before considering immunosuppression.

But I agree we tend to reach for immunosuppressants quite quickly in PLE cases.

Andy

RE: emaciated dog with chronic diarrhoea

David Mills — Tue, 05 Jun 2018 23:02:21 GMT

With PLE do people not start preds etc straight away?

RE: emaciated dog with chronic diarrhoea

Andrew Kent — Tue, 05 Jun 2018 22:55:01 GMT

Not really. The work from Linda Toresson did not suggest that was predictor of response but clearly not a great idea in inappetent patients etc.

anecdotally I sometimes give an injection at diagnosis (when likely also starting other treatments) then continue with oral.

Andy

RE: emaciated dog with chronic diarrhoea

Sarah Keir — Tue, 05 Jun 2018 22:35:53 GMT

[quote user="Andrew Kent"]

I largely consider oral or injectable protocols as being equivalent for B12 and do tend to use cobalaplex so whichever is easier!

Andy

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Does that advice vary with the severity of the malabsorption/disease?

RE: emaciated dog with chronic diarrhoea

Andrew Kent — Tue, 05 Jun 2018 19:24:23 GMT

Yep I think B12 and diet would be a good starting point then maybe biopsy or immunomodulation if no response.

I largely consider oral or injectable protocols as being equivalent for B12 and do tend to use cobalaplex so whichever is easier!

Andy

RE: emaciated dog with chronic diarrhoea

Martin Atkinson — Tue, 05 Jun 2018 14:03:01 GMT

Thanks Andrew, I'd already found that reference and I knew from a previous post about you advising supplementing B12 at < 400.

So where now, I figured a hypoallergenic diet, supplement B12 and see what happens? How do you rate Protexin's Cobalaplex capsules?

RE: emaciated dog with chronic diarrhoea

Andrew Kent — Tue, 05 Jun 2018 12:03:50 GMT

Hi Martin,

High TLI is also seen with malnourishment/GI disease - https://vetmed.tamu.edu/gilab/service/assays/tli

So that seems likely in this case.

Would also call that B12 low - I supplement anything less than 400 pmol/l.

Andy