EPI * Exocrine Pancreatic Insufficiency

I don't know if many of you remember me and Kaisa.  We went through quite the ordeal last summer when she was diagnosed with EPI.  With the help of this great group, we got her on track and she gained weight and was healthy.  Until about the one year mark....

She started losing and I started doing what I could to get her back.  She's continued to lose and is looking really bony again. I'm really at a loss.  I've gone back to giving her B12 injections, mixing wet food with her regular food.  We did another 30 days of tylosin but as soon as it was stopped her stool went back to cow pattie piles.

How did this happen?  I'm doing everything I can and I hope it's enough to get her back on track.  But it's so frustrating and sad to see her withering away again.

Hi DaniLynn,  I am sorry you are having a setback with Kaisa.  As we say around here, take a deep breath.  It often happens and this is where we all become epi Sherlock Holmes!  In my mind there are two ways to track this: one is to assume it is epi and figure out what needs to be tweaked/changed....the other is to make sure it is not something else.  When we have epi dogs we do have a tendency to think any change/illness is epi related and it is important to make sure it is not something else.  I know when you feel at a loss the last thing you may want to do is answer a bunch of questions...but the more info we have the better we can try to help.  So, these are my questions:

1.  Is the info in your signature the most recent info or from last year.  If you have more current info you may want to edit your signature so we have all the current info (maybe date the old info and new info so we know which is which)

2.  What is her current weight?  What is your goal weight?

3.  What are you feeding her?  (brand, primary protein (chicken, beef, etc.)?  Amount?  Frequency?

4.  Which enzymes are you using?  How much with each meal?

5.  Have you had her B12 tested recently?  How often are you giving the B12 injections?

6.  What does her poops look like?  color, frequency, etc.?  Given what you said above about using 30 days of tylosin and then her stool getting bad after you stopped it makes me think SIBO and she may need more than 30 days.  30 days is considered the minimum, but some pups need it a lot longer and some even chronically.  You may want to get another 30 to 60 days of the antibiotic and see how she does with that.

Hang in there and keep us posted as you have come a long way and we want you to continue going forward!

1. Is the info in your signature the most recent info or from last year?  Both.  She has had check ups since then, but was doing well and the vet did not feel the need to repeat labs.

2. What is her current weight? 49lbs  What is your goal weight? 55-60lbs.  55 is her highest weight and the healthy weight range our vet recommends for her bone structure and joint health.

3. What are you feeding her? (brand, primary protein (chicken, beef, etc.)? Amount? Frequency?  Taste of the Wild High Prairie Blend was her usual.  We just switched this last week to Wetland Formula to entice her to eat more.  She gets 2 cups twice a day with 1/4 can EVO beef formula mixed in.  At first this worked really well and she was devouring her food....now she seems bored with it so I am mixing in leftover meat from our meals to get her to eat.

4. Which enzymes are you using? How much with each meal?  When she was stable she was down to just 1/4 tsp per 2 cups of food  of pancreatin 6x US.  When she began this set back we increased to 1tsp per 2 cups of food and had solid stools again.  We reordered but US was out so we got the EU and either she was sensitive or they went bad during shipping due to the high temps during the heatwave.  Got another batch of US and things were improving until the tylosin stopped.

5. Have you had her B12 tested recently? How often are you giving the B12 injections?  I have been out of work since May due to my husband's job relocating us (again), so there is no money to take her to the vet.  Which is why we have gone back to the treatment she received in the beginning that stabilized her.  She is getting 0.6mL of B12  two - three times a week.

6. What does her poops look like? color, frequency, etc.?  Currently at cow pattie stage with some solid.  Which is an improvement since restarting the tylosin.  I plan to continue the tylosin for another 30 days and see how she does.

Right now her energy level is decent.  She still likes to run and play.  There has been the noticable decrease in appetite and the weight loss has been since the end of May.  Obviously I want to stop the weight loss and get her gaining again.  And as soon as I'm back to work (September at the latest), she will get a proper check up with a local vet and we will retest protein, b12 and folate levels.  So right now I have to manage the best I can with the tools I have.

Hello DaniLynn,

I do remember the extremely hard time you had stablizing Kaisa last year and have often wondered how she was doing.  So glad to hear she had a good year... but very sorry to hear she is now having some troubles.  I think you have a good idea of going back to treating her as if she was just newly diagnosed.  Can you increase her food intake slightly and maybe split it across 3 meals a day?  The enzyme to food ratio seems a little on the low side.... while her stools are solid, maybe try slightly increasing it to see if it helps with absorbtion?  Since B12 is also heat/light sensitive, are you using a new vial to make sure it has not expired?  Glad to hear you are continuing the Tylan... sounds like she responded well to it before.  I also think it was good that you tried another food with her.... perhaps she developed an intolerence to that protein source?  Terry made a good point in not becoming too focused on EPI and missing something else... if some tweaking does not get the weight loss stopped soon, it could be time to chat with the vet about what else could be going on.  Good luck!

Hi, Becky.  I would switch to the 3x a day but it takes her all day just eat what I give her in the morning.  I will try increasing the enzymes and see if that makes a difference. 

The B12 is not expired and I keep it in a dark cabinet and it traveled in our cooler during the move, so I'm pretty sure it is okay.   I have thought about requesting a new bottle when we meet with the vet, though just in case, unless you know of a place I can get it over the counter.

I believe you need a prescription for B12 here in the US... but maybe someone else will chime in with an OTC source.   I see you have been adding EVO canned.... if you can find it at your pet food store, you might want to try adding some Instinct canned and see what she thinks of it.  For the past few weeks we have been using it with our picky eater Boss and I have never in his whole life seen him take to any food (including human) as well.... and we have tried a bazillion!  I know every dog is different, but maybe it would have the same amazing effect on enticing Kaisa to eat?

Another thought.... you mention moving.... maybe in that process she has been exposed to something new and picked up a bug of some sort?   When you meet with the vet you might want to take in a stool sample to have checked.  She responded to the Tylan but if she did pick up something, it might need a stronger antibiotic.  

Hi DaniLynn - I absolutely remember you!  Sorry to hear you had a setback.   The first thing that jumped out at me was the amount of the enzymes - I would def try upping them slowly.   Becky is giving you great advice so I just wanted to say hi and let you know I am sending good vibes your way.

Hi!  I don't know you, since I've only been here since March, but it's nice to meet you!  I just moved recently myself, only across town though, but I've done the long moves before so I can feel for you there.  Everyone else has already made all the good suggestions, so I just wanted to say hi and toss in my own good wishes and hopes that you figure out what it is and Kaisa starts feeling better!

Hi DaniLynn,   I also remember you and are so sorry that Kaisa is having problems once again.   I jsut wanted to "second" Becky's and Terry's advice.   I think the enzymes really need to be increased to the 1 tsp per cup ratio. 

Sure hope Kaisa is back to normal soon.  I think this will turn around quickly.  

Have faith,

Hi Danilynn,

Yes, I certainly do remember you and Kaiser and I’ve cited your case more than once in where a dog’s CTLI score that initially may not be indicative of EPI can and does go down into EPI range…

I’m so sorry you are having issues now…I agree with what you are doing in starting over from scratch. Although sorry you are having issues getting Kaiser to eat as well. I agree with Michele in that the enzyme dosing sounds way too little. This may have worked in the beginning for awhile, but also remember that as a dog gets older, they often require a dosage readjustment. Regarding B12, try www.b12-shot.com Someone on here just ordered their B12 from there and I looked it up and it is pure cobalamin, so see if that will work.

Early last summer, I had an incident where Tara dropped about 15 pounds in what seemed like overnight…It was pretty frightening!! I figured my enzymes were compromised by the heat and the B12 was as well. I got new enzymes and B12 and started over from scratch, just as you are doing. It took me over 6 months to regain that weight because as you know, it comes off much faster than it goes on. Hang in there!!!!

Thank you everyone for your kind words and advice.   The one thing that has kept me encouraged is she has not had the energy loss she had last year when she was super sick.   She is still playful, ears perky and tail wagging.  When I had to take her in last year, we had none of those. 

I think the restart of the Tylan is helping as she ate both bowls of food yesterday (even if she did wake me up at midnight to let me know she wanted to eat).  I had reduced the amount of canned EVO I was using because I don't want to give it to her all the time and use it when I need to entice her to eat.  I guess she got spoiled because I went ahead and added a little more this morning and she went to town, eating half of what I gave her.  So, we'll see.

Again, thank you to everyone for your awesome support!!

That is wonderful news that she ate and is acting spunky   Does she still look pink polka dotted when she gets B12 shots?

AK GSD at August 26, 2011 at 2:41 PM

That is wonderful news that she ate and is acting spunky   Does she still look pink polka dotted when she gets B12 shots?

Not usually!  LOL  Although yesterday the syringe seperated from teh needle when I started injecting it so some leaked onto her fur.  So she had  a little pink spot.  Poor things knows when she's getting them now.  She lays down and gives me a "do we have to" look.  LOL  Then she's ready for her ice cube (her favorite treat).