Trixie's new digestive upsets

[TrixEPIMama]

Trixie (~4YO cattle dog mix) has always done well on her -- admittedly non-standard -- EPI regimen (described in the footer to this post). Her poops are still sterling, but in the last three weeks her digestion has otherwise gone to h*ll.

In late September she was hit hard with what the vet diagnosed as pancreatitis. She had only one episode of vomiting, but it was pretty horrendous, and she was slow, sluggish, in apparent pain, and completely without appetite for days. The vet did ultrasounds, found fluid around her pancreas, gave us enough Prilosec for a week, and sent home a couple doses of anti-nausea medicine, and some canned prescription Science Diet (which Trixie, who eats everything, hated and refused to eat even after she recovered).

When Trixie's appetite still hadn't begun to improve after several days, the vet did another ultrasound, said 90% of the fluid around her pancreas was gone, and sent us home with several syringes of Entyce appetite stimulant.

Two hours after a single dose of Entyce, Trixie was her old chow-hound self again.

Through all this, whenever we could get her to eat anything at all, we continued to give her usual supplements of course. Her poops were completely unaffected. .

Great, right? Except that three times since then Trixie has suffered mini-versions of the same thing. Today is the latest. She's walking with a slight hunch, as if her mid-section hurts, she's hiding in corners, moving slowly, and refusing food. She cries in her crate in the middle of the night, but again has had no vomiting or diarrhea. I persuaded her to eat about 1/2 cup of brown rice with small bits of chicken in it, but she's not herself at all.

We have no idea what's brought all this on. Two times over the years she's had nasty cases of the pukes-and-squats, but each of those times she had gotten into something she shouldn't have, and both ends of her digestive system suffered the consequences.

In none of the recent attacks is there any evidence of eating anything nasty. We do give her more treats than most EPI dogs get, but those are usually freeze-dried liver or bites of apple, cheese, or steamed vegetables. Occasionally we allow her to lick the residue off an empty dinner plate as long as the food wasn't too fatty or spicy. And until now she's tolerated those limited treats well. We're cutting out all but the liver bites and some necessary mobility treats until her problem resolves

What should we try?

We've got on hand: tylosin, Prilosec, famotadine, slippery elm, and two more doses of Entyce. I'll be taking Trixie in for her annual exam and shots this week & would like to run this problem by the vet. But you good people know more than any of the local vets do. I look forward to your ideas and advice. Many thanks in advance.

[Eddiespaghetti]

Pancreatitis is rare in dogs with EPI. It is possible it rare. The pancreas is usually in full atrophy before EPI is diagnosed.
Did the vet do a cPLI test to diagnose the pancreatitis? I am confused. The vet found pancreatitis and only gave Prilosec? Did I read that right? If they are treating for pancreatitis why didn't they give panquell CA1?
I will never tell someone what to do, but if my dog was diagnosed with pancreatitis and they gave me Prilosec, I would be finding a different vet.

All that being said, you might be dealing with cysts around the pancreas instead of pancreatitis.

[TrixEPIMama]

Thank you, Eddiespaghetti.

The vet -- who was not my regular one, but the only one available on the Saturday when I realized how sick Trixie was -- did no cPLI test. He did allude to the possibility, but said by the time the results were in we'd have a pretty good idea (by her healing progress) whether Trixie really had pancreatitis or "just" gastroenteritis.

I did not know pancreatitis was rare in EPI dogs. I thought perhaps because the pancreas was already in bad shape she might even be more susceptible. (Please forgive my ignorance; I've never dealt with anything like this before.)

In any case, she did recover from the immediate sickness. But now we have these mini-sicknesses recurring.

If there were cysts, would they have shown up in the ultrasounds?

After being miserable last night and this morning, this afternoon Trixie ate another small bowl of food (rice mixed with the regular canned food we always mix into her kibble) and seems generally better. This seems the typical pattern with the "minis."

[Tuckaboo Pam]

Not sure about most of your dilemma, but on another note, and based on the philosophy of my favorite pediatrician, I don't think I'd assault her immune system with vaccines until this is cleared up.---Pam

[TrixEPIMama]

Good point, Pam. Thank you.

I've been working with the vet to get Trixie onto a less frequent vaccination schedule in any case. This is an unfortunate opportunity. She'll have to get her leptospirosis shot soonish, but yes, let's get this taken care of first.

[jmeredith19]

I’m not sure how rare pancreatitis is in dogs because my dog had pancreatitis twice this summer and has EPI. Get a snap cpl test just to be sure.

[Chance]

I was told by two vets that dogs with EPI could get pancreatitis. When Chance was under the weather, it was something they wanted to rule out. I was kinda surprised, saying he's had EPI for a while, would it even be possible?! They said yes, dogs with EPI can get pancreatitis. (Pancreatitis can sometimes be the cause of EPI, so if Trixie had this in the past, it would make it more likely to occur again).

cPLI or snap test can be done to confirm. But it can usually be seen by ultrasound. If there's inflammation in the pancreas (ie: pancreatitis), it can be seen in ultrasound. If the ultrasound did show inflammation there, it's likely that diagnosis was correct. If the pancreas wasn't inflamed, then it's possible they were barking up the wrong tree.

Were the ultrasounds a full abdominal check, or just specific areas? I'm curious if gallbladder was checked (it would be, if it was complete abdominal ultrasound). Gallbladder can be pretty darn painful, and could explain some of the symptoms. That is something that can be seemingly fine one minute, then suddenly very painful. Gallstones are very rare in dogs, but infection or inflammation can happen.

SID can also be quite uncomfortable, if it's really out of hand. Normally poops would go funny with this, but not always. Something to maybe rule out?

[Eddiespaghetti]

I should clarify, when I say rare it's more of the medical term of rare. It's something like 1:2000 - 1:10000. A lot of it is dependant on the cause of EPI.
I am not saying they didn't have pancreatitis, as it is possible, I am just shocked they didn't give anything for it. Managing EPI and chronic pancreatitis is tough. Weight management is already hard enough without having to worry about feeding low fat or modified diet.
As for the cysts, they would show up on the ultrasound unless they raptured, releasing a bunch of fluid in the area. Another option is; there was too much water and it was blocking it.
Pancreatitis can easily claim dogs which is why I am still weirded out they didn't treat it.

[TrixEPIMama]

Thank you, jmeredith19 and Chance (and you for the clarification, Eddiespaghetti).

I'm getting quite the lesson here about pancreatitis -- and vets.

Chance, I appreciate your detail and voice of experience. Yes, Trixie did have a full abdominal ultrasound.

Trixie's early history is unknown, but her original vet (Dear Vet or DV for the purpose of these forums) and I always speculated that she did have a case (or more) of pancreatitis that triggered her EPI. We'll never know. But her rescuers found Trixie near a homeless camp, already voraciously eating anything and everything and already suffering cowpat poops and weight loss before she was a year old. So very likely she' d been scrounging and eating heaven knows what all her life, including items that could have triggered pancreatitis.

Although DV had never seen a case of EPI, or perhaps one in 30 years, she has an inquiring mind, does research, and helped lead me to make a "guess-ignosis" of EPI -- even though by then Trixie and I were living 2000 miles away.

I've tried three vets in my new state. None had much knowledge of EPI, which seems to be the usual thing. One (who had never treated an EPI dog) thought she knew all there was to know and made wrongheaded and expensive recommendations. The other two have been more caring and responsive, but still aren't as knowledgeable or knowledge-seeking about EPI as DV.

This latest episode puts me into despair. We'd been managing well, but now I feel there's so much I don't know, and my ignorance is so deep I apparently didn't even know the right questions to ask when Trixie was sick.

Fortunately, DV, in addition to being the best vet I ever had, is my good friend. It happens that she's flying in to my state tomorrow for an event and will visit us briefly. So I will unload some pancreatitis and EPI questions on her -- including Eddiespaghetti's question about why the emergency vet didn't treat for pancreatitis if that's what he thought she had.

[TrixEPIMama]

Well, my Dear Vet/friend was here and she said I should be looking at:

* Gall bladder issues (including a plugged duct and gallstones), as Chance suggested

* Liver issues (including a plugged duct/billiary mucoseal)

Even though DV has a lot more real-world EPI experience than she did at the time of Trixie's rescue (what with EPI now that so many more dogs are getting it) she, too, was surprised to learn that EPI dogs can get pancreatitis. But she doubted that's what afflicted and may still be afflicting Trixie. She thought the fluid the emergency doc observed around Trixie's pancreas was "just inflammation" and not necessarily an indicator of where the problem originated.

I was assuming all along that these problems were somehow EPI/SID related, when they may not be at all.


SIDE NOTE: I gave her the 2025 EPI calendar. She keeps the 2024 calendar on the wall in her exam room & told me today that she takes it down uses it as a reference, particularly for showing GSD owners who bring their dogs in for related issues how GSDs are disproportionately afflicted. She knew before she leafed through the 2025 version that she'd still see a preponderance of GSDs.