New to EPI questions from the UK!

[scoozle]

Update on Oscar

After finishing antibiotics on 1st Feb he was great for a few days, then 2-3 days ago he's gone back to being very lethargic and slow, tail and head drooped all the time, unsteady back legs and can't jump up. When he's resting he is constantly shifting/fidgeting, like he can't get comfortable.

Stomach is making all sorts of gurling noises but his poop is almost the best it's ever been: solid, not too much of it, he doesn't seem to be straining.

Most worrying is in the middle of the night we have noticed him suddenly sit up and start panting rapidly. It only lasts for a couple of minutes, then he settles back down again but it's like he wasn't breathing?! I did a bit of middle of the night googling/searching on here and have seen a couple of people describe similar things but I'm still a bit lost.

We didn't restart his probiotics after he finished antibiotics, so even though his poops ok I might go get him some of the paste today to see if that settles his stomach a bit.

I'm going to try and get a call back from the vet today, if not then definitely on Monday.

Any thoughts on the panting in the meantime much appreciated though - we're obviously worried it's a sign of something more serious but could it be a reaction to the enzymes/B12s or SID/SIBO reccuring?

[jilbert57]

Hi Susie.
It sounds like maybe a tad bit of pain or a wave of nausea overtaking him at night causing him to sit up.

I am wondering with his high bile acids test result (24, reference <15) if he might be suffering gall bladder issues like sludge causing pain? Or a bile obstruction? For this you would need the likes of a sludge thinner like Ursodiol.
Mickey had this and it was painful. Usually diagnosed by abdominal ultrasound. Don't know if it would show on x-ray.

Jill

[scoozle]

Hi Jill, thanks so much for the reply. That's interesting re gall bladder. Oscar did get some omeprazole prescribed before we got the blood test results which seemed to help but he wasn't displaying quite the same symptoms then.

Weighed him again today and his weight hasn't changed despite being fed more for the last 10 days or so. Probably takes longer for them to gain.

He kind of just seems like he needs a bit of paracetamol or something!

We have ended up getting a vet appointment for later today. I'm probably going to end up using this thread as my own diary/log of our journey - grateful to anyone who reads/responds but apologies in advance for my rambling

On a side note I went down a rabbit hole on here reading about pancreatitis and the work of Dr Watson (https://epi4dogs.com/pancreatitis-to-epi/) and am quite startled at how similar Oscars history is to the following:

" Typically, dogs with low grade chronic pancreatitis will have a long history of occasionally going off their food, having colitis like diarrhoea and occasional vomiting. Some cases have had flare-ups of ‘acute’ pancreatitis or acute haemorrhagic gastroenteritis. "

This describes our last 2-3 years with Oscar almost exactly!

[jilbert57]

Yes I agree. Chronic pancreatitis can segue into Epi. Mickey had chronic pancreatitis for 3 years but he did not get Epi before he passed.

Please do address the high bile acid results and his sudden sitting up symptoms with your vet as possible gall bladder issues.

Let us know the results of your vet visit.

Jill

[scoozle]

We had a challenging rest of our weekend!

The vet asked us to come in on Saturday in the end and we went over everything that's happened the last couple of weeks. It wasn't his usual vet and they said the notes were a bit vague which wasn't reassuring!

Symptoms were: very lethargic, obvious discomfort when trying to rest, very weak and unsteady back legs, gurgling stomach, random rapid panting

They had a good look and then suggested Oscar might be stiff because it's cold and he's old and might have arthritis....................... I could have screamed! I appreciate vets are the experts but this is a dog that was chasing our other 8yo dog on a frosty morning last weekend, you don't go from that to unable to use your back legs in the space of two days from arthritis!! Sorry, had to rant!

Anyway, the vet did then say it was unusual to have an EPI diagnosis in an older dog, so I asked about chronic pancreatitis and they were a bit vague. In the end they wanted to do a blood test for pancreatitis but he hadn't been starved so they sent us home with paracetamol and we've been giving him 1/4 tablet every 8 hours. It doesn't seem to be having any effect.

Yesterday and today I have tried breaking his food into even smaller meals (5 per day) but I'm not sure if it's helped or made it worse. He is obviously quite uncomfortable after eating, burping, farting, stomach gurgling. But he still has a good appetite. It's difficult to do a body condition score with him because he has thick dark fluffy fur but he feels quite boney like he's lost muscle mass.

Had an isolated incident of diarrhoea yesterday and his poops have been inconsistent from runny to soft and lumpy to solid and I spotted a little bit of blood in them too. We've been using probiotic paste since Saturday but have just got our Chemeyes probiotic powder which we will start now.

Had a call back from his usual vet today (Tuesday) and she has given us some more omeprazole (antacids) and we've booked a blood test for Friday if Oscar hasn't improved by then. She does agree that chronic pancreatitis is probably the explanation behind his history, but did say it was odd to have a flare up as pancreatitis is the opposite of EPI? This didn't make sense to me, as after reading the info on EPI4dogs re pancreatitis and EPI it seems completely possible for an EPI dog to have a pancreatitis flare up? Would be interested to hear from any other older EPI dogs who struggle with pancreatitis

I did ask about gall bladder and sludge but our vet seemed to think it was unlikely and/or it was too difficult to tell what was causing the issue because it's all in the same area. Not hugely helpful but she did say an ultrasound would be the next step after a blood test if he's still bad.

Question re enzymes: Can you overdose on enzymes? I have been trying to split capsules between his small meals but then was worried he didn't have enough so today I've given him a whole one with 3 meals and two halfs, which is probably double the daily dose it says on the pack for his size.

I think I will try and go back to 4 meals tomorrow and maybe 3 by Thursday

Another question: because Oscar now has "lunch" he ends up needing to poop in the middle of the night!! Has anyone else had this problem?
He is not settling at night anyway at the moment unless he is on a bed with us so Doug and I have been taking it in turns to sleep on our sofa bed with both dogs to let the other one get a good nights sleep. We're both quite stressed, exhausted, and fed up

Fingers crossed the Omeprazole helps and we can get back to stablising his EPI routine without battling pancreatitis as well!!! Thank you again for this brilliant forum!

[Olesia711]

hopefully the omeprazole will help.
If not, ask the vet for Tylan (Tylosin Tartrate) it's a macrolide antibiotic that is for chickens, honey bees and pigs but used off label to treat SID/SIBO/Dysbiosis in dogs with EPI and/or Pancreatitis.... as it works on the small intestine and DOES NOT kill all the bacteria like Metronidazole. Tell the vet you do not want metro.

If the vet refuses to get and give Tylan (made by Elanco) and yes it IS available in the UK... but not easily to come by. then ask the vet for a course of Oxytet for 30 days instead.

[scoozle]

Thank you Olesia! I will definitely refer back to these suggestions if we get more runny poop. We have a tub of pre and probiotic powder now so hoping that will sort his gut out. I guess I don't know how to tell what combination of symptoms means what at this point. So grateful for this forum and website!

[Olesia711]

please keep us posted and we will help as best we can

[scoozle]

Thank you so much Olesia <3

We kept our vet appointment today because Oscar is still the same after a few days of omeprazole, ie very lethargic and weak on his back legs, still gurgling and farting!!

He has lost a bit of weight, down to 13.3kg despite eating enough for a 20kg dog! Vet checked him out and he's got virtually no muscle mass in his hips. I just don't understand when/how that happened so quickly

In this whole time he has never lost his appetite or had consistent diarrhoea and hasn't vomited once, which seem to be the signs the vet is looking for to signal how bad it is. But he is dramatically different to his usual self.

I asked about his B12 levels and whether they could be contributing to the muscle wastage etc and we decided to try a B12 shot. How soon would you expect to see effects of a B12 shot? or do you need to build up a few shots before you see a change? His B12 was 111 (200-600) on his test on 21st January

Vet said it was too soon to redo full blood test, so main thing is trying to stabilise/increase his weight at the moment and hope that he gets some energy and strength back.

[Olesia711]

sometimes it takes a few shots of B12 before you see improvement and yet others hae reported seeing an improvement right away, so it really depends on the dog.

I went back of the test results... and although poor Oscar apears to have EPI with raging SID/SIBO/Dysbiosis.... there were some other markers (low WBC, low Platlets, low Neutrophils, high Bile Acids and high GLDH along with back leg weakness)..... that i am wondering if the vet mentioned possible liver or bone marrow issues??????? if they did not..... maybe you can ask them about this. Unfortunately, sometimes WE have to be the advocates for our pets and not automatically assume the vet will exhaust all/any possibilities....................

The fact that Oscar is being lethargic with the above test results would prompt me to seek more answers from the vet... maybe ask them WHY they don't think that
"low WBC, low Platlets, low Neutrophils, high Bile Acids and high GLDH along with back leg weakness" is anything to worry about and pursue further............

And YES! although not very common older dogs do indeed get EPI. Years ago they didn't think it would happen,,,, but fast forward a few years and sure enough, we are now seeing older dogs all of a sudden develop EPI. Why?? i have not idea, except to say that it does happen .