EPI * Exocrine Pancreatic Insufficiency

Hi, I am grateful I found your site about a month ago while doing some on-line research about our 15 year old Dalmatian. For the last year, she has lost weight and the stools have gotten increasingly softer and more frequent, she had even began having accidents in her own bed frequently.  Last month, after a course of antibiotics for a skin lesion, her stools got much, much worse. To make a long story short, I had her tested for  parasites and SEBO, that was negative but I got her Vet to prescribe the enzymes and we noticed improvement almost immediately. After 3 weeks on the Pancrelypase, she had put on two pounds, was eating very well, and her stools were completely normal. The only thing I noticed on the enzymes was increased thirst and urinne output, but other than that she was doing great. This week, I got a new batch of the enzymes; I had also began adding some ground beef to her diet, (previously chicken and rice, with about a half cup of her dry food, sometimes a little cottage cheese and yogurt). I am not sure if it was the new batch of the enzymes or the ground beef but for the last 2-3 days her stools got a little softer and yesterday she would not eat. Today, she had diarrhea with the mucous like before she was diagnosed, she doesn't want to eat, or drink for that matter. I am planning on keeping her off food today, I am given her diluted pedialite with a syringe every couple of hours to keep her hydrated, and keeping her indoors resting. I think she has had a set back and I am hoping to get some feedback from you guys on this. I know she is already 15 but she is otherwise healthy, very active, and frankly, we are not ready to part from her any time soon. Any advise is greatly appreciated.

Hi Dottie and welcome to our little EPI family.  Sounds like you are doing a great job with your baby..even with the set back.... and i know exactly what you mean when you say you are not ready to part  from her....

Increased thirst when initially starting on enzymes is very common with replacement enzymes... but it does go away.

Anyway...first it will really help us help you if you can tell us exactly what the strenght  (we need to know the Lipase, Amylase and Protease potency that is stated in USP Units on the bottle you have and what type...pills or powder.... and how are you administering it.

.. i just looked up Pancrelipase and this is what i came up with... which one are you using?

- Capsules 4,500 units lipase/25,000 units protease/20,000 units amylase

- Tablets 8,000 units lipase/30,000 units protease/30,000 units amylase

- Capsules 16,000 units lipase/48,000 units protease/48,000 units amylase

- Tablets 16,000 units lipase/60,000 units protease/60,000 units amylase

your comment: "I am not sure if it was the new batch of theenzymes or the ground beef but for the last 2-3 days her stools got alittle softer and yesterday she would not eat. Today, she had diarrheawith the mucous like before she was diagnosed, she doesn't want to eat,or drink for that matter. "  really sounds like SIBO.....(small intestinal bacterial overgrowth)... which means she would require antibiotics for 30 days...however, you said she got sick when on antibiotics for the skin lesions... was it Metronidazole that the vet gave her that made her so ill? if so...talk to your vet and discuss Tylan instead... for 30 days for possible SIBO. HOWEVER... if it was Tylan that made her ill... then ask your vet's opinion on Metronidazole, or, if because she is a Dalmation (don't they have bad reactions to certain drugs???) ask your vet's thoughts on treating her with Oxytetracycline.....

Sometimes although it doesn't appear that your dog has SIBO.... it might be there... lurking in the background and then, WHAM... the dog gets... *sigh*

The other thing would be a possible B12 deficiency.... is there any way you can do a B12 deficiency test on her (Cobalamin & Foalte testing) along with a TLI so you know for sure if it is EPI you are dealing with??  Regarding B2.... Just for the fact that she is a much older dog, she probably would benefit from getting B12... if she has a B12 Deficiency, then injections would be the proper way to treat ... however... even if she doesn't have a B12 deficiency... with older dogs, they are kind of like us... body starts to break down and things just don't works as well.........her B12 may not be optimally manufactured...and she might benefit from B12 pills by "Metagenics Intrinsi B12/Folate" pills

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

(I am probably over-whelming you... right about now... so i will only mention two  more things)... of course i will need more specific infor from you, but i would suspect that the enzymes you are giving her are not strong enough..if she positively has EPI (which it sounds like you haven't tested for, but that she immediately respnded to once given enzymes- - so i am going on the premise that she hs EPI)....... . all batches are not exactly identical, even though they test in quality control and try their best... the potencies are within specific ranges. Not sure if this is what is going on but it is possible... so she might not be able to handle the hamburger because she isn't getting enough Lipase concentration (digests fats) and my last thought is that she has a sensitivity to beef protein....and the hamburger set her off....

SOOOOOOOooooooooo before i confuse you anymore....i'll let others chim in and also wait for more details from you.

By the way,... i Love the picture of your baby with the multi-colored tutu :D... she looks like a real sweetie!

Dottie, to start with, are you incubating her enzymes with her food? If not, check the insides of her mouth to see if her lips mouth are irritated. The enzymes can cause burning making her not want to eat. Then let everyone here know how you are mixing her food with her enzymes. Start with 1 tsp. enzymes per 1 cup food then let sit out for 30-40 minutes before feeding. You may have to grind or soak the dry kibble so that it mixes well. Read the files well, there is a tremendous amount of helpful information, and others will be logging in shortly to help I'm sure.

Renee

looks like I'm a few minutes late posting this, the real "pros" are already helping as I was typing! 

Thanks so much for your reply; here is what she is taking:

Powder Pancrelipase, PancraPowder Plus by Butler, I get it from her vet.:

Lipase 71,400usp, Pretease 388,000 usp, Amylase 460,000 usp,  witth Vitamin A, D, and E/

1 tsp per feeding, she eats two times a day these days.

Although we did not run the blod work, (I guess they are not 100% conclusive) she did respond immediately to the enzymes, and like I said,  her stools had normalized within a week of taking the enzymes.   Her stool was tested for SEBO in the very begining, about 3 weeks ago, and it turned out to be normal.  I had discarded the though since the stools had normalized.  In addition, her vet had prescribed Fortiflora which I gave her daily in the begining and then every other day, (it seems to make her very thirsty). 

Dotties's story is long on account of her years so I don't want to bore you with too many details but she has had two skin cancer lessions removed and when she started the antibiotics she had a lesion on her underbelly that had gotten nasty from her licking it.  THis is why the antibiotics were given, itinitially a shot, followed by Clamavox, and then Cepodoxine,  The last one I only gave for a couple of days before the Diarreah got really bad.  But like I said, all of that was a month ago and she was doing great, with totally normal stools for 3 weeks until now,  THis is why I am thinking it was the new batch of enxymes or the ground beef, the only new things this week.  I have gone back to the vet and they excanged the Enzymes for a new bottle but I have not fed her yet. 
I had also read that if her EPI is do to pancreatitis it was best to withhold food for a couple of days.  THis is a no brainer with DOttie since today she is not intereted in eating.  I am leaning towards waiting it out.  That's what I did last time and it seemed to work.  I guess I need to make sure I should not try to feed her, I hate to think she is going to loose the couple of pounds she had managed to gain!

 By the way, my name is Betty, Dottie is the Dal.

Renee, you are as "pro" as any of us!

Hi Dottie.  Welcome.  I do have a question though.  What test was done?  Was it for SIBO which is the cobalamin/folate or the cTLI for EPI?  Knowing for sure what was ruled out would help.  Was it blood work or just a stool sample?

You guys are amazing; thank you!!!

I mix 1tsp of the enzyme with about 4 tablespoons of the rice and let it incubate for 15-20 minutes, I then add the rest of the food, cut up roasted chicken and a little bit of her kibble and mix it well.  I tried initially mixing all food with the enzyme and letting it sit for 20 minutes and found out she did not seem to like the texture.  When I started mixing it this way a couple of days into it she would it all right away and it worked fine until a couple of days ago.  There is about two cups of food total per feeding and she eats twice a day? should I p;ut more enzymes than the 1tsp per feeding?

The tests that were done for SIBO were done from a stool sample.  No blood work has being run on her but, like I said, she was initially constipated with the enzymes but then the stools became formed and normal looking within a week of taking the enzymes.  Her Vet thinks this is indicative of EPI, most likely do to her Pancreas not working well on account of her age.  She does so poorly on oral antibiotics I would hate to have to put her back on those.

I am relatively new to epi to just the end of jan. this year.

 But what maked me wonder is did you boil the hamburg and rinse of the fat if any. before i knew Anja had EPI i was doing thewhite rice hamburg little bit of kibble thing and didn't help the poop thing at all. but this was of course before i knew and before the enzymes.

My vet also thought it was not enough nourishment for her either. I would elimate on thing at a time or see if your vet could recomend a gastro type food something easy to digest, that is what i tried and it worked we went to a canned gastro for a couple of weeks and then went to a dry type. AND all this gastro food and enzymes started at the same time. It is soooo hard to be patient.  These are just my thoughts on the subject.

But sometimes our thoughts bring on other thoughts of someone else that works.

Good Luck and keep us posted.

Wanda.

Hi Dottie and welcome, although sorry you need to be here...

Karen is right, there are no experts here, just folks who have lived with EPI and can try to help.

Hi Betty.  Sorry about the mix up in names.  There is no real diagnostic test for SIBO, normally the cobalamin/folate is run.  Even that for SIBO is not conclusive.  With EPI, all things have to be treated, if needed, in order to stabilize.  Three things I am thinking here.

Due to Dottie's age, see if your vet is willing to start B12 supplementation.  Even older humans are found to be low on it.  It won't hurt, if you don't want all the tests run.  That may help w/ appetite also.

Second, see if he is willing to let you start L-glutamine to start healing the gut.

Third, and you won't like this, SIBO can make a dog not want to eat.  If after trying the B12 and you still have a prob, you may want to discuss treating or testing for it, via blood work.

From what I have seen, I'd start w/ the B12 if vet agrees, it was probably the burger that may have triggered this, as the enzyme should not have that much difference in strength, I wouldn't think.  beef intolerance?

If you were having normal stools on the 1 tsp/c food, stick w/ it, if you can get Dottie to eat.  Normally it is more, but ea dog is different.

You can try an appetizer, such as a sardine in the food to try to tempt Dottie to eat.  Some do parmesian cheese.  What Dottie likes, just a bit, to tempt.

Good luck.

Karen at April 24, 2010 at 9:02 PM

Hi Betty.  Sorry about the mix up in names.  There is no real diagnostic test for SIBO, normally the cobalamin/folate is run.  Even that for SIBO is not conclusive.  With EPI, all things have to be treated, if needed, in order to stabilize.  Three things I am thinking here.

 

Due to Dottie's age, see if your vet is willing to start B12 supplementation.  Even older humans are found to be low on it.  It won't hurt, if you don't want all the tests run.  That may help w/ appetite also.

 

Second, see if he is willing to let you start L-glutamine to start healing the gut.

 

Third, and you won't like this, SIBO can make a dog not want to eat.  If after trying the B12 and you still have a prob, you may want to discuss treating or testing for it, via blood work.

 

From what I have seen, I'd start w/ the B12 if vet agrees, it was probably the burger that may have triggered this, as the enzyme should not have that much difference in strength, I wouldn't think.  beef intolerance?

 

If you were having normal stools on the 1 tsp/c food, stick w/ it, if you can get Dottie to eat.  Normally it is more, but ea dog is different.

 

You can try an appetizer, such as a sardine in the food to try to tempt Dottie to eat.  Some do parmesian cheese.  What Dottie likes, just a bit, to tempt.

 

Good luck.

When you say it is normally more, do you mean more than 1 tsp per meal? About the B-12 shots,  I can probably talk my vet to prescribe them, how often should I give them and how much do you recommend each tine?

Because Dottie objected to the runny food the first couple of days, I began imcubating the enzymes in the rice and adding the meat right before serving, mixing it well of course.  Do you see any trouble with this practice? she does end up consuming the whole enzyme dose. 

She ate tonight although I gave her a little less food to keep her tummy from getting upset.  I will watch it closely and if she does well will give her a little bigger portion tomorrow morning .

Hello Betty,

Welcome to you and Dottie.  If you look up at the top of the page you should see where it says OVERVIEW, EPI, TLI, DIET, SIBO, B12, etc.  Click on the B12 and it will open up a link that talks all about B12 levels.  Scroll down to the bottom of that page and it shows the B12 dose and talks about the frequency.  Works great to print it out and take it into the vet with you.

Hi Betty (sorry i called you Dottie) and hellow to Dottie too!

So glad to see that you are using the replacement enymzes withe the proper potency ... i was worried that one possibility was that you were using too low of a dose of a product and that a possible difference within the range may have caused the set-back... but you are using the right stuff so scratch that off the list!

Thank you for sharing more of Dottie's details....In order to successfully treat EPI... even if it is most likely a results from Pancreatitis... (and now i understand why your vet feels it is EPI even though a TLI test wasn't done... since EPI often comes about with chronic Pancreatitis) ... to successfully treat EPI, there are 4 things you will need to address:

  Enzymes

  B12 (if needed)

  Antibiotics for SIBO (if needed)

  Diet

I agree with everyone here....talk to your vet about B12 ... (please go to http://www.epi4dogs.com/b12.htm) print and share with vet.)...if Dottie gets the shot, be sure it is the generic B12... not the B12 with additional vitamins in it.(the multi-one stings the dog and is weaker in B12 concentration). if you do not see any change within a couple of days after a B12 injection then i would move on to the big next change......antibiotics..

although I understand you don't wantto put Dottie on antibiotics....the fact that just a fecal test was done- - 3 weeks ago - - all was fine.... but now you have diarrhea with slime , she doesn't want to eat... still makes me think SIBO is at playhere also......SO................. because of her antibiotic issues...the gentlest wayI can think of to approach this is to down load an EPI Log http://www.epi4dogs.com/downloads.htm  .... record EVERYTHING you give Dottie.... make 1 change at a time, wait a couple of days, record her reactions .. Start with the food incubatnig & enticers (smaller meals) ... that way you can start this today... talk to your vet about B12 ...that could be in the next couple of days.... if no positive immediate reaction with that... then talk to your vet about anti.  For SIBO there are only a few antibiotics that will address it. Tylan, Metro and Oxy.... but please talk to your vet since Dottie has such major issues with antibiotics........

The way you are preparing the enzymes should be just fine.However....some dogs really do better if you let the enzymes sit in thefood- - but if Dottie won't eat.... then i can understand why youstopepd doing it.... but i would encourae you to go back to tryingincubation with an enticer... something REAL stinky...crumbed cannedsardine on top or canned herring (this is one of the stinkiest i havefound so far), or parmesan cheese, etc...

Last question i have... is the rice. EPI dogs don't do well with Fiber. They usually need reduced fiber.... but then some will require a wee bit of the right fiber added to their diet. (it can be very confusing)

Is there any way, as a trial an error 1 change at a time thing ,  you can remove or greatly reduce the rice for just a few days and see if Dottie does any better.... just a thought and something non-invasive to try.....

Hi Betty, Im new at this too!! The clavamox did nothing for my Sascha but give him urination problems. The tylan worked when he started getting loose stools a week after we started the enzymes also. It didn't take long for the tylan to kick in, it might be worth a try.

catherine

Hi Betty,

Nothing I can say other that I sure hope  things get better for your gal. You have a great support team here and every one will be pulling for you. Good luck.

Susan and Zorro

THANK YOU, THANK YOU, THANK YOU...to all of you. I can't believe this site. I am a dog lover with a capital L and have so often felt a bit out there. Most people I know can't understand why am I putting myself, and my family, through this with Dottie, at her age and all, but the truth of the matter is that Dottie IS family. It is obvious that on this site I'm not alone.

Today she is eating better but I have not seeing any poop yet, I will let you know how that goes when she does. I will certainly call the vet tomorrow about the B-12 and get her started on it right away.

To clarify, I only give Dottie about 4 tablespoons of rice that I use to incubate the enzymes, then mix it well into her chicken and a little kibble. I also feed her yougurt or cottage cheese right after she has consumed her main meal containing the enzyme. Like I said, this was working well until the setback last week but when you said to try to incubate with a sardine, (Dottie use to get them daily and loved them), do you mean I can add the enzymes to the sardine and feed that to her prior to the food or just place it on/in the food? Also, does any body have any suggestions where to buy the B-12 and syringes at a reasonable price? Wow, this is getting expensive but that doesn’t matter…

Hi Betty ~

:)... sometimes we may seem a wee bit crazy to the rest of the  world... but here.... everyone "gets us" and our love, care and concern for our dogs' 

Okay, so you are not feeding much rice at all....that's good... but if things don't shape up according to plan.... this still might be something you will want to try and cut out... just to see if it improves anything.... or not.........Dottie just might be one of those dogs that i mentioned that really needs a wee bit of fiber.... but it's worth trying as a possible elimination if you don't get the results you want.

Anyway... Yep... you can just place (or crumble ) the canned sardines on top of the food............ No need to put enzymes in the sardines....

When you talk to your vet about the B12 shots..... the way a lot of folks save money is to have the vet show you how to give the injections yourself and they will sell you the B12... this will save you money... OR... i think (but not sure because i do not have to do this... yet......hopefully others will chime it).... you may be able to purchase B12 yourself to do the injections with...

Clarification anyone on the B12???

DOn't worry... when you start getting near the end of the enzymes you ahve.... contact EnzymeDiane http://www.enzymediane.com/for 6x or 8x  generic Pancreatic and you will save 50+% on the cost of the enzymes.

Hi Betty - you are def not crazy - you are crazy in love, as we all are!   You are a wonderful mama and your dog is blessed to have come to you - other people would not go the extra mile like all on this forum do.  I do give Jackie B12 shots and the vet gives me 4 prefilled syringes and it is $60 for a mos supply (4 of them).  I feel like this is a lot and am wondering if I can fill them myself and save some $$.  I do give her the weekly shots and it is fairly easy.  Jackie has come to "know" the needle so I have to hide it and my husband gives her treats while I do the injection.  I REALLY don't like needles but would do anything for my girl.   As a PS - Enzyme Diane is a lifesaver also - I had no issue switching to her enzymes and the cost savings is amazing.  Keep up the good work and much love to you and your Dottie.

HI Betty (sorry, I called you Dottie too - I should have guessed based on your profile picture :wink:),

I purchase my B12 vial and syringes from my vet... I don't know where you are located, but here in MA it's illegal to get syringes without a prescription, so I just get the whole kit and kaboodle from them...The injections are very easy to give and a vial of B12 cost me under $40 and expires (in about 2-3 years) before I even use it all... Ask your vet or vet tech to show you how to do sub-q injections...They go under the skin and the shoulder area is usually the best place because there is excess skin there.  I've heard of folks practicing with an orange to know when you've penetrated the skin.

Good luck and let us know what your vet says!!  Yup, I don't think there is a one of us here who is not a dog lover with a capitol L!!!