EPI * Exocrine Pancreatic Insufficiency

Hi Sarah, Olesia and Debra,

Thank you all for the info on Slippery Elm, which I managed to get in capsule form, yesterday, late morning.

Here’s the update on Angel-girl. Following the cow-pats yesterday morning (Friday 5 Nov) I fed her a small amount of food, with a plan to feed her small meals 4 x during the day at 3 hourly intervals. Her poop after the first meal was slightly better – grade 2 small sizes - having a little formation but they were yellow.

On the second feed, I sprinkled one capsule of slipper elm on her partially incubated, food. This was around lunch time.

At 1.15 Angel passed a few small stools – grade 2 small sizes - that were light brown.

Hubby fed Angel’s late afternoon meal but he failed to include the slipper elm, which left me to sprinkle it at the last minute and hope for the best. Angel didn’t pass any more stools at this time.

Her last meal was at 7.30 with fully incubated slippery elm.

At 9.42 pm, Angel passed a few stools - grade 5 in firmness, small & medium sizes, but dark mustard and smelly.

Shortly after, yellow splats ensued. This continued for a while and then eased up.

At 4 am this morning, Steatorrhoea in full glory over the kitchen floor.

I took her to our veterinary practice today around noon, but knew my vet was away for the week. A very young vet was on duty. He was a very nice chap but didn’t know anything about EPI. The short of it is, I had to lead the way and request:

• Blood extraction for TLI/B12/Folate and full biochemistry. Done.

• Antibiotics – he started to give me 5 days supply of oxytetracycline …. I was calmly assertive when I said: "Sorry, I am not taking those – Metro is the prescribed protocol and, beside, oxy is injurious to the liver and kidneys and Angel has partial moderate liver fibrosis. And please can I have 30 days, as in keeping with EPI/SIBO protocol?” The poor young vet looked slightly embarrassed. He went away and re-conferred with a senior colleague who thought 5 days was enough to treat diarrhoea caused by the toast Angel ate. Things became a little awkward for the young chap as I maintained the 30 day antibiotic course in the belief we should now treat this as SIBO. We compromised on his suggestion of giving me 10 days, taking Angel to the time when our epi vet was back on duty.

• Vitamin B12 injection. Done – Angel completed her course of two weekly B12 shots three weeks ago on 21 Oct 09. The vet and I agreed at the time of Angel’s last  two weekly injections that we would do her second TLI/B12/Folate and full biochemistry in 4 to 6 weeks time, calculating enough time for her system to get used to the change of food and enzymes so that all things were in place for a final assessment.

Up to the point of angel snatching a piece of toast, her poops were consistently grade 5 and mid-brown in colour, but she began passing too many stools over the last week. I couldn’t make this out because her new food contains slightly less fibre than her previous and she was producing good stools, no tummy rumbles and was bright as a button. However, I talked to the vet about the amount of stools she was passing. We concluded between us that it was most likely due to the two recent changes Angel had incurred on top of each other – the change of food and enzymes. On reflection, I suspect this is SIBO and that it has been building over a period of time. I immediately took action with apple cider vinegar when Angel was on porcine enzymes and had loud tummy rumbling with slight flatulence. It all settled down when I immediately reverted back to my former plant-based enzymes and the 12 day cider vinegar course. But it would seem it didn’t. Also, I feel part of this is due to my having become over confident with allowing Angel the occasional, untreated starch rice bone to help clean her teeth and supper biscuits, although I ceased the latter food item at the onset of starting the new veggie dog food and enzymes. About three weeks ago, I gave her a narl bone – inedible but good for cleaning teeth. Hmmmm, this morning I noticed that one end of the narl bone had been completely chewed.

Angel is showing no signs of illness, for which I am thankful. Funnily enough, before taking myself to bed last night, I laid one side of my face on Angel’s tummy to listen for any rumbling, but it was as quiet as a mouse. Nonetheless, I gave her Reiki healing ….. They say that things get worse before they get better …. Well …. I would say this holds true ….. Angel-girl certainly opened up the flood gate at 4.15!!! Although this would have happened either way!  BTW: Angel has lost 1 kg. I am not overly worried as most of this will be fluid loss.

I am deeply thankful for this forum, for without it I am sure I would not have kept a detailed log and I wouldn’t have been so well armed when faced with this issue and an inexperienced young vet. I am actually pleased with myself for avoiding panic mode. I know Angel will be ok – it’s just one of those things where one intuitively knows.

My ending note is to say the moral of this tale is not to give even the occasional treat without enzymes and not until your fur-babe has been stable for a long period of time. Diane of “enzymesdiane” is absolutely right!

I am a bad mummy and deserve to take the “Plonker of the Year Award”!

Warmest best wishes,

Julie & Angel-girl

HI Julie~

Wll, I must bow in awe...you are very calm and that is a great accomplishment in keeping company with an EPI dog!  It is SO easy to freak out!

To me it sounds like one of a couple of things.....my number

#1 thought is SIBO (same as what you suspect),

#2 thought is the result of cheating... with the rice bone

#3 if not one of the above culprits.... it might be that her B12 deficiency is starting to gain momentum again

#4 my last but distant thought is maybe TZ enzymes are not working as well as expected.... but since you have had luck in the past with this, this is at the bottom of my list

So sorry you had to cleanup that yellow muck this morning...yuck... been there done that....so frustrating... but then your heart goes out to the dog for having to go through this.......

Is the Narl bone the same thing as a Nyla bone?  My dogs love that.... but then i too am concerned when i see some of it "missing"

Sounds like Slippery Elm is doing it's job....Please let us know how she continues to do.

Hi Olesia,

Thank you for the great compliment ...... I guess it's a sign of my acceptance of the condition and having gone through with Angel, her health issues back in August and incurring a wee bleep when I allowed her a tiny, tiny piece of mashed potatoe from my finger and seeing the result, I feel somewhat acclimatised to these problems. Experiences from other members have also helped. It was one of those days yesterday where nothing would go right!

Your numbers are in accordance to mine, although I haven't at this point placed T.Z on the list. I also thought about her B12 level dropping, hence asking for a precautionary injection today.

The amazing thing with T.Z is that the enzymes have procurred consistently better stools than previously - I'm glad I got hubby to take regular poop pics which I intend on posting  when I have a proper evaluation, including blood test results. This episode hasn't deterred me from continuing T.Z, as I am inclined to go with your 1 to 3 numbered items. There is one other, perhaps serious, aspect I fail to take into consideration - Angel's partial moderate liver fibrosis. This must have some bearing on her metabolism.

Ah, yes .... it is the Nyla bone - thanks for the nudge/question. This very well could be one part of the issue in hand.  I was getting worried about her teeth, although they look fine, but for how long with nothing to help reduce tartar build-up and such like? Your darling Izzy does seem to cope very well with the extra's you give her. My lesson is that I have harmed Angel in falsely thinking she could cope now, given she was doing So well. It might be that she can never have anything other than her main food - her liver might be the component that determines this. Poor love, she has paid with an upset stomach and I have paid with guilt. She is ok, tho' - still bright and happy and at the moment her stomach is feeling easier.

I feel very guilty as I had no idea about the 4 am mess Angel made, bless her ...... Hubby got up and dealt with it :unsure:!!!!

Warmest best wishes,

Julie & Angel

Ps. There is another reason why I haven't placed the enzymes on the suspect list is that Angel has been on them for three weeks now and as said, with good results, and because this type of thing happens with epi dogs on porcine enzymes.

Warmest best wishes,

Julie & Angel

Hi Angel.  This is just my thoughts.  I would add the TZ onto the list as if it is not digesting all of the food, even though you have good stools, some may be sitting there waiting for the bacteria and hence in the past week of more stools, "Up to the point of angel snatching a piece of toast, her poops were consistently grade 5 and mid-brown in colour, but she began passing too many stools over the last week. I couldn’t make this out because her new food contains slightly less fibre than her previous and she was producing good stools, no tummy rumbles and was bright as a button."  This could have been ongoing and it is now catching up.  You probably wouldn't see the results immediately, as it is digesting some, but as it builds up, it starts to show.  Not all dogs have probs w/ the porcine enzymes.  In fact, most don't.  More often than not, the tummy rumbling is from SIBO, which could be an ongoing thing due to how long this went w/o dx.  It seems like the sooner epi is caught, the easier it is to control.  Those of us that took a long time to dx, then treat all the symptoms, have a harder time than those that had a quicker dx/treatment of all things that go w/ it.  Hondo is on porcine, and I can lay on his belly and not hear rumbling.  I would keep it in the back of your mind, even way back, but don't rule it out.  There are so many who can only have good results w/ the porcine for that reason, the plant based are not strong enough, even if it does firm up the poops.  Think how long these guys are sick before we notice it.  It took time for the symptoms to show thru.  Same w/ the digestion.  It can be there undigested and we won't know until it "explodes" and all of a sudden we know there is a prob.  That is usually what keeps sibo going, all the undigested foods that the bacteria like.

On another note, sorry you are going thru this.  Sending cyber hugs to you and Angel and hope all the tests come back good.  Hope she is on the mend soon,.

Oh Julie, it's Sunday morning here, & I'm reading all this 'news' about Angel.  I don't really have anything extra to add, except to please know you are both in our thoughts.  Lots & lots of 'feel better' vibes & cyber hugs being sent over to your beautiful Angel. 

Hi Julie,

I sure hope this little 'glitch' ends itself soon... Get well soon Angel!

Donna

Thank you all for your lovely well wishes - I love the card Lynn ..... it's SO cute!!!

Karen ~ I do see your reasoning, it's just that Angel, on diagnosis, received 28 days of metro and synulox for a heavy e.coli infection. All became well when we got under-way with additional epi treatment, I emphasis that the loud tummy rumblings happened whilst she was on porcine enzymes. This episode might be from that time, despite my effort to stop anything nasty developing, or it might be the e.coli hadn’t cleared up. Angel didn’t have any tummy rumbling with this episode and she hasn't passed any waste since 10.40 am today, given that she has had three meals, slightly less in quantity, with the use of T.Z enzymes, but then she has obviously had a good clear out.

Nb. I meant to say in my previous post that Angel’s mess got worse after using slippery elm. She only had one meal where it was fully incubated with her food. Incubation might or might not have made the difference, or she might be allergic to it. She passed a stool of grade 5 in form, so her condition was improving and then it took a turn for the worse from the evening on.

If she goes through the night without messing in the house and poops are normal tomorrow then I feel SIBO can be ruled out. As I mentioned, her compromised liver could have some bearing on her metabolism and reason of passing too many stools at this moment in time - it might only just have caught up with the recent changes and now trying to acclimatise ..... synchronise its rhythm with her digestive system. Or another aspect could be the change of food, although slightly lower in fibre than her previous food, it contains 2% more oil.

I might not be using enough enzymes and three days ago I added half a boiled egg to her food and didn't make allowance for extra enzymes. So there are quite a few aspects to consider, for which are coming to the fore for chucking in the pot, which means I now have a thick 'soup to sort through.

T.Z are unlike normal plant-based enzymes - the proclaimed literature on it offers more than any other plant-based enzymes - and there are three epi dogs doing well on them, so they have proven themselves to work.

I have no reason to doubt your claim based on fact that epi dogs do well on porcine enzymes. I only beg to differ slightly, which I hope the following will illuminate. Some epi dogs do have trouble with porcine enzymes and naturally some, no doubt, would not do well on T.Z. We have no ratio of numbers on this due to the leading standard porcine epi treatment, On the reverse, when an epi dog on porcine enzymes has a bout of SIBO, is consideration given to porcine enzymes possibly causing a ph imbalance in the gut microflora? As we know, ph imbalance creates the perfect breeding ground for opportunistic, natural bad bacteria to thrive. Is this the reason why some epi dogs have to remain on antibiotics and/or pro/prebiotics?

For some dogs, It does seem that porcine enzymes are not without their problems, in one way or another. Some dogs adapt instantly and have no future problems, but, in reiteration, what about those dogs who have SIBO on initial diagnoses, receive 30 day anti therapy, are on porcine enzymes but later suffering intermittent bouts of SIBO? Is it possibly due to three main aspects:

• ph imbalance 
• cheated with treats, like in Angel's recent situation
• brand/strength of porcine enzymes

Naturally, there are no clear answers but I do bring these questions into the equation, because both types of enzymes - plant or animal-based - are pseudo enzymes that some systems will reject by degree and the manifestations will be variable. All we can do is make adjustments and compensate where we can.

I can only speculate on Angel’s episode but I should have a better picture when her blood results come in, although they won’t be dispatched until Monday – Friday isn’t the ideal day to have blood drawn!

Again, thank you So much for your well wishes. Angel is doing fine thus far …… the thing she wasn’t happy about was missing her breakfast, as I wouldn’t feed her,  but I did squeeze three feeds in from 2pm onwards!

Warmest best wishes and a big hug to gorgeous, handsome Hondo

Julie & Angel

Julie,

in reiteration, what about those dogs who have SIBO on initial diagnoses, receive 30 day anti therapy, are on porcine enzymes but later suffering intermittent bouts of SIBO? Is it possibly due to three main aspects:

•ph imbalance

•cheated with treats, like in Angel's recent situation

•brand/strength of porcine enzymes

I think there might be another reason, the SIBO was never cleared up in the first place. Teddy has had it continously since I've had him and the only time when he had tummy rumbles is when I first got him. The last time I had him on Tylan I kept him on it 8 weeks. I think that was when we finally cleared it up. He hasn't been on it since Sept 13th which is by far the longest he has gone. We could never make it even 2 weeks before. As I mentioned before Teddy was on the Total Zymes in the shelter and I used them when we first came home. He was going a minimum of 10 times a day and always cow patties. They certainly did not work for him. Put him on the porcine base and the weight gain was immediate, a very noticable change in his coat and he was no longer frantic. I hope they do work for Angel as it would be wonderful to have another alternative but quite frankly saying it works on three EPI dogs doesn't impress me. A much larger study would need to be done to convince me it could be used as an alternative. I hope they are succesful for Angel

I really don't understand where the enzymes would change the ph balance.  We are only giving them what a non epi dog would make normally, we are just having to give it in another form since they cannot make their own.  Like a diabetic gets insulin as they cannot produce it, which is the endocrine part of the same organ, we just have a prob w/ the exocrine part.  Also, on these three where they are doing good on plant based, I'd be interested in knowing what the initial tli score was and about 6 months- 1 year later, what the scores were.  Are they true epi, or one of those that initially tested for it and then after a bit, the pancreas started working again.  And honestly, I am not trying to argue.  I, like so many others, would like to know there is an alternative that works, as the porcine seems to be what works for the majority.

Anyways, I hope Angel is feeling better this morning.  Hugs to Angel and her mom.  I do hope there were no surprises waiting for you this morning.

Hi Julie....so glad to hear that Angel "appears" to be doing a wee bit better ...so sorry that she had this flare-up. Please do keep us posted on how she continues to fare.

It is highly unlikely that porcine pancreatic replacement enzymes causes enough of a PH imbalance and is responsible in any way for SIBO for a few reasons.

(1) The SIBO that 50-70% of the time (along with B12 deficiency) does accompany EPI happens prior to proper EPI treatment with proper enzymes and diet manipulation. (as both Karen and Kathy mentioned). THe longer EPI + SIBO goes untested and properly treated, the more difficult it becomes to get the SIBO under control..... sometimes never. SIBO does not re-occur in dogs because a marked PH imbalance is caused by treatment with porcine enzymes.

(2) EPI has been treated for well over 30 years with porcine based pancreatic replacment enzymes with case after case of 1000's of dogs treated with success... without any issues  ....over these many years, many other options have been tried, to no avail. Plant enzymes have not been successful long -term. My hope is that the current much improved plant enzymes can indeed work, even if not as optimal as porcine, for the very fact that there are some dogs that have pork allergies and those poor EPI dogs are now given pretty much a death sentence without any effective treatment in sight, so I am keeping my fingers crossed and am so appreciative of your attempt to use these plant enzymes and am very respectful of  the extremely careful monitoring that you are doing.

Although enzymes can alter the PH in a dog's digestive system, it is a minor degree .... not enough, nor has it been proven to cause SIBO. As a matter of fact, improper enzyme treatment or no enzyme treatment actually promotes SIBO by allowing bacteria to proliferate. We need to look elsewhere for causes of continuing SIBO...the majority of consensus is a host of many other factors, not porcine based pancreatic replacement enzymes.

"The species of bacteria in duodenal juice of dogs with SIBO varies markedly, with coliforms, staphylococci, enterococci, and Clostridium and Bacteroidesspp predominating. Anaerobic overgrowth is most common, found in approximately 70% of dogs with SIBO. This is of clinical significance,since anaerobic bacteria have a much greater potential to damage the intestinal brush border and cause malabsorption; in addition, anaerobes,especially Bacteroides, are the major cause of bile salt deconjugation resulting in fat malabsorption and steatorrhoea."

An attempt should be made to identify and correct anunderlying cause, such as partial obstruction due to intussusception,tumours or foreign bodies. Detection of dysmotility is more difficultand often not feasible; however, motility modifying agents such ascisapride or low-dose erythromycin may empirically be used in refractory patients. In many dogs with SIBO a cause cannot be found,and long-term oral antibiotic treatment is required. Oxytetracycline(10-20 mg/kg TID for 28 days) is used initially, and may need to be continued for extended periods if clinical signs recur on withdrawal of medication. Its mechanism of action may involve more than just pure antibacterial action (e.g., direct influence on the mucosa), althoughthis is not certain. Metronidazole (10-20 mg/kg TID) and tylosin (20mg/kg BID) are good alternative choices and are used if dogs fail to respond to oxytetracycline. Broad-spectrum bactericidal antibioticstend to be less effective.

Dietary management with a low fat diet may also be valuable with SIBO, because this can minimize the secretory diarrhoea, which is a consequence of bacterial metabolism of fatty acids and bile salts. Since intestinal permeability is often increased in SIBO, a restricted antigen diet may be of value to reduce theincidence of secondary dietary sensitivities. Dietary supplementation with fructo-oligosaccharides has been suggested as a means of modifyingbacterial counts in the small intestine in German Shepherd Dogs with asymptomatic naturally occurring bacterial overgrowth. However, since these compounds are more likely to affect the large rather than the small intestine, further studies in clinical cases are required to assess the efficacy of prebiotics in the management of canine SIBO.

Probiotics are a mixture of non-pathogenic bacteria, often containing Lactobacillus, which can change intestinal pathobiology by preventin genteric infections, modifying metabolic actions of intestinal bacteria,and promoting nutrition. They also may promote local mucosal and systemic immune response. Probiotics are extensively used in large animals, and have also been advocated as a means of modulating gut flora in people with gastrointestinal disease.

Hi Olesia ~

Thank you for the very interesting info, which I started to read but due to distractions I will get back to it when I am in peace and quiet mode. I am extremely grateful for this as what I have read thus far answers my questions.

A quick update on Angel-girl: As you know, her last mess" was 10-45 am yesterday. I didn't put any slippery elm on her food today in case this was responsible for making things worse.  Her first poop of the day was at exactly 10.45 am, so she had gone 24 hours since her last poop. There were three large pieces, it was formed and was light brown.  About half an hour later she passed two very tiny pieces, formed and light brown. She hasn't defecated since. Time now is almost 6 pm.  She had a run with Shayne and the toy today, but I wouldn't let her over-do-it. She is remains bright as a button.

Sorry about the poop detail  but figured we are used to it by now!

Again, Many thanks for the detailed info, which I will certainly read later and many thanks for asking after Angel-girl.

Warmest best wishes,

Julie & Angel

Just a quickie ......Karen, sorry ..... thank you for your input. No, I know you weren't trying to argue, me neither ...... I just want to know more, hence the questions? Some of us over this side of the pond can be rather direct, especially those born and bred in Yorkshire, north of England like me, but please understand that I don't mean anything by it.

Thank you also for your well wishes and hug, which we truly appreciate. Sorry to dash :-)

Warmest best wishes,

Julie & Angel

Hi Kathy,

Thank  you also for your valuable input, which is extremely intereting as it pertains to your experience on T.Z - sorry I never picked up on this properly when you last mentioned it. Please can I pick up on the following: Total Zymes in the shelter and I used them when we first came home. He was going a minimum of 10 times a day and always cow patties. They certainly did not work for him.  Would it be fair to say that the effectiveness of T.Z was due to poor Teddy suffering SIBO - a particular viriluent strain of bad bacteria - because the shelter didn't clear it up properly in the first instance? BTW: I  am really pleased for you and dear, gorgeous Teddy that he is enjoying better health free from SIBO.

I realise there might be a simple identifiable pattern with Angel with what you have said:

1. the initial e.coli wasn't properly cleared
2. she started epi with porcine enzymes
3. I then changed to a standard 71% absorption plant based enzymes
4. reverted to porcine enzymes because her poop was ok but lacked that final finess
5. porcine enzymes hardly made a difference and this is when the tummy rummbling occurred
6. reverted back to the standard 71% absorption plant based enzymes.

Angel gained weight and improved her coat and overall vitality throughout these changes. She has obviously obsorbed nutrients to make this outstanding difference. She pooped three times per day up to 2 pm throughout - tho' we had the occassional extra poop after 2 pm.

Looking at the pattern, it certainly corrulates with Karen's premise - the 71% absorption on the standard plant-based enymes would be more than likely the culprit, alongside the occasional rice starch bone and the few dog buscuits I gave her untreated. I would get a slight softer poop after the rice starch bone but it would return to normal so I thought it was ok, but of course, remnants sit in the gut for bad bacteria to feed on.

As you will know, I started T.Z a little over 3 weeks ago but a week later I changed Angel's food. She has had a lot of changes, and the recent episode is prompting me to also consider the status of her liver.

The good news is that her stools are almost near normal in colour - I would have expected more than one day cow-patties with SIBO, but I could be wrong. The good news is that I had blood drawn before her going on metro, which she only started yesteday afternoon, so this way I should get an accurate reading of her levels and full biochemistry. I know I will have to review my management if there is cause for concern.

I wouldn't argue the case against what you said about a large study being in place to convince the effectiveness of T.Z.

I can only say that for me, I think T.Z is worth attention thus trying, given that three epi dogs are having success with them.

Guys, I do appreciate your input. I do apologise for failing to say this. I am at the point of untangling what is relevant to my girl, given that thus far she has defied the standard epi treatment protocol, if that makes any sense. I will give in to the alternative route when I really have to. That time be closing in - we'll see when the blood results are back.

Warmest best wishes,

Julie & Angel

Hi Julie, sorry to hear that Angel is not well. Hope she gets better soon. My thoughts and prayers are with you both. Please keep us posted on how things are going!

Warm Wishes

Elly and Tyler

Julie,

It certainly could have been the SIBO, I don't know if it was particularly violent strain or he was never on the antibiotics long enough to clear it up although I do think he needed it longer than suggested, as he was on it for 4 weeks several times and it always came back. He was on a grain free food at the shelter and he did come in with porcine (PanaKare) enzymes. When they ran out the shelter started with the TZ. So there are some unknowns with Teddy.

As I said before, I really hope they do work for Angel.

Hi Elly ~  Thank you So much for your well wishes and healing prayers - the power of healing prayers and vibes are always helpful, on many levels. I am pleased to say that Angel hasn't gone to the loo more than twice today - this is when I could do with a graphic of a smiling dog sat on a toilet! .....Debra, where for art thou?!  All of which were formed and on their way to colour recovery.  So fingers crossed that Friday through to Saturday morning was just a 24 hour blip.

Olesia ~ OMG: I've just noticed the angry emicon ~ SORRY ....... me not at all angry  The expression I chose from the selection of tiny faces didn't look angry, just like it was saying "yuck"!  And I never re-viewed my selection after placing it, normally I do. Gosh, I see I have missed out some words that would help join the sentences together ....... "more haste, less speed", eh?!

Kathy ~ I can see that one needs to acknowledge the possibility that dear Teddy might have contracted SIBO when after he was placed on T.Z.   Mmmmm .... it might be the case that porcine enzymes remain in the gut longer than plant-based enzymes, so that any food that has slipped by that were not coated with enzymes stand a better chance of being caught by the number of the earlier enzymes retained in the gut. I do work on a double dose of T.Z., which I feel is necessary under epi circumstances. I have extended my initial incubation time from 20 minutes to 40 minutes (actually, I have been on a trial and error with food amount and enzyme incubation period (two new major items placed me back at the starting  line and now I can see that through this I might be solely responsible for messing up Angel's system). The shelter might only have worked on the single dose and might not have incubated them appropriately, leaving dear Teddy vulnerable to SIBO. However, I certainly appreciate the *unknown* here and your support in hoping that T.Z will work out well for Angel. Thank you!

Warmest best wishes to you all,

Julie & Angel

Hi Julie,

Thinking of you & Angel.  So hoping that your lovely girl is feeling better today. 

Here is a little something for Angel.

Hi Lynn,

What a lovely hug for Angel-girl ~ THANK YOU!!!  The hugs sure go a long way to making a girl feel better ...... We now  have normal poop in every respect! The poop is tootsie role quality! I'll hold my breath on "regularity" until we get through the rest of today, but as she only went twice yesterday, I am hopeful. I am sure she has re-gained a good portion of the 1 kg she lost, less poop means more absorbed nutrients. The pro/prebiotic I ordered from the US is in transit and shold be here this week. I feel this will bolster Angel's internal mechanism. YAY!!!!  It's a good start to the day!

I love your cards, Lynn ..... the animated elephant is SO cute ..... love the face expression ...... I want to hug her/him myself!!

Now I know I am ready for the asylum :ohmy:!!!!

Warmest best wishes,

Julie & Angel

Makes 2 of us Julie, except I'm there already (lol)   So pleased Angel girl is better.  I'll keep all fingers, toes & paws (girls) crossed that she continues this way.   Will be waiting patiently for the next update, probably tomorrow for us. 

Love to you both

Lynn & girls.