EPI * Exocrine Pancreatic Insufficiency

The Monday weigh in showing Boss down to 68.5 from 70.3 two weeks earlier. After some wa-wa-was and consoling myself with some chocolate, I am now moving on to figuring out the next best steps for him. His poop is solid but still too large, so we are increasing his enzyme dose to two Creon 10 capsules with each meal. He has been getting a B12 pill with each meal but I am going to talk to the vet next week about trying B12 shots. He has been off the Tylan for a little over a week with no stomach upset or gurgles resuming, so far. He has been on EVO low fat with additonal cooked chicken breast added and I am going to try Natural Balance Sweet Potato/Venison with added cooked beef to see if changing the kibble and protein sources has any effect. I might also try doing 3 meals a day instead of 2, but he usually will not eat his first meal until mid- morning, so not sure if that will work out timewise. He has been on the Creon for three weeks and as another optional step we could go back to using the PancreaPowder loaded in capsules. Or try again to get him to eat it on his food... but he has been a member of the clean plate club lately and actually enjoying his meals, so I am hesitant to mess with that and have him get all suspicious of food again. Any other ideas?

Coming to this forum where there are others that have been down this path and can sympathize/understand the problems is a huge help

Thanks,

Becky

HI Becky ~

Okay, first i have to commend you..... You have excellent plans of action in place already and are planning like a seasoned EPI'r!!!!

The only thing i would not consider (at this point in time) is changing from CREON back to powder.

Now remember.. do only one change at a time or else you'll kick yourself in the pants later because you won't know what it was that you did that worked!

1. I would do what your vet recommended first ... increase the CREON.... try this for 3-5 days..... record results. Personally i don't think this is it, but maybe... so try it. If you do not get smaller poops.... then on to the next "trial"

2. By this time it ought to be next week, and definitely schedule that B12 shot.... my bet is on this. Again.... record the results.... and let us know .. we often see  "not optimal absorbtion" a lot of times because the B12 levels are off....

3. My next thought would be to try increasing the food... feed a little bit smaller portionl, but add another meal... again... try for 3-5 days... record results...

4. If it is not the CREON nor the B12, nor increase in food amount....my next "trial" would be to change the food. With my Izzy, different foods DO make her eliminate different amounts (of the same portions fed). And once again, try this for 3-5 days, record results and let us know what is going on.

Looking forward to hearing other's thoughts on this! And by the way.... I'll take a bite of  that chocolate.... yummmm... I LOVE chocolate

Hi Becky,

It took me over a year to get Tara back to her pre-EPI weight and she never gained an ounce until I started the B12 protocol.  This condition is so very frustrating (I refere to that first year with Tara as the "dark days") and I too commend you for having a very good plan of action in place!  Boss is a very lucky boy having you to take care of him!!

its tough work boomer and i are still working hard to settle him,just remember the good days out way the bad

"Boss is a very lucky boy having you to take care of him!! "

Donna-  I consider myself the lucky one to have him in my life!  I have loved all my shepherds but he is one very special boy to me

Becky,

I am a firm believer that we don't ever really chosse our dogs - rather they choose us... Boss needed someone special in his corner to fight for him and he picked the right lady!!!

Hi Becky,

You sound like you're in a similar situation to me.. Kobe is currently stable but his poos are fairly large (Although he is having 6 cups of biscuits a day..) and I'm having difficulty getting him to gain weight. By the sounds of your post though, Boss is losing weight while his stools are still firm?

I started B12 injections last week, the 2nd one is today.  I keep a poo diary (Romantic, huh?) and grade each of Kobe's poo on a scale of 1-5. 1 being completely runny, 5 being 'normal'. What I did notice, following the B12 injection was that Kobe's poo was smaller in size. I saw this for 3 days following his injection.

I'm not a pro on giving advise like the other ladies on here, but keep at it and talk to your vet about the injections.

Samantha at 09:33PM on Feb 17, 2010

Hi Becky,

You sound like you're in a similar situation to me.. Kobe is currently stable but his poos are fairly large (Although he is having 6 cups of biscuits a day..) and I'm having difficulty getting him to gain weight. By the sounds of your post though, Boss is losing weight while his stools are still firm?

I started B12 injections last week, the 2nd one is today.  I keep a poo diary (Romantic, huh?) and grade each of Kobe's poo on a scale of 1-5. 1 being completely runny, 5 being 'normal'. What I did notice, following the B12 injection was that Kobe's poo was smaller in size. I saw this for 3 days following his injection.

I'm not a pro on giving advise like the other ladies on here, but keep at it and talk to your vet about the injections.

Hello Samantha,

Yes, it was our first backslide on weight since starting treatments in December.   

Oh yes... the poop log.  We have a grading system also - Solid, Formed, Soft, Cowpie and Diarrhea.   Your 1 to 5 system might be more simple but I have my husband used to ours and don't want to confuse him by changing it now     I think I might add a sizing of S/M/L to our grading system since our main concern now is volume more than consistancy.  Our friends and family think we are a bit over zealous in our quest for the perfect poop!  But everyone here on the forum knows just how important it is.

I am hoping that adding the B12 shot , instead of just the pills he has been taking, will be the missing piece to the puzzle.  Glad to hear it helped Kobe.

Becky

Hey Becky....where's my chocolate???? Actually i think you, me and Samantha can ALL use a bite (well, maybe a couple of bites) of chocolate!

I still have a nagging feeling that Boss is having a B12 issue... as could very well be what is going on with Kobe... but then again, this could be way off-base  .... *sigh*......... that's the problem with EPI.. it's like you feel like you almost know what is wrong and possibly how to fix it, but sometimes EPI likes to play games with ya, and it turns out to be something totally different that got skewed with all the systems being compromised.... it can be so frustrating!

Oh Becky... i meant to tell you... thanks for the update on that new EVO grain-free fish-based food....I will ahve to wait until my supplier carries it... shipping prices are ridiculous...almost doubles the cost.

Olesia, 

Oh!  you wanted a piece?  I thought you just wanted me to eat a piece for you!  Which I did, along with a piece for everyone else here since I polished off the whole bag!     Sorry... it was a bad day.

That is funny to hear Alaska actually got a product in before somewhere else.  We are usually behind times here.  Hopefully if your supplier carries the regular EVO line they will also have the fish formula soon for you to try out.

Just got back from the vet where we had our first B12 shot!  Now we wait and hope for smaller poop

He weighed in at 67.5, so down another pound from last week.  I will not worry, I will not worry, I will not worry...

Becky

???? is the poop smaller yet???

Becky:

Geesh, I posted a couple of days ago, and I guess my post went into cyberspace!  Have you noticed a difference since he got his B12 shot?  How are things going???? 

My post that disappeared, truly only addressed your comment "I will not worry, I will not worry, I will not worry..."  That's why I tell people to sit down, take a deep breath and relax.  Yes, you will worry...I'm the biggest worrier of all...I worry about everything!  I've gotten much better as I've gotten older but I'm still bad.  I've also lived long enough that I know that you don't solve a thing by worrying, you just drive yourself nuts.  I can't stop you from worrying...geesh, I've never been able to stop myself, but I can try to give you some assurance that somehow, between all of us, hopefully you'll be able to get this worked out soon.  We all care, and we're all here for you.  It can take time for everything to come together...I know it did for Akira  and she didn't have issues with SIBO or wasn't low on B12.  Just getting them on the right food, right amount, right enzymes, right amount of enzymes and so on makes a huge difference.  Please keep us updated.

Nothing too dramatic yet in the poop department, maybe slightly smaller.  He had the shot yesterday afternoon at 3:30PM.  Not sure how soon effects would show up? 

His usual feeding schedule is:  A snack at 4:30AM when dear husband goes to work.  Lately this has been 1 cup of kibble with a little cooked meat and cream cheese for bait.  Then his first meal around 10:30AM and second meal around 6:30PM.  Lately these have each been 2 cups of kibble and the all important cooked meat and cream cheese for bait. 

Lately his poop schedule has been 3 times the first part of the day: around 4:30AM, 9:00AM, 1:00PM with random evening ones either before bed or in the middle of the night. 

I have thought about weighing poop but have not gone to that extreme yet.  But, here are pictures from 2 yesterday poops and then the 2 he has produced since the shot, one at 1:00AM and one at 4:30AM.  Still waiting for the next one this morning.  But maybe things are kicking in and he won't have another one this morning?  One can always hope!

YESTERDAY

THIS MORNING

Linda,

The "I will not worry, I will not worry, I will not worry..."  is my new mantra.  Being a newbie at this, I foolishly thought after Boss had started to gain weight In January that we had everything under control.  So in February when things took a turn backwards I was not emotionally prepared.   I read a post yesterday from another veteran here, like yourself, and how 3 years later she is holding her breath at a weigh in and then celebrating.  So, I now realize that there will be bumps in the road, but also victory celebrations down the road, so "I will not worry, I will not worry, I will not worry" about every little hiccup

Becky

On Friday, I had printed out the B12 protocol from TAMU and took it into my vet for him to review and suggestion to try.  He ordered the B12 and we had the first shot yesterday given by one of the techs.  Two vets practice there on a 1 week on, 1 week off rotation so this week was my vet's week off.  Last Friday when I took the information in for him, I forgot to ask if I should continue the B12 pills with the shot also.  He had me giving Boss one pill in the morning and one in the evening.  Next week he will be there giving the second B12 shot  so I can ask him then, but in the meantime what do you guys think?  I did not give him a pill last night or this morning yet.

Thanks,

Becky

tic-toc, tic-toc.... past noon here and still no poop  

OMG... i laughed so much when i saw the poop pictures and the measuring stick....   I mean like my eyes were watering and i had to wait a minute before I could type!!!

Still chuckling.....

Okay, Becky, now i can type... His poops look great.. damn near perfect. Might need a little more liquid with his meals, but other than that, damn near perfect. WOW... you are doing good mom!

So tell me... did anyone see you taking these pics ??? you do realize that folks not familiar with EPI are gonna think you're certifiable !

For now, I would continue the B12 Metagenics pills, but just do one a day until you talk to your vet next week while getting the next B12 shot.  Better to have too much B12 than not enough... besides Boss will just pee out any excess.

Let us know when the next pile arrives 

Olesia,

Thankfully we have no neighbors to see me, but my dear husband has gotten so used to me running around in the dog yard after Boss has done his business, with my measuring stick and camera in hand, that he called out to me when he was in the bathroom the other day "Are you gonna bring your measuring stick and camera in here or is it okay for me to flush the toilet?".   "No Honey,  I don't need to document your business, you go right ahead and flush".   

Isn't this normal conversation around EPI households?

1:30PM here and still nothing since 4:30AM...  that puts him behind by almost 2 piles from his usual schedule!!!