Thoughts on possible other issues in addition 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.
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and04276
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Country: United States
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Pet name: Ada
My name: Alia

Thoughts on possible other issues in addition to EPI?

Post by and04276 » 02 May 2022, 10:56

Hi guys, I’m new to this forum! Our 1 year old Border Collie mix (mixed with what we don’t know for sure. Shelter told us lab, but we think pit maybe.)

So story goes: about a month ago she was getting yellow diarrhea, lost a whole bunch of weight, and had dandruff like I’ve never seen. Tried a whole slew of things, I don’t think I’ve ever hoped for worms so much. Anyway did some blood panels with a minor kidney issue that we got some supplement to resolve it. Other than that, the high levels of fat in her stool + symptoms, the vet said it was a high likelyhood of EPI. Instead of doing the GI panel, we decided to put her on the enzyme.

Fast forward she’s been on the enzyme for a little over a week. After about 5 days without much of any progress we upped her dosage of enzyme to 2 tsp per cup at the direction of the vet. She has also been on a low-fat GI prescription diet at the direction of the vet. She gets a about a cup of food per meal, and we’ve been feeding her 3 times a day.

No progress right away, but all of the sudden this morning, it was like normal poop, totally out of the blue. My only concern is that it WAS slightly grey colored. Another thing is that ever since she went on the enzyme, she does an occasional groan (for reference this is almost the exact same as when she was teething and losing teeth as a puppy.) so we think she’s experiencing some slight discomfort. She was also taking an anti-inflammatory to reduce her accidents for a while, and has run out now. About the same time her gas has returned to pre-treatment levels. She’s also had one evening meal where she was licking her lips like crazy, but I assumed that was us not waiting quite long enough for the enzyme to settle in the food, because since then she hasn’t been doing that.

Another note is when she was first on the enzyme and we weren’t seeing too much progress, one thing we did notice was a mucusy casing with her poop. Kind of like a falling apart sausage but the casing was noticeably darker/browner than her yellow poop.

Have any of you experienced slight discomfort with introduction of the enzyme? Do you guys think there’s any cause for concern?

Tuckaboo Pam
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Pet name: Tucker
My name: Pam H.

Re: Thoughts on possible other issues in addition to EPI?

Post by Tuckaboo Pam » 02 May 2022, 16:31

Hello Alia? Alla?(my screen is smudgy) and welcome to the forum.

So many of the issues you have listed do sound like possible EPI, with the ever-present SID, but the only way to tell for sure is to do a fasting blood test. I personally haven't heard of dandruff being a symptom, but who knows.

PLEASE ask you vet to test TLI, Folate, Cobalamin, and Lipase. That's all I've got on Tucker, but there may be more. If so, someone on staff will mention it. The test is somewhat costly, but it's the most responsible thing to do.

Two teaspoons per cup of kibble seems a little extreme after only one week, and it doesn't sound like you are addressing B12 & SID, which are important parts of the protocol. There is a lot more information, which I won't go into right now, but I really hope you can get the FASTING blood test run. You'll want to do it by tomorrow or maybe Wednesday, so the sample gets to Texas A&M before the weekend. Otherwise, wait until next Monday. It's best if the blood is fresh when they test it.

The enzymes you are currently giving will NOT affect the test.

Back to the enzymes---they take a little while to start working, every dog being different. If you have good solid poop, that's great, but you are right, grey isn't great.

Diet should be made up of a low fiber food, less than 4% fiber. Fat is not an issue for EPI dogs. No need for low fat.

There is more, but for now you should probably concentrate on getting the test done. If you think it can be done tomorrow morning, you should fast her from everything but water for twelve hours prior.

Hope this helps. Hang in there---Pam & Tucker

I'm sorry you are going through this, but here on the forum you will get lots of support.
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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Olesia711
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Re: Thoughts on possible other issues in addition to EPI?

Post by Olesia711 » 03 May 2022, 11:32

Hi Alla,

Pam gave you are very important suggestion ... PLEASE have your vet do the proper test for EPI.....do not go on a best guess from the vet since there was a lot of fat in the stool... THis is not an accurate way to test for EPI.

I am sure your vet is only trying to help you out (save money) by not running the cTLI blood test, but the problem with not properly testing via TLI test is that we have had actual cases here on the forum where others did the same (assumed it was EPI without proper testing) and the dog died because it had another condition that displayed similar signs as EPI so they missed treating the real problem and that could have and should have been easily treated.
FYI.....SID can also happen in dogs with liver disease, kidney issues, Pancreatitis, EPI, IBS, IBD......

So please DO the cTLI test.

Everything that you are describing sounds like typical SID (formerly called SIBO)....there is a LOT of good information on SID located under the "MANAGING EPI" section, and then read the information under the "SID/SIBO" tabs.... packed with information on how to treat SID.....

Also... in summation... this is SID... that we share in our " Effective Management of EPI " page:
SID (small intestinal dysbiosis) / SIBO & TREATMENT

Because of the very nature of EPI (pre-diagnosis/treatment) undigested food/ bacterial imbalance/not enough different bacterial strains/ excessive fermentation … all this combined triggers SID/SIBO in all EPI dogs. Goal is to get SID under good management.

The best way to assess SID/SIBO is by (1) symptoms and (2) accompanying medical ailment, in this case EPI, and treat early on for best results. Years ago, it was thought that only high folate test results indicated SID. This has since been proven wrong. Folate test results such as Culturing, Counting bacterial numbers, and Duodenal juice collection all have majors flaws in their technique rendering them inaccurate indications of SID/SIBO, but rather “the type of flora and/or how the host and flora interact is most important.” Recent studies have revealed that all dogs with EPI have SID. The goal now is to keep SID under good control. Unfortunately, with EPI dogs, research has also recently proven that EPI dogs do not have enough of a variety of bacterial strains nor enough bacteria overall.

SID is not under good control if the dog displays any repeated signs such as yellowish or pale colored stools, loose stools, gelatinous stool coating, flatulence, lack of appetite, stomach noises, vomiting, acid reflux, low or low normal B12 then treat for existing secondary SID/SIBO. In trying to keep SID under good control, much success is seen with prebiotics (FOS/Fructooligosaccharide). FOS is a soluble dietary fiber, a non-digestible food components that is fermented by intestinal bacteria. FOS is most abundant in Inulin (Chicory Root), Jerusalem Artichokes, and Slippery Elm powder which has prebiotic and mucilage properties. This may lead to more normalization of the intestinal microbiota. Many EPI folks use Slippery Elm powder given with breakfast and dinner. The following are suggested doses for Slippery Elm: 1/8 tsp for dogs under 10lbs, ¼ tsp for dogs 10lbs to 30lbs, ½ tsp for dogs 30lbs to 80lbs, 3/4 tsp for dogs 80lbs to 100lbs, and 1 tsp for dog 100/+lbs. Mix in meal, add 1 to 2 tablespoons of water, mix and serve meal as you normally would. Incubating not necessary. HOWEVER please know that too much of any prebiotic can cause loose stools and an upset stomach. So always give just a little. Do not give if the pet has an allergy to the American Elm Tree.

If just a Prebiotic doesn’t work or doesn’t work well enough, try a prebiotic + probiotic. If this 2nd option still doesn’t work well, then you will need to resort to an antibiotic regimen to get SID/SIBO under good management. A 45 day regimen/twice daily with breakfast and dinner of Tylosin Tartrate antibiotic is recommended. Metronidazole is no longer recommended for any dog with chronic gastrointestinal issues.

In some cases, if the Tylosin is not working, then try Amoxycillin (which may or may not work) or try Oxytetracycline which often does work. Tylosin appears to work best for the majority of EPI dogs with SID/SIBO.
The current recommended Tylosin dosage has recently been changed to “25mg/kg BID with food for 6 weeks”, but some still prefer to administer twice daily [every 12 hours] with food:
30 lbs – 1/8 tsp
60lb – 1/4 tsp
90 lb – 3/8 tsp
120 lb – 1/2 tsp

Be sure to add a pre+probiotic product about halfway through the Tylosin regimen to increase bacterial population and the bacterial strain variety.
Also, although not clinical proven, what has been observed by diligent pet owners is that some are able to completely remove a SID/SIBO-prone dog from antibiotics through a methodical process at the end of 45 days of Tylosin, then instead of stopping completely, slowly reduce the antibiotic dose before stopping completely.

In a recent study the use of fructooligosaccharides (FOS) in the diet showed a lasting advantageous effect. This syndrome is also a potential target for probiotic therapy but one must be careful when administering prebiotics. However, please know that too much FOS can cause the opposite effect! Per Dr. Jorge Steiner of Texas A&M University “…unrealistic expectations have been replaced with well-defined requirements for probiotics and controlled studies of their beneficial effects. A probiotic must be efficacious. In order to be efficacious, the bacteria must reach the intestinal lumen. This requires that the bacterial species being used in the formulation are both acid- and bile-acid resistant. Also, the bacterial species of the probiotic preparation should adhere to the intestinal mucosa to prolong the time of interaction.

When possible use a 3rd party laboratory such as http://www.consumerlab.com/ to verify product “claims”
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.........

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