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Forum Home > General Discussion > recover from EPI?

Xena
Member
Posts: 28

Hi

Xena was diagnosed with EPI in July 2011 at 1 year of age TLI= 1.3. We have treated with enzymes and weight has been fine, actually a little over weight.   

Retested recently, 7 years later, and EPI = 9.3. Was fasting blood draw.

Is it even possible for a dog to recover from EPI?

Thank you for any info.


--
April 10, 2018 at 9:09 PM Flag Quote & Reply

Jill
Administrator
Posts: 3719
Hi Beth, good to hear from you. I have never heard of a pancreas regaining its ability to produce enzymes once it has atrophied. Someone else will come on and might be able to provide more information.
--

   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.





April 11, 2018 at 1:36 AM Flag Quote & Reply

Jean and Kara
Administrator
Posts: 7457
I agree with Jill, if the result originally was 12 hours fasted as this one was, then it has always been accepted that the pancreas has failed. And will not recover, Is this the same lab that tested it the first time...........?..........i think I would be tempted to consult the lab , or indeed TAMU, Clearly this result is not EPI are you going to continue as you have been with enzymes?............ what was your vets response, and just as curiosity what made you retest
April 11, 2018 at 4:33 AM Flag Quote & Reply

Epi4Dogs
Site Owner
Posts: 17178

Hi Beth,


There can be a few reasons for this, but the first thing i would like to stress is for now, continue the enzymes.

Possible Reasons:

1. the first test was not accurate due to possible mis-handling or a mix up at the lab (this is the least likely scenario)

2. the second test was not accurate due to the same reasons as above ... ( or....more likely)..... because previously the TLI test was performed with radioactive materials that were extremely accurate.  However, very recently they have revised the materials in the TLI test and no longer use the radioactive materials (they use something else probably due to new rules and regultions is my guess!) and on occasion we see an inaccurate result/however, this is rare, but it does happen.   This was explained to me last year and i am responding to you via memory, so i "think" i have the facts right.... but i will do some digging to make sure i am not giving you bad information. To date.. the TLI is still the most accurate test for EPI.  The fecal EPI tests have been and continue to be "iffy"....


IN the meantime.... if Xena reponded well to the enzymes and you are not seeing loose stools fromt he enzymes now, then i would continue using the enzymes until we know more.


To-date, once the acinar cells atrophy, there is no way yet that we know of to bring them back.  I am so hoping the current research sheds more light on some of these questions :)


--

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.

April 11, 2018 at 10:47 AM Flag Quote & Reply

Epi4Dogs
Site Owner
Posts: 17178

Hi Beth.....  i still have not found my files to confirm what i mentioned above... BUT.... i do have a piece from the researchers that also "might" explain to some degree what might hav happened... or not:


6/29/2017


A cTLI test value less than 2.5ug/L is the current “gold standard” for a diagnosis of EPI. However, there is an “equivocal” range between 2.6 and 5.6 ug/L in which the ability of the test to confirm or rule out EPI is less certain. While dogs with cTLI values in this “equivocal” range do not meet the criteria for a diagnosis of EPI, some (especially at the low end of the range) may still benefit from pancreatic enzyme supplementation. There are at least three potential explanations for this observation.


· First, it is possible for the cTLI value of a dog with EPI to be above the diagnostic cut-off value of 2.5 ug/L at any single sampling time based on natural fluctuations in the patient (if tested on repeated days the cTLI will not be exactly the same). Normally this makes no difference to interpretation of the result, since for example if a patient’s results vary between 1 and 2 ug/L they are still low and consistent with EPI. Similarly, normal results will always be normal.


· A second cause of variation is the inherent limits of precision of the cTLI test itself (or any similar laboratory test) - if you test the same sample repeatedly on the same day or different days you will not get exactly the same result. Again, this unavoidable variation usually is of no clinical significance – the results always indicate EPI (or normal). However, when the result is at the upper level of the diagnostically low range or the lower end of the equivocal range, there is inherent uncertainty. This means that a dog with a cTLI value of 3.2 may not be that different from one with a cTLI of 2.4 and may still have a severe enough deficiency in pancreatic enzyme production to warrant enzyme supplementation. Veterinarians often consult with us regarding management of these patients, and we make individualized recommendations based upon all the clinical information available.


· Third, it is also possible that some dogs with a cTLI at the lower end of the 2.6-5.6 ug/L range may respond to pancreatic enzyme supplementation due to individual variability in the production of digestive enzymes from other parts of the body. For example, normal dogs digest about 20% of the fat in their food using a gastric lipase made in the stomach). This is quite a different enzyme than the pancreatic lipase made by the pancreas, that digests most of the food in the diet, and that is deficient in dogs with EPI. However, some dogs produce far more gastric lipase, and some far less, than the average. If a dog with normally low production of lipase from the stomach develops a more mild degree of exocrine pancreatic damage than a typical dog with EPI, they may benefit from pancreatic enzyme supplementation because they are very dependent on pancreatic digestive enzymes and have much more limited ability to compensate with gastric lipase.


If your dog’s health has improved with the addition of pancreatic enzymes, it may be prudent to continue this therapy.

 

If your dog has persistent clinical signs of gastrointestinal disease (weight loss, changes in appetite, vomiting, soft stool/diarrhea), despite enzyme supplementation, we recommend that you discuss other diagnostic and treatment options with your primary care veterinarian, as EPI may not be the primary, or only, cause of your pet’s illness.


In the overwhelming majority of cases results of serum cTLI testing are absolutely clear-cut and interpretation is unequivocal. Very few tests in medicine give such “black and white” results. Nonetheless, after decades of experience interpreting serum cTLI test results, there are certainly rare individual patients whose cTLI values are unexpected and perhaps even seemingly inexplicable, especially on repeat testing. Simplified interpretation algorithms cannot cover all these eventualities, but after consultation with a specialist and discussions with the owner, veterinarians can usually come up with a logical plan to help manage the patient’s clinical problems most effectively.


Patrick Barko, DVM


David Williams, MA VetMB PhD DACVIM ECVIM-CA


--

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.

April 11, 2018 at 11:08 AM Flag Quote & Reply

Xena
Member
Posts: 28

Jean and Kara at April 11, 2018 at 4:33 AM

I agree with Jill, if the result originally was 12 hours fasted as this one was, then it has always been accepted that the pancreas has failed. And will not recover, Is this the same lab that tested it the first time...........?..........i think I would be tempted to consult the lab , or indeed TAMU, Clearly this result is not EPI are you going to continue as you have been with enzymes?............ what was your vets response, and just as curiosity what made you retest

Hi

thank you for the response. yes continuing with enzymes, vet is looking into it...we retested to check her b12 and folate and its all in the same in the TLI test. Vet was just as confused as we were.

April 11, 2018 at 8:45 PM Flag Quote & Reply

Xena
Member
Posts: 28

Epi4Dogs at April 11, 2018 at 10:47 AM

Hi Beth,


There can be a few reasons for this, but the first thing i would like to stress is for now, continue the enzymes.

Possible Reasons:

1. the first test was not accurate due to possible mis-handling or a mix up at the lab (this is the least likely scenario)

2. the second test was not accurate due to the same reasons as above ... ( or....more likely)..... because previously the TLI test was performed with radioactive materials that were extremely accurate.  However, very recently they have revised the materials in the TLI test and no longer use the radioactive materials (they use something else probably due to new rules and regultions is my guess!) and on occasion we see an inaccurate result/however, this is rare, but it does happen.   This was explained to me last year and i am responding to you via memory, so i "think" i have the facts right.... but i will do some digging to make sure i am not giving you bad information. To date.. the TLI is still the most accurate test for EPI.  The fecal EPI tests have been and continue to be "iffy"....


IN the meantime.... if Xena reponded well to the enzymes and you are not seeing loose stools fromt he enzymes now, then i would continue using the enzymes until we know more.


To-date, once the acinar cells atrophy, there is no way yet that we know of to bring them back.  I am so hoping the current research sheds more light on some of these questions :)


Thank you, this is helpful. definitely no plans to take off enzymes. :)


April 11, 2018 at 8:58 PM Flag Quote & Reply

Terry Bin
Member
Posts: 2059

Is there any update from her vet?  One thought (though an expense) would be to retest in another 6 months and see what is going on.  How was the B12 when you did the test?

--

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.

April 15, 2018 at 1:11 PM Flag Quote & Reply

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