Cooper - New to EPI

Epi4Dogs Foundation Inc.’s mission is the advancement of science and education relating to EPI (Exocrine Pancreatic Insufficiency), yielding useful insights and positive outcomes in better managing EPI in dogs and cats. Our goals are to support and/or collaborate with veterinary EPI research and researchers, and to promote EPI awareness by educating the general public, pet owners, pet organizations, rescue and shelter organizations, veterinary schools and veterinarians.
hardingj_9
Member
Posts: 10
Country: United Kingdom - England
Pet name: Cooper
My name: Josh

Cooper - New to EPI

Post by hardingj_9 » 15 May 2021, 05:52

Hi,

I'm Josh and I own a lovely 5 month old GSD called Cooper.

Ever since we have had cooper from 8 weeks old, we have struggled with his tummy and runny poo's.

Started him off on Pro Plan large athletic (poos were always huge, very soft, always white bits in it which looked like undigested food - wasn't worms he had multiple doses of wormers in case that was causing him the issues), then moved him to grain free carnilove large puppy (poos turned grey, then gradually got more soft until it was liquid), then moved him onto Arden Grange grain free sensitive stomachs (poos immediately improved from what they were but still very soft). What cooper also does is a huge poo of mr whippy consistency, then takes 10 paces does another smaller poo which is even softer and then another 10 paces and then liquid poo.

The vets are concerned with how skinny he is so suggested upping his food which we did by almost 50%, this didnt make any difference to his condition. Hes always putting on about 1kg a week but hes growing tall and long so its all bone rather than muscle. Hes very ribby and also boney around his hips.

Vet then suggested EPI or a shunt of the liver, so we fasted and did the blood test. He said TLI's came back normal, B12 normal, folates normal, bacteria levels normal, and there was no chance of a shunt(I didn't get the numbers but im sure he can provide these). So he was a bit stumped, but suggested putting him on Panzym anyway in case the TLI result was not accurate which he said can sometimes happen.

I have just started on Panzym, I feed him 3 x a day of 175g per meal. I'm confused by the dosage... a teaspoon weighs 5g rather than 2.6g suggested on the tub.

Should i feed him 2.6g per meal or the 5g teaspoon per meal?

Doesn't sound like i need to incubate Panzym so is it just ok to mix with kibble and room temp food and feed straight away?

Should I notice change in poo within 24 hrs if working and change in weight/condition within 7 days?

Im going to attach a few photos of his typical poo so people can see what its like and comment if it looks like an EPI poo as Im not sure what one looks like. The one next to tennis balls are his latest - where he does one straight after the other.

Thanks Josh & Cooper
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Based in UK
Suspected EPI
Dogs name Cooper
German Shepherd - 5 months old
weight 22.5kg
Currently on Panzem enzymes since 15/05/2021
food - Arden Grange Puppy Sensitive Dog Food
B12 Levels - 721 ng/l
TLI 22 ng/ml
Folate 11.5 ug/L

User avatar
jilbert57
Staff
Posts: 1241
Country: United States
State: Washington

Re: Cooper - New to EPI

Post by jilbert57 » 15 May 2021, 09:48

Hi Josh and welcome to you and Cooper. We love to see pictures of our Epi members so feel free to post!
Thanks for the poop pictures, definitely could use some help.
Please have your vet email your test results and post them first chance. It will help us better to help Cooper.
Have you heard any burping or tummy noises that would indicate SID?
I will get more info for you on the Panzym.

https://www.animeddirect.co.uk/panzym-powder

I will see about the amount per food amount.

Jill
My name is Jill and we live on the Hood Canal in Washington State. We currently have one pup. TJ is a 5 year old Jack Russell.

Mickey and his pancreatitis brought me to Epi4dogs.com site in 2012 to help manage it.
He lived from 6/99 - 8/2014

Mickey, Jack Russell. Chronic Pancreatitis. Dianes enzymes, 1/8t 3x/day with meals.

hardingj_9
Member
Posts: 10
Country: United Kingdom - England
Pet name: Cooper
My name: Josh

Re: Cooper - New to EPI

Post by hardingj_9 » 15 May 2021, 10:45

Hi Jill,

Thanks for your email. I will try get these sent over Monday.

No I have never heard him burp or fart or noticed any tummy rumbling from him to suggest SID.

Thanks

Josh
Based in UK
Suspected EPI
Dogs name Cooper
German Shepherd - 5 months old
weight 22.5kg
Currently on Panzem enzymes since 15/05/2021
food - Arden Grange Puppy Sensitive Dog Food
B12 Levels - 721 ng/l
TLI 22 ng/ml
Folate 11.5 ug/L

User avatar
Jean
Staff
Posts: 1237
Location: South Liverpool
Country: United Kingdom - England
Pet name: Kara, lost 10th May 2019
My name: Jean

Re: Cooper - New to EPI

Post by Jean » 16 May 2021, 04:03

Good Morning Josh from Liverpool, where are you ?

I remember that poo very well

ok so the vets say normal for folate, b12 and the cTLI test, the numbers would be useful

Kara was much the same she grew long and failed to put much weight on from when we got her at 5 months old she was 44 pounds at that time, and at 14 months when EPI was diagnosed she was 39 pounds and a mess

Panzym is the one we used for 7years and it does not need to be incubated, we started off at 1 gram (1/4 teaspoon ) per 100 grams kibble, the instructions arent the best , however too much enzyme is as bad as too little, and if the test results are way off, then not necessary, but you have to try anything, and everything

https://epi4dogs.com/epi-quick-guides-outside-usa/

have a read of the quick guide to the UK

We mixed it with a teaspoon of plain live yogurt so that it covered the food properly, 50% over and above what it says on the bag of food for the weight the dog SHOULD be is a good start

Did the vets do a stool test to see if there is anything that stands out ? there is definitely undigested food in that poo picture, I would be temped to supplement b12

Chemeyes in Surrey do this

https://www.chemeyes.co.uk/product/vita ... ic-factor/


Briliant company to deal with

can I ask which variety of Arden Grange you are using ? looking at the fish variety it has chicken oil , a lot of dogs for some reason cannot tollerate chicken or its derivitives, mine could only tolerate lamb as a protein in dog food, we could cook some foods from fresh and she was ok, but.............................................................................................

Many moons ago EPI was called Shepherd Tummy and a lot were put to sleep because the vets didnt have a clue, luckily in the mid 80's here in Liverpool, Dr David Williams researched and developed the cTLI test, and the rest is history as they say

If you could answer the points raised we can help, and I am always at the end of a phone

Jean
My name is Jean we live in Liverpool in Uk

My Kara born 21 July 2009 diagnosed with EPI by cTLI test August 2010 TLI = <1...folate 14 Cobalamin 408, shot down to 94, b12 injections every other day

Lowest weight 39 pounds

We used Panzym enzymes, Tylan and Chemeyes b12 capsules

Sadly, on 10th May 2019, we lost her to DM


Jeanx

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Madelon
President
Posts: 1275
Location: Nashville, TN
Country: United States
State: Tennessee
Pet name: Doc

Re: Cooper - New to EPI

Post by Madelon » 16 May 2021, 10:15

Hi and welcome to you and Cooper. You've already been given great advice so I won't muddy the waters but want to jump on the band wagon of letting us know the exact test results. Unfortunately what vet's consider "normal" for B12 for an EPI dog is not the case. Also, there is a gray area in the TLI results where it could indicate your dog may be heading towards EPI which we recommend treating as if EPI even though the numbers are not definitive.

My other recommendation is to keep a detailed journal of everything you give and the resulting poop (remember a dog's transition time can be anywhere from 12-72 hrs so the poop you're looking at is likely not from the last meal given) - whether or not your dog has EPI this is a good way to figure out what's going on with your dog and keeping track of the things you've tried.

It definitely looks like you've got SID going on (small intestinal dysbiosis) - we recommend first trying Slippery Elm bark powder - here's a link to information and dosing https://epi4dogs.com/slippery-elm/. If you don't see any improvement in 3-5 days then we next suggest trying a pro/prebiotic like Proviable (the prescription one from the vet) and again if no improvement then you'll need to talk to your vet about a 45 day course of Tylan (I can't remember if you can get Tylan in the UK - if not Jean or someone else can suggest the proper antibiotic to try).
MADELON and Doc. DX EPI and SIBO: 5/22/2015
Test Results: (1st) 7/2014 = TLI 16.5, B12 894, Folate > 24; (2nd) 5/2015 = TLI < .4, B12 406; Folate >24; (3rd) 10/2015 TLI < .4; B12 >1000; Folate 14.4. Prior to DX: May 2014 (2mos) - DX coccidia/bladder infection; July 2014 (3mos) 1st EPI test = TLI 16.5, B12 894, Folate >24 - Dx SIBO not EPI; Feb 2015 thru May 2015 - weight loss only; May 2015 vomitted several times, diarrhea and eating poop. Regimen: 4 cups Sport Dog Food Elite Herding - Diane 6x 1tsp per cup; 1 WonderLab PetFactor B12 2x day; 1/2tsp Slippery Elm 2xday; Multivitamin; 1 Zyrtec 10mg 2x day; Salmon Oil

User avatar
Jean
Staff
Posts: 1237
Location: South Liverpool
Country: United Kingdom - England
Pet name: Kara, lost 10th May 2019
My name: Jean

Re: Cooper - New to EPI

Post by Jean » 16 May 2021, 11:02

we cannot get Tylan at the moment in UK but Oxytetracycline is the next best, and sometimes much better if you need an antibiotic
My name is Jean we live in Liverpool in Uk

My Kara born 21 July 2009 diagnosed with EPI by cTLI test August 2010 TLI = <1...folate 14 Cobalamin 408, shot down to 94, b12 injections every other day

Lowest weight 39 pounds

We used Panzym enzymes, Tylan and Chemeyes b12 capsules

Sadly, on 10th May 2019, we lost her to DM


Jeanx

hardingj_9
Member
Posts: 10
Country: United Kingdom - England
Pet name: Cooper
My name: Josh

Re: Cooper - New to EPI

Post by hardingj_9 » 19 May 2021, 04:10

Hi,

Please see all the blood work results below, hope this helps:

Serum Interferences Lipaemia:-, Icterus:-, Haemolysis:1+
Total protein * 52 g/L Low (56 -81 )
Albumin 27 g/L (24.0 -38.0 )
Globulin 25 g/L (20 -47 )
Sodium 145 mmol/L (139 -154 )
Potassium 4.9 mmol/L (3.5 -6.0 )
Na:K ratio 30 (25.0 -35.0 )
Chloride 109 mmol/L (99 -125 )
Total calcium 2.7 mmol/L (2.0 -3.0 )
Phosphate * 2.7 mmol/L High (0.8 -1.6 )
Urea 7.2 mmol/L (2.0 -9.0 )
Creatinine 86 umol/L (40 -110 )
Alk Phos * 112 U/L High (0.0 -25.0 )
ALT 16 U/L (0 -25 )
AST 29 U/L (0 -49 )
GLDH 3 U/L (0 -10.0 )
Gamma GT 0 U/L (0 -27 )
Total bilirubin 3 umol/L (0 -9.0 )
Bile acids 1 umol/L (0 -10.0 )
Glucose * 5.8 mmol/L High (3.0 -5.5 )
Cholesterol 6.1 mmol/L (3.8 -7.0 )
Triglycerides * 0.4 mmol/L Low (0.45 -1.9 )
Amylase 543 U/L (0 -1800 )
Lipase (DGGR) 23 U/L (0 -150 )

HAEMATOLOGY
RBC 5.73 x10^12/L (5.0 -8.5 )
Hb 14.2 g/dl (12.0 -18.0 )
HCT 45.3 % (37.0 -55.0 )
MCV 79.1 fl (60.0 -80.0 )
MCH 24.8 pg (19.0 -26.0 )
MCHC 31.3 g/dl (30.8 -37.0 )
RDW 14.3 % (12.9 -17.8 )
Platelets 241 x10^9/L (160 -500 )
WBC 11.58 x10^9/L (6.0 -15.0 )
Neutrophils 5.18 x10^9/L (3.0 -11.5 )
Lymphocytes 4.24 x10^9/L (1.0 -4.8 )
Monocytes 0.86 x10^9/L (0 -1.3 )
Eosinophils * 1.28 x10^9/L High (0 -1.25 )
Basophils 0.02 x10^9/L (0 -0.2 )
Reticulocyte % 2.2 %
Reticulocyte count 126.06 x10^9/L
Platelet comment Platelet count appears normal in film
RBC comment Polychromasia + , Anisocytosis +
Leukocyte comment Eosinophil count confirmed in film, Leukocyte
morphology unremarkable

ENDOCRINOLOGY
Basal cortisol 43 nmol/L ( <125 )
B12 721 ng/L (250 -900 )
Folate 11.5 ug/L (6.0 -18.0 )
TLI 22 ng/ml (5.0 -40.0 )

CLINICAL COMMENTS


The phosphate and Alp values are within the reference interval for a pet of
this age.

The mild hyperglycaemia is compatible with a stress (steroid) response if there
is no concurrent glycosuria.

The mildly elevated eosinophil value may be within the reference interval for
this breed however, further differentials eg hypersensitivity/allergic disease
and parasitism should be excluded. Hypoadrenocorticism is a further less common
differential and the cortisol value does not fully exclude it. An ACTH
stimulation test is recommended if this is suspected.
Based in UK
Suspected EPI
Dogs name Cooper
German Shepherd - 5 months old
weight 22.5kg
Currently on Panzem enzymes since 15/05/2021
food - Arden Grange Puppy Sensitive Dog Food
B12 Levels - 721 ng/l
TLI 22 ng/ml
Folate 11.5 ug/L

User avatar
jilbert57
Staff
Posts: 1241
Country: United States
State: Washington

Re: Cooper - New to EPI

Post by jilbert57 » 19 May 2021, 09:28

Thank you Josh for posting the results. So the Tli doesn't appear in the Epi range.
Is the poo getting any more solid with the enzyme added?
I would suggest adding in the Slippery elm. I think Madelon included a link for you.

Jill
My name is Jill and we live on the Hood Canal in Washington State. We currently have one pup. TJ is a 5 year old Jack Russell.

Mickey and his pancreatitis brought me to Epi4dogs.com site in 2012 to help manage it.
He lived from 6/99 - 8/2014

Mickey, Jack Russell. Chronic Pancreatitis. Dianes enzymes, 1/8t 3x/day with meals.

hardingj_9
Member
Posts: 10
Country: United Kingdom - England
Pet name: Cooper
My name: Josh

Re: Cooper - New to EPI

Post by hardingj_9 » 19 May 2021, 14:14

Hi Jill,

Yes the enzymes have made a huge difference to his poo, today he has been twice once in morning and just now, and both were solid and well formed which i dont think I have ever seen from him! I never thought i would be so excited over poo! I have ordered the slipery elm which should be delivered tomorrow so I will start that and hopefully see further improvements.

Yes my vet did say that the TLI value wasn't in the EPI range, but he couldn't work out why the food wasn't getting digested properly and he was pooing the way he was. I also used to give him carrots (the dog not the vet) when he was very small with no issues. But then I gave him a carrot a few weeks back and he had an upset stomach then did the same the week after and same thing happened. So the vet said it seems like the added fibre was making things worse which pointed towards a possible EPI issue even if at the very early stage.

Thanks

Josh
Based in UK
Suspected EPI
Dogs name Cooper
German Shepherd - 5 months old
weight 22.5kg
Currently on Panzem enzymes since 15/05/2021
food - Arden Grange Puppy Sensitive Dog Food
B12 Levels - 721 ng/l
TLI 22 ng/ml
Folate 11.5 ug/L

User avatar
jilbert57
Staff
Posts: 1241
Country: United States
State: Washington

Re: Cooper - New to EPI

Post by jilbert57 » 19 May 2021, 14:55

Good to hear the poo is good!
Thanks for the update and explanation.
My name is Jill and we live on the Hood Canal in Washington State. We currently have one pup. TJ is a 5 year old Jack Russell.

Mickey and his pancreatitis brought me to Epi4dogs.com site in 2012 to help manage it.
He lived from 6/99 - 8/2014

Mickey, Jack Russell. Chronic Pancreatitis. Dianes enzymes, 1/8t 3x/day with meals.

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