EPI * Exocrine Pancreatic Insufficiency

After a three-month hiatus, Milo-Moooooo is back, but not with good news.

As some of you who have been around a while might recall, Milo was diagnosed in March 2009 with cTLI of ..04.  Grain-free kibble and enzymes stabilized his EPI within 72 hours (good poops!)  He also had SIBO, which was treated first with metro, then tylosin.  At dx he weighed 58 pounds, and by January '10 he was pushing 85 pounds, probably a few more pounds than he needed.  He had been stable for nearly a year, off tylosin for a long time, and now his SIBO has returned with a vengeance. It probably started when I changed his food to a higher fat kibble than he had been eating, and I was also adding ground beef to supplement. I stopped the ground beef in February.  In February cobalamin was 286; folate 12.1. Things started to go south in March.  He was back on tylosin starting March 28.  Tylosin dose was increased from 1/4 tsp to 3/8 tsp per meal.  Throughout April, at the urging of some other members, I was gradually adding to his menu:  Metagenics, L-Glutamine, NOW probiotics, most of which caused soft serve to become cow-pies. 

He needs a food change back to DVP Natural Balance at 10% (min) fat.  I think Milo is one of the EPI dogs who cannot tolerate any higher fat, ever.  However, it is not the right time to do the food change, as he has now been taken off tylosin and probiotics.  After stopping the probiotics, poops started to get a little bit better.  He is now, as of yesterday, on amoxicillin 2x a day.  Morning meal is reduced from 2 cups to 1-/2 cups, since he never finishes it anyway.  Evening meal is still 2 cups but he doesn't finish that either.  It is quite rare when he will eat a full meal at one time.

He has gone as long as two days without eating anything.  Energy is lower than it used to be, and he is sleeping a lot.  Play will last for about 3 tosses of his favorite toy, then he quits.  He will gladly ride in the car, but doesn't want to go out and walk.  He keeps trying to turn around and come back home once we get about a block away.

The goal is to go back to square one -- where we were a year ago -- and start over with no supplements other than the amoxicillin until we can get this SIBO under control.  Then gradually do a food change and after that slowly re-introduce some of the supplements, but not all of them.  Another cobalamin and folate check will be done in June.

Meanwhile, and the point of all this, really, is that I have a very beautiful boy here who simply does not like to eat -- no matter what it is  He has lost nearly five pounds.  He still looks good, and losing the five pounds certainly didn't hurt, as he was getting a bit overweight.  So, I'm not concerned about his having lost weight, but I am extremely concerned about the reasons, the causes. 

I have used every enticement / teaser ever mentioned having been used by anyone.  Either nothing entices him to eat, or he will eat the enticement for a day or two then stop eating altogether again. 

Vet does not have a clue, as usual.

Well, I thought I could keep this brief, but apparently not.  I wanted to provide as much info as possible in case someone has some ideas I haven't tried or thought of yet. 

I have had some excellent help and advice from three other EPI dog owner who have dealt with SIBO in a major way. I probably would not have gotten this far without them.  However, something is just not right yet, and I think we are all stumped.

I know everyone thinks their own dogs are the most special, and that is as it should be, but Milo is one very special dog in so many ways.  It has been difficult for me to give him all that he needs, but I'm struggling along to do it.  But now, I don't know what he needs.  He does need your help, and trust me, he is very much worth saving.

Hi Lanie and Mr Milo,

I'm so sorry to hear that Milo is having a hard time at the moment.  I've quickly read your post but I want to go back over the information you've given again so will come back later.

The eating thing is a real bummer, Holly (Bonnie's sister) has gone 3/4 days at a time without eating, just walks away.

Is it because her tummy is unwell or she just has no appetite???????? She has boundless energy and is a skinny thing.. My sister tried every single food, wet and dry, cooked and raw..... she eats for the first day or so and then walks away.....My sister tried this cheap moist kibble brand and she cleaned the bowl, she's then introduced a better kibble a bit of a time with the cheaper one as a topper and she ate.  Its so frustrating.

Speak soon

Hi Lanie,

Yup the eating thing is a real bummer, as Debra said...I cannot tell you all how many things we tried to get Tara to eat...

Milo was doing fine on Natural Balance before, so why not go back to what you were doing?

Hi Lanie & Milo,

Wish I had some suggestions for you, but unfortunately we are very limited in our choice of foods over here.  We only have one grain free kibble available & that is Evo, & again, not all varieties.    I really feel for you with the eating thing.  We just went through a bad time a few weeks ago & Megg stopped eating.  It absolutely frightened me to death but once the anti's kicked in, all was fine.  We all know how you feel;  it's just so frustrating.

I'm sure others will have suggestions for you.  Hang in there & please give Milo a hug from me & my girls. 

Lynn & girls.

Donna at May 15, 2010 at 7:52 PM

Hi Lanie,

 

Yup the eating thing is a real bummer, as Debra said...I cannot tell you all how many things we tried to get Tara to eat...

 

Milo was doing fine on Natural Balance before, so why not go back to what you were doing?

Donna,

That is the plan and the goal.  However, I don't want to risk changing too many things at once.  He first needs some time for the amoxicillin to work and some time away from the probiotics that made him worse.  We are gradually going back to where we started, with Natural Balance and enzymes, and probably L-Glutamine.  We might try the probiotics again, gradually, after a food change back to NB, just to find out the degree of his level of intolerance to them.  Yes, I am very eager to get him back to NB.  It has become apparent that the lower fat in the NB is what works for him.  Thanks!

Hi Lynn.  I've missed your smiling face and seeing your girls.  Yes, this is certainly frustrating to say the least.  It is encouraging to know that Megg responded well to the antibiotics and is back to her usual self again.  Milo and I thank you for your support, and Milo says hugs back to your beautiful girls.;-)

Lanie ~

From what you posted... what jumps out at me is that for an EPI dog.... Milo's B12 is low. Which would explain is lack of energetic enthusiasm and lack of interest in food.

Many times, when the B12 goes down, it just plumments..... seemingly overnight after a period of things being fine and dandy.

Might want to some give consideration to B12 injections or supplementing with Metagenics Intrinsi/B12 Folate pills.....

Oh my goodness, looks like something happened when I posted to Lanie earlier on.  That huge gap appeared in another posts also if I remember correct.   Does anyone know why?  I have no idea. 

Olesia, perhaps you can fix it as it does look as if there's nothing else on the page & you have to scroll down quite a way to see the next post.  Thanks heaps.  Hope it doesn't happen again now. 

Lynn

Oh No Lynn, Gremlins again at work! 

Olesia, I think you may need your toolbox.................Where's Frank?????

Hi Lanie,

Apologies for the delay in getting back to you....... I have some gremlins of my own!!! 

After reading your post, I've had a few thing going round in my head, bear with me and again its only my observations.

B12

Milo's B12 is on the very low end of the scale - Bonnie's was a bit lower than Milo's, she was battling with SIBO and looking back on her B12 results now, I see this was never addressed.  It was when I found this site and it was climbing up well and SIBO bouts were tailing off.

Food

Now this is a hard one and probably one we fear changing the most:ohmy:.  I agree with you that Milo possibly can't tolerate the higher fat content and is probably having probs digesting it leaving some fermenting in his stomach possibly adding to SIBO problems... You know Milo better than anyone and whether you can do a cold switch,  if not start to introduce the lower fat food now.  My reasoning is he is on antibiotics for the SIBO so thats being addressed and any help he can get with easier digestible food will benefit him.

Did you up the enzymes to accommodate the extra fat content of the new food?

What about giving him three smaller meals instead of two, this would also give him three meals of his original food being added and not so much of a shock for his tum. As to trying to get Milo to eat, well that has all of us stumped.  My sister, out of desperation did resort to opening Holly's mouth and placing food in there for her to get a taste of it (drastic I know) half she spat out and half she ate, after three goes of that, she then went and ate all her food:roll:.  Will he eat out of your hand?...

I know a bad habit but needs must sometimes, whatever it takes as we all know.

Apologies if you've tried any of the above.... give Milo a big hug, he is a special boy.

Hi Lanie,

Glad to see you back.  It sounds as if Milo has been to hell and back.  I'm not very well versed in SIBO since Ayasha had it once when she was diagnosed and the 30 day treatment of metro took care of that, knock on wood.  As for B12 issues, I am also not well versed, knocking on wood a lot more.

About the only thing I can suggest is go back to basics.  Go back to where Milo was stable.  Like going back home where all was well and safe.  Go back to DVP Natural Balance. 

If this is a financial burden, e-mail DVP products.  The following is from the Facebook page of Dick Van Patten's Natural Balance Pet Foods, Inc.:   "If you have any specific questions or concerns regarding Natural Balance products, please contact our customer service:

info@naturalbalanceinc.com   or call  800-829-4493"

This may sound foolish, but you may want to go to the DVP facebook page and write about trying to get Milo well with DVP food.  Tell the whole story.  This could be a financial bonanza for them by sending you a couple of bags of food.  They couldn't pay enough for this kind of advertisement for DVP.  A happy customer will tell a few friends, a pissed off customer will tell every person he knows and people they don't know.  It doesn't hurt to drop names like www.epi4dog.com member (261 members), k9-EPIGLOBAL@yahoogroups.com (1624 members),  k9enzymes@yahoogroups.com (592 members) 2500 people have lots of friends.

Giving suggestions is easier than giving solutions, but that is all I got for you at this point.

Debra,

I'm here, but I am not a miracle worker, just a P.I.T.A..  I know absolutely nothing about this web site's inner workings and don't know if I want to go down that road of learning.  Sometimes ignorance is bliss.  Sorry Olesia.  you have more guts than I do on starting a web site.  I have had a web page for three years and it is still nothing more than a list of directories.

Frank

epi4dogs at May 16, 2010 at 3:22 PM

Lanie ~

From what you posted... what jumps out at me is that for an EPI dog.... Milo's B12 is low. Which would explain is lack of energetic enthusiasm and lack of interest in food.

Many times, when the B12 goes down, it just plumments..... seemingly overnight after a period of things being fine and dandy.

Might want to some give consideration to B12 injections or supplementing with Metagenics Intrinsi/B12 Folate pills.....

Yes, I knew his B12 was low from the last test that was done.  He has been on Metagenics, but I had not considered the possibility of adding injections to that.  It might help with energy and appetite, as the Metagenics has not seemed to affect either one of those.

Debra,

You're right, his B12 is low, and he has been getting the Metagenics for a few weeks with no notceable change from that so far. 

The enzymes are being increased as of today.  He has been getting smaller meals more often, but he has set his own schedule these days as to when he will eat and how much.  Usually it is no food or maybe a couple of bites.

He won't eat out of anyone's hand.  I think he must have trained that way by his former owner, who must have been pretty strict about that.  What he won't take out of someone's hand he will then eat if it is put into his dish.  That is just for some things, though.  If he doesn't want it, he puts up a really strong resistance.

Thanks Debra, and Milo thanks you for the hug!! :-)

Hi Frank,

I can't tell you how many times I have emailed and phoned that company.  Occasionally they will mail a coupon for $1 or $2 off. 

I think that is a great idea about Facebook.  We can shame them into helping those who use it!  Good thinking.

Lanie

Hi Lanie,

My sister started using Metagenics just after Christmas and it did take a while, five/six weeks before any improvement was noticed. Probably a kick start with injections if finances will allow and then carry on with the metagenics.  There is definately a link with B12 and low appetite and digestive problems.

From a human side, My Mum had poor appetite and tummy problems last year.  Through the information shared here, I thought I'd apply the same principal to our dogs and requested the Dr give her a Colabamin/folate blood test, it showed her levels were extremely low and the folate indicated bacterial infection, plus her iron was bordering low.  After a course of B12 and iron supplement there was a marked improvement about 6/8 weeks after taking the B12, appetite improved and digestive problems settled. Her B12 is now up in the acceptable range and she's stopped the B12 and so far so good with appetite.

It is very upsetting when you have a dog that just won't eat.... by the way, would he eat the food without the enzymes, could it be that turning him off?  Another thought is perhaps he doesn't feel well inside to eat, no appetite.

In my observerations with my sister when she fed Holly, she was so dejected when she started to get Holly's food ready... she was already in the state of mind that Holly would walk away, the poor woman had gone through bags of kibble, tasty dishes, etc she was at her wits end, the dog was so thin.  I didn't live with that on a daily basis so when I asked to feed Holly, I of course was upbeat, bounced around with her, talking to her as I was getting her food ready, dropping her a kibble as I was doing it. I then put her bowl down and sat with her, moving around the kibble and she started to eat.  She did that every time I fed her, not always finishing it but at least getting a good bit down.

I suppose what I'm trying to say is did Holly pick up vibes from my sister and didn't feel good? meal times were bad times???? I don't know, its just an observation and a very easy one from someone not living with a dog that won't eat.

Could you try someone else putting his food down, knocking him off guard of his mindset?  What did help one friend of mine was to put his food in a kong rather than a bowl again taking his mind off of the usual routine (I know this is rather more challenging when using food mixed with enzymes but perhaps worth a try.

With my sisters dog Holly (Bonnie's sister for those of you who don't know) I think it was a physcological mind block to the food, its been a good two years of walking away from her food.  My sister added a puppy to the mix before Christmas, it didn't make much difference in the beginning, Holly then started eating out of Ruby's bowl, so it just kept getting topped up but for the last 5 weeks Holly has finished her meal AND eaten the extra put in after..... and she has turned meal times into a game with the pup, Ruby so wants to get to Holly's bowl and now Holly guards it.  I watched her last night in fact, she stood and waited by her bowl till Ruby had finished her own meal she then went up to Holly, Holly pushed her away and started to eat all her food with Ruby dancing around underneath her for the odd kibble to escape!!  My sister is one relieved lady, its released the tension build up of meal times too.... fingers crossed it continues.   Its trying to find that trigger to unfreeze the block when there's no obvious signs of illness etc

Who said having dogs was easy?

Milo is BEAUTIFUL and def keep working with him - what I have learned is that you manage EPI...you kinda juggle and keep the balls in the air and most days are fantastic.  Def look into the B12 - I give jackie weekly injections and it made a def difference...Good luck with your beautiful boy...

Milo's appetite is a little better last night and this morning -- not a lot, but better.  Poops are not better yet.  But, I think the amoxy is starting to kick in.

Debra, about the injections, they are dirt cheap--a lot cheaper than the Metagenics.  A bottle of B12 lasts a long time, and the clinic gives them to me free.  They can do that because they get a lot of freebies from the manufacturers reps.  We were doing injections the entire time he was stable.  It was when I took him off the injections and changed food that everything started to go downhill.  I do think he needs to be back on injections.  For now, it is just a waiting game, taking one step at a time, and trying to be patient!

No, sometimes having dogs is not easy, for sure.

Thanks, Michele.  Jackie is also beautiful.  102 pounds -- he's a big boy, isn't he!:)

Hey Michele,

I think we could all join a Circus with the amount of juggling going on:D.

Jackie's profile picture is beautiful................Hmmm, are we due some more photos:roll:.

Duhhhhh -- I meant to say the clinic gives me the syringes free, not the B12.

Did someone say more photo's................ Yes please

Michele, think it's time for some more of your beautiful Jackie & Lanie, how about some of Milo too.  What a gorgeous profile picture you have also. 

Lynn & girls. 

Hi Lynn & Girls.  I'll try to get some photos on here -- soon as I get around to re-learning the process of getting them here from photobucket.

Meanwhile, we are still battling SIBO, but he seems to be getting better (except for the not wanting to eat much of the time.)  Apparently, he will be on amoxy for a full 30 days.

Maybe it's the sudden hot weather here, but he is shedding like crazy.