EPI * Exocrine Pancreatic Insufficiency

Hi there!

I've been reading some of the posts and scouring the website, and this really sounds like where we need to be. 

 A little background:

Have a 10 year old Weim/Lab mix who at good weight was 55 pounds.  She had a bout of pancreatitis at age 4, but with great care from our local vet, she was back to normal within a month.  We did go on a completely homecooked meal schedule after that, and are stringent about it.  She gets brown rice, chicken, carrots, and green beans.  That's it- no treats, table scraps, etc.  She could not tolerate commercial food, and it worked wonderfully for the next 6 years.

Where we are today:

Had another bout of pancreatitis two  months ago, and it has been downhill from there.  Dallas now weighs a meager 32 pounds, and looks like she is just melting away.  Seems like every time we go to the vet she loses a pound.  After a few weeks with pancreatitis and no results from hospitalization, we decided to do exploratory surgery.  They did find a blockage and removed it (said it looked like bird seed?  She's not a yard scavenger, so we think it may have been undigested rice).  Expected her to improve, and she did not.  Back to vet, more antibiotics and IV fluids for dehydration, etc.  Went to old vet for consult (have moved to new city)- he suggest just mashed potatoes for a few weeks, then to add white fish.  His reasoning was that her Lipayse was extremely high, but her Amalyse seemed normal. 

That actually worked after 2-3 weeks, and her Lipayse came down from over 6000 to 3800. 

Well, this week we are back to where we started.  Her Lipayse is back up to 5800, and she is miserable.  Her little belly just screams bloody murder all the time (sounds like horrible gas), she is exhausted, has no appetite, and her muscles are weak and shaky when she stands.  Worst part is, we got our TLI results this morning, and the vet said they were NORMAL.  Ugh.  We were actually both hoping for an abnormal result.   What are the chances that she has EPI but got a normal result?   Didn't ask for the actual number, but I will.   The only symptom Dallas doesn't have from this site is the greasy poop- she has had bouts of super watery diarrea. 

We're at a total loss, she is completely miserable, and we can't stand to see her in so much pain.  Sometimes, she is our old dog, has a good attitude, and exhibits signs of normalcy.  But most of the time, like right now, she just wants to lay by me and sleep.  Hubby is ready to euthanize, she is just so small and weak and he feels horrible for her.  I guess the Mom in me wants to pull out all the stops and be sure we have given it our all before we have to do that.  She's such a great companion, but we just don't want her to be in any more pain. 

Sorry for the length, but we would love and truly appreciate any thoughts or suggestions.  Has anyone heard of anything that mimics EPI but isn't, or gotten a false normal TLI reading?

Thanks so much to you all! 

Kerri and Dallas

Kerri:

Welcome to the forum, but I'm sorry you've been going through so much with your girl.  It's heartbreaking to feel so helpless.  Okay...she's had the fasting TLI done?   Has she been tested for SIBO?  Have her B12 levels been checked?  Pancreatitis can lead to EPI but it should have shown in the test.  You said that she has "bouts" of watery diarrhea?  Akira did that as a puppy which is why we didn't figure out that she had EPI sooner...she didn't have diarrhea all the time so it appeared that it was a food allergy or something else.  When your vet said that the results were normal...did he give you a number?  Sorry to ask so many questions... 

Ahh Kerri, I feel so bad for you... That is the worst thing in the world to watch them waste away before your eyes and no matter what you do nothing seems to be working.

Linda already asked some great questions which will really help us better help you.. but in the meantime, even if this is not true EPI.... since Dallas has a history of pancreatitis.... call the vet and ask them to PLEASE give you some pancreatic replacement enzymes now!!!

The enzymes will not hurt Dallas in anyway on a temporary basis...until you can figure out what is really going on.

Sometimes, a dog does not have EPI, but the pancreas is so damaged that it ceases producing the enzyme producing  activity resulting in what you are describing....in short, it needs help for something else to do the digesting giving everything time to heal... once this takes place, then you can stop the enzymes.

OR...... Dallas is indeed developing EPI, in which case, nothing heals... once the damage is done, it is done... and you will need the enzymes forever. (but if this is the case, we can set you up with bulk-priced enzymes and save you almost 50% of the cost.

The other thing that i would insist that the vet do is to give Dallas a B12 shot... if she has been wasting away, no energy, she most likely has a B12 Deficiency.... a dog doesn't have to have EPI to have a B12 Deficiency This is another case of no harm will ever come from giving a dog B12. If they do not need it, they will just pee out the excess. B12 is a water soluble vitamin.

There is a lot more but for now... start with enzymes and B12, (and also ask the vet if he/she feels a for a prescription of Tylan for for 30 days for SIBO would be appropriate) .... and download and EPI log from http://www.epi4dogs.com/downloads.htm

and record everything you give Dallas and how Dallas reacts... this will greatly help you figure out what is going on with Dallas. Honest.

Let us know what your vet says.

Oh. so sorry... i forgot to welcome you.

WELCOME to you and Dallas.....we will share all of our expereinces and hopefully something will help you and Dallas!

Hi Kerry.  Sorry you are going thru this.  If the test was normal, I'm gonna say this is not what you are dealing w/.  I know, as bad as it seems, we want to know something.  Have you thought about seeing a specialist?  When they did the surgery, did they do any biopsies to rule in/out IBD?  It sounds as though that would be a possibility.  I'd see an IMS to find out what is going on.  You may want to think about a prescription food for now, also, until you find out what is going on.  They are easier digested.  Good luck.

Hi Kerri,

Oh, I can feel the despiration in your words and my heart is breaking for you...You have already been given some wonderful advice, but I want to ask you, has Dallas been on Metro before and if so, has it helped?

As Karen mentioned, they should have done biopsies of the intestine during exploritory (at least I thought that was a part of the reason why they do it). With recuuring pancreatitis, the dog is usually getting more fat than their body can handle and I think the fish and rice is probably a good choice, but some of the prescription diets do address other factors that we cannot control with a homecooked diet, like making a protien a dog may be allergic to not seem like a protein for the dog's body...

I'm sorry you need to be here, but we're here for you...

Thanks guys- you are all wonderful!!

Talked with the vet this afternoon, and we decided to proceed with the Viokase until we can figure it out.  Dallas had her first meal with it tonight and seems okay, she is resting comfortably.   She said it would not hurt if it wasn't EPI. 

We're also going by the office tomorrow for a B12 shot!

I'm wondering if her TLI count was not correct for some reason- it was 12.4.   The vet is thinking that the course of prednisone caused the pancreatis flare-up last week. 

She had a course of metrozonaide (sp?) last month after surgery for 3 weeks to clear up any leftover issue.

Will post again tomorrow after the B12 shot and 2nd meal.  Will also post picture of our sweet girl and her sister!

Thanks again!

Kerri

Hi Kerri

Did you fast Dallas for 12 hours before the blood was taken for the test?

Sometimes not fasting will give the wrong reading.

Either way its good to give some enzymes before its figured out and maybe when things heal a bit you will see better results.

Sending prayers and good vibes your way.

Val

Kerri:

Just checking in to see how things have gone since giving enzymes and the B12 shot.  Keeping good thoughts...

Phew!!! So glad your vet put Dallas on pancreatic replacement enzymes temporarily until you can figure this out.... AND that She is going to get a B12 shot today.

Please do let us know how Dallas does after her B12... if her energy levels perk up a bit, increased appetite, etc.. And of course we would love to see pictures.

Val asked a good question... Was Dallas fasted for 12 or more hourse prior to her TLI test (for EPI) ? And was the blood sent to the lab Monday, Tuesday, or Wednesday?? If  not fasted OR if the test was done on Thursday or Friday, (this means that the blood sits around in a package at the lab and not tested until Monday)  the results will be skewed.

Yep, some dogs cannot handle prednisone... I think Karen's Hondo has issues with it too.....

If you can, do look into the down loading the EPI log that i mentioned earlier... even if not EPI, by keeping track of everything it can really helpfigure out what is going on....you'd be surprised at what all of a sudden jumps out at you, once you start keeping records!

Looking forward to hearing from you later today

Hi all,

Thanks for the great advice.  Got our B12 shot around 4:30pm this afternoon.  No change yet, and have had trouble getting her  to eat.  Vet said it's ok to let her eat any starch (since her amalyse has been the lower enzyme, and it would be easier on her belly) and withhold any meat/protein for now.  She's going through waves of what she feels like eating- some days mashed potatoes, some days noodles, some rice... and she turns her nose up at anything else.  Tonight she tried to eat a piece of bread out of my hand, so that was dinner.  Not ideal, but at this point, if she'll eat ANYTHING, we are happy.    She does not like the Viokase though, so that is a little bit of a challenge. 

The fasting test was last Saturday.  It was exactly 12 hours from meal to blood draw.  Thanks for the encouragement about the result and the test sitting around- the vet and I discussed this, and he agrees that it could have been a skewed result.  (For anyone curious, we actually have 2 vets at this clinic- Dr. Heather and Dr. Tim, both of whom are extraordinary, and have taken Dallas' case on as their personal challenge.  They conference every day to catch up on which one talked to me or saw Dallas that day- fantastic!)

After talking to Dr. Tim today, he is thinking that either it is EPI, some other form of malabsorption, or her intestines are shutting down.  Unfortunately, we can't treat for that last one.  She hasn't pooped since Tuesday, but it's not exactly terrible- she's not eating much, so maybe she is absorbing everything she's eating.  Too bad we didn't do a stomach/intestine biopsy during surgery, but she's too weak for that now.

Hubby and I decided to keep our appointment to take Dallas to Memphis on Saturday to see our vet of 10 years, Dr. Parker, with Dr. Tim's blessing.  Everyone is hoping that Dr. Parker will think of something different to try.  Thanks so much for listening- it definitely helps to bounce things off folks that have been there.

Below is a photo of our sweet girls when Dallas was well.  Dallas is the Weim/Lab mix, Kaylie is the Yorkie.

Kerri:

Keeping good thoughts about your appointment on Saturday.  I have one who was a nightmare when it came to mealtime.  She just truly isn't terribly interested in food in general.  I can't tell you how many meals I've sat on the floor with her and cried.  Well...I should add that it's much better now than it used to be but it's been a learning experience on both of our parts.  I had to come up with an alternative way to give enzymes because she wouldn't touch food with them on...what we do works for us.  I feed kibble but the teasers are ever changing with each meal.  Please keep us posted and know that you and Dallas are in my thoughts and prayers. 

Your picture didn't come through...if you can't get it to work, email it to Olesia and she can post it for you.  There's a thread on posting photos that might help too.

Was the PLI test done for pancreatitis?  Just wondering if you knew for sure that it is pancreatitis you are dealing with also?

Good luck with your vet in Memphis.  I hope they come up with something else to try to get her back to normal.  I just wonder if scoping would be something to try to see what is going on.  Have they done xrays or ultrasound?  Those may show something, also.

Ahh Kerri~

Thank goodness you have fabulous vets!  They sound wonderful!!

I am hoping today shows some improvement, even a tiny bit!  I hope your visit wtih Dr. Parker yields some more ideas.

One of my dogs doesn't do well with mashed potato or noodles... So I have learned to use Tapioca. I soak the Tapioca small pearls in water for 30 minutes, beat up a few eggs, throw them in and then bring to a boil while constantly  stirring. I have found this "starch" to be the kindest on his stomach  (and even my EPi gal seems to be able to tolerate tapioca )

I also cook oats and use that.... but for my dogs, it seems that the Tapioca is by far the easiest to digest especially when they are having "issues".,

Anyway, I do not know if this will work for Dallas.... but I am just mentioning this in case you are ever looking to try another "starch"  ingredient to your arsenal of what to feed Dallas that would be gentle on her gut..

Of course, right now you are just trying to get her to eat... that is so FRUSTRATING!

Your Photo did not come thru.

upload your photos in  http://photobucket.com/

copy the "direct link" that is assigned to your photo in photobucket

then... go to the FORUM and prepare to respond with a reply ( a "Post A Quick Reply" )

see the "blue box" next to the smiley face, click on that and past that "direct link" that you copied from photobucket.

Your picture should appear in your FORUM response.

Looking forward to hearing from you today and hearing how Dallas does............

Linda- I would love to know your alternative ways to feed the enzymes.  Dallas has not liked them AT ALL. 

Also, the Tapioca is a great idea- I will have to try that.  The last few days, mealtime has been a huge struggle.

Last night out of total desperation, we went to our local Humane Society retail store- our vet suggested we try them for food options if we needed.  The lady there was wonderful- we tried a couple different things, and Dallas really liked the Innova.  She said it was specifically for pancreatic Scnauzers, which is perfect.  7% fat, 18% protein. 

When we got home, Dallas ate about 3/4 of a cup and then drank water, which was the first time she's voluntarily gotten a drink of water.  Had to poke the enzymes down her though, and she was unhappy the rest of the night. 

She skipped breakfast; just not interested.  Seems like we have a good meal, then a day of no meals. 

We're driving to Memphis to see the vet, but I pulled out my laptop to post.  Oh- to answer the test questions above... 

We have not had an ultrasound or xray since the surgery.  Vets really felt like it was an intestinal or pancreatic thing, not another blockage or mass.  I know they took her stomach, intestinal tract, etc, and gave them a good once over while she was under. 

Don't think she's had a PLI?  They say pancreatitis bc her Lipase has been higher than 6000 at one point.  Dropped to 3800 a few weeks ago, but last week posted at 5800 again.  Her Amalase has been the lower of the two, which is why we were feeding mostly starch.  They are wondering if when we go on the proteins (aka chicken), that is what is skyrocketing her Lipase??  At this point, no one really knows for sure what is going on.

Had a few rabbit poops yesterday morning (yay), and then a little green runny moment last night.  She tried this morning, but nothing happened.

Thanks and I'll fix the photo thing when we get home.

Have a great Saturday!

Hi Kerri~

Keep trying with the Viokase, and hopefully Linda will chime in, and others too regarding ways to hide the taste of the enzymes....but if Dallas continues to completely refuse food because of the enzymes... you might want to check out CREON capsules. One of our members here, Frank, did a amazing job on where to get CREON, what dose and how much it will cost.  Since you are traveling with your laptop.... when you get to Dr. Parker, ask his opinion on this suggestion.

Also... read the thread "CREON pricing"

CREON are enteric coated granules in capsules, do not break open and are not needed to incubate on food as instructed for all other enzymes.

CREON is commonly used in many places outside the U.S.  The CREON enzyme capsule products comes in 5, 10, 20 strengths.  The one that seems most suited to treating EPI dogs is CREON 10 which has 10,000 USP of Lipase,37,500 USP of Protease, 33,200 USP of Amylase. And you can also increase the dose if needed

Hmmmmmmmmmmmmm... I am wondering if she ate because the B12 kicked in and increased her appetite??? However, briefly.

If you want privately email me your home address and i can send you 8 Metagenics Intrinsi B12/Folate pills... for B12.

All my dogs get these. You can give these twice a day to Dallas for 4 days (that ought to carry her to her next B12 injection) ... if her appetite picks up... then it means she needs the B12 but she is not maintaining the B12 weekly injection for the full week (we have seen this happen with some dogs that just don't do well and no one seems to be able to figure out what is going on).

Talk to Dr. Parker about this, and you can email me privately: olesia@insightbb.com

Hi Keri,

Like Linda's Akira, Tara was a terrible eater...I could not put weight on her for the life of me simply because she wouldn't eat...The B12 helped a lot, but it it was still inconsistant eating.  I used to make make capules out of the enzymes and pill her, but I could never tell when she was going to eat, so I was a bit fearful of putting all those enzymes into her when she decided to just say "no" to food (yes, I know they will not hurt, but she also had ulceration in her pyloric opening and I didn't want to aggrivate it. Not to mention I was spening hours and hours every week making capsules...

Linda, puts her enzymes in meat baby food first and makes Akira eat that first, then immediately serves her the meal...Yes, I know neither one of these methods are suppose to work, but guess what...they did/are working.

I was asked to foster an abandoned GSD who was on her euthenasia day at the shelter and my first question to the shelter was, "Does she LOVE food?" They assured me she in fact danced for food...I agreed to foster her, and adopted her shortly afterward...Yup, my Zoey still dances for food and when done, gives Tara the "Hey Mikey, are you going to eat that?" look...Since we got Zoey almost 4 years ago, I've not had any issues with Tara eating...While I realize this is not an option for many, it's what worked for us...

I still have to add things to Tara's meal to make it interesting...We add fruit, veggies and cooked meat to her kibble and so does Linda...Both of us have to mix it up often to keep these girls from getting too bored with their food, but they are both eating now...Heck, I've even added BBQ sauce before Zoey to get Tara to eat!!!!

Linda, I hope you don't mind that I answered this and please correct me if I'm wrong on any of the details.

I've spoon fed Tara, lit candles for ambience, played classical music for a soothing effect and yes, have cried many, many, many times when Tara went 3-4 days without touching her food...It's not a fun place to be, I know...

Hi Keri:

Sorry I'm so late in answering, but today regionals were held for Battle of the Books and one of my granddaughter's was on a team that was competing. 

Donna...why on earth would I care that you've shared information about Akira and the way she eats or what I have to do to get her to eat?  I trust you...feel free anytime.

Because Akira has been a challenge (to put it mildly) to get to eat at all...I've had to be creative.  Like Donna, I've hand fed, fed by spoonfuls, tried music, atmosphere, kept things quiet and calm during meal time...all kinds of things.  I'd tried sooooo many different additions to her food.  She's one that if you drop raw meat on the floor...or anything else for that matter, she might sniff it but usually will just walk by.  I've never had to worry about the grandkids feeding Akira goodies, because she just hasn't been interested for most of her life and this started from the beginning when I brought her home at 8 weeks of age.  I'm not just talking about a meal here and there...Akira just didn't care to eat period and if it had been her choice, would go for many meals without food.  However...I had different ideas.

When I started Akira on enzymes, I figured out quickly that the best way to use them, just wasn't going to work for her.  There was "nothing" that I could add to her food if enzymes were on it, that would make a difference.  I filled blank capsules with enzyme powder and gave them before her meal for a while, but it was kind of a pain in the neck, and I had to give her so many to equal 2 teaspoons that she'd kind of balk a bit by the end of the dosage.  I tried putting enzyme powder in many different things...from ice cream, to yogurt, or broth, green tripe...well you get the idea.  I had some baby food here because of one of my grandkids, and decided to give that a try one day.  Most "flavors" didn't work, but meat baby food seemed to interest her.  I start with a rounded teaspoon of meat baby food, add a bit of water...and then mix the enzymes in very well.  I make it a slightly warm mixture...so if it's in the refrigerator, I put it in the microwave after I've added the water for about 9 seconds...or add hot water from the tea kettle.  It looks like a very smooth gruel when I've finished mixing it and if you'd like I can take a picture of it lol.  She doesn't always want to eat it, and somtimes will even shudder but she knows that she has to and it's the one mixture that I "can" get her to eat.  As soon as she eats her enzyme mixture, I put her food down and she eats that.  She's learned over time, that she has to heat and it's become much easier over the years, but...if there's a distraction of any kiind, she'll walk away, if I don't stand right there, she'll walk away, if one of the other animals approaches her food dish, she'll walk away...well, you get the idea.  I stay put, I make the grandkids sit quietly while the dogs are eating and I make sure the cats are outside.  Indy won't touch his food until Akira is nearly finished but won't approach her food...it's an alpha thing.  Her meals consist of 1 1/2 cup kibble (she'll rarely eat more than that no matter how much I put in the dish), with whatever additions I include in that particular meal.  It can be anything from boiled meat, to veggies (steamed), yogurt, sardine...and that's normally about 1/2 cup of any of the above or mixture of those things.  She does fine with green beans although not all dogs do, and she likes shredded steamed carrots.  If she's less interested than normal, I sometimes will add mac and cheese with the meat because that's one thing that I've found is a great "teaser."  No, it's not necessarily healthy but neither is not eating.  After I add whatever the day's menu is, I add some very warm water and mix the kibble/teaser mixture well.  I've never had a problemm with mouth sores, and that may be the reason.  Akira can have a treat if she has enzymes in her tummy....say within an hour or so of each meal so right after each meal, she gets a small treat. 

I've noticed that she's showing more interest in food lately...which is very nice.  I know that what I do, isn't what's suggested and some people will tell you that it doesn't or can't work.  Akira has had EPI since birth, and she's going to be 7 in September.  She's healthy and active so something is working right.  The vet is pleased with her over-all health...what more can I ask? 

Hope this helps...

HI Kerri ~

Just checking in on you and Dallas.... also wondering how the vet visit went...........

Hi guys- sorry I am just now posting.  After seeing Dr Parker, we went to my parents' house and spent the rest of the weekend with them.

Dr Parker's biggest comment was that "her mind is willing, but her body is weak."  He says her intestines and stomach seem extrememly thickened, and he is not sure what would have caused it or how to stop it.  She has a great attitude, but like he said, just no energy.  Her poor muscles twitch after standing for a few minutes. 

He said we are doing the right thing by trying the enzymes, but it might not have been quick enough.  He was worried that at this point she's likely to tear a muscle or break a bone from weakness, and that we need to be careful of that.  His suggestion was to give the enzymes another few days, but without results, we would be better off putting her to sleep while she is still not in major pain.  We trust him completely, and if he didn't see anything new to try, then we know we have tried it all.

She ate a little of the Innova Saturday (after tearing into it Friday night), and then didn't want anything Saturday night at all.  I ran to Kroger and got some baby food since Linda's kid likes it.  That was a charm.  The only thing she liked was the Gerber meat sticks, but I was able to poke the enzymes into those, and then mixed some pieces in half a jar of Beef&Veggies, which she ate fine.  Yesterday morning she ate a little of the leftover Beef&Veggies, but nothing to write home about.  Last night she ate a little of the Ham puree, but again, not enough to sustain her.  Today- nothing.  She absolutely will not touch anything I offer her, even her favorite treat of crackers.  She's completely listless, and while she doesn't look like she's in pain, she just seems exhausted.  Her little tail wags, and her ears perk up, but that's it.  When you mention "eat" she seems interested, but then completely turns away when she smells what you are offering her. 

I have cried most of the afternoon, and feel like we are reaching the inevitable.  I just don't know what else to do.  I have a human B12 shot of 1.5ML that I could give her today, but I certainly don't want to prolong anything for her. 

Have talked to hubby and considered making the appt tonight, but cannot seem to make my fingers dial their number.

Thanks for listening, you have all been a wonderful support system to have, EPI or not.

Kerri