EPI * Exocrine Pancreatic Insufficiency

Onza weighted 61.5 lbs at vet's office Thursday evening. She was there for her Adequan injection for her hips. We had Onza up to 72 lbs last October, so this is a slow decline in weight. She has just finished a course of Tylan and is on FortiFlora daily now. She is getting 4 meals a day with 1/4 generous tsp 6x enzyme in each meal; she gets 1 heaping tsp canned pumpkin in 3 of those meals. Dr. Gordon had suggested the pumpkin b/c it is fiber that absorbs acid caused by the porcine enzyme. About 2 wks ago, we increased the pumpkin to 2 tsp each meal (per Dr. Gordon) to see if it would stop her from eating wood, bark and leaves, thinking she may have something like pica. However, the 2 tsps of pumpkin caused poops to be softer, lighter in color, not staying in her system as long .. all of which Dr. Gordon suspected would happen. So we went back to 1 tsp per 3 meals and are now experiencing some stinky burps, which is actually acid reflux. Hopefully the burps will not progress. If we 'up' the enzyme, it makes the stinky burps worse.  Today we gave her a Pepsid tablet. (in past we have tried Pepsid, Malox, Prilosec, none of which worked long term).  We have ordered the plant enzymes and probotics and they should arrive next week (not a minute too soon); we are praying that the plant enzymes will fill the void and provide whatever is missing in her regimen that's keeping her from absorbing her food. I watched her walk towards me today and just wanted to cry; she is SO thin.  We have added 2 vitamins daily. Dr. Gordon is concerned that she is malabsorption, essentially not being able to absorb nutiments from her food. He feels there is not much that can be done about that. We may look into a canine nutritionist or accupuncture -- or anything that could help Onza and turn this thing around. I know I sound like I'm in a panic -- I guess you could say we are!  But as her scarf says, "We can lick it".... somehow, someway we just have to lick this! If anyone has any suggestions, please respond.  Many  thanks and thanks to Olesia for this wonderful, fantastic website and Forum which helps to give us hope when we feel like hope is fading.   Donna W,   ... and William & Onza

Donna, when you get the plant enzymes to add to the pancreatic pork replacement enzymes be sure to double whatever is the recommended plant enzymes dose.

I have two more thoughts on Onza's dilemma (and hope others will chime in with thoughts too!!)

1. I know Onza is receiving  B12 shot for low B12 deficiency.... however, there is a possibility that she is one of those EPI dogs that still do not maintain her B12 levels even with the shots...hence the malnourishment......Pebbles on this FORUM and other dogs I know of have all of a sudden turned the corner and began to flourish when the B12 shots are supplemented with Metagenics Intrnisi B12/Folate pills  (these are the only pills that seem to work)

http://www4.shopping.com/xPO-Metagenics-Metagenics-Intrinsi-B12-Folate-180-Tablets

It cost about $50 for 180 pills..... you might want to try this..... it is a thought. If you do do this, i would start off with 1 pill with breakfast and 1 pill with dinner.....if you give more than what Onza needs, she'll just pee it out... The only waste is $50 for a 180 pills......

2. The other thought i have is that  because of Onza's problematic wet-burp issues...... talk to Dr.Gordon about this......., but Onza might be a good candidate for CREON 10 (enteric coated capsules of panceratic replacement enzymes).... you do not have to incubate the food and the way it is released in the gut may be better suited to Onza's digestive system.

Anyone else??????

yes I can tell you we really struggled with Pebbles..... she would lose b12 so fast that it was a constant battle even tho we were giving her a b12 shot every 3 - 5 days.......  the quick decline gave her diarrhea every few days..... wasn't until I went on the above b12 pill daily that she turned around and has been doing fine since..... I no longer give any shots this has worked much better for Pebbles..   Best of luck to you and your beautiful Onza

Donna,

I wish I had an answer, but I don't...I think Olesia is correct in that the additional B12 might just do the trick (this is what ultimately is the one thing that makes Tara loose weight).  If Onza wasn't having the burping issues, I'd say increase the enzymes, but now I'm not sure...

Keep us informed...

Thank you for the info Olesia! We had not thought about the B12 issue --duh.... So much to learn, know and remember. Ya know, when Onza was 1st diagnosed on 4/20/09 w/EPI, and before we started the B12 shots, Dr. Gordon had put us on B12 tablets (not the ones you mentioned but just ones from the drugstore); I went to the Medicine Shoppe and bought B-12 3000mcg tabs and she got 1 per day. Her B12 level went from:  on 4/22/09 at 162 to on 6/17/09 at greater than 1000. Dr. G was amazed at the increase and actually said we could keep on that in lieu of shots, but we wanted to do the shots. SO, w/that said, we pulled out that bottle of B12 tablets and are giving her one a day. So we'll see if this added B12 can help her pick up some weight. Just as soon as the plant enzymes arrive, we'll start them - double dose per your recommendation - added to her 1/4 tsp pork enzymes. Also will keep giving the probotic - switching to the new ones that will come w/the plant enzymes, but at a decreased dose. I think we have a game plan for now and will see how things go and will keep you posted. We are praying the plant enzymes will be the ticket b/c the stinky and wet burps have come back w/the decrease in the pumpkin from 2 tsps per meal to 1 tsp per meal. Tonight we will go back to the 2 tsp pumpkin per meal b/c this acid burp thing must be controlled.  We'll just have to deal w/the softer, lighter color poop (b/c of the increased pumpin we are guessing) until we can get those plant enzymes in her. Well, just so you'll know, she is very, very happy and playful and you'd never know she has this horrible disease except for her diminished body weight.  Thanks, everyone, for listening to me ramble - it helps to know you are all out there. Oh, by the way, we have about 4-5 inches of snow in Raleigh, NC -- and Onza LOVES it!!!

HI Donna~

Wouldn't that be great if Onza's recent fluctuation is simply becaue she needs a minor adjustment to her B12!

Hey, I also need to ask ya, what is the brand name of the B12 pills that Dr. Gordon put Onza on initially that appeared to help her increase he B12 level?  So far, any B12 pills that anyone tries does not work.... except for the Metagenics "Intrinsi B12/Folate" pills....1 pill  has:

• 800 mcg of Folate
• 500 mcg of B12
• 20 mg of Intrinsic Factor
  

So if we can add to our bag of possible EPI tricks.....another B12 pill brand... that would be great!

Update on Onza... and to answer your question, Olesia, about the B12 -- First and foremost.... Onza is DOING BETTER!!!!!  We are SO excited, relieved, thankful, etc. Yesterday at Dr. Gordon's offce she weighed 63 lbs -- a weight gain of 1.5 lbs in a week (sketchy scales at Gordon's office, but Wm lifted her up and got on scales with her at home and she did appear to weigh 63 lbs). She seems "satisfied" at night and does not pace the floor constantly as she had been doing; and when goes outside she does not try to eat every stick, leaf or piece of bark she sees. So we think she is finally feeling "full" from her food.

Where do I start? We were in such a panic about her weight loss, that we took a shotgun approach - even tho we know you're only supposed to add/change 1 thing a a time -- we just felt like we had to bring out the crash-cart method -- just did not feel like we had "days" to play with in the things we wanted to change or add. First, we did increase the enzyme to 1/4 'full' tsp per meal. Adjusted the pumpkin according to "bad burp-meter" -- and are giving her about 2 generous tsps per 3 meals a day. Added a 4th meal that we give her about 11:30 to 11:45 pm every night. Added 2 vitamins a day that we got from Dr. Gordon (may drop that back to 1 per day). We are slowly switching her food back to the "fish" foruma -still keeping her on the Dick VanPatton's Natural Balance (the Fish food has Salmon Oil; looking back thru our log, we discovered she started losing weight about the time we switched to the Venson -- and we switched to that to see if the Fish was causing the stinky burps/which it was not). She is still on the FortaFlora once a day. Then the B12 tablets; when she was first diagnosed w/EPI Dr. Gordon recommended the B12 Sublinqual Tablets. I went to the Medicine Shoppe and bought their brand B12 sublinqual tablets. They are 3000mcg...yes 3,000. The Label reads: Dietary supplement, take with meals, one every day;  NO yeast, corn, wheat, sugar, salt, soy starch, dairy, citrus, fish, preservatives, artificial color or flavor added. It is their brand. Her B12 went from ...?like 160 in mid-April 09 to greater than 1000 in about 2 months (June 09). We stopped those pills when we started the injections. We are now still giving her one B12 injection a week and one of these tablets every day (except for shot day).

Something is working. I know when you do different things at same time you're not quite sure what the magic thing is, but at any rate - bottom line - our baby is better, actually does not feel as 'bony' in her ribs & backbone, seems content at night -- and we are 2 thankful parents! 

The plant enzymes and the probotics that we ordered arrived yesterday. We will hold off on adding any of that until we get a little bit more stable or on track.  By the way, her poops have improved tremendously. We still figure our neighbors think we are a bunch of weird people out stool gazing every time the dog poops!  Let them wonder.    ....  thanks for everyone's concern. It means so much. 

Happy in Raleigh...., Donna W, William & Onza

Hey Happy (aka Donna)... this is GREAT news and we are ALL happy..... if i had to bet  on anything... i would bet it was the B12.

We have heard of similar situations where the B12 shot help but after a while it seemed like for "some" dogs the B12 shots stopped "maintaining" ... but if coupled with the B12 pills ... the dogs all of a sudden improved.

Not sure if this is what happened with Onza, but it is a possibility. And am thrilled to hear the good news.

Now... the only pill that i know of that works with EPI is the Metagenics... but you are saying Medicine Shoppe carrys their own brand of B12 sublinqual tablets... i could not find that pill for a description... Can you please share the ingredients of those pills with us... does it contain folate in it and/or 20% Intrinsic factor? Once we know the ingredients, it will better help us understand why it is working (if this is what is going on). Thanks Donna!!!!

Hi Donna,

Soooooo pleased that Onza is doing much better.  It is such a relief when things are finally coming together again. 

Olesia, in regard to the B12 pills, I now use the Metagenics Intrinsi/B12 folate pills for Megg, one every 2nd. day, but these pills arn't available here in Oz.  I found a company in the US who would ship them here, so I'm very happy about that.  Had to check with customs etc.., (nightmare), but all was fine. 

Before this, I used the normal Metagenic B12/folate tablets (no intrinsi) but now they wont sell them to me because they are for my dog (grrrrrrrrr).  Shouldn't have told them the truth (lol).  Anyway, I am happy that I can get the Intrinsi one's so all is o.k. 

The last time Megg had her B12 checked (around 6 months ago), her levels were 771 which I was happy about.  Her previous levels were in the mid 300's but my Vet didn't mention injections.  I checked around, found out I could get the Metagenics from our local health food shop, who employs a Naturopath, (which I thought at the time were the one's everyone was talking about), & started using them.  I gave Megg one per day (1000mcg), & her levels rose to 771. 

I know everyone says the ordinary ones don't work but we do hear now & again that sometimes they do.  Megg also got EPI from having a life-long history of pancreatitis so that might have something to do with why the tablets seemed to work for us, I don't know, but still pleased that I can now get the Metagenics 'intrinsi' ones.  I'm sure they will be much better & are 'proven'. 

Lynn & girls.

Donna,

This is great news!!! I'm so happy to hear Onza has found the right pill!  I'm as interestesd as Olesia is in what is in it?? While Tara doesn't mind her b12 injections one little bit, I'm sure there are many members who would rather not go this route....

HI Lynn~

Aha... so you had success with a B12 pill that did not have the folate nor Intrinsic factor in them eh? ... I am so glad you are sharing this with us ... this is good information to know, because although i will still recommend that folks use the Metagenics Intrinsi B12/Folate since we know it works... maybe this can be another option that some folks can try.... especially if they cannot obtain the Metagenics Intrinsi B12/Folate pill.... We will just have to let folks know that although regular B12 pills most often do not work, there are some cases (megg as one) where they have worked with an EPI dog (in this case, one that has the secondary form of EPI (from Pancreatitis) and for them to please work work with their vet on this, check their dog's  B12 levels  to verify if their dog's B12 level is improving on the B12 pill.  Thanks Lynn... The more options and information we can share with one another, the better!!!

Thank you so much, everyone, for responding. Olesia, here is the description on the bottle of B12 we are currently giving Onza with the list of ingredients, etc.

Name of tablet:  The Vitamin Shoppe B12 3000 mcg, Sublingual

Supplement Facts: Serving size: 1 Lozenge

Vitamin B12 (as cyanocobalamin) 3000 mcg (amt per serving) 50000%(% Daily Value)

other ingredients: Microcrystalline cellulose, stearic acid, croscamellose sodium, magnesium stearate, silicon dioxide, citric acid.

NO Yeast, Corn, Wheat, Sugar, Salt, Soy, Starch, Dairy, Citrus, Fish, Preservatives, Artificial Colors or Flavors Added. 

Directions: as a dietary supplement, dissolve one (1) lozenge under the tongue daily, preferably with a meal.

Manufactured for: The Vitamin Shoppe

www.VitaminShoppe.com

Note: Dr. Gordon said not to worry about the fact that it's impossible to hold this pill under her tongue until it dissolves. It's ok for her to swallow it.

Thank you and take care, Donna

Thanks Donna... this is very helpful...I plan on putting  something in the FILES about B12 supplements.

I did mis-quote Lynn's B12 pill.... the one that she used had Folate in it, but yet yours didn't ... the only thing i did notice is that in the absence of Intrinsic Factor and/or Folate, the higher they are in B12:

B12 sublingual tabs = 3000mcg B12 (no folate no intrinsic factor) "Vitamin Shoppe B12 3000mcg Sublingual"

B12 pills = 1000mcg B12 with Folate (no instrinsic factor) "Metagenics B12/Folate"

B12 pills = 500 mcg B12, with 800mcg Folate, with 20mg Intrinsic Factor "Metagenics intrinsi B12/Folate"

Thanks Olesia -- thank you for compiling info re: B12 pill type supplements. As you have said about all our "EPI woes" in general, different things work for different pups and as we find out daily, it's all a matter of balancing what's right for your own dog whether we're talking about B12, enzymes and/or food. I'm anxious to begin the plant enzymes and the probotics that came with it -- BUT, since "things" seem to be working right at the present moment and she has gained 1.5 lbs in a week, we are gonna hold the course and not add/subtract anything just yet. We'll wait until she gains more weight and we feel like she's more stable before venturing into a new regimen. The log has helped us so much in these last few scary and challenging days - it's so helpful to look back (even to the beginning of the log) and see what worked and what didn't and adjust the game plan accordingly. Again, thank you so much for everyone's support. It is a warm feeling to know we are not in this alone and to have caring support each step of the way. Have a wonderful Saturday with your sweet pups!  Donna W  (& William and Onza)

thanks Donna... yea... I thought it might be helpful to compile lists of what seems to wrok all the time and sometimse... s long as folks understand that these are all suggestions and that not every EPI dog is going to respond the same way..........

Good new continues.....Onza has gained another 1/2 lbs since "weighing in" at Dr. Gordon's last Thursday... so now up to 63 lbs. We think the extra B12 pills are helping her absorption.  We may visit the idea of adding the plant enzymes later this week b/c we still have the stinky burps happening -- mainly at night  -- and we had not been adding the pumpkin to the "mid-night" meal b/c too much pumpkin makes softer, lighter colored stools -- but tonight we'll go ahead and add the pumpkin at the late night feeding. I am hopeful if we can add the plant enzymes ... and who knows, eventually decrease even more the porcine enzymes.... maybe it will help her acid/stinky burping. Again, test-test-test, balance-balance-balance, adjust-adjust-adjust -- and log-log-log.   How do we have time for our "real" jobs??? Take care, Donna W

YEAH!!!!... that is great news Donna that Onza now seems to be better absorbing her food by adding the B12 pills to her B12 injection regimen... geezzzzzzzzz......it is just so typical of these EPI dogs to not always be"typical" !!!!

Please do report in on how Onza reacts when you supplement her pork enzymes with plant enzymes to see if that takes care of the evenng wet burps, since she obviously needs a wee bit more enzymes but when given the right amount of pork enzymes it seems to give her acid indigestion.....and too much pumpkin gives her more runny stool.... boy oh boy, you certainly got that right... "test-test-test, balance-balance-balance, adjust-adjust-adjust -- and log-log-log."

Hello everyone and Wow oh Wow do we have good news! Onza weighted 72.5 lbs (about a 10 lb gain) at the vet on Fri., Feb 26!!! We are SO excited, relieved, and thankful. All the tweaking of food, etc., advice from several people on the forum and from our vet and keeping a daily log has really paid off and Onza is doing so well. We think she is feeling "full" because she is not trying to eat every leaf, stick or wood bark/chips when she goes outside to do her business or to play. Before, no matter how bad she had to pee (or whatever) she would immediately go to leaves, etc. to eat, eat, eat (never poop tho, thank goodness). I must say that the log has helped us so much; it was great to go back in time to when things were good with Onza and see what was working then. Adding notes every day during this current crisis helped us to know what was or was not working. I'll list below Onza's current regimen. 

We feel that the things that helped her the most was the additional B12 and changing her food. We switched her food back to the fish forumula - the Fish/Sweet Potato (Dick Van Patton's Natural Balance); back in Oct  we had switched her to the Venson formula to see if the Fish could have been causing her "stinky burps", poor baby. But it was NOT the food.  She had a 30 day course of Tylan and then a round of probotics in the form of FortaFlora; at the end of FF, we have continued daily probotics with Total-Biotics. We think her system tolerates the Fish foruma better (I guess sorta like some of us people -- we can digest fish better than we can beef/meat). Two teaspoons of canned pumpkin seem to be keeping the stinky burps at bay, or at least it's helping with all the other things we've tweaked; that was suggested by our vet, Dr. Gordon, because the fiber in the pumpkin absorbs acid. Then the other big thing was we started her back on B12 3000mcg Sublingual Tablets, one every day other than the day she gets her B12 injection. So, "FishFood", add'l B12, Total-Biotics, pumpkin, ...and also 1 Vitamin per day -- all this has helped up be where we are today.

Keeping the log is so critical and helps so much when things go wrong -- as Olesia has always stressed; it is SO true. We have had help and advice from many people on the forum and from our vet to help us get through what we were so afraid was a downward spiral from which there might have been no return. But thanks to tweaking, advice and logging....we are GOOD now!!! Through this trerrifying ordeal we have connected with a friend from afar who is very caring and offers wonderful, sound advice ---thank you Julie!

I would like to list Onza's regimen so it may help others who are having difficulty; and we are always open to questions or suggestions.

Oh, by the way, we did give Onza 4 meals a day when her weight was so low (a "mid-night" meal as we called it and she loved a late night snack -- but we only gave her 1/2 cup of food w/enzyme of course).

Onza's regimen:

3 meals per day - 1 cup per meal - (food as above); food is ground to consistency of sugar

1/4 tsp enzyme 6x porcine (Diane enzyme) incubated 20 minutes

Breakfast: 1 Dasuquin (joints), 1/8 tsp Total-Biotics, 1 Palatech F.A./Plus Chewable Tablet (vitamin)

Lunch:  (just food...no add'l stuff)

Supper: 1 B12 3000mcg Sublingual Tablet (Vitamin Shoppe), 2 heaping teaspoons of canned pumpkin (using organic right now)

Weekly: B12 injection 1000 mcg/mL  1cc  and  Diethylstilbesterol ("DES") 1 mg (urinary incontinence)

Thank you again everyone for your continued support and advice. Without this website and the Forum, WHERE would we all be today??

Kind regards to everyone, Donna W, William and Onza  

Hi Donna & Onza,

What fantastic news.  I am so pleased for you both.  Such a wonderful feeling when everything begins to come together, & WOW, what a great weight gain.  So happy for you both. 

Donna:

This is the best news...thank you so much for sharing the news and posting your information.  Your thoughts, and trials with success are so very important for new people to be able to read when they come aboard.  Please continue to keep us posted.  Congratulations!