EPI * Exocrine Pancreatic Insufficiency

Hello! So glad I found this forum! I am worried about my boy.. 

Maxwell is a 4 year old Great Pyrenees, recently diagnosed with hypothyroidism. He has always had trouble eating, putting on weight and trouble maintaining a firm, consistent stool. Years of battling weeks of not eating, vomiting bile, losing weight, etc, we found EVO and raw.. for a year, his stools were great eating EVO in the AM and raw in the evening. Finally, my boy was having "picture perfect" stools that most dog owners take for granted. (though he would still skip some meals) his weight started going up.. 

Natura gets bought out by P&G and he downright refuses EVO.. back on the food roller coaster. Finally, we found a kibble that seems to work... Back To Basics. He loves it, he eats it, his stools are sometimes (though, more often not) normal.. he won't gain weight. 

Flash forward... Maxwell has always been a sweet, get up and go, even tempered boy. He starts sleeping a lot, his patience has a short fuse and he is no longer interested in walks or dog park trips, etc. He is diagnosed with hypothyroidism but only shows a few classic symptoms (IE aggression, lethargy and no appetite) 

Soloxine has been a miracle... he starts eating, he's interested in dog parks, walks, etc. He is roughly 95% back to his normal, sweet self. 

Maxwell is a Great Pyrenees.. his weight is dropping rapidly (he is down to 97 pounds... should be roughly 130-140, though due to his poor appetite, he's never hit his target weight) Soloxine is known to increase metabolism (most dogs with hypothyroidism are overweight, despite not having a good appetite). The vet says if he hits 95 pounds, he is coming off of it, he is dangerously underweight. 

We discussed his new symptoms... cow patty poops, poops that range from grey to beige to yellow, sometimes slimy, sometimes not, (I am so sorry to be so gross) and sometimes light brown in color. Every once in a while he will have that picture perfect poop, though not very often. 

Here is the thing... Maxwell has ALWAYS been extremely picky and NEVER one to overeat... I used to have to bribe him to eat. Now.. he will eat and eat and eat and still lose weight. He is eating things he would NEVER touch in a million years.. he is counter surfing, he is getting in the garbage, he has no control over himself when it comes to food... he acts like he is starving to death .. 

He gets tested next week. I am so worried about him, but I am so glad I found a forum with other dog owners who understand my worry. 

Do his symptoms sound like classic EPI signs? Does the insatiable appetite just come out of no where? 

Welcome to our family Ms "I'm with the Pyreness" and welcome to your boy Maxwell.  Yes and Yes.... everything you are describing sure sounds like he could have EPI... if so, he actually may have been battling subclinical EPI for years.... and the onset of Hypothyroidism may have been the stressor that brought his EPI to the forefront (if he does test positive for it).

Glad to hear that he will be tested next week. Couple of things to know..... be sure to fast Maxwell for 12/+ hours prior to the TLI blood test... AND.... just in case your vet did not mention it... ask your vet to also draw enough blood to run a Cobalamin test. THis will test the B12. If Maxwell has EPI.... then there is an 82% chance that he might need generic B12 shots to bring up his B12 levels to upper mid-range.  If you have the tests done together, you will save money... AND it is better to treat everything at once rather than treat with ENzymes only for the EPI, and then find out that it seems like the enzymes aren't really working and it is because he also needs B12............and/or antibiotics for possible SIBO...

I know this probably seems very overwhelming.... but EPI is manageable ... once you find the right balance of:

• proper Enzymes (porcine enzymes, not plant, given according to amount of food)
• change diet to low fiber (grain free)
• B12 injections (if needed)
• Antibiotics (if needed for SIBO)

..... and this is what we do here on the FORUM... we help others find the right balance if they are having a little difficulty getting the dog stable (delivering consistently  good poo and putting lost weight back on) 

Please keep us posted... and if Maxwell does have EPI.... post here and share the test values, let us know what the vet prescribed and how Maxwell is doing.  We can help you with management techniques.

Oh, and if you want to understand EPI in a nutshell... go to the home page (Overview) and scroll about halfway down... read the "Detailed Management of EPI" section... it is a good summary of how to manage EPI....;)

ANd just so you know... many, MANY of these dogs, once they start receiving the proper EPI treatment, many have to be placed on diets because they become a little "too healthy"...

..

Welcome Maxwell and 'Mom'           Sorry that you have had to research and find this website.  Olesia is awesome and we do understand what is happening with Maxwell and how you are feeling !!!  Kodi is our 2nd EPI pup and I seem to learn something new all of the time.   A great source for enzymes is www.enzymediane.com , great enzymes and 1/3 the cost of enzymes  from the vet. Also as you make these changes, keep a log... input and output is very important, and each pup is different, but there is ALOT of experience here!!  I will be watching for those tests results........

Hi hon,

Its a shame you have to be here but you have found a refuge where we all understand what you are going through.

Please stay with us and give us the information so we can help you.... but first take deep breath... breathe out slowly and tell yourself you WILL beat it.

By the way I LOVE Great Pyreneans they are so gorgeous I nearly had one once... but hubby is a confirmed GSD man, so I missed out.

Good luck.

Val from over the pond in UK

Thank you all so much for the replies! This is a great forum!! 

It is hard to tell how skinny Maxwell is because he has so much fur (despite being hypothyroid and having digestive problems, he is very lucky that he has always maintained a beautiful coat) however, when you pet him, even underneath all of that pretty fur, you can feel every bone. I can count every vertebrae and clearly feel his hip bones. 

I will ask for the B12 test, thank you so much for the advice on that! 

If Maxwell is diagnosed with EPI, is it costly to manage? From what I gather from reading the forum and info on the site, prescription diet is not neccessay and a lot of EPI dogs do very well on grain free, which is great because he does best on grain free foods. I have tried grain included foods to try to put some weight on and they all seem to wreak even more havoc on his digestive system. A short stent with a homecooked diet had him an absolute mess, he even went to the bathroom in the house, something he's never done before.. just couldn't hold it. 

I also read that a lot of dogs with EPI respond well to a raw diet... this is wonderful! I would of course be more than willing to go raw with him! I feed my Chow mix raw and recently found a great co-op! 

I feel so bad for my boy... he went from not wanting to eat to gobbling everything up in site and begging for more. He went from nibbling to inhaling kibble so fast there's no way he could even taste what he is eating. 

[IMG]http://i115.photobucket.com/albums/n304/irritableromance/RSCN0227.jpg[/IMG]

Here is Maxwell in March of 2011. He looks to be at a good weight, but a lot of it is coat. He has lost roughly 25 pounds since then. 

Hi, and welcome!. Maxwell is gorgeous! (even if it is just the coat). Good that his coat is still in good shape, it means you've caught it early.  The food inhalation and cow patties sure sound like he has EPI, but you'll know soon enough. In answer to your question about cost, if you buy your enzymes from a group - on this forum, many of us get our enzymes from enzymediane.com. Diane also has an EPI dog and is our enzyme angel. Using her enzymes saves about 67% off of vet-prescribed enzymes, for exactly the same thing. I would say that for Maxwell,you are looking at somewhere in the order of $500 - 700 a year in enzymes, a little more at first, since you'll be feeding him 150% of normal to get the weight back on (which requires more enzymes at the recommended starting point of 1 teaspoon enzymes to 1 cup of kibble). Once stabilized, many dogs are able to use reduced amounts of enzymes. Maya is down to almost 1/2 tsp per cup.

Maya lost about 10 pounds before diagnosis and within a month had put it all back on. She's added another 10 pounds since to a beautiful, healthy 70 pounds.

Wishing you much luck on your journey with Maxwell and looking forward to seeing more pictures. I'm sure you'll get much more advice from these caring people once you have confirmation of the EPI - and even if it's not. We'd love to try to help you sort it out.

Hi, and welcome!. Maxwell is gorgeous! (even if it is just the coat). Good that his coat is still in good shape, it means you've caught it early.  The food inhalation and cow patties sure sound like he has EPI, but you'll know soon enough. In answer to your question about cost, if you buy your enzymes from a group - on this forum, many of us get our enzymes from enzymediane.com. Diane also has an EPI dog and is our enzyme angel. Using her enzymes saves about 67% off of vet-prescribed enzymes, for exactly the same thing. I would say that for Maxwell,you are looking at somewhere in the order of $500 - 700 a year in enzymes, a little more at first, since you'll be feeding him 150% of normal to get the weight back on (which requires more enzymes at the recommended starting point of 1 teaspoon enzymes to 1 cup of kibble). Once stabilized, many dogs are able to use reduced amounts of enzymes. Maya is down to almost 1/2 tsp per cup.

Maya lost about 10 pounds before diagnosis and within a month had put it all back on. She's added another 10 pounds since to a beautiful, healthy 70 pounds.

Wishing you much luck on your journey with Maxwell and looking forward to seeing more pictures. I'm sure you'll get much more advice from these caring people once you have confirmation of the EPI - and even if it's not. We'd love to try to help you sort it out.

I know what you mean about coat my EPI Razzy had such a thick coat you wouldn't have known there was anything wrong... even when she had the full blown EPI and lost weight really badly in the first few weeks.

Val

Oh WOW.... he is GORGEOUS!!!!!!!!!!!! (Thanks Val for putting Maxwell's pic upfront :))

If Maxwell does have EPI, we can help you with lots of " tricks of the trade " to help you save money.

For example..... when my medium size dog (she is now 48lbs but had dropped down to 27lbs when she was diagnosed!) was first diagnosed and we purchased brand name enzymes from the vet, it was costing me $1,200 annually just for enzymes. When i switched to the same enzymes but generic from EnzymeDiane (she buys the enzymes in bulk and consequently passes the savings on to us) my enzyme expense dropped down to $400 a year.... and then... once my dog was stable, i was able to further reduce the amount of enzymes i was using and saved another 50% so that my enzyme cost was only $200 a year....... HUGE savings!!!

..and, as you discovered, yes, " most " EPI dogs do wonderful on just over the counter grain-free food,..  some do great on raw..... the diet part will be a trial and error to see what works best for your individual dog ;).

Many of these dogs need B12.... one way to save money is to have your vet teach you how to administer the shots yourself at home.....

With antibiotics..... we recommend working with your vet , but it you need on-going antibiotics and if your dog  responds well to Tylosin for SIBO (if beeded... Tylan/Tylosin is the current drug of choice for SIBO) you can purchase it from Amazon.com ;)...or your vet. Tylan (Tylosin) is pretty cheap.

Keep us posted!

Hello and Welcome to the Forum!  From everything you have described, I think running the tests for EPI is a good choice... kudos to your vet. Paula has covered the best way to save $$$ on enzymes by ordering them from enzyme Diane.  With B12 shots the best way to save $$$ is to have your vet show you how to give them at home... A vial of B12 is not expensive and lasts a long time. And when antibiotics are needed for SIBO, Tylan is one that works well and a jar of it can be obtained online to save $$$ compared to getting it via your vet... just make sure and keep your vet in the loop that your are giving it to your pup. Thank you for sharing pictures of Max.... He is a handsome fella!

Sorry for the duplicate info.... Looks like Olesia and I were typing at the same time and she is obviously a quicker typist 

hahahha....:D.... hey at least we all are consistent!

Hi WithPyr and welcome to the Forum...the very best place to be if you have a critter with EPI.  Maxwell is absolutely regal!  What day this week is he being tested?  I was so sure that our Cedar had EPI that I asked the vet for enzymes the day she was tested and started her on them presumptively.  And Maxwell sure sounds like he has it too.  Since his weight is such a concern it's something you may want to consider.  He's obviously not absorbing nutrients and even if it isn't EPI the enzymes will likely help.  It can take anywhere from a day or two to a week to get results back, depending on the lab your vet uses and the day it's drawn etc. Oh and as well as the TLI and cobalamin, most vets also test for folate...it's a 3 test panel, so maybe mention it just in case your vet is new to this too. Please let us know and we do love pics so feel free to post more of the beautiful boy and even his nasty poop :D. 

G'day and a big fluffly mountainous welcome to you and Maxwell. We look forward to getting the test results if you know what I mean, at least then you'll know what you're dealing with. If it is EPI, and it sure soundss like it, as others have said there are a number of things to keep a track of particularly while he's stabilising so I'll just reiterate the usefulness of keeping a log or journal. There's a template in the downloads section or click here. Start recording everything that that goes in and comes out, it'll be useful believe me even if it isn't EPI and your vet will love you 

Here's to a greater flesh-to-fur ratio soon!

Craig

p.s. Olesia, Back to Basics looks like a great GF food, that's one for the US list...

http://www.backtobasicspetfood.com/

Welcome to the group!!!!   This is a most fantastic place to be with your pup.....  These folks have already given you great advice, I just want to echo that Maxwell is absolutely gorgeous!!!! 

Susan

Welcome. I sure hope you're not dealing with EPI but if you are then this is the best place to be.

Gillian x

What a beautiful boy your Maxwell is!!  We will be waiting for those test results, but Maxwell's symptoms sound very much like what we've all been through with EPI.  If so,  you have a lot of company and many combined years of experience and knowledge to help you through.  EPI is very manageable and there are lots of people here who are very generous with time and suggestions to help you manage. 

Give Maxwell a big hug....hopefully, you will have results soon and will have a positive direction so that your handsome boy will be on his way to good health.

Barb

Thank you all so much!! You guys are awesome!! 

I didn't know how to make the image show up, so thank you very much doing so! I appreciate it! 

I do have a question... I had Maxwell's bloodwork sent off to Dr. Dodds of hemopet in October for a full thyroid panel, it's more specific and personal than what most vets do. Obviously, his T4 was low.. but, Dr. Dodds said the low T4 was not an indication of a thyroid problem, something else was causing it and she didn't know what.. I got a new vet who wrote that off and redid a thyroid panel (Free T4). Maxwell came back a 0.6 .. normal being 1-4. He also shows other signs of hypothyroidism (aggressive tendencies, lethargy, high cholestorol confimed by a CBC panel, lipoma, etc.) so my vet decided to treat him with Soloxine and diagnosed him with hypothyroidism. Like I said, Soloxine has been a miracle for him, it's really turned him around. 

My question would be... could Dr. Dodds be right? Could it not be hypothyroidism, but something else causing the low T4? Could EPI do that? To me.. it would make sense (I am not very educated on the manner) but I think the thyroid would need proper nutrition to produce the horomone... if it isn't getting the nutrition it needs, could EPI be the cause? 

Maxwell has always had trouble maintaining and putting on weight, he's also always had trouble maintaining a firm, consistent stool. Could the Soloxine, which causes the metabolic rate to increase finally uncovered something? (Someone mentioned he could have been suffering from Subclinical EPI for years and the hypothyroidism brought it on full force) 

So sorry to have so many questions... but it's actually all starting to make sense now (never thought I would say that haha)