Chances are, if you haven’t cared for a pet with lymphangiectasia, you’ve probably never even heard of this disease. The word lymphangiectasia means “dilated lymph vessels.” The disorder is rarely seen in cats, and most often occurs in the Basenji, the Norwegian Lundehund, Wheaten Terriers, Yorkshire Terriers, Shar-peis and Rottweilers. The average age of dogs with lymphangiectasia is 5, but it’s also seen in older and younger dogs. Females are slightly more likely to acquire the disease than males.
Lymph Vessels Dilate in Response to Inflammation
Lymphangiectasia causes significant dilation and dysfunction of the intestinal lymph system. Lymph is fluid that travels throughout the body, but unlike circulating blood, which is pumped by the heart, lymph is pumped through the body as a result of normal muscle activity.
Lymph is made up of cells of the immune system called lymphocytes. The cause of lymph vessel dilation is typically inflammation that puts pressure on the vessels, causing them to enlarge. Lymph flow can be blocked by the inflammatory response.
There are special lymph vessels in the intestines called lacteals. Their job is to absorb fats from food. When the vessels become dilated and are under pressure, the lacteals rupture and the fluid, cells, fats and proteins inside them are lost. The intestine may reabsorb some of these substances, but if the inflammatory process is widespread, the net result is loss of nutrition.
Lymphangiectasia results in a condition called protein-losing enteropathy, which is the abnormal loss of protein from the digestive tract or the inability of the digestive tract to absorb proteins. This disorder is often lumped in with other malabsorption diseases or protein-losing enteropathies, but it actually has its own distinct characteristics and causes.
Types and Causes of Lymphangiectasia
Lymphangiectasia can be either a primary disease or secondary to another disorder. Primary lymphangiectasia is typically congenital (inherited) and takes one of the following forms:
|Intestinal lymphangiectasia||Cholecystitis (accumulation of lymphatic fluid in the abdominal cavity)|
|Widespread lymphatic abnormalities||Thoracic duct obstruction|
|Chylothorax (accumulation of lymphatic fluid in the chest cavity)||Lymphedema (swelling of the body due to poor lymphatic drainage)|
Secondary lymphangiectasia is more common than the primary form, with potential causes that include cancer, hepatic veno-occlusive disease, constrictive pericarditis and right-sided heart failure.
Inflammatory bowel disease (IBD) is often diagnosed along with lymphangiectasia, but it’s not yet known if one of these conditions precedes the other, or if they’re both a result of the same disease process. However, I have a strong suspicion chronic gut inflammation causes IBD, which precedes lymphangiectasia.
Signs and Symptoms
Symptoms of lymphangiectasia include:
|Chronic diarrhea||Fluid accumulation in the abdomen and under the skin|
|Loss of appetite||Excessive gas|
|Weight loss||Difficulty breathing (from fluid buildup in the chest)|
The major clinical symptom of lymphangiectasia is protein loss, but there are several other disorders that also involve loss of protein, and those must be ruled out before a confirmed diagnosis can be made.
Your veterinarian will run a complete blood profile. In particular, he or she will be looking for a low lymphocyte count, which is almost always present in cases of lymphangiectasia. A low cholesterol level due to loss of lymph fluid and a low albumin level, which is a type of protein, will also be present and are very consistent with this disease.
A urinalysis will also be required as well as a fecal smear and flotation to check for intestinal parasites. Feces may also be cultured to look for infectious agents. Chest and abdominal X-rays and an abdominal ultrasound may be taken to rule out various forms of heart disease and cancer. If a problem with the heart is suspected, an ECG may be necessary.
Your veterinarian will probably also perform an endoscopy, which involves passing a camera down into the gastrointestinal (GI) tract to examine and collect microscopic tissue samples for analysis. Once the diagnosis is made, functional medicine veterinarians will often use C-reactive protein (CRP) as a means of monitoring the inflammation status of the body, and evaluate response to treatment with repeated CRP tests.
The first step in treating lymphangiectasia is to address the inflammation that is always present. Whereas conventional veterinarians typically prescribe drugs such as prednisone (a corticosteroid) and azathioprine (an immunosuppressive drug), integrative veterinarians, including me, prefer to use natural GI anti-inflammatories to decrease or offset the pharmaceutical drugs required to treat the condition.
I find proteolytic enzyme therapy very beneficial for this condition, as specific enzymes address inflammation and improve nutrient assimilation at the same time. Compounded plant sterols can also reduce the need for prednisone and other steroids that may be prescribed long term for this condition.
Nutraceuticals that help move lymph can also be very beneficial, and working with a functional medicine vet allows for a customized medical plan based on your dog’s specific symptoms.
Natural and traditional diuretics are also commonly used to help increase the amount of urination and reduce the amount of fluid accumulation throughout the body. Percussing or tapping the parts of your pet’s body where fluid has accumulated can also be beneficial. Occasional suctioning of the fluid may also be required.
Mild exercise, therapeutic massage and laser therapy can be very beneficial to help improve the flow of lymph through the body. If the condition is secondary to another disease that can be resolved or well-controlled, there’s a good chance the lymphangiectasia can be managed into long-term periods of remission.
Diet must always be addressed when a pet is diagnosed with lymphangiectasia. Most dietary fats are transformed into lymph, which must then travel through the intestinal lymphatic ducts, which aren’t working properly.
By limiting fat intake and supplying an abundance of lipase (the enzyme necessary to break down fat), we can reduce the amount of intestinal lymph that is formed, which reduces pressure on those malfunctioning ducts. Less lymph is leaked, and symptoms often decrease or fully resolve.
Diets for pets with lymphangiectasia should initially contain no more than 20 percent of calories from fat. I recommend feeding medium-chain triglycerides (MCTs), as these beneficial fats are diffused across the GI wall with no digestion required. The natural form of MCTs I prefer is organic, raw coconut oil, but I have also used MCT powder and oil with dogs who won’t eat coconut oil.
I also recommend a low-residue, low-fat, bland, novel protein diet during treatment, and Seacure, which can help the GI tract heal. Lower fat meats to consider include skinless chicken breasts, turkey, venison, goat, buffalo and rabbit. Lamb and pork are generally high in fat. Ground beef and other cuts of red meat vary in fat content.
I suggest avoiding commercially available low-fat pet foods, including prescription and therapeutic diets sold by veterinary clinics, as well as vegetarian and vegan formulas. Most don’t have sufficient protein or good-quality protein and are high in grain-based carbs and other non-nutritious fillers.
I also believe these diets contain processing byproducts (advanced glycation end products), preservatives and synthetic ingredients that may make it harder for the GI tract to heal and recover from this disease.
Also consider working with an integrative veterinarian to design a human-grade, GMO-free, balanced nutrition plan to meet the individual needs of a pet who requires a low-fat diet either short or long-term. You can also have a customized, homemade meal plan designed for this condition at Animal Diet Formulator.
In the majority of lymphangiectasia cases I have treated, the disease is the result of significant GI inflammation and degeneration. When the gut is finally healed, the secondary lymph issues also resolve.
Oregon Veterinary Specialty Hospital (OVSH) has been serving the Portland and Beaverton area community since 1979. Dr. Robert T. Franklin (Internal medicine) welcomes referrals from veterinarians all over the Pacific Northwest. Our goal is to help your pet regain health and live a long and happy life.
Oregon Veterinary Specialty Hospital
9339 SW Beaverton Hillsdale Hwy,
Beaverton, OR 97005.