Epi, pancreatitis or something else?

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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TheDude
Member
Posts: 3
Country: United States
State: Florida
Pet name: Pixie
My name: Nate

Epi, pancreatitis or something else?

Post by TheDude » 12 Jan 2023, 19:21

I happened to find this forum while googling. I've been struggling with my now just recently turned 13 female Dachshund.

She has been diagnosed with pancreatitis when she was young. Always had her in a low fat diet without any flare ups. Three years ago she was having some back issues so vet had her on Galliprant...an nsaid and ever since then I have been struggling trying to help her. Shortly after going on it for just 2 days I noticed she was having tons of gas, acting very off, all of a sudden became allergic to every protein, etc. Over 3 years I have been to numerous vets and internists and even the vet school in Gainsville FL spending a good 23k and still no answers. I have tried every food, diet, supplements and still havent gotten anywhere.

I had taken her to Blue Pearl who did blood work up, ultrasound and nothing came back. I had her on a prescription low fat diet at the time and she was gulping all of the time with it so I figured food allergy so got her onto something else.

At one point it was thought she had IBD so of course diets trials, meds and supplements were tried. Acupunture, laser treatment, you name it. She was given the steroid Budesinide at one point which made things worse. I had hired 3 nutritionists and all failed.
She was checked for cushings a few times. I actually had another Daschund who I had to let go at 12 due to very similar issues, was told he had cushings and they aren't even related, however he did have nodules in his small intestine. Her ACTH always came back slightly high, but not enough to diagnose. A low dose dex test was all normal and she was actually more on the Addisons side. I had always suggested atypical, but no vet has wanted to actually test her for it.

The only food I could ever get her on with the least symptoms was Honest Kitchen Base Fruit/Veggie and alligator. This seems fine, but then I swear she flares.

Two months ago Pixie got into something outside and next day was having blood mucus stools. Took her to the ER where the vet flat out told me vets don't know anything and they just act like it after I had told her my long history getting nowhere. She said it "could be" pancreatitis and considering her history I had agreed. I was sent home and told to followup with the vet in the morning. The vet I had seen at that time put her on metronidozole and it did stop the blood, but was giving her neuro side effects. She was put on Tylan before thinking she had sibo, but it did nothing.

I told my current vet I really think she has pancreatitis which is causing damage to her small intestine. I was given some prescription enzymes and what I saw was more poop, bulky and almost greyish. In the past she's had mustard yellow or bright orange stools during flares. No vet has ever cared about her stool color. None. I've been told her tli is high so dont give her enzymes because she's already producing too much.

The last few weeks I feel she has been going very downhill. I have seen my current vet several times and things get ignored, no care and no advice. I have seen so many vets around here and all are the same.

Her labs history has shown high TLI, but normal B12/Folate every time I've checked in the past. Her Amalyse/Lipase where always normal and CPL would be normal or abnormal.
She has had high ALT at one point where even the vet school tried to blame her teeth on it.....which is wasnt.

Her labs lately have shown elevated amaylse, but told non specific due to many causes, high lipase that is consistent with pancreatitis, a GI panel from VDI labs showed possible pancreatitis, but no IBD according to their lab. It did say she has some small intestinal inflammation, but now she has low vitamin D, low folate......but high B12.

So here I am confused because she has low folate, but high B12. If she had sibo wouldnt the folate be high? I havent redone the TLI yet, but just had one done 2 months ago along with the 4th ultrasound I have done and that was quite high. If she has EPI wouldnt the B12 be low and the TLI? I know high B12 could be her pancreas or even liver. I had always suspected liver issues, but I'm always told no. At one point I thought kidney failure and that's what brought me to the vet school and 2 other vets saying she had stage 2. I was then told no she doesnt by the vet school head kidney dr there. They to did an ultrasound which showed nothing. Out of all of the ultrasounds I've had done only the first said they saw some scaring from past pancreatitis.

I'm just at loss what to do because here my dog is going downhill and all I do is shell out money for vets to not help. It's really sad here with the treatment I've received.

Her stools as of late have been all over the place. Usually normal with some of the honest kitchen in it, but early 4 am this morning it was like her entire intestinal tract let go and she pooped so much 3 times. They were very bulky, but not quite liquid. No mucus, but smelly. Color was brown yet slightly yellowish. Today she went a little and it was small, formed, but a tad of mucus.
I have noticed her limping after she eats there is some confusing behavior at times and all I'm told is its probably her back because she's a Dachshund. If that were the case then she wouldnt walk perfectly normal at other times.
I've mentioned for 3 years how she always acts like she is starving and they just laugh or ignore it. They figure as long as she's eating no worries.
I've mentioned how her weight when this all had started was 14 lbs. She dropped to 12.5 for quite sometime and recently is almost 11 now. Again, they don't care. I dont think they ever will and I feel like I'm almost to the point I'm going to have to let her go. Sad part is there's times she seemed perfectly fine and looks good, but then she begs to eat, eats and its all downhill.

I have tried probiotics and even those seem to flare her up. I found Grandma Mae's dog food which is limited ingredient and low fat, but it is kibble and she hasn't been on kibble for over 3 years so I'm worried it will just cause more problems or make her really sick if I even attempt to give her even a piece. I have been mentioning on how I think her biome has a lot to do with things and no one understands it even with 1 vet actually getting a dysbiosis score test from Texas A&M.

Oh and she has random muscle weakness, sometimes has these weird jerk back things if she barks and shakes....which has to be pain. The muscle weakness is clearly because of the loss. She barely has any muscle on her....but ribs aren't showing yet. I was referred to a neurologist who said he saw nothing wrong with her. She was checked for an auto immune disease that Dachshunds cant get with muscles and that was normal.

She does urp and gulp a lot. Gas used to be crazy and I finally got that under control and have no idea how (gas x makes her sick so I couldnt use that), but now it only seems to happen after she poops. Her stomach does go crazy after she eats though and wasnt doing that 2 weeks ago.

I thought 2 weeks ago she was actually doing pretty good and wouldnt even think food allergies, but that didnt last.

I've asked about having her in the hospital on IV, but around here I guess they don't do that anymore unless she's constantly vomiting and she has vomited if bad enough.

Only thing I havent done is an actual intestinal biopsy and in the past no one wanted to do it based on labs, ultrasounds, etc. Now, I've have a few mention it, but then you're told what the prep is like and I cant put her through that in the state she's in. I also worry if she'd eve survive being put under at this point. Her labs and history just in 3 years though is huge.

Early today she was playful and seemed fine then tonight back to being messed up. That's what makes this so hard.

Does anyone have any advice for me based on the low folate, but high b12? Couldnt she be at the point of epi now or could it be pancreatitis or maybe even both? Should I try her back on enzymes if she's having active pancreatitis?

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jilbert57
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Posts: 2088
Country: United States
State: Washington

Re: Epi, pancreatitis or something else?

Post by jilbert57 » 12 Jan 2023, 21:00

Hi Nate, will you please post the latest blood tests including Cpl, Tli, folate and B12?
When Mickey had chronic pancreatitis his Tli was >50, B12 was around 900 and Cpl was >1000. I joined this forum and put him on Dianes enzymes, 6x and within 6 months his Tli came down to 25 however his Cpl remained >1000.
He was on Tylan twice daily for SIBO. He ate white rice, hard boiled egg, Balance-it and seaweed supplement.

Maybe after looking at the blood works we can figure something out.

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.

TheDude
Member
Posts: 3
Country: United States
State: Florida
Pet name: Pixie
My name: Nate

Re: Epi, pancreatitis or something else?

Post by TheDude » 12 Jan 2023, 21:44

Here's the latest:
On 12/29/22
Amylase 1,992 (337-1,469)
Lipase 1,200 (0-250) was at 429 prior
Vet didn't want to add cpl

12/13/22 VDI Labs GI Panel
B12 1280.1 (220-1080)
Folate <2.4 (4.3-21.0)
Lab says could be proximal SI damage

10/12/22 (Idexx Labs)
Spec cpl 654 (0-200)
TLI >50 (5.0-35.0)
B-12 543 (284-836)
Folate 6.4 (4.8-19.0)
Amalyse 940 (337-1,469)
Lipase 429 (0-250)

As far as food goes one of the nutritionists had hey on rice, fish, butternut squash and a balance it supplement. She ended up having pancreatitis on that. Ended up with bright fatty orange stools. Just a tiny amount of the supplement after trying the food itself set her into a crazy flare.
I've tried rice a few times and she definitely can't seem to handle it. All grains seem to cause problems. Potatoes cause gas. Pretty sure she's allergic to eggs. I'm not kidding when I've said I've tried pretty much everything. I do think the Honest Kitchen is becoming way too hard for her to digest now and is too high in carbs and the gator even though low fat can't tolerate even that now.
If it's a low fat protein I've tried it. She was on Pollack when she actually vomited and her ALT was around 700. That went down when I switched back to the Honest Kitchen with gator.
I never thought I'd have such trouble finding something she can eat. I'd love to get some weight on her.
My biggest fear is she's starting to have necrosis pancreatitis where it's starting to digest the fats in her brain. If her SI is being damaged that's bad enough for absorbing anything.

Most foods go right through her, cause allergic reactions, stomach acid, gas, or give her pancreatitis.
I go slow and she starts out OK on some then doesn't.

positivesuddenly
Member
Posts: 1
Location: United States
Country: United States
State: Florida
Pet name: Flo

Re: Epi, pancreatitis or something else?

Post by positivesuddenly » 11 May 2023, 00:29

I've had a few people bring it up, but you're told how difficult the preparation is, and I can't subject her to that right now. I have my doubts that she could be put under anesthesia at this time. Even in just three years, her lab work and background are impressive.

TheDude
Member
Posts: 3
Country: United States
State: Florida
Pet name: Pixie
My name: Nate

Re: Epi, pancreatitis or something else?

Post by TheDude » 11 May 2023, 23:41

I haven't updated this thread until I got notice of a recent reply. I've also been trying to figure my dogs issues out getting dismissed by vets.
She was just diagnosed recently with Cushings through a new internist which explains a lot over the last few years. Tests were always grey area with it until now.
She doesn't have epi, but unfortunately does have Cushings.
The sad part is I had another Dachshund who also had Cushings and they aren't even related. The fact I have to go through it all over again sucks. Diet is the reason labs have been in most cases stable, but there are pancreatitis flare ups unfortunately because of the cushions.

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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: Epi, pancreatitis or something else?

Post by Jean » 12 May 2023, 05:40

I am not up on Pancreatitis Jill is so you are in good hands
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

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

Re: Epi, pancreatitis or something else?

Post by Jean » 12 May 2023, 05:42

positivesuddenly wrote: 11 May 2023, 00:29 I've had a few people bring it up, but you're told how difficult the preparation is, and I can't subject her to that right now. I have my doubts that she could be put under anesthesia at this time. Even in just three years, her lab work and background are impressive.

not sure what this is about, can you explain "positivesuddenly"
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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