Possible Case- Minimal Weight Loss

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.
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PennysMom
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Country: United States
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Pet name: Penny
My name: Lauren

Possible Case- Minimal Weight Loss

Post by PennysMom » 11 Oct 2021, 21:18

Hello,

My approximately 9-10 year old Shih-Tzu Mix has been struggling with diarrhea since Labor Day weekend (onset 9/3) and has been diagnosed twice with Stress Colitis. Both times she has been given a 5 day course of Flagyl which has stopped the urgency of her diarrhea. However we have only been able to get her back to a somewhat solid stool once for a period of 3 days. Tonight she had another incidence of the urgent diarrhea and an accident in the house and I finally called the vet for a 3rd appointment (on Thursday 10/14 as they had nothing before then). It is important to note that she has IVDD and is recovering from a disc herniation. She takes Gabapenten, Methocarbamol and Prednisone daily (we are working to very slowly wean her). She is a rescue who came to me with some GI and skin issues that have been attributed to allergies for about 8 years. She eats the Royal Canin HP food and we have tried multiple allergy medications. She had blood work in March 2020 and her Amylase was 505/UL and her Lipase was 46 U/L so both on the lower end of normal but not a concern at that time. Her glucose at that time was 106. She has not had blood work since (which I am going to ask about at her appointment Thursday). She has also been very anxious recently and Trazadone did help but it was discontinued when the diarrhea started because they thought it could be the culprit.

My online research keeps pointing me to EPI, however she has not lost a significant amount of weight (she is about 20 pounds and her highest weight during her 6 weeks of crate rest while on high doses of prednisone was 24 pounds, she typically is in the 19-21 range). I see the following symptoms that I have read about online:
-Increased gas- the smell has also gotten awful
-Increased Stomach noises (she has had a gurgling tummy for years but it is worse recently)
-Increase in anxiety in August (has always been anxious since adoption).
-More frequent pooping - during the episodes she goes as often as every 45 minutes. When it calms down she goes 1-2 times daily (sometimes 3 times)
-Poops are extremely high in volume (1.5 to 2 times her normal stool)
- Stools have a consistency of pudding to a semi-formed log that I end up scraping out of the grass. They are almost an orange-ish tinge and sometimes have areas that look fatty or mucus filled. I remarked to my dad the other night that it almost seemed that her food had been blended with liquid and stink and came out the other end without digesting.
-Very hungry- the vet asked me to try a 24 hour fast now that she had another occurrence and she is sitting at her food bowl and container pawing at them and whining.
-Eating rabbit poop almost obsessively- When we walk I am constantly stopping her from eating rabbit poop. It is like she physically needs it and feels compelled to eat it. I live in the country so there are tons of rabbits around.
-Over the time I have had her she has always had issues with vomiting bile when she didn't have enough food before bedtime or early in the morning
-Very small teeth (I have seen this in some research I have stumbled on)

We are taking her to the vet on Thursday morning, which is as soon as they could get her in and I am going to bring up EPI as a possibility and ask about possible testing and cost. Any other recommendations for us? Do we ask if we can try to start treating her either with powder or raw pancreas (there is a pet shop locally that seems to carry it) until testing comes back. Any other ideas until we get a diagnosis? I am very overwhelmed as we have been dealing with a lot of health issues for her since the end of March and have spent a small fortune on her! It always seems like when one thing is going well something else starts to fall apart and I am always anxious about it. Hoping this may be our answer to some of her symptoms, even though I don't want her to have this.

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PennysMom
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Pet name: Penny
My name: Lauren

Re: Possible Case- Minimal Weight Loss

Post by PennysMom » 11 Oct 2021, 22:01

I want to reply to add that the 3 days of more solid stool were when using 'Bernie's Perfect Poop' supplmenet which includes digestive enzymes.

I also have a followup question. Over the last year my parents dog has been having similarly symptoms with no results. The vet has him on a daily B12 Pill and an extremely low dose of Flagyl daily. His poop is still very soft and he has been losing weight (he was 13 last fall and is now 10). Is this something that can be transmitted? We are looking at this and wondering if they both have the same disorder and how likely that would be as both are rescues, different breeds, different ages and while they spend a lot of time together do not live together!

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Montgomery
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Pet name: Montgomery (I'm a CAT!)
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Re: Possible Case- Minimal Weight Loss

Post by Montgomery » 12 Oct 2021, 00:18

EPI isn't something that is shared between animals, though I think it can be passed along genetically, yes? There are a great many other things that can cause diarrhea that they may have shared, however.
Montgomery was born 20 March 2012. He eats extra lean ground chicken, lean ground pork and lean ground beef completed with Alnutrin and freeze-dried chicken liver, with hard-cooked egg. He gets two size zero capsules of Enzyme Diane's enzymes at each of his six meals, and a size four capsule of Tylan three times a day. He's a fierce little Spitfire with a roaring Merlin engine.

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PennysMom
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Re: Possible Case- Minimal Weight Loss

Post by PennysMom » 12 Oct 2021, 14:45

Thanks Montgomery! It was just a question worth asking.

I have a feeling that my vet isn't going to know anything about this disorder and I am going to be printing out a bunch of information to ask them to test (either by ordering the test kit or looking into sending a blood sample off to Texas). I have the information for that already printed! Any other advice to prepare for the appointment is appreciated. I live with a chronic illness so I am very used to advocating for myself at appointments but for my dog it is totally different!

Lauren aka Penny's Mom

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Patsy
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Re: Possible Case- Minimal Weight Loss

Post by Patsy » 12 Oct 2021, 17:06

Hello Lauren
You have certainly been doing your homework. My springer was also a reject whose poor condition turned out to be epi. Are the enzymes you tried the plant based ones? Maybe our porcine ones will work a miracle.
I m happy to leave the medical comments to my colleagues in the US, as British stuff has different names and is all metric.
I can mention feeding little dogs . Mine, not epi, is 5kg (about 10-11 lbs). She can’t tolerate much fat, grain, some veg or certain meat proteins, but I have a balanced simple food that suits her.
RC hydrolysed protein sounds like it could be a problem.
Rice is a grain, chicken fat could be a chicken problem. 17% fats is pretty high, unless you are using proper porcine enzymes for diagnosed epi. Beet pulp is a fibre filler.

Ingredients
Brewers rice, hydrolyzed soy protein, chicken fat, natural flavors, dried plain beet pulp, monocalcium phosphate, vegetable oil, sodium silico aluminate, fish oil, calcium carbonate, fructooligosaccharides, potassium chloride, salt, DL-methionine, L-tyrosine, taurine, vitamins [DL-alpha tocopherol acetate (source of vitamin E), niacin supplement, L-ascorbyl-2-polyphosphate (source of vitamin C), D-calcium pantothenate, biotin, pyridoxine hydrochloride (vitamin B6), riboflavin supplement, thiamine mononitrate (vitamin B1), vitamin A acetate, folic acid, vitamin B12 supplement], choline chloride, trace minerals [zinc proteinate, zinc oxide, manganese proteinate, manganous oxide, copper sulfate, ferrous sulfate, sodium selenite, copper proteinate, calcium iodate], marigold extract (Tagetes erecta L.), magnesium oxide, rosemary extract, preserved with mixed tocopherols and citric acid.

Calorie Content

This diet contains 3856 kilocalories of metabolizable energy (ME) per kilogram or 332 kilocalories ME per cup on an as fed basis (calculated).

Guaranteed Analysis
Crude Protein (min) 19.0%
Crude Fat (min) 17.0%
Crude Fiber (max) 3.1%
Moisture (max) 10.0%
Eicosapentaenoic Acid (EPA)* (min) 0.18%
Docosahexaenoic Acid (DHA)* (min) 0.08%

It often bothers me that dog food manufacturers put so many supplements in to make a processed food usable, when meat and offal from a butcher, ground bone or eggshells, or fish, and certain fruit and veg will give everything . Sorry, I get carried away!
How are his teeth? If he has an over or underbite, loose teeth and gum disease can happen and cause widespread body infections. Also they can’t crunch kibble well, so soaking helps, or a wet food.
It’s difficult when a dog is on several medications, they can have their own side effects, so you can’t work out how they really are. If epi is diagnosed, I like to go back to square one and keep it simple……enzymes, tylan for US, B12, appropriate grain free normal dog food, Make one future change at a time,

Let’s hope your vet is happy to follow your requests, you are paying for their little luxuries, So why should they object to an epi test. If it is epi, we are here to help.
Springer spaniel Marti had Epi, PLE , MMM just to confuse me. She lived till 12yrs, chubby and happy despite eight years of epi.
Capsule enzymes suited her best. B12 supplements made her into a new dog!
After a cocker with PLN kidney disease, I now have two healthy rescues, a lively, suicidal , small ginger terrier, adopted with pneumonia, and gum disease needing nearly all his teeth out, and a fluffy grey toy poodle/terrier from Greece.

Tuckaboo Pam
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Re: Possible Case- Minimal Weight Loss

Post by Tuckaboo Pam » 12 Oct 2021, 19:21

Lauren, here is an informative video on EPI. Tucker, too, was never emaciated, but his ribs showed. Until I insisted on getting the blood work done, my vet didn't think there was much of a problem.

https://healthypets.mercola.com/sites/h ... -dogs.aspx

Good luck---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.

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PennysMom
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Re: Possible Case- Minimal Weight Loss

Post by PennysMom » 12 Oct 2021, 20:16

Thank you.

Patsy the HP food is a prescription food because my girl has never tolerated a food with an animal protein that is recognized by her body (we trialed about 15-20 dog foods before resorting to this including unique proteins such as alligator, kangaroo and Bison). It got so bad she was literally ripping the skin on her feet and backside open. The protein in this is broken down so far that her body is unable to recognize it. She has been on this for about 4 years and until now had been totally fine and had solid poops! I am going to ask the vet about trialing another hydrolyzed food but I know going back to a regular food will mean she will be literally ripping her fur out and skin open. It seems like this is one thing after another with this pup.

We always get complimented on her teeth being very clean for her age however she did come to me with an underbite. I am going to ask the vet that we leave with a set of plans of what we are going to try. Financially it is getting very tight going to the vet every 2-3 weeks and paying for all of her medication and taking time off of work. I would like to stop going back every few weeks and have a set of plans we are following.

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Patsy
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Re: Possible Case- Minimal Weight Loss

Post by Patsy » 13 Oct 2021, 06:35

Oh wow! Poor little girl, You have done so well to get her back to health! So all her current meds are for her back problem.
At the moment, if the over the counter digestive enzymes help, I would carry on with them, they wouldn’t affect an epi blood test draw. I hope your vet is open to your idea, since they ve tested for everything else.
One of our committee members, Madelon, has a dog that is overkeen on rabbit droppings. What can they like in it??
Springer spaniel Marti had Epi, PLE , MMM just to confuse me. She lived till 12yrs, chubby and happy despite eight years of epi.
Capsule enzymes suited her best. B12 supplements made her into a new dog!
After a cocker with PLN kidney disease, I now have two healthy rescues, a lively, suicidal , small ginger terrier, adopted with pneumonia, and gum disease needing nearly all his teeth out, and a fluffy grey toy poodle/terrier from Greece.

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PennysMom
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Pet name: Penny
My name: Lauren

Re: Possible Case- Minimal Weight Loss

Post by PennysMom » 15 Oct 2021, 09:05

We saw the vet yesterday and he completely shut down considering EPI as her weight has remained stable (the vet even suggested losing weight even though she is about a pound lighter than she has been most of her life). We did a full blood panel (but they didn't want to add the appropriate test for EPI on) and they switched her from Flagyl to Tylan Powder and a better and exceptionally expensive probiotic. I had to push for the switch to Tylan so I am glad we at least did that. They also switched her meds a bit to try to keep her calmer (they had taken her off of Trazodone after the onset of diarrhea and increased her Gabapenten thinking the Trazodone may have caused it since she had started doses recently) since the Trazodone worked better than the Gabapenten for that. My plan from this point is to give this course of action about 2 weeks to see if it helps and if we don't see results I will order the home test from EnzymeDiane and see what it shows. I am going to continue to keep a daily log of observations and see what changes I see.

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Jean
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Pet name: Kara, lost 10th May 2019
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Re: Possible Case- Minimal Weight Loss

Post by Jean » 15 Oct 2021, 10:47

Good Afternoon from the UK

My speel on this is its your dog your money, I had to stand my ground too.

One of our staff has had multiple EPI dogs, and the one thing I remember vividly was they didnt lose weight.

Every dog/cat is different. Tylan is a far better drug as Metro has side effects, and if you wanted to use some fresh pancreas to just see if there is a difference why not ..............................................can you get porcine from your source

I will say more but my back is really sore and needs bed and tablets


Jxxxxx
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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