EPI * Exocrine Pancreatic Insufficiency

Hello everybody my name is Mike and my 26 months old rescue GSD named Sasha has been diagnosed with about 10 different problems from EPI to diabetes to mal-absorbtion to masticory muscle myositis to cancer. i rescued her from a shelter in harlem december of 08 and she was around 45 pounds which was a little under what i think she should have been but she was healthy. there were no bones visible. she did not eat much so i did not think there was a problem. i would feed her a lot of cooked beef and chicken mixed with purina puppy chow and she put on about 5 pounds in 2 months. i switched her to eaukanuba because i was told that would bulk her up. in march of 09 she started to have problems. she was shaky, lethargic and would wimper when i would touch her snout. the vets in NY came up with mastocory muscle myositis. 400 dollars of inconclusive blood work and a 20 dollar cortico steroid shot and she was good as new. there were no problems after the one shot.

In september of 09 i moved with sasha to mexico. 2 weeks after the move i ran out of her bag of eaukanuba and switched her to the "best" dog food available here which is royal canine. immediatly the diarria started and her appetite went through the roof she was eating more and losing weight. i assumed it was the food change but after 2 weeks of poo puddles i kew something was up. long story short i went to 7 different vets in cancun and a specialist in the capitol merida and got nothing. dewormed her 3 times. deparasited her 2 times. anti biotics vitamins minerals medications human and animal 3 more steroid shots nothing nothing nothing. she came to mexico at between 50 and 55 pounds. she dropped to fluctuating between 40 and 45. i found this website a month ago and started her on the pancrease which is luckily relatively easy for me to get here in mexico once i found the right sources. the vet has taken her off of dog food saying she cannot digest carbs. also there was a time when she was literally greasing out of her hips. she would leave puddles on her bed like a hamburger was cooked there and it was from her hips not her anus and did not have a smell like stool but it smelled like grease.so now she eats meat alone. raw beef or tuna from a can or half cooked chicken breast. the vet told me to give her 300 grams a day i was giving her triple that around a kilo a day broken into 5 meals with 3 scoops of ground pig pancrease mixed in. she still lost weight. i weighed her in on thursday at a miserable 36 pounds. i am now feeding her 2 pounds of regular meat with anbother half pound of ground pancreas spread out into 4 meals a day. along with 2 yakult drinks and one ensure daily. 1 zimeton tablet. one calcium tablet. one b complete tablet one calcium tablet.also i mix a small amount of rice or potatoe in every other meal and a s,all can of veggies atleast once a day.this is her daily regiment AND SHE IS STILL LOSING WEIGHT.

she is still a happy dog although she gets spacy at times and she is not 100 percent of what she was but id say atleast 80 which is amazing since she only retained something like 60 percent of her weight. she is literally skin and bone and im worried that since she obviously is not losing fat or even muscle at this point she may be digesting her organs because she must be losing something. she runs jumps chases cats and balls and wants to play all the time. before the pancreas she was taking between 8 and 10 yes 8 and 10 craps daily. at one point she would eat half her bowl go outside and leave a poo puddle and come in and finish her bowl to go back out an d drop another. she is not taking 3 or 4 normal dumps a day that are solid and not so big so the pancreas is helping but she will not hold any wieght. she will hold something for a day or two and she will have something of a stomach but it alwas just sucks back in after a day or so.

i get stares and shouts from people that i need to feed her and i am almost ashamed to walk her i used to take her everywhere i go in sotres to the beach on the bus anywhere and now i dont even wantr to walk her around the block. i dont want to put her down but i dont want to wait until she is suffering. i told myself if she dropped under 35 id do it and it looks like that will be happening in the next 2 weeks. my 8th and current vety says i should just wait since she is still happy until she has a diabetic shock goes blind and cant get out of bed. this doesnt seem fair to her or to me. if anybody has any mniracles up their sleeve i havnet tried i would love to hear them im open to any suggestions and any help would be greatly appreciated. if there is nothing left that i havnt tried my question is where do i draw the line at what weight or what sign of discomfort. thank you all for your time reading my saga. i love this dog with all my heart and this is the hardest thing i have been through i wish you all the best of luck with your own pups and hope that things work out much much better for you and them.

Hi there Mike, wow, what a tale. I'm so sorry for the hard time you've both had, it just sounds awful but much respect to you for not giving up and not letting others grind you down. Her condition has so many odd complications it seems, in particular the hip 'grease' episodes. Not much help I know but I've never heard of that. We're admittedly relatively new to EPI so I suspect this one calls for more experienced heads. Can I ask though which Eukanuba and which Royal Canin kibble you fed her? And were you able to go back to the cooked beef and chicken mixed with purina puppy chow (availability notwithstanding)?

We'll follow your thread and see if we can make a worthwhile contribution, I'm keen to know what others will say. For now, well done, you sound like a great and loving doggie guardian. Our best wishes for you both.

Craig & Jemima & Lulu

Oh my gosh, what a terrible time you're having. I'm too new to this to give you any advice, however my heart goes out to you both. This site is excellent for help and advice so hopefully someone will be able to give you some guidance.

i was giving her german shepherd breed specific in ny but they dont have that here and i tried to go back to the purina puppy chow she was on when i first got her but it put her back to the poo puddles. the royal canine i  went through the whole list i think. it seemed like every vet ws getting a commision off it they acted like it was gold. started with RC german shepherd high energy then on to RC intestinal then RC sensitive digest with tapioca and last RC hypoallergenic but i never actually fed her the hypo i took her off kibble to give her the meat diet. its 80 bucks for a 15 kilo bag and it did absolutly nothing for her. i think its actually cheaper to give her chicken and steak if i didnt have to give her over 2 pounds a day. also she now started to have puss come out of her vagina which the vet thinks is a UTI and she has gone through bouts of hair loss due to the m,alnutrition.

Hi Mike.  Welcome.  Oh my goodness, I don't really know what to say either.  What a terrible time you have been through & it comes through so very clearly, how much you love your Sasha.  I'm sure that with everyone's help here, things will get better. 

Again welcome to you both. 

Lynn & girls. 

Hi Mike and of course Sasha,  really sorry to hear how tough things are for you guys.  I'm by no means an expert on any of this, but having been through a number of food brands over the last 6 months, there may be a little something I can add.  Gunner my English Cocker has recently been diagnosed with IBD, and his is sub clinical EPI,  he seems to be unable to tolerate pretty much everything he has tried, like you we have tried the Royal Canine senstiive with tapioca,  have to say this was the quickest one that Gunner reacted to,   we have tried Purina, Euknauba, Hill etc,  have to say out of all the early ones,  Hill Ultra ZD was the one that Gunner could tolerate the best, it has hydrolyzed chicken in it, and because of the heat treatment the food goes through he seemed to be able to stomach it,  but following a trip to the Royal Vetinerly College for his latest round of tests he has been on  a vegeterian diet since, Purina HA, it is has a single source protein of Soya, and has coconut oil in it,  have to say, it is by far the best diet he has been on tolerance wise for him,  it is bland and there are moments when we have little relapses and things are still not a 100% but  for the best part he seems to be doing well on it, and only fluctuates a little on the weight front, but he certainly hasn't lost masses,.....  just a thought, bu maybe something like this, totally off the beaten track of what you have tried before might just help,,,,,, it was never a protein source I had thought of using, but glad Ihave.   Hope you see some real improvement soon. Hayley & Gunner x

HI Mike and Sasha ~

Glad you found us but SO SO sorry you have to be here.Sounds like Sasha is in dire straits. So here is my punch list for you.....

FIrst it sounds like Sasha is responding somewhat to the enzymes but there may be a couple of other things at play...so I am going to give you a list of things to try.

1. Talk to a vet and see if you can get her started on generic B12 injections once a week ASAP.

Please let us know if this is not possible - - because if not, then buy a bottle of Metagenics Intrinsi/B12 Folate pills (internet) and start giving her one a day.

2. Next... since she has had problems for so long, i am not even going to ask if she has tummy grumbling or gas ... ask a vet to start her on one of any three of these antibiotics for 30 days:

• Tylan (Tylosin)
• Metronidazole (Flagyl)
• Oxytetracycline

A lot of times, the enzymes are working but if you have either B12 deficiency (which to me it sounds like she does) or SIBO going on the enzymes will "appear " to not be effectively working.

Start the B12 and antibiotics ASAP and at the sasme time. Sasha needs as much help ASAP as possible.

2. Sometimes some dogs do not do well with the raw pig pancreas....other times... it is just not being prepared properly... you can grind up the fresh raw pig pancreas.... freeze it in ice cube trays.... but when you serve it to her with her food... it needs to be defrosted  and at room temperature WITHOUT nuking it in the microwave nor can it be cold. Cold inhibits the enzymes activity and heating it up kills the enzymatic activity...defrost SLOWLY at room temperature.

3. Next... some dogs do not respond unless you allow the room temperature enzymes (whether powder or raw) be mixed in the food weel at room or slightly warm tempratures and let this mixture  sit for 20 minutes... this doesn't help all EPI dogs... but some do do better with the foor and enzymes prepared this way.

4. The food..... if you cannot get any "grain-free" food..... raw meat or cooked meat is a great option to try. Skip everything else( veggies, grain, etc)  for now until you get this dog somewhat stable... then you can start adding stuff bacck to the diet.....the otheroption for food that you might want to try ... and some dogs do well on (but not all) is certain prescription dog food- - if you decide to do this....check with your vet or go on-line to make sure, as Hayley said, the food is HYDROLYZED.  Not all brands are created equal....it depends on the dog which brand they may respond to. The results from a meal is "usually" 12 hours after digesting a meal...... unless she is doing  liquid poo...

5. To help with the liquid poo.... see if you can get your hands on an herb called Slippery Elm..... you can givbe this to her for a few weeks. This will not harm her.... and should help firm her poos up enough for things to start settling down in her system......

6. After the B12 and Antibiotics for SIBO.... anything and every other change you make... do only 1 change at a time... WAIT approx 3 days... record what you give Sasha and how she responded to it..... this is the only way we can really figure out how best to manage each individual EPI dog.

7. If none of the stuff above helps... you may be dealing with what Hayley alluded too... and protein sensitivity, or IBD.... the list can be endless.

But.. if you aggressively treat with B12 (if she doesn't need B12, she will just pee this out... so this will not harm her). Neither will the antibiotics harm her either......yuou might see things start to turn around... if not... start doing the other changes... one at a time... wait 3 days... add another change.

8. and last but also yet another consideration... is that she may be one of those dogs who do not respond to raw pig pancreas. If so see if you can get your hands on the powdered enzymes or if not... check with your vet and ask if you can get CREON for her... if not... you can buy CREON (enteric coated enzymes in capsules) on-line. We can help you with this too.

Well, this is a heck of a long greeting.... sorry i was so long winded..... looking forward to hearing back from you.

Hi Mike and Sasha, but so sorry for all you are going through.... Wow, that is rough!!!

Olesia gave you some great advice regarding the B12 and the antibiotics and everything else, I just wanted to make sure you are grinding the pancreas well, as in putting it through a food porcessor?

hello EPI and no need to apology for a long greeting i am desperate for any help i can get and was eager to see a reply that said more than i dont know anything but the next person might. i am willing to try anything and everything possible because i do not have much choice left.

1-i have been asking my 3 most recent vets about the b-12 injection and they all brush it off but i will go in tomorrow morning and make sure she gets one from one of them wether they agree or not. with weekly injections should i take her of the b complete tablets or combine the two?

2-she was on metronidazole for ten days in december and ten more in february but since they are just anti-bioticsi can give her another run. she has also gobbled a few piles here and there when im not on my game so im sure she could use the help again.and your right lots of grumbling in the tummy but she hasnt had bad gas recently but at the beginnning she did.

3-i usually get the pig pancrease but at times it is unavailable becausae igo through so much of it and the pigs are small so i get the beef pancreas when theyr out of pig. i put it through a meat grinder until it is liquid and freeze enough for 4 meals(one day) in each tuberware. i give it to her at room temperature and i never nuke it or cook it sometimes i will let it sit in warm(just from the faucet not heated on the stove) water if i forget to defrost it the night before. i have only been letting it sit for 2 or 3 minuites because she cries and cries when i have her bowl up on the counter and food in it but i have now started to incubate it for 10 minutes and will begtin allowing for 20 wether she cries or not.

4- it is easier for me to get the meat here in mexico than any special dog food so i will just stick with the diet. it consista of tuna from a can with water ofcourse or half boiled chicken breast minus bones and skin or raw steak with bone.she has been on this diet for a month now give or take and i have begun adding in veggies and rice and her stools are still solid. the vet said to try to give her some carbs since she has been losing so much weight. do you think i should remove the veggies and rice or leave them as long as the poop stays firm?

5- for now her poop is solid

6-will comment after the injections and metro trial

7-comment after injections

8- i do not know if i will be able to get CREON here but i will ask. she is currently on a pill called ZIMETON and here is the ingredients...130 mg pancreatina/50 mg dry bile extract of ox/40 mg dimetilpolisiloxano(sorry its in spanish and some words do not translate on babblefish lol). when i try to take her off these Zimeton pills she starts the greasing again. is this something you have seen or heard of before with EPI dogs?

also i must admit she has not been "professionally" diagnosed with EPI because i do not think the vets down here know what EPI is. they call it mal-absorbtion but i think that it is the same thing just translated differently but she shows all the signs of EPI. they dont have the TLI test here and if i take a sample and send the blood to texas i was told it would coagulate(i think thats the word) and be useless by the time they got it.with what ive seen with her and read on your site im pretty confident in my personal diagnostic. thank you again so much for taking the time to make this site and help everyone here including myself and i will give you constand updates on her situation anything you can think of feel free to throw it at me im willing to try whatever i can and money is not a big problem for me thankfully.

hi donna thanks for your concern yes i use a meat grinder for the pancreas before i freeze the daily portions she gets it as a liquid mixed onto her meat

HI again Mike,

Yup, I'd walk into the vet's office and demand a B12 shot. Make sure it's pure B12 (Cyanocobalamin injection) and not a multiple B12.  She will need these weekly in the beginning and if you can get the vet to let you do them yourself, it's easier and less stressful for her.   Also, to combat SIBO, these dogs really need 30 days of metro... Ten days is standard with most vets,  but simply not enough in the case of SIBO. If your vet is uncomfortable and he/she speaks/reads english show them this website and the tabs above on SIBO and B12 protocols from TAMU.

Also, just to ask, does she do any worse or better when you switch from porcine to bovine pancreas???  I'm just wondering if their may be a food allergy in play here???

Oh, and download the EPI log in the tab above. If she gets better or worse, you con look back and wee what you changed and maybe make a correlation between them?

Hang in there...We're here praying with you...

thanks donna yeas it will be the first thing i do tomorrow morning(after i feed my starving pup ofcourse) i dont notice much difference between her reaction with pig of beef but i am constantly paying close attention i can honestly say i am a expert on dog poop now. im sure the vet would let me do it myself but i would rather let him do it i have no problem holding her for a shot but i doubt id be capable of sticking her with a needle and its not like the vets down here charge 60 bucks to say hi.thank you for your prayers i will keep this link updated regularly with any info i can give to get help or give the next poor owner tips

Hi Mike,  Boy!  do you have our full attention, and boy! did you find the right website.  I'm new at this, so I don't have much to offer, except that I saw, on the internet that it is possible to buy the meds and equip. for the B-12 shots, if you can find someone to teach you how to give the shots.  Maybe a registered nurse?  I'm very sorry that you have this worry, but with the help from Olesia, and the others, you now have a fighting chance for this poor boy.  Good, good luck to you both.  Gini

Hi Mike,

I meant to mention that when I took Tara out in public years ago when she was under 50 pounds, I'd put a tee-shirt on her to hide her body so I didn't get those "looks"...To this day she loves to dress up despite the fact she's a tubby 84 pounds...

Also, have they tested her for PLI (protein loosing entropothy)?

Hi again Mike~

Thanks for posting again.... now have a much better idea of some of the finer points of what treatment Sasha has been given.

You are handling the raw pancreas perfectly.. just let it sit on the food for a little bit longer... sometimes that makes a difference.... and sometimes it doesn't... but it is worth a try.

Are you giving her the raw pancreas AND the Zimeton?  Near as I can tell, the Zimeton is pancreatin... but i cannot compute how it stacks up to CREON on dosage (in EurBP or to the generic powder that is in USP units....) Definitely continue to give her the Zimeton.... they are giving her the right stuff... it's just that the dosage may be off..... or not..... That is the same problem with CREON...some dogs need CREON 10... others do not do weel unless they use CREON 25... each dog can vary greatly from the next.  The powdered pork enzymes that many of us use in the USA is a more standard dosage ... sometimes it needs to be upped or reduce... but it doesn't vary as greatly as the CREON. I suspect that Zimeton may be similar to CREON.... so this may be another adjustment you might need to look at.... you may actually not even need the raw pancreas.... but don't make any changes yet in the enzymes dept.  Focus on the B12 and the Antibiotics first and give that two to 3 weeks.... make sure you keep us updated and we'll walk you thru things.

Sometimes EVERYBODY is on here... or sometimes it can be hours before someone who has experiences with a similar situation as you chimes in.... but the nice thing is sooner or later.... someone on this FORUM has had experience with what you are dealing with and will help  

After reading your responding post....i really do think the issue is not that the enzymes (pill and raw) are not working but rather that Sasha needs B12 and SIBO addressed. 

Donna gave you great advice... make sure the vet gives generic (not the multi vitamin) B12 injections. PLease go to http://www.epi4dogs.com/b12.htm and print the entire thing... bring it with you to the vet. Have the vet follow the TAMU protocol.. 6 week a shot every week, then bi weekly, etc. the weight and dosage protocol is also listed on that page (i think near the bottom.)

Since you already had Metronidazole...and can get it.... get more... Have the vet put  Sasha on it for 30 days.  

Regarding her diet.... since you mentioned in your following post that she is doing solid poop...at this point, ignore what i said about just giving meat and do not give Slippery Elm (that is just for loose stools) so.....i would continue with everything with how you are feeding her now ...since she appears to be doing fine... the meat (chicken, fish, steak)...should be fine...... veggie  tolerance usually depends on the individual dog.(ans Sasha seems to be tolerating whatever you are giving her)... the rice "usually" is bad for an EPI dog... HOWEVER...there are some EPI dogs that do not get better unless they do have some grain added to their meal... so just be aware of this... but if she is doing solid poos... than she is tolerating it..... (welcome to the CRAZY world or EPI.)

Just so you know... the trick with EPI is finding the right "balacne" for your dog.... once you find the right balance... it is amazing how things fall into place.. and finding the right balance is what we can help you with.

ALthough the best thing is to do the TLI test... no sense doing it if the blood samples cannot be shipped chilled to TAMU.... so just treat as if she does have EPI....none of the treatment for EPI will hurt her short-term anyway.

Donna brought up a great point... the best tool in dealing with EPI is the EPI LOG... go to the DOWNLOAD page:

http://www.epi4dogs.com/downloads.htm  and scroll down until you see a PDF for an EPI LOG... print it ans start recording EVERYTHING..... you'd be amazed at how telling this little tool can be in identifying what works and what doesn't....

Please let us know how your request for B12 and Metronidazole goes tomorrow at the vets

Hi Mike,

Another thought... (please no flaming here from the raw feeders), is that you might want to cook her meat...I have nothing against raw feeding, but she's at such a touch-and-go point, that the bacteria overload might be more than she can handle...Also, I've been to Mexico (Cancun almost every year for 10-15 years) that I know the "standards" there differ from the standards here in the US...  Just a thought...

Just want to echo what Donna & Olesia said about the antibiotics, 30 days minimum course and even then you may not nuke the SIBO, Lulu is on her second course of 30 days now and there's progress but we still haven't cracked it. Next course might be a different anti (as she's stable we're starting her on probiotics in this week to offset any negative influences on gut flora but don't you worry about that yet)

Craig

I'm anxious to hear how this is going to turn out, Mike. My heart goes out to you and Sasha here in Phila, Pennsylvania. Please keep us posted..I'll be checking back here often.

ok heres the update i just got home from the vet. she is up .2 kilos which is almost half a pound since thursday so i am happy about that. its not much but i will take every ounce she can get. he never heard of creon but i am going to the local pharmacy now and there is a more expensive one a few blocks away that i can try if i strike out at the cheap one on the corner. the vet said he would give her the b-12 injections but he does not want to start them yet he doesnt think its safe to mix them with her current meds. i will go to the last vet before him and get his opinion on it. he did give her the same pair of injections as thursday. a cortico steroid anti inflammitory shot and a deposit solution?? he says these shots have a one week effect. she has incresed in her enery level since the first injection,she is back to sitting at the shelf her tennis balls are on and whining to go out and play.i like that. i also asked him for another run on the metro but he said that it is also a bad idea now because it would be toxic??again i will see what the other vet says on this. the pills are labeled messeldazol with metronidazol labeled underneath. i dont need a script to get them if i choose to go against the vet incase they both say no.

she has taken 2 soft poops these past 2 days they were not puddles but they were barely firmer than mashed potatoes(sorry but over the past 4 months me and my freinds have come \up with analogies to inform me about her piles soup/pancake mix/mashed potatoes/nuggets in order from worst to best). so no more rice.

i have been letting the pancreas incubate on her meat for 20 minutes we will see how that helps.

heres is a list of her new reginment see if i need any more tweaking

between 200 and 300 grams of cooked chicken breast/steak/or tuna from a can per meal

3 scoops of ground up raw pancreas aprox 150-200 grams per meal

one zimeton tablet daily

one nutriplus tablet daily

two equilibrium tablets daily

one b- complete capsul daily

all pills are crushed and mixed with a meal/pancreas

one corticosteroid shot with deposit weekly

one ensure daily

two yakults daily

two hepisimi(liver immunity)capsules

also one of the vets said since shes not getting any kibble it would be good for her teeth to get lots of rawhide bones. she enjoys them like any dog and i usual give her one every other day and opinions on the rawhides or the frequency?also the liver and b-12 capsules should i be breaing them open and letting the pancreas touch the liquid or giveing them to her in the plastic capsule? i got my vets email adress so i will try to translatew the overview of this page with google and mail it to him he does not speak any english. lemme know if you guys have any ideas. thanks again and hope all your pets are improving quickly.

4 meals a day

Hi Mike,

I'm not sure about the translation here and I'm "assuming" a bit (I'll have to go translate when I have a bit more time), but I'm thinking that the vet might be worried as long term use of Metro can be associated with neurological side effects...If that is the case, ask him about Tylan?  While tara was on 30 days of metro with no problem, others have reported it, so he may be playing on the side of caution.  As for the B12, I have never heard of it interfering with any other drugs, but again, I'm not a vet, nor do I play one on TV.    Excess that is not used is simply peed out. The cortico steroid, I'm assuming is prednizone? Why is she taking this?  Is it for inappetance or does he suspect IBD?

Those are my immediate questions...I have no idea about any of the other drugs/suppliments you are talking about...