Epi4Dogs

I am new to this forum but have referenced it many times throughout the 4 years that my GSD Aksel has been diagnosed with EPI. He is now 6 yrs old and recently not eating and after we weighed him since May has lost 10 lbs.
Up until this point - we have been successfully managing his EPI. He is under the care of a veterinarian (who diagnosed the EPI), a gastroenterologist, and a dermatologist. To manage his EPI he is receiving 2 tsp of PancreVed enzyme powder per meal, B12 injections twice a month, 1 tsp of psyllium fiber powder 1x daily, Visbiome probiotic (one capsule per meal). Under the gastroenterologist he received an ultrasound and result was “unhealthy gut health”, so signs of IBD or SIBO at that time (November 2021). Aksel is under a dermatologist care due to frequent fistula lesions on his paws - which resulted in a skin allergy test - which resulted in him receiving immunotherapy treatment every 10 days. A serum composed of what he is allergic to. He is also currently receiving Atopica - prescribed by the dermatologist- to mange the fistula which is currently under control. 150 mg of Atopica daily. I was told that the cyclosporine is also beneficial in managing his digestive issues.
Aksel’s diet for the last 4 years has been primarily hydrolyzed kibble and canned food. I recently added some turkey bone broth with the hopes of enticing his pallete. He does like it and tolerates it well but its not enough to get him to eat better. At this point a good day is 1-2 cups of kibble and 1-2 cups of canned food daily. This is the thinnest he has been and has never lost that much weight in a short amount of time….I have a appt. With the gastroenterologist but not able to be seen until 8/25 and the dr.didn’t feel the need to see him sooner.
In summary, I am extremely concerned and any advice, guidance or direction would be greatly appreciated!

oh geez.... poor Aksel ... and poor you. You sure have him on everything you possibly should..........

YOu are doing everything i normally would suggest... but.....just in case your vet hasn't checked already.... can you contact your vet and confirm that they checked Aksel for any possible kidney issues.... I am only saying this because sometimes with some of our dogs.... when their appetite starts to fade and no one can figure out why, what has popped up is a kidney issue..........

SO.... just to be on the safe side..... check with the vet on this.

The ONLY other thing i can think of to help at this point in time, before you see the gastro dr on 8/25..... is ask you vet if maybe you can try an appetite stimulant like mirtazapine or something similar............

Please let us know what your vet says....

Aksel and yourselves are certainly having problems. Also a variety of specialists. Personally ,I would ask them to thoroughly check his conditions with regards to using Atopica (cyclosporine) through all there disciplines.m It works well for many, but can have wide variety of side effects. True, it can help ulcerative or inflammatory gastro conditions, but epi is firstly enzyme related.
I am not a medical person, though my OH is a dermatologist. I hope the vets monitor atopica use with blood tests for kidney and liver levels. These are far worse than the original problem. Take a urine sample with you , just in case, can give an instant check as well. Also , does he have bad breath, without a dental problem.?
A few other people on here have mentioned fistulas, so it would interesting to here how they managed the condition.
https://www.drugs.com/pro/atopica.html
I don’t want to alarm you unnecessarily, but having an alarming drug reaction myself that fitted the warning ‘contact your doctor immediately ‘ I am extremely cautious.
Best wishes, Patsy

Hello. So sorry you and Aksel are going through this. I was wondering if there is the possibility of moving up his vet visit. Sometimes we are so used to managing EPI that we and our vets see everything through that lens. Perhaps there is something else going on that needs attention as Patsy and Olesia mentioned with regard to liver and kidney issues. It's more confusing when our pups have appetite issues. Our Kolby never liked the enzymes.....even though he thrived on them for 11 years....and we were always doing all kinds of things to get him to eat his enzymed food. So when he went off his food at one point we switched him to a canned version of his prescription food and he loved it .......however, he still lost weight. His issue turned out to be a fluid retention problem and had nothing to do with EPI. I am not suggesting that this is Aksel's problem, just that you might want to get him checked out sooner rather than later in case there is something else that needs attention.
Let us know what you find out.

Barb

UPDATE:

I was able to get Aksel seen by a specialist (Internist) yesterday and after a lengthy discussion of his history, she took blood from him and we are waiting results. She did not feel that it was necessary for an ultrasound (he had one in November 2021) nor a biopsy at this time. She suggested finding a board certified veterinarian nutritionist to help put together a diet that would be enticing to Aksel. Per her recommendation- we are slowly adding fruits and vegetables to his hydrolyzed food in the hopes that he will eat more. I have started with blueberries this morning - he ate a little bit but nothing since the morning.
So unless the bloodwork comes back with something significant - we are moving forward with tweaking his current diet to find that perfect combo of food that he will eat. I am also entertaining switching his kibble to commercial rather than prescription hydrolyzed (still adding the enzymes of course) to hopefully get him to eat better.
Please share any successful diets that have worked for your dogs! I am open to any suggestions! (Within the EPI guidelines of course!)

Looking forward to hearing his results .....or his new diet.

Barb

UPDATE - August 2

Recent bloodwork shows a low B12 level so per the emergency internist who we saw last Friday is increasing his 1 ml injections weekly for the month of August. I also chatted on the phone with a pet nutritionist who is not a veterinarian (I have spoken with her before concerning Aksel’s diet) so she was somewhat familiar with him. We have taken out kibble all together for the time being and he is getting canned hydrolyzed food, lean ground turkey with small amounts of sweet potato with homemade turkey bone broth. He is eating, not scaring his food but definitely eating.

I would love to receive some recommendations on what you guys feed your EPI dogs. Is is just hydrolyzed food? I think we are dealing with EPI in connection with IBD or SIBO as well. So it is challenging to manage the two of them. I may have mentioned in my earlier post - he did have an ultrasound back in November 2021 and at that time no inflammation of the lining of his stomach. But diagnosed with “poor gut health” so I feel we need to manage his diet, bacteria, etc. along with the limitations that go along with EPI.

Last few days he has tolerated the turkey and sweet potato well. Stools are somewhat firm. I’ll take that as a win!

I admire the research you are doing considering how much is being thrown at you. One thing I can’t see is antibiotics. Surely a regular vet can set this up without waiting for the gastroenterologist. All our dogs regress at times, and really need a another course of it.

Regarding food, most epi dogs do not need hydrolysed food. However yours has allergies so this may be why. Do you know the specific allergies?
Adding fruit and veg as toppings is something new to me, because of the fibre. I used canned fish, yogurt, low fat cheese, but this would mess up the hydrolysed food protein test.

By Antiobiotics do you mean Tylinson? Aksel has been on that multiple times in the past but was given to him for treatment of loose stools. Ironically throughout all of this his stools are somewhat firm. The best they have been in quite a while.

Aksel has been skin tested for environmental allergies and as a result is given ASIT injections every 10 days of the allergens for which he is allergic to. He has had skin allergies (mainly fistula on his paws) repeatedly and is on Atopica to mange that. Which is a cyclosporine which ironically suppresses the immune system which “should” help with the possible IBS. He has not been tested for food allergies but on my own I sent in a hair sample for a pet intolerance test which showed me which foods on different levels he would or would not be in tolerate to. Not necessarily allergic to. Very confusing to me!

What I am struggling with is that is he not eating the way he should because he simply doesn’t;t care for his hydrolyzed food anymore or is it because his “gut” is not working properly…Does he not feel well? I plan on weighing him end of this week after making some changes in his diet this week to see if there has been any weight gain.

I am afraid I am no help. I thought you used hydrolysed food when you were trying to rule out allergies and only used the food!
Good luck and per Patsy watch out for the added fiber with the toppers.

Jill