EPI and liver medication

[kroeten]

Just wondering if anyone has had experience with EPI and giving the liver medication Denamarin? Jagger has never had issues luckily since his diagnosis of EPI. Last week ended up taking him in because his overall behavior was off. Blood work done and everything for the most part was okay except for liver levels. They were extremely high(really can’t remember all the numbers that were said to me). Went in thinking diabetes because of behavior and came out with liver issues (go figure). He is now on liver medication and food which has low fiber. Everything is some what back to normal except for stool. It is very, very soft like before when EPI was diagnosed. Vet said to give liver med 1 hour on empty stomach before meal. I am wondering if he is absorbing enough of new meds. It says that it can be given 2 hours after meal and I just wonder if that would be better and if EPI meds would help absorb liver meds after he ate? Looking for any suggestions to help get his stool regular again. We have been very fortunate not to have any issues since his EPI diagnosis.

Thanks for any suggestions or advice.

[Olesia711]

Hi Kim,

I know there are EPI dogs that have been placed on Denamarin..... yes you can give meds anytime away from a meal with enzymes (unless the meds need to be given with a meal) and the meds should be properly absorbed and utilized. What i would do is try both methods and just watch the poos to see if it makes any difference.

BUT.... i am also wondering... was it just the ALT liver values that were high??? If so, not that i am saying there may not be liver issues going on ... BUT.... with EPI dogs, they ALL have SID.... and our goal is to do our best to keep it under good control as best we can. WELL...... when SID is out of whack, specifically the ALT liver enzyme will be elevated... sometimes greatly elevated....and of course when SID is out of whack one of the most common signs is loose stools.... among some of these other signs: "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." ..... so...... i am saying all this because i am just wondering if "maybe" this is going on....... if you can check the blood test results and see if out of the two liver enzymes (ALT & AST) it is jsut the ALT that is greatly elevated... if yes... then you might want to ask the vet if it would be appropriate (in addition to the Denamarin) to try to treat with the follow and in this order (this is the new protocol from Texas A&M Gastrointestinal Lab on how to treat SID):
1. prebiotics (if this doesn't work in short order... then try)
2. prebiotics + probiotics (if this doesn't work in short order... then try)
3. Tylosin Tartrate soluble antibiotic powder. (needs to be given 45 days/twice daily https://epi4dogs.com/antibiotics/

Also... just a FYI.... we have some good information on liver enzymes here on this page: https://epi4dogs.com/antibiotics/[url]h ... onditions/[/url]

[Madelon]

Thanks Olesia! I had no idea that liver enzymes were often elevated with SID - learn something new all the time from this group

[kroeten]

Honestly I can’t even remember because I wasn’t even thinking that route when I took him in. He was reading the results over the phone (bc of Covid) and it was just way to much. He was very concerned with liver, but can’t remember which was high. I have had dealings with liver from our first dog (non EPI) and it has been so long since we had to deal with it I wasn’t even expecting the vet to mention there being a problem. I will get a copy of the report and see what it says and let you know. I will say he is so much better than when we went in. Definitely appreciate the information and will let you know what report says. I’ll also pass on the information about the new protocol. Our goal was to get liver kind of under control and then do new EPI blood work to make sure levels are in the right range.

Thank you so much.

[kroeten]

When Jagger was first diagnosed with EPI, he was prescribed Purina Fortiflora Canine Nutritional Supplement. Do you think it would be a good idea to try this again? I am using the same vet clinic, but new owner and previous vet retired so it’s like starting over. I have actually thought about starting this again when this new issue came up. It did seem to help the first time.

[Olesia711]

Sre you can try Forti Flora ....or.... one of the researchers strongly recommended "Proviable" which has prebiotics in it....so that is what i am suggesting to folks. Also someone else here on the forum is finding success with a Vetri Science product called: VETRI PROBIOTIC BD™ CHEWABLE TABLETS which i looked into and i was very impressed with this product has a lot of good ingredients and prebiotics in it... But honestly although our EPI dogs NEED probiotics... it really is hit or miss since each dog's gut has an individualized gut flora composition and we are giving them one-size fits all .. OTC probiotics which may or may not help them... but it's the best we can do for now until they come up with more targeted probiotics.

SO... YES.... try Forti Flora or another brand of probiotics... just make sure there is some prebiotics included in the probiotic product.

[kroeten]

The only slippery elm I can find locally on short notice is in tablet/capsule form. Do you know the dosage for slippery elm tablets or would I just crush one up to get the dosage for a powder? Trying to get things under control and we are starting to take a down spiral if we can’t get a fix on it.

[kroeten]

Was able to find powder that is 1500mg of slippery elm. So would I just use 1/2 tsp morning and evening on his wet food?

[Olesia711]

That sounds about right depending on weight .... best to look at the SLippery ELm dosing suggestions and check according to his weight:
https://epi4dogs.com/slippery-elm/

Oh and YES!!!! if the Forti Flora helped before, i would try using it again..........