EPI * Exocrine Pancreatic Insufficiency

Hi everyone.  I just joined and as you can see I'm new and need some help.  My poor guy (Joey) has been diagnosed with EPI and he's 7 and a golden retriever.  He's really had a tough year and it actually started when he was 4 when his stomach flipped, but that's a whole other discussion.  I need advice on what to try or do for the poor thing.  I'm feeling like I've tried so much and nothing seems to help him.  Here's what we've got:

*I just switched him to Hill's rx  Canine i/d.  He was on Blue Buffalo Turkey and Potatoes

*I give him 1 1/2 tsp per serving and he eats about 1 to 1/2 cups of food twice a day

*With his morning feeding, he gets 1 doxycycline and 1 tum

*with his evening feeding, he gets 1 doxycycline, 1 tum, 1 prilosec, 1 flagyl

*He is lactose intolerant, and I've found a probiotic that is dairy free and he gets that around lunch time.

*He does have SIBO

*I did give him the b12 shots

Here's the thing.  His poop is never normal, very mushy and cow pie in texture.  He is constantly trying to vomit, but nothing comes up and it sounds so awful to hear him and see him like this.  He does struggle to eat from time to time as well.  Ever since his stomach flipped, it's been down hill with him and that was in 2008 and in March of 2011, I saw a specialist and that's when she did all the testing on him and found out he has EPI and she keeps saying he'll get better, but I don't see how he is.  He did gain a few of his pounds back, but I just see how miserable he looks and how he strains to poop.  I'm sure I'll get some comments and this will help me start in the direction of what to do or try and what else I may have forgotten to mention on him.

A very warm wlecome to you Julie and Joey... only so sorry you even ahve to be here.

Lots of questions.

1. Why is he on Doxycycline... does he have another condition going on... like tick disease?

2. What is the name of the enzymes you are giving him? I am assuming you are mixing it in the food, adding a wee bit of warm  water, and letting it sit for approx 20 minutes before serving?

3. WHy is he on Hills RX canine i/d?

4. WHy are you giving him tums?  Does he have acid reflux? If so, try pepcid Ac instead.

5. How long has he been on the Flagyl?   he may not be responding to it and may fare better on Tylan for SIBO.

6. How long did he receive the B12 and at what frequency (and how long ago ) did you stop?

Looking forward to hearing more from you.,..from your post, I am not sure that you have all the right steps in place.... but we will help you as best we can to walk you thru this.....just need a little better understandng of what is being done now.

Manageing EPI is all about finding the right balance of

• Enzymes
• Diet
• B12 (if needed)
• Antibiotics (if needed)

.........but instead of overwhelming you right away .. i figured i'd ask some questions first to get a better picture of what is going on... and then i'll overwhelm you ;)... seriously.... it probably is going to sound like a lot.... but once you get the hang of it and find the right balance for you dog.... it is not so bad... and besides, you now have a WHOLE family to talk to about this!

Hi Julie,   I am sorry your  pup is not feeling well.   We will support you as you try to get his EPI under control. 

Olesia asked all the questions I was going to ask, so I will wait to hear some of your answers too.   Balancing the Food, Enzymes, B12, and Antibiotics for SIBO is challenging at first and it sounds like you have a few more things going on.  I am interested also in Joey's B12 levels since he has been diagnosed for a while.  His B12 may not be holding and this could be keeping him from stabilizing. 

We will wait to hear more information from you so we can better help you.

Hang in there. 

Barb

Thank you both.  I'll try to answer these in the order to keep things straight.

1. He's on doxycycline instead of tetracycline for the SIBO.  This is what the specialists said to do.

2. He's on the PancreVed Powder by Vedco and I get it online vs my vet.  It's cheaper.

3. He's on the Hill's because I read an article online where it said if the digestive enzymes aren't working that well, to try this food and I emailed it to my vet and he said let's try it.

4. The specialist said to give him tums and I don't remember the explanation.  He does try to puke a lot, but nothing ever comes up.

5. He's been on the flagyl since March 2011 and gets one daily.  I've tried to Tylan and stopped the flagyl and his diarrhea was back immediately.  The flagyl seems to control his diarrhea and his poop is at least soft.  Also, when I stop the flagy, he'll have accidents in the house because he can't control his diarrhea.

6. When he was test, he got 4 shots, once a week and they stopped in May of 2011. The printout I have on his Cobalamin level is either 135 or 185.  I can't read that middle number and it's flagged as L.  His folate level is 21.1 and says H.

Do you think I should have his B12 rechecked?  He was just in for his annual and his blood work came back fine, meaning his liver and kidney's because I've been concerned on those, but didn't ask about the B12 and if I remember correctly, I think that's a separate test.

I also had him back into the specialist and she tested his poop and says there's still a fat content in his poop and to give him more enzymes and that doesn't seem to help.

He does have all sorts of things going on with him it sounds like!  The specialist also noticed when she did his endoscopy that his sphincter is open, which is odd.

Thank you both for the concern and support.  We've been struggling with him since 2008 when his stomach flipped and here recently, he's taking a downward turn and we keep asking ourselves if we need to put him down, but it breaks my heart to even think of that.

gaserupjj at November 14, 2011 at 1:23 PM

Thank you both.  I'll try to answer these in the order to keep things straight.

1. He's on doxycycline instead of tetracycline for the SIBO.  This is what the specialists said to do.

2. He's on the PancreVed Powder by Vedco and I get it online vs my vet.  It's cheaper.

3. He's on the Hill's because I read an article online where it said if the digestive enzymes aren't working that well, to try this food and I emailed it to my vet and he said let's try it.

4. The specialist said to give him tums and I don't remember the explanation.  He does try to puke a lot, but nothing ever comes up.

5. He's been on the flagyl since March 2011 and gets one daily.  I've tried to Tylan and stopped the flagyl and his diarrhea was back immediately.  The flagyl seems to control his diarrhea and his poop is at least soft.  Also, when I stop the flagy, he'll have accidents in the house because he can't control his diarrhea.

6. When he was test, he got 4 shots, once a week and they stopped in May of 2011. The printout I have on his Cobalamin level is either 135 or 185.  I can't read that middle number and it's flagged as L.  His folate level is 21.1 and says H.

Do you think I should have his B12 rechecked?  He was just in for his annual and his blood work came back fine, meaning his liver and kidney's because I've been concerned on those, but didn't ask about the B12 and if I remember correctly, I think that's a separate test.

I also had him back into the specialist and she tested his poop and says there's still a fat content in his poop and to give him more enzymes and that doesn't seem to help.

He does have all sorts of things going on with him it sounds like!  The specialist also noticed when she did his endoscopy that his sphincter is open, which is odd.

Thank you both for the concern and support.  We've been struggling with him since 2008 when his stomach flipped and here recently, he's taking a downward turn and we keep asking ourselves if we need to put him down, but it breaks my heart to even think of that.

Hello

Welcome to the forum we are all here to help and support you and we feel your anxiety ans understand it

Firstly the B12 is low the minmimum is 250 we need it higher then that  so you need to get weekly injections for the first six weeks and then see how you go...........my dog needs these she cant hold the weight without it.

Your food some dogs do okay on theses diet foods others just tolerate grain the first food you used is better.

For SIBO are you using two antibotics you need either metro or Tylan

Most people in the states use enzyxme diana it is proven and it works perhaps you could look at ordering this.

We have all been in the same position as you wondering which way to go but you will get there.

ANN

x

Okay... something is funky here.... based on what you stated above i am wondering if you poor baby is dealing with EPI + food allergies .. especially with an open sphincter and this is one possibility for on-going diarrhea (is it brown liquid like??) ..... in short... the enzymes might be working but you can't tell because there are food allergies going on...............this could have lead to IBD or PLE.... PLE is protein losing enteropathy and can be a concurrent condition with EPI (kind of like severe IBD... ... which also displays in leaking or runny diarrhea).... unfortunately,so many things can display with diarrhea.. so sometimes it is very hard for the vets to pin down what is really going on.... this is why we strongly recommend keeping and EPI LOG writing down EVERYTHING you give the dog, brand name, how it is prepared, when give, etc..., then watch the poo for 3-5 days and record what comes out the other end ([poo) the color, texture, volume, frequency... i know this is gross but it really REALLY helps the vet, you and us figure out what might be going on and what direction to head in,.................and... only make one change at a time..... or else you will drive yourself batty trying to figure out what was it that worked or didn't!

OR............ it could be that his B12 has slipped and no matter how much enzymes you give him or anti's .. if his B12 levels are not properly maintained... that also can display with on-going brown diarrhea.......and yes, you are correct... the B12 test is a separate test. a cobalamin blood test and he will need to be fasted for 12 hours

For an EPI dog.. they NEED to maintain an "upper-mid range normal B12 level" in order to do well.....................something in the upper 600's or 700's....

Stop the Tums... try cimetadine (tagamet) or famotadine (Pepcid AC)...(pick one ;)) the acid reflux you are describing can also be indicative of low or insufficient B12.. Also... try giving 1/2 teaspoon of canned pure pumpkin.. work up to 1 teaspoon over a weeks time... this is good fiber and should help with the "vurps" and should also help (hopefully) with the poo straining...OR......the other thing that your dog may need is a wee bit of psyllium... (if he is straining but is delivering brown diarrhea) another possibly indication that he has IBD or a food allergy going on. ANother thing you can try.... if you cannot get psyllium... is to add just a tiny pinch of Metamucil to his food... (this has psyllium in it)  JUST DON"T DO ALL OF THIS TOGETHER... pick one thing and try it for the 3-5 days... if no + results.. then try the next thing on your list.

.... he appears to have a couple of symptoms that "may" be indicating (or not) a couple of different things........just let us know when your head stops spinning.................

My thought is #1 get some Milk Thistle and start giving this to your dog to make sure his liver continues to stay fine because you havehad him on the doxy.  THis is usually not done for SIBO....and VERY rarely should you haveto have an EPI dog on two antibitoics to treat SIBO,...usually one will suffice... it's just finding the right one and the right dose.

Talk to your vet .. but maybe try this.... get a HYDROLYZED food...try any one of these 3........some dogs never turn around until they are placed on a hydrolysed food... while others actually do worse.... but it is one of those things that you simply have to try to see what will work best for your dog... also... some respond to one but not another brand... so if you can just buy a couple of cans of each... to try... (or the smallest bag you can purchase)

Royal Canin Hypoallergenic HP 19 http://products.royalcanin.us/products/veterinary/canine/hypoallergenic-hp.aspx

Royal Canin Digestive LF Veterinary Diet http://products.royalcanin.us/products/veterinary/canine/digestive-low-fat-lf.aspx

 Hill's® Prescription Diet ® z/d® products are the only Hills "prescription" foods that are hydrolyzed at this time (12-2010). http://hillspet.com/

I noticed you are on the I/D right now... if this is what is going on with Joey... it won't work cuz it is not hydrolyzed..................and even then it still may not work. but worth trying......

So... to recap....

1. try changing the food first

2. make an appt to re- test the B12 levels

3. you might want to stop the probiotics (for now) strip things back to the basics to better help you determine what the triggers are...

4. Talk to the vet about stopping the Doxy and tell him you'd like to start Milk Thistle and administer for a couple of weeks...just to make sure liver is free of toxins from the Doxy... ask him for the correct dosage for your dog's weight.

5. Stop the Tums... start either tagament or Pepcid AC, or try the pumpkin first...

Cautions

Prilosec should not be given to dogs that have liver or kidney insufficiencies, are pregnant or nursing, or may have sensitivity to the medication. If they are taking phenytoin, warfarin or diazepam, this medication may increase their effects. Due to a change in the pH level of the stomach, the absorption of any other oral medications may be decreased.

Read more: Prilosec for Dogs | eHow.com http://www.ehow.com/about_6054886_prilosec-dogs.html#ixzz1di3lUFwx

Hi Ann... good mention not to give omeprazole magnesium (Prilosec) ....to treat our EPI  dogs with acid issues.... just stick with Tagamet or Pepcid AC...

Thank you all.  I'm going to try and print this out.

I've been wondering if he could have IBD.  His poop looks gold actually and it's just one big mush, no form.  I even took a video to show it takes thim 2-3 mins to go and how he's straining to show the vet.  I also forgot to mention how bloated his belly is all the time and how gurgly sounding he is.

I don't think I've ever heard of PLE and will read about it to compare the symptoms.

Luckily, I write everything down in my calendar daily of what he gets and how he is and know to change 1 thing at a time.

My concern with Milk Thistle because I read about it was is there actually milk in it with him being lactose intolerant?

He's on Doxy for the SIBO and the Flagyl for his diarrhea.  As soon as I stop that, his diarrhea is back and bad.  At least now it's just mush.

In Feb of this year, I had my vet run a number of test, trying to eliminate what he could have and he came across pancreatitis and he had me go to the RC Hypo 19 for food and did good, but still had his flare ups and his diarrhea.  That's when he sent me to a specialist and she then did all of her test and said to put him on the Blue Buffalo food and has been since.  It wasn't until last week when I found this article and emailed it to my vet that we said lets try it because we didn't know what else to do.

http://pets.webmd.com/dogs/dog-pancreatitis-symptoms-and-treatment

I'll ask the vet to get him tested again for his levels.  I'll stop the prilosec and tums too and get the others.

Thank you again.  I'll be in touch once I get more comments:)

hello and welcome from UK

BLIMEE lots going on

Well if it were me I would get rid of all the prescription food and try a grain free like Taste of the Wild

these prescription foods have far too much in the way of grain and corn which most of our dogs cannot tollerate

Kara was given RC by our vets and as soon as I took her off it she improved along with Tylan or one of the tetracycline drugs she got even better but I would go with Tylan and b12 injections these square the circle with good enzymes from Enzyme Diane

I am going to post Karas poo again ,sorry guys

this might give you some hope

I know you have other issues but we can address them one somewhere along the way it makes me cry when I see these pics of Kara

Just let us know

Jxxx

Hello and Welcome to the Forum.  I am sorry to hear you and Joey are really struggling to find the right balance of what he needs to get back on the right path to good health.   It does sound like he has a lot going on besides just EPI... poor pup    If you have not already done so, you might want to check out the tab at the top of the page named  "Concurrent Conditions".  I think Olesia has given you a good run down on where to start in the tweaking process and I just wanted to add my best wishes that you see some positive results soon. 

That picture of the poop, the left one is what his looks like.  I have some, but didn't know if I should post them.  I've been thinking he has developed IBD as well and that's what my vet first thought, until he sent me to the specialist and she did the endoscopy on him and said no.  I really didn't have any luck on Tylan and I'm wondering why.  Joey was on blue buffalo, then was put on 2 different RX foods and seemed to do well and then went back to Blue buffalo and his poop still looks like that picture.  I will keep researching and appreciate all of the support and advice.

Joey is in my picture and he's the one on the left, in case you're wondering.

Julie.... the Flagyl (also called Metronidazole) is one of the two best drugs used to treat SIBO.... Tylan (Tylosin) is the preferred drug of choice for SIBO...but... if you do not see results... then Flagyl should be used.... which you are already doing.. so i jsut assumed the Flagyl was for the SIBO.... anyway...just so that there is not confusion... CONTINUE with the Flagyl.... twice a day- -to treat the SIBO ... oh... what is the weight of your dog... need to make sure you are giving the right dose....but stop the Doxycycline....not the best drug to use for SIBO.

The MIlk Thistle is an herb from the daisy family ...... no dairy products in it;). I use it when ever i give Doxycycline, fleas meds, heart worm meds... or anything that is a "chemical" that may have a negative effect on the liver..it contains silymarin which protects the liver from toxins. 

Kara's colorful poo is indicative of SIBO.... glad the picture helped!  And yes... you can post poop pictures here .... we have had many a giggle or a groan over some of the poop pics... but seeing a picture really does help!

Ahhh... if Joey is on the left, poor baby... he looks so forlorn!!!  I hope we can help you get him feeling better soon!!!!!!!!

Hey regarding the Tylan not working.....Tylan address SIBO (or ARD) a little differently than Flagyl (Metronidazole).... not a clue why one dog responds to one and noth the other..... 

WHat is the dose of the Flagyl that you are giving Joey... and you are giving it twice a day... correct?

It's 500 mg of Flagyl and I only give it to him once.  If he gets it more, then he starts puking and won't eat at all.

How do I upload a picture to a post like this?  I was going to show you 3 of him for you to have a better understanding and see how large his belly is.  He looks like an orange barrell.

There is so much on this site it is overwhelming!

Okay.... your case is really bothering me... i went back and am re-reading your post and noticed.... you are only giving the Flagyl once a day...to address the SIBO you NEED to give it twice a day (breakfast and dinner) or 12 hours apart.  THis may (or may not)  be part of the problem of  why you have not been able to get rid of the SIBO.

What is the dose of the Flagyl... what is your dog's weight.... and can you nimmediately start giving it to him twice a day (with food)?

Also..... if i read your post right....you are giving the enzymes with every meal. are they prepared with a little warm water and allowed to sit for about 20 minutes?

your comment" how gurgly sounding he is" is very indicative of SIBO!!!

Try the hydrolyzed food (1 of the 3)

Give the Flagyl 2x daily

... and if none of this works within the next 30 days...*sigh*....... talk to your vet about trying short-term steroids ....just to straighten Joey's gastrointestinal issues  out ....and then see if you can put all of the above in place, if after the steroids, it might then be able to be managed.... 

looking forward to seeing what others may suggest... i feel SO bad for you right now ..............

hi again.. we must ahve been typing at the same time.... what is his weight?

are you giving the flagyl with food (at mealtimes)? 12 hours apart?

put your photo's in photobucket. then use the "direct link" and open up the blue box (next to the smiley face) in these posts and paste the picture's ;photobucket URL in it... and the pictures will pop up... more explicit instructions are on the FORUM homepage.... top of page... in the ~To Participate~ section.

 .

Hi Ann - welcome to the forum!    You have gotten great info so I don't feel I can add much.   Please DO post pics of poop and even your video - it helps see exactly what is going on - the poops tell a lot...

Here is a link to how to post pics.   Most of us use Photobucket - create an account there then follow the directions from there.   http://www.epi4dogs.com/PDF%20Files/Steps%20to%20take%20to%20insert%20a%20photo%20in%20your%20post.pdf

could the bloated belly be bloat??? or gas from SIBO... or has your vet suggested something else like a possible tumor or something? Just wondering....

Hello Julie - Again, with the swollen belly your describing, it sure sounds Joey has a lot more than just EPI going on    You guys have been thru lots of ups and downs and I am trying to follow the timeline.... I think your indicating that Joey was at one point on one of the hydrolyzed prescription diets and did okay on it for a bit?  And has not done well on the Blue Buffalo or the current non-hydrolyzed diet?  If so, you might want to consider trying to go back to one of the hydrolyzed diets... maybe it was working for him but the other pieces to the puzzle were not all in place yet for it to fully work.  We went thru a bazillion different diets with our pup and it was not until we finally tried the Hills Z/D that we were able to stabilize him.  The couple hydrolyzed prescription kibbles Olesia has listed above are different than other prescription kibbles in that they break the ingredients down into such small particles that a dogs system does not recognize them as potential allergens.  If Joey is dealing with food allergies, in addition to everything else, it could be why he responded well when on the hydrolyzed diet previously.