Trixie's new digestive upsets

[Tuckaboo Pam]

Yes, EPI used to be referred to as "That German Shepherd Problem", and in fact it seems many vets who even know about EPI believe GSDs are the only breed who can have it.

As you can see reading through the posts, this is not true (well, your Trixie is a good example!), and the reason for this forum's existence was Olesia's Spanish Water Dog's condition.

I'm glad your DV is open to learning more about EPI. ---Pam

[Chance]

Yeah...that German Sheppard disease

It's true though, that most are GSD. But I am on my 2nd Lab!

I did have one vet say he would never test a Lab for EPI, adding "I have never seen one test positive, and don't think I ever will". I just responded "I have". He didn't quite know how to respond lol

Any and all breeds have been affected by this. And even some cats. Thankfully not my cats, as I would certainly go insane having to pill a cat every meal! I'd be a regular at the hospital getting stitches

[TrixEPIMama]

Just a (frustratingly inconclusive) follow-up.

Took Trixie to her regular vet today. Told him what my DV said about looking for liver/gall bladder issues. Told him what EPI4Dogs thought about the possibility of pancreatitis (which was his first assumption about the likely problem). Had bloodwork done.

All normal.

Came away with a recommendation that we simply keep her on either famotidine or omeprozole pretty much forever.

Very anticlimactic and hardly a true solution to anything. But there it is.

It's a strange and uncomfortable position, having to deal with vets who know less about EPI dogs than I do (and I don't know that much). Guess it's a familiar position for many people here -- and I'm sure glad this place exists to keep us relatively ahead of the game.

[Eddiespaghetti]

Long term, Omeprazole is the recommended medication of course. It can actually lower the amount of bile produced. Slippery elm does help coat the stomach the same way famotidine does. You can start with slippery elm. If you are giving it, start increasing it slowly. Give a little more every couple days. Too much slippery elm can cause loose stools, which is why I say increase it slowly.

[Chance]

I wouldn't want to go to Omeprazole long term, unless you have to. It's a great drug, but does have problems.

1) long term, it is known to cause SID/dysbiosis. EPI dogs don't need help in that department.

2)long term, it's been linked to certain cancers in humans. It is assumed that it might be the same in dogs.

3) once you've been on it for a while, it's very difficult, if not impossible to come off of it. Once you do start gradually weaning, it very often rebounds, and comes back worse than it ever was. Then you are back to concerns with points 1 and 2. (This was what I was told by the IMS when Rylee was on it - for GI bleeds prior to diagnosis).

So, if you need an acid reducer, my choice would be Pepcid.

I have to wonder if it's possible that you need more enzymes. With Rylee, her acid reflux (empty belly pukes) was horrible when her enzymes were too low. At the time she was on 4 meals per day. An hour or two before each meal, she would puke up bile. 4 times a day, every day, I had to pick up at least 2 pukes. Omeprazole twice a day wasn't helping! Vet told me she thought the enzyme dose was too low. I absolutely did not believe that was the case; but I agreed to try a slight increase. It was an instant cure, and I successfully managed to stop the antacids completely. She eats 3 times a day now. Other than after a concussion, she hasn't had any acid reflux symptoms.

I'd really try the enzymes before resorting to Omeprazole indefinitely. If it doesn't work, then go back...at least you would have tried.

[Eddiespaghetti]

Here is the latest study of the most common indigestion medications. The increased chances are pretty low for all. It is also in humans. It may or may not equate to the same in doggies.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11012754/
Use whatever you feel comfortable with. I do hope you find something that helps.

[jilbert57]

Just to add to Chance's list on long term use of Omeprazole, or any PPI(Proton Pump Inhibitor) for that matter.
Keep in mind the body contains more Proton Pumps than the one for stomach acids. There are PP cells in the brain that collect and release cerebral spinal fluid as well as in the joints for synovial fluid release to lubricate the joints. These are just a few. So be aware down the line some people as well as animals can suffer other issues with PPI use.
When puppies are born hydrocephalic they use intravenous Omeprazole to take the extra fluid off of the brain.
Short term use is generally well tolerated.
Just something to be aware of.
I use Pepcid, an H2 blocker when my pups need it.

Jill

[TrixEPIMama]

OP here, I'm sorry to have been away from this thread so long, especially with you all giving such good information. (Life, you know.)

Bottom line:

* I knew already that omperazole could be bad news, but your info convinced me to avoid long-term use of it at all cost.

* She seems to do okay with famotitine (Pepcid) & I have fewer worries about that; but it's still just treating symptoms rather than solving the problem. She's also already on slippery elm, 1/4-tsp per meal, two meals a day.

* Chance, your tale of Rylee and her painful empty-belly vomits, cured by upping enzymes, was intriguing. That would never have occurred to me; I'd have assumed that more enzymes would simply mean hard poops. I cautiously tried giving her 50% more for a few days.* Her poops were and are fine. Unfortunately this morning she's back to being sluggish and low-appetite. (Eats, keeps food down, but doesn't seem all that enthused about eating or anything else.)

I gave her 20mg of famotidine and am now waiting to see if she starts feeling better.

-----

* Unlike most people here, we give freeze-dried pork pancreas, not enzymes. We originally tried this with Trixie before she was officially diagnosed because the capsules of powdered pancreas were something my partner already had on hand. They worked so well we never saw the need to switch. We're certainly open to changing if that would help, but want to be cautious about changing something that's worked so well..

[Chance]

Your mentioning 50% more enzymes That does sound like quite a lot? Admittedly, I'm not sure what that means for freeze dried pancreas. I am used to more concentrated enzymes.

I just increased by a teeny bit. I *was* giving 4 and a half Creon per meal. Per poops were good. Since poops were good, I thought that was "her" dose. When I increased, I just gave the extra half capsule (so 1/5th of her dose. About 20% extra. We knew that Rylee had terrible acid reflux since long before enzymes, which was greatly improved with enzymes).

I'm concerned that an extra 50% enzymes, with no change in food, might be a tad too much. That might also trigger acid reflux.

[TrixEPIMama]

Because the freeze-dried pancreas capsules are small, it's not easy to increase, say, five or 10%. I could go up 25% by giving her the powder from 2.5 capsules instead of two or three. To cut the increase finer, I'd need some very small tools for measuring powder. But that's doable if there's reason to believe a small increase would do the trick.

Today, with breakfast and a famotidine pill in her, Trixie slept most of the day and moved with reluctance and apparent discomfort -- until late afternoon when she woke up from a nap and wanted to play. (These episodes are often like that; she's miserable for 18 hours or so, then suddenly fine.)

I can't tell at this point whether anything I'm doing is helping or hurting her. She just seems to get over it when she's ready to get over it. Then it comes back again a week later.