Atypical case? Possible EPI but Vet not sure

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Wedge
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Country: United States
State: Pennsylvania
Pet name: Franklin
My name: Rob

Atypical case? Possible EPI but Vet not sure

Post by Wedge » 25 Mar 2023, 15:05

Full story: We adopted Franklin from a rescue at 8 weeks, the mother gave birth in the rescue to the litter. According to his DNA test his 3 leading breeds are lab, rottweiler, and GSD (with small amounts of boxer, Belgian Malinois and Great Pyrenees). He has always been thin, but the couple vets he's seen have always said he's just at the low end of normal for weight.

When we got him he had diarrhea. Seems the vet the rescue used knew that he was positive for coccidia and had put him on a couple rounds of metro but after we got him we took him to our Vet and he was diagnosed with both coccidia and giardia. Anti-parasitic medications (non-metro) were prescribed for both and his condition cleared up and follow up tests showed no more parasites.

Overall he's been a happy, normal pup. Grew to around 72 pounds by 9 months. At that point we noticed a little bit of change in his eating habits. Whereas before he would gobble down his kibble (Purina pro plan puppy, large breed, chicken & rice), he started eating more slowly. Sometimes he would eat some breakfast and save the rest till after lunch time. Other times he started not eating all his food, although he normally always ate his dinner. We never noticed any change in his activity level. But otherwise there was nothing that stuck out to us that required attention from the vet.

As he reached roughly 11-12 months, we noticed that his poops were getting looser. Typically he's out in the back yard and goes in the weeds & ground cover, not the grass, so this was most noticeable to us when we'd take him for walks (like 30 minutes, around the block type walks). When we took him in for his vaccine boosters, his weight was exactly where it was at 9 mos (72lbs). The vet was somewhat concerned by the diarrhea so we didn't give any vaccines and he recommended Hills prescription GI Biome food, chicken & vegetable. Unfortunately Franklin's taste for dry kibble hadn't really improved and when we took him back to the vet 2 weeks later he had lost 2 pounds. Dr recommended adding in some of the canned/wet version of the HIlls Biome food which we did, and Franklin seems to enjoy that and gobbles eats all of his breakfast and dinner. We're giving him 2.5 cups of dry and roughly 1/2 a can of wet at each meal (2 meals a day).

On the Hills Biome I feel like we saw a little improvement. The wet diarrhea had turned to more of a thick pudding, and at night, before bed, I would notice him take completely normal poops (2/3 on the scale). But his poops on walks were always stills like a 5, more of a mound with no definition. And if he had 2 poops on a walk the 2nd was pretty watery.

The Vet, at the first time we brough him in at 12 months also prescribed a one week treatment of metro (which I now know is not what is recommended here...but I didn't know that then). All the blood work and fecal tests came back normal.

After a month on Hills Biome the Vet ran the GI panel to test for pancreatic function and the like. Cobalamin and folate levels are normal (797 and 16.2, respectively), but TLI was 6.5 and PLI was 61. The Vet said that since TLI was normal, but at the very low end of normal, he suspected EPI and recommended we start enzymes.

I also brought Franklin in yesterday to get the vaccines that had been delayed. At this time he weighed 71lbs, so he seems to have gained back 1 pound over past few weeks.

So as of yesterday we started with enzymes, 1 Tbsp, twice a day in his food. Continuing with the Hills GI Biome food.

Franklin's poops up until this point have still been inconsistent. This morning I went out with him when he woke up and his poop was a total 2/3, completely normal. I just got back on a walk and his first poop was like 25% a 3, but then 75% a 5. 2nd poop was all 5 or worse. I figure we're probably a little early to see if Enzymes fully working or not since he's only had 2 meals with them so far.

So what do you think? Maybe his gut was just rocked by his early treatments for coccidia and giardia? He definitely has some good poops, but it's not consistent at all (although it was consistently fine for a long time before things started acting up around 12 months). Had a little weight loss, but maybe that was just because he didn't like 100% dry kibble and with adding wet he's eating full meals. His energy level has always been high and he's always been thin (but supposedly normal thin). His TLI is technically normal, but at the lower end. And we've never changed his diet away from a chicken based food to try and rule that out (it's been in the back of my head that we should just move him to a salmon based food or something like that and away from chicken).

I'm definitely willing to go the enzyme route since this is what the Vet is recommending...and it's too early to see if it's working. But this stuff is expensive, and I'm not sure if his pet insurance is going to cover it because TLI is technically normal (which seems like an easy way for them to reject the vet suggestion...or at least not be willing to pay for it).

Any ideas or suggestions are much appreciated.

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Olesia711
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Re: Atypical case? Possible EPI but Vet not sure

Post by Olesia711 » 25 Mar 2023, 15:24

It is possible that this is a case of your dog segueing into EPI... But... That being said there is also a very good chance that this is not EPI but rather something that imitates much of EPI symptoms.
My first question is.. has your vet tested for Addison's, my next question would be has your vet tested for possible A-Typical Cushing's. Be sure to have your vet check cortisol levels.
I agree with your vet about temporarily trying the enzymes.. but if you only see improvement for 1 or 2 eliminations.. and the rest show no signs of improvement.. then that most likely is not it...
Would like to hear more from you so that hopefully I can be of further help....
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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Olesia711
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Re: Atypical case? Possible EPI but Vet not sure

Post by Olesia711 » 25 Mar 2023, 15:33

Also.. while I am thinking of it.. we usually recommend 1 tsp of powder per 1 cup of kibble with enough room temp water added to moisten the kibble so that the enzymes can adhere to it... HOWEVER.. fiber in the food that you are feeding "may" destroy the efficacy of the enzymes from 0% to 50% depending on the individual dog and we just don't know from one dog to the next how much each dog may or may not be affected by this.
Also... It is possible, if this is not EPI, but rather a large bowel issue and since your dog kind of responded to the biome food earlier. That it might be that your dog simply need a hugh fiber food. Maybe try the smallest bag possible if royal canine high fiber gastro food vs the biome food.
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.........

Wedge
Member
Posts: 8
Country: United States
State: Pennsylvania
Pet name: Franklin
My name: Rob

Re: Atypical case? Possible EPI but Vet not sure

Post by Wedge » 25 Mar 2023, 15:52

Thank you for the quick reply. I looked back through the blood work but don’t think we’ve ever checked cortisol levels. My neighbors dog across the street has Addisons, randomly. Franklin did just have a small patch of hair grow back easily, but that’s my full knowledge of Addisons (and probably doesn’t mean anything, ha).

I just want to make sure I understand your comment about the food and fiber. Because we also feed 1/2 can of wet food with the dry kibble, the vet said we can just let the enzyme soak into the wet food for a bit before feeding. So I hadn’t planned to moisten with water. And because we’re feeding 2.5 cups dry and 1/2 cup wet per meal, I think that’s where the 3tsp (or 1 Tbsp) of powder suggestion is coming from.

If we tried Royal Canine high fiber, would you recommend not using enzymes at that time?

Wedge
Member
Posts: 8
Country: United States
State: Pennsylvania
Pet name: Franklin
My name: Rob

Re: Atypical case? Possible EPI but Vet not sure

Post by Wedge » 25 Mar 2023, 15:59

Also, not sure if this matters in terms of testing food alternatives. Royal Canin high fiber is 12.5% max fiber whereas the Hills Biome is 9%. But his regular food before all this was just ~4.5%. So the Hills food is already kind of high fiber, just not as much as the Royal Canin.

Wedge
Member
Posts: 8
Country: United States
State: Pennsylvania
Pet name: Franklin
My name: Rob

Re: Atypical case? Possible EPI but Vet not sure

Post by Wedge » 25 Mar 2023, 16:06

Apologies. One thing I forgot to mention is that we were also advised to add a packet of Fortiflora powder for additional probiotic support. Will this interfere with enzymes?

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Olesia711
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Re: Atypical case? Possible EPI but Vet not sure

Post by Olesia711 » 25 Mar 2023, 17:49

I will respond in detail in a few hours.....
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.........

User avatar
Olesia711
Founder & Research Director
Posts: 3858
Location: North Carolina
Country: United States
State: North Carolina
Pet name: Izzy
My name: olesia

Re: Atypical case? Possible EPI but Vet not sure

Post by Olesia711 » 25 Mar 2023, 19:46

Okay, now I can talk.. so sorry for the stop, go, stop responses.. I am away at a vet conference right now and it was difficult for me to fully respond at times.
SOOOoo.. first, please be sure to share with your vet EVERYTHING we suggest to you! The best treatment for your dog is when everyone works together.
Going forward...
1. Try the enzymes, as your vet suggested, for a week. The ratio (enzymes to food amount) you are doing is correct. Thank you for explaining about the wet food added
. Again you vet is correct, this is enough moisture for the enzymes..so no need to add any water..just make sure you mix the enzymes in the wet food and then mix in the dry food.
2. If the poos do not show any improvement.. then, of a confirmed EPI dog, I would suggest otherwise, but since Franklin is not EPI confirmed.. then next I would try a different food with the enzymes, & forti flora.. try a low fiber food with no peas.. buy the smallest bag possible..maybe try Castor & Pollux pristine beef and sweet potato at 3.5% fiber content.. be sure to first mix 1/4 new food with 3/4old food.
Next day try 1/2&1/2
Day after try 3/4 new food 1/4 old food
Then 100%new food.. try this for 5 days..
If this works, then it means that the enzymes were helping ,but that the fiber in the old food was interfering with the enzyme efficacy.

3.If this doesn't work then the next thing to try is stay on this regimen BUT stop The forti flora.. try stopping the forti flora for 3 days.
If things improve, then this probiotic wasn't agreeing with franklin's gut flora
.
If this doesn't help things, then the next step is to go in a different direction....

4.This is when I would next try a high fiber food and no enzymes..the biome is not that hi in fiber, but loaded with prebiotics.. which you already tried...
So I would next try the smallest bag possible of royal canine high fiber prescription food... With no enzymes.
Just to see if possibly the issue is that more fiber is needed.

If the above doesn't work.
5.THEN I would talk to your vet about testing cortisol levels.. whether Addison's or even possibly A-Typical Cushing's... Both of these conditions are great pretenders and can mimic other conditions.

Sorry for all the try this, then that, etc... BUT.. a lot of figuring out certain gastro issues can be a lot of trial and error.. and I am trying to give you a step by step plan what to try and in what order... And hopefully this will help.

The problem with enzymes and fiber which is what you are doing now is that fiber can destroy the efficacy of the enzymes from any where between 0%to 50%... Unfortunately we have no idea which dog may be affected and if affected we have no idea by how much for that dog, this is why we suggest low fiber food to begin with, but this too can be changed if fiber is agreeable with the dog.

Ditto with probiotics.. probiotics are typically one size fits all.. unfortunately dog gut flora are not all the same, so there can be a lot of trial and error especially if there is some sort of gastro health issue going on.

It sounds like your vet is on top of things, he did all the right tests so far, and is open minded.. this is all good. Again share with your vet my suggestions and please keep us posted. ... As we will help you as best we can.

Oh, and last detail... Start keeping an EPI log.. this will greatly help you and your vet better ascertain what might be going on with Franklin
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.........

Wedge
Member
Posts: 8
Country: United States
State: Pennsylvania
Pet name: Franklin
My name: Rob

Re: Atypical case? Possible EPI but Vet not sure

Post by Wedge » 25 Mar 2023, 20:21

This is great and very clear. Thank you very much. I’ll be sure to follow the suggestions and report back.

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Jean
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Re: Atypical case? Possible EPI but Vet not sure

Post by Jean » 27 Mar 2023, 04:11

Good Morning from the UK

This is a website which I love that explains what Olesia was saying about fibre , especially for me !

https://www.petmd.com/dog/wellness/evr_multi_soluble_fiber_for_epi

but then again if this isnt EPI then its just interesting

Are you going to get tested or am I mis reading


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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