Cavalier King Charles with EPI

[JJinOhio]

Hi, have just joined this group after my 6 year old CKCS was diagnosed with EPI. Vet thought it couldnt be the case given his breed, but he had all the symptoms and blood work confirmed. I have attached in case helpful! So far, my insurance will cover the tablets and have started him on those. It's been one week and he is up from 15.4lbs to 16.1 lbs and while minimal- he didnt lose any more, so calling that a win.

Can anyone help with the 'why' around his sudden onset? He lost 25% of body weight in just 3 months, and the symptoms seemed to start overnight. He started counter surfing lots of foods (hamburger buns, pistachios, candies) - and he is NOT counter height so he must have really worked to get up there. I wonder what came first... the sudden hunger and therefore drive to reach foods he had to someone jump onto counter for and thus inflammation and EPI or the EPI was driving him to take measures into his own hands to get food.

I feed him: Natural Balance Limited Ingredient Grain-Free Salmon & Sweet Potato Small Breed Bites Recipe Dry Dog Food, plus 3 pancreplus tablets + b12 supplement.

My other dog has since put ON 3 lbs and is constantly eating Williams poop - guessing bc it has undigested food? Trying to pick up/remove immediately now.

Appreciate this forum and any tips.

[Olesia711]

Hi William's dad,

Thanks for posting.... and first let me address the easy part of your post, the lab results. Yep, your dog has EPI, (TLI of 1.3) and very low B12 of 150. Make sure you dog is on B12 supplementation! the high AST, ALT are liver indications. THe high ALT is usually no big deal with EPI as it often comes down once SID/SIBO/Dysbiosis get under better control.... but i am sure the vet will watch the AST which may or may not come down with the ALT. The Phosphate Precision is often high with EPI just because your dog now has EPI. The Precision PSL is no big deal either... it is just marking a view at the moment.... so it can't give any conclusive indication of anything. This is why you go by the TLI test. The Lymphocytes are high, simply because of EPI and inflammation (SID and all)... and often goes down once you get SID under better control....or... it could be something to watch. Your vet will stay on top of this if need be. The neutrophils tend to be out of whack when something is going on.... as it is, EPI.

Ahhhh so you are asking the age old question... why did EPI happen and why now???!!!! We'd ALL like to know. Previously they thought that when it happens at a young age (2 or under) it appears to be a primary condition, with maybe a genetic component that drove it.... however... when it appears to happen after 3 or 4, it is what they used to call a secondary condition, where maybe something triggered it like chronic pancreatitis that you may or may not have known was happening and it segued into full blown EPI, or some sort of blockage or something.

Before the above, they used to think it was all genetic. Then they came up with the above. Then they figured it's got to be environmental... Now they don't have a clue but wonder if there is a little bit of both, genetic propensity and environmental triggers maybe??!!

We, Epi4Dogs, just got done doing a 7 year gastrointestinal research with EPI Microbiome and Metobolomics... (see: https://epi4dogs.com/epi-research/ ) there were some indications, but nothing definite. NOw we are embarking on another EPI genetic research project with bigger and better technology and techniques then was was done 13 years ago... so hopefully THIS research will yield some answers!

[Tuckaboo Pam]

Hi JJ and welcome to you & William. I'm a former resident of the buckeye state, too.

EPI can seem overwhelming at first, but it sounds like your vet didn't take long to get the testing started & putting you on the right track.

The food you are feeding sounds good...is the fiber less than 4%? Be sure you give him 150% of the amount that is recommended for his IDEAL weight, enzymed accordingly, and spread into three meals if possible, but at least two.

B12---Wonderlabs Pet Factor works best, and he definitely needs supplementing, as EPI dogs need to be at 600+.

All EPI dogs have SID, but not all show the symptoms. If they are symptom-free we don't have to worry. Sounds like you are OK for now.

My Tucker had always been bony, but my vet wasn't worried. He also ate paper, eye glasses, rocks, and whole rolls of toilet paper. My vet wasn't worried. At Thanksgiving he stole an apple pie. Then on Christmas Eve he ate 13 cupcakes & went into full blown EPI, with all the classic symptoms. It took months to figure this out.

I wrote to an EPI researcher about getting Nina( my second EPI dog...Tuck died last year) involved in her study, and she told me that several other respondents had similar stories of incidents like Tucker's before their EPI diagnosis. My feeling is, in Tucker's case he was starving, and doing everything he could to sate his hunger, and he finally pushed himself over the edge. But you bring up an interesting question. I'm not sure we can know the answer for certain, but it's possible that it's a little of both---the chicken and the egg both came first!

So funny that your other dog is gaining weight! Is it named Kate or Harry?---Pam

[JJinOhio]

Thank you, both.

Actually my vet did not walk through lab results with me... more of a 'yep, EPI'. I get the sense it's new for them. So appreciate the comments around his results!

Yes he is on b12 Supplementation as well. He has a some fear based agression as well as resource guards. I have read b12 can sometimes helps- here is hoping this has a positive side to it too!

No Kate or Harry, but he has a brother Dash. He is the one GAINING the weight. Im guessing its from eating up after William outside. Ill be starting the stuff that makes then want to NOT eat their poop!

Im also hoping the tablets will work for us. Sounds like trial and error, they work for some but most use the powder. I am going to do weekly weigh-ins at the vet and keep an eye on stool for a couple weeks to see if I can continue with the tablets.

[jilbert57]

Most of us here that have used tablet enzymes crush them first, sprinkle over the food, add room temp water, stir and let incubate 20mins. Stir then serve. If you are still seeing undigested food in the poop you might need to add one more tablet.

Jill

[Olesia711]

SOunds like a good plan.

UGH... that poo eating. what you can try is adding crushed pineapple to the food start with 1 tsp) ... supposedly pineapple tastes good going in, but not so much coming out the other end.

Or... sprinkle some ACCENT (meat tenderizer) on the food... that supposedly can help too.

And yes, you are correct, when others start eating the EPI dog's poo, that is usually a good indication that the food is not being fully digested/or/the nutrients are not being fully absorbed. sometimes more enzymes are needed... other times it's antibiotics or pre+probiotics that are needed to address out-of-control SID.

My favorite story about how one family could tell when SID/SIBO/Dysbiosis was getting out of control in their EPI dog was when they noticed that the magpipe birds were bomb diving their dog's poo!!! It was loaded with nutrients that the dog was not fully digesting

[Olesia711]

oh... and yes, your dog has EPI.... check out the TLI test results.... see where it says 1.3 ???? that is confirmed EPI.... HOWEVER.... the test gave the right value, the bar graph reflects the 1.3 low value... but it incorrectly placed an H there when it should have been an L for low ...

[Chance]

Welcome!

As Jill has already indicated, if using tablets, most people do find that they need to crush the tablets and mix the resulting powder through the food, and let it sit before feeding. For that reason, most do wind up getting powder later on. But every dog is different; so might be fine with just the tablets.

B12 levels are very low, so it's good you are starting supplementation! Many people have success with Pet Factor, by Wonderlabs. (It has the intrinsic factor required by EPI dogs to absorb the B12). BUT be careful, as not all dogs can actually absorb any oral B12. Chance was one who did not respond at all to Wonderlabs. He needed to have the injections! Since B12 can affect anxiety levels, it's something you'll need to be mindful of.

If B12 levels come back into a healthy range, and anxiety levels don't do back to normal, I would consider having thyroid levels checked. (Total T4 is affected by sooo many things, and cannot be used to diagnose anything. So a full panel would be required). But hopefully B12 fixes all of that!

Ha ha ha! Olesia is very right. I didn't even notice the 1.3 (LOW) TLI was reported as high on the graph! That's a really strange glitch!

[Olesia711]

the "glitch" that misrepresented the TLI value on the test results- - made me chuckle... i guess even machines/computers make mistakes!

[JJinOhio]

Agree, seems that would be automated to a L result!

I am ordering the Wonder Labs Slippery Elm and have a probiotic from the vet (Advita). Is there a reason to avoid the antibiotics at first diagnosis to get the gut in better condition? His stool went from firm, but yellow/grey, to orange and very soft, to now orange/brown diarrhea. I feel like that is worse, but maybe not?

I need my other dog to stop eating William's poop. Will try the Accent or pineapple. Was hesitant to change much with William's diet since his tummy is so bad. I think my other dog may also need to antibiotic since he has been eating up after William and therefore likely sharing bacteria. William has the gurgles, burps and occasional vomitting, but my other dog is who has developed the horrendous gas. I will hear William pass gas, but no odor!

I have dealt with 3 types of cancer, cushings, DM, lots of neurological, CHD... and adding EPI is certainly a new challenge. Especially when William just wants his treats all day.