EPI * Exocrine Pancreatic Insufficiency

Hello all. I am new here I have a 20 month old Tamaskan and a 6 month old German Shepherd. My Question is regarding Boreal, my Tamaskan. She always had quite soft stools, especially when she was a puppy, She came to me on Evo, (and a dose of metrodonizole) I thought the protein was too high, giving her soft stools ,so I tried Chicken soup for the puppy lovers soul(chicken), still soft stools. Then I switched to Taste of the Wild (salmon and potato), she was eating that for the longest time, and her poop seemed to be formed pretty good, but then early in spring getting soft again, and just kept  getting worse, and she was starting to get skinny, Although she was as energetic and hyper as she had always been. I thought maybe it  was coccidia so I gave her panacur for 2 doses(3 days wait a week then another dose) .Took stool samples to 2 different vets, both stool sample was negative for anything. The one vet said her temperature was on the high side( by one degree) so he gave her a dose of Albon. and to try lamb and rice dry food.  I was trying her on Natures Variety raw food (beef) at that time, She actually had 2 solid poops, when she ate only raw for two days. So I tried the lamb and rice. back to sloppy poops. Menwhile i was looking oline and found out about EPI and I thought that MUST be what the problem is! I  finally called my main vet to try to get her in cuz I wanted blood tests done and mostly a TLi test,. Tests came back negative for kidney or liver disease. They didnt do xrays cuz there hadn't been no vomiting.And also there was no blood in poop.  I had to wait two weeks till test came in, and they gave me Science Diet i/d dry food. She did even worse on that!! her poop was like soup!  her TLI test came back a 9 which he said was in normal range, but on the lower end of normal. I told him that food was terrible for her!  So I bought a bag of Califoria Natural (venison) she had a couple of semi-firm poopsat first, then back to sloppy poop from there, she likes to eat dirt and mud from pulling up sods of grass in the yard (like she needs some sort of nutrient?)  3 days ago I started giving her Steves raw (beef) , her poop has improved, but not hard yet.        Okay so here is my questions to all of you-  with a tli of 9 could that mean that I should have her tested again, like it may test even lower next time?  Would it hurt her to have a pancreatic enzyme? Would it make her poops solid?  Why does it have to be porcine based pancreatic enzyme?, What about raw beef pancreas?  Okay enough for now. Please Forgive me for writing a short story, but I thought maybe her history would help.Thank you all in advance, I await your responses:)

Julie

Hello and welcome both you and Boreal to the forums : ) I am so happy that you have found your way here, and you've definitely come to the right place to get your pup back on the right track. I'm so sorry that you have been through ups and downs with Boreal. I hope to help you as best as I can!

FIrst thought:

It seems as if you've been switching foods quite a bit. Have you been gradually mixing it little by little, or has it been just a "cold turkey" kind of turn over with the foods?

Second thought:

It sounds as if it could definitely be EPI. I would definitely recommend another TLI test. Was Boreal fasted for 12 hours before the test was taken? Somtimes this can alter the test results.

It wouldn't hurt to have Boreal put on a pancreatic enzyme to see what kind of reaction she has. It definitely will make her poop solid if it works.

Also, you should get her B12 and SIBO tested. These both go hand in hand with EPI.

I've never had any experience with raw beef pancreas so therefore I cannot help you in that, but I am sure someone else will chime in.

That is just my two cents  : ) I hope I was some help for you today.

I am fairly new at this still too. My Bella was diagnosed in May. It will be a bit overwhelming in th ebeginning, but I promise it is all worth it in the end!

: ) I'll be checking back here soon!

When I switched dry to dry I mixed it gradually for about 5 days. After the venison dry food i went "cold turkey" with the raw. I forgot to mention that when the vet put her on that science i/d prescription food, he gave me a 14 day supply of metrodonizole (2x a day) and that never helped solid up her poop. Yes she was fasted for 12 hours before the tli test. They may have tested her B12 level, They would have it in her file, They did a urine test also and said that was ok too. Do they test for B12 through blood test? I assume SIBO test is done by fecal exam? Thanks

I thought Marley was headed toward EPI as our experience sounds nearly the same our yours (TLI was 4.1) - finally had an endoscopy and colonoscopy and she has severe IBD.  You can't really diagnosis IBD without the procedure but it might be something to discuss with your vet.  Our get an Internal Medicine Specialist to work with your vet.  Good Luck!  She was only finally diagnosed about 5-6 weeks ago but is doing great and has gained 10 pounds back (7 more to go is all.)  I'm sure we'll have our set backs, and she is on lots of meds right now but they have begun to taper them off.

Karla

Hi Julie, and Welcome.    OMG!!!!!!     Boreal is absolutely georgeous.      Hope I spelled that right, I am very spellcheck spoiled.  LOL    Anyway, she is just so beautiful it takes my breath away.   Remindes me of a wild timber wolf.  Is that Snow behind her?   

I have had my Suzie on Porcine Enzymes since 2006.   I can verify, for sure that if you give them to her, they will not hurt her in any way.  I have a neighbor dog who steals Suzies food almost daily, and is just fine.  My Vet told me in a non-EPI dog, it would only help in their digestion.  So, why not, I say.    Dont think the beef pancreas will work.  Dont remember why exactly, but I am sure someone here can chime in with the details on it.  If she has SIBO, the Metrodonizole must be given for a minimum of 30 days to be effective.  You might talk to your vet about trying that again and for the full 30 days this time.

Wish I could be of more help.  Trust me, there will be many who will chime in here to help you in the morning.  I am on the west coast and usually up very late at night. 

OH, AND JESSICA!!!!!!!!!    I am so impressed with your expertise now.  I remember when you were the scared little gal with the sick puppy that her Dad was talking about putting down.   Just look at you know.  YOu make all of us proud.   And, so glad that you saved Bella and take such good care of her.   Keep up the good work, girl.

Julie,  hang in there.  There will be lots of help on the way.

Hi there

This is so hard

Kara was diagnosed in August 2010 and I was devastated

We are part of a university study into EPI and the vet leading this said beef pancreas just does not work

Right from day one we were told that some enzymes are better than none so go for it

Your dog is amazing

Good luck

Jean and Kara

Hi Julie,  First...THAT is one AMAZING AMAZING AMAZING looking dog - I never heard of that breed...just beautiful!   You might want to start on the enzymes - it will not hurt and if it is EPI it can only help.  If you do go that way, do 1 tsp per cup of food - mix with a little warm water/room temp water - let sit for about 20 mins - be sure to stir stir stir.   I also would go grain free right now as most EPI pups do better on grain free.   This would be my recommendation for right now and see how it goes from there...good luck with Boreal...WOW, we need more pictures.   Let us know how things are going...

Julie and Borel... Welcome!!!

My goodness... i have never seen a Tamaskan... had to look it up... absolutely BEAUTIFUL!!!!

Regarding your questions:
Okay so here is my questions to all of you-  with a tli of 9 could that mean that I should have her tested again, like it may test even lower next time?  Would it hurt her to have a pancreatic enzyme? Would it make her poops solid?  Why does it have to be porcine based pancreatic enzyme?, What about raw beef pancreas? 

YES... it would be a very good idea to re-check the TLI levels in the future. Just to make sure it is not slipping into EPI territory. But just because it is low does not mean you dog is heading towards EPI... my non-EPI dog has a TLI level of 8.5 and has for years and does not have EPI.

I too would think you probably need to look at IBD and as mentioned above... scope or ...talk to your vet about treating for IBD and see if that seems to make any improvement.

No... it will not hurt to place on pancreatic replacement enzymes.... just until her gut settles down.... not to keepher on it forever.

Sometiems something else other than EPi is going on and there is such stress... that the enzymes are not being produced as they should and the pancreatic enzymes do help while the gut takes it's time healing and getting back to normal.

It may or may not make his poop solid... depends on what is going on in her gut. But it will not hurt to try and see if it helps.

Porcine based pancreatic based enzymes appear to work the best with dogs and humans who have pancreatic issues.... Each species responds differently to different enzymes.... Pork is not the best for all animals... but like i said, appears to work best for dogs and humans.

I do disagree somewhat with the statement that beef pancreas just does not work.... we HAVE seen it work here... and success with raw beef pancreas is also reported in various EPI veterinarian research reports....HOWEVER.... i do agree that it may not work best for all EPi dogs.... as a matter of fact raw beef is often recommended over raw porcine because  of a particular  bacteria that is sometimes found in raw pork... however, many folks still do use raw pork pancreas with out any issues..... BUT as with any thing with an EPI dog... it's success still depends on the individual dog... simply put some dogs do very well on raw pancreas and or raw beef pancreas....... and others do not do well.

The other thing is... it is possible she has SIBO going on... especially with the temperature spike Borela seems to have.......................did your vet prescribe any Tylan or Metronidazole???????? Did your vet consider SIBO???

Hi Julie and welcome to you and Boreal.  Like everyone else has pointed out, Boreal is just stunning!!!!!  I too had to go look up the breed as I had never heard of it!!!  We definately need more picture of Boreal!!!  His profile picture is just a tease!!!!

You've been given good advice, but I just wanted to caution you about all the food switching if it turns out you are dealing with IBD... I have been blessed/cursed with two IBD dogs, my current Corgi and my Bridge GSD, Tess. Once an IBD dog is intolerant of a protein, they are always intolerant, so as you go along in life, novel (never before used)  protein sources get scarce... With my Bridge girl, I was thinking the next protein source was going to involve me in hip boots hunting up frog legs in the swamp...  Just wanted to warn you that switching out food alot is not a good thing for an IBD dog.  The only way you can dx IBD is via endoscopy with biopsies taken.  I think if the sloppy stools continue, I'd go that route...

Pictures...pictures...I am back here looking for pictures of that amazing pup!!! :-)))

First -Thank you  I will try to get a full pic of Boreal up. When vet gave me the 14 day supply of Metrodonizole, they didn't exactly say what they suspected, or if it was just precautionary. SIBO is found out through a stool sample right? Cuz before I had her to vet the last time she had her stools checked 3 times and all times they said it was ok.  I did ask the them about checking for IBD and was told in order to get a biopsy, they had to cut her open! I told them can't you just do the endoscopy thing, and was told no.  Must be they don't have the right surgical stuff for that? I don't live near no big veterinary hospitals, closest big city is almost 2 hours away. As far as protein sources I think the only one she hasn't had yet is rabbit!

Donna- "frog legs in the swamp" lol. I guess that could be me too!  What do you feed your IBD dogs? and what treatment is used for an IBD dog?  i heard there is different "types" of IBD (been looking online)example- lymphangiectasia.  Another question- what brand of pancreatic enzymes are the best? I'll check in again tomorrow. Thanks for your replies so far

Julie

First -Thank you  I will try to get a full pic of Boreal up. When vet gave me the 14 day supply of Metrodonizole, they didn't exactly say what they suspected, or if it was just precautionary. SIBO is found out through a stool sample right? Cuz before I had her to vet the last time she had her stools checked 3 times and all times they said it was ok.  I did ask the them about checking for IBD and was told in order to get a biopsy, they had to cut her open! I told them can't you just do the endoscopy thing, and was told no.  Must be they don't have the right surgical stuff for that? I don't live near no big veterinary hospitals, closest big city is almost 2 hours away. As far as protein sources I think the only one she hasn't had yet is rabbit!

Donna- "frog legs in the swamp" lol. I guess that could be me too!  What do you feed your IBD dogs? and what treatment is used for an IBD dog?  i heard there is different "types" of IBD (been looking online)example- lymphangiectasia.  Another question- what brand of pancreatic enzymes are the best? I'll check in again tomorrow. Thanks for your replies so far

Julie

Here is the official Tamaskan website www.tamaskan-dog.com if you want to learn about the breed ,and they have lots of pictures there! and yes that is snow on Boreal's nose and in the background (thats my avatar pic on the Tamaskan forum too.)

Julie

Hi Julie - SIBO is a tricky test.  Usually they test B12 and Folate - but even if they come back ok you could still have it.   Jackie had good Folate but low B12 - others can have low Folate and good B12 but still have SIBO.   Best indication that you have it is the poops are "filmy", yellow and accompanied by rumbling tummy/gas - those are signs that typically jump right out - keep in mind you don't need to have all of the signs - any can be signs of SIBO...

My husband LOVED your pup also...very very unique...

Julie:

And here I thought that I knew of most breeds of dogs...what a surprise to learn about Tamaskans.  They are truly beautiful dogs and the puppies take your breath away.  Boreal is stunning! 

I do have one question.  When they did the blood draw, had you fasted her? 

Hi Julie,

It sounds like your vet doesn’t have the equipment to do the scope, but you could check around at other practices. It doesn’t necessarily have to be a university hospital. I know my vet doesn’t have much for equipment either, but he does have a surgeon that travels between clinics in the area who does have the equipment. I think that’s quite common these days. You might want to check around.

The treatment for IBD is twofold…First, the offending protein needs to be removed from the diet and replaced with a novel protein and carbohydrate, or switched to a hydrolyzed protein in a prescription diet (such as Hill Z/D). By hydrolyzing the food, the body doesn’t react to it as an offending protein. Second, you need to stop the inflammatory response. This is generally achieved by using a steroid, usually prednisone. Also, Metro is used to take care of any bacterial infections. You are correct on the three types of IBD, which are also referred to as mild, moderate and severe. My Zeke has mild, but my Tess had severe. Zeke does fine on venison and potato and I was able to wean him off the pred. pretty quickly. At the end of Tess’ life here, she developed Cushing’s disease and she had to spend a lot of time at the vet’s office while they did specialized blood tests that took all day. As she was very stressed at the vet’s office, she began to flare often. When this happened, she’d become intolerant of the protein she was eating. We had pretty much been through them all…Rabbit, Kangaroo, you name it, she’d eaten it…At the end, I was pretty much home cooking for her and she was eating tilapia and quinoa. For whatever reason, she always did best on fish and was able to stay on various fish diets much longer than most other proteins. BTW, neither Cushing’s nor IBD took her from us. At age 13 she developed a mega-esophagus and it was time to say good-bye.

The best enzymes to use for EPI are Porcine, rather than plant based enzymes, which are not strong enough for an EPI dog. But since she doesn’t have EPI, clinically, maybe you could try some Prozyme (plant) enzymes? Many of us here in the US get our enzymes from Diane as the prescription stuff you get through the vet is quite costly!!!

Linda raised a good point…Often times the vets don’t tell you to fast the dog for 12 hours and it can make the results off a bit, although I’m not sure how much…

Her poop has been darker brown lately, but it was yellowish and very runny when she was on the hills i/d.(probably cuz corn is the main ingredient in that)  it was lighter colored when she ate the lamb and rice too.  Yes she did fast for the 12 hours before her blood test.  I see that the pancreatic enzymes sold have different count values of the lipase. protease and amylase. why is that and what exactly does  that mean?

Julie

Donna has given you good information on IBD.  I think she is right in that someone should be able to do a scope - just ask your vet.  There must be some sort of specialist close (within reason) - I wouldn't want to do the surgery either, but... if it is your only option don't delay too long.  Marley has severe IBD, she is on both prednisone and azithiroprine but is getting weaned down. S She is up over 10 pounds and looks amazing (and we are just 6 weeks out now.)  Her poops are still soft and I still think she has SIBO, but the IMS and I don't really agree.  It is nothing awful so we are trying the meds for one more week but I'm guessing she will go back on antibiotics next week. (Of course I think I am right, we'll see.)  They will not want to prescribe the prednisone or meds as a precaution - only if it is confirmed IBD.  If they are wrong and it is something else it can really wreak havoc on them.  Again, who knows if it is IBD, but it does sound similar.  Marley is on Hills z/d ultra allergen free and it sits very well with her.  I don't believe you will want to switch foods to this until you know if it is IBD, or it just may turn into one more food not tolerated.  Good luck.... I know how frustrating it is to just not know!  Boreal is a beautiful dog!

Hi Julie - I may have missed it, but before you put your pup through a biopsy you might want to try the enzymes to see if they work.  My first vet wanted to biopsy Jackie and "cutting her" was def not high on my list of things to do :-(  Good luck...