EPI * Exocrine Pancreatic Insufficiency

sasha is up 3 or 4 pounds since starting on her new regiment 4 weeks ago.not much but ill take it. shes had dry skin fdor a few months and dandruff and hairloss problems. now she has been chewing certain spots so much shes making them raw and bald with red dots. ive been using a topical spray and rubbing alcohol for 3 days now but not much improvenent. is there anything i can add to her food to help her skin that wont mess up her insides?she gets a bath once a week and frontile sprays every 2 weeks so i cant see flees being a problem.

Hi MIke,

Others will weigh in with their expertise. You can try all the oatmeal based shampoos etc for topical relief of dry skin but my understanding is that with EPI dogs dry skin and itching can be caused by the lack of fat in their diet.

Some owners supplement with oily fish (mackerel, sardines) others like Olesia (see her tagline) give coconut oil or even fish oil capsules. If  higher fat isn't tolerated you'll just get oily poo's. When we tried Lu with the higher fat kibble, we got oily poo but when we stopped the kibble the oily poo stopped.

There is the Royal Canin Hypoallergenic hydrolyzed kibble with the higher fat content (about 45% from memory) and there is a study showing that EPI l dogs with skin conditions did well on this diet. Someone linked to the article in another thread but I can't lay hands on it. It was a scientific study albeit sponsored by Royal Canin and the sample was not big ( 3 or 4 dogs) but it did seem to indicate that some EPI dogs can tolerate higher fat and it's good for their skin. Some of the dogs on here use the RC formula with good results I believe, its the RC Hypoallergenic 19. RC also have a skin support formula but how that agrees with EPI dogs, I don't know.

The only other thing that I can think of is that rubbing alcohol applied topically might be drying the skin more and maybe you could try massaging an emollient oil like jojoba or similar onto her skin, just for topical relief.

Jemima

Hi Mike,

Good news on Sasha's weight gain however small................little acorns as all that!

I don't have any constructive information for you unfortunately but what you are describing is exactly like my sisters dog Holly (non EPI - but sister of Bonnie with EPI).  I wonder if its a condition in itself or connected in some way to EPI.  Mass hair loss, top coat falling out leaving circles of undercoat on show, hot spots under her chin, along her flanks and her tummy has broken out too and she nibbles heself ....BUT no chewing of her feet).  My sister is using the oatmeal shampoo at the moment, having been through nearly every topical application on the market.

It may be worth having a skin scrap to ascertain if there is a fungal/yeast problem.  I wonder if you try stopping the frontline spray for a while, perhaps it could be an allergic reaction to that??????? grabbing at straws, bathing once a week will strip the skin and coat of essential oils leading to dryness (this is the vicious circle my sister has - needing to apply the shampoo to help topically and the shampoos may just give a momentary relief (sigh)

I think the problem is from within, maybe allergies to ingredients in food??? and the body throwing out toxins hrough the skin??? Wish we could get to the bottom of it.

Hi Mike,

As Jemima said, the dry itchy skin could very well be a result of the low fat requirements of an EPI diet and past inability to process fat (given your recent diagnosis it sounds like you're still catching up with weight and nutrients). I have been lucky that my Sandy can supplement her main diet (low fat MediCal) with about a third of her total intake coming from Natural Balance limited antigen diet (Fish & potato). The NB is still quite low in fat compared to other commercial diets, but the source of fat is higher quality.  I am also able to give her a small amount of wild salmon oil or Omega 3 oil every other day without affecting her poops.  Her skin was a bit dry in the winter when she was originally diagnosed, but she now has an amazing coat again. Some past posts suggested 1tsp of oil per day, but we've only had success with about 1/2 a teaspoon every other day (some is better than none!). Nutra Sea also makes a good quality Omega oil that comes in liquid format for cats/dogs. You can find it at most health food stores next to the human grade capsules. It'll be trial and error, as with everything EPI related.

The other suggestion to go with a hydrolyzed soy protein is a good one too. Biting the skin raw sounds like more than just dry skin. You could very well be dealing with a food-based allergy also (with dogs typical allergies are to meat proteins or wheat).The MediCal HP formula is higher in quality fat too, which may help with the coat. When Sandy was first diagnosed, the food companies had suggested this as an alternate EPI diet should the low fat not be suitable (because there was also the possibility that we too were dealing with a food allergy). Fortunately for us she did well on the low fat, but we added the Natural Balance to give her something with a slightly higher calorie/fat intake (to help regain the last few pounds and keep her more satisfied - which this does). Difficult to test for food allergies other than trial and error (typically an 8 week trial with no other foods during this period, except the inital transition period). Opting for a novel protein (like bison or venison) or  fish-based grain free diet (like the Natural Balance one) may work too. Some people I've spoken with said they did well with any grain free diet, but lots of them are quite high in fat or protein, which can cause problems on their own, so you do have to do your homework. I'm not advocating any particular diet, this is just what has been tolerated well on our end.

Also, the frequent shampooing could be stripping the coat of essential oils. If at all possible, you may want to consider changing and limiting the shampoos to when it's absolutely necessary (which I hope, for your sake isn't every week :-). When it comes to shampooing, less is better. If you need to bathe, get a prescription shampoo from the vet specific to the current skin issues, especially if you have open sores. There really are a lot of different types out there, and what may seem suitable on the label might end up doing more damage. Definitely stay away from rubbing alcohol, which is drying.  I've never heard of a flea control spray which wasn't harsh, so your doctor may be able to prescribe a topical or oral option which works through the skin glands, as opposed the the skin surface (like Advantage Multi, Sentinel, etc - these cover a host of other parasites too, which could be compromising a healthy skin balance when your dog's immune system has been under stress). Did your doc ever do a skin scraping to test for parasites? The "hair loss" you mentioned makes me think of that too.

Good luck!

HI Mike,

First off, weekly bathing is way too much...I'm fanatical about having my dogs groomed and with the exception of Zoey, who is a long coat and needs more frequent  trimming, once every three months is more than sufficient.  How much trouble/dirt can Shasta get in? 

Also I agree with the skin scrapping as either one of the Manges could be at play here and you'd never know unless the vet did a scraping and put it under the microscope.

You can try to add fish oils or coconut oils, but beware, she may not tolerate them well.  Tara has never had an issue (she gets 1000 mg a day of wild salmon oil), but beware as every EPI dog is different.  Good luck and let us know how it goes.

Mike- Craig is right about the Royal Canin Hypoallergenic HP 19. The study was done with German Shepherds with EPI (as he said it was a small study).  It really helped our male GSD with his biting, chewing, bleeding quite a bit.....You might want to give it a try. It's expensive, but worth it if it helps. You need a prescription from your vet.

HI MIke ~

Glad to hear that Sasha is heading in the right direction... and congrats on the weight gain!!!!.  I see folks gave you lots of good advice already!

I too am going to say  stop the alcohol..... if you want to put something on where she is chewing herself....here we have something called Betadine Solution http://www.pet-dog-cat-supply-store.com/shop/shop_image/product/157a2dadaffaafe02eafd35a4bb12f82.jpg" /> or even Betadine Douche (dont' laugh... i already know where your yound male mind is probably going with this)... but this is a cheap way of buying this iodine... many vets use this..... if there is any kind of skin fungus, bacteria, etc... it will help with that....

However... if she just chewing because of allergies, the Betadine won't do a thing....or if she is chewing out of habit... well, that is just a whole other issue.

Craig is right... i alternate 1 teaspoon daily of coconut oil or wild salmn oil... this works great for a lot of dogs... but it takes about 3 weeks before you will notice they stop scratching itching or chewing... but if she has bald spots... something more might be going on as others suggested.

Debra's suggestion of having her skin scrapped is an excellent suggestion... sometimes all they do is pull some skin via sctoch tape and look at it under a microscope....

Keep us posted!

Good luck and keep us posted

i went for her weekly weigh-in and shes up another .2 kilos so thats 1 kilo in 6 weeks. the vet said he thinks its from an overload of vitamins he wants her off all the vitamins except one that is heavy on B12 andB6 and he said no to the B-12 injections i bought them at the pharmacy but theyr 10,000 mcg each should i give her the injections without his consent?i started her on a 30 day metro this morning against his advice. also he gave her a second steroid shot today another corticosteroid so now its a steroid for her liver in the ass some type of depository solution in the ass and a corticosteroid in the neck.go back next tuesday for the weigh in and shots.

Mike,

I'm not sure I'm following your vet's thinking here at all particularly re vitamins leading to the weight gain (??), I'm sure others will chime in. While any weight gain is fantastic 200g can also be a normal fluctuation depending on the time of day, bowel movement, what's in the dog's gut etc. 1kg in 6 weeks sounds like a great steady gain but what vitamins is she on, how much/how often and from when? Are you still using the regime you posted last month here?

Re the B12, were you able to get her levels tested at all? Presuming not as Olesia said the B12 should not harm her, she'll just pee it out, but you need to be sure of the dosage - this is a dosage chart at the bottom of the B12 page:

Table 1 : Recommended dosages of cobalamin for dogs and cats

Animal Bodyweight Range

Dose/injection

cats, dogs up to 5 kg (10 lb)

250 µg

dogs, 5-15kg (10-30 lb)

400 µg

dogs, 15-30 kg (30-65 lb)

800 µg

dogs, 30-45 kg (65-100 lb)

1200 µg

dogs above 45 kg (100 lb)

1500 µg

"Most generic cobalamin preparations are 1mg/ml, i.e. 1000µg/ml. Multi-vitamin and B-complex injectable formulations contain very much lower concentrations of cobalamin, and often cause pain at the injection site, their use is not recommended. Cobalamin is non-irritant and may be given subcutaneously or intramuscularly, most clinicians deliver it subcutaneously."

µg stands for microgram (mcg) so your 10 000 mcg seems way too high (human strength?). I suggest you wait for others who inject their dogs to comment on dosage etc I just thought I'd throw this info up asap to inform things. Make sure it's generic B12 (Cyanocobalamin) not the multivitamin.

Our Lulu was on B12 injections from day 1 until we got her tested and found she was a B12 factory, it did her no harm (and didn't add weight as she was still losing over part of that time). 

Craig