Complicated EPI Case

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mbellant
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Posts: 7
Country: United States
State: Colorado
Pet name: Konan
My name: Miranda

Complicated EPI Case

Post by mbellant » 15 Mar 2023, 11:33

Hello everyone,

I am new to this forum but have been reading up for the past 4 weeks. My 4yo GSD was just diagnosed with EPI, but it is a more complicated case. 6 weeks ago he underwent emergency surgery for a mesenteric torsion and colonic torsion and miraculously survived. No bowel even had to be resected. 2 weeks later he went back into surgery because they thought he had another torsion. Thankfully it ended being only a severe ileus. While they were in there though, they noticed his pancreas was atrophied and took biopsies. He came back positive for EPI and his bowel biopsies were positive for IBD. The thought is he had subclinical EPI most of his life and things spiraled after the mesenteric torsion. This is where it gets tricky. Our dog, Konan, has always been a finicky eater. His body habitus was always thin, but not cachectic like your typical EPI dog I've seen. He has been prescribed a prescription diet Purina hydrolized, which he will not touch. The only thing he wants to eat is raw meat. We have been doing enzymes religiously with him 1 tsp per cup of food of the Enzyme Diane 6x. He is also on Reglan 20 mg twice a day, a probiotic twice a day. He goes between great formed poops to the runny poops. He is still vomiting every 2-3 days and we can't seem to put weight on him. He is getting loaded with Vitamin b12 shots weekly. He also is getting an appetite stimulator and is on Prednisone 30 mg for his IBD.
We are really struggling trying to get him healthy and seem to be running out of options. He doesn't appear to be gaining any weight. We have started to do syringe feedings with him so his stomach isn't empty. In addition, he has been on Slippery Elm for the past 3 days. Last night was the worst vomiting he has had but he is still stooling, so another ileus is unlikely. Any advice would be appreciated.

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Olesia711
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Re: Complicated EPI Case

Post by Olesia711 » 15 Mar 2023, 12:48

Hi Miranda,

Thank you for writing in about Konan's issues and for providing details... that helps a LOT!. he certainly has been through a lot recently!!!!
I would like to offer some suggestions.

First, as long as he does not have a serious sensitivity to any of the raw food / protein that you are feeding him (and that he prefers) raw often is more agreeable with many EPI dogs, especially those that won't eat kibble. Are you able to rotate the meats somewhat?And have you been able to determine that there is not a sensitivity to any of the proteins that you are feeding ? Also.... are you cutting up the meat into small enough pieces? Maybe "mincing" the meat... that would be best if possible and also add a tsp of water when mixing in the enzymes and letting it all incubate for 15-20 minutes............

Some things to try one-at-a-time.
1. Next... can you sneak in some baked, skinned sweet potato to mix in with the meat, or will he refuse it? Just wondering if a little controlled fiber will help cause what you are describing sounds like uncontrolled SID (small intestinal dysbiosis)...

2. It sounds like your vet prescribed the Reglan to help with the vomiting and stomach acid (most likely from SID) ..... but it sure doesn't sound like it is working.... it is also possible that Konan could be having an adverse reaction to the Reglan. So... i am going to recommend something, but you need to talk to your vet and get his approval. We have another case where the EPI dog has forever had trouble eating, nothing seemed to help until we tried a specific live probiotic that is very similar to Visbiome (which we often recommend for a probiotic) but this probiotic, Kepro for Pets
https://keproforpets.com/
is more broad whereas the Visbiome is more targeted. And the dog is finally eating it's entire meal. If your vet does agree for you to stop the Reglan (for now) and "try" this Kepro probiotic, please be sure to start with less than half the recommended dose and work your way up to a full dose over the course of a week. Just PLEASE get your vet's approval to try this product, especially since you dog has been through so much recently with torsion.... there may be some supplements that may not be safe for you to try.

3. OR.....ask the vet if you can stop the Reglan (for now) and have him prescribe a course of Tylan (Tylosin Tartrate antibiotic powder) twice a day for 45 days with a meal (you can enclose the bitter tasting powder into empty gel caps and administer this way near a meal). Please explain to your vet NOT to use Metronidazole (Flagyl) as Metro kills ALL the bacteria in the gut flora and some of these bacterial strains can never be replaced no matter how many probiotics you give the dog.... and the problem with this is that EPI dog don't have enough gut flora bacteria and they also don't have enough of a variety of bacteria in their gut flora.... hence why Tylan instead ..if pre+probiotics don't work.. as Tylan inhibits the reproduction of more bacteria, so short term, it does not destroy bacterial strains.

4. The other thing you can mention to your vet is that with EPI dogs, they have a bile acid dysfunction.... when "noticeable" we treat. Often the best results are obtained with Omeprazole.... but again, your vet will have to work with you to determine exactly how much to give.

BTW...If the SLippery Elm has not helped in 3 days, then stop it... SLippery Elm (if it is going to work) is very effective and works quickly... but if you do not see any results in 3 days, then stop. And there also is a slim possibility that the prednisone is triggering adverse reactions.... but that is something that you and your vet will have to determine.... i am just throwing this idea out there as a remote possibility, cause we have seen this happen, rarely, but it does happen....

Just from reading your post, although i can't say with 100% certainty, it does sound like Konan's issue is uncontrolled SID.... something that ALL dogs with EPI have.... and even though we can't eradicate SID, we do our best to get it under good control.

Also.... i am including an attachment that share the ingredients of the Kepro for Pets, for your vet to review
KeproFor Pets ingredients.docx
(456.71 KiB) Downloaded 29 times
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.........

mbellant
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Posts: 7
Country: United States
State: Colorado
Pet name: Konan
My name: Miranda

Re: Complicated EPI Case

Post by mbellant » 15 Mar 2023, 13:23

Thank you for your input! As far as the Reglan goes, it does seem to help and the vet did just increase his dosing from 10 to 20 mg BID. He is on this due to his history of severe ileus. She thinks he may not be emptying his stomach well, causing the nausea. She doesn't want to start an antibiotic yet due to his age and she thinks moving things through his gut is the most important aspect considering his history. She would like us off the raw diet if possible due to his IBD. She wants the low fiber, easily digestible food. She thinks his nausea is due to his slow gut motility.
Konan really likes a variety of food. He won't eat the same thing for more than 2 days in a row. Some days he will eat sweet potato, other days not.

I do wonder if we, as pet owners, are contributing to the problem by giving him what ever he will eat instead of letting him be hungry and trying to get him to eat the prescription diet. Has anyone had any success with not feeding to the point they get so hungry they will eat anything? I am afraid we created this "picky monster." Yet, I HATE seeing him not eat.
His case is difficult because he has IBD, EPI, delayed gastric emptying and slowed intestinal motility, most likely SID, and when we get one thing under to control, the other condition acts up. I don't know what the correct balancing act is and how we manage all of these conditions at once.

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Olesia711
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Re: Complicated EPI Case

Post by Olesia711 » 15 Mar 2023, 13:51

Ahhhh... thank you so much for mentioning that the Reglan does help and that your vet suspects delayed emptying..... in this case, skip the Kepro probiotic suggestion but do talk to your vet about trying Tylan tartrate antibiotic powder..... it is a Macrolide antibiotic (just like Erythromycin) which is a macrolide antibiotic and macrolide antibiotics can actually help with delayed motility "Researchers eventually determined that erythromycin stimulates motilin receptors in the GI tract. Motilin receptors stimulate GI contractions and result in increased GI motility. This medicine also increases stomach-muscle contraction and may improve gastric emptying.7"
https://www.frontiersin.org/articles/10.3389/fendo.2021.700884/full

I am so sorry your dos is struggling with this.....but now i understand WHY your vet wants your dog on the hydrolyzed kibble.... would it be possible to grind up the raw meat and "initially" include with the hydrolyzed kibble? Just to get Konan to start eating the kibble?

If not, then ask your vet, if it would be agreeable for you to try the following.... buy some freeze dried liver, take a dehydrated liver cube and shred (shred like you would shred a carrot for carrot cake!) some on top of the hydrolyzed kibble..... when shredded, it comes out like a dusting...... most dogs LOVE liver and this is a trick to get them to eat foods they don't like.......but is good for them ...
liver.jpg
liver.jpg (43.33 KiB) Viewed 746 times
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.........

mbellant
Member
Posts: 7
Country: United States
State: Colorado
Pet name: Konan
My name: Miranda

Re: Complicated EPI Case

Post by mbellant » 15 Mar 2023, 14:03

Konan was on a Macrolide during his hospital stay to help with motility, so I will definitely bring it up at our appt next week. Thank you so much for the suggestion.
I just ordered the Stewart treats. Love Amazon same day delivery. I am open to try anything to get him to eat. Thank you again.

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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: Complicated EPI Case

Post by Olesia711 » 15 Mar 2023, 14:06

hopefully putting a liver "dusting" on top of the needed hydrolyzed kibble encourages Konan to eat... but do ask your vet if okay to do... especially if it works and you want to do it with every meal.............

Please keep us posted!!!!!!
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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Michaela
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Posts: 148
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Re: Complicated EPI Case

Post by Michaela » 16 Mar 2023, 08:38

Konan sure has been through a lot. Texas A&M IM put Nikki on Cisapride, maybe you could ask your vet about it?

https://www.vin.com/apputil/content/defaultadv1.aspx?id=3843799&pid=8708&print=1
https://todaysveterinarypractice.com/gastroenterology/gi-intervention-approach-to-diagnosis-therapy-of-the-vomiting-patient/

R.I.P. Nikki 11/21/2009 - 05/23/2023

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."

mbellant
Member
Posts: 7
Country: United States
State: Colorado
Pet name: Konan
My name: Miranda

Re: Complicated EPI Case

Post by mbellant » 16 Mar 2023, 10:01

Thank you for those articles, those are a great resource. After Konan's mesenteric torsion, he was placed on Cisapride and still developed an ileus, which is why we switched to the Reglan. \. After looking through those articles you sent, I will ask my vet about an H2 blocker for him. Thank you again!

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DocX
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Re: Complicated EPI Case

Post by DocX » 16 Mar 2023, 18:45

Hi Miranda,

I have had previously a dog with severe IBD and currently have dog with EPI. I am sorry you are dealing with both at the same time. Do you know whether Konan has lymphoplasmic, eosinophilic, or some other IBD subtype?

My experience has been that with both (IBD) and (EPI + the accompanying small bowel bacterial overgrowth it causes), my dogs were very smart, so they were very prone to food aversion because eating was making them feel terrible. So they would be very hungry and up for trying a new food, and then they would eat it for a day or two with rapidly diminishing enthusiasm, and then they wouldn't eat that thing at all but might be up for something else (because they were convinced that whatever they had been eating lately was responsible for making them feel awful). I definitely relate to feeling like you are creating a 'picky monster'.

For both my dogs, when I fixed the underlying problem so that food was no longer making my dog feel terrible, they stopped being picky monsters. For my EPI dog with SIBO it took about a month of cooking all her meals and slowly working dog food back in.

I completely appreciate how upsetting it is when your dog won't eat. Something I didn't appreciate nearly enough myself when my dog was first diagnosed with IBD is how important diet can be in canine IBD management, and how feeding an IBD dog a protein that their immune system is sensitized to is like adding fuel to a fire. Some IBD dogs need to be rigidly adherent to hydrolyzed diets forever, while others do OK as long as they are eating a protein source their immune system does not react to. When IBD is badly controlled, dogs are more prone to developing new sensitivity to whatever they are eating because their guts are so inflamed, so feeding hydrolyzed especially when they are flaring is a good idea if you possibly can, because it's the only food source that can't possibly be contributing to gut inflammation. There are multiple types of hydrolyzed kibble and they also come in cans. When my IBD dog would flare, I would feed her cans for a few days to help her get past her food aversion.

If you have access to an internal medicine or GI specialist vet referral hospital, I'd highly recommend it. I've also personally found that cerenia and entyce are both incredibly useful tools for helping my dogs get past food aversion.

With so much empathy your situation.
-DocX.

mbellant
Member
Posts: 7
Country: United States
State: Colorado
Pet name: Konan
My name: Miranda

Re: Complicated EPI Case

Post by mbellant » 17 Mar 2023, 09:47

Hi DocX,

Thank you so much for your post. I will ask my vet about if he has an underlying IBD subtype, as biopsies were done. The way you explain your dogs is exactly how Konan is acting. He only will eat a food for a day or two and then completely avoid it. The ONLY thing he will always eat are Nub bones. Did you have a certain protocol with introducing foods and what you cooked for them? We haven't tried the prescription hydrolyzed can food, but I will go out and get some today.
Thankfully, Konan's care is being managed by an Internal Medicine Vet. I have another appointment with them in a week and will definitely bring all this up. Thank you so much again for your insight and sharing your experience.

Miranda

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