Advice prior to EPI testing

[Kay Pups]

Hello,

My almost 9 year old Standard Poodle, Lilah, has a history of what we suspect to be pancreatitis - occasional episodes of low appetite with some vomiting and abdominal tenderness. She was seen last by the vet approximately a month and a half ago for similar issues, including rejecting food and acting withdrawn for a few days. Bloodwork all came back looking good, minus some elevated liver enzymes that the vet thought indicative of pancreatic issues. She wasn't tested for EPI at that point, was stooling normally, and after a week or so of a bland diet we were able to transition her back to her normal food (Simply Nourish grain free lamb). She did well for approximately a month, and now for the past week she's had watery / cow pie stool that is almost bright orange in color and with undigested food visible in it. I fasted her for approximately 24 hours and then started her back on a rice/cottage cheese bland diet to see if that would resolve the diarrhea, but her stool has been largely unchanged (she did have one half-formed brownish-orange stool and I hoped the diarrhea was resolving, but then it immediately went back to the orange cow pie stool). Her activity level is fairly normal for her, perhaps just a hair more reserved than normal, but she's tolerated her walks well. She however has started having a bowel movement mid-walk, where for the past eight years of owning her, she has NEVER gone potty while on a walk, only ever in our backyard. She also had an accident in the house overnight, which is only the second time she's ever had issues holding her bowels overnight. She also lost 2 lbs between Nov 20 and Dec 20 vet visits, and I think she's probably lost a bit more weight, but I don't have a scale for her at home.

I'm planning on calling the vet first thing Monday to get an appointment (I was hoping this would clear up, and then the holidays mean they had a shortened week last week) but I'm hoping for some advice in the meantime. I did read through the site information, and I'm very glad that you've put together such a wonderful resource for this disease. I know diets are very much per dog, but is there a general recommendation on what to feed prior to getting enzymes? Unfortunately I don't have anywhere near-by I could get emergency enzymes from, and I know she won't absorb much food in the meantime. Is rice and cottage cheese okay for now, should I mix in some of her regular kibble? I also have plain pureed pumpkin I can swap the rice with, if rice isn't suggested for fiber.

Between her activity level being okay, her still drinking plenty of water, and no blood in her stools, I haven't taken her to the emergency vet - but what would be the signs to take her in instead of waiting for our normal vet? Lethargy, bloody stools, the normal warning signs of serious issues?

Thank you, and again - it's absolutely wonderful that this site exists as a resource for this very nervous dog dad!

Kay

[Olesia711]

Hi Kay and thanks for writing in about Lilah. SO sorry she is having these issues and it does sound like it can very well be EPI. EPI can happen as end stage chronic pancreatitis.... so this sounds very likely... however... it is a very good plan to bring her to the vet next week and confirm or not with the proper TLI blood test because EPI symptoms can also mimic many other conditions.

SO.... when you schedule Lilah for the TLI blood test, be sure to food fast her 12 /+ hours prior to the blood being drawn. And while they are drawing the blood ask your vet (if you are willing) to also draw enough blood for a Cobalamin (B12 blood test) as over 80% of all EPI dogs have insufficient B12 levels and you will want to know if Lilah is one of them so that you can also take care of this too.

SO.... to answer your food question.... i'll start with the easy explanation first .
AFTER you start the enzymes, THEN you will want to "start" with a low fiber content food simply too much fiber and/or the wrong kind of fiber can destroy the efficacy of the enzymes from anywhere between 0% to 50%. The problem is that we don't know which dog is affected by what %. SOOOooo... this is why we suggest in the beginning and once on enzymes to initially avoid food with any grain in it, and watch the fiber content %...Many of our EPI dogs do MUCH better with a fiber content of 4% or even less like 3.5%. Also, once on enzymes don't limit the fat (unless another health condition requires low fat)... but rather just feed normal amounts of fat. Not only do EPI dogs need to replenish the weight they lost via fat, but normal amounts of fat actually helps process the enzymes more efficiently in the body.

HOWEVER.... before you can put the dog on enzymes and if you do suspect EPI.... then you do things differently. Because without enzymes, the dog is having trouble digesting fat, limit the fat in the diet. And yes, feed food with normal amounts of fiber in it (since the dog is not on enzymes yet) because the fiber (especially prebiotics) will help with the ever present dysbiosis... whether this is EPI, or IBD. However, just don't over do. The other thing is to not feed large amounts of food all at once... but rather, if you can, feed smaller portion meals just more meals through out the day. (this smaller meals but more often is also advised once the dog is confirmed with EPI).

Because you have not started the enzymes..... YES! Rice is okay, cottage cheese is okay (as long as she doesn't have an issue with dairy. You can even try giving a scrambled egg every couple of days, you can add cooked, skinned and defatted white chicken meat.... and sure try give some of her kibble..... just remember not to overload. Less is better- -just cover to total amount via multiple smaller meals.

When to take to the vet??? I don't even worry about bloody stools as long as the blood is bright red.... this can happen with SID (dysbiosis) or colitis, and both can wait until regular vet office hours. BUT if the blood is dark red... then take her immediately to an emergency vet.

The other symptom i do not wait around on is if they start acting very lethargic, take them to the vet ASAP. If may be no big deal, but lethargic symptoms can also be serious.

IN the meantime, if you have any slippery elm powder, you can try giving a little bit of this... Sometimes, this will abate the loose stools for a while until you start a proper treatment regimen for EPI.

I hope this helps a little.

[jilbert57]

You say suspected Pancreatitis. Did she ever have the test specific for lipase released from the Pancreas? The cPl?
Mickey had chronic pancreatitis for a couple years. His cPl stayed >800 but with the implementation of dianes enzymes his Tli went from >50 to 25.

Jill

[Kay Pups]

Thank you so much for the information Olesia! I'll go ahead and try offering some kibble mixed in then, and try to get her into her normal vet as soon as I can. It's definitely not a fun process, but there's a lot of relief if it turns out to be EPI vs something harder to deal with. It's just hard to be unable to do much for her in the meantime.

Jill, I'm not sure exactly which blood tests were run. I think it was more of a general liver panel that indicated pancreatitis, but I'll check with my vet when I'm able to get in to see her. Even if this is more related to 'just' pancreatitis, as long as we can find some way to relieve her symptoms and stop her from dropping weight, I'll count it as a win.

[jilbert57]

Agree, just was wondering if sometime in the past instead of suspecting pancreatitis they actually ruled it out. Thanks

Jill

[Eddiespaghetti]

If EPI or pancreatitis is suspected, and you aren't starting enzymes yet. You will want to find the lowest fat food you can find. I would add some boiled chicken to the rice and cottage cheese. Just make sure the chicken is well shredded or small cubes. Alternatively, you can get some baby food and give that if they are refusing to eat. They actually give baby food to a lot of dogs at animal hospitals. You don't want to give it for long term but for a couple days should be fine. At least until you get the tests done.
Everyone else has you covered for the rest. Was just offering some pre test food options.

[Kay Pups]

Thank you again for the advice, and a small (terrible) update. Unfortunately Lilah was diagnosed with an aggressive type of liver/spleen lymphoma and the prognosis is not good. She is currently comfortably at home on palliative care until it's time for her to leave us. Thank you again for advice and reassurance, though it unfortunately doesn't apply to Lilah. I still think this forum and website is a wonderful resource and the people here seem wonderful, and hopefully it will help others in the future.

[jilbert57]

Kay, I am so sorry to hear of Lilas diagnosis.
There is a therapy that has helped many people and animals you might look into. It uses Tagamet and Benadryl.
Here is a group: https://www.facebook.com/TagametBenadry ... tid=ZbWKwL

Best wishes, give Lilah a hug.

Jill