Is this EPI? My poor dog needs help

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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FishersMOM
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Posts: 2
Country: United States
State: Connecticut
Pet name: Fisher
My name: Kristine

Is this EPI? My poor dog needs help

Post by FishersMOM » 31 Oct 2022, 18:53

Long post but MAJOR help needed!

Fisher is 8 years old. In March 2020 he started w loose stools. After no success w vet we took to see a specilaist. iMS did an ultrasound (neg). Ran GI panel.
Cobalamin 313
Folate 7.6 (low)
Pancreatic Lipase 191
TLI- >50

Dr started on B12 shots weekly. Then every month. Metronidazole and Hill biome diet and boiled chicken breast
(Told likely IBS)

Did great! Solid poops.

Aug 2022. Needed anal glands suppressed. One swollen. Vet puts on rimadyl.
Starts diarrhea. Vet puts on probiotic. Met, and omeprazole. Poops begin to form BUT I notice he’s pooping mass quantity 3-4 times a day. I’d say 5-6 times his normal amount (used to be twice a day). They’re formed but mushy to pick up.

Suddenly he’s ravenous. Eating like crazy and begging for more food. Looks like losing weight

Oct 7. Take to vet. 78pounds to 66 pounds. Vet tells me feed him extra. Grrrr

We take to IMD last week. Bloodwork and GI panel. Lost another two pounds
ALT -550

Cobalamin >1000
Folate 16.3
Pancreatic Lipase >30
TLI- 4.6

They want ultrasound. Everything clear.
Do endoscopy- see a swollen intestine and biopsy. I’m waiting results.

He’s on:
Probiotic in morning
Omeprazole in morning
Tylan at night
Pepcid at night

30 mins after he eats, he passes loud gas and you can hear stomach churning. If you lay hand on belly, you feel the bubbling.

He’s pooping 4-5 times a day. If he has Immodium the stool gets more firm. After the endoscopy he went back to diarrhea mush.

I need thought. Suggestions. Anything to help this beautiful, strong born. Please.

Does this sound like EPI? IMS says he must be below 2.5 TLI

Pics- one Aug. one October.

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Olesia711
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Posts: 3858
Location: North Carolina
Country: United States
State: North Carolina
Pet name: Izzy
My name: olesia

Re: Is this EPI? My poor dog needs help

Post by Olesia711 » 31 Oct 2022, 20:33

thanks for posting the time line of events... very helpful!

Your vet is correct that your dog is not "clinically" EPI unless the TLI value is 2.5 or below BUT...... with a TLI value of 4.6 something hinky is going on with the Pancreas and it is now suggested, when the TLI comes back below 5.7 and if you ARE seeing physical signs or EPI, even though not clinically EPI... go ahead and treat with enzymes for now and retest in the near future. (TAMU recommends to retest in a month, but EPi4Dogs would like to suggest retesting in 3 months.... as sometimes it takes more than a month for EPI to come to full fruition with some dogs if whatever is going on is EPI developing)

Here is the ACTUAL suggested protocol from Texas A&M:
In dogs, values below 2.5 µg/L are diagnostic for EPI. Values between 3.5 and 5.7 µg/L are rarely if ever associated with signs of EPI but may reflect subclinical pancreatic disease such as subtotal pancreatic acinar cell destruction secondary to on-going immune-mediated lymphocytic pancreatitis. Progression of the disease in such patients may ultimately lead to EPI. Values between 2.5 and 3.5 µg/L are sometimes (but rarely) associated with clinical signs due to EPI. In these cases the TLI assay should be repeated after one month paying particular attention to ensuring that food is withheld for 12 to 15 hours before the blood sample is collected.

SOOOOOOOooooooooooo all this to say, tell your vet you want your dog on pancreatic enzymes now and you would like to run another TLI test in the very near future.........
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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Jean
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Location: South Liverpool
Country: United Kingdom - England
Pet name: Kara, lost 10th May 2019
My name: Jean

Re: Is this EPI? My poor dog needs help

Post by Jean » 01 Nov 2022, 06:45

Good morning from the UK

Certainly sounds like you are heading in the direction of EPI

the rumbling tum is indicitive of SID Small Intestinal Dysbiosis sometimes called SIBO Small intestinal Bacterial Overgrowth , and in someways easier to get your head round in understanding what it is

This means Fisher has bad bugs in his gut /belly

so regarding the Tylan which you are giving is what we recommend

this is the Tylan doseage chart

https://epi4dogs.com/antibiotics/

And should be given twice daily, with several hours between doseage, so with breakfast, and evening meal if possible, you say you are only giving at night , it needs to be as I said twice a day

in a way the vet was right in giving more food

the recommendation is to give 50% over and above the instructions on the food for the weigh Fisher SHOULD be over a few meals a day if that's possible

I can understand the Imodium working but why is my thought

what are you feeding ? what brand and variety, how much per feed and how often

have you had his Tyroid checked? that can cause ravenous appetite and rapid weight loss

has the vet said anything about enzymes for Fisher ?

keep a diary and have a look at our new template

https://epi4dogs.com/epi-log/?fbclid=Iw ... T-ed7hxG84

very useful

are you still giving Metro ?

I am sorry about all of the questions but if you can bear with us we can hopefully help

Jxx
My name is Jean we live in Liverpool in Uk

I am the Forum Director which I am very proud of

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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jilbert57
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Posts: 2091
Country: United States
State: Washington

Re: Is this EPI? My poor dog needs help

Post by jilbert57 » 01 Nov 2022, 08:48

Welcome to the forum. Mickey had chronic pancreatitis and when the vet ran bloods his Tli was >50 but the pancreatic lipase was >1000. Started him on porcine enzymes and on retest in 3mos his Tli was at 25 but Pli remained elevated >1000. He was fed macaroni and hard boiled egg with enzymes and supplement and he did well.
The vet started him on Pancreazyme but after that I switched to Enzyme Diane as her enzymes are less cost and a great product
www.enzymediane.com. The enzymes are NOT prescription you can buy them over the internet.
Also you can get a sample pack and call and ask her help.

Jill
My name is Jill and we live on the Hood Canal in Washington State. We currently have 2 Jack russells, TJ is 8 and Sadie is 2.

Mickey and his pancreatitis brought me to Epi4dogs.com site in 2012 to help manage it.
He lived from 6/99 - 8/2014

Mickey, Jack Russell. Chronic Pancreatitis. Dianes enzymes, 1/8t 3x/day with meals.

FishersMOM
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Posts: 2
Country: United States
State: Connecticut
Pet name: Fisher
My name: Kristine

Re: Is this EPI? My poor dog needs help

Post by FishersMOM » 01 Nov 2022, 12:03

Tylan question- so if he was prescribed a 1/4 tsp daily I should give 1/8 with each mean instead? Or ask for them to double the dose and do 1/4 with each meal?

I haven’t switched foods because he has not been diagnosed. He could have IBD. I’m waiting for endo biopsies done last Th. I don’t want to give him grain free food if high fiber food is what he needs for IbD.

The internal med dr wants me to wait until Biopsy results come back.

She said to give Gas X for stomach gurgles. It’s a soft gel capsule but I see peppermint is in ingredients. Is this ok?

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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 this EPI? My poor dog needs help

Post by Jean » 01 Nov 2022, 12:09

the dosage was was worked out by a vet for us. and based on the weight of the dog, and the recommendation is to be given twice daily
so for 60-70 pound dog would be 1/4 teaspoon twice daily
l
AS for the Gas X it seems to be ok for dogs
My name is Jean we live in Liverpool in Uk

I am the Forum Director which I am very proud of

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

Barb
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Posts: 918
Country: United States
State: New Jersey

Re: Is this EPI? My poor dog needs help

Post by Barb » 01 Nov 2022, 15:39

We used Gas-X for Kolby, to prevent bloating.....one gelcap each day (125 mg simethicone) recommended by our vet at the time and it was fine.

Barb

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Jean
Forum Director
Posts: 1707
Location: South Liverpool
Country: United Kingdom - England
Pet name: Kara, lost 10th May 2019
My name: Jean

Re: Is this EPI? My poor dog needs help

Post by Jean » 02 Nov 2022, 06:14

remember it well Barb
My name is Jean we live in Liverpool in Uk

I am the Forum Director which I am very proud of

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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