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MillyGrams
Member
Posts: 6

Hi!

I dont know if my dog has EPI - but I am trying to find asnwers!

I have a 10 Year old female (spayed) Golden Retriever. She has generally been healthy, but had 2 TPLO's in 2016. She had some occasionall stomach upsets, but more serious GI issues began 10/17. She has been to an internal medicine specialist at Angell Memorial in Boston (I dont love him, if anyone in the area has another suggestion, please let me know). We've had a lot of issues over the holiday and I am getting desperate for answers.

 

Seen at Angell memorial by Internal Medicine MD (Crouse) following GI upset initially thought to be obstruction or mass -involving grass eating, loud stomach noises, flatulence, reverse sneezing, and coughing. She vomited up a large tube of grass, which proved to be the "mass" in original x-ray.

 

After appointment, dog developed diarrhea

Ultrasound/GI panel etc. performed

Diagnosis was IBD - Tylan powder and probiotic prescribed (already on rx diet- Royal Canin hypoallergenic Rabbit and Potato)

Diarrhea resolved - stomach noises are somewhat better - still a bit gassy - Vet suggests OTC Prilosec

 

12/17- dog vomits at 5pm, and proceeds to vomit yellow bile nearly every hour for 24 hours - including at vet/ER (goes to ER - suspected pancreatitis). Labs are good. Remains at ER

12/19- Regurgitating (though only a few times per day - not interested in food), so abdominal ultrasound performed. Pancreas normal - pancratitis ruled out. Only slight thickening of stomach wall seen - however, thought to be inflamation due to vomiting (lymphoma darker on ultrasound in radiologists opinion/experience). Diagnosis is Gastritis - they think she ate something.

Dog stays at ER and on fluids

12/20 - Comes home from ER in PM after eating several meals and keeping them down. Has mucousy diarrhea.

Eating boiled chicken/rice/chicken bone broth - still has loose stools

12/25 - Switch rice to kibble as she is not digesting rice (can clearly see rice in stools)

12/26 - Regurgitates dinner 1.5+ hours after eating

12/27 - Acts a bit strange after long walk/dinner- regurgitates dinner 1.5 hours after eating.


We will likely go for an endoscopy when I get home from Christmas, though I was trying to avoid putting her under general anesthesia. She has had multiple ultrasounds, all sorts of labs run- and all the Texas GI panel showed was likely bacteria in her gut and I believe low folate levels.

She seems to be keeping her breakfast down - so any ideas on dinner?

Any ideas/questions/suggestions to ask the vet would be very much appreciated. 

And also, if anyone has a suggestion for an excellent internal medicine doctor (the one we have now has terrible bedside manner and doesn't make me feel like he's invested in resolving this).

Thanks

 

 

 


December 27, 2017 at 10:08 PM Flag Quote & Reply

Terry Bin
Member
Posts: 2059

Sorry to read you are all going through this.  Can you post the results from the Texas GI panel?  If you have them would like the results of the cTLI (EPI test), cobalamin (B12) and folate.  Some dogs are not EPI but are headed that way...so low normal cTLI might indicate you are going that way.  You could try enzymes with meals for a few days to see if that makes a difference (sometimes it does).  Take a look at the kibble and see if grain-free as that might be best right now.  

If giving both Tylan and a probiotic make sure they are taken hours apart or the probiotic counters the antibiotic.  Have you started the Prilosec?  Many EPI dogs do better in the beginning with smaller meals eaten more frequently so you may want to try that.  If your schedule doesn't allow much more than 2 meals you might want to try a small meal (cup or so) before bedtime.

--

Terry

Mom of three EPI Shiloh Shepherds: 

Pharaoh born Nov. 2007 and dx with epi December 2009.   Pharaoh weighed 62.4 lbs. (15 lb. weight loss) when diagnosed in 12/2009.

Weight 10/31/11 was 76.6; 85lbs on 9/22/12; 85.5 lbs. on 11/13/14.

Received six weeks of B12 shots Jan-Feb 2010 but his B12 on 8/10/2010 was only 232. So started weekly shots at home, which we continue to give. 

His older half sister is Taiko born Sept. 2006  and was dx with epi June 2010.  Since she has severe bilateral hip dysplasia she had always been on the thin side.  Taiko's weight was 70.7 lbs. in June 2010 (time of diagnosis; about a 10 lb. weight loss).

Weight on 10/31/11 was 80.4 and on 9/22/12 was 82.4 lbs.  Weight 11/13/14 was 83 lbs.  B12 was 211 in June 2010 so started six weeks of shots and was only 293 on 8/10/10.  She receives B12 shots weekly at home.  B12 in September 2014 was over 1,000.

Both are fed twice a day and we use Merrick BG brand: 1 1/2  cups kibble in the morning with 1/2 can dog food with 4 crushed tablets and in the evening 1 1/2 cups to 2 cups kibble with 1/2 can dog food  with 4 crushed tablets. 

Moku was born 4/15/14 does not have epi.  His grandfather is Taiko's and Pharaoh's father (through his mother).  On 11/05/14 his weight was 78 lbs, on 12/11/14 he was 85.7 and on his first birthday 15 April 2015: 90.2 lbs.

December 27, 2017 at 10:16 PM Flag Quote & Reply

MillyGrams
Member
Posts: 6

Thank you - 

I dont have the panel results but I will get them tomorrow and post. 

She has been getting Probiotic and Tylan powder at the same time (they said it didn't matter when I gave them) - so I will try separating them. 

She was getting human prilosec (OTC from CVS) before breakfast until she went to the ER last week. They've given me the same drug in a slightly different form- capsules instead of tablets - but she's having that every 12 hours.

She also just finished Sucralfate every 8 hours for 7 days (last dose tonight), which should make feeding her multiple meals easier - she wasn't allowed to eat or have other medications 1 hour before or after a dose of that - which got complicated. 

https://www.chewy.com/royal-canin-veterinary-diet-selected/dp/35129?utm_source=google-product&utm_medium=cpc&utm_campaign=f&utm_content=Royal%20Canin%20Veterinary%20Diet&utm_term=&gclid=EAIaIQobChMIkLahj-Wr2AIVkISzCh31HwVSEAQYASABEgLF8PD_BwE&gclsrc=aw.ds" target="_blank" rel="nofollow">Her regular food is this, which I believe is grain free (she eats the wet and dry normally, though just dry right now). She's been eating this for at least 4 years, though we used to get Venison and Potato, but that is hard to come by now for some reason. She hasn't really had any weight change in the last couple of years- maybe a few pounds up and down. 

Any suggestions on which enzymes? There seem to be a lot of different choices. Is there any risk of them causing complications with the other drugs she's on? 

Thanks again

December 27, 2017 at 10:55 PM Flag Quote & Reply

MillyGrams
Member
Posts: 6

Has anyone tried CBD? 

December 27, 2017 at 11:18 PM Flag Quote & Reply

Paige's Guardian
Member
Posts: 101

Sorry your pup is not doing well.  Is it clearly regurgitation that you are noticing?  I ask bc that is different from vomiting.  Regurg is completely unexpected. Like a quick burp and her food or water just comes up.  If regurg, has she had chest x-ray and if so, have the ruled out megaesophagus.  Regurg can be a problem with that diagnosis.  So, assume it's NOT ME but highly recommend continuing with prilosec to protect her esophagus.  Maybe ask for another round of sucralfate to protect esophagus until she stops with vomiting/regurg/reflux cycle. I have an 10 yo Great Dane with ME and wished someone had told us to be more aggressive protecting her esophagus a year ago when she had reflux which was probably from food allergy and/or SID. 

My other Great Dane (6yo) has LOW folate and soft mushy stools.  She was dx'd with malabsorption at 9 months of age and does well on enzymes so, your pup may have improved stools with enzymes and we also gave her a folate supplement a few times/week.  She has never needed Tylan.  With malabsorption, she did not have vomiting or regurg/reflux.  So, for your pup Tylan should help with bacterial overgrowth.

You asked about suggestions other than rice since your pup does not digest it.  Anytime my pups have digestive upset, we use boiled chicken and quick cooking oatmeal.  They digest it very well and they love it.  It also adds a little fiber.  Our vets were ok with that change and actually liked it. 

Hope that helps.  Sorry to hear your pup is not feeling well.  Will be interesting to hear other comments/opinions.

December 28, 2017 at 8:47 AM Flag Quote & Reply

Paige's Guardian
Member
Posts: 101

Oh, CBD oil.....I have small lab (7yo) with horrible hips.  She gets CBD oil 2x/day.  Cosequin, and 2 large fish oil tabs were not working anymore.  So far, the CBD oils seems to have helped.  I have not seen any digestive upsets but this lab eats everything and has a cast iron stomach. 

December 28, 2017 at 8:49 AM Flag Quote & Reply

MillyGrams
Member
Posts: 6

Ok labs- this was done fasting. 

Combaiamin and Folate: 

b12 372 pg/mL (reference range 249-733)

Folate 21.1 ng/mL (reference range 6.5-11.5- High- Differentials for an elevated folate concentration include small intestinal bacterial overgrowth, vitamin supplementation, or an artifact due to sample hemolysis. 

Trypsin Like Immunoreactivitiy

Trypsinogen/TLI 28.2 ug/L (Reference range 5-35) 


I am having trouble with vomiting vs regurgitiating  - from your description she is vomiting. She puts her head down, dry heaves 3-4 times, and then expels whatever it is. It is undigested or just bile. 

I spoke with my vet and we are eliminating kibble since the latest vomiting started with that. I gave her some wet food and rice with some homemade bone broth this morning (less than a cup total), along with tylan powder. She kept that down and had a fairly normal BM. At midday I gave her a similar sized meal with her probiotic and she has kept that down also. My vet suggested i give her another small dose of Tylan in the evening (so just under 1/4 tsp 2x a day instead of 1/4 tsp 1x a day). I am still hoping for a longer term resolution and really appreciate this resource. 

Paige- where do you get CBD oil and what kind are you using? 

 

December 28, 2017 at 4:06 PM Flag Quote & Reply

Terry Bin
Member
Posts: 2059

Thanks for the update.  You may want to try some B12 supplementation....372 is on the low end...and even though not EPI at this point she may benefit with some B12....either shots or the pills with intrinsic factor.  EPI dogs should optimally be over 600 and we have found some pups who are having other intestinal problems do better with higher levels of B12....if they don't need it they just pee it out.

--

Terry

Mom of three EPI Shiloh Shepherds: 

Pharaoh born Nov. 2007 and dx with epi December 2009.   Pharaoh weighed 62.4 lbs. (15 lb. weight loss) when diagnosed in 12/2009.

Weight 10/31/11 was 76.6; 85lbs on 9/22/12; 85.5 lbs. on 11/13/14.

Received six weeks of B12 shots Jan-Feb 2010 but his B12 on 8/10/2010 was only 232. So started weekly shots at home, which we continue to give. 

His older half sister is Taiko born Sept. 2006  and was dx with epi June 2010.  Since she has severe bilateral hip dysplasia she had always been on the thin side.  Taiko's weight was 70.7 lbs. in June 2010 (time of diagnosis; about a 10 lb. weight loss).

Weight on 10/31/11 was 80.4 and on 9/22/12 was 82.4 lbs.  Weight 11/13/14 was 83 lbs.  B12 was 211 in June 2010 so started six weeks of shots and was only 293 on 8/10/10.  She receives B12 shots weekly at home.  B12 in September 2014 was over 1,000.

Both are fed twice a day and we use Merrick BG brand: 1 1/2  cups kibble in the morning with 1/2 can dog food with 4 crushed tablets and in the evening 1 1/2 cups to 2 cups kibble with 1/2 can dog food  with 4 crushed tablets. 

Moku was born 4/15/14 does not have epi.  His grandfather is Taiko's and Pharaoh's father (through his mother).  On 11/05/14 his weight was 78 lbs, on 12/11/14 he was 85.7 and on his first birthday 15 April 2015: 90.2 lbs.

December 28, 2017 at 10:33 PM Flag Quote & Reply

MillyGrams
Member
Posts: 6

Thanks!

She is due to go to the vet next week for her annual check-up and I will try requesting B12 injections (I gave her allergy injections weekly for awhile and they seem to be similar). We did B12 oral supplements for the few weeks between the labs and the ultrasound, but I was told to discontinue once the GI panel came in. 

We also discussed changing her diet from Royal Canin Hypoallergenic to a different Rx diet. She did seem to do better with the venison and potato version than she is on the rabbit and potato version. 

December 28, 2017 at 11:01 PM Flag Quote & Reply

Paige's Guardian
Member
Posts: 101

My old Dane with SID also had low B12 and is on omeprazole.  Also, on Tylan 2x/day.  As others chime in, I am pretty sure Tylan should be 2x/day.  My old Danes' IM vet specialist said to always supplement low B12. 

For my healthy little lab with poor hips, I use Innova Pet's CBD oil.  For your pup, I would wait until everything had settled down to start CBD oil because if you get stomach/bowel upset you won't be able to tell what is or is not working. 

December 29, 2017 at 7:18 AM Flag Quote & Reply

Epi4Dogs
Site Owner
Posts: 17178

My vet said the same about b12..... told me that any dog over 5 years old would do well to get a maintenance dose of B12, even if they never had a problem with B12.  Since then my dogs  (going on 11, 13 & 15) all get oral B12 3 days a week :)

--

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.

December 29, 2017 at 6:51 PM Flag Quote & Reply

MillyGrams
Member
Posts: 6

Update: 

She had her annual visit last week and has lost about 3 lbs in the past month - not surprising since she mostly was eating small meals of chicken and rice, and spent 3 days in the ER.

We also ran a full senior panel, which was normal, and another GI panel. Her folate is now normal, but her B12 is still low -in the 360's -  so we are going to start B12 supplements. 

Her vet said that since her folate is normal but B12 is low - her small intestines aren't absorbing nutrients normally- and the causes could be IBD or something like cancer.

I have to decide whether I want her to have an endoscopy to try and get a more definite diagnosis. 

I'm going to try the B12 for a week before I decide, and also am going to try an aloe detox that a friend who has a rescue has had a lot of success with for dogs with IBD. 

The possibility of cancer also has me wanting to know more about CBD - and what kind to get? There seem to be a lot of choices.  

January 10, 2018 at 6:35 PM Flag Quote & Reply

Donna
Member
Posts: 959

Starting B12 supplementation is a very good idea until you decide your next step.

Donna

January 10, 2018 at 6:48 PM Flag Quote & Reply

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