Advice for borderline 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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slawson1996
Member
Posts: 2
Country: United States
State: California
Pet name: Bogi
My name: Sarah

Advice for borderline EPI?

Post by slawson1996 » 07 Feb 2023, 00:06

Hi there,

New to this forum and the world of EPI. As I've been on this journey with my 11-year-old (er, 12-year-old, tomorrow!) Cavalier King Charles Spaniel, I've found reading this forum super helpful. So, I figured I'd pick your brains to get some advice.

The details:
About a month ago, my CVKC started to suddenly lose weight. He was down about 3 pounds, which was super noticeable on him. At the same time, his appetite was through the roof. And his stools were frequent (4x per day) and very light in color.

I took him to the vet, who suggested we run a senior blood panel. Everything came back within normal limits. They wanted to do a whole work-up, ultrasounds, x-rays. I came online, and that's when I found EPI based on his symptoms. I had the vet do a specialized GI blood panel, and his TLI came back at 3.9. Being a bit higher than what's considered EPI, they decided he didn't have it.

Still having the symptoms, I asked what we could do. They put him on Hill's prescription diet I/D low fat, along with 1 teaspoon of PancrePlus for each meal (he eats 1/2 cup per meal). He was doing well – gaining weight and pooping less, but coughing a lot. I lowered his dose to 1/2 teaspoon with each meal, and the coughing has subsided. I do mix it in with water (dry kibble) and let it activate on the kibble for about 15 mins (while he impatiently waits).

His weight has stabilized - he's not losing, and he's slowly gaining. He's still voraciously hungry (maybe even more so than before?), but could that be because of the enzymes? He's stinky, for sure, but I heard that's a side effect of the enzymes – it's getting better day by day. And his stools are back to a normal amount (1-2x per day), although still a bit loose.

The vet recommends I keep him on this regiment, since it seems to be working, and we re-test his TLI in a few months.

Given the above, what does the group recommend? Stay on the enzymes and prescription food, or keep testing? I hate to put him through more testing, when he's 12-years-old and happy as can be, but I want to do everything I can to prolong his life and keep him healthy and comfortable.

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jilbert57
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Posts: 2089
Country: United States
State: Washington

Re: Advice for borderline EPI?

Post by jilbert57 » 07 Feb 2023, 09:20

Welcome to you and your pup. Good for you and your vet for being proactive on starting the enzymes and they are helping.
Yes you are in the tweenerville area for the EPI test.
Was the B12 and folate checked at the same time?
Is there a underlying condition for the low fat diet? EPI does not require low fat.
The enzymes are dosed according to amount of food and not times a day or weight of dog. Usual start point is 1 level teaspoon enzyme per cup of kibble. So you were right to lower it to 1/2 teaspoon per 1/2 cup kibble.
The enzymes should not make her ravenous but you could try adding another meal with enzymes.
The 4 cornerstones of EPI:
ENZYMES-you have that covered
DIET: most pups do better on a grainfree diet of 4% or less fiber.
ANTIBIOTICS: Most EPI animals have SID in the small intestine. Are you hear grumbling stomach, burps, more gas?
B12: EPI needs B12 up at the high end of test result.

Jill
My name is Jill and we live on the Hood Canal in Washington State. We currently have 2 Jack russells, TJ is 8 and Sadie is 2.

Mickey and his pancreatitis brought me to Epi4dogs.com site in 2012 to help manage it.
He lived from 6/99 - 8/2014

Mickey, Jack Russell. Chronic Pancreatitis. Dianes enzymes, 1/8t 3x/day with meals.

Beatrice
Member
Posts: 44
Country: Canada
Pet name: Sushi
My name: Beatrice

Re: Advice for borderline EPI?

Post by Beatrice » 07 Feb 2023, 13:43

Hi Sarah,

After $1000 for a fecal test, a complete blood test, a course of metronidazole, the vet decided to put her on a 1 carb/1 protein diet for a month. Sushi by this time had constant diarrhea, oil leaks and lost over 10lbs. She was just skin and bones. I landed on this website and decided to try enzymes.

After 1 month of enzymes with weight gain although the poo was not perfect, I approached the vet to test TLI, B12 and folate. The vet said no, she would have to do a global assessment of the pancreas starting with an ultrasound, then complete fecal test, complete blood test and hopefully not, a biopsy. I said no. I don't have money to waste nor Sushi has the time for and the strength to withstand all those tests.

I got Sushi tested with a new vet and the TLI was 3.1. To be honest, I wasn't even going to test her. But I need to know her B12 so I did the whole thing. Although 3.1 is considered SEPI, to me, Sushi has EPI. I will not waste time and money for more tests. I'll have her TLI tested again in 6 months. If TLI gets worse, we will continue on. If TLI gets better, we will work on decreasing the enzymes.

What really gets to me is that it's the same story all around. Vets don't know...Vets suspicious of EPI but want to do more tests...If the TLI is highly predictive of EPI, why on earth do we want to carry out more tests???...Just test the TLI to eliminate EPI suspicions...

And you know what really got to me??? $20 for withdrawing blood (my husband and I had to hold Sushi down since she had no assistant) and $45 for 21 tablets of metronidazole when I could get them at cost for under $3.....I am very glad that the new vet has an assistant and a receptionist. The former vet, sometimes has an assistant but most of the time, it's a 1 woman show.

I am sure Vets know best but sometimes I just wonder....
TLI 3.1
1 Pet Factor B12, 1 small scoop of aventi GI complete pre/probiotic
Enzyme Diane in EC HPMC delayed release capsule (1 full capsule + 1/2 capsule for each meal)
Nutrience Grain-Free Subzero Prairie Red (up to 2 cups if no other meat given)
AM 1/2 cup of kibble, plain yogourt with 1/2 banana
Noon 1/2 cup of cooked meat + boiled egg
3:30pm 1/2 cooked meat + boiled egg
6pm 3/4 cup of cooked meat
9pm 1/2 of kibble
apple, peanut butter snacks with enzyme capsule

slawson1996
Member
Posts: 2
Country: United States
State: California
Pet name: Bogi
My name: Sarah

Re: Advice for borderline EPI?

Post by slawson1996 » 07 Feb 2023, 23:43

Thanks for the reply, Jill! They did test folate - his level was 18.9. I don't believe they did B12 – I will call and ask tomorrow. No underlying condition for the low fat diet - the vet thought it would be better for absorption. I was desperate for a solution at the time, so agreed to the shift - maybe I will consider switching back to his regular old food (Purina Pro Plan).

Re: SID - that's interesting. YES, he burps a lot, and his stomach often makes very loud rumbling/gurgling noises. What is the typical solution for this?

Edit - is B12 cobalamin? If so, his level is 449.

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Olesia711
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Posts: 3857
Location: North Carolina
Country: United States
State: North Carolina
Pet name: Izzy
My name: olesia

Re: Advice for borderline EPI?

Post by Olesia711 » 08 Feb 2023, 14:05

Yes B12 is Cobalamin. at 449 it is low normal... This is not sufficient for a dog with chronic gastrointestinal issues.... like SEPI which is what Bodi is. Talk to your vet about either giving B12 shots or just giving B12 pills.... we highly suggest B12 pills:
https://www.wonderlabs.com/itemleft.php?itemnum=K9688
The dosage set forth by TExas A&M Gastro Lab is here: https://epi4dogs.com/b12-protocol/

Yes, going by your description, Bodi has SID (small intestinal dysbiosis) "burps a lot, and his stomach often makes very loud rumbling/gurgling noises. What is the typical solution for this?"
Here is a good read on how to treat SID.....
https://epi4dogs.com/sidsibo-management/

..................but in short:

1. start with giving prebiotics... we suggest trying SLippery Elm Powder: https://epi4dogs.com/slippery-elm/
2. if you do not see any improvement within a few days..... then talk to your vet about starting a course of Probiotics with prebiotics preferred: Some of the products that we have seen good luck with (although there are no guarantees from 1 dog to the next) are" Visbiome, Proviable, VetriScience Mega Probiotics, Mercola Complete Probiotics,.... ALWAYS start with less than half the recommended dose and work your way up to a full dose over the course of a week or two.
3. If the above does nothing..... then look at changing the food to a lower carb/fiber content food... and avoid food that has Pea as one of the top 3 ingredients or that uses multiple variations of peas and lentils.... these just make SID worse... a LOT worse...........
4. If all above fails.... then talk to your vet about starting a course of Tylan antibiotic (Tylosin Tartrate) https://epi4dogs.com/antibiotics/
Do NOT use Metronidazole (Flagyl) as it will kill ALL the bacteria in the gut and whereas Tylan will only inhibit the bacterial reproduction.... give for 45 days/twice a day.

Please share everything we are suggesting to you with your vet............
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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