Stabilize Protein Losing Enteropathy

fiona1775

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My cat was recently diagnosed with Protein Losing Enteropathy (PLE), possibly IBD. I can't get him to eat much, lucky if he's eating 2-3oz a day right now. He was 12 lbs last year, and now that I think about it, we were having issues with his weight staying constant, but he was within 10-12 lbs, which is where his vet said he should be for his size. He was just at the vet last week for acupuncture, B12, and SRT/infused hemp drops, and when they weighed him, he was only 7lb, 11.5oz, which was down from 9lb 1.5oz only a few weeks before that. The vet said it's mainly muscle wastage, but given that he's barely eating, it has to be more than just muscle. I don't know what to do for him. The vet said they're usually diagnosed at 5 years old, and generally last till they're about 8. My cat is 12, and the vet said he now considers him to be a "super senior". His albumin and globulin levels are low, but were normal last June. He's been on 0.2m prednisolone and 0.25ml mirtazapine for the last 2 weeks. It doesn't seem to be doing much for his appetite, though I should say he seems hungry, so maybe there's some nausea too? He'll eat something one day, but not want it again.

He has an old spinal injury that the vet said can slow digestion, which may have led to the IBD, and believe could be the cause for the PLE. I have been using walnut shell cat litter, and though I like it because it's natural, I now wonder if it's prevented me from seeing diarrhea in the litter box because it's dark brown. I have constantly told the vet that he vomits, usually hairballs (until recently), and he said that if it's more than 2-3 days in a row, then it's a problem. I have read an article from a vet that if it's more than 1-2 times a month that they should be proactive about testing for IBD. He also started an odd behavior November 2021 looking for towels to try to shred and eat string from. He did end up a bit constipated, but not too bad, luckily. The vet said he was looking for, and probably needed more fiber, and I tried everything to get him to eat pumpkin or canned food with pumpkin pieces.

Is there anyone out there dealing with this, or has gone through it and able to stabilize their cat, and give them quality of life? I want to get him healthy, but I don't want him to suffer from this. Has anyone tried coconut oil for PLE and had good luck with it for gut healing and calories? What diet has worked best? He was on Stella & Chewy's raw food, with a little top dress for probiotics. We wanted to keep him on grain free, but the vet said he can't process the higher proteins, and needs plant-based protein because it's easier to process. I'm concerned about the inflammation from corn and wheat (I have celiac, so know about that), and the vet said the prednisolone will take care of that inflammation. I didn't expect that from a holistic vet. I am not really getting any answers. Any advice would be greatly appreciated!
 

mrsgreenjeens

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PLE is caused by many different things, and the only way to treat it is to fix what caused it in the first place. I'm guessing your Vet thinks IBD is causing it? And, of course, the very worst thing for IBD is wheat, corn, etc.. :sigh:. Can a cat survive on plant based proteins? They are obligate carnivores. Could you use digestive enzymes with this issues? I know they are plant based, but don't know if they would be harmful or not. I do know their purpose is to help the nutrients get into the bloodstream better.

For fiber, can you give something like psyllium husk? Can you give him things like Nutrical to supplement his calories? And another of our members adds baby food meats supplemented with EZ Complete to her cats food for added calories.
 

FeebysOwner

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I searched this site for PLE and really did not come up with much, other than one case of PLN which was over 10 years ago. I did find that S silent meowlook had a horse with PLE, but I have no idea if is comparable in cats. If there is anything they went through that might help you in any manner, I am sure they will see they are tagged in this post and offer what they can.
 

silent meowlook

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Hi. Yes I had a mare with protists losing enteropathy. She was treated with daily steroid injections and antibiotics, and special pelleted diet , and a special probiotic paste.

Cats should have a full blood panel and a GI special panel sent to labs. A complete fecal test should also be sent in and a urinalysis.

Ultrasound is important to have done by a boarded veterinarian in internal medicine. This is the kind of thing that you need a referral to a specialist ASAP. With the amount of weight your cat is losing, you don’t have much time to get it under control.

Since you were feeding raw you need to have a complete fecal sent in to the lab that will not only check for parasites bur also bacteria counts. Antech doe a good one.

This is tho much for a regular vet to handle.
It could be a nasty bacterial infection, parasites, intestinal neoplasia, or many other things. The PLE is a symptom.

 
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fiona1775

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Thank you for your replies! I will look into the suggestions.

As for checking the bacterial count, I will ask them about it. A fecal was done, and no parasites at that time.
 
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fiona1775

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Another question, I read that the prednisolone can cause nausea and decreased appetite, and mirtazapine can cause decreased appetite, even though prescribed to increase appetite 🤔

Any good ideas for the nausea? I'm sure he is nauseated because he is asking for food, but then eats little to nothing.
 

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Some use Cerenia - but it seems to be mostly focused on vomiting. Others use ondansetron, which seems to be more focused on nausea. I can't determine if my cat actually needs ondansetron, but she is getting 4mg twice a day as a precaution. A lot of folks use less than that, but my vet, and other sources, say any less is likely not effective enough.

If for some reason mirtazapine doesn't seem to help too much after adding an anti-nausea med, you might look into Elura.
 

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I wish the Vet would have elaborated on muscle wastage. If your barely eating your body starts using up its fat storage, in order to supplement missing fat it moves onto eating muscle which then starts weakening connective tissue. It’s possible to rebuild your muscle with protein, but your kitty is having a problem circulating the protein in his blood as well as converting it from food in the low gut. Other members on this thread have a lot more information and experience with medications than I do, but I hope that helps in understanding how everything connects.
 
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fiona1775

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I wish the Vet would have elaborated on muscle wastage. If your barely eating your body starts using up its fat storage, in order to supplement missing fat it moves onto eating muscle which then starts weakening connective tissue. It’s possible to rebuild your muscle with protein, but your kitty is having a problem circulating the protein in his blood as well as converting it from food in the low gut. Other members on this thread have a lot more information and experience with medications than I do, but I hope that helps in understanding how everything connects.
I've asked the vet about it. This isn’t long term wasting like some older cats, even though they're eating well. This is over the last 2 months. I feel like the vet just isn't doing enough. I don't want to put my cat through this, and would like to stabilize him. I just found another vet that does holistic/ traditional, so will try to book an appointment with them for a 2nd opinion.
 
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fiona1775

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I had an appointment with a different vet for a 2nd opinion. She said his protein levels haven't dropped enough for her to consider that it actually is PLE. His albumin/globulin levels are slightly low. She did an ultrasound, didn't find what she'd suspect to be lymphoma. Because of the prednisolone, she said that intestinal inflammation was limited, but with the symptoms, she'd agree IBD. She also said his pancreas is mildly inflamed, so mild pancreatitis. And, as everyone has said, the wheat and corn will not help. She also did a maldigestion profile. Results should be back in a couple days. I can't understand why my regular vet didn't recommend doing the test. Hopefully, some good news to come.
 
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fiona1775

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I meant to include that this new vet is switching him from mirtazapine to Elura. He's been so nauseated. I started slippery elm several days ago. It's helped stop diarrhea, but he's still been vomiting a little. She's prescribed Cerenia as anti-nausea as well, but said the SEB is fine to continue, since it has some nutrients, and continue with the bovine colostrum I started him on a week ago. She gave him B12 and some fluids since he was mildly dehydrated again.
 

silent meowlook

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Good. Just remember if your cat had a recent vitamin B12 injection, it will alter the cobalamine results. Still good this test is being done. Protien losing enteropathy is not seen much in cats. It is more common in dogs.
 

mrsgreenjeens

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Until the final test results are in, what did she say to feed him? Have you given him the Cerenia, or did they give him an injection of it while you were there? Is it working at all? Is he eating? SO glad you have found another Vet!
 
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fiona1775

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He had a B12 shot 2 weeks before she drew blood for the maldigestion profile. She gave him another at the end of the appointment. I just took him back yesterday for acupuncture and another B12. The results came in Thursday from the lab. He has low folate 6.3 ng/mL (range 9.7-21.6) and high TLI 97.7 (range 12-82). She said proximal small intestinal disease and most likely pancreatitis.
 
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