New EPI diagnosis

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.
belgin
Member
Posts: 18
Country: United States
Pet name: Elsa
My name: Beckie

New EPI diagnosis

Post by belgin » 04 Dec 2021, 22:28

Hello all. I have a female GSD who turned 8 months old today. Elsa was diagnosed this week with EPI. Her TLI was 3.9. B12 425. Folate 7.8. Elsa had normal weight gain for the first six months of her life, but then virtually stopped growing. When I compared her weight and height to that of my 4 year old very healthy female GSD, Gretel, it was apparent there was an issue. I had heard of EPI but knew very little about it, but it was lurking in the back of my mind. I kept feeding Elsa more and hoping her weight would increase.

On Thanksgiving day Elsa became quite ill. She had diarrhea, vomiting and was quite lethargic. I took her to the vet on Friday and had them draw the EPI labs due to her issues with weight gain as well as the fact that I had seen a few cow-pie stools left by Elsa. That day she was diagnosed with C. difficile and put on Flagyl. They gave her 500 cc of LR subqu, sedating her first with Ace Promazine as she was very resistant to any treatment. She did not improve over the weekend. I kept her hydrated with chicken broth but she would not eat anything solid. The diarrhea continued as well as her lethargy.

I took her back to the vet on Monday and received the EPI diagnosis. Elsa was put on Amoxicillin and kept on the Flagyl. I purchased a 20# bag of Royal Canin Ultamino ($100!) and started hand feeding her that, holding back on all other food or treats. Although I admit to giving her a tiny bit of ground meat to get the antibiotics into her so I didn't have to put three pills down her throat twice a day (Amoxicillin was one cap and one pill for correct dosage). The poor pup was rather traumatized by all that was done at the vet clinic as well as my own efforts to take her temperature and administer her meds. Her weight was 37.5 lb.

By Tuesday she felt a bit better. I managed to get 4 cups of the Royal Canin kibble into her and she was drinking a lot of water. She had one formed BM that day. Throughout the week, I got her up to 4 cups of kibble a day and she had 2-3 normal looking poops a day. Energy level greatly improved. On Friday, when I picked up the enzymes at the vet, Elsa was up to 39 lbs and feeling pretty perky.

Today, I added 3/4 teaspoon of the Pancreas powder to her kibble and let it soak in warm water for 20 minutes. She ate it right down. Things were looking good, except that when I tried to give her another meal a few hours later she wouldn't even get close to the bowl. Her energy level declined as well. Poops still formed, light brown in color. Perhaps the enzymes irritated her mouth causing her not to want to eat, but that would not explain the return of the lethargy.

I have so many questions and am so concerned about this beautiful and very sweet pup. I am grateful to have a venue like this to share my experience and received advice from others who are going through the same or similar issues.

Do any of you have any ideas on what I should do next?

As I normally feed primary a raw diet I would like to get back on that. I prepare their raw using Steve Brown's recipes from his book Unlocking the Canine Ancestral Diet. I have done tons of research on raw feeding and feel this is an excellent method. I also give some prepared raw, like Answers and Small Batch, as well as sardines, eggs, mackerel, raw meat that is not ground including chicken wings, etc. I feed some kibble as well as canned. Kibble is usually Fromms and canned is Evangers.

If my pup will not tolerate the Pancreas enzymes I would like to switch to raw beef pancreas. However, how does that work? If everything she eats needs to be treated with enzymes how can one do this?

I also do a ton of training with my dogs, including tracking, agility, obedience, tricks, and reward with treats. Is there a way to make some acceptable treats that will align with the EPI diet? Elsa loves the training and it is difficult to replace treats, especially in beginning tracking.

I'll stop there. Thanks in advance for any input. And thanks for this wonderful website.
Elsa
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Kodis Mom
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Posts: 62
Location: Custer, WA.
Country: United States
State: Washington

Re: New EPI diagnosis

Post by Kodis Mom » 04 Dec 2021, 23:51

Hi and welcome ! All questions are encouraged. Some I can answer, but I'm sure others can help in more detail. If they refuse to eat enzymed food in a bowl, try a flat glass plate or pie plate. You can also try toppers, such as parm cheese, a squirt of whipping cream, bits of meat, tuna juice. We have to get creative. Also can rinse out the mouth directly after a meal with a squirt bottle, or some have them bob for a piece of hot dog in their water bowl. As for being lethargic, I must remind you that some dogs cannot handle metro ot Flagyl. Just to keep in the back of your mind. I see your girl was lethargic before....so I cannot help you there. Your pup is beautiful 😍. Also, keep a journal or log. This is a world wide site, I am west coast USA.
Kodi
B. 8/19/2010 Diagnosed at 11 months.
Kodi is now on Natures Logic turkey and/or pork kibble, 2 cups with 2 teaspoons of enzymes, 1/8 teaspoon of ground coriander, 1/16 teaspoon of cinnamon and ground fennel seed (for tummy upsets) twice a day, plus one one B12 capsule from Wonderlabs. She has been very stable and on occasion needs a dose ofTylan.
She is our second GSD with EPI. It was not so scary this time ! And thank goodness for epi4dogs.com ! 💝 Kodi passed on August 25, 2023 just after her 13th birthday.💝 Forever grateful to Olesia and epi4dogs. She live a long and adventurous life with EPI.

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Montgomery
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Posts: 418
Country: Canada
Pet name: Montgomery (I'm a CAT!)
My name: V

Re: New EPI diagnosis

Post by Montgomery » 05 Dec 2021, 00:20

One of the best things I ever got for Montgomery was a pill gun. About $3.00 at the veterinary clinic. I don't know why veterinarians never seem to tell people about these things, but because of it, I still have all ten fingers.
You could try dusting her food with nutritional yeast. That's my secret weapon, and it doesn't take much, either. I put his enzymes into capsules because he gets mouth sores if I don't. He just takes it directly before he eats and it seems to work just fine.
Your pup is beautiful. She's lucky to have you looking after her.
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.

belgin
Member
Posts: 18
Country: United States
Pet name: Elsa
My name: Beckie

Re: New EPI diagnosis

Post by belgin » 05 Dec 2021, 00:45

Thanks so much for your responses! They are immensely helpful.

Kodis Mom, I was concerned about the Flagyl too and will be very glad when we are done with it. Only two more days. I am managing to get some probiotics into Elsa so I hope that is helping.

Montgomery, I have honestly never heard of a pill gun but will look into it. Sometimes, there is no choice but to get that pill into the animal. And I like the idea of putting the enzymes into a capsule.

So it is all right to add some food to the prescription diet to get them to eat it? My vet was pretty adamant that nothing else should be given. But it makes sense to me that one needs to get the dog to eat, or no gain will be made whatsoever.

Thanks for the compliment. She's a pretty pup and will be even prettier when she gains some weight. She doesn't look awful but her hip bones and ribs are quite apparent. And she's only 39 lbs at 8 months. Sad. My other GSD was 58 lbs at that age. :(

Do they tend to make up for lost growth when on the correct diet and supplements? I worry about that. And I also wonder if her prognosis will not be as good as she was diagnosed at such a young age.

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Kodis Mom
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Posts: 62
Location: Custer, WA.
Country: United States
State: Washington

Re: New EPI diagnosis

Post by Kodis Mom » 05 Dec 2021, 01:30

My girl was diagnosed at 11 months,she is now 11 years old and doing well. Yes, you can add a small amount of extras as long as they have enzymes. Most dogs don't need perscription foods unless they have other issues. Some are successful feeding raw but i have no experience with it. But you have to start somewhere. Make only one change at a time. You will learn patience.....easier said than done, at least in my case !! Kodi is my second EPI girl and is totally different than my first. She needs more B12, which should be above 600, can't tolerate probiotics, and is allergic to anything chicken.
Kodi
B. 8/19/2010 Diagnosed at 11 months.
Kodi is now on Natures Logic turkey and/or pork kibble, 2 cups with 2 teaspoons of enzymes, 1/8 teaspoon of ground coriander, 1/16 teaspoon of cinnamon and ground fennel seed (for tummy upsets) twice a day, plus one one B12 capsule from Wonderlabs. She has been very stable and on occasion needs a dose ofTylan.
She is our second GSD with EPI. It was not so scary this time ! And thank goodness for epi4dogs.com ! 💝 Kodi passed on August 25, 2023 just after her 13th birthday.💝 Forever grateful to Olesia and epi4dogs. She live a long and adventurous life with EPI.

Jane&Clyde
Member
Posts: 157
Country: United States
Pet name: Clyde
My name: Jane

Re: New EPI diagnosis

Post by Jane&Clyde » 05 Dec 2021, 01:35

Hello, Beckie, and welcome to you and Elsa.

IF (and that's a BIG IF) Elsa truly needs a hydrolyzed food, then no, you shouldn't give her anything except the prescription food, at least until she's stabilized. However, hydrolyzed foods are usually given to dogs with multiple food intolerances or food allergies. Dogs with EPI alone do not need prescription foods. I don't know anyone who feeds a prescription food to a dog with EPI unless there are other issues. However, the dog will need food that meets certain guidelines (grain free, 4% fiber or less on a dry matter basis taking into account the water in wet foods, limited or no peas, and avoiding chicken if possible). So, if I were you, the first thing I would ask my vet is why Elsa needs hydrolyzed proteins. If the response is for the EPI, that's simply not true, and we can suggest foods (kibble) that our dogs tend to do well on and can help you transition back to a raw diet or partially raw diet.

How much food did you add the 3/4 teaspoon of enzymes to? The ratio should be 1 teaspoon per cup of dry food (kibble), 1/2 - 3/4 teaspoon per cup of wet food.

I noticed that Elsa's TLI wasn't quite in the range for EPI, but rather in the borderline or "subclinical" area. If she still has symptoms after the c. diff is gone, then it should be treated like it is EPI. My above statements are based on the assumption that she has symptoms of EPI after the c. diff is gone.

Also, let me assure you that her diagnosis at an early age doesn't mean a poor prognosis. Dogs with EPI can live a long, healthy life.

Oops. I was typing at the same time as Kodis Mom, so some info is a repeat.

belgin
Member
Posts: 18
Country: United States
Pet name: Elsa
My name: Beckie

Re: New EPI diagnosis

Post by belgin » 05 Dec 2021, 11:56

Thanks again for your responses!

I plan to start Elsa on oral B12 using the product suggested on this website.

Her TLI was 3.9 with a reference range of 5.0 to 35.00 on the printout from the lab. It also says the result is "...Inconclusive. Mild decrease is suggestive of EPI and may be seen early the disease. Consider retesting in one month, or sooner if patient was not fasting prior to the event." She was fasting, as would not eat anything and actually went four days without food.

I would suspect she is definitely an EPI pup due to the lab as well as her inability to put weight on (39 lbs at 8 months) and occasional cow-pie stools. Her height is not bad for a female GSD, 22 inches at the shoulder. But that weight is way off. And her spine, hips, and rib bones are very apparent.

When I gave her the enzymes yesterday morning I put them in one cup of the prescription kibble, moistened well with warm water, and let sit for 20 minutes.

It is good to hear that she will likely not need prescription dog food. I do want to return her to raw but am not sure how to handle the enzyme intolerance. If I put it in capsules, how to do I moisten it? And after re-reading the articles on this awesome website, I'm still not sure if I need to put enzymes on everything she eats and it so, how I will do that with treats and/or if Elsa is refusing to ingest anything with the enzymes on it. That's why I'm thinking the raw beef pancreas might be a good solution for her.

Today, her energy level is fairly low, although she did chase Polly the cat a bit (instigated by Polly as usual). She had one formed stool. I have not attempted to feed her yet.

The vet said to use the Royal Canin as it was "easily digestible." She, nor I, are aware of any food intolerances. Before, all this came up, Elsa seemed to be able to eat a wide variety of foods.

It's very reassuring to hear that she can, once we get this diet figured out, lead a healthy and happy life. I adore her!

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Olesia711
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Location: North Carolina
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Pet name: Izzy
My name: olesia

Re: New EPI diagnosis

Post by Olesia711 » 05 Dec 2021, 13:03

Hi Beckie (is that your name?)

SO sorry to hear about Elsa.... but... what you are describing could be some typical EPI symptoms "IF" Elsa is actually segueing from subclinical EPI to clinical EPI.

SOME POSSIBILITIES:
1. The lethargic reaction could very well be SID (small intestinal dysbiosis) ... becoming more evident after starting the enzymes.... what happens with a lot of these dogs is that all dogs with EPI have SID, however, you often don't notice SID signs until after being on the enzymes, usually for a week or two but it can happen quicker. Everything initially appears fine and the poof, all of a sudden you have some of the same reactions you had before starting the enzymes and many people think the enzymes stopped working or something is wrong. What happens (and this is a non-medical explanation :)) is that prior to giving enzymes, there was a lot of bad metabolites from food not being properly digested floating around. once you give the enzymes the food particles are properly being digested and all the accumulated bad particles are now being dislodged and you are seeing the full ramification of SID. Some dogs with SID act like nothing is wrong while others act sick, or like they are in pain, or get lethargic. So.... this is one possibility.

2. It is possible that this is just SID and he needs this addressed. The way we currently address SID is to first try prebiotics, then if that doesn't alter the gut flora enough, then try pre+probiotics. If that doesn't work, then you go the way of an antibiotic called Tylan (which only inhibit bacterial reproduction, not kill all bacteria), but NOT metronidazole, which kills all the gut flora bacteria and the problem with this is that some of the killed bacteria will never ever come back no matter how may probiotics you give the dog. However, your vet put your dog on Amoxy & Metro because of c. diff diagnosis- - which are the proper drugs for this. But for SID, Metro doesn't always work and you just don't want to give it to a dog to fix a chronic condition like SID...
This is why, even while on Metro and Amoxy (although AMoxy does sometimes help with SID it is jsut not the best) you "might" be seeing SID reactions. ... or not.

3. This lethargy could be a reaction to the metro as mentioned in another response.

4. This lethargy could be a reaction to insufficient B12 (Her TLI was 3.9. B12 425. Folate 7.8. ) even though her B12 was 425.... which with an EPI dog is low mid range.....with an EPI you want them in the upper mid range level of 500-600)... so maybe her B12 plummeted since the test.... but i think this is a possibility but a remote possibility.

5. the other possibility is that something else is going on. Don't always assume that everything is "EPI" related.... what i do strongly recommend is to not get too nervous yet about things.... BUT contact your vet firs thing Monday and describe what is going on. How Elsa is acting, eating/not eating..... and see what the vet suggests.

Regarding feeding her the enzymed food if she is having such an aversion.... you can pour the designated amount of enzymes into empty gel caps and give her the enzymes this way about halfway thru the meal.... if after trying the hydrolyzed food... your vet deems it not necessary.... then go back to the whole raw food, Many EPI dogs do well on raw. you just have to mince the raw food so that you can mix in the powdered enzymes.

OH.... and just in case this does segue into full blown EPI and she continues to have an aversion to the the enzymes... ... you can always switch enzymes and give CREON... these are enteric coated enzymes that have no taste or smell. But they are expensive so we recommend getting a script from your vet (if it comes to this) and ordering from Canada .

I know it was mentioned above about why your vet placed Elsa on Hydrolyzed food.... i suspect it is because of the Folate score of 7.8. A Folate score of 7.7 indicates Small intestinal proximal disease.... which covers multiple conditions, but the most common one is a food sensitivity/allergy....... and Elsa's score is 1/10 of a point away... i think your vet is being proactive and i agree with her placing Elsa on a hydrolyzed food.
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.........

belgin
Member
Posts: 18
Country: United States
Pet name: Elsa
My name: Beckie

Re: New EPI diagnosis

Post by belgin » 05 Dec 2021, 13:43

Yes, this is Beckie. Thanks much for your response, Olesia.

I wondered if the issues weren't partly stemming from SID and if the C. difficile acted as an opportunistic infection due to Elsa's compromised health. Whatever it was, the effect ten days ago was acute and hit her hard.

She just threw up her breakfast, almost completely undigested. I had fed her about 1 cup total, consisting of the prescription kibble and Primal raw Turkey and Salmon patties. No enzymes in the food. Her temp is ok, 101.9. I give her the antibiotics right after she eats so they aren't on an empty stomach so she probably threw them up too.

I understand your non-medical explanation of how the enzymes can affect the GI system. It makes sense, as she was doing quite well for four days eating the Royal Canin before I got the enzymes. Good energy, normal poops, acting like her old self. She did eat only one meal with the enzymes though...

I will start her on a pre-biotic. Is Slipper Elm, 1/8-1/2 tsp, the best way to begin? And is it with each meal? I read that it should not be given with an antibiotic.

And I will order the B12 oral and start her on that ASAP. Perhaps I'll see if I can find any locally first.

I'm fine keeping her on the prescription diet, IF she will eat it. I hand fed it to her for 4 days and will do so again, however, she won't eat it alone now, not since I put the enzymes on it.

That is a bit concerning about the "small intestinal proximal disease." Is this typical with an EPI dog, or something completely different to worry about? :?

And now that she threw up again, as she did when this all started, I don't imagine I'll get anything into her. I hate that. She had put on 2 lbs after not eating for 4 days when this all started. I was so thrilled to see her eat again. There is nothing quite so difficult as an animal, or person, not eating. It tears away at the mother, caregiver, nurse, in all of us.

Good to know about the Creon.

Thanks again,
Beckie and Elsa, the very cute pup who only wants to feel better so she can play with her housemates, Gretel and Polly, and chase her ball. ;)

Jane&Clyde
Member
Posts: 157
Country: United States
Pet name: Clyde
My name: Jane

Re: New EPI diagnosis

Post by Jane&Clyde » 05 Dec 2021, 13:56

Olesia, thanks for your information about the folate score! I will try to remember this when I give advice in the future.

Beckie, you are in the hands of the REAL expert here, Olesia. I will be following your story, and may still chime in from time to time.

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