New Member - Melissa and Lucy

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.
Melissa&Lu
Member
Posts: 4
Country: United States
State: South Carolina
Pet name: Lucy
My name: Melissa

New Member - Melissa and Lucy

Post by Melissa&Lu » 13 Jun 2021, 11:29

Hello! Lucy and I are brand new here and desperately seeking info and suggestions. Apologies for the lengthy post...and I hope I get most all of the critical pieces in...some labs in the signature block...

Lucy was diagnosed with acute kidney failure the week of Christmas 2020. Truly thought she was leaving us. We did the three days of IVF and then started her on subq fluids and our vet was talking hospice as the only option. Thankfully, I joined the K9Kidney forum and the moderators immediately pointed out pancreatitis was likely an issue for Lu. We started treating as such with a short fast and then slow food advancement and all vomiting and food refusals have stopped. My vet is wonderful, but very much a primary care provider. She has allowed me to request lab tests - Lu's spec cPL has ranged from 216 to 606 and has never fully resolved. I suspected chronic pancreatitis so we went to see internal medicine and get an ultrasound. The IM vet was great, but discounted anything going on with pancreas. He focused on kidney disease (which likely causes the pancreas numbers), her significant weight loss (more below) and on potentially chronic hepatitis because on ultrasound he reported her liver was uniformly "bright". He also reported there were no changes in her pancreas (what?!?!) and her kidneys demonstrated progressive disease (no surprise). When I received the overread report from radiology, however, there was comment that "the pancreas (mostly on the right side) is hyperechoic". No one will diagnose her with pancreatitis, let alone chronic pancreatitis...but that is my diagnosis for her at this point. His only recommendation at the end of the appointment was to add bile salts to the next round of labs and if indicated, we could start treating chronic hepatitis with hydrocortisone or cyclosporine (after telling me all of the reasons why he would not give this to a kidney dog). He also gave us a referral to a nutritionist which I declined.

Despite getting her daily calories in a reasonable range according to her weight, she continues to lose weight. She has weighed as much as 53# (that was heavy) in 2016. In January 2019 at the time of bloat, she weighed 48#. Her weight was relatively stable until 7/2020 when she was seen at the emergency vet for blood in vomit and stool, and vulvar drainage and she was at 45.5#. This was when she was diagnosed with early kidney disease. She has continually lost since then, with small increases occasionally, and is now down to 33#. If we stick to her pancreatitis diet - boiled chicken breast, white rice, boiled egg white, coconut oil and Seacure, she has no vomiting, eats eagerly and completely, has some minor tummy grumbles and stool is typically smelly, voluminous, soft but formed (leaves a residue) and a yellow-orange color. After reading more about the function of pancreas in dogs, I added oral B12 and folate earlier this month and she perked up dramatically for about three days. I was ecstatic! But she slipped back into low energy, wobbly legs, increased anxiety and did not tolerate any progression/changes in her diet.

So here I am at EPI. It makes sense. By my notes, this has all been building since she had GVD in January 2019. She had a splenectomy and pexy, and recovered pretty well. But shortly thereafter started regularly refusing food, vomiting and loose stools - wish I had seen the potential of pancreatitis then. Frankly, I have not had labs drawn since April 2021. We have not yet tested for EPI. I am hesitant to test because I end up chasing numbers on a piece of paper and none of the vets we see seem to pay any attention to them anyway. (Cynical me coming out...) On 6/9 I did start adding a very small amount of Prozyme to her food...less than recommended by the manufacturer and any other enzyme guidance...because she has been so sensitive and I don't have a test saying she does indeed have EPI. Within two days, her stools were completely normal...solid, formed, more brown than orange, minimal odor, easy to pick up and no residue...and she is no longer wobbly on her feet. But she is now INSANELY hungry! Bless her! I started with Prozyme because I was familiar with the product from many years ago. This morning she woke me up with dry heaves. Did more research and started incubating her food today instead of just mixing it in...which seriously upsets her...she sits and barks at her bowl sitting on the counter. After reading here, I am also now seeing that I really need to be using a replacement enzyme and not a plant-based product (also wondering if the dairy in it is an issue for her), so I'm planning on getting Biocase.

At this point, I feel relatively comfortable with our path going forward but I would appreciate hearing from you all what you know/see that I am still missing. If it is really critical that we get the lab work, I'll schedule a visit and we'll get repeat labs this month.

I'm also really interested in anyone's experience with chronic pancreatitis and EPI, specifically feeding. I see in the files that the recommendation is to feed 150% per day to help her regain weight. I would LOVE to do that, but am concerned about the pancreatitis. I can slowly advance her diet, and will start making changes to get her calories up, but am limited by her tolerance which is about 6T of food per meal, 9-10x daily. She eats every two hours 6am-10p, and we've done that since Christmas. We're all exhausted. Does it make sense that pancreatitis would actually calm down or not be as reactive if she is on an appropriate enzyme? Any suggestions on how to advance her diet? I guess I'm looking for some glimmer of hope that I can potentially get her diet advanced enough that she will gain weight and stabilize on 3-4 meals a day.

Thanks so very much! All of you who run these forums are true angels.

Melissa and Lucy
Lucy, 12yo, 33.6#, standard poodle
s/p untyped cancer (2015), HGE (2017), GDV s/p gastropexy and splenectomy (1.2019), “kidney disease” (7.2020) and acute renal failure v. pancreatitis (12/2020), chronic pancreatitis (2021)
4/16/2021 (3/19/2021): BUN 93 (92), creatinine 3.8 (3.9), phos 4.8 (4.5), calcium 11.8 (10.9), cPL 359 (606).
Pepcid 10mg PRN, calcium carbonate added to food, B50 complex BID, Milk Thistle 150mg daily, Seacure added to food, Gabapentin 100mg BID
Lactated Ringers subq 500cc daily, split into two boluses

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Jean
Forum Director
Posts: 1707
Location: South Liverpool
Country: United Kingdom - England
Pet name: Kara, lost 10th May 2019
My name: Jean

Re: New Member - Melissa and Lucy

Post by Jean » 13 Jun 2021, 11:45

welcome from the UK

My first question herE unless I have read wrongly, is that have you had the 12 hour food fasted test for EPI called cTLI

FORGIVE ME IF I HAVE READ WRONGLY
My name is Jean we live in Liverpool in Uk

I am the Forum Director which I am very proud of

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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jilbert57
Staff
Posts: 2088
Country: United States
State: Washington

Re: New Member - Melissa and Lucy

Post by jilbert57 » 13 Jun 2021, 13:16

Hi Melissa, if you strictly adhere to the low fat diet for pancreatitis she is ok? No bellyache posturing?
With the poops being weird I would ask the vet for a 45 day course of Tylan and treat for SID(small intestinal dysbiosis). Are the poops ever covered with slime?
The only way you will know if the pancreatitis has turned Epi like Jean mentioned is to have the 8- 12 hour food fast test the cTli.
When Mickey was diagnosed with pancreatitis they tested Tli also. His cPl was >1000, Tli >50.
He was prescribed porcine enzymes which helped immensely and after 3 mos his Tli came down to 25 but cPli remained >1000.
If you had your pup tested for Epi and he still had pancreatitis the Tli would be >35, (35 is the upper normal.)

Maybe ask your vet if you can try enzymes to help the pancreas rest. Enzymediane.com is a lot less expensive than the vet and you would want 6x strength. Also ask for the tylan as that made a world of difference in the poop.

Jill
My name is Jill and we live on the Hood Canal in Washington State. We currently have 2 Jack russells, TJ is 8 and Sadie is 2.

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.

Melissa&Lu
Member
Posts: 4
Country: United States
State: South Carolina
Pet name: Lucy
My name: Melissa

Re: New Member - Melissa and Lucy

Post by Melissa&Lu » 13 Jun 2021, 15:44

Hi, Jean and Jill! Thank you for the notes.

To clarify, we have not yet done the TLI test. We haven't done any labs since April, so I will schedule an appointment to have the basics, a UA, another cPL and the TLI done.

Lucy does well on the pancreatitis diet except that she continues to lose weight, even if I get her calories well above what is theoretically required for her weight. I am also limited on how much volume she will tolerate at one time. And I have noticed since all of this began, I can make significant changes in the amount of protein she gets in one recipe, e.g. chicken or egg white, without much of an issue. If I make changes in the amount or type of carb, e.g. white rice or No Yolk Noodles, she will flare very easily. Changes in carbs have to be made extremely slowly. Not sure if that may be a clue? :)

Poops are never covered in slime. They have been smelly, yellow/orange in color and everything from liquid to formed but quite soft. Since starting Prozyme, they are as normal as I have ever seen from Lucy.

From the reading I have done and as you mention, Jill, it looks like pancreatitis can artificially increase the TLI. Is that the same with chronic pancreatitis...where is just smolders for an extended period? As mentioned, my vets haven't bought into there being much going on with her pancreas. Having to explain the interpretation of another test makes me nervous. I will read through all of the info available on the EPI4dogs website. Any other sites or reading you recommend?

Thanks so much!

Melissa and Lucy
Lucy, 12yo, 33.6#, standard poodle
s/p untyped cancer (2015), HGE (2017), GDV s/p gastropexy and splenectomy (1.2019), “kidney disease” (7.2020) and acute renal failure v. pancreatitis (12/2020), chronic pancreatitis (2021)
4/16/2021 (3/19/2021): BUN 93 (92), creatinine 3.8 (3.9), phos 4.8 (4.5), calcium 11.8 (10.9), cPL 359 (606).
Pepcid 10mg PRN, calcium carbonate added to food, B50 complex BID, Milk Thistle 150mg daily, Seacure added to food, Gabapentin 100mg BID
Lactated Ringers subq 500cc daily, split into two boluses

Tuckaboo Pam
Member
Posts: 1345
Country: United States
State: Florida
Pet name: Tucker
My name: Pam H.

Re: New Member - Melissa and Lucy

Post by Tuckaboo Pam » 13 Jun 2021, 15:48

Melissa, WELCOME!!!

So, all I can add is, since you don't want to do the cTLI at this point, there is an easy test you can order, which can tell you if your dog does NOT have EPI. It is not definitive FOR EPI, but it can tell you if she doesn't have it. I used it when I couldn't afford the fasting bloodwork, and I got a positive, and so when I could do the official testing, I did. Here is the link---

https://enzymediane.com/product/schebo- ... nine-test/

It's funny, isn't it, when you figure things out for yourself, by joining a forum? I love my vet, but she is aware that she doesn't know everything, and she is happy for the advice I get from EPI4Dogs.

---Pam & Tucker
Tucker was a shepherd/lab mix--- TLI 1.3, Folate 9.7, Cobalamin 666, Lipase 38. Took Diane's Enzymes 4 teaspoons/day, Wonderlabs B12 one capsule per day, and Tylan 1/16 teaspoon/ morning (to hold SID at bay). Taste of the Wild High Prairie, 1 1/2 cups/day, with a total of 4 cups of Fresh Pet. Stopped eating everything in sight, and went from 60 to 85 pounds! Tucker was my boyfriend, and my husband was OK with that. Tucker succumbed to hemangiosarcoma, but we cherished every day we had with that wonderful, beautiful boy. I will always, always miss my sweet big boy.

Melissa&Lu
Member
Posts: 4
Country: United States
State: South Carolina
Pet name: Lucy
My name: Melissa

Re: New Member - Melissa and Lucy

Post by Melissa&Lu » 13 Jun 2021, 16:01

Thanks so much, Pam! What a great resource!

Of course, I have all sorts of questions swirling right now. For anyone who has mentioned SID/SIBO - I don't see where there is a test for SID/SIBO, did I miss something? And what would be the order of concern here? Does EPI trump SID/SIBO for concern/treatment? Or the other way around? She has been through so much - and, thankfully, she's crazy stubborn! - I would like to change things as methodically as possible, but am unclear on order.

Thank you all so much for your patience and wisdom!

Melissa and Lucy
Lucy, 12yo, 33.6#, standard poodle
s/p untyped cancer (2015), HGE (2017), GDV s/p gastropexy and splenectomy (1.2019), “kidney disease” (7.2020) and acute renal failure v. pancreatitis (12/2020), chronic pancreatitis (2021)
4/16/2021 (3/19/2021): BUN 93 (92), creatinine 3.8 (3.9), phos 4.8 (4.5), calcium 11.8 (10.9), cPL 359 (606).
Pepcid 10mg PRN, calcium carbonate added to food, B50 complex BID, Milk Thistle 150mg daily, Seacure added to food, Gabapentin 100mg BID
Lactated Ringers subq 500cc daily, split into two boluses

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jilbert57
Staff
Posts: 2088
Country: United States
State: Washington

Re: New Member - Melissa and Lucy

Post by jilbert57 » 13 Jun 2021, 16:13

In Mickeys case he had chronic pancreatitis at least 2 years. His cPl remained >1000 (>200 is indicative of pancreatitis) and it was after implementation of the porcine enzymes his Tli came down and stayed around 25. So in his case his Tli did not remain elevated with chronic pancreatitis.

Jill
My name is Jill and we live on the Hood Canal in Washington State. We currently have 2 Jack russells, TJ is 8 and Sadie is 2.

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.

Melissa&Lu
Member
Posts: 4
Country: United States
State: South Carolina
Pet name: Lucy
My name: Melissa

Re: New Member - Melissa and Lucy

Post by Melissa&Lu » 13 Jun 2021, 16:59

Thanks, Jill!

I found one of the vets on the list is about 90min from me. Going to call tomorrow and see if we can add another member to Team Lucy. :D Would be nice to have a vet who can have a conversation with me about all of this stuff.

Appreciate you all immensely!

Melissa and Lucy
Lucy, 12yo, 33.6#, standard poodle
s/p untyped cancer (2015), HGE (2017), GDV s/p gastropexy and splenectomy (1.2019), “kidney disease” (7.2020) and acute renal failure v. pancreatitis (12/2020), chronic pancreatitis (2021)
4/16/2021 (3/19/2021): BUN 93 (92), creatinine 3.8 (3.9), phos 4.8 (4.5), calcium 11.8 (10.9), cPL 359 (606).
Pepcid 10mg PRN, calcium carbonate added to food, B50 complex BID, Milk Thistle 150mg daily, Seacure added to food, Gabapentin 100mg BID
Lactated Ringers subq 500cc daily, split into two boluses

User avatar
Olesia711
Founder & Research Director
Posts: 3857
Location: North Carolina
Country: United States
State: North Carolina
Pet name: Izzy
My name: olesia

Re: New Member - Melissa and Lucy

Post by Olesia711 » 13 Jun 2021, 17:52

Hi Melissa and a very warm welcome to you and Lucy!

I see that everyone pretty much suggested what i was going to suggest..... have the TLI blood test done so that you know for sure if you are or are not dealing with EPI and then you can proceed accordingly.
Just be sure to "food" fast your dog about 12+ hours prior to the vet drawing the blood and sending it off to a lab. We suggest scheduling an appt first think in the morning so you can feed them breakfast right afterwards. And if you are giving enzymes before the test, whether plant enzyme or pig enzymes.... not need to have your dog stop taking them because the enzymes will not skew the TLI test.... just remember to food fast before they draw the blood.

A Jill mentioned, dogs with chronic pancreatitis are often given the same pig enzymes that we give to EPI dogs to help the dog, although with EPI they have to take enzymes for life.

Regarding SID (small intestinal dysbiosis).... there is not accurate test for this, but rather you go by the underlying condition and the symptoms. ALso All dogs with EPI have SID to one degree or another............. basically their gut flora is greatly lacking in bacterial population and variety.......however, if the stools become "normal" once enzymes are given or via a change of food.... then no need to treat SID. We only treat when needed.

You mentioned about the 150% food.... yes, this is what we suggest with EPI dogs... BUT...... it needs to be fed in smaller portions throughout the day, and you are already doing this......

Sounds like you have a good plan in place.... contact the new vet or even yet, it does NOT have to be a vet well versed in EPI, but rather what we have noticed is that some of the bst EPI vets are those that may not know much about EPI, but are all excited to maybe have an EPI case, and they do their own research, think outside the box and are willing and excited to work with you. So... maybe what you can do is check with your neighbors, friends in the community and find out who they recommend as a vet and who sounds like they are very approachable and willing to work with the EPI parent ........."with" being the operative word here :)

Hope this helps and please keep us posted.
Olesia, was owned by Izzy, a 35lb Spanish Water Dog (SWD), Diagnosed at 1.5 years old - TLI results 1.. Izzy passed away on February 13, 2020 at 15 years old. She lived with EPI for 13+1/2 years. It was because of Izzy that Epi4Dogs was started... she was the inspiration. May her legacy of helping others with EPI continue for as long as needed.........

Tuckaboo Pam
Member
Posts: 1345
Country: United States
State: Florida
Pet name: Tucker
My name: Pam H.

Re: New Member - Melissa and Lucy

Post by Tuckaboo Pam » 13 Jun 2021, 18:59

Sorry, Melissa. I thought you wrote that you did not want to do the TLI right now, which is why I mentioned the Schebo test.

BUT, now you've found Enzyme Diane, and if you do end up using porcine enzymes, you have found a resource that many, many of us here on the forum use for our enzyme supply!---Pam
Tucker was a shepherd/lab mix--- TLI 1.3, Folate 9.7, Cobalamin 666, Lipase 38. Took Diane's Enzymes 4 teaspoons/day, Wonderlabs B12 one capsule per day, and Tylan 1/16 teaspoon/ morning (to hold SID at bay). Taste of the Wild High Prairie, 1 1/2 cups/day, with a total of 4 cups of Fresh Pet. Stopped eating everything in sight, and went from 60 to 85 pounds! Tucker was my boyfriend, and my husband was OK with that. Tucker succumbed to hemangiosarcoma, but we cherished every day we had with that wonderful, beautiful boy. I will always, always miss my sweet big boy.

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