5 month old puppy with all symptoms and normal test

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.
Mooncloud
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5 month old puppy with all symptoms and normal test

Post by Mooncloud » 10 Nov 2022, 20:54

I have recently bought an old English puppy. For weeks, he has had on-going soft stools and diarrhea that smells terrible, flatulence and he’s thin. I can hear his stomach grumbling when brushing him. I transitioned him to a sensitive stomach food that had completely different protein source (fish). No improvement. Took him to the vet and she did a complete blood panel, fecal, SIBO test and TLI test with folate and B12 (full GI blood panel). She gave me a course of dewormer. Didn’t work. I put him on boiled chicken and rice for 5 days to get the diarrhea under control. He had the best poop ever on that! Solid poop. I slowly transitioned him back to his regular food and smelly diarrhea returned within a few days. He is thin but not terribly so, but he eats 4 cups per day and at one point was up to 5 cups bc I was trying to put weight on him. Upping food above 4cups per day makes his normal ‘soft-serve ice cream’ poop turn to liquid diarrhea. On walks he just stops and poops diarrhea in the middle of the side walk.
He is 6 months and his TLI came back within normal range, 11. Just on a hunch I started the enzymes like he had EPI. I’m giving him 2 teas with 2 cups of food. Within one day his poop was better and by day 2 his poop was totally normal. He is responding so well to enzymes but EPI test was normal.
I wondering if there is another disease that would respond to enzyme treatment and mimic EPI?
He has another appointment with the vet in about a week. Should we retest or wait a few months? His last test was after 20 hours of fasting. Would fasting too long effect the test?

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Olesia711
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Re: 5 month old puppy with all symptoms and normal test

Post by Olesia711 » 11 Nov 2022, 11:41

Hi,

So glad you decided to try the enzymes. We have seen this more often than what we would like... The dog is tested for EPI with the TLI test... test results comes back in the teens... so clinically not EPI, but yet all the typical EPI symptoms continue. When given enzymes ... they help. Fast forward 6 months to a year later and the dog is retested and is confirmed with EPI.

You are doing the right thing, . continue with the enzymes...let your vet know, keep an EPI log to monitor things, but do retest for EPI in about 3 to 6 months.

If the physical symptoms continue, your dogs will edge into SEPI (sub-clinical EPI)... in other words not clinically EPI yet but something is going with the pancreas. WHat i can share with you, is the massive EPI research that we have been involved with over the last 5+ years, although not yet published, one thing that i can share is that approximately 50% of those that become SEPI dogs (from the research) went on to develop EPI, while the other 50% didn't.

The good thing about the enzymes is that if not needed, it won't hurt, short term. What you don't want to do is keep a dog on the enzymes (if not needed) long term... for example a year or more.........

In the meantime, the other conditions that can mimic some of the EPI symptoms, if this does not eventually turn into EPI is.... small intestinal proximal disease, IBD, IBS, PLE, Pancreatitis, and unfortunately the list goes on and on... cause the physical EPI symptoms are common to so many other conditions... even tick disease and or some Cushings or Addisons conditions........... but when your vet tests for things and nothing else shows up, keep EPI on the back burner, as it may be brewing............

So... for now, talk to your vet, share what is going on and what we are suggesting, follow the suggested EPI protocol, and re-test in the near future.
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.........

Mooncloud
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Re: 5 month old puppy with all symptoms and normal test

Post by Mooncloud » 11 Nov 2022, 12:07

Thank you for responding! Vet did mention Addison’s disease but we ruled that out from blood work. I thought about IBD but his diarrhea/soft stools are so consistent, and he did so poorly on the limited ingredient diet for sensitive stomachs. He never had solid stools except on boiled chicken and rice diet. We are on day 4 of enzymes and still not one episode of diarrhea. His poop is now a little lighter colored than my other dogs and a little softer but still very scoop-able. (It’s awful to go on walks and have him poop a soft pile in the middle of the side walk that is super smelly and completely unscoop-able 🥹)
It is hard to not have a definitive answer nor a diagnosis. I guess I’ll ask for a retest in several months

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Olesia711
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Re: 5 month old puppy with all symptoms and normal test

Post by Olesia711 » 12 Nov 2022, 20:10

i know this is going to sounds counter intuitive.... to what we normally suggest.... that fiber may reduce the efficacy from anywhere between 0% to 50% of the enzymes... BUT... we have had some dogs that don't do well at all UNTIL you add some fiber.... so... it won't hurt anything if you try adding some boiled rice to his meals and see if that improves or worsens his poo.............. he just might need more fiber.... and rice is a good place to start.
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.........

Chance
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Re: 5 month old puppy with all symptoms and normal test

Post by Chance » 12 Nov 2022, 22:50

I'm by no means an expert; but I have learned that EPI can be "borderline" for a long time. During this time, tests can be in the lower range of normal, or even a little better. Blood work is by no means an exact science, as many vets or doctors would have you believe! During this stage, a dog might be "okay" other than weight loss. They still aren't getting in as many nutrients as required for the body to thrive...especially a puppy!

My dog was very thin his entire life. Could not get weight on. Poops were okay. Later weight loss became more of a problem. A big problem. Poop still okay. I was even told "there's only one reason a Lab would be underweight. Neglect "! This was an emergency vet I had gone go when he was sick. They debated whether they would release him into my care! I did say, "I brought him here because he is sick, knowing full well my wallet will be a minimum $1,000 lighter! If I was neglecting him, would I still be here "? And I did tell them, if you do choose to keep him until you can speak to my vet, you have to let me go back to bring you food. He cannot tolerate your prescription diets. And he's on a high calorie food. And whether or not you choose to release him, I still want to try to get help for him tonight. I don't want him to lose more weight while you decide if I am suitable or not. They ultimately did release him; but I had to argue for treatment...after all, Neglect was already diagnosed! (My vet called me in the morning and apologized on their behalf, and apparently made them note on his file that he's got a weight problem). Weight problem...but they never would check for a reason. Other than being so thin, he was seemingly healthy! I wish I knew then what I know now. I'd never heard of EPI.

Anyway, point is, it happens! It wasn't until later that he started pooping out food. I feed a raw diet. I could see the meat coming out as meat. Looked exactly the same as it went in. Knife marks still visible on the meat. I called the vet, who wasn't concerned, as long as it improved. I was concerned! I started researching causes. EPI came up. I saw he had every symptom! I called the vet and said I know Chance has EPI, and it's killing him. I want him checked now. He tried reassuring me he was fine. He just needs to eat more. I argued I've heard that for a long time! Now please listen. Stop and think for one minute! He is 20 lbs underweight. His body is eating his own muscle to survive. He's pooping out pure food! I can clearly identify what meal is pooped where. Feeding more is NOT going to change that! FINALLY a light bulb goes off in his head. He finally agreed EPI would answer a lot of questions. He finally agreed testing was worthwhile.

Later he said he would have had it his entire life. There was enough digestion he could survive and be OK. But not enough that he could maintain a decent body weight. Until now, for whatever reason, the pancreas virtually stopped pumping out any enzymes.

Anyway, we did have a gauntlet of tests done before. Pancreatitis ruled out with blood work and ultrasound. Ultrasound and biopsies confirmed there was no IBD. No tumors. So we do know that it's *only* EPI Chance has.

But in your case, I assume you did not check for IBD, and your vet raised that question. So that may be possible! And if it is the problem, enzymes can definitely help in the interim! If there is inflammation in the intestines, digestion is often reduced. Adding enzymes will help improve that. And one day, if and when you find the best diet for him, the inflammation may go down enough that enzymes are no longer required.

If it is EPI, then enzymes are always in your future. And it's likely that repeating the blood work one day down the road will confirm your suspicion! Vets aren't always infallible. And only you can advocate on the pup's behalf.

Ok. I'll shut up now. I've bored you to tears. Go back to sleep 😇

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Olesia711
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Re: 5 month old puppy with all symptoms and normal test

Post by Olesia711 » 13 Nov 2022, 13:15

Good post Andrea.

YES... sometimes EPI is like a slow boil....... where as other times it happens because of something (like chronic pancreatitis, blockage, etc...).... but in either case, if all the symptoms are EPI-like, and yet the TLI test says not EPI.... continue to test for other possibilities... but do re-test for EPI in the future.
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.........

Mooncloud
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Pet name: Chuckie

Re: 5 month old puppy with all symptoms and normal test

Post by Mooncloud » 25 Nov 2022, 22:22

Thanks for all the helpful advice. The vet suggested stopping the enzymes and trying a prescription food: Purina EN. It is low fiber, 2% and lower fat 10.5%. He is a puppy and eating 7 cups a day. So far, only a couple days, he’s been really good on it. No diarrhea.
He is still negative for EPI but responds to treatment for EPI. I plan to retest in the coming months.
He’s a large breed puppy, so I’m not sure keeping him on Purina EN with low fat and lower protein, 23%, is better for his growing body verse the regular food with enzymes added? He does really well both ways; meaning no problematic symptoms with both options

Chance
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Re: 5 month old puppy with all symptoms and normal test

Post by Chance » 26 Nov 2022, 03:37

I'm probably in a minority here; but I have 2 very firm rules set for myself. I will never give one cent to anything Purina, nor anything Mercola. Purina (and most prescription diets) are mostly fillers and contain carcinogenic preservatives. Fillers have no nutritional value at all; so they are just pooped out. Having said that, there *may* be rare circumstances where prescription diet is useful. But most often, I look for safer/cheaper alternatives.

Personally, I feed a homemade raw diet. I have 100% control of every ingredient. My only preservative is my freezer. With raw, it's so much easier to control stool quality. Poop too soft, add more bone (ground meat/bone is fine). Poop too hard, add extra offal (organ meats).

On a couple of occasions, we've had a SIBO setback quite badly. During these times, I have cooked the food fora couple weeks,
(aiming to reduce fats, as I am told bacteria feed off of fats during a SIBO flare).

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Michaela
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Re: 5 month old puppy with all symptoms and normal test

Post by Michaela » 27 Nov 2022, 09:00

Chance: Where are you getting your information about prescription diets? Will you also be sharing all the RISKS associated with feeding raw meat?
Nikki was diagnosed with EPI in 2010
Royal Canin Gastrointestinal Low Fat canned
Slippery Elm syrup for stomach issues
1 tsp Pan-Tenex enzymes with each meal
Weekly B12 shots, pills didn't work for her
Tylan for life


"If there ever comes a day when we can't be together, keep me in your heart, I'll stay there forever."

Chance
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Posts: 149
Country: Canada
Pet name: Chance
My name: Andrea

Re: 5 month old puppy with all symptoms and normal test

Post by Chance » 28 Nov 2022, 01:49

I've been researching canine nutrition for many years. Consulted with a couple of holistic vets and canine nutritionists. Registered for several nutrition podcasts. There is also tons of information online; just gotta filter through what is accurate or partly accurate.

Many foods list corn or corn meal as one of the main ingredients. Corn is not easily digested, and has zero nutrition value. So this is one example of a filler.

Ethoxyquin is one example of a carcinogenic preservative. (BHT and BHA are others). These are banned from human foods because of the risks; but is still legal for pet foods. Some companies like to "skirt the truth" by omitting the names on the bags. Legally, they only have to list ingredients they add. But if their suppliers add it, it's still there, but doesn't have to be printed. (If you contact a manufacturer, they will tell you if their suppliers add it or not. Diamond is one company I did contact a few years back. They did confirm that their fish and meat suppliers do preserve with ethoxyquin. This was back a few years, so I can't say if it's still that way).

As for risks with raw feeding: Raw feeding is not for everyone. There are certain conditions for which raw feeding is NOT recommended. For most, it's fine. Dogs and cats (Coyotes, wolves and large cats included) have enzymes in their saliva that neutralizes some of the bacteria. (Humans lack these enzymes. E coli and streptococcus are just a couple of examples of bacteria dog's saliva can kill). Certain bacteria, such as salmonella poses little risk, as the digestive tract is short enough that bacteria does not have enough time to reproduce. Spoiled meat of course might already contain dangerous bacteria load. (Human digestive tract is much longer, thus we are more at risk). If you go back and look at any of the dog food recalls for salmonella, you will see that the risk was for humans, but very little risk to pets. But it's always wise to know where your meat is sourced from, and how the animals were cared for; as this can affect quality of meat and nutrient value.

Another way to reduce risk with raw meat is to deep freeze for a minimum of 3 days. I very, very rarely feed meat that has not been frozen at least a week.

Again, I don't propose that *all* dogs should be fed raw. Risks are not zero (but then it's not zero with kibble). However for most healthy animals, Risks are very low.

But I always recommend people do their own research. Feed what you are comfortable feeding. I'm by no means suggesting that anyone is wrong to feed what they feed. It's just not what I am comfortable feeding my pets.

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