EPI * Exocrine Pancreatic Insufficiency

This is Stanley, my 4 month old German Shepherd/Belgian Malinois (atleast I'm fairly confident he is part malinois). I've had dogs my whole life, but they were my family dogs. Stanley is MY first dog, since I live on my own now while away at college. He's an amazing dog, he has so much character and he is extremely loyal and trainable. Most of all, Stanley is my best friend. 

I brought Stanley home in early May at the age of 6 weeks. He had consistent diarrhea since the day I brought him home. I hadn't changed his diet at all from what the breeder had been feeding him, so the diarrhea episode worried me. On the third straight day, I noticed a bit of blood in his stool and immediately took him to the Michigan State University Small Animal Clinic (an amazing veteriniarian school, by the way). He was diagnosed with Giardia, and after a few days of antibiotics everything cleared up and his stools became solid. 

Shortly after the Giardia cleared, I switched Stanley form Purina Puppy Formula Chow to Purina Large Breed Puppy Chow, as my primary veterinarian suggested. This caused no problems for several weeks. When his bag of Large Breed ran out just over a month after his Giardia cleared up, I gave him the leftover Puppy Formula Chow I had from when I first got him for a day. His diarrhea came back that night and I spotted blood in it once again, and a bit of mucus as well. I took him to the same MSU Animal Hospital as before and he was diagnosed with Hematochezia (blood in stool, basically). The veteriniarian believed that this may have been caused by an overgrowth of bacteria in his intestines. Stanley was sent home with Metronidazole, an antibiotic with anti-inflammatory and immunomodulatory effects, and it worked just fine. During both the Giardia and this case, Stanley showed no signs of illness other than the diarrhea. He was just as playful and alert as he normally was.

Stanley is now 5 months old. After the last diarrhea episode, which occured on June 16th, he experienced no problems at all. He weighs 25 pounds and has continued to eat Purina Large Breed Puppy Chow. I did notice that, from my vet appointment in June to my appointment in July, Stanley only gained around 2 lbs. That surprised me a bit. 

This past Thursday, Stanley was at my girlfriend's apartment while I worked and he had an accident inside (diarrhea). This is not expected anymore of him because he is house-broken and had not had an accident indoors since the last time he was sick in June. I monitored him once I was home and didn't notice anything wrong besides the loose stools. That night he woke me up three times, crying to go outside, and once I took him out he had terrible diarrhea each time. He also vomited each time I took him out, although it was mostly bile. That morning he was not himself. I went to work and left at my lunch break to check on him. He had ate his food and drank his water, and he seemed back to himself again. His stool was much more solid afterwards, so I decided to refrain from taking him to the vet. That night he woke me up again multiple times and experienced both the same diarrhea and vomiting episode that he had the night before. The diarrhea was yellowish-green and contained mucus most of the time. I immediately took him to the animal hospital. They ran multiple test on him, including blood-work, x-rays, and the Texas GI Panel. Nothing foreign was found in his body and no parasites were found in his fecal sample. 

My veterinarian spoke with me and explained the situation. The fecal sample revealed once again that there was an overgrowth of certain bacteria in his intestines. This is currently being treated with antibiotics, but she does not believe this is the primary cause of Stanley's vomiting and diarrhea. She said that since he has had a history of similiar clinical signs in the past, he may be suffering from either Inflammatory Bowel Disease or EPI. She seemed to lean more towards EPI. She told me that she had submitted a Texas GI panel to help evaluate how well Stanley is able to absorb nutrients from his diet. I should hear back from her in about a week. Last night I researched EPI for a while. Though it seems they can vary, Stanley does and does not meet some of the most common symptoms. He is not overly excited to eat his two daily meals, but he definitely is not uninterested in his food. He's never tried to eat his own poop before, only smells it occasionally. He does fart a lot from what I've noticed, but it's hard for me to tell if his flatulence is more frequent then other puppies his age. 

What are your thoughts on my pup's situation? I'm new to this all, so any opinions at all would be very helpful to me. 

Hello,

A warm welcome to you and Stanley!    Such a handsome boy he is! 

I am sorry he is having these issues and I know how upsetting it is for you.   You are doing all the right things.  What you need is a diagnosis.

The definitive test for EPI is the TLI test which I hope is the one they are running.   Along with the TLI should be the Cobalamin test (which he has to fast for 12 hours for) for his B12 level. 

If Stanley does have EPI, it can be very manageable and all the good folks here will help you through, especially the beginning stage, which in my opinion is the hardest part. 

You will need to balance, Food, Enzymes, B12, and Antibiotics (at first for SIBO or that overgrowth in the intestines).

Food:  most dogs with EPI do best on a grain free diet, but each dog is different, so each dog will tolerate foods differently.  We finally had to go to a prescription diet with Kolby, but many dogs do very well on a good quality grain free food.  The tabs at the top of the page can give you good suggestions.

Enzymes:   If Stanley does have EPI, everything he eats will need to be treated with porcine based powdered enzymes which can be purchased for very reasonable cost from Enzymediane.com.  EPI means that his pancreas is not functioning properly (or at all) and the enzymese help him to absorb the nutrients from his food.  Basically, we recommend 1tsp powder per 1 cup of food.   We dissolve the powder in a small amount of warm/room temperature water and pour it over the food.   Most of us incubate for 30 minutes or so.

B12:   Most dogs with EPI have low B12 and will need a 6 week course of injections to raise their levels.   If dogs cannot hold the B12 levels, many members use B12 supplements with Intrinsic factor which you can get very reasonably or we give injections ourselves to our pups at home.   B12 is very inexpensive. 

Antibiotics:  Most EPI dogs also have SIBO, or Small Intestinal Bacterial Overgrowth from undigested food and they will need a 45 day course of either the metronidazole or tylan.  It sounds like Stanley could be experiencing SIBO.

You can download the overview from the tab at the top of the page and read any of the individual headings also while you are waiting for the results of the test.

Please keep us posted on the results.  If he has EPI you have come to the right place.   If not, we will try to point you in the right direction.  

Hang in there.    Stanley is very lucky to have you.

Barb 

Welcome to you and Stanley . What a cutie!!!  Love the collar.     Barb has given you a great place to continue reading.Waiting for the test results sucks......but if it wa s the TLI you will knowwhat you are dealing with. Not all pups have ALL of the symptons...each pup is different. I'm glad you have a great vet to help...  Keep in touch, please let us know the test results!!

Hello from the UK

wow Barb nothing more to add except to keep a journal but you certainly have recorded everything somewhere

I vote for the grain free food too some dogs just cannot deal with grains or rice especially if it is EPI sometimes they just have delicate stomachs all the noise you are experiencing sounds like intestinal overgrowth and is one of the symptoms of EPI

so we await the results with interest

jeanxx

Welcome to the forum, but sorry Stanley is having these problems.  He is a cutie!  Barb covered the basics.  I'll just add that tylan (tylosin) is the preferred antibiotic for SIBO, which it sounds like he probably has.  It's not as hard on the body as metro, and can be used safely long term.  Some dogs do better on metro, though.  I would just suggest if you don't see results from the metro within a week or so that you talk to your vet about trying tylan instead.  Good luck, and let us know when the test results come in. 

Hi.  I just wanted to say welcome and if you are near the MSU area, I am not far from you if you ever want to talk or need any help.  You can private message me and I will give you my phone number. I'm about 40-45 min. from there.  It may even be closer, haven't been that way in a long time.  Keep us updated.

Hi -welcome to you & Stanley-what a good-lookin boy. You have been given some very good advice as you wait for the lab results. If it is EPI, this is the best place to get support, advice & the latest research info. 

My dog does best on Tylan, but as has been already said, every dog is different. I hope you will get some answers soon on the diagnosis.

Looking forward to hearing the results, and of course, more pictures of Stanley!!

Hi there,

I too live in Michigan (Grand Rapids area) and reading your post gave me a little deja vu.   My dog Chase is almost 4 years old and had/has a lot of the symptoms that your pup Stanley has.  I found myself here a little over a year ago because my vet diagnosed Chase with EPI via a poop test.  I learned quite quickly that the TLI test was the way to go.  Lets just say, my dog does NOT have EPI.  If yours does, this is the place to be!

I got Chase at about 5 months old and he was skin and bones...he too weighed in at a measly 25 pounds.  He should have weighed a lot more than that!  When I got Chase a 12 week old puppy last year she weighed 26 lbs and she is a much smaller dog than he is!  I took him to the vet 4 days after getting him, for shots and the fact that he had terrible diarrhea.  He had round worms and the vet said that the diarrhea should clear up after the deworming treatment....well, it didn't entirely.  We had some good poops here and there, but his poop was never "normal." 

Unlike stanley, I had issues with getting Chase to eat....he would eat anything but dog food.  I tried everything from raw to homecooked to kibble....it was a struggle.  On top of the waxing and waning diarrhea, he vomited bile a few times a week.  Seemed to happen more in the morning.  If this is the case for Stanley too, try giving him a bedtime snack, it seemed to help for Chase. Then there is the gas....he was always gassy (still is sometimes), he could clear an entire room!

Chase never had blood in his stool only until recently.  About 2 weeks ago, I noticed he was having a flare up and the poop wasn't looking so great and noticed the blood.  His vet too said there was a bacterial imbalance in the intestines (Most likely SIBO) and put him on Metronidazole, which he will be on for at least the next 4 months.  I took him to an IMS and he was ultrasounded last week and everything internally looks normal.  some of his blood work is abnormal, but it could be from the meds he is on right now.  Chase was also x-rayed.  I spent 8 hours at the vet so they could watch barium go through his digestive system...the only thing abnormal was the barium didn't move out of his stomach as quick as it should have ( if all else fails, might be something else to look at).  The IMS that I saw said that IBD makes the most sense since he has been tested for EPI and failed, LOL.  And other things have been ruled out.  There are so many diseases that have the same symptoms, it really is a process of elimination.  I really hope that you are getting the TLI, B12 and Folate test done, because that is the most accurate way to confirm if he has EPI.  For now, Chase is being treated for IBD with prescription dog food, antibiotics and steroids.  I also thought I would attach a pic, so you could see that there is no way that my 5 month old dog should have weighed 25 pounds (should have been at least 45lbs), nor should yours....there is something going on in there.  Pictured with Chase is my 7 year old daughter who is 44 inches tall.  Good luck and I hope that Stanley gets diagnosed soon!  Also, I love his ears!

Megan

Hi and welcome,

Not all dogs show the exact same symptoms so while some might apply, some might not. There are so many gastrointestinal issues that mimic EPI that without the cTLI test it's nothing more than a guessing game. Let us know what the test results reveal. If it is EPI we can help.

Welcome to you and Stanley. I stand with the others....he is a handsome young pup! I'm curious, during this waiting time, how is Stanley doing? Does he still have the loose stool or loosing weight? I know he is a little guy, but our vet suspected EPI in Sable as well. We started her on the enzyme prior to getting her tested for TLI and waiting for the results. This may be a thought to run past your vet. It helped stabilize Sable and gave me a better night sleep.

Lastly, this is an excellent website for EPI. THe people here are very knowledgeable. I found a lot of answers here that even my vet didnt know.

hello again

we also started the enzymes prior to diagnosis as I was so certain Karas test would be positive

the thing is that vets cannot know everything so ask......................

jeanxxx

Hi and a very warm welcome to you and Stanley, who by the way is a real cutie!!!!

I am assuming that your vet did a blood test after fasting Stanley to check for EPI? "She told me that she had submitted a Texas GI panel to help evaluate how well Stanley is able to absorb nutrients from his diet."  If so, although i know the waiting can be so hard, it is best, as others have mentioned to have confirmation if Stanley does or does not have EPI. If she ran a blood test, the test is called a TLI testl  Please keep us posted.

Hello and welcome.....   Stanley is indeed a real "looker"!!!!   When my pup became ill, she showed absolutely NO "typical " signs of EPI until after diagnosis, so when they say each dog is different, they couldn't be more right.....   the TLI test is the most reliable test for EPI, my hope is that they are also running the B12/folate test with it.  If Stanley does have EPI (and in some cases even if he doesn't), he will almost assuredly need B12 supplementation.  Let us know how things are......

I apologize for the late respone; it's the busiest week of the year for the reality company I'm working for. Since taking Stanley to the animal hospital last Friday, he has been doing great. The last time he had diarrhea or vomited was Friday morning. He has been having solid, healthy looking stools ever since and he is taking Tylosin capsules to restore his normal bacteria balance in his GI tract. I have yet to hear back from the veteriniarian, but I'm expecting the results within the next two days. I've continued feeding him Purina Large Breed Chow. I'm waiting to hear the results before I begin to change his diet. This website has been an excellent source and I've learned so much already. I can't believe how willing you all are to share your advice and opinions with me. It means so much to me knowing that, in the event he is diagnosed with EPI, Stanley will be in good hands thanks to the information and experiences from this forum. I wish the best for all of you who are currently caring for a pet with EPI or awaiting results! I'll continue to expand my knowledge here for now, and I'll post an update on Stanley as soon as I am contacted.

Here's a picture of Stanley taken a few days ago:

Hi!  (would love to know your name too!).  He is a beautiful boy and I can see he is going to be a BIG boy when he is done growing!  Waiting for test results can be the hardest...and it feels like forever.  Good news that he is having good poops with the Tylan.....maybe something else caused a bacteria overgrowth and the Tylan is handling it and it's not epi...but once you have the test results you will really know which direction for treatment to go (if it's epi).  One thought your vet may/may not know:  if it is epi then the B12 (cobalamin) results need to be in the high normal range.  Some vets will say the B12 is normal if it is anywhere in the normal range but generally they need to be in the top 25% or so of the range.  When you hear back from the vet ask for a copy of the test results and then post here....because not only do we have a wealth of knowledge from research and experience with epi there are a number of people that still post on the forum who either found out their pup does not have epi or have concurent conditions and can share info on a number of other diagnosis.

Oh WOW.... Stanley is quite the handsome dude!  NICE dog!

I wouldn't change the food just yet until you hear back from the vet.......just in case it is not EPI..... but Terry brought up a great point about the B12 ....if EPI, the B12 (Cobalamin) value needs to be in an upper mid-range level (around 600) and there is more... SIBO and insufficient B12 often times feed off of each other too.... so even if not EPI.... you might want to be aware of this.

Definitely keep us posted.... and hey... real busy at work... welll... that is a good thing

Wow that is a good looking dog and yes... he will be a big boy.

I'm glad to hear the news so far and it could be its not EPI... just a digestive melt down. Which ever way it comes we will be happy if you keep us informed. As Olesia says there are some here who thought it was EPI but it turned out to be a different problem. The more people we have with knowledge the better it is for everyone.

Val

Olesia's right about the B12...it can be low with other digestive/absorption problems also, not just EPI, so I hope it was checked.  Last year (just when we got our EPI girl Pixie), one of my other dogs, Lucy, started having diarrhea for no apparent reason.  She had it for months, and we couldn't get it better or figure out why.  We tested for EPI, and her TLI was over 50, but she came back negative for pancreatitis when we did a PLI.  We finally got the diarrhea under control and it's been pretty good ever since.   We suspect IBD or IBS, but didn't scope for a diagnosis.  Anyway, with all this going on, her B12 levels were low, too.  So I had both Lucy and Pixie getting regular B12 shots for a while!

Keep us posted!

My name is Brad, by the way. I forgot to mention that before! My vet seemed very well educated and she seemed sincerely concerned about Stanley's health (mainly because I received him in May and he has been taken to the animal hospital once each month since then with diarrhea symptoms and, more recently, vomiting). Had I suspected this prior to last week, I would've asked her about testing his B12 levels. As I said earlier, I am so new to all of this and I had never heard of EPI until last Friday. At this point I really don't know what to think as far as his diagnosis, if any. Though he has experienced some of the symptoms associated with EPI, I still feel that IBD is a possibility or that he could simply have bad luck. I've researched the Texas GI Panel recently (this is the test that was submitted to the veterinarian school at Texas A&M). It requires certain minimum levels of TLI, PLI, and Cobalamin, among others. I had read earlier that an EPI test requires a 12 hour fasting period, which confused me at first. After thinking about it, I did not feed Stanley Friday morning or give him any water, and it was most likely 10-12 hours since the last time he had either. I told the vet this as well, so I beleive I now understand why the Texas GLI Panel was submitted without a doubt. I'm going to contact the MSU Small Animal Clinic tomorrow to see if Stanley's test results have been received. If so, I'll be sure to ask for a copy of the results and I'll post everything here. Thanks to everyone, you've all been such a great help!