Intestinal lymphangiectasia, Inflammatory bowel disease, Protein Losing Enteropathy)
Symptoms: diarrhea (especially if it persists longer than a few days or there are repeated bouts)
vomiting/nausea (usually episodic, rather than constant)
weight loss, especially loss of muscle mass or tone.
swollen abdomen (looks pregnant) and/or swollen legs
low serum protein (sometimes that is the only sign)
Onset: any age, dogs from 6 months to 10 years have gotten it.
Cause: At this point, the cause is totally unknown. Certainly there is a genetic predisposition to the disease, and then something sets it off. Intestinal infections (viral, parasitic, and bacterial) have been implicated. Periods of stress (boarding, estrus, pregnancy, shows) seem to bring on episodes. Dr. Williams of Texas A & M’s GI Lab strongly believes that there is a hypersensitivity/allergy to protein antigens (either from food or bacteria) that are in or pass through their GI tract. He feels that the normal protective mechanisms of the intestines are reduced, allowing increasing permeability in the intestinal wall so that the intestines are exposed to substances to which they would not get exposure normally.
Course of the disease: Lundehunds are born with apparently normal intestinal systems, but with time something in their system causes inflammatory cells to build up in the intestinal walls and this causes the lymphatic vessels (which normally absorb proteins from the intestines) to clog up and ooze protein/lymph into the intestines. Some dogs get the clogged up lymph vessels (lymphangiectasia) worse than others and lose protein quickly with no signs of diarrhea. Other dogs get the inflammatory build-up worse and are more prone to diarrhea than low protein. Either way, all dogs lose protein into the intestinal tract and as the inflammatory cells block up the intestinal walls, diarrhea may start, and the dog will not be able to absorb nutrients and protein from its food. Many dogs get an intestinal bacterial overgrowth and vitamin B12 deficiency, (which causes even worse diarrhea and malabsorption). This malabsorption can cause even more weight loss. In some dogs the diarrhea will be only occasional, but the loss of protein can continue insidiously. Weight loss (especially loss of muscle mass) will start, and become more and more severe as the process continues. Some dogs will improve on their own, or with treatment, and the disease will appear to go away. But actually it is only in remission. Sometime later in life, especially after periods of stress and change in the dog’s life, it will usually reappear. The dog will have repeated bouts of the illness, frequently controlled with medication. Eventually, the disease process becomes resistant to medication, and the dog progressively loses weight. Once they have lost enough protein, the abdomen swells up with fluid accumulation (recall photos of malnourished children with big stomachs?) and/or the fluid will accumulate in the limbs, usually the hind legs. Sometimes the fluid may also build up inside the chest, causing breathing problems. If the dog is not euthanized, death will occur due to dehydration, extreme anemia & malnutrition, abdominal/chest fluid build-up, or they will throw a blood clot to the brain or other vital organ.
Treatment: is addressed in a separate article for veterinarians. Current treatment uses special food, (high protein, low fat), and drugs, both to reduce the cell build-up in the intestines and improve the lymphatic flow. Once fluid builds up in the abdomen or legs, there are i.v. treatments that the veterinarian can do to improve the situation in the short term.
Prognosis: can eventually be fatal, although bouts of the disease can be controlled with medication and the illness can go into remission for various periods of time, and the dog can live for many years, but the occasional dog will get a fatal case the very first time.
Incidence in the Lundehund Breed: at present is unknown, although we are trying to gather statistics. The disease can appear at a late age and some dogs get such a mild case that no one really ever diagnoses it, that it is difficult to gather firm figures. Certainly Lundehunds get this disease incredibly more often than other breeds.
Outlook: Research is being done on the treatment, diagnosis and inheritance of this disease, both here and in Norway. Researchers are looking for genetic markers and non-surgical means to find affected dogs. However, progress is very slow as this disease has multiple and variable manifestations, and therefore may not be simple to pin down.
Recommendations: Do not breed highly affected dogs. Have serum protein levels done very often, at least twice a year on a healthy dog and once a month on a dog who has had an attack. Have fecal tests done every 6-12 months. If your dog has abdominal surgery for any reason, please request that your vet take an intestinal biopsy (of the proximal small intestine close to the duodenum) and submit it to the pathology lab, with the request that they look for inflammatory bowel disease and lymphangiectasia. Sometimes the signs of lymphangiectasia are visible to your vet on surgery, but other times, it requires a pathologist to make a microscopic examination. If your dog is diagnosed with the disease or has a clear biopsy, please inform your breeder.