EPI * Exocrine Pancreatic Insufficiency

I just stumbled accross this site - and i can only tell you what a relief all the information on this site has been for me and my family.   A little info about our GSD - we bought Sultan when he was 18 months old as an addition to our family of 4 kids and 4 other dogs.  After he turned 2 he started with severe stomach probems and we could not get him to add weight. Our estimates given the size of his paws and head (see picture) he should be around 90 pounds - he currently weighs 72 pounds.  After numerous trips to the vet, trying all the typical tests and drugs for stomach issues, nothing seemed to work.  We had Sultan scoped to determine what the issue could be and he was diagnosed with IBS and placed on steroids - as you can guess that did not work either.  After some more testing - we found him to be deficient in B12 and started some B12 shots along with pumpkin, yogurt etc.  Again not a lot of help with poop still watery, oily etc and no weight gain.  After several bad flare ups and accidents in the house we could tell that Sultan was not living a happy life - and our decision was to have him put down. As he was my dog i could not bring myself to do this so we tried one last effort and got a 3rd opinion.  the second opinion came from the animal clinic doctor that did the scope.  This doctor took one look at Sultan and immediately put him on the enzymes to treat for EPI. We are currnetly 3 days into the enzymes and are hopeful that this will work. 

Interestingly enough our first vet tested for EPI and it came back negative - we are having the tests rerun but my question is have there been cases where the tests are inaccurate? 

This is an abreviated story but some other details will help - he has had his stomach issues for over 12 months.  We had him on tylan and metz drugs for several months as well as steroids for 2 months - absolutely no improvement.  in additon, we tried pumpkin, fiber one, changing his diet to single protein, no grain etc.  nothing helped.  any insight into a flase negative test would be helpful. 

Hello Sultan's Dad and Welcome to you and Sultan.   We are sorry that you are having difficulties getting help for Sultan.  It sounds like the vet who put him on enzymes is a keeper.  I am glad you found this site because there are many knowledgeable and generous people here who have lots of experience with EPI and are more than willing to share with you.

If you could give us the numbers for the cTLI tests that were run for the EPI, we can give you a better idea.  Sometimes a dog is heading towards EPI, but the numbers don't show it yet.   Olesia just posted on another thread that in some cases dog will not have results that show EPI, but will be helped by the enzymes. In addition, a dog may have concurrent conditions that such as you mentioned that complicate things.   Once you get the new results back and see how the enzymes are affecting Sultan (hopefully positively)  you will know how to proceed.   

EPI is managed by balancing FOOD,  ENZYMES, B12, and ANTIBIOTICS (for SIBO).  If Sultan has EPI it sounds like you were working on some of these, but not all.   And many of us know that when one gets out of whack, the poops go south again.  Sometimes several foods must be tried since every EPI dog is different and each one reacts to food differently.  Kolby went through 5 foods before we had to switch to a prescription food which worked wonders for him.   Not all dogs do well on this. 

When you prepare enzymes we also recommend 1 tsp per 1 cup of food to start.   Dissolve the enxymes in  warm/room temperature water and pour over the food.   Let soak for at least 20 to 30 minutes to adequately cover all the food and to avoid ulcers.

We recommend that you keep a daily log, so that you can see at a glance what you are giving Sultan and how it is affecting him (poops, energy, behavior etc.)  It will give you enormous amounts of information. It also helps to take the log with you to vet visits so that you can adequately explain what is going on.

We know this is rather overwhelming at the beginning, but you are doing a tremendous job for Sultan.   He is certainly lucky to have you in his corner.   What a beauty he is and what a great family (human and canine) you have.  We are surely glad you found this site for Sultan's sake and we welcome you again.

Barb

Please keep the questions coming and let us know the results of the tests. 

Thanks Barb for the input - a lot to digest here.. ha ha!!  It has been a long process and our family is hoping this is what Sultan needs.  We are dog lovers as it appears everyone on this site is.  We have just started the enzymes a few days ago and will start  a log today.  in addition i will get the lab scores and report them back!!

Thanks again,

Mark

Hi Mark,

I forgot to tell you that if you go to "Downloads" under the tab at the top of the page, you can download form log pages that you just fill in.   We kept ours in a notebook because I tend to lose pages, but they make it easy to fill in. 

You might also want to read some of the research that has been done that is contained under those tabs and that may apply to Sultan.   There is a wealth of information there.   But don't overload your brain......  I will also  find the thread where Olesia (site owner)discussed testing so you can read about that in more detail. 

Keep us posted.

Barb

Hi Mark and a very warm welcome to you and Sultan... to our family.

To answer your question first, yes there are false reads..however.. not very often...... but what more likely happened (if Sultan does have EPI now) is that he did not have clinical EPI at the time he was tested.. but  was heading in this direction.... to get a better understanding of how crazy convoluted EPIs  go to the NEWS tab and read the latest research by Westermarck....also EPI can effect a dog in varying degrees and the condition can progress in varying degrees .. or not ever develop into EPI at all..... it can be very crazy...

AND...... there are conditions that are not EPI but benefit from temporary EPI treatment until things get back on track.... AND there are also conditions... we have seen a few on this FORUM where it is not EPI (clinically) where the TLI value is in the 11's but... the dog ONLY responds to the EPI treatment with enzymes, etc and when stopped the dog gets ill again..... thank goodness enzymes won't hurt the dog!!! Even if you use it as a tool to "help" until the body heals enough and can take over for itself (if not EPI).

ANyway... because your dog has all the EPI symptoms AND low B12..... i'd be very thankful of the vet who put him on enzymes at this time.... and whether Sultan needs to stay on them because he will be diagnosed with EPI or whether it just helps him navigate thru this malnourioshed .... either way... it's a good thing for now.

Now that he is on Enzymes (powder i hope)... and Barb gave you good isntructions on how to use) I personally would  treat the entire dog all at once now.... Even If Sultan doesn't have EPI.... the good thing is none of this treatment will hurt him..

So... since you started the Enzymes (3 days already ) call the vet and ask if he can start generic B12 injections weekly for 6 weeks, etc (see B12 page).. especially since you already know he has a B12 problem. Also...ask the vet for a 30 day course of Tylan for SIBO as you want to take care of all the details now.... When they have B12 deficiency, their system consequently set the stage for SIBO to invade.... and i also would strongly consider changing him to grain-free food now also. Many of us suggest starting with Taste of the WiIld because it is middle of the road grain free and the  most dogs seem to respond well to this food.

Start all these things together at the onset of EPI initial treatment... also, down load an EPI Log from the DOWNLOAD page. ...(this is a great tool whether Sultan has EPI or some other condition)... start keeping detailed notes.... what you give him, how much, how it is prepared,... and then.... chop up a piece of raw carrot... include it in one meal... watch for those undigested carrot pieces to come out the other end :D.... this way you will also have a base line of what your dog's digestive transit time is.. SUpposedly it is supposed to be 12 hours... but we have seen it range anywhere from "real soon to 72 hours!"

Then... after you started with the enzymes, diet change, B12 & Tylan..... watch for a few days to make sure things are improving... IF Sultan gets to a point where things have gotten better but there is still something not quite right (you determine this by the poo.... frequency, volume, color and texture... then that means something needs to be "tweaked" and this is where you make only one-change at a time... watch SUltan's reaction for 3-5 days.... if things improve.. then you now know where your adjustment needs to be made.... if nothing improved... then make another "one-change-at-a-time"

THis is tedious but a great techinique to determine if you are dealing with food allergies, SIBO, B12, etc....

Also... keep it simple in the beginning.... after you have introduced the Enzymes, Diet change, B12, Abtibiotics...and things are moving along nicely ..... then you can do as ""one-change-at-a-time" such as the pumpkin, probiotics, etc...

CAn you tell me what his poo is like and how many times a day is he going? 

Has the vet mentioned anything more specific like lBD that developed into PLE, did they mention possibly food allergies, have they suggested any hydrolyzed foods?

Looking forward to hearing more from you about Sultan and to hopefully helping you heal Sultan!

P.S.  So sorry i am so long winded.......................................................

Mark,

This is a small part of Olesia's post to another member whose dog's TLI came back at 11.5, which is usually not indicative of EPI, but her dog had symptoms of EPI and perhaps some other conditions:

"Hi SHerri... damn .. i wrote you a huge response and it disappeared...........:(

OKay... without being a vet... i am going to go out on a limb here and share with you what worked for two other dogs who also had very similar values and identical symptoms and were consequently diagnosed with canine disease of the proximal small intestine (a catch-all phrase!) . Neither dog did well until they were treated as if they had EPI. They were given EPI strength pancreatic enzymes, grain free food, Tylan for SIBO and were started on a B12 regimen. Actually one of the other dogs actual had a TLI value of 11 something also.  Not EPI but responded to EPI treatment...... this is a case of where keeping a LOG record EVERYTHING you give Sophie and her raction (poo's, vomiting, weight gain, loss) will greatly help you determine what is or is not helping/working."

Olesia also recommended the reading of other research, but you should probably wait until you get the results of the new test.

Barb

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Hi Mark - I am so sorry for all Sultan has been through and hopefully now you are on the right track to helping him.  

You have gotten great advice so need to spin your head any more.   Welcome to our EPI family - there are amazing people here.   I can't believe you had 4 dogs and home and took in Sultan - wow - good for you!!!

Many of us here get our enzymes from our enzyme angel Diane - please feel free to check out her site - it is a generic version of pancreatin at 1/3 the cost of the vet -  http://www.enzymediane.com/

Please do keep us posted on his progress and any questions, please do not hesitate to ask...

Hi Mark and everyone.  It has been a long while since I have visited the forum and posted.  If I remember right (and it has been a long time since Jed had a TLI test) but doesn't the test have to be done on a 12-hour fast?  That may have been right your got a false reading.  If this has already been addressed I apologize.  I have three TLIs done, each came back confirmed EPI, but I just didn't want to believe it.  Anyway, two years after diagnosis he is 100 lbs., stable and silly as ever.  Plus he has had to deal with two additional autoimmune diseases.  Our best to your and Sultan.

Leslee (and Jed)

Sorry about the many typos! 

Leslee

Hi Leslee... SO nice to hear from you and glad that Mr. Handsome is doing so well now... thank you for sharing your words of encouragement for Mark too...;)

Welcome to the Forum Mark and Sultan.  I won't add info, just will reinforce that the log is a precious tool and will help you a lot in these early stages of learning what works best for you and Sultan.

Hello Mark and welcome from UK

Nothing much to add

what were the results from the ctli tests sorry may have missed them somewhere along the line

As said fasting is imperitive otherwise there is a risk uf false reads

Anyway my moto is keep it simple

we give grain free food, for us this turned our corner to normality. the enzymes and the antibiotics all work beautifully together ,  just a note Kara is on antibiotics for life as she reverts to SIBO almost immediately if we stop we use Tylan now, much at the beginning to the vets distrust now with their blessing very underused drug

most folk from the US use Enzyme Diane with awesome results, wish we had her here

Anywy good luck

Jxx 

Thanks for the great advice. I am getting the original test scores but for sure he had a low-normal vitamin B deficiency and we are giving him weekly B12 shots. My first post, I realize now, is missing quite a bit of info Sorry – still trying to figure it all out. Here is some more detail – I will get all scores early next week and post.

We adopted sultan when he was 18 months old and he flew from CA to OH to his new home. He checked out healthy after his first visit – but shortly after having him fixed his Diarrhea got very bad. We treated with metronidazole for a few weeks – to no improvement – continued loose stools with flare ups where he could not even make it outside. We changed his diet as the vet suggested a food allergy – again to no improvement. Given continued weight loss/no gain and him eating 8-9 cups of food a day in some instances and on other day’s sultan did not eat at all. We took him to have a scope. We chose the less invasive scope vs opening him up because of a problem (and I will get exact terminology) but because of some low scores they did not think Sultan would heal and he had a greater chance of infection. The scope found some issues in his intestines – but was ultimately inconclusive. The Vets said IBS and possible food allergies. He was put on Tylan and steroids. Again this did not help. We switched his food again to now he is on Hills prescription i/d Canine gastrointestinal Health Canned and kibble – he eats 3-4 cups of kibble and ½ of can of wet 2 times a day – he is hungry! Again still no improvement. Finally our new vet put him on enzymes – funny thing is she suggested 1 teaspoon with every meal – not the recommended dose on this site. Obviously 1 teaspoon will not help given what I am reading here. We are upping his dosage to the recommended 1 teaspoon per cup of food – but before I do I just want to make sure – given what he is eating – and we are going to break it down to 4 meals a day starting today (Fortunately my wife stays at home). – he would get 4 3/4 teaspoons of enzymes with a meal at 4 cups of dry kibble and 1 cup of wet? I think that is what I understand the correct dose to be? In addition we have a lot of tylan powder left over as well as continuing the b12 shots. Another question can I put the tylan powder on the food with the enzymes? Or should this be done separately? In addition, starting tomorrow we are switching to grain free food – is there a protein preference? I read Taste of the Wild above is there a preferred flavor? In addition, we have thought about the raw diet is that an option and what benefits/drawbacks could there be?

Thanks again to everyone for all the great info – I will post next week results etc. and I look forward to some suggestions about dosage etc.

Hi Mark,

If he is getting 5 cups of food total he should get 5 tsp of the enzymes (4 cups of dry kibble and 1 cup of wet).   The ratio is 1 tsp per cup food weather wet or dry and adjust accordingly if you lessen the food, i.e. feeding 3 1/2 cups give 3 1/2 tsp enzyme) - hope this answers the question.    It is recommended to feed them 150% of their normal amount of food in the beginning - just to bulk them up a bit and cut down on the appetite.  When they slow down eating, that will be your cue to cut some food back.

You can put the tylan on the food but it does have a bitter taste and some dogs won't eat the food with it on it.   I was able to put it directly on the food.   BUT...do not incubate the Tylan, add the Tylan right before you serve the food.   Some people have to put the tylan in pills because their dog won't eat it, others mix it with yogurt or something else your dog likes that has been proven to agree with them.

I personally use TOTW High Prarie and the dogs love it and have done great on it.  I have to leave it to others to comment on the raw - I never did that...

Hi Mark, Welcom to you, Sultan and your family.  I think once you have Sultan on grain-free food with the correct dosage of enzyme, Sultan may slow down a bit on the amount of food.  Right now he is literally starving and will continue to eat and eat, but soon once they start putting on weight their appetite usually slows down.  But we usually feed 150% of the recommended normal to begin with to help them gain weight and feel better.  I have read here that a little less enzyme is needed with wet food over dry.....so you could try 3/4 tsp. for the 1 cup of wet or do the 1:1 ratio still and just tweak it up or down if needed.  Too much enzyme will give you the same effect as too little enzyme.

In terms of the protein preference I would say two things: what your dog prefers and what he can handle.  Some epi dogs cannot handle chicken or other fowl as it will give them loose stools, but our dogs do just fine on chicken (our mantra here is every dog is different).  And we have noticed with our dogs certain preferences on foods.  In the past, even though they love real fish (when we are eating it) they hadn't seem to like fish based kibble so we steered clear of them.  We are trying them now in a small bag (TOTW) as our local Costco only carries the Nature's Domain fish based kibble (which is a lot cheaper than any of the other brands) and we wanted to try a small bag before buying a big bag.  A lot of people here use TOTW, we use B.G. (before grain by Merreck) and a number of people are now using Costco's grain free.

My guess is switching to grain free and uppping the enzymes will make a huge difference.  Glad to see you will keep up the B12 shots....I recommend reading up on the protocol and making sure you test again the recommended interval to make sure he can "hold" his B12.  We made the error of not re-testing Pharaoh until about 6 months later and his numbers were back down to almost below normal....so he and Taiko receive weekly B12 at home.  If we forget or they have boarded when they should have had their shots we can usually tell within a week:  decreased appetites.  Also some dogs with low B12 can have some temperment changes such as anxiety and/or fear agression.  Pharaoh is a happy go lucky kind of pup but when his B12 is low he gets growly towards other dogs when on walks.....when his B12 is up he is fine. 

Keep in mind while making changes and watching for outcome that each dog's "transit time" (time from eating to pooping) varies from 12 to 72 hours...so the poop you see may not be related to the last meal he ate.  Some people add carrot to a meal and then watch for when it comes out (doesn't digest) and then have a better idea of that time.  If you keep a log and know the transit time it helps a lot to know what change you made had what effect.

Again welcome.  Sultan is fortuante to have you and your family working so hard to get him better.  Thank you for opening your home and hearts to him.  I think once he is stable you will really get to see the pup he is meant to be!

Wecome Mark and Sultan,

As Terry suggested, go with 3/4 tsp with canned food as it has a higher water content and go with the 1 tsp for dry - level teaspoons.

As far as food, there are a lot of grain free to chose from. I rotate foods with Ted but always grain free. I mostly use the Wetlands formula for TOTW, the Merrick Before Grain Chicken, Earthborn Holistic. Since Sultan does have SIBO I would stay away from the Costco Nature's Domain for right now, maybe try it later. It was a high carb content and high carbs can contribute to SIBO.

The Tylan does need to be given with food. it is bitter but Ted doesn't mind it, I mix it in his food right before serving.

Hi Mark.  Sorry you have been having such a rough time of it.  When switching foods, are you using novel protiens/ carbs?  Something not eaten before?  If some of this is intolerances, you need to cold switch to a novel food.  Here is a link on intolerances.  http://www.peteducation.com/article.cfm?c=2&aid=143  And one on IBD.  http://www.peteducation.com/article.cfm?c=2+2090&aid=305  There is a difference between IBD and IBS, too.  Just a thought.  Hydrolized food  is also another option.

We had numerous food intolerances.  We could not find a kibble that worked for Hondo, even on treatment for everything.  I finally in desperation switched to raw.  This is what it took for us to turn him around.  It is not for everyone, though.  But if trying enzymes, novel kibbles, etc does not work, it may be worth a try.  Cindi/Brodie also just switched to raw which has helped him.  I make my own, she buys hers.  We both keep it simple, esp in the beginning.  She uses the Bravo original.  I kept him on just skinned, ground chicken leg quarters, then very slowly added stuff into it so I knew what would/would not work.  Even switching meats, I would only add a bit, to  see how he did.  I probably did it too slow, but I was scared of another intolerance.

I hope some of this helps  you.