EPI * Exocrine Pancreatic Insufficiency

Can a puppy just 10-14 weeks be diagnosed with blood work as having EPI?

Is a false positive something that can occur at this age?

What other issues may symtpoms similar to EPI be?

I have a puppy that at 10 weeks was healthy as a horse, biggest in litter, fantastic health.  Then at 15 weeks has had bunches of tests, xrays, numerous stool checks, bloodwork, etc. barium x ray to rule out blockage,  antibiotics and has lost some weight , can eat only chicken and rice boiled without getting greasy cow patty poops.

Vet suspects EPI based on symptoms and she saw the poop today, cow patty and greasy like.

This is a pure bred german shepherd , repeat breeding, litters totaling 30 puppies over the last couple years and no other puppies with this symptoms.

Hi Vader? (you didn't sign your post)

You know, I don't know the answer to that question, but I do know that yes, puppies have been diagnosed, although not quite that young...

Have you ruled out Giardia? This is quite common in puppies.

I'm sure your vet is looking at the breed and he is correct in that this condition is most commonly associated with GSD's. As they are working on finding the gene responsible for this, there really is no rhyme nor reason at this point for why it occurs... I will say that Tara was the largest pup in the litter, much larger than even the boys, but at about 5-6 months old, she stopped growing...While it took several months later to dx her with EPI, I'm convinced this was the beginning of it...

Forgot to mention...I don't think a false positive is possible with a cTLI test.

Hi "Vader"and welcome .....but so sorry that you have to be here..........

"Can a puppy just 10-14 weeks be diagnosed with blood work as having EPI?"  YES

"Is a false positive something that can occur at this age?"   YES

I'll try to explain as best i can.....I have met and/or spoken with both the EPI researcher who developed the TLI test (he is a gastrointerologist) and with the EPI resarcher who is heading up the EPI genetic reserach, trying to find the actual genetic markers to this disease (he is a geneticist).....

Overall, the cTLI test is the most accurate test to test for EPI... it is the "gold standard". However, the values are not absolute..... please read a recap of my conversation  with Dr. Williams on "EXPLANATION FOR POSSIBLE TLI VARIANCE": at the bottom of

http://www.epi4dogs.com/tli.htm even though this does not answer your question....

Although the TLI is the most accurate, i am pointing out the variance, because nothing is absolute. Although rare, sometimes there is indeed a false reading, and this has nothing to do with whether the dog is a puppy, adult or senior.

According to the gasroenterologist, he stated that if a dog's score is in the range for EPI, it is safe to assume your dog has EPI. They do not get better, they do not heal, they have EPI. Treat with enzymes, etc. This is true 99% of the time.....but there is that itty bitty 1%.

According to the geneticist, he stated that if a dog's score is in the range for EPI, assume it has EPI, treat for EPI..... however, if possible, once the dog is stable and remains stable for a while (maybe 3 months + being stable) re-test, because there have been cases (although VERY RARE) where a dog tested positive for EPI but in the end, it was a false read, ... from my Whole Dogs Journal article: "For example, chronic inflammation can put such a strain on the pancreasthat the production of digestive enzymes ceases or is greatly reduced. Consequently, when the TLI blood test is analyzed, it accurately depicts lack of enzyme production, even though the dog may not actually have EPI. In this case, it is important for the dog to be treated with pancreatic enzymes until his condition is stable. Enzyme treatment breaks down the food, allowing the stressed albeit non-EPI pancreas to recuperate and, in time, start producing the enzymes needed to digest foods."

Also... when I was writing the article, "Starving, Not Starved", I interviewed a vet and this is what she had to say... she has actually had some experience with exactly what you are asking about: "Dorsie Kovacs, DVM, of Monson Small Animal Clinic in Monson, Massachusetts, has seen some young dogs with false-positive EPI readings. Even when they display the lighter-colored “cow patty” stools, something other than EPI may be the cause. Sometimes a food allergy or an over abundance of bad bacteria has irritated or inflamed the pancreas, temporarily inhibiting enzyme production. In these situations, says Dr. Kovacs, it's important to put the dog on a pancreatic enzyme supplement for two months, allowing the stressed pancreas to heal. The dog should then be retested to confirm or rule out EPI."

She is of the same opinion as the geneticist. Treat but then re-test.

Most likely your pup does have EPI..... I would treat as such.... but in time, after you pup responds and has been responding well to all EPI regimine of treatment, If you would like, for extra assurance, re-test, ... just to make sure your pup isn't that 1 or 2 dogs in 1,000 that had a false read.

I hope this helps a little bit... if you have anymore questions, just ask. Unfortunately with EPI,  there are always variables...........

Puppy has had numerous fecal checks...all negative for parasites, giardia, coccidia ,etc.

The ONLY factor different in this puppy is that it was fed an Iams dogfood at his new home instead of the food given by the breeder which puppy was thriving on prior to pick up at 10 1/2 weeks of age.  The puppy started having loose stools, diarrhea and vomiting shortly after this new food was introduced.  The bag of food was thrown away so it is unable to be analyzed for contaminents unfortunately. 

Two Parvo tests both negative, blood work within normal ranges apparently, (I do not have privy to all bloodwork).  Puppy has had no throwing up after initial "bad?" food given,  just a continual loose stool and weight loss.  Puppy can eat boiled chicken and rice with addition of Probiotic and vitamin supplement with normal poop, tootsie roll type.

The vet suspects EPI and is treating as such , puppy given enzyme and special food from Eukenuba with low ash?  Anyone familiar with this food?

Puppy is going to be left on this diet with the enzyme for a week to see result and then bloodwork as necessary.

Any advice regarding any of this?

Vader:

You didn't mention the puppy's name...and I didn't even catch from your post whether it's a male or a female.  Welcome to you (is your name Vader?) and your sweet puppy. 

My gsd with EPI is a female named Akira, who showed signs of EPI as early as around 8 weeks.  The only problem was, that at that point, it wasn't all of the time at that point.  She would have loose stools part of the time, runny stools part of the time and part of the time there wasn't a problem.  It's funny, when I first brought her home, I had an elderly dog who was on a good senior kibble, as well as a dog who was on a quallity kibble for dogs in their mid years.  The puppy food I bought for Akira was what she had been feed along with the rest of the litter.  She would turn up her nose at her food and try to eat Dakota's (senior) food instead.  I now know that it was because it's more what her body needed (low fat).  It was such a struggle that I mixed some of her puppy food in with some of Dakota's food...and while she wasn't entirely pleased, I could get her to eat "some."  As time went by, her stools continued to be better and worse but not necessarily good.  The vet and I kept thinking that it was this problem or that problem and truly I felt that it was a food issue.  By the time they were around 10 months, two of the puppies in the litter had been diagnosed with EPI, and another had been tested but the results weren't back yet.  I had Akira tested as soon as I found out.  By the time they had their first birthday, two of the puppies died and as it turned out 7 of the 8 pups in the litter ended up having EPI.  I'm happy to report that Akira and the rest of her siblings are all alive, and well...yes, they have EPI but they are happy, active and healthy dogs. 

I have no experience with the food you mentioned.  There are many different foods that dogs with EPI thrive on so please don't feel that you're stuck with only one food choice. 

I hate to have to say this, since you're dealing with a puppy so young...but remember that you need to fast him/her before the test.  All of the information is in the tab at the top of the forum.   Keep a journal of "any" change you make, no matter how small it may seem to you.  That way you'll have a reference point to go back to if needed.  Make only one change at a time as time goes on...believe me, this is very important.  

I'm glad you've joined us...and please know that we're here.  Give that sweet baby a special tummy rub and lots of scritches from me.

Hi "Vader",

I personally do not have any experience with "Eukenuba with low ash" dog food... but it sounds like your vet is trying to rule out things, which is the best, along with tests,  that anyone can do. And it sounds like this poor little pup has already been thru the wringer with tests.

With the enzymes, you "should" see some improvement and this improvement should increase over time.... but if the food has any grain in it (rice, corn, oats, wheat, etc) the poop still may not become as fully formed as it probably should even if the dog is receivnig the appropriate enzymes.

Also...there is another side to this...... sometimes vets put dogs on HYRDROLYZED dog food which do indeed have grain in it.. but it is processed in a special manner so that most dogs with digestive issues can better tolerate/digest it.  In actual reality, some dogs do well on prescription hydrolyzed diets, and other dogs get worse... it really depends on the individual EPI dog.

I am probably over-whelming you with details..., but to me, it sounds like the plan you vet has in mind is a reasonable plan of action.1 week is a good time frame to try things out...

Let us know how your pup responds day by day or whenever you want to post....and we can get a better feel of what is going and help you with our experience. There are a lot of little tricks to managing EPI

Hi Vader and your little pup, Welcome to our family, I hope we will be able to help you.

My Bonnie also was the fatest, largest pup out of a litter of 7, she was nicknamed 'Miss Piggy' by the breeder!

She was always hungry and used to fall into her food bowl, knocking her food all over the place and always was gulping water.  She had no other signs at all, poops were great, she put on weight and grew and grew, she was far taller than her sister (when they were both fully grown, Holly looked like Bonnie's pup next to her), then at 7 months old, overnight the poops started. 

Your vet's treatment sounds good for now, a week will give you an indication of any improvement with enzymes etc.

If it is EPI you and your vet have caught it early before too much weight/ muscle loss has occurred  especially in a puppy so young at a time when they need all the nutrients etc for their bones and muscles. 

As Olesia has said, when you have time, do give us an update and ask as many questions as you like, there is a wealth of experience here which have benefited us all. Sadly some dogs are not as lucky in getting a diagnosis quickly and unnecessary weight/nutrients/vitamin loss occurs, making the stabilising more difficult,   Managing EPI isn't rocket science, it just needs to be identified and treated correctly.

Hi everyone and thanks for all your thoughtful and informative replies. 

Puppy name is Vader by the way:) a 15 week old.

The biggest concern I have right now is he is 25% less in weight than his littermates!  I fear it may be too late for him even if I get the diagnosis.  Can a puppy this young even survive with his body being SO deprived of nutrients for the past 5 weeks?  I am really worried.

He also has hair loss around his eyes, vet did scraping,  no mites.  She attributed it to his weakened immune system.  He is a mess and I am devastated.

DON"T  give up!!!! You would not believe how much weight these dogs can loose... to the point where they cannot even get up andymore because their muscle mass is so wasted from lack of nutrients... and once properly treated they come back and many even ahve to eventually be put on diets!!!

My Izzy lost a litle over 1/3 of her weight .... some other dogs that i know of have lost 1/2 their body weight and some, believe it or not, even more... and they survived.

Since you are sounding so scared... the best immeidate suggestions i can give you is

1. since Vader is tolerating for now, what he is being fed..... what ever the recommended amount of food is ..give 150% instead.

2. if you are feeding (for example) 3 times a day, feed smaller meals but feed more often... (for example) like 4 times a day.

3. since Vader is just coming out of diarrhea episodes, and has lost a lot of bodily nutrients, try giving him some Pedialyte (in the children's section of Walmart) to replenish his electrolytes.

And again, please don't loose hope...

It's not too late!!!! Tara as a full grown dog went under 50 pounds from a very lean adult weight of 72 pounds....I don't know how much under 50 pounds because I stopped weighing her when the scale said 49.5 as it was just too depressing...Today, she is 78 pounds and actually, a bit chubby!

So sorry to hear about your puppy.  Taya became sick in March when she turned 1 year. She was seen by many vets but was not diagnosed EPI until 7/28/09 at CSU by Dr. Twedt.  She only weight 8 pounds, she had lost half her body weight.   Today she weighs 15 pounds 10oz. 

OK... you are feeling panic stricken and we all know what that is like.

So take a deep breath... expel the air slowly... and know you can beat this.

First with enzymes the puppy can come back in a very short time... but don't panic and use too many enzymes... getting the ratio to food right is annoying and sometimes takes a few days... but puppies are unbelieveably strong so hang in there.

I had a 12 week old puppy who was at deaths door with parvo only 24 hours after I brought it home. The vet gave it antis and electrolyte solution and I nursed it for 4 days when it could hardly lift its head.... it survived and lived 15 years.

We are all with you and sending the most amazing love and good wishes for Vader...

Be strong.

Val

Hi There!  Please do not give up on Vader - Jackie was 8 mos old and lost 20 lbs in 2 weeks - I was devistated - 3 vets later - then finally I found this forum and they gave me my Jackie back.   It does take time - but it works!!!  Your pup is so small but Jackie didn't stop her cow pies until the B12 shots - she was low in that also.  It took 4 different foods to find the right one for her - then to get her on the antibiotics - then to add the B12 - it took a few mos and it doesn't happen over night.  I would still like to see a little more weight on Jackie (she has been the same weight for several mos now (and she is 15 mos) but she is the happiest dog ever.  Here's a pic with her and her friend Bo - taken today at the dog park after 45 mins of romping.  Hang in there and I have faith the people here can help you with EPI - unfortunately, it is not an overnight fix, but there is a fix.    Vader is so young and I have faith will pull through - hang in there - don't be hesitant to question you vet if you see something here - bring it up.  If you don't see your pup doing better - keep posting what is going on and the people here have amazing recommendations.   I look forward to learning about Vader as he/she??  grows up...

I understand the panic you're feeling and I know this is going to sound silly, but please, sit back, take a deep breath and try to relax.  EPI can be very scary, and especially so with a young or very small dog.  It takes a while to get everything adjusted just right but I know that you're on the right track and that in no time you'll start seeing small improvements.  Which enzyme did the vet put him on?  I can't remember now if you already said how much food you're feeding and how much of the enzymes you're using per meal.  I do know that food plays a huge part for most of these dogs.  Please have hope and know that you're in my thoughts.   

Michelle:

I'm so glad to hear that Jackie is doing so well.  I love the picture you've posted...who is the rottie?

Everyone has been wonderful here thanks so much...it sure helps to have someone who has gone through this and offering encouragement and advice.

Vader had a great night slept well in his crate.  I will admit that I am NOT using the food the vet gave...I just don't like the idea just now of a kibble AT ALL so I bought the canned DICK VAN PAtton foods for allergy, no grains etc that you all recommended here.

I gave him a tablespoon of that on his chicken and rice (about 1 1/2 CUPS)  and he is getting 3 tablets of Pancreazyme with each feeding.

He weighs 37 1/2 pounds as of Friday.

I put the tablets crushed into a bit of lukewarm water then let sit for 15 minutes then thoroughly mix into the food , let sit for a couple minutes with food (vet said too much longer than 20 minutes is not good?) He also gets a probiotic from vet's office that is 1 gram a day.

He is ravenous constantly and is always searching for food , any thing even that has fallen on the floor, a crumb.  He drinks LOTS of water.  Because he is such a good boy he will go outside to pee and poop.  He had a very decent poop this a.m. formed more brown than yellow and not puddingy but semi solid with no greasiness. So hopefully this is a good indication things are working for him.

He if full of SPUNK and energy,  wondering where is the "Off" switch sometimes:D

I hopefully will be able to speak with my vet today and get his testing arranged for Monday AM.  Does my vet need anything special to do the testing ?  I know I must fast him for 12 hours but does that mean NO WATER as well???

Please tell me again which page on this site is the info for the testing.  Thank you.

Another question, well actually a few more....

Brown rice versus white rice....we always eat brown for the family but I had been using white rice for him.

I cooked the chicken in extra virgin olive oil  which I just mash and include with the chicken mix.  Olive oil ok?

Addition of Vit E capsules...how much?

What about using Goat Milk ...I have a fresh supplier...unpasturized  that is super good. 

Another question...sorry....

With regard to the Probiotics...I'm concerned that within a dog's gut the probiotic is not effective....can someone explain how this would get through effectively on a dog's system.

Hi there, its good to hear there is some progress.

Re your questions... and this is just MY oppinion.

1) Water is OK with the fasting as long as you don't let Vader drink gallons.

2) My Razzy can't have rice at all so I won't comment on that.

3) I would rather take the skin and fat of the chicken and cook it in water rather than oil but if Vader is OK with it then thats OK too.

4) Goats milk is great and I have fed it to all my dogs (I bred pedigree goats for years)... not sure about it for a possible EPI dog... try it and see, I guess.

5) not sure on Vit E capsules as I don't use them.

6) I don't use probiotic but humans take it and it gets through the stomach acid into the digestive system... it must be the same for dogs?

I think you will find testing details right at the top of the page... titled TLI

Val