Is EPI Sudden Onset?

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.
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sierra2020
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Posts: 9
Country: Canada
Pet name: Sierra
My name: Ben

Is EPI Sudden Onset?

Post by sierra2020 » 23 Jun 2020, 09:57

Hello to All. Reporting from Northern Ontario Canada. My Name is Ben and my Dog is Sierra who is nearly 4 years old. She is a GSD x Tervuren or maybe Rough Collie. Not quite sure, the breeder had all 3 types of dogs on the property but the Mother is GSD. We are kinda new to the Forum and EPI4Dogs. I did Explore the site and forum a couple of years ago When our GSD Beowulf was having complications with Perianal Fistulas, soft stool and poo eating. His test was negative for EPI and unfortunately he passed on not much later.

Sierra has been Happy and Healthy Ever since she was given to us by Beowulf's Breeder but lately she has developed several of the EPI Symptoms. In January 2020, we brought her to the vet for some vaccinations and to check in with our new puppy. She had a weigh in at 40.5kg. The Vet at the time suggested more exercise and less food because she felt that Sierra was heading towards the overweight end of the spectrum and we took the advice to heart and started to Include Sierra on winter bike rides and x-country ski adventures. Without fail, Exercise would trigger a Bowel Movement, but her stools were well formed and Large. (Nothing but 2s and 3's)

Fast Forward to Early May 2020. After a swim, my wife commented that Sierra looked skinny. We thought this was great given that the vet had suggested that she lose a couple of Kilos. We figured that the increased exercise and playing with the new pup was paying off. Stools Still Fine. Towards the End of May I first started to notice the Diarrhea and Sierra had a couple of accidents in the house overnight. We live in a rural setting, and all of our dogs would get a bout of spring indigestion so we still didn't think much of it. The Diarrhea has morphed to the dreaded Cow-Pie type stool, and Sierra gets urgent bowel movements with any exercise. She also started cleaning her bowl, eating the puppy's food, counter surfing, begging, and other signs of being really hungry. Prior to that she would seldom finish he bowl in the morning or evening and often let food sit.

We brought her to the Vet June 12th and she weighed in at 35.5 kg so we had a chat with the vet and he suggested that we re-weigh in 1 week. Weigh in on the 19th and her weight was down another 0.5kg so the vet scheduled EPI testing and samples were taken yesterday the 22nd of June. Her weight was down again another 0.5kg. Now her body condition is starting to show signs of deterioration with her Hip Bones starting to show (by feel), and her ribs and spine prominent as well (by Feel).

Her Stools have not improved and it pretty clear that she is not absorbing much. The stools look like Organic Peanut butter - or what I imagine her kibble would look like if i watered it down and pureed it.

So now we are waiting on EPI test results, but I am very concerned with the Rapid decline. She has had loose - cow pie stools for over a month but we are really noticing the body changes over the last couple of weeks since her june 12th vet visit.

Is it Normal for EPI onset to be so sudden? Or has this been gradually going on and we are now noticing it?
Would it make sense for me to try to get my hands on Enzymes or fresh/frozen pancreas while waiting for the results? I have a feeling that it will take a week after diagnosis to get enzymes or treatment through the vet and am concerned that her condition will worsen over the next week. Sierra is still very frisky, energetic, and upbeat. Without seeing the stools, and the rapid weight loss, one would not think that she is ill. I hope that we are getting on this quick enough, but I feel that it is not happening fast enough from the Vet.

Any advice on what to do in the meantime?
thanks
Ben

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Shirl D.
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Re: Is EPI Sudden Onset?

Post by Shirl D. » 23 Jun 2020, 11:23

Hello Ben, and welcome to the forum. What you're describing sure sounds like EPI...I'm glad you've had her tested. From my understanding, EPI is caused by the acinar cells in the pancreas atrophying, which happens over time. Overt symptoms usually are not seen until 80-95% of these cells have atrophied. Many people look back after diagnosis and see things that may have been very early signs, just as you are doing, but they are so subtle that they can easily be explained by other things. So the condition itself is not really sudden, but the symptoms can come on suddenly.

There is no harm in trying some enzymes while you wait for the results of the TLI test. The proper enzymes have to be ordered, although some vets may have some in stock. You would obviously have to ask your vet if they would provide some to do a trial run. The enzymes themselves do not need a script, though, so you could order some on your own, although it will take time to get them. A lot of us get our enzymes from EnzymeDiane.com. Diane is great. Her product is basically a generic version of the same stuff the vet sells, so it's about 1/3rd the cost. I have been using it with Pixie for 9 years, so I know it works. She has sample sizes. You can contact her about getting some if you want. Another option is to check out some "emergency enzyme" options on this page: https://epi4dogs.com/emergency-enzymes/
They are not exactly what you need (not strong enough) but they can help short term while you wait for the diagnosis and/or proper enzymes.

The good news is that she is still acting well! That is definitely a good sign.

One more thing...try to make sure that the vet has also ordered a B12 (cobalamin) test along with the EPI test (TLI). They can be ordered together and it makes it more cost effective. Many EPI dogs have low B12, and for our dogs to thrive, it should be in the upper normal range, 600 or above. Even if she does not have EPI, low B12 is very common when a dog has had lots of diarrhea, so it is a good idea to check.

I hope I've answered your questions. Good luck, keep us posted, let us know the results of the test when you get them, and keep asking questions!

Barb
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Re: Is EPI Sudden Onset?

Post by Barb » 23 Jun 2020, 13:09

Hello, Ben. A warm welcome to you and Sierra. Shirl has given you excellent advice and it sounds like you are waiting for results. I just wanted to make sure that Sierra was fasted before the test. I am sure your vet knew the protocol, but I just wanted to make sure so the results are not skewed.

Your description of the onset of symptoms, if it is EPI, is as Shirl said, what many of us experienced with our pups. Looking back, I remember having all sorts of reasons why Kolby's stools were on and off like cow plops. Even our vet was thrown off by the way he presented symptoms.
So don't feel bad. Everything is 20-20 in hindsight. One tool we can use to keep our vision sharp is keeping a log/journal and recording everything you give Sierra each day and what the resulting poos are. Even if she doesn't have EPI, this can be a very helpful device. It helps you to see what is working and what may need to be adjusting. It saved our sanity......I still use it with my non-EPI girl.

Please let us know the results of the tests and ask any questions that you have. Right now, waiting is the hard part.

Barb

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Madelon
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Re: Is EPI Sudden Onset?

Post by Madelon » 23 Jun 2020, 13:49

Hi Ben and welcome to our EPI family. I'm so glad you had your pup tested. Shirl gave a great explanation of EPI. While we from the outside think of it as happening all of a sudden, as Shirl explained the pancreas has been atrophying for a while without showing symptoms. Read as much as you can while you wait for the results and when you get them please let us know. If this is EPI there's no need to worry as it's totally managable and these dogs go on to live long happy full lives.
MADELON and Doc. DX EPI and SIBO: 5/22/2015
Test Results: (1st) 7/2014 = TLI 16.5, B12 894, Folate > 24; (2nd) 5/2015 = TLI < .4, B12 406; Folate >24; (3rd) 10/2015 TLI < .4; B12 >1000; Folate 14.4. Prior to DX: May 2014 (2mos) - DX coccidia/bladder infection; July 2014 (3mos) 1st EPI test = TLI 16.5, B12 894, Folate >24 - Dx SIBO not EPI; Feb 2015 thru May 2015 - weight loss only; May 2015 vomitted several times, diarrhea and eating poop. Regimen: 4 cups Sport Dog Food Elite Herding - Diane 6x 1tsp per cup; 1 WonderLab PetFactor B12 2x day; 1/2tsp Slippery Elm 2xday; Multivitamin; 1 Zyrtec 10mg 2x day; Salmon Oil

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sierra2020
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Pet name: Sierra
My name: Ben

Re: Is EPI Sudden Onset?

Post by sierra2020 » 23 Jun 2020, 19:39

Thanks to All who have replied so far. Your words are encouraging and if it turns out to be EPI I look forward to all the help I can get and give if I learn about this condition.

We Love our Dogs, but have we ever had bad luck with them. They all seem to have developed conditions somewhere between age 3 and 4 despite lots of love, exercise, and top notch diet. Dog 1 - Coleus, lymphoma, deceased before age 4. Dog 2, Beowulf, Severe Perianal Fistula and associated complications Deceased before age 5. Now Sierra is approaching 4 and She loses over 10% of her weight in less than half a year and we are watching her deteriorate as we wait for diagnosis.

The Vet has ordered a battery of tests, and I am sure that the B12 test was included. She was also fasted for at least 12 hours prior to blood samples taken so now its the waiting game. I am not sure if EPI would be the worst case scenario, or a best case. Not sure what other conditions are out there that would cause these symptoms.

We did manage to find at the local pet health food store, some bovine enzymes. The analysis is in line with recommended on this site so we are starting her on this right away while we wait for the diagnosis and treatment plan. The product is Thrive Bovine Pancreatic Enzyme by Big Country Raw. Not sure if anyone has experience with this one. We are told its an Ontario Company. Analysis is per 1250mg or 1/4 tsp: 250k USP Protease; 250k USP Amylase and 40k USP Lipase. The Dosing listed on the package is 1/4 tsp per 25lbs of body weight, but it is not clear that it is per meal, per cup of dogfood or anything else. I have not checked the manufacturers webpage for more info, but that will be my next step. Hopefully this is good enough to get us going until we get diagnosis and our hands on the right Enzymes if they are needed.

I will update once the test results are in or if we see any improvement with Sierra in the meantime. She is in great spirits and had no issue with her first enzyme tainted meal so here is hoping.

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Jean
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Pet name: Kara, lost 10th May 2019
My name: Jean

Re: Is EPI Sudden Onset?

Post by Jean » 24 Jun 2020, 05:33

Good morning from the UK

EPI hit my Kara like a brick, she was fine until 14 months old, and then, bang......she lost so much weight it was dreadful, 39 pounds at her worst, projectile pooing, and the smell is horrible

however, we made it, and she did well at 90 pounds till we lost her in 2019

the one thing I would reiterate is that we recommend feeding 50% over and above what the food bag suggests for the weight they SHOULD be, and most of our dogs do well with grain free, and that includes no rice, and they seem to be intollerant of chicken dog food and that includes poultry fat, almost always chicken, Kara couldnt deal with it at ALL , and feed over a few small meals over the day, all enzymed if it is EPI

I really feel for you at the start you feel alone and deserted, but you are no longer alone

ask away

Jeanx
My name is Jean we live in Liverpool in Uk

My Kara born 21 July 2009 diagnosed with EPI by cTLI test August 2010 TLI = <1...folate 14 Cobalamin 408, shot down to 94, b12 injections every other day

Lowest weight 39 pounds

We used Panzym enzymes, Tylan and Chemeyes b12 capsules

Sadly, on 10th May 2019, we lost her to DM


Jeanx

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Shirl D.
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State: New York

Re: Is EPI Sudden Onset?

Post by Shirl D. » 24 Jun 2020, 07:19

Ben,

I'm so sorry you've lost Coleus and Beowulf way too soon! I can tell you, though, that most EPI dogs lead full lives and do not die from EPI. My Pixie (a shetland sheepdog) turned 14 this past April. She was diagnosed a couple years before we got her in 2011, so she's had EPI for about 11 years, I think. Her EPI is well managed. Her biggest problem right now is arthritis. And being a pain in the neck...barking at 5:15 AM to get us up, deciding she wants to be spoon fed for some meals, not going with my husband when he tries to let her out or feed her (I have to go, too), etc... :lol: We are here to help you get Sierra back into good health if it turns out to be EPI, and we'll help any way we can even if it's not. Finding the right combination for treating EPI can be tricky, especially at the beginning, but with patience and perseverance, we should be able to get you there.

The only thing I really know about bovine enzymes is that they are available, but typically only used if the dog is allergic to pork. I would think that the dosing should be the same as for porcine enzymes, since they are working in the same manner, they just came from different animals. We recommend 1 tsp per 1 cup of kibble as the starting dose. That way, the enzymes should be sufficient for the amount of food the dog is eating, which in my head makes sense because its purpose is to break down the food. Going by weight could work if we assume that every dog at a certain weight eats the same amount of food, but since we are often feeding our dogs more to get them to gain weight, we want to make sure they have enough enzyme for that extra food. Let us know if you see any difference from the enzymes.

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sierra2020
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Posts: 9
Country: Canada
Pet name: Sierra
My name: Ben

Re: Is EPI Sudden Onset?

Post by sierra2020 » 24 Jun 2020, 09:13

Thanks Again to those who have posted. I did spend a lot of time on the EPI4dogs site the last few days and seem to have a grasp of what we may be in for. I did notice that many members who's dog info is listed show dogs living well into or beyond expected lifespan which is encouraging. Still a lot of questions but I'm glad that this resource and all of you are available though the forum as well. Sierra has only had a couple meals with the Bovine Enzymes and she seems to really like it. If it is EPI or borderline EPI I will be reaching out to Diane. For what we paid for the 90g of the Bovine, we can get almost 0.5kg through Diane. Now In the process of finding a good grain-free Kibble. We are currently Feeding Acana, and all of their Food Shows 5% to 6% Maximum Fiber Content. Most of the "Flavours" have peas or legumes high up in the list so we will probably have to address that. We have also started with the Smaller meals + higher frequency. This was suggested by the vet even before the Testing just to help get her weight up, and avoid Bloat or gastric torsion. The biggest observed change in Sierra aside from the weight loss, is the increased appetite which we originally attributed to more exercise / new pup.

I will hold off on posting until we get our Test Results back or if there is any significant change in Sierra's state for better or worse. Fingers Crossed and All the best.
Ben

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sierra2020
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Posts: 9
Country: Canada
Pet name: Sierra
My name: Ben

Re: Is EPI Sudden Onset?-

Post by sierra2020 » 26 Jun 2020, 08:28

So the tests came in and Sierra is Borderline EPI.
TLI 3.6 and B-12 120. First B-12 injection scheduled for Today and Vet has recommended treating for EPI. He has Enzymes for us, I guess we will see the cost of them and have to compare with other sources - Like Diane. We had already started on Enzymes per my previous posts and she is already showing signs of improvement. Mainly Better Stool Colour but also some behavioral improvements. Seems like here Energy Level is back up to 11 when with a bit of Hindsight it was probably down to 7/8. These things are so gradual it's hard to tell. I am Glad we are catching this early enough so hopefully we can get her weight stabilized and get her on track to recovery.
Oddly Enough, Sierra Really enjoys her new food + Bovine Enzymes. I bet she would eat pure enzymes if we let her and our other dog has tried to snatch the enzyme jar off of the counter. Maybe this will get old for them eventually but for now its really encouraging to see her super eager to eat.
The recommendation coming from the Lab report and the Vet is to re-test in 30 days although the vet was not optimistic that the TLI will get better. Second test would be to confirm EPI or downward trend in TLI score. Not sure about the value to re-test? I get that the treatment will not change much with re-test and we are in this for the long haul. Any opinion on the second test would be welcome.

I see there are a couple of other New Diagnosis posts on the Forum as well Probably same questions that I have. I am not sure about posting our test results. There is too much personal information on it for me to be comfortable posting, but the information package that came with our test results is pretty good info. One is Fairly recent from "Blackwell's Five -Minute Veterinary Consult." This document Confirms, or Back's up Everything that I have read here on EPI4dogs.com (Short Summary. Enzymes, B-12, Antibiotics if necessary and Low Fibre Food) The other document is a little dated and still recommends low fat-diet.

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Jean
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Location: South Liverpool
Country: United Kingdom - England
Pet name: Kara, lost 10th May 2019
My name: Jean

Re: Is EPI Sudden Onset?

Post by Jean » 26 Jun 2020, 11:27

you certainly DO NOT have to, nor should you, post personal details, the only thing we are interested in are the result numbers, which can give some inspiration in helping

the thing that stands out is the information you have from your vet, which is encouraging to say the least, and from the accompanying information about the test results, mine were very specific, my vet had been treating EPI since the mid 80's, and went to university with Dr Williams who created the cTLI test in Liverpool right here where I am,

I am so pleased thet you have a map to this journey and keep us up to speed

have a glass of wine on me

Jeanx
My name is Jean we live in Liverpool in Uk

My Kara born 21 July 2009 diagnosed with EPI by cTLI test August 2010 TLI = <1...folate 14 Cobalamin 408, shot down to 94, b12 injections every other day

Lowest weight 39 pounds

We used Panzym enzymes, Tylan and Chemeyes b12 capsules

Sadly, on 10th May 2019, we lost her to DM


Jeanx

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