EPI * Exocrine Pancreatic Insufficiency

managing EPI

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Forum Home > General Discussion > No EPI...I find that hard to beleive....

Judy
Member
Posts: 14

I am trying to learn as much as I can about EPI....I have test results back and I saw somewhere the number we are looking for to determine if it is EPI or not. My vet said it is not...but my dog has all the symptoms, well, I think so. His results show he is very low B-12...so I will start those injections tomorrow...my vet said to do them every week, and also panacure to deworm him...his stoll showed no parasites. Kolby will not eat. I have been hand feeding him for almost a month...he has lost 30 pounds so far...I also started him on amoxicilian and am feeding him small meals a day, with yogurt which seems to keep it down,,,sometimes. His stools look just like those shown on this site. I even ordered enzymes, I was so sure. I think I will do them any way...what can it hurt...he is getting so thin. Any ideas..you all have so much experience.

Thank you, Judy

December 4, 2012 at 6:40 PM Flag Quote & Reply

Terry Bin
Member
Posts: 1551

HI Judy...welcome to the forum.  On one hand no one wants their dog to have epi, but then at least you have a diagnosis and then a treatment plan.  When it is all a big ? of what is wrong, it is then unclear what to do.  Can you post the numbers for cTLI, cobalaming (B12) and folate here?  It's helpful to see the actual numbers.  Sometimes vet will say it is not epi and though technically it is not in the epi level it is close and/or headed that way....so some pups respond well to the enzymes even though they do not have "full blown" epi.  We would love to help you both so the following info would be helpful:

1.  what are the lab results, esp. cTLI, cobalamin and folate

2.  what are you feeding: type and brand of food and amount

3.  What are the medications and/or supplements you are giving

4.  Breed and age of pup as well as current weight and optimal/goal weight

If you wish, please post a photo of the poop...a lot of us here are "poopologists" and can tell a lot by looking at poop photos.  You will need to be on a photo sharing site like Photobucket and then take the URL of the photo and paste it here...you click on the box next to the smiley face and that will give you a box to paste the URL...and then the photo should how up.

I know it is frustrating to not have a definitive diagnosis yet, but the treatments for epi/lowB12 will not hurt even if not needed.  And low B12 will really decrease a pup's appetite, soften poop, etc.  So the low B12 could be the main culprit, though the question comes up:  why low B12.

--

Terry

Mom of two EPI Shiloh Shepherds: 

Pharaoh born Nov. 2007 and dx with epi December 2009.   Pharaoh weighed 62.4 lbs. (15 lb. weight loss) when diagnosed in 12/2009.

Weight 10/31/11 was 76.6.

85lbs on 9/22/12.

Received six weeks of B12 shots Jan-Feb 2010 but his B12 on 8/10/2010 was only 232. So started weekly shots at home, which we continue to give.

His older half sister is Taiko born Sept. 2006  and was dx with epi June 2010.  Since she has severe bilateral hip dysplasia she had always been on the thin side.  Taiko's weight was 70.7 lbs. in June 2010 (time of diagnosis; about a 10 lb. weight loss).

Weight on 10/31/11 was 80.4 and on 9/22/12 was 82.4 lbs.  B12 was 211 in June 2010 so started six weeks of shots and was only 293 on 8/10/10.  She receive B12 shots weekly at home.

Both are fed twice a day and we use  Merrick BG brand: 1 1/2  cups kibble in the morning with app. 4 oz cooked meat (usually chicken) with 4 crushed tablets and in the evening 2 cups kibble with 4 oz cooked meat with 4 crushed tablets.

December 4, 2012 at 7:10 PM Flag Quote & Reply

Judy
Member
Posts: 14

Thank you Terry...I will be going into the vet to pick up test results tomorrow morning...then I will post answers to all your questions. Of course I didn't want it to be EPI...but I want him well again. I will not give up without a fight...He still wags his tail and wants to go for a ride.

December 4, 2012 at 7:17 PM Flag Quote & Reply

Karen
Member
Posts: 1828

Low b12 alone can show the same signs as EPI.  As can other intestinal issues.  If it is not EPI, try to find out what it is.  You want to be treating the correct diagnosis.  An Internal Med Specialist (IMS) would be a good idea if your vet is unsure.

--
Karen & Jaime-Lyn
DOB 3/31/11
cTLI 7/9/13 3.0  10/19/13 2.4
EPI, low B12, SLO
Raw Fed
-----------------------------
Always in my heart
My Angel Hondo
EPI, IBD, SIBO, PLE, Weekly B12 injections
Raw Fed
7/19/04-5/22/13
December 4, 2012 at 7:36 PM Flag Quote & Reply

nancy
Member
Posts: 27

Judy, I feel your pain! We are newly dx w/EPI (one month) but longer story is that Sadie was sick with some symptoms you describe beginning in May of this yr. I will share in hopes it may help your babe.

We have never been big travellers, always had dogs and enjoy incl. them in holidays. Had a chance to visit Cuba in May, leaving Sadie w/ my mum. This dog had not been left in 6yrs, however, mum loves her to bits(it's mutual) and she was staying in her own home with normal routine ( I hired a dogwalker as my mom is sr.). Well, 10 days later and our lives changed significantly. We got home to a sick dog. My mom was a mess as Sadie would barely eat while we were away. She smelled bad and had been isolating. I drilled poor mum re: possible over treating, etc. but nothing too bad. Sadie has always trended high strung/serious(gets it from me, no doubt). She is thunderphobic (my first dog with this ~ hard to watch), dog reactive on leash, etc. I just determined our absence caused anxiety and things would turn around. But they did not. I was pulling out all the stops to get a meal into her that wk. forward. But herein the case differs to yours as Sadie did not have poop issues then. Off to vet we went. CBC indicated high aspartate transaminase, high CK and high Lipase. We then did a bunch of add on tests like lyme, ehrlichia , heartworm, etc. All neg. Vet thought pancreatitis but that test came back neg. ('tho it does not mean she did not have a bout of it ). After looking at me and my furry stress basket, vet decided it was an ulcer. Perfect. We treated with sulcrate plus. Just a pepto like substance to coat her tummy, reduce inflammation when digesting food and allow healing. But we had no improvement into June and July. My normally highly food-motivated dog was completely off her feed. Normal poops, great stamina for exercise, but just a monumental struggle to get her into food. Then suddenly we turned a corner. She began to eat normally & I had my dog back for August (exception of hideous bug bites on her ear flaps). And then September arrived and brought the bad poops & finally EPI dx in Oct. Looking back now, I truly see that Sadie's B12 must have been waning/dangerously depleted since May.

I don't know if any of this helps at all, just thought perhaps you could share our story with your vet. Apparently EPI dx is oftem preceeded by a bout of pancreatitis. Have you noticed any isolating/ strange fearful behaviour/pain reactions? Hopes you are just dealing with a bout of pancreatitis. But I think you are on the right track! Enzymes cannot hurt things to my knowledge and B12 is a great start. Keep us posted! nancy w/sadie

--

EPI! (Oct.27/12) CTLI <1 (ref 5-35), Folate 29 (ref 7-39), B12 <110 (150-700)

We feed a gluten-free reduced grain/increased protein(gr. turkey/tuna) version of home-prepared 'muffins' www.theskyesthelimit.com

We are stabilizing at 3/4 to 1tsp. of Pancrease-V per meal ~ presently 3x/day * Switched to generic pancreatin 6x from EnzymeDiane Dec.14/12

Completed 21 days of 300mg Tylosin 2x/day end of Nov. for SIBO

Injected 1ml.B12 weekly for 4wks. Retested high normal (650). Next steps tbd...

Daily Supplements: Incubated:900mg salmon oil, 1 1/2tsp multi vitamin www.breedersbis.com Topper: 3tsp. pure pumpkin, 3/8tsp. Genestra brands HMF probiotic formula(incl. prebiotic)

Sadie is up 7lbs ~ whoop! (16/12/12)

Ever tried. Ever failed. No matter. Try again. Fail again. Fail better. ~ Samuel Beckett

December 4, 2012 at 8:33 PM Flag Quote & Reply

maddie ann
Member
Posts: 3155

Hi Judy and welcome posting your results would be great but yes Low b12 can cause syptoms that Mimic EPI also it might behelpful if you tell us what you feed and wether as karen has suggested the vet has looked at sending you to a specalist.

 

--

 ANN (UK)

 “Saving one dog will not change the world, but surely for that one dog, the world will change forever.”

Maddie DOB 01-10-2007 she is now  6 DX 04/11 .B12 140 now 644 TLI <1.00 Folate 14.2.

After 15 months on the B12 tablets with the intrisic factor she was retested and her b12 is now 902.

Weight was 22.3kg now 33.2kg (04-05-12) she is a small GSDbut she gained .(24lbs)

Feed a mixture of foods she does better on fibre 3% and below she has  b12 tablets daily (imported from the USAhttp://www.wonderlabs.com/itemleft.php?itemnum=6881) now changing to the uk version from http://www.chemeyes.co.uk/

organic virgin  coconut oil dailly. Use Panzym 1/4 a tsp per 200 grams of food .Got SIBO under control after antibiotics ( stormormgyl) used synbotic by protexin. a pre-probotic also given daily.

December 5, 2012 at 7:28 AM Flag Quote & Reply

Judy
Member
Posts: 14

Kolby's results...

Cobalamin <150 ng/L.....Folate 12 ug/L....

.Pancreatic LipaseImmunoreativity 586 ug/L

TLI 13.9 ug/L

Vet sent me home with B12 injections...panacur for next 3 days.

I feed Fromm Gold, with Merrik grain free canned...yogurt,,,some tripe. Try to get a half cup down him 4 times a day.

Kolby does not eat on his own. I make a mash and feed it to him. I add ProBio to his food in the morning with a amoxicillin....My enzymes should come today.

Kolby is an Irish Field Setter small...was 65 pounds in July, now is 34 pounds. Stools are tannish pudding mush. He is looseing energy by the day. A few days ago he would jump up on my bed...but now waits to be lifted. He still gets excited to go outside or for a ride...

Thank you all so much for your responses. I just feel helpless but won't let my boy go without a fight.

December 5, 2012 at 3:21 PM Flag Quote & Reply

Judy
Member
Posts: 14

This is a picture of his poo....it has bits of chunks...the canned Merrik food has tiny chunks...so I figure this is going right through and not digesting at all...

December 5, 2012 at 4:57 PM Flag Quote & Reply

Terry Bin
Member
Posts: 1551

looking at that poop I would think either Tylan or Metro for an antibiotic might help as well as the B12 injections....

--

Terry

Mom of two EPI Shiloh Shepherds: 

Pharaoh born Nov. 2007 and dx with epi December 2009.   Pharaoh weighed 62.4 lbs. (15 lb. weight loss) when diagnosed in 12/2009.

Weight 10/31/11 was 76.6.

85lbs on 9/22/12.

Received six weeks of B12 shots Jan-Feb 2010 but his B12 on 8/10/2010 was only 232. So started weekly shots at home, which we continue to give.

His older half sister is Taiko born Sept. 2006  and was dx with epi June 2010.  Since she has severe bilateral hip dysplasia she had always been on the thin side.  Taiko's weight was 70.7 lbs. in June 2010 (time of diagnosis; about a 10 lb. weight loss).

Weight on 10/31/11 was 80.4 and on 9/22/12 was 82.4 lbs.  B12 was 211 in June 2010 so started six weeks of shots and was only 293 on 8/10/10.  She receive B12 shots weekly at home.

Both are fed twice a day and we use  Merrick BG brand: 1 1/2  cups kibble in the morning with app. 4 oz cooked meat (usually chicken) with 4 crushed tablets and in the evening 2 cups kibble with 4 oz cooked meat with 4 crushed tablets.

December 5, 2012 at 5:48 PM Flag Quote & Reply

epi4dogs
Site Owner
Posts: 12832

Yup... i was going to suggest Tylan... even thought the Folate number is at 12.... the folate test is just an "indication"..... and what might be going on is SIBO .... talk to your vet and let him know that you want to or are going to try Tylan for 30-45 days...

--

Olesia, owned by Izzy-35lb SWD, Diagnosed at 1.5 years old - TLI results 1.3, Stable almost 8 yrs! Once stable, was able to reduce enzymes to only 1/2 tsp of Enzymes with each meal, but after almost 4 years of stabilization... had to increase the amount of enzymes to 3/4 teaspoon with each meal. Feed various grain-free kibble+real meat, 6x pancreatin enzymes from EnzymeDiane. I give 1 tsp of coconut oil one day and 1 tsp salmon oil next day, and also give canned sardines packed without salt or canned herring for extra omega oils.

In Feb 2013, Izzy developed a very serious condition called IMHA which she (thankfully) beat and is now in remission. We also discovered that now, at 8+ years old, she not only has EPI, but also Diabetes, Low Thyroid and High Cholesterol.  Izzy was able to receive excellent care because of the kindness of so many here on epi4dogs and  is currently  doing extra-ordinarily well. If anyone could spend a day with Izzy, they would never guess that she has any health problems!  Because of Izzy's concurrent conditions of Diabetes and High Cholesterol we had to make chnages to our daily EPI routine. We had to alter the fiber, type of fiber and the fat content  her diet. She now gets 1/2 Annamaet Lean kibble and 1/2 TOTW kibble with either lean pork loin meat, or chicken breast or tuna twice a day. She also receives  9 or 10 units of Vetsulin (depending on her blood glucose reading) a pork based insulin. We tried Novolin N a human synthetic RNA insulin.... but Izzy did not do well on it. And now we have to monitor her exercise.   It's been one heck of a journey... but aside from all that Izzy has gone thru with her health issues.... she continues to wake up every day full of joy and a great sense of humor!


December 6, 2012 at 12:06 AM Flag Quote & Reply

Judy
Member
Posts: 14

I just don't know what to do any longer. Kolby does not eat...will NOT eat. I have been making mush balls and putting them in his mouth..this is all the food he gets for the past month or more. He is now so thin, he is skeletal...every bone in his body sticks out. Skin on bone. I do the B-12 and Tylan powder but don't know what else to try. I feel it is time to just let him go. It is so hard to make this decision, he still gets up and walks, goes outside, but he is just wasting away, it is so sad. My heart is broken, I have to make the decision to let him go. I can't stand to see him like this and what do I do, wait till he jsut dies from starvation. So thank  you for what you gave me...I hope this never has to happen to any of you.

Judy

December 29, 2012 at 7:13 PM Flag Quote & Reply

Dar
Member
Posts: 2478

What does your vet say?? If not EPI.. what have they looked for? I can hear your pain in your words.....(((Hugs)))

--

  Dar and Kodi, From Washington state

 ' I aspire to be the person that my dog thinks I am !!'

Kodi (GSD female) , born August 19, 2010 , was diagnosed July 15, 2011 at 11 months .Lowest weight, 47 lbs, weight as of  4/27/2013  62.9 lbs. Our goal for her at this time is now 65 lbs. !!!   And she made it!! .  TLI .07 , Folate 9.4 , Cobalmin 536 .

Kodi is on Pioneer grain and potato free Pork, 2  cups kibble with added canned or home cooked pork 2 times a day with  3/4 teaspoons of enzymes (X 8 ) per cup,from Diane. (Also some home cooked meals)1 Trinfac-B capsule once a day. Also  1/8 t. of ground coriander, 1/16 t. of ground fennel seed and cinnamon per meal (for stomach acid and burps). Cylosporine 100 mg. every other day for her terrible spring allergies.

December 29, 2012 at 7:23 PM Flag Quote & Reply

Marie
Member
Posts: 57

I am so sorry to read this. I had the same feelings not long ago before we diagnosed our dog. Maybe you can call your vet one last time and let her know how you feel. Maybe she can run a few tests.

Maybe if you give the Tylan 48 hours to work and keep force feeding your dog you would be surprised how much of a turn around can happen once a-biotics kick in.

I feel your pain. Big big hugs to you and you pooch. Let us know how he is doing :(

December 29, 2012 at 7:44 PM Flag Quote & Reply

Jill
Member
Posts: 1792

Oh my gosh. Don't give up yet. As long as your dog still is getting around and interested in things. Where is the nearest Vet school? They are great at diagnosing. Please, if your pup is still interested in things don't give up. Is he drinking water still? Can you try some of the dog resemblance to people extra calorie drink like boost for dogs or something? I am sure they have that. or they have extra calorie paste? just till you can get him seen by an expert. We have all been there and felt so badly for our pets . Giving you hugs.

--

 

Mickey 6/99  17.5 lb  jack russell, chronic pancreatitis, hyperuricosuria

eats hard boiled eggs, RC Hepatic, mashed potato

2 #2 Dianes enzymes 6x premeal

 2.5 mg Amlodipine, .15mg soloxine am/pm, 100mg ursodiol started for gall bladder thinning 3/24

arthritis:  6.25mg tramadol 1x/day, 12.5mg gabapentin every 12 hrs,  Assisi soft loop used on back and elbow,started Yucca Intensive 2x/day 4/29/14, 1 540meq potassium citrate nightly

Denamarin once a day, 1/16 t tylan (150mg)  2x/day 

 Senilife started 12/14/13, Trixsyn

Optimmune and Dry eyes,  

Kiya is Mickeys sister, 3/4 aussie, 1/4 blue heeler born 9/2006.  She thinks she is a 44 lb jack russell who tries to heel Mickey!!



 

 

 

 

 

December 29, 2012 at 9:07 PM Flag Quote & Reply

Judy
Member
Posts: 14
December 29, 2012 at 9:13 PM Flag Quote & Reply

Judy
Member
Posts: 14

I really can't give up....not as long as he is still getting up and moving around. Just I feed him 4 times a day, he is not gaining back any weight, he is actually getting worse. The Tylan powder isn't doing much, if anything. I will call the vet on Monday and see what else he can do .He said something about panacur, but there are no parisites, we did panacur a few weeks ago. I just don't understand what is going on. His litter sister died on Christmas day of cancer. Maybe that is what I am dealing with. Frustrating when 3 blood tests were done, and you have to ask what tests were done, was this test, that test, why do we have to tell the vet what to check for. Frustrating is to put it mildly. I could scream. Very disgusting because I can't help my boy. I have always had multiple dogs and this is so hard to deal with. Feeling helpless is the worst. 

December 29, 2012 at 9:26 PM Flag Quote & Reply

Marie
Member
Posts: 57

What kind of bloodwork did you have? CBC? Complete biochem?

Hang in there. You are not alone. Hugs

December 29, 2012 at 9:43 PM Flag Quote & Reply

Sailin Suzie & Brenda
Member
Posts: 1017

Judy,   take a deep breath.    I have walked your path.   My Suzie was not eating and I got down to force feeding her with a syringe and did this for months.  That was back in 2006  she is alive and fat and sassy to this day.  See her pic.   She had lost 1/3 of her body weight and would not eat anything.  It turned out that yes, she has EPI but it was the SIBO that was stopping her eating.  the vet gave me 14 days of antis.   flagyl   a couple of times and would niot give me 30 days worth in a row.  This was thje problem in a nut shell.  The SIBO would die off only to return again.  It takes 30 days of tylan at a minimum.  I am not sure, but are you mixing the enzymes in every meal as listed on the above tabs and information?  It might not be EPI, but the enzymes wont hurt your baby, so dont stop.  I am wondering if you fasted Kolby for 12 hours before the blood draw?   This will make the results different if you didnt do that step.  If there were no parasites I would not do panacur or any other parasite meds.   My Suzie was going down hill frrom Feb. to August and finally I got rid of the SIBO and got her food right.  I triedf everything on the market too.   Please hang in there and keep trying.

I am lighting a candle for Kolby right now and it will burn most of the night and I will light it again in the morning.   Keep the faith.

--

Brenda & Sailin Suzie.   Worlds Greatest Boat Dog

December 29, 2012 at 9:47 PM Flag Quote & Reply

epi4dogs
Site Owner
Posts: 12832

Judy, please give the Tylan time to hopefully start working.... at least 3-5 days....but then if the Tylan isstill  not helping.... can you ask the vet to switch it out to Metronidazole and see if that helps?  IN some cases if Tylan does not work....sometimes Flagyl (Metronidazole) will work instead....although usually the opposite happens.....


You mentioned that you are now feeding Kolby 4 times a day....whereas before he did not want to eat at all.... this sounds like some improvement..yes? Even if he has not gained any weight yet, sometimes it takes a short while and other times it takes a long time.... the important thing is to first stop the loose stools, then get them to eat. Please continue the weekly B12.... and maybe talk to your vet about bringing Kolby in for IVs?  Sometimes that helps especially if he is dehydrated... Is he drinking enough?


I am so sorry you and Kolby are going through all of this ...

--

Olesia, owned by Izzy-35lb SWD, Diagnosed at 1.5 years old - TLI results 1.3, Stable almost 8 yrs! Once stable, was able to reduce enzymes to only 1/2 tsp of Enzymes with each meal, but after almost 4 years of stabilization... had to increase the amount of enzymes to 3/4 teaspoon with each meal. Feed various grain-free kibble+real meat, 6x pancreatin enzymes from EnzymeDiane. I give 1 tsp of coconut oil one day and 1 tsp salmon oil next day, and also give canned sardines packed without salt or canned herring for extra omega oils.

In Feb 2013, Izzy developed a very serious condition called IMHA which she (thankfully) beat and is now in remission. We also discovered that now, at 8+ years old, she not only has EPI, but also Diabetes, Low Thyroid and High Cholesterol.  Izzy was able to receive excellent care because of the kindness of so many here on epi4dogs and  is currently  doing extra-ordinarily well. If anyone could spend a day with Izzy, they would never guess that she has any health problems!  Because of Izzy's concurrent conditions of Diabetes and High Cholesterol we had to make chnages to our daily EPI routine. We had to alter the fiber, type of fiber and the fat content  her diet. She now gets 1/2 Annamaet Lean kibble and 1/2 TOTW kibble with either lean pork loin meat, or chicken breast or tuna twice a day. She also receives  9 or 10 units of Vetsulin (depending on her blood glucose reading) a pork based insulin. We tried Novolin N a human synthetic RNA insulin.... but Izzy did not do well on it. And now we have to monitor her exercise.   It's been one heck of a journey... but aside from all that Izzy has gone thru with her health issues.... she continues to wake up every day full of joy and a great sense of humor!


December 29, 2012 at 10:50 PM Flag Quote & Reply

maddie ann
Member
Posts: 3155

Judy-sorry to hear you are struglling have you tried a food change sometimes it is some sort of allergy that can start thses things the other week a dog  changed from chicken to lamb and the response coupled with b12 and antibotics was amazing.

Just a thought.

--

 ANN (UK)

 “Saving one dog will not change the world, but surely for that one dog, the world will change forever.”

Maddie DOB 01-10-2007 she is now  6 DX 04/11 .B12 140 now 644 TLI <1.00 Folate 14.2.

After 15 months on the B12 tablets with the intrisic factor she was retested and her b12 is now 902.

Weight was 22.3kg now 33.2kg (04-05-12) she is a small GSDbut she gained .(24lbs)

Feed a mixture of foods she does better on fibre 3% and below she has  b12 tablets daily (imported from the USAhttp://www.wonderlabs.com/itemleft.php?itemnum=6881) now changing to the uk version from http://www.chemeyes.co.uk/

organic virgin  coconut oil dailly. Use Panzym 1/4 a tsp per 200 grams of food .Got SIBO under control after antibiotics ( stormormgyl) used synbotic by protexin. a pre-probotic also given daily.

December 30, 2012 at 8:15 AM Flag Quote & Reply

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