EPI * Exocrine Pancreatic Insufficiency

Hans has had perfect stools and is on Probiotics for over a year.. I knew because of weight loss and a slowing appetite something was aria.

I figured it was SIBO/ARD or B12.

My suspicions have been confirmed with a foliate level of 20; max being 11. As I said no diarrhea since Probiotics were started over a year ago.

We have had major Enzyme issues starting back in Oct. of 2010, I’m sure this caused the SIBO/ARD. I just thought I would let you know how things went here.

So to me the down side to Probiotics is that when the foliate level goes up, the diarrhea may not show up. So your dogs SIBO/ARD may go untreated.

Good to know!  Thanks for the info.

Did Hans' B12 levels drop as well (with the high folate)?

B12 is at 1000 with a max of 700 so there goes the idea they pee out what they dont' need!!??  I don't know what's up there yet.

His sister non epi but a carrier is gettin B12 injections every 2 weeks also, her b 12 was normal..........it don't make sence at this point.

If anything is should have been high??

Hello all....boy do i need help.Bella has done well on the enzymes...her stool is good.I had to get her on a grain free food that helped aslo. Buffalo..she loves it. This is my issue. My vet took her off the tylan powder after 3 weeks...but her stool got runny again and bright yellow so we put her on it again. And after 2 days she was good again. Another 3 weeks and I took her off of it last friday. Well....today she not only had to poop (6) times she pee'd in the house 3 times. and chewed my couch down. She has never had this type of behavior problems. NOw I have only had her 3 months(adopted her from GSD rescue) but this is like night and day. Could it be from taking her off the tylan powder. Anyone else have this issue. I am bringing her to the vet for testing but really need ya'lls advise. I also cant figure out how to post pictures...but am working on it.

Hi everyone

Just to let eveyone know........at this point it looks like I was giving/feeding to much Folic Acid ( I never heard of it before)

and that is the best possable cause for the 20.5 Folate. Tylan and Metro not being used at this time.

I was using the Metagenics Intrinsi B12/Folate 2 times a day plus B12 injections.

The problem may have also come from changing to Raw Pancreas for enzyme replacement and feeding tripe. With all of this being done at the same time the B12 went up to 1000 max 700 and Folact 20.5 max 11.

Alll Vitamins have been stopped and he will be retested the week of the 8th of August.

I will be posting these blood tests along with the others I have in my profile for anyone to check out.

Sharon and Hans

Hopefully you've got it figured out, and things will get back to normal soon.  Good luck and keep us posted.

Kris Damiani at July 25, 2011 at 8:22 PM

Hello all....boy do i need help.Bella has done well on the enzymes...her stool is good.I had to get her on a grain free food that helped aslo. Buffalo..she loves it. This is my issue. My vet took her off the tylan powder after 3 weeks...but her stool got runny again and bright yellow so we put her on it again. And after 2 days she was good again. Another 3 weeks and I took her off of it last friday. Well....today she not only had to poop (6) times she pee'd in the house 3 times. and chewed my couch down. She has never had this type of behavior problems. NOw I have only had her 3 months(adopted her from GSD rescue) but this is like night and day. Could it be from taking her off the tylan powder. Anyone else have this issue. I am bringing her to the vet for testing but really need ya'lls advise. I also cant figure out how to post pictures...but am working on it.

 

Kris,

If you dog has EPI, she will need the Tylan or other enzymes with every meal forever (in almost every case). The back and forth on and off is probably making her very sick and uncomfortable. Keep her on the enzymes!!!

Amy

Amy at July 31, 2011 at 9:48 AM

Kris Damiani at July 25, 2011 at 8:22 PM

Hello all....boy do i need help.Bella has done well on the enzymes...her stool is good.I had to get her on a grain free food that helped aslo. Buffalo..she loves it. This is my issue. My vet took her off the tylan powder after 3 weeks...but her stool got runny again and bright yellow so we put her on it again. And after 2 days she was good again. Another 3 weeks and I took her off of it last friday. Well....today she not only had to poop (6) times she pee'd in the house 3 times. and chewed my couch down. She has never had this type of behavior problems. NOw I have only had her 3 months(adopted her from GSD rescue) but this is like night and day. Could it be from taking her off the tylan powder. Anyone else have this issue. I am bringing her to the vet for testing but really need ya'lls advise. I also cant figure out how to post pictures...but am working on it.

 

Kris,

If you dog has EPI, she will need the Tylan or other enzymes with every meal forever (in almost every case). The back and forth on and off is probably making her very sick and uncomfortable. Keep her on the enzymes!!!

Amy

Kris,

Sorry, I was typing too fast (lol)... she will need the enzymes for life. The Tylan should usually be given for an extended period to clear up any SIBO. We had our pup on for 6 weeks before slowly taking her off (reduced the dose by half for a week after that). You should also give probiotics while she is coming off of the Tylan to create new, healthy probiotics in her body. Hope that helps!!!

Amy

Hi Kris....

ENZYMES: clarification....simply put..... EPI dogs need the enzymes for life with every meal.... there are a handful (and i mean just a handful) of cases where  a confirmed EPI dog that does not need enzymes.... but this is EXTREMELY rare.... so just plan on forever giving enzymes. Off and on enzymes promotes SIBO.

SIBO: clarification..... there is none :roll:... SIBO can be very difficult or very easy to deal with.... it really depends on the individual dog.

THe latest research suggests that all EPI dogs ....when first diagnosed.... also have SIBO. "THeoretically" if/when the dog starts receiving enzymes with each meal it should allow the good gut bacteria to replenish itself......hahahahhaha.....in reality this rarely happens.... what seems to happen most frequently is that the EPI dog with SIBO needs to be treated heavy and hard with specific antibiotics (Tylan is now preferred over Metronidazole) for 4 to 6 weeks ..... Tylan is milder than Metro hence the extension to 6 weeks if needed is safe.  This 'usually" helps most dogs... but not all.  There are some that need re-occuring treatment with Tylan (or Metro).... and then there are other EPI dogs with SIBO who do not respond to Tylan but do respond to Metronidazole (and yet  the opposite happens too!!!)

If this isn't enough to make your head spin.......there are some cases, and we suspect these are the dogs that had SIBO and/or EPI for a long time to where the SIBO has done permanent damage of sorts... and these poor dogs appear to only do well when on life time antibiotifcs..... and then can be a reduced dose daily... or a dose to maintain (for example)  every so many days.....and then there are dogs that were thought to need to be on antibtioics forever, but have been able to slowly withdraw from the antis via propbiotics- -but (more head spinning) not all.

PROBIOTICS: The problem with Probiotics and or Prebiotics is that not all are suited to all dogs.... some can work magic on one dog... and the same probiotic can make another dog sick. Reason.... EACH dog's gut flora is different. 

While at the AVMA Convention.... i did a one-pager of more in-detail researched facts about EPI that received very appreciated comments from the vets themselves... which included a research portion on Probiotics / Prebiotics that i will share here:

"An inclusion of prebiotics such as fructo-oligosaccharides are logical although not yet proven. Basically, prebiotics are non-digestible food components (dietary fiber) that are being fermented by intestinal bacteria. This can lead to normalization of the intestinal microbiota. In a recent study the use of fructooligosaccharides (FOS) in the diet showed a lasting advantageous effect. While this has not been evaluated as of yet, other prebiotics, such as inulin or beet-pulp may also prove to be beneficial. This syndrome is also a potential target for probiotic therapy but one must be careful when administering probiotics. Per Dr. Jorg Steiner of Texas A&M University “...unrealistic expectations have been replaced with well-defined requirements for probiotics and controlled studies of their beneficial effects. Three key requirements for a probiotic for use in dogs are:

1) the probiotic must be safe;

2) the probiotic must be stable; and

3) the probiotic must be efficacious.

In a recent study, 8 veterinary and 5 human probiotics were evaluated and only 2 of the 13 products contained the strains and concentrations of those strains indicated on the label. Several of the products contained bacterial species that could potentially act as pathogens. Thus, in order to ensure safety,

1. the probiotic product should adhere to strict production and storage requirements.

2. The probiotic also must be stable throughout transport and storage until the product is being administered by the pet-owner. 3

3. In order to ensure that a certain number of colonies are administered to the patient, the colonies in the product should neither proliferate nor die.

(use a 3rd party lab to verify product “claims” such as http://www.consumerlab.com/)

4. Finally, a probiotic must be efficacious. In order to be efficacious, the bacteria must reach the intestinal lumen. This requires that the bacterial species being used in the formulation are both acid- and bile-acid resistant.

5. Also, the bacterial species of the probiotic preparation should adhere to the intestinal mucosa to prolong the time of interaction.

6. Finally, the presence of the probiotic species must have beneficial effects in the host.

Several controlled studies have been conducted in dogs that also show that certain probiotics carry health benefits in dogs with gastrointestinal disorders.”

....................so.....................my thought is to share ALL our positive and negative experiences with these products, in hopes that in the difficult cases what one product that one EPI owner uses "may" help another...... BUT to always be aware and watch for symptoms or signs that it also may just make things worse because it doesn't agree with a particular dog.......

.

Olesia, thank you for your Probotics report from the Convention (impressive). We are treating Onza for SIBO, started 3 days ago (weight loss to 65-66 lbs, mucous covered stools, stinky-wet burps, some gas); giving Metro. We prefer her weight to be around 69-70 lbs so if she has health issues, she has a little more body weight to fight with. Poor girl can not gain weight. Had been giving Probotics for several months for burping, added Pepsid x2 daily a week ago; have stopped Pepsid. After 3 days of Metro, much better; not much burping, stools good. ? Is current advice to give Probiotic AFTER SIBO tx'ment? We want to get this right to help this sweet girl. Have not had to treat for SIBO in long, long time, so a little rusty and before there were different opinions about sequence so wanted to get  any comments or advice. All would be very much appreciated. Take care everyone ! Donna W .... and William & Onza

Kris Damiani at July 25, 2011 at 8:22 PM

Hello all....boy do i need help.Bella has done well on the enzymes...her stool is good.I had to get her on a grain free food that helped aslo. Buffalo..she loves it. This is my issue. My vet took her off the tylan powder after 3 weeks...but her stool got runny again and bright yellow so we put her on it again. And after 2 days she was good again. Another 3 weeks and I took her off of it last friday. Well....today she not only had to poop (6) times she pee'd in the house 3 times. and chewed my couch down. She has never had this type of behavior problems. NOw I have only had her 3 months(adopted her from GSD rescue) but this is like night and day. Could it be from taking her off the tylan powder. Anyone else have this issue. I am bringing her to the vet for testing but really need ya'lls advise. I also cant figure out how to post pictures...but am working on it.

 

Isn't some over the counter B12 packaged with Folic Acid?  I remember seeing it alot when I was shopping around...

Donna, I think probiotics should be given while on antis - just 2 to 4 hours  either side of the antis - which for me meant an extra meal.  Olesia - your report to me begs the question - which ones are safe. Are there specific strains we should be looking for? brands?  I use a product called Geneflora for Maya and it seems to work, but how can one be sure?

Donna, I think probiotics should be given while on antis - just 2 to 4 hours  either side of the antis - which for me meant an extra meal.  Olesia - your report to me begs the question - which ones are safe. Are there specific strains we should be looking for? brands?  I use a product called Geneflora for Maya and it seems to work, but how can one be sure?

HI Paula..... Because each dogs gut flora is different.... the only way to really know if something works or doesn't on your dog is to try it. IF you noticed positive improvement with Geneflora... that i would guess that it's composition os well suited to Maya's gut imbalance... BUT that being said.... it may or may not work for someone else's dog.

If someone is just starting out with Probiotics.... and have a dog that appears to be REALLY sensitive to the least little change... then i would opt to try a veterinarian product called: PROVIABLE as it meets all the specifics for probiotics.

BUT this doesn't mean not to try some other probiotic/prebiotic products...it really depends on the individual dog- -with many of these dogs we have a lot of leeway....they are not so sensitive to a little cheating, etc... and we can try things....... my thought is to always just be careful and carefully observe your dog's reaction whenever you try any of these products... you'll know right away (by the poop quality and/or gas) if it doesn't really agree with your dog.

hi Donna ... are you still giving ONza just 1/4 teaspoon of enzymes?  THe reason why i am asking this is because i am wondering why Onza had a relapse.... WHen my Izzy had one... and developed SIBO... turns out it was because she aged and needed more enzymes.  I wonder if this is a possibility with ONza.

 Probiotics can be given just nlike Paula recommended OR you can wait until after an antibiotic regimen is completed.  THat is a personal choice.  IF things do not turn around within 7-10 days on the MEtro... ask the vet to put Onza on Tylan.

I know she has that burping thing going on....and that you tried pumpkin increased  B12, reduced enzymes, antacids, short term steriods, etc.....and i remember psyllium was mentioned in the past... and i suggested the more benign things first....but since you have tried all the benign things... maybe you might want to try psyllium???

The other thought is that if she does need her enzymes increased... try it... but if it make her regurgitation worse... then what you can do isto do the incrased portion of enzymes with CREON... but still keep her on the 1/4 tsp of powdered enzymes for the best effect.

more on the CREON... if you do decide to try the CREON..... i would get the CREON 10 or CREON 12.... open the capsule... and sprinkle 1/4 of the capsule on the food DO NOT MIX and DO NOT INCUBATE these tiny enteric coated spheres in the food- -but rather put on  top of the powdered enzymes already prepared food just as you are getting ready to feed the bowl of food to Onza. 

I would try just 1/4 of the capsule.... as a tiny increase and observe the poo to see if things improve (once the SIBO is cleared up) and this might let you know if this is what Onza needs... increased enzymes....