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Forum Home > General Discussion > looked like it might be EPI

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I am so grateful I found the wealth of resources available on this website. My 3 year old German Shepherd Husky mix has had chronic vomiting, pica, skin allergies, and occasional diarrhea. He weighs 68 pounds and has not gained any weight since I adopted him 2 years ago despite trying a variety of high quality grain free foods fed at the recommended feeding guidelines for a 100 pound dog. Following a bad bout of diarrhea in Jan, started z/d and received temaril-p 3 tabs twice a day for 5 days, once a day for 5 days, and every other day for 5 days and 5 days twice a day metronidazole. rule out IBD vs EPI. Within a few weeks after stopping meds, vomiting returned and he was trialed on prednisone for 5 days twice a day, 5 days once a day, 5 days every other day. Again after a few weeks, he vomited twice in a week and was having retching. He had lost 2 pounds when we returned to the vet after a bad day of diarrhea after eating treats with grain. He acts like he is hungry all the time and like his tummy hurts often for the last 2 years. We re-started temaril-p, 5 days metronidazole, and tested him for EPI. Diarrhea resolved within a day. We started enzymes because the lab results wouldn't be back until after the weekend. Folate was 16.7 with range of 4.8 to 19. B12 was 289 with range of 284 to 836. TLIwas27.3 with a range of 5 to 35 heartworm neg. We are going to continue the enzymes for 2 weeks and start cobalamin injections. After reading the forums, I saw other dogs that initially did not test as having EPI but did eventually so I wanted to join the forum and introduce ourselves.
May 17, 2017 at 8:13 PM Flag Quote & Reply

Posts: 3728
Welcome to the forum. You say your dogs tummy hurts often. Did your vet test for pancreatitis?

   Jill-  Washington State

Mickey 6/21/99 - 8/29/2014 

17.5 lb  jack russell, chronic pancreatitis, hyperuricosuria,high blood pressure, hypothyroid, spinal stenosis

diet of  hard boiled eggs, macaroni,  RC Hepatic, mashed potato

2 #2 Dianes enzymes 6x premeal

 2.5 mg Amlodipine, .15mg soloxine am/pm, 100mg ursodiol started for gall bladder thinning

arthritis:  6.25mg tramadol 1x/day, 12.5mg gabapentin every 12 hrs,  Assisi soft loop used on back and elbow, 1- 540meq potassium citrate nightly

Denamarin once a day, 1/16 t tylan (150mg)  2x/day ,  Senilife started 12/14/13, Trixsyn sirup for arthritis, .1mg Adequan weekly by shot. 75mg Tylan 2x./day for SIBO

Optimmune for Dry eyes

 Kiya is Mickeys sister, 3/4 aussie, 1/4 blue heeler born 9/2006.  She thinks she is a 44 lb jack russell who tries to heel Mickey!!

TJ is the newest addition.  He is in the bottom picture with Kiya.  He was born 7/05/2015. 

I am not a vet, just a pet owner sharing what experiences I have had in helping my dogs with other pet owners.  If you have an emergency please call your vet.

May 17, 2017 at 10:44 PM Flag Quote & Reply

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Posts: 17180

HI Erin and welcome to you and your pup to our EPI family!   And thanks for the test results.. that is very helpful.

As of now, your pup does not have EPI according to the TLI test.  However, what you are describing sure sounds like something is going on and my first suspect would be either a food sensitivity or IBD- -but in reading your post... did your vet rule out IBD... or was it a toss up until you got the TLI test results in?

I had to look up what Temeril-p and in short it is "This steroid works in combination with the antihistamine trimeprazine, as the trimeprazine reduces the itching and the prednisolone the inflammatory effects associated with allergic reactions.'    

And if your dog is dealing with some sort of food sensitivity or IBD.. this might be why it appears to do better when on this drug.... or ......it could be that something else is going on.

Good thatyour vet is starting you pup on b12 as the B12 test results are on the low side.... the B12 shots ought to help.

Next... that Folate score.... that is only an "indication" of possible SID/SIBO.... we have seen more than our share of dogs with a Folate score in the "teens" and the vet will think "good.. no SID" but in reality the dog does have SID.  At this time there is no accurate SID/SIBO test... there are 3 ways to test for it and each technique has a flaw: 


The best way to assess SID/SIBO is by symptoms and accompanying medical ailment, in this case EPI, and treat immediately for best results. Unfortunately, Folate test results, Culturing and Counting bacterial numbers, and Duodenal juice collection all have majors flaws in their technique rendering them inaccurate confirmation of SIBO. Recent studies have determined that it is not the number of bacteria but rather “the type of flora and/or how the host and flora interact that are more important than numbers.”


Any imbalance in the intestinal bacterial flora is also likely to reduce the absorption of cobalamin (B12)."

I am wondering if your dog is actually battling SID.... and it might be what your vet already suspects because i noticed your vet prescribed Metronidazole.... however... to treat SID with Metro... they recommend that the dog be on Metronidazole for 30 days... not 5...

The rule of thumb with SID/SIBO is if the dog doesn't respond well enough within 7-10 days to the antibiotic you currently have the dog on, then swap out the antibiotic for another.  Usually with SID, the drug of choice nowadays is to try Tylan (Tylosin Tartrate powder) first for 45 days twice a day (breakfast and dinner) .... if not working, swap it out for Metronidazole (but only for 30 days/twice a day with the Metro)

And the reverse is true too... if you start with Metro and don't see a positive response within 7-10 days then ask  your vet if he would consider swapping it out for Tylan.

If your vet suspects that this is IBD.... then what he might want you to try next is hydrolyzed foods.....

Regarding this being EPI in the makng... it is possible as anything can happen.... but with a score of upper 20's, mostly unlikely at this time.  However... i do think if you can afford it... maybe re-test (TLI) in 6 months to see if the TLI score is going down, down, down... if so... then that "ups" the possibility that something is going on with the pancreas.

One thing you might want to share with your vet is that we have seen dogs here on the forum that never do have EPI nor did their TLI test results show EPI, however... they did have small proximal intestinal disease..... (symptoms are what your are describing - -but then again, those are the same signs for other diseases too)  anyway... we have seen dogs with small proximal disease do well once placed on enzymes even without having EPI.... and then not do well when the enzyems are removed.  Why this happens i have no idea... and it doesn't happen with every single small proximal intestinal disease case... but we have seen it happen multiple times....  

Please be sure to share everything we suggest to you with your vet .... and please keep us posted!



Olesia, owned by Izzy, a 35lb SWD, Diagnosed at 1.5 years old - TLI results 1.3, Stable 9+ yrs! Once stable, was able to reduce enzymes to only 1/2 tsp of Enzymes (use EnzymeDiane's 6x) with each meal, but after almost 4 years of stabilization... had to increase the amount of enzymes to 3/4 teaspoon with each meal. Fed various grain-free kibble+real meat, 6x pancreatin enzymes from EnzymeDiane., gave 1 tsp of coconut oil one day and 1 tsp salmon oil next day, and also give canned sardines packed without salt or canned herring for extra omega oils.... until she developed Diabetes and now cannot tolerate higher fat foods.

In Feb 2013, Izzy developed a very serious condition called IMHA which she (thankfully) beat and is now in remission. We also discovered that now, at 8+ years old, she not only has EPI, but also Diabetes, Low Thyroid and High Cholesterol.  Izzy was able to receive excellent care because of the kindness of so many here on epi4dogs and  is currently  doing extra-ordinarily well. If anyone could spend a day with Izzy, they would never guess that she has any health problems!  Because of Izzy's concurrent conditions of Diabetes and High Cholesterol we had to make changes to our daily EPI routine. We had to alter the fiber, type of fiber and the fat content her diet. She is now on an all home-made diet which she does best on and has even been able to reduce the insuline (Vetsulin:pork-based insulin) . Because of the diet change to all home-made i no longer worry about hypoglycemia or hyperglycemia- -she is much more even-keeled with a diet of sweet potato, a lean meat/fish, sometimes a free range egg, cottage cheese,  fish oil+vitamins and bone meal. We tried Novolin N a human synthetic RNA insulin.... but Izzy did not do well on it. aside from all of Izzy's health issues.... she continues to wake up every day full of joy and a great sense of humor!

I am not a vet.  All of my suggestions/recommendations are based on personal expereinces, observations, information gleaned from EPI research, and information shared with me by EPI researchers....that hopefully may help others. Please always share anything and everything recommended on this forum with your vet.

May 17, 2017 at 11:03 PM Flag Quote & Reply

Posts: 3
Thank you for your replies. It has been difficult having a dog that acts like he is starving and not being able to find an answer and it makes me feel much better to read the success stories on this forum of folks who found answers after long struggles. I am also very grateful to have found a vet that is willing to explore possibilities and look for answers after previously having my concerns dismissed as puppies are skinny and eat inappropriate things. He also had two sets of x-rays with no findings to check for bowel obstruction in January, as well as a chem panel with no out of range values. He has been on hills z/d (hydrolized protein) since January. Since it's been responsive to steroids, the thought was/is IBD. But since he had not had any weight gain and return of symptoms, we tested for EPI, which led me to this website (yay!). My vet is very proactive in helping find the answer and is going to check into a study at TAMU we found thanks to this website. Since his primary symptoms have been hunger,, vomiting, indiscriminate eating of grass and non-food items, poor coat, and inability to gain weight, small proximal intestine disease seems like a possibility so it is helpful to know that other dogs have been helped by enzymes. I will talk to my vet about a longer course of antiobiotics when we go in for our B12 injection. It looks like the next step for the IBD diagnosis will be endoscopy and intestinal biopsies so I had actually hoped it would be EPI. Thanks for the warm welcome.
May 18, 2017 at 6:47 AM Flag Quote & Reply

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