EPI * Exocrine Pancreatic Insufficiency

Hi all, 

I've just found this forum/site a few days ago when looking for info on how I should be preparing my dogs meals with Tryplase. A massive thank you, as I now know I was doing it wrong and things have sort of improved.

Background -

7 year old GSD, Bandit, has had problems with his stools from approx 18 months old, although from younger they always smelt horrendous. He had the odd vet visit with stool samples showing nothing wrong, probiotics, etc. Tried every food I could find over the course of a  year to find something that suited him, nothing did, most mornings I would wake up to diarrhea everywhere. Then I read up on raw feeding and switched him. It took 5 very long weeks but finally his stools were firm, a bit less smelly and he put on some weight. This worked for a few years with the odd downward slide.

Around the middle of last year, it stopped working. Off we went to the vets, prescription food was tried, then testing commenced, stool samples and bloods and talk of biopsies. During this time I switched him to wet food with a very small handful of dry, as dry seems to set him off worse than anything else. After the stool sampkles, he was diagnosed as having E-Coli, so antibiotics followed, these worked and he was fine for a few weeks, then he got ill again, more antibiotics, didn't work, tried type after type, nothing, he was at 24kg at this time. Blood tests were done and showed he had low B12, my vet eventually diagnosed him with food allergies so severe that he cannot deal with any food, said it'svery rare and BAndit is the first dog he's seen with it since the 70s when it was more common. Prednisolone started and it was like it was heaven sent, got him to a slightly porky 35kg in a few months. 

A couple of months ago, things started to go wrong again, the steroids were not working, his appetite is crazy from them, he spends most of his time hanging out in the kitchen, but when offered food that isn't treats, mostly refuses it, he just doesn't want to know, I can't work out if this is him trying to get his own way as repeated attempts to feed will sometimes get him to eat some, other times not. He is now down to just 23kg.

Back to the vets a few weeks ago afetr trying and trying to get things right, upped steroids, didn't work, etc. Stool samples showed low Trypsin levels, so started on Tryplase, they showed no salmonella, giardia, etc.

He has been on Tryplase a few times and it has never worked, this may be due to me doing it wrong, vet told me to sprinkle on food but didn't say about incubating for a certain time, so it was sa there for a max of 5 - 10 mins while I sorted my other 2 dogs their dinners.

The last week he has had very bad wind, so bad I kept looking around to see if he had lost control of himself and some very acidic smelly burps, lots of tummy rumbling even when he has eaten something, possible SIBO?

A few days ago he had 24 hours where he kept vomiting up large amount of undigested food dark brown with a load of water (drinks a lot from the steroids) and diarrhea like water, kept losing it indoors. I have now been feeding him very tiny meals out of a large meal made up, left for 40 mins with the Tryplase and then put in the fridge. His poo has gone dark but it's still liquid, no urgent accidents though and he is no longer vomiting.

He is going to the vets in the morning (UK) should I suggest SIBO to the vet, I am so sure this is what's wrong. Can anyone suggest anything that I can do to help him?

I know his life is going to be cut short by the steroids, he already has lost all his muscle tone, his undercoat, the hair on his tail has thinned so much you can see his skin. I keep wondering how I can let him go through this anymore.

I hope it's ok to post here as I know he doesn't have EPI but I figured you would all understand what him and I are going through.

To add a bit more history - he has a high grade heart mumur and slow progressing CDRM, as a baby he had almost deformed legs and was not expected to live for more than a few months, however he defied the odds and his legs straightened up fine.

Hello and welcome to the Forum Bandit's Mum -  I am sorry to hear Bandit has had such a rough go of it overall with health concerns    If he did show low B12 at one time, was he ever given any B12 shots to help supplement his levels?   Low B12 is common with EPI but also can be a factor with other malabsorption problems.... and the great thing about trying to see if B12 shots help is that if they do not need it, they will just pee out the excess.  If you and your vet suspect SIBO (SIBO and low B12 often go together),  I think Oxytetracycline is used in the UK but metronidazole or tylosin are what is commonly used here in the US... for a minimum of 30 days.  There are a couple active Forum members from your neck of the woods that hopefully will chime in with their experience on the type of enzymes used over there... along with how to best prepare them and the recommended food to enzyme ratio.  He sure is a handsome boy!

I am so sorry to hear you have been going through all this - but kudos to you for sticking with it.   I see you say "I know he doesn't have EPI" - was he tested for it?  I can't offer you much advice - I've only dealt with EPI.   Hopefully other can chime in and help out.   My best to you and Bandit...

PS.   He is STUNNING!!

Hello again.... if you can post what food you are currently feeding and with what ratio of Tryplase... I think it is the middle of the night over there right now but when the other UK forum members wake up and are having a quick read of the Forum in the morning with their coffee/tea that information might better help them to give you guidance.

I'm sure EPI was mentioned and he said it wasn't that, but a lot of the vet stuff goes straight over my head, I have a terrible memory! I will ask today and find out exactly what he called Bandit's condition.

Currently he is on 4 capsules per meal (the large meal I make up and put in the fridge) He's being fed boiled chicken and rice or pasta, with half a tray of Wainrights wet food and a tiny handful of Applaws grain free kibble. I couldn't tell you the amounts of chicken/rice/pasta (vet suggested pasta as a way to bulk him up a bit) as I tend to do it by eye. This is about the amount of one of his usual two meals a day as I just can't get him to eat anymore than that at the moment.

Before he became unwell again, was having between 1 and 2 trays of Wainrights per day with a small handful of Applaws grain free dry plus a chicken carcass as another meal, the only amount of raw he can seem to handle now.

Thanks for your replies, it helps knowing others know what we are going through!

Oh, when he was diagnosed as not absorbing B12, he had some tablets for a few months, I think they were called Cytacon.

Welcome Bandits Mum,   Have you ever had a EPI test?   If so, did you fast your dog for 12 hours before the blood was drawn?  You see, if not then the test might not be accurate.   This is just a "gut feeling" of mine, but I "feel" that Bandit does have EPI, and you need to get retested for it.   Oh, and i did get one thing from yoru information about his diet.   You are feeding rice, and with EPI dogs, any grain is usually not good.  Rice gives my Suzie the "screaming runs."   Every dog is different, but most of them cant tolerate grain.   It would prolly be very helpful for you to get him tested, and soon.   

There are many UK people who will chime in here soon to help you.  And I agree with Michele..............HE IS STUNNING.  

Hang in there, you are among friends here with lots of helpful information. 

hi and welcome from uk

what a story

my thoughts are that if  you have a food allergy it could be grain related

we use

http/www.nutrixpetfoods.co.uk/acatalog/duck-and-potato-cereal-grain-free-dog-food.html

so no rice or pasta  you can bulk the meals out with potato and vegies which we have found work

wainwrights do a grain free too

did you get the results from your vet of the epi test if there was one though from what you have said he has been tested for everything

tryplase is one i havent used only in a cat many years ago and i do know that you need several a meal as they are low in content

http/www.petdispensary.co.uk/shop/tryplase_capsules.html

we use

http/www.petremedies.co.uk/product.asp?strPageHistory=category&numSearchStartRecord=0&strParents=83%2C252&CAT_ID=252&P_ID=777&btnProduct=More+Details

this is hard when you dont know exactly what you are dealing with but my friends dog non epi has turned a huge corner on grain free foods and this was a dog that the vets had given up on

to me if there is undigested food coming out then the pancreas is not working properly and you may have to use more tryplase per meal its all about tweaking and recording

if you want a chat let me know

so get yourself a diary and record everything it keeps you sane

jxx

meant to say that antibioutics for the small intestinal overgrowth we use oxytetracycline for life

we also use tylosin as the oxytet has to be on an empty stomach and often that is not convenient

jx

Thanks everyone, I have noted down some stuff to ask the vet. The thing I couldn't understand is when he was on full raw with no grains at all, he had these problems. We haven't used rice for a few days as he just didn't like it at all, had more sucess with pasta but given that is made from wheat I guess it's just as bad  The vet said he will react to any food given hence the evil steroids.

I don't recall a test where he was fasted but he did have lots of bloodwork done last time. I'm definitely going to keep a diary, I know some foods react more than others, tripe for example comes out smelling like tripe and looking like tripe water! Very pleasant 

Well, unless he was fasted for 12 hrs before the blood draw your TLI numbers will be off.  I have found, as many on this forum have, that many vets are not that up on EPI, and might need you to lead the way.  i know that I went thru 4 vets and finally it was the internet that saved my Suzie's life.    I would bet that Jean from the UK can be of great help to you with Bandit.  She knows all about the meds and protocol used in the UK.   I can only speak from the USA, and our meds for this are different.   Please update us on what the vet says.

Bandits Mum at December 7, 2011 at 3:12 AM

Thanks everyone, I have noted down some stuff to ask the vet. The thing I couldn't understand is when he was on full raw with no grains at all, he had these problems. We haven't used rice for a few days as he just didn't like it at all, had more sucess with pasta but given that is made from wheat I guess it's just as bad  The vet said he will react to any food given hence the evil steroids.

I don't recall a test where he was fasted but he did have lots of bloodwork done last time. I'm definitely going to keep a diary, I know some foods react more than others, tripe for example comes out smelling like tripe and looking like tripe water! Very pleasant 

HI Bandits mum

I am one of those that have just woken up.

Jean is right try grain free and she has recommended some good food  i would go with he salmon justin case we have a poultry allergy .

I use tryplase but you need more than it states on the packet and you just need to mix it in can you let me know how much you are using. for epi dogs we need to use about 2-3 capsules per 100 grams of food.

B12 this cannot be treated with tablets unless it has the intrinsic factor in it we need to get him weekly shots for this.

SIBO the recommended drogs are Metro and Tylan Maddie had .Metro and it cleared it after 30 days.

CDRM or the onset of this is difficult my last dog had this have you read the paper done by Dr clemons in respect of this beacuse he doenst recommend the use of steroids i think it says you are adding fuel to the fire.

there is another dog on here who has suspected Gluten intolerance this may be something to bear in mind.

IF YOU WANT TO TALK RING 01584 881144

maddie ann at December 7, 2011 at 5:52 AM

Bandits Mum at December 7, 2011 at 3:12 AM

Thanks everyone, I have noted down some stuff to ask the vet. The thing I couldn't understand is when he was on full raw with no grains at all, he had these problems. We haven't used rice for a few days as he just didn't like it at all, had more sucess with pasta but given that is made from wheat I guess it's just as bad  The vet said he will react to any food given hence the evil steroids.

I don't recall a test where he was fasted but he did have lots of bloodwork done last time. I'm definitely going to keep a diary, I know some foods react more than others, tripe for example comes out smelling like tripe and looking like tripe water! Very pleasant 

HI Bandits mum

I am one of those that have just woken up.

Jean is right try grain free and she has recommended some good food  i would go with he salmon justin case we have a poultry allergy .

I use tryplase but you need more than it states on the packet and you just need to mix it in can you let me know how much you are using. for epi dogs we need to use about 2-3 capsules per 100 grams of food.

B12 this cannot be treated with tablets unless it has the intrinsic factor in it we need to get him weekly shots for this.

SIBO the recommended drogs are Metro and Tylan Maddie had .Metro and it cleared it after 30 days.

CDRM or the onset of this is difficult my last dog had this have you read the paper done by Dr clemons in respect of this beacuse he doenst recommend the use of steroids i think it says you are adding fuel to the fire.

there is another dog on here who has suspected Gluten intolerance this may be something to bear in mind.

IF YOU WANT TO TALK RING 01584 881144

 

Bless you, thank you so much!

Right, just back from the vets, plus pet shop, plus Tesco, lol 

The condition he has is Eosinophilic gastroenteritis (no wonder I couldn't remember it!) http://en.wikipedia.org/wiki/Eosinophilic_gastroenteritis

He too thinks Bandit has SIBO, he's now on a course of Oxytetracycline and B12 to see if it clears things up, keep up with the Tryplase as it has shown a small improvement if not much and I'm to phone again in a week with a progress report.

He's suggested some small amounts of puppy food and to give him some goats yoghurt with each meal (which will be fun as he hates it since last time.) I'm also going to drop the pasta and start introducing potato to see if it makes a difference.

I had no idea about the steroid thing with CDRM, thankfully Bandit's seems fairly stable and hasn't changed in the last year since being on the Pred, unfortunately there is no way he can come off it as it stops the reaction of his condition (well, it does when he's well!) but I can now start dropping his dose back down to what was working before he had this relapse.

Thank you everyone for your comments, it helps so much to know that other people understand the hell of digestive conditions in their dogs. I hope no-one minds if I stick around here for tips and advice even though it's a different condition? I know so many dog people but none of them seem to understand just how sick Bandit really is!

Hi.  Just a thought.  There is a Yahoo IBD group.  Maybe you might want to see if you can join?  Not sure if this is classified as IBD or not, but may be worth the try.  http://pets.groups.yahoo.com/group/IBDogs/?yguid=455903410 

Hi Bandits mum

I am walking this path with you, hon.... been there done that.

When my Razzy was a puppy we tried all kinds of food with either the 'runs' or it hyped her up until she ran on the ceiling/

Over 5 years we tried 30 kibbles and none worked.... soft food didn't work either.... tinned food was the 'runs' incorporated.

She had endless meds that did nothing and eventually had her anal glands removed because the bad poop caused big infection..... THEN IT HAPPED!

I knew nothing about EPI but she had wind that smelled vile and a belly that rumbled so loud I could hear it across the room... it all happened in one morning and I later found she had probably had EPI coming since birth... the stress of the anal gland op was a  'trigger'  than brought it to the suface.

We joined a group like this and they helped us get a handle on it after we had the TLI test after 12 hours fasting and blood being drawn and sent toTexas in US.

It took10 days to get the results back a count of 1.7 and my poor girl lost FOUR kilos in that time... thats the bad news.

Now the GOOD news.

We found a kibble that she could just about tolerate called Bakers Complete Chicken and Veg... not a very good kibble but she could just about toterate it and we experimented and found 1 Tryplase worked with 4 oz well soaked kibble... working on that we did 8oz well soaked kibble with 2 Tryplace for each of four meals for about a year then we went raw... she was on raw for more than 3 years and did very well.

Raw is different for EPI dogs because it needs lower bone ratio and it all needs mincing finely.

You sound as though you either have an EPI dog or one on the way.... I would get the TLI test done and in the meantime well soak any kibble he can take (if you use kibble) or experiment with the food you feed and find out how much food to Tryplase brings the poop good. Bear in mind that wet food takes less Tryplase than dry kibble (even if its soaked)

Start with a set weight and one Tryplase... then tweak by a quarter or half Tryplase capsule every three days until the poop looks good.

I found 4oz soaked kibble... four times a day was a good start... all with the same enzyme to food and all tweaked the same..... sounds complicated? A bit of a nuasance?

YEP... but getting things sorted in the begining is the best way forward.

Oh, and as for allegies... Razzy had MEGA food and contact allergies so if you want to chat e-mail me at     razzysmum@yahoo.com

Val from UK

Hi Bandit's mom,

I have never heard of this disease but I can certainly see why your dog is on pred from the link you sent so I  would not take Bandit off. Val and Maddie can help you with the tryplase but you might want to check out the link Karen sent. I also don't know if that group can help since I am unfamiliar with the disease. It is not EPI, so I don't know what suggestions we normally give for EPI dogs would apply to Bandit.

there used to be a member called Donna who had a cdrm dog and could have possibly helped but she hasnt posted for a very long time

my first shep had it sadly and we were on various antinflamatories for a long time  we were told at the time never to give steroids or raw diet but you do what your vet says as you think they are the bees knees

anyway we dont know it is or it isnr epi as the tests are not in so maybe you should be asking specifically

you can ring me if you want a chat 0151 726 1468 between us we have done a lot for the folk in uk

jean  

Stool samples showed low Trypsin levels

Okay you havent had the TLI test done but i beleive this can also show malabsorption problems .

Often an improvement wont be seen until the SIBO and the B12 is under control .

The Tryplase is about 1/2 the strength of the Lypex which me  Val and Jean have used so you could also up this.

the disease also seems to be linked to Gluten intolearnce so be careful on this.

CDRM requires lots of Vitamin support, Swimming small amounts of excersie and an holisitic approach to food if you put DM into google search engine you will find DR Clemons study on there.

Ann

In a previous post Bandit's mom said it wasn't EPI.

I'm sure EPI was mentioned and he said it wasn't that

Reading the article you sent  mentions other gastro conditions associated with this and says Protein losing enteropathy and I did find a PLE support group.

http://savelouie.com/phpBB3/