EPI * Exocrine Pancreatic Insufficiency

I adopted Lex at 9 weeks old. He always had looser stools and did not gain as much weight as the vet thought he should, but didn't seemed too concerned. He had issues with vomitting bile in the mornings and some bouts of watery diarrhea. When he was almost two he got canine influenza. Then shortly after his second bday, he had emergency surgery for bloat with torsion. His stool has not been right. So for over a year now he has been tested, B12/Folate, did the regimen and then the vet said his Folate was too high. He did not respond well to Metro(Flagyl). He has been to a board certified nutritionist, no luck with the diet. He is currently of Purina DCO and lean turkey meat added. The vet has mentioned SIBO, IBS, IBD, Colitis, Boxer Colitis, etc... but not EPI, I have asked several times about EPI. he has been on Sulfa drugs, that seem to work, Baytril and is currently on Tylan Powder 1/8 tsp 2x a day. he weighs 67 lbs. He has had an ultrasound, nothing major noted. he has an appt. with an internal medicing specialist monday. His stool is very mucousy, at tiimes yellow, gray, orange, rusty. He has had diarrhea for a week now, he got his bordatella and distemper last week. The vet has swicthed him back to sulfa drug and off tylan. he takes proviable daily and prilosec at night. Any info will be greatly appreciated. I feel like he is getting worse and its been a year with no game plan. Please help. Thank you

Hi Lex's mom and a very warm welcome to you both although sorry to hear that Lex has been struggling with issues for so long without any answers.

THe stools and the other symptoms you are describing could be EPI...or.... a lot of other things.....but instead of trying this and that and guessing...... we have a motto here "your dog, your dollar" .....in other words you pay your vet to do a service, tell you vet that you would like a cTLI blood test run on Lex to either confirm or rule out EPI. It is a simple blood test, should cost around $125  and you simply have to fast Lex (from food) for 12 hours prior to the blood draw.  

THese are the instructions: http://www.epi4dogs.com/tli.htm

Since he has already been tested for B12/Folate... if it was fairly recent you don't have to do that again right now.... but the fact that his Folate number was high coupled with yellow/orange mucus stool sure does "indicate" SIBO. .... which very commonly accompanies EPI.... Also.... did your vet explain to you why he is taking Lex off of Tylan and back on Sulfa drugs???  The new protocol especially for difficult SIBO cases is now a 45 day regimen of the TYlan... and sometimes dogs need to be on it even longer.....

IN the meantime, what you might want to do is to go to the drug store and get some pancreatin 4x.  Try giving Lex this enzyme with his meals and watch the poo for a few days... see if it appears to improve a little... if so... then i would definitely insist that the vet run a cTLI test  ....

the other thing that comes to mind is a possible combination of a food sensitivity/allergy (IBD) along with SIBO.  In which case you might want to try hydrolyzed food (to mask any protein allergy) and if this improves the poo... you might be dealing with a food allergy of sorts.....or it could be one of many other things... *sigh*...

Oh... is he still vomiting bile in the morning? If so.... (my dog did this) and once i startewd feeding her a little snack at bedtime, she no longer vomited bile in the morning...

Olesia is right about the morning bile... with tummy upset the dog gets over hungry by morning... sometimes a small late supper gives the tummy some food to work on over night.

It's worth a try.

Without knowing what you are dealing with its frustrating, but do try a pancreatin 4 added and see if it helps.

The other things like allergy can drive you bats but they can be sorted if thats the problem. A hydrolised food is useful to try because it is made in a way to fool the dog that the protein is non allergenic.

You will get there... chin up.

Val

I am sorry i cant check your food out at the moment but one thing that some times help is if you also switch to a novel carbohydrate as well as the protein i am wondering wether that diet is Rice based there site isnt working at the moment Alot of the IBD dogs seem to do well on Hills Z/D .

Ann 

Hi, and welcome - you've found a great place with lots of caring, knowledgeable people. So sorry Lex has been struggling. Hopefully you'll get some answers soon.

Purina DCO is a high-fiber food; fiber is usually prescribed by vets to help resolve diarrhea. Maya was on it and it seemed to work for a while, leading up to her full-blown EPI symptoms and diagnosis. All of a sudden, the fiber just stopped firming up her stool.  For EPI dogs, one of the things we need to avoid for our dogs is fiber - it's too hard to digest. That's where the digestive enzymes come in, like the 4x Olesia's recommending you try. You might also want to switch to a grain free diet, "just in case" - you could take care of the novel protein, novel carb concept that way as well - if you can find a food that has proteins and carbs that Lex has never eaten. Natural Balance and Taste of the Wild are two brands commonly used by folks on this forum, but there are others. I don't know whether I'd do both at once, or stagger them to learn what is having an effect; I'll let others comment.

Hi Lex's Mom,

I am so sorry that Lex has been suffering.   Once you get a diagnosis, you will feel so much better.  I totally agree that you should have the cTLI test done.   It is definitive and you will know if Lex has EPI or not, so you can proceed.  Otherwise, you are floundering and guessing.   If he has EPI, it is manageable and there are plenty of people here to walk you through it.   It he doesn't have it, then you will know to look for other causes so you can begin treatment there. 

Putting him on some enzymes in the meantime, as Olesia and others suggested, is a good move and won't hurt. 

Please let us know what you decide and how things are going.

Barb

HELLO AND WELCOME

http://www.purinaveterinarydiets.com/Product/DCODualFiberControlDogFood.aspx

The fibre content if it is 10% is way too high needs to be around 4% or lower it also has grain and corn in it which our dogs and mmany others find hard to digest

if you can try to find a grain free lower fibre paula has given some excellent suggestions

good luck

jeanxx

Hello...very belated.  Was wondering how things are going and if the specialist has any new suggestions?  We would love to know how you are both doing.....

Hi Lex's mom..... i do am wondering how Lex is doing... if you were able to try the OTC Pancreatin 4x and if so what were the results.

Hi.. thinking about you !!!  How was the vet visit??