EPI * Exocrine Pancreatic Insufficiency

Hello Brad

well whatever you are studdying you will do well if you research that as well as EPI

if you have a look at my thread on" thoughts on EPI " you will see that none of us had a clue at the start and you limp along and struggle and then eventually you see the light

let us know what the results are

jeanxxx

Hi Brad,

I am just so glad that Stanley had tests done.....we can all guess and guess and guess... but with gastrointestinal problems, so many of them mimick one another.......... so it is really hard to determine until some testing gets done.  Now the wait.... which is the hard part.........

Sounds like you have a keeper for a vet

Keep us posted!

Hang in there Brad......waiting is the hardest part !! Yes, it sounds like your vet it a keeper.

I feel for you. My sons are in university as well and I know how intense your schedule can be. Stanely if very lucky to have you. He looks great in the picture - let us know what the results are.

Kathy and Phoenix

Hope you are close to getting results! You are in the right hands with this group if it is EPI (and even if it isn't EPI as they are all a tremendous resource.) I actually have an IBD dog vs. EPI - but a few things like B12, SIBO, etc overlap so I find so much value in this forum. I'll keep watching your posts. It actually doesn't "sound" like IBD to me - to have anything normal in the poop arena without a specialized food (even if temporary) would be surprising (at least to me - but I am not a vet!)

Karla & Marley

4 1/2 y/o female GSD w/ severe IBD.

Well, Dr. McCarthy called me this morning from the MSU Small Animal Hospital. She's the one who saw Stanley last and I can tell she genuinely cares about his health. Definitely a keeper. She said that EPI is a possibility, but she can't say 100% at this time if that's the case. She wants me to make an appointment and come back to the Internal Medicine Department in three weeks so Stanley can be evaluated, and in the meantime she told me to continue giving Stanley the Tylosin twice a day and maintain his diet of strictly Purina Large Breed. Stanley has had no problems since; his stools are solid and appear to be healthy (yellowish in color, similar to his food). The only thing I've noticed, which has been consistent since I've had him, is that he still poops several times a day. I'd say anywhere from 4-5 times (I give him around two cups each meal, two meals a day, but he usually doesn't finish at least one of his meals). I just went to the animal hospital and had a copy made of the Texas GLI Panel test results so that I could post them here. Here's what I got:

The three parts that the lab tested for were Cobalamin Fasting, Folate Fasting, and TLI Fasting:

• Cobalamin Fasting: Result- 884 ng/L  Control Range- 251-908                                               Interpretation: Result is within the normal range.
• Folate Fasting: Result- 18.5 ug/L  Control Range- 7.7-24.4                                                       Interpretation: High normal serum folate concentration. May reflect a derangment of the bacterial microflora and warrants either a change in diet and/or an antibiotic trial in those patients with signs of GI disease.
• TLI Fasting: Result- 10.4 ug/L  Control Range- 5.7-45.2                                                             Interpretation: Result is within the normal range.

Hi again!  Well, at this point he probably doesn't have epi...most of us when our pups are diagnosed it is below 1!  However it is on the low side and he's so young, if it was me, it would be something I would test periodically, especially if there are problems to see if it goes down.  Once it is in epi range you don't need to test again as once epi, always epi (well, rare cases numbers can go up, but that is EXTREMELY rare).  Glad he is getting the Tylan as it looks like he needs the antibiotic from the folate results.  The cobalamin (B12) is great!  So it is a head scratcher for me.  I'm wondering if the food doesn't agree with him or if IBD is in play. 

I'm glad the results came in and you got the numbers.  I had the same thoughts as Terry.  At this point, it's not clinical EPI.  The TLI would have to be under 5.7 to be considered definitely EPI.  That being said, it could be developing which is why Terry recommended maybe rechecking later on.  The folate can indicate SIBO, which your vet has covered with the tylosin.  And the cobalamine is the test for B-12 levels.  His B-12 level is great!  Many times the B-12 is low with any digestive/absorption issue, so it's good that his levels are on the high side.

It sounds like something is going right since his poops have been good.  I'm not sure if 4-5 poops a day is excessive.  Every dog is different.  My dogs often poop at least 3 times a day if not 4.  That's just them.  As long as the poops are "good form" and he's gaining weight appropriately for his age, I wouldn't worry too much about the number of times a day he goes.  But, it's a good question for the vet when you go to the Internal Medicine Department.

Good luck and keep us posted on how he's doing.  By the way...I love the new profile picture!

Hi Brad,

I am so glad that you got the test results back and shared with all the people here on the forum.  I am also sorry that you still don't have a diagnosis.  However, I found Stanley's test results kinda familiar.  When Chase had his done, I was SURE it was EPI, well it wasn't.  Here were his results.

TLI   14.2                 RANGE 5-35

B12  654                 RANGE 244-733

FOLATE 17.1          RANGE 6.5-11.5

Everything was fine except for the folate.  I will also be interested to see what the IMS has to say about Stanley in a few weeks.  Good luck and I hope you can get things figured out.  (I am still working on it.....SIGH)

Megan

Hi Brad,

In dogs, values below 2.5 µg/L are diagnostic for EPI. Values between 3.5 and 5.7 µg/L are rarely if ever associated with signs of EPI. As you can see 10.4 is just fine. Good news is his B12 is great and the folate is also within range. With B12 that high I wouldn't think Stanely would have SIBO, usually the B12 will be lower and the folate higher. I know you are sticking with the food for 3 weeks until your next vet appointment but if Stanely is  still pooping 4-5 times a day perhaps the food does not agree with him, something you can run by your vet.

HI Brad~

At this point your pup does not have EPI according to the values....and the B12 is GREAT!!!!  But (and here i kinda of take an opposite view from Kathy)... i'd suspect SIBO or some sort of bacterial imbalance in the gut.... SIBO and B12 tend to go hand in hand.. but not always.....and this is what can drive us nuts!   Trying to figure out gastro causes can be a minefield.... thank goodness you have a great vet working with you!.

One thing you might want to discuss with your vet is, if she agrees, starting Stanley on an antibitoic like Tylan and then immediately after the 30-45 days completed, start on a viable probiotic.... to alter and permanently improve the gut flora.

Also..... as others have suggested, sometimes it is the food the doesn't agree and triggers SIBO environment in the gut.............. so you might want to just start keeping an EPI log..... and thru these notes you might be able to determine if it is the food not agreeing with Stanley.

Update us when you can!

P.S. My other on EPI dog (i have 3 dogs!) had a TLI value of 5.8 and never developed EPI.... so you never ever know for sure, but when close to the cut off mark.... best to have the test repeated in 6 months or a year later .... just to make sure it is not EPI in slowly happening in the back ground...............

Hi Brad.  From how I am reading these results, they look good and you don't have to worry about EPI,SIBO or the B12!  That is great news!  As long as things continue to look good, I wouldn't even worry about retesting down the road.    Things look good lab wise.  Everything in the normal range.  SIBO does not show up on stool samples, so since they did find some bacteria, it would be something other than SIBO.  Even though we are on full time anti's, earlier this year we had clostridium show up in the stools.  And he was on the anti's that should have taken care of it, so we switched to another one for the clostridium and SIBO.  I hope the tylan takes care of this bacteria for you guys and you don't have any more problems.  MSU is a very good place so I know you are in good hands.

Re the going a lot.  Our 16 month always did, 3-5 x day.  Large amounts.  Last weekend I switched her food to RAW and OMG, what a difference it made!  2X day, small amounts.  Not suggesting RAW for you, but it is normal for some dogs to go alot, I guess, on kibble.  She grew fine, was a good weight, but the output I thought was a lot also.  But she was fine with it.  So don't worry too much about that right now as long as everything else seems fine.

Brad, as you can tell.... there are just as many varying opinions on gastro issues with folks dealing with this day-to day as there are with vets dealing with these gastro issues! Dealing with gastro issues can be very hard to figure out.

Best thing to do (if you even have the time, cause i know you are straight-out) is to keep a journal of what goes in and what comes out ;).... sometimes (not always though)  this can save you from spending lots of money on expensive  "exploratory" tests....and it will help your vet also better understand what is going on.... and hopefully they will find out some answers with what is going on with Stanley soon.

I realize others may disagree with me, but i still stand by my recommedation to re-test for EPI in the distant future "if"  you and your vet do not find a definite other cause, and if Stanley does not improve.... my reasoning is because Stanley is a young dog and still developing, sometimes it can even take years for EPI to become full blown. Please read the EPI research on EPI dogs they followed for 10+ years http://www.epi4dogs.com/research.htm 

Brief Communication - J Vet Intern Med 2010;24:450–452

Heritability of Exocrine Pancreatic Insufficiency in

German Shepherd Dogs

E. Westermarck, S.A.M. Saari, and M.E. Wiberg

Also, the reason why i am not completely dismissing possible SIBO Or SID as they are now calling it) is because there is such a thing as idiopathic SIBO that sounds like a possibility with the test values and the clinical signs that Stanley is displaying, even with his great high B12 levels .... in which case i am sure your vet may prescribe an antibiotic course and then a pre+probiotic......or, as i said earlier, it could be something else.... there are so many different intestinal bacterial issues... it can really keep you guessing,....so thank goodness you are working with a great vet !

Please keep us posted.