EPI without diarrhoea?

[Hannahwilks219]

Hi,
My 14 month old female flat coated retriever has been losing weight for months (22kg should be 27kg), has developed bloating after meals (abdomen visibly swells, burping, and putting head down) and intermittent vomiting (i.e when she eats more than 90g of her food at one time). Other than this, she is well in herself with appetite and energy. Parasites and blood work already done, coming back clear, she has also been on antibiotics and a hypoallergenic diet. Her symptoms fit those of EPI but her stools have been normal over this time, and I have been told diarrhoea/cow pat stools is characteristic of EPI. Is it likely that it would be EPI despite not having this symptom? We are working with our great vet but very lost as to what the problem is. Any advice would be greatly appreciated, particularly whether any dogs have been diagnosed and successfully treated with EPI without the diarrhoea symptom.
thanks,
Hannah

[Hannahwilks219]

Extra point - She is completely ravenous all the time - she is getting her daily allowance, split into 4 meals and is still constantly looking for food i.e licking the kitchen floor and trying to eat sticks - she also tries to eat poo any chance she can get!!!

[Tuckaboo Pam]

Welcome to the forum Hannah!

There is a time where a dog may be segueing into EPI. Tucker always had bad habits, but it was when the intense yellow diarrhea, which he pawed at the door to get outside & eat---laced with dirt & dry leaves---it was at this time when I stopped listening to my vet who said his ribs showing since 6 months old, was OK. I was lucky to read a story about a GSD rescue who was skinny because she had EPI. I did my research & my vet agreed.

Here's a very comprehensive video, if you have time to watch---

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

If I were you, I'd ask my vet to run the blood test. It's expensive over here in the States, so it's up to you. I'm sure some staff members will also respond soon, and they may have different advice, so please keep checking for responses.

---Pam & Tucker

[Hannahwilks219]

Hi Pam and Tucker!

Thanks for sharing your story, I am definitely leaning towards just getting the TLI blood test done, and if it comes back ok then at least it is something else ruled out. I can't bear the thought she is having to suffer longer if theres a test which could confirm her issue, and go on to make her better.

Thanks for your help,
Hannah and Harper

[Tuckaboo Pam]

Someone more knowledgeable than me will jump in here soon.

I do know that there have been times when a dog tests negative because he's just not there yet, but is on his way. I believe advice has been given to start on enzymes and see what happens. There have been other times when all things pointed to EPI, and it turned out not to be.

I would probably start her on B12 & slippery elm. But again, I am not a pro.

The burping, throwing up, bloating sound a bit like SID, which can be helped by giving the slippery elm. More about SID here---
https://epi4dogs.com/sidsibo-in-brief/

Hang in there----Pam

[DocX]

Hi Hannah,

I'm going to start with the disclaimer 'I'm a doc of science, not veterinary medicine' so I'm not qualified to give veterinary advice, but I will share a couple of thoughts about my experience as a dog owner.

My EPI dog started showing some GI symptoms about nine months before she got very sick & we diagnosed her. For almost that entire time, her poop was a bit softer than other dog, but not remarkably so, although I suspect TLI was slowly dropping the entire time. We never tested TLI early because she responded so well to metronidazole. She has always burped a lot and been prone to nausea, but never bloats after meals, and rarely pukes. Also, not all dogs present with EPI the same. For example, I had a really hard time getting mine to eat anything.

My IBD dog was a severe case. Some important things I learned from her are 'hypoallergenic food is a really important tool, but it can't completely control IBD in all dogs', 'dogs with small bowel problems tend to feel pretty sorry for themselves', 'dogs with colonic problems tend to feel much less sorry for themselves'.

My third dog is healthy, but an important thing I learned from him is 'young dogs are prone to making very poor life decisions about eating things.' (Actually, all three of mine have done that).

Has your vet ruled out a foreign body? Puking and bloating after meals sounds like a possible motility problem or partial block. Dog #3 once ate part of a cell phone wallet that was too big to vomit back up or pass from stomach into small intestine so the vet had to fish it out with an endoscope. He really didn't feel at all sorry for himself, was happy about eating, but puked afterwards. Is there any difference in amount you can feed between soft / canned vs kibble?

If your vet is sure your dog is not obstructed, there are several different drugs that might help with vomiting. In my experience, all of them are pretty good for vomiting, but if a dog is feeling really sick, sometimes they still won't want to eat. Cerenia is probably the best because it both shuts off vomiting and helps with gut pain, but it is expensive and not usually given for more than a few days. Metaclopramide is inexpensive & promotes motility. Ondansetron (zofran) prevents vomiting but my understanding is it doesn't help much with dog nausea. This is not a complete list of dog anti-emetics.

So in summary: You can't rule out EPI without the TLI (but doing it might give you peace of mind, or an answer). You can't rule out IBD without an endoscopy ( the hypoallergenic food is a really good idea). If your vet has ruled out GI blockage, there are a lot of drugs that might help with puking & make you both happier.

I wish you all the best in figuring out what is up with your dog. It is so hard to see them vomiting and losing weight and not knowing how to help.

[Olesia711]

thanks MIna's Doc.... some good suggestions.... and i especially liked your comment " young dogs are prone to making very poor life decisions about eating things.' oh how very true!!!!!!!!!!

So...... the possibility of an EPI dog not having loose stools..... YES!!!!!!!!!!! This can and does happen although not very typical, since the most common symptom of EPI is loose cow patty-like stools that are pale/pasty looking in color......but not every single EPI dog will display with this... We have had just a few cases where the dog never had loose stools, a couple of cases where the dog didn't lose weight and just a small handful where the dog did not have a voracious appetite....

My suggestion is if there are other EPI symptoms, then i would (if possible) go ahead and just have the TLI test done. At least that way you will know once and for all if you are dealing with EPI. If not, then you know to pursue other possibilities.........

[Hannahwilks219]

Thank you for your advice @DocX and @Olesia711, our vet says endoscopy is the next stage, and we will likely do a GLI test as well, to rule it out. Harper is definitely in the 'young dogs are prone to making very poor life decisions about eating things.' club!!!!

All the best for you and you dogs,

Hannah

[Olesia711]

Hi Hannah,

You are very welcome. And it sounds like you have a good vet! Please do keep us posted.