EPI * Exocrine Pancreatic Insufficiency

Greetings, so glad to have found you! My 10 year old Pom was recently diagnosed with EPI by me! She has had severe pancreas attachs all her life! I have had her on SD i/d since 1 1/2, and isolated her from everything forever because the smallest of anything other than I/d and she was terribly sick. Two years ago she was diagnosed with diabetes and we have successfully mangaged that. But last sept she was getting very sick even from i/d. I had to go to 2 tsp. of powdered i/d every 3 hours, anymore and she would get very sick and go off feed. Well in the last year she has got so skinny, and 2 months ago fell off the wagon again and couldn't even digest or keep down a pinch of food, After many failed attempts by several vets to save her, I decided to put her down as she hadn't been able to eat for a week and was almost gone, When tons of late night research i matched her symptoms with EPI, no one thought I was right but started her on Pancreplus and for the first time in over a week she kept her food down and the rest is history. She has put on 2 lbs and is going hair back everywhere ( it was falling out, I am sure because of severe malnourishment. So much for the history now my problem. I feed her every 4 hours because she is diabetic, But I am having a time getting the right amount of emzyme. I feed her 1 tab. plus 1 tsp of powdered i/d with aprox 1/4 tsp of pancreplus wetted and mixed in. But she is still getting some stomach cramps. I was feeding her a heaping 1/4 tsp and then she would often stay humped up and get crampy, so I cut it back till I was just a little under 1/4 tsp. she did fine there for a week or so then had a nasty growley crampy tummy and went of food for 2 feedings. I kicked her back up to a slightly rounded 1/4 tsp and she has done fabulous for 2 weeks, Then yesterday she was a little crampy and today she was crampy right after she ate and stayed that way finally throwing up her food almost 4 hours later, now I had to deal with insulin shock since I had given her her insulin at that feeding and she refused her 4:00 feeding. I am thinking too much emzymes again but not sure, how can I tell the difference between too much and getting cvrampy and not enough and crampy. I am thinking too much this time because the cramping started right after she ate. Also I am concerned about the vitamins in pancreplus being fat soluable and her being so small and getting 6 feedings a day. probably not something I have to worry about for a while with her being starved so long but I wonder about that as well. It wouldn't be so bad but when I am at work and this happens she could go into insulin shock so I would really like to get her stable. I am sooooo blessed I found you all and any help you can give will sure help my peace of mind! Thank you

Welcome Vickey,  It is a balancing act to try and get the right amount of enzyme, type of food and either B12 or antibiotic if needed.  It doesn't sound like you have had the blood test for epi (cTLI), B12 (cobalamin or SIBO (folate) and would recommend doing that as soon as you can (12 hour food fast and best to do Mon, Tues or a Wed) to confirm what is going on. 

There are some others on the forum who have pups who are diabetic as well as epi and they will be able to provide more assistance in balancing the two diseases.  Is the pancreplus tablets the only enzymes you are giving?  Most people here use a powdered enzyme and the recommended dosage for the powdered enzymes is 1 tsp. per 1 cup food, but tablets are different.  We use tablets for both are epi dogs and have found that 1 tablet per 1 cup food plus 1 tablet works....we crush them and add to the food with a little water, mix in well and let sit for about 20 minutes, stir again and then feed.  What is powdered i/d?  With the tablets don't use the tsp. ratio per food as used with powdered enzymes as they are two different types of enzymes.  You can have the same reaction with too little enzymes as too much.  How much does she weigh now?  How much food per feeding?  What food?  We are here to help and appreciate the info you have given but need a little more info to give better advice.  Thanks!

Thanks for the quick reply Terry, She weighs 5.9 lbs. i/d is Science Diet intestinal diet, highly digestible, the only food she could digest for years. I give her 1 tab plus 1 tsp (ground up i/d) every 4 hours with the emzyme added and moistened and incubated for 12 hours. I am giving powdered PancrePlus with each feeding aprox. 1/4 tsp. Thanks for the advise on the blood test, my vet just isn't into that but I will work on him. I did read that b12 was necessary so I have been giving that to her weekly.

Hello Vickey and welcome to you and your wee little Pom.....   I'm glad Terry can help you out with the Pancreaplus....  Are you giving the B12 via syringe or tablet?  If you are giving the shots, how much are you giving?  If by tablet, mke sure the tablets contain intrinsic factor, that is necessary for the dog to absorb the B12.  Are you incubating then refrigerating?  Did you mean to say incubating for 12 hours, or is that 1/2 hour?  As Terry said, there are members who have EPI and diabetic dogs, and they will respond soon.....   Please feel free to ask any questions you may have.....  

Boy am I glad I found you guys, my little Pom was the first "small" dog in my vet's 30+ year career he has seen with EPI, that is why he just didn't see it. I am the only person in our town with a small dog with EPI so I am pretty much on my own. Till now that is! Buttermom I am giving B12 injects 1/4 cc, once a week, will be dropping to every two weeks soon. I meant to say I am incubating it for 20 minutes. sorry for the blond moment! After reading some of your articles, I got some Science Diet z/d I am going to try instead, as the lack of fat in i/d my be contributing to her problems. If they need an antibiotic due to undigested food in the bowell does that show up in body temp? Do they have a fever?? The Pancreplus emzyme is the only meds she is getting except for insulin. Terry you said you give 1 tablet per cup plus I tablet, does that mean you give 2 tablets? I was thinking of going back to the tablets for a while in concern she is getting to much soluble viitamins although she has only been on the pancreplus for about 4 weeks,, before that she was on Pancrezyme tablets. Thanks again, you guys are wonderful!

Hello from UK

you are no longer alone

Tylan is the oreferred antibiotic for getting rid of SIBO which results in  the gut being infested by bad bacteria

 there is no temperature difference noticeable the most noticeable thing being rumblings in the tummy and cow pat poops as nothing is being degested properly

The one thing I would add is maybe the ID diet needs to be tweaked as grain does not suit most of our dogs maybe try a grain free food but I dont know much about  diabetes in dogs so I am sure someone who has the knowlefge will chime in

the majority of folk from US use Enzyme Diane for enzyme needs so maybe have a look on her website

good luck

jeanxx

Hi. Welcome.

I see that you lives in the US, so you're able to do TLI, cobalamin & folate test. Please make sure you had it first to properly diagnose whether its really EPI or not.

What is powdered i/d? What I know that its available in kibbles & canned. Before you go for z/d, you might want to try another food, which is better in quality. As you said that your pom was able to digest it without having issues for long, then I'm just guessing here (I'm NOT a vet), she may have allergy to certain protein and/or grain. As it happened to my pom, first we thought that it was EPI but later turns out to be allergic to chicken, beef, fish, pork, grains and not EPI. And now he's eating canidae pure land which based on bison & lamb meal and grain free.

Regarding the diabetes, I'm very sorry I can't help you.

How's her poo? How many times she goes a day?

HI Vicky and a very warm welcome to you and your beautiful Pom... although so sorry you have to even be here. Since your baby sounds like she developed EPI from repeated attacks of pancreatitis..... you probably do need to watch the fat content in her food.....

When reading your intial post.... what jumped out at me, aside from maybe too much enzymes... is that what you are describing sounds like your baby most likely has SIBO ... when dogs first develop EPI, jsut because of the very nature of EPI... SIBO is in play. THeoretically, once on the enzymes they suggest that SIBO "may" correct itself, however, in reality this doesn't seem to happen very often and tummy aches, gas, tummy grumbling, mushy stools, any yellow in the stools, sometimes refusing food, sometimes regurgitation, sometimes non of these symptoms... indicate SIBO and it is usually best to take care of with antibiotics.    As Jean mentioned, Tylan is the drug of choice... for 30 days.  BUT, i too like Anderson, (if possible) strongly recommend that you ask your vet to run a TLI test to confirm EPI (even though it sure does sound like EPI).  The TLI test is a blood test that the dog needs to be fasted for 12 hours first.  Again, if possible, when having this test done, ask the vet (to save money in the end) to also draw enough blood to run a Cobalamin (B12) test. 

I am going to contact one of our members, Sue... who owns Claire..... Claire is a little rat terrier who also has diabetes and EPI and they just put on Tylan for SIBO and Claire is doing great now...... because of dealing with both EPI + Diabetes.......hopefully Sue will be able to help you .....

Oh..... since your little gal is really hurting right now.....maybe you can call your vet first thing tomorrow (or today) and ask if he thinks it would be okay to try Tylan prior to any testing......

Hi Vicky. Welcome to the forum. Sorry your little girl has been having such a hard time lately. Hopefully she'll be feeling better in no time. Like the others the possibility of SIBO jumped out at me. It can sometimes be difficult to get rid of and sometimes causes it to seem like the enzymes are not working at all. So, I'd start with the tests to make sure of her levels.

Also, I don't know if you've seen these, but there are little measuring spoons that are a smidgen, pinch, and dash. If you're trying to tweak the enzymes it's recommended to go up or down by 1/8th tsp. However, with these little ones like ours, 1/8th will be a large portion of their enzymes. I used the smidgen (1/32) when adjusting Rosina's enzymes because it was always too much or too little using an 1/8 tsp. She's 20 lbs, but still only gets 1/2 cup of food twice per day. The little spoons really helped me alot in keeping the exact measurements of the enzymes and food.

Keep us posted  on how she's doing!

Thank you to all who have come to my rescue! I am at the vet's now and we are drawing blood. About the SIBO, she has had good bowell movements since we have had her on the emzyme, some a little soft but no runny ones, can she still have SIBO without runny bowells??? My poor baby had a nasty night, cramped untill 4:00 this morning! Now she is no longer cramping but her tummy is growly and she is still off food and water.  She is starting to feel some better. Will be starting sub q fluids. I talked to my vet about starting her on Tylan as soon as she starts eating again, he said to ask how you guys are giving it as it is a antibiotic used on pigs normally and is powder form, so how are you dosing it??What is the recipe??? And once again is SIBO only present if they have loose bowells??? Thanks so much!

HI Vikey and welcome to the forum. Yeah, Tylan is an antibiotic normally used for livestock (chickens too), but the researchers have found that it kicks SIBO better than Metro (second choice) does. I'll copy the dosage here, but do feel free to read the SIBO tab above for more information. Also, if you are having trouble getting your pup to eat, I wouldn't recommend putting it in the food - the stuff is very bitter. If you can get your hands on a capsule maker and make your own pills, that would be better.

Tylan Dosage for Dogs (administer twice daily with food):
30 lbs - 1/8 tsp
60 lb - 1/4 tsp
90 lb - 3/8 tsp
120 lb - 1/2 tsp

Hi Vickey and welcome to the forum.  Sorry you have to be here but hopefully you'll be able to get your little girl stable and feeling better.  Congrats for being on top of her diabetes for the past 2yrs, that in itself is a big accomplishment. What's the little ones name??

Claire is my EPI/diabetic girl, she's an 11lb Rat Terrier that I pulled from a county shelter.  In her case, we don't know what came first EPI/db, but we have never had good control over the diabetes.

She does pretty well with the EPI though.  I've always used powdered enzymes, pancreatin 6x that comes from enzymediane. Just recently switched Claire from I/d to Wellness Core which is completely grain free, thought being maybe she'll digest better and it will help the diabetes.

Claire often had stomach grumblings and we have noticed less with the change in food.  In the past couple weeks she'd been having some bad days, not feeling well, wanting to eat grass, a little bit of vomiting, so she is having her first go at Tylan.  She did not have diarrhea, but they still felt it may be SIBO.  Two days of being on it, she is feeling much better.

I see your furbaby weighs 5.9 lbs, what's her ideal weight?  I'm always interested in how others are managing the diabetes.  Do you home test and what kind of insulin is she on?  Looks like you feed her about 5 tbsp of food a day, roughly how much kibble is that before you grind?

Was the blood work today for EPI testing?  At least with that you'll know for sure.  With the sensitivities to food, it does make you wonder about allergies.

I hope she starts feeling better soon.  You'll be in my thoughts and prayers as you anxiously wait for results.

Sue and Claire

Hi VIcky~  hope your little one is feeling a little better after her visit to the vet!

To answer your question.... YES!!!!  These EPI dogs can indeed have SIBO without loose stools.... sometimes all we hear is a fart :D.... or no symtpoms but they just don't want to eat... or.... the have acid reflux... or their tummy makes noise... or nothing but an occasional not so great poop, etc...... I can honestly say... we all detest SIBO!!!!!!

IN regards to how we administer it... good question from your vet.... cuz it is nasty bitter stuff. We give the powder form.

Donna already gave you the standard recommended dose in  the post above and her suggestions of putting the Tylan in capsules via a capsule make is a great suggestion!

Some other suggestions are:
you can have a compounding pharmacy put it in gel caps for you, or... (as long as you dog is not lactose intolerant) you can camoflage it by making a little pouch of cream cheese -pour the correct dose in the cream cheese-seal the cream cheese as if it was a tiny ravioli and serve with a meal, or....mix a little in something really stinky like a few pieces of anchovies, sardines, etc (canned stinky fish without salt) and serve with an enzymed meal,.... or mix it in a few tablespoons of baby food- -also served immediately during an enzymed meal,... or tuck it in a few spoons of stinky canned cat food,.... or mix it in a few spoons of BBQ sauce....... we have come up with any and all kinds of tips and tricks to administering Tylan.  The thing about Tylan though is that it is very bitter tasting so many dogs will not eat it if it is mixed in their food.... however.... some dogs don't mind it mixed in their food........ but it is something you might want to try by hiding it first in something and then if all went well.. the next serving you can "try" mixing it in the enzymed meal and see if your dog will or will not eat it.

The other thing you need to know about Tylan is that it get air-borne when handled.....try tasting your finger tips after you open the bottle and spoon some in something.... EEK!!! they will have a horribly nasty bitter taste to them... no wonder why so many dogs won;t eat it if mixed in their meal.!!!!!  I found that when i have to give Tylan powder (it works like magic for us getting rid of SIBO!) i make the cream cheese pouch first, then open the bottle of Tylan, pour the required amount in the pouch and then i wash my hands with soap and water before i pinch the cream cheese pouch with the Tylan in it together.   If i just rinse my hands with just water before pinching the cream cheese pouch- -my dog STILL won't eat it because some Tylan reside appears to still stick to the fingers..... 

I know this sounds like a lot of work..... but SIBO can sometimes be more difficult to manage (get rid of)  than managing  EPI itself.... so when  we find something that works....  so we don't mind the extra work for 4-6  weeks.... anything to get rid of SIBO once and for all.

And the last   few things about Tylan is that that it needs to be given twice a day (they say about 12 hours apart), serve during a meal so that they don't get an upset stomach and we like to suggest just 30 days to start with..

Hi Guys,thanks for the posts, I am reading and re-reading them, learning so much! Mylittle one’s name is FoMoCo. Her ideal weight is around 7.5 lbs. I think. Igave her subQ fluids around noon and she drank some on her on around 4:00, sofar has kept it down but she is cramping a little again now and still does notwant any food. I have the Tylan and I figure her dose should be about 1/32 tsp.I do have some vegetarian capsules I could use but I am concerned how she willreact with them, what do you think? As for putting it in cream cheese orsardines etc. I am terrified, since she was 1 ½ she hasn’t been able to eventhink about any food other than i/d or she would get deathly ill, so I amtrying to get over that and believe the enzymes will handle it.  As for her food I was thinking of switchingher to Science Diet z/d ( as i/d is mainly rice base), main ingredients of z/dis(Starch, Hydrolyzed Chicken Liver, Soybean Oil (preserved with BHA, propylgallate and citric acid), Hydrolyzed Chicken, Powdered Cellulose, DicalciumPhosphate, Calcium Carbonate, Glyceryl Monostearate, Potassium Chloride,Iodized Salt, Choline Chloride). Andersen you said to wait and try a higherquality food, I have looked at what you guys are feeding and don’t have accessto those in my small town, won’t be able to shop till next weekend, or I couldorder on line, just so many choices I am over whelmed and can’t even imaginefeeding meat raw or cooked to my fragile little one. She can really processthat???? Now to answer the questions about her diabetes, she is on Humulin N, 2½ units twice a day, at noon and midnight, (the only time with my job I canalways count on being home) I check her blood sugar before I give her insulinat both times and adjust as necessary. I feed her every 4 hours, 12-8-4, myhusband does the 8:00 am before he leaves and I set up an auto feeder to giveher the 4:00 pm one which I set up at noon while I am home. I think total sheis getting slightly less than ½ cups of kibble a day. Sue which wellness coreare you feeding??  So now I am justwaiting for my baby to want to eat again, thank God she had gained some weight beforethis happened. I am thinking about trying a larger amount at noon and notfeeding until 6:00, cutting the feedings back to every 6 hours instead, as Iread in the EPI link that anything over 3 feeding a day is counterproductive.But I will have to see how that works with her blood sugar, if it gets to lowbefore her 6:00 feeding it may not work. My poodle does fine on two ¼ cupsfeedings twice a day and insulin with each but FoMoCo has always been morefragile than Honey. Hope I have answered all your questions and look forward toyour continued advice. Pray my baby wants to eat soon so I can start the Tylan!By the way she just passed some stinky gas so it may indeed be SIBO!

Hi Vickey

Wow, sounds like you really have your hands full.  What a devoted Mom, FoMoCo is lucky to have you.

Claire is on the Ocean formula of Wellness Core. The decision to change food was mine alone, my vet is in favor of keeping her on a Rx food.  We were struggling so with the diabetes I thought it might help, but we still aren't getting good numbers. 

It is overwhelming and my heart goes out to you.  You try to search for good products but with so many on the market, and not being able to believe what your read, it makes it tough.  Claire is a very good eater, she would eat the bowl if she could, so that has never been an issue.  It has to be heartbreaking when your little one won't eat or if she does, she can't keep it down.

I wish I had more answers for you. With Claire we just take it one day at a time. Yesterday she felt so..... good, not nearly as good today, and tonight I can tell she isn't feeling good at all.

Keep us posted and don't hesitate to ask questions.

Sue

Actually more frequent meals is just fine....we started with 4 (we work at home) and worked back down to 2.

Thanks Terry, I am actually feeding 6 meals a day but I plan to try to adjust it to 4, if that will work with her blood sugar. Also one other thing that FoMoCo does after a feeding is Vurp, that is a burp that food comes out, she thens eats it right back up and acts like she feels fine. Do you guys think that is another SIBO symptom? She does it quite often. Sorry about Claire not feeling good Sue, my heart hurts for you cause I know how bad you hurt when she does as I am the same way. The good news is FoMoCo ate at 8:30 and is still doing well, it is going to complicate her insulin as I had to give her a dose or she gets so high she vomits. but now I can't do it at midnight as normal and I won't be here for the 8:00 feeding so she may get high before noon, Oh well can't be helped the joys fo having both EPI and diabetes lol! Just happy she is eating again. I gave her 1/32 tsp of Tylan she took it right in her food no problem. And I decided to follow your advice and only make one change at a time, so I will not go to 4 feedings yet or switch her food yet, will work those in one at a time.

Vickey

Vurp's often means GERD (reflux) and they often do well with an antacid about an hour before one of the meals.  I am blanking as to the one we use and we give it as needed.

Hey, its good to hear she's improving. Let us know how she's doing with the tylan.

My pom also eating 6 times a day, every 3 hours, not a diabetic, but large meal will upset him.