GSD keeps throwing up - only stops when on meds

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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Denver27
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GSD keeps throwing up - only stops when on meds

Post by Denver27 » 12 Mar 2019, 09:31

Hi,

First post to the forum. My GSD is 7 years old and has been living with EPI for 5 years now. He has been very stable up until six months ago when he had his first issue with throwing up 2-3 times per day between feedings (all bile, no food remnants). The vet gave us the following treatment that worked six months ago. His throwing up cycle lasted about 1-2 weeks six months ago and then was solved.

Switch to a soft food diet during recovery - boiled chicken and rice
Cerenia 160 Mg pills - 1 per day
Sucraflate 1 Gm Tablets - 2 per day injected into mouth with slurry tube
Additional B12 injection

This cleared him up six months ago and now he has it again, so we tried the same treatment after determining via X-Rays that he didn't ingest a toy or have a blockage. He did very well while on the medicine, but after the medicine ran out he's back to throwing up (still on the soft food diet). His bowel movements are pretty solid with the PancreVed Powder, but he's still throwing up after about six hours of not eating. When we have tried feeding him before we go to sleep to prevent him from throwing up in the middle of the night, he gets diarrhea even though his PancreVed mixture is the same during the day. Our vet says that his pancreas is "inflamed," but our dog is a rarity at this vet to have EPI so I don't know what confidence level I should have with the vet's diagnosis.

Has anyone else had issues with their EPI dog throwing up bile multiple times per day? We have also tried to increase his portion sizes and he's getting diarrhea with that too. I'm thinking it is normal Pancreatitis, but he's got plenty of energy and doesn't really have diarrhea when we stick to his normal feeding routine. I'm confused how to get him over the hump of throwing up.

Any suggestions? Thanks.
"Denver" is a male GSD born December 2011, diagnosed December 2013

Average weight fluctuates from 70-80 lbs.

Medicine we use is PancreVed Powder, four scoops per meal.

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Miss Maddie Moo
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Re: GSD keeps throwing up - only stops when on meds

Post by Miss Maddie Moo » 12 Mar 2019, 11:18

Hello
Lets start with the EPI basics all food must have enzymes with it this includes treats...we normally say 1 cup of food to 1 tsp of enzymes any food given without enzymes can cause a problem.
Do you supplement with B12 ?
It sounds like your dog may have acid reflux but we need to eliminate whether this is caused by untreated food which in turn causes SIBO ( needs antibiotics to treat this such as tylan ) the food is causing it not sure what food you use ??? or wether he just has excess acid which an acid reducer may help with or something like slippery elm may address.
We dont encourage people to use chicken and rice with an epi dog we suggest a sweet potato as an alternative .
If you could give us some more info.
Maddie DX April 2011 along with low B12 she was feed with a low fibre food below 3% , fat was not restricted ( she wasnt good on pea based foods ) She initially had a course of B12 shots weekly over a period of 6 months and then we used the B12 pills from Chemeyes in the UK . We used Panzym and slowly had to increase the dose as she aged when she was first DX she was 23kg but she gained weight quickly and got back to 33 kg .
Maddie gained her angel wings in Jan 2018 at the age of 10 to a condition unrelated to EPI.
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Denver27
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Re: GSD keeps throwing up - only stops when on meds

Post by Denver27 » 12 Mar 2019, 12:14

Miss Maddie Moo wrote: 12 Mar 2019, 11:18 Hello
Lets start with the EPI basics all food must have enzymes with it this includes treats...we normally say 1 cup of food to 1 tsp of enzymes any food given without enzymes can cause a problem.
Do you supplement with B12 ?
It sounds like your dog may have acid reflux but we need to eliminate whether this is caused by untreated food which in turn causes SIBO ( needs antibiotics to treat this such as tylan ) the food is causing it not sure what food you use ??? or wether he just has excess acid which an acid reducer may help with or something like slippery elm may address.
We dont encourage people to use chicken and rice with an epi dog we suggest a sweet potato as an alternative .
If you could give us some more info.
Hi Miss Maddie,

Thanks for the response. I don't intend to come across callous, but after five years of him living with EPI, I am aware that all food must have enzymes with it including treats. We do give him B12 supplements and the injection that the vet gave him was an 'additional' injection.

We started giving him Performatrin Ultra Limited Sweet Potato Chews as treats and Fruitables Pumpkin Digestive Supplement as a 10% supplement to his meals. He recovered from his throwing up with the medicine (and these items) very quickly, but then when the medicine ran out he's back to throwing up.

Is there any particular sweet potato food that you would recommend? Actual baked sweet potatoes or possibly a canned dietary supplement?

Also, so I better understand the boiled chicken and rice issue, why is it not recommended? Is it too high in fat content even when boiled?

Thanks for the quick response and the help.
"Denver" is a male GSD born December 2011, diagnosed December 2013

Average weight fluctuates from 70-80 lbs.

Medicine we use is PancreVed Powder, four scoops per meal.

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Jean
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My name: Jean

Re: GSD keeps throwing up - only stops when on meds

Post by Jean » 12 Mar 2019, 14:25

my Kara had this for a long time, acid reflux

we added Ranitidine 75mg tablet 30 mins before food (zantac)

for some reason, Chicken just does not agree with our dogs, Kara could have it in dog food for a good while, and then, no way, my vets said it was the dregs of the chicken, however, you say you boil chicken, so........My girl cannot tolerate rice in any way, and many others cannot either

what happens if you feed kibble

Jean
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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Denver27
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Re: GSD keeps throwing up - only stops when on meds

Post by Denver27 » 12 Mar 2019, 15:14

Jean wrote: 12 Mar 2019, 14:25 my Kara had this for a long time, acid reflux

we added Ranitidine 75mg tablet 30 mins before food (zantac)

for some reason, Chicken just does not agree with our dogs, Kara could have it in dog food for a good while, and then, no way, my vets said it was the dregs of the chicken, however, you say you boil chicken, so........My girl cannot tolerate rice in any way, and many others cannot either

what happens if you feed kibble

Jean
Thanks I'll look into the Ranitidine. When we were experimenting with a diet years ago to determine what he could stabilize on, we stuck with feeding him Blue Buffalo Life Protection (orange bag, chicken and brown rice formula) with one boiled egg and his PancreVed. The Vet told us that this kibble was partly what caused him to be throwing up because he was having a harder time digesting the hard food. Now that he's had his course of medicine and wasn't weened off the soft food before he started throwing back up again, I'm beginning to believe that the issue wasn't his kibble being too hard to digest.
"Denver" is a male GSD born December 2011, diagnosed December 2013

Average weight fluctuates from 70-80 lbs.

Medicine we use is PancreVed Powder, four scoops per meal.

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Stacie & Dizzy
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Re: GSD keeps throwing up - only stops when on meds

Post by Stacie & Dizzy » 12 Mar 2019, 15:48

It does sound like acid reflux to me. I give Dizzy an original strength Pepcid with her evening meal. She has thrown up bile in the past. Also had wet burps, but after I started the pepcid all that went away.
My name is Stacie and my girl's name is Dizzy. German Shepherd, Age 10-diagnosed 12/24/2011 at 55 pounds, current weight is 93 pounds.
Feeding Taste of the Wild 4 cups a day with Enzyme Diane 1tsp per cup. Wonderlabs b12 once daily.
Dizzy has Pannus, given Cyclosporine drops in each eye twice daily. Pepcid once daily. Apoquel for allergies once daily.

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Patsy
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Re: GSD keeps throwing up - only stops when on meds

Post by Patsy » 12 Mar 2019, 15:52

Sorry to read the problem, it’s probably painful as well for him.
How many meals do you feed per day? Bile can only be sicked up from an empty stomach, so maybe you could divide the food and enzyme ratio into into a a pattern of more meals, closer together.
The chicken and rice problem hit us as well, though the symptoms were different. I understand the vet suggesting this if your dog didn’t have epi. I changed to fish and potato / sweet potato.
Kibble can always be soaked till soft before you add the enzymes.
My last thought is whether the vet did a general blood test to check kidney and liver numbers.
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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Madelon
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Re: GSD keeps throwing up - only stops when on meds

Post by Madelon » 17 Mar 2019, 12:08

Hi. I am so sorry your boy is going through this. We don't recommend chicken and rice typically because chicken does not agree with A LOT of EPI dogs for some reason and rice can interfere with the efficacy of the enzymes.

I agree it sounds like reflux. Here is information from our website (on the SID page) on reflux:

Possible causes and fixes with “acid reflux” from SID

Acid reflux, wet burps, slight regurgitation?? Although for years we have referred to this as possible Acid Reflux…recent research theories now suggests that what we may be dealing with in EPI dogs is Bile Acid Reflux not true Acid Reflux….. however until there is substantiating research, which we will post when available…. for now, we will continue to refer to it as Acid Reflux, unless we have specific information that states otherwise.

Sometimes our EPI dogs struggle with this and the easiest response is to just offer acid reduction drugs…. BUT this may not always be the best solution. It all depends on why the acid reflux issue is happening. What is not told to us is that some of these “acid reducers” often permanently alter the inhibition of gastric acid secretion, which is not such a good thing.

Acid is supposed to be in the stomach. Oftentimes, the real issue isn’t too much acid in the stomach, but rather too little of the right type of acid“.. Of course there is much more to acid reflux such as why is the esophagus shortening, where is that acid going and why is it going there, sometimes there is a malfunctioning stomach valve, but for purposes of managing acid reflux in EPI patients, we will focus on the most common causes:

The two most common causes of acid reflux are:

· Inadequate stomach acid not able to process the food properly

· Inadequate digestive enzymes leading to improper digestion of food

Some triggers of acid reflux can be things like:

· Food sensitivities/allergies

· Gut flora imbalance (hmmmmmm?. Sound familiar???!)

· Some antibiotics

· Parasites

· Ileocecal valve dysfunction

· Environmental toxicities

· Blood sugar imbalances

What to try to help reduce the acid reflux???

Sometimes too little enzymes cause acid reflux by not being enough enzymes to digest food properly causing fermentation and gut imbalance.
Sometimes too much enzymes cause acid reflux (depending on why the acid reflux is happening) try reducing the enzymes by a pinch for a few days.
Try Slippery Elm first before chemically prepared mfg acid reducers. Slippery Elm coats the intestinal lining with mucilage without permanently altering the digestive gastric inhibitors.
http://www.scirp.org/journal/PaperInfor ... 9ZQ7_ldXzt
Try pre+probiotics, to help alter the gut flora imbalance, a frequent cause of acid reflux.
Try pure canned pumpkin, for the correct fiber to help move the food better and not ferment.
Try feeding smaller portions but more often.
Sometimes the B12 is slipping and this prompts acid reflux, try adding B12 to the regimen.
Often times a food change is needed? something in the diet is not agreeing, either the composition isn?t right or there might even be a food sensitivity.
Sometimes it is not real acid reflux… but a little “vurp” which can come from the following which you might want to curb:
drinking too much liquid just before or after a meal
running /bouncing around too soon after a meal
Please be sure to try any of the “acid reducers” treatments above one at a time? give it 3-5 days to see if there is a positive or no change at all. As mentioned above, the most common cause of acid reflux is not too much acid, but not enough of the right acid?. HOWEVER.. If none of the above works, then the problem is more likely the less common cause of acid reflux, too much acid, in which case, an acid reducer is needed. Please talk to your vet about which product might be best suited for your pup: Pepcid AC (famotidine), Prilosec (omeprazole), ranitidine, cimetidine, sucralfate, etc….

FYI. Famotidine dosing recommendations are listed in this publication… a very good read that also points out possible interactions of famotidine with other listed medications : https://www.mypetneedsthat.com/famotidine-for-dogs/
Madelon, owned by DOC. DOC dx EPI 5/2015 = TLI < .4, B12 406; Folate >24. DOC taught me so much and together we battled and overcame EPI, food sensitivies, environmental allergies but we lost the cancer battle. DOC was dx with hemangiosarcoma 5/2022 and crossed the rainbow bridge July 24, 2022. He is and always will be the love of my life, my soulmate, my heart dog.

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Denver27
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Re: GSD keeps throwing up - only stops when on meds

Post by Denver27 » 29 Mar 2019, 11:31

Thank you to everyone who replied. It seems like it must've been acid reflux, because the Tums helped. He's no longer throwing up and is back to his normal EPI diet. Getting him to eat the Tums was interesting... he didn't want anything to do with it, so I was able to teach him 'tit for tat' in about 5 minutes. He doesn't get a small sweet potato treat until he eats the Tums, so now he immediately eats the Tums knowing that a treat will soon follow. (Now that his frequency of throwing up has stopped, I'm not giving him the Tums anymore. Good to know that's an option to try if it happens again though).
"Denver" is a male GSD born December 2011, diagnosed December 2013

Average weight fluctuates from 70-80 lbs.

Medicine we use is PancreVed Powder, four scoops per meal.

Tcworld
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My name: Angela

Re: GSD keeps throwing up - only stops when on meds

Post by Tcworld » 09 Sep 2022, 21:24

Question on this topic of acid reflux.
My vet is not keen on me giving my pup any over the counter pepcid or similar medications. My 8 year old lab has pancreatitis and frequently has an upset stomach. I have prescribed cerenia from my vet. For the pepcid or prilosec are you getting medications through a vet or buying in a normal store and basing it off of the dogs weight?

Thanks for helping.

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