# Exocrine Pancreatic Insufficiency - HELP!!



## yvonneglen (Sep 20, 2008)

Does anyone on this forum have an EPI dog or experience with it? I decided to go back to Pet Pantry to do some research on kibble food and get some help from their awesome staff. Turns out two of their staff ran up to me and ask if you're the woman with the skinny GSD, Bacchus. They told me Bacchus was the topic of conversation during with their inhouse nutrionist who was just happening to have a seminar this past Saturday. John (who had helped me prior) had asked her some questions about Bacchus.

She said she believes Bacchus to have Exocrine pancreatic insufficiency and that she had suggested to three other owners three dogs in the past several months and that the "functional vets" are missing all the signs because basically they are not trained in dogs diagestive systems. She told me to forget about the holistic vets and changing around for a better vet, etc and just to high tail Bacchus to an vet who does internal medicine.

I an trying desperaterly to keep my composure without falling apart. I read a bit about this disease and it's horrible. If it's not caught in time their pancrease already is damaged 80-90% and they only have 10% capacity then the remainder of the organs go. They basically starve to death because their bodies are missing the enzymes to propertly use the foods for growth.

I guess I will have to get a TLI done on him to rule this out too. I just spoke to our stupid, dismissive vet and he told me to change his food Eukanuba, that it's his digestive tract, continue on with his prozyme, no raw supplement and try panakare or tylan. Then said "I said all I can say to you I have to go, I have other pressing things to do". What a creep and insensitive. I hate him. Oh and then he goes on about how a nutrionist (for dogs) is not going to advocate giving a dog a raw meal supplement especially with disgestive issues... Just so patronizing.

I have too many variables with Bacchus now and don't know what to do.


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## GSD MOM (Apr 21, 2010)

WE have an awesome EPI family here. 
I say 1st step is a new vet. 2nd step (asap) get the TLI test done.


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## jan630 (May 29, 2007)

Hi,
If you think your dog may have EPI (exocrine pancreatic insufficiency) find a vet that will do a FASTING (no food for 12 hours prior to the blood draw) cTLI, B12 and Folate test. That will determine it one way or the other. Unfortunately there are too many vets that are unaware of EPI or if they are aware of it they do not know how to treat it.
Most EPI dogs can live a long and healthy life with the aid of replacement enzymes, supplemental B12 and treatment for SIBO if required.
If it were me, I would get the cTLI/B12/Folate test done asap.
Jan


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## Rerun (Feb 27, 2006)

EPI is not the be all end all scary thing some websites will make it out to be. What other symptoms does your dog have other than difficulty maintaining weight? What are his stools like?

My 6 yr old female was diagnosed just after turning 3 yrs old, and has been maintained on regular kibble dry food with enzymes ordered from Home - ENZYME DIANE (many other board members order from her as well). She doesn't need anything else special and just had her yearly checkup and vac's (I only do 3 yr vac's on my dogs) and the vet said she was in perfect weight and beautiful health.

On another note, your vet sounds like a first class (insert your choice of words here) and I'm glad you are looking for a new vet.


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## Zoeys mom (Jan 23, 2010)

My lab has EPI and it's not that bad unless I'm missing something. We add a powder to every meal for him and have his blood taken yearly- thats it. Before we knew he was thin, lethargic, and had runny slimy stools which disappeared in 2 days after we began the enzyme powder in his meals. He's 8, a healthy weight, active, and happy


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## yvonneglen (Sep 20, 2008)

Rerun said:


> EPI is not the be all end all scary thing some websites will make it out to be. What other symptoms does your dog have other than difficulty maintaining weight? What are his stools like?
> 
> On another note, your vet sounds like a first class (insert your choice of words here) and I'm glad you are looking for a new vet.


He is very lethargic, coat is not healthy looking, diarrhea (not chronic but had had a bout with it three times within the last couple of months), his poos are always runny almost like soft-serve ice cream but the color varies in darkness to light brown but it's never a yellowish color but never really look like they should either, burps up a storm, no appetite whatsoever , his weight at 10 months was 85 lbs. and 9 months later he is still at the same weight. Our vet tells me this is normal. "at least he is not losing weight". I am no doctor but I should think that a 10 month old shepherd weighing in at 85 lbs. should have at least put on a minimum of another 5 -6lbs. in the last several months??? He looks emaciated (http://www.germanshepherds.com/forum/b-r-f-raw-feeding/138781-supplementing-raw-meat-patties.html. I posted some pics of him on another thread, so take a look at what he looks like currently) Vets answer, "if you want a "bigger dog" get him fixed. All GSD who are intact are never big and bulky" That is a load of absolute rubbish. Seems like the fix for this vet is to get Bacchus fixed and all his ailments will go away magically.

I know I am not being paranoid and it cannot be a coincidence that I always get asked, "are you feeding your dog" because he looks like he is starving. And yes, our vet (and all the other vets) are totally useless and that is putting nicely. Once I get this settled I will be writing a letter to the Westchester County, NY Veterinarian Association and will also make sure to rate them online on every site I can..


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## PuffinGirl (Feb 20, 2009)

I had much of the same difficulty while trying to get my dog diagnosed. I KNEW something was wrong, but the vets didn't really seem to take me seriously. His poop was always soft, he was very skinny, and he didn't eat very well. I insisted on testing him for EPI twice, both of which came back low normal. Since that didn't give me an answer, the next step was to see an internist. We eventually got a diagnosis of IBD. I know how frustrating it is, but you have to be proactive and get to the root of the problem.


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## yvonneglen (Sep 20, 2008)

*Went to the Internist today!*

and I am excited to report that I am very happy with the visit today. Not that the problem has been resolved *BUT *that there was *FINALLY* a vet who agrees and sees what I am seeing: a skinny GSD that is still young and should ***STILL*** be gaining weight and not stop his weight gain at 10 months old!! And that there is something going on inside of him as is very evident just from looking at his coat.

We went over his entire history not that there is much in the span of 1.5 yrs. and said that he definitely has muscle wasting on his hind legs, bones are sticking out and that he should be at least a minimum of 6 lbs. more and that "fixing" him will *NOT* solve the problem Bacchus' problem. She, of course could not say anything about my previous vet other than that he does shows the signs of an EPI dog in the early stages.

She gave me a prescription of panacur for three days, once every 24 hrs. and then I have to repeat again in 3 weeks. IN the meantime she took blood from him to confirm EPI & SIBO. She also took a stool sample to rule out Giardia (but we do not live near any rivers, streams or ponds, and nor does he visit places like that. Those results will be in tomorrow. The EPI results which were sent to Tx. A&M will be back in a week.

Other than his GI problems she said that he is gorgeous and has an amazing tempermant and gave me kudos for his training..  That I have done everything I could posssible do and am glad that we are so intuned with Bacchus. Upon me leaving I had to ask again Does she think Bacchus is an EPI dog and she said yes in her opinion but bloods are the only way to confirm..

I feel much, much better and am now able to put all of this energy I have been using all on Bacchus for the last two weeks and spread some to my little girl, my baby son and my husband (and get to the management of the other mundane house stuff that has been put on the back burner).

She does want me to stop the raw feeding of his supplement until we figure out what the game plan is. One thing I do need to ask (when she calls tomorrow) but maybe some of you can answer for. Why three days on panacur and then another dosage not until three weeks later?? I find that kind of odd. Is this the nor? When you're waiting for blood results?

Thank you again for all your input and help.


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## Jax08 (Feb 13, 2009)

It's the worm life cycle. My vet does the same thing. make sure you thoroughly clean up after him and spray a bit of bleach water where he goes to kill anything he expels.

Stop raw feeding? Why? I don't understand that. What did she suggest in place of that?


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## PuffinGirl (Feb 20, 2009)

I'm so glad you found a vet who was responsive to your concerns! I hope you get some answers from the labwork - while it's never good to find out your dog is sick, it does help to FINALLY have a diagnosis of what's going on.


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## yvonneglen (Sep 20, 2008)

Jax08 said:


> Stop raw feeding? Why? I don't understand that. What did she suggest in place of that?


According to this vet because Bacchus' GI tract is super sensitive she rather I wait until we have all the answers confirmed, then we can resume with the supplementation of his raw patties and go fourth with a game plan for his food. She said because of the bacteria the raw feeding may present, I guess she wants to play is safe for now??? 

We get the results back in a week's time and I cannot wait to finally have some closure to this, whether he is EPI, Sibo or thyroid, etc.

One thing for sure if this comes back positive for EPI I *WILL* be making a visit at my former vet, sending a letter to the BBB and another one to the Westchester County Veterinarian Association. The amount of money I spent on drugs, office visits from the last several months could have paid for this one visit alone and I would have had conclusive results. Instead they kept on wanting to put a band-aid on each problem that presented itself or the usual preaching, "get him fixed". All doctors in that hospital are stupid, insensitive and totally incompetent!! And care nothing about the welfare of animals just the "business of a veterinarian practice".


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## Jax08 (Feb 13, 2009)

I think you should research RAW diets and EPI. Have all your research with you so that you can discuss this with your vet. It doesn't sound like she is against RAW diets though. I'm sure there are people on here that can give you an idea on whether RAW diets have an affect on EPI.

Also, there is a support group for EPI where you can buy the enzymes at a discount price. You could research that while you wait also.


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## GSD MOM (Apr 21, 2010)

AWESOME!!! That is great news. It is such a good feeling to have a vet that understands you and makes you feel like you and your dog are in good hands. 

As far as food goes. I can't say the stopping the raw is a bad idea. But I can say that when we switched Nellie to a grainless food we were able to cut back on her enzymes. She only gets half of what she was getting before and her poo's are as close to normal as they have ever been since she was 9 months old. We feed TOTW.


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## yvonneglen (Sep 20, 2008)

*Catching EPI early*

How do you know if you caught it early on? Or if you caught too late? I am really upset and am hoping that perhaps he just has Giardia (I seriously doubt it) but we don't live near any stream, rivers, lakes, etc. and don't visit places like that. This is a lot to handle and the horror stories I am reading. I just hope if he does have it he is one of those cases that are simple, sprinkle on the enzymes and continue on without any complications. This waiting is so difficult.

How long does a dog have to have EPI before his pancreas is 80-90% damage? Is this a long process or can is happen within months? I am waiting to hear from our vet today and will ask her but thought I would ask those who have hands-on experience with EPI. I call our breeder from time-to-time to give her updates about Bacchus and of course this is of concern to her. She's the one who told me whatever you do get him on panakar now (find a new vet; yell at him, demand it she was referring to our old vet whom I have severed ties with). Doesn't that mean Bacchus' mother or father have that recessive gene? Can you do genetic testing like that on a dog to find out if their carriers of EPI especially if one of their offsprings have been diagnosed with it?


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## JeanKBBMMMAAN (May 11, 2005)

exocrine pancreatic insufficiency
Genetic info

I don't believe there is a genetic test.

I have a foster recently diagnosed with EPI, but don't know the answers to your other questions.

Maybe try the www.epi4*dogs*.com forum if no one else knows, or talk to the new vet, check the Texas A/M site too - they have some good info - but referred me when I emailed about their study to the EPI4dogs site. 

Giardia is common enough that it is possible, as is SIBO without the EPI.


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## DaniTy (Nov 3, 2009)

We've been dealing with this with our white GSD. It all started when her serum protein levels came back low prior to her being spayed. We had her TLI done and while it didn't come back in the diagnostic range, it was still low. We are still having issues and I plan on asking my new vet (we had to move) to repeat the TLI as well as test her B12 level. 

Please check out this group...they've been very helpful!
EPI * Exocrine Pancreatic Insufficiency


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## DaniTy (Nov 3, 2009)

You'd be appalled to see my shepherd. She's 7 months old and barely breaking the 30# mark. Our last shepherd, which we lost to megaesophagus, was weighing in at 50# when he was 9 months old and was a healthy weight and size before the megaesophagus started causing him to lose and he lost fast.


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## yvonneglen (Sep 20, 2008)

DaniTy said:


> You'd be appalled to see my shepherd. She's 7 months old and barely breaking the 30# mark. Our last shepherd, which we lost to megaesophagus, was weighing in at 50# when he was 9 months old and was a healthy weight and size before the megaesophagus started causing him to lose and he lost fast.


I am sorry to hear that. It's so hard when you lose them that young --*actually any age is hard.*


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## yvonneglen (Sep 20, 2008)

JeanKBBMMMAAN said:


> www.epi4*dogs*.com forum


I have tried registering with that that forum several times but I am having a hard time getting confirmation for membership. I tried to register again today to no avail, even sending the administer an email. Perhaps they are on vacation?? Guess I will have to wait some more, I hate this waiting.


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## goatdude (Mar 3, 2009)

I just registered today.


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## yvonneglen (Sep 20, 2008)

goatdude said:


> I just registered today.


Glad that you got on, I can't. I have been communicating with the admin all day trying to find out why she can't get me logged on. She gave me her log on and password in the interim which was very nice because the other EPI group from yahool will not accept my application until Bacchus has his blood results back. BUt the admin of that site sent me some info in the meantime which was very helpful.

Also received word from our vet that is is NOT Giardia.


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## goatdude (Mar 3, 2009)

That forum is very helpful.
I'm getting Ruby in for the blood draw on Monday.
Hoping for the best but from the description of the symptoms
it looks like she may have EPI and possibly low B12 

Hope you get your logon issues solved soon


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## GSD MOM (Apr 21, 2010)

yvonneglen said:


> Glad that you got on, I can't. I have been communicating with the admin all day trying to find out why she can't get me logged on. She gave me her log on and password in the interim which was very nice because the other EPI group from yahool will not accept my application until Bacchus has his blood results back. BUt the admin of that site sent me some info in the meantime which was very helpful.
> 
> Also received word from our vet that is is NOT Giardia.


It was hard for me to get signed up with yahoo also. It is a very different site then others I have been on. Once I did though it was VERY helpful. They are the ones that talked me into changing Nellie's food to grainless. How are you guys holding up?


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## Mark444 (Jul 16, 2010)

*Epi*

My female dog will be 4 next month. Right after her first birthday, about 13 months old, she began having the runs and rapidly losing weight. We took her to the vet and they took some tests and determined she had no enzymes in her pancreas at all! She had a very bad case of EPI and would need the replacement enzyme for the rest of her life. We began purchasing BioCase V, from KV Equine. It costs a lot cheaper because it is the generic form of Viocase V. I give her regular kibble, Natural Choice for large breed dogs, wet it down, then drain the water out. I then put the powder on her food and mix it well. The directions say to let it sit for atleast 15 to 20 minutes. I find it is better to let it set for 30-45 minutes.
She now looks great!! She is healthy and full of energy.


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## yvonneglen (Sep 20, 2008)

GSD MOM said:


> How are you guys holding up?


We're great, thank you. I took Bacchus to the groomers today. He loves that place, he gets to play with a 100 different cats she has all over the place. Gayle took him in and he ran into the back put his paw on the tub and jumped in! 

I am worried though because getting food down him is very difficult. He did not eat his breakfast today and only half of his dinner. Thank god I let up on the exercise and joggins with him a couple of months ago because I noticed that he was so skinny. Just imagine if I did not let up, how skinny he would be now... It's makes me cry just thinking about it. We are strong and will get through this. Like my husband says, we will do whatever it takes... Just trying to pass time until next week...while I am biting my nails....tick, tock, tick, tock...........

Thank you for thinking of us.


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## DaniTy (Nov 3, 2009)

yvonneglen said:


> I am sorry to hear that. It's so hard when you lose them that young --*actually any age is hard.*


True that...and is making watching Kaisa continue to be so skinny without getting any help from the vets here all that much harder...it's like reliving it. But luckily I was finally able to find a vet about 45 minutes away that knew what I was talking about when I said her TLI needs retested. We have an appt Monday. Hopefully things will start looking up for her now!


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## DaniTy (Nov 3, 2009)

yvonneglen said:


> We are strong and will get through this. Like my husband says, we will do whatever it takes... Just trying to pass time until next week...while I am biting my nails....tick, tock, tick, tock...........


Waiting is the most difficult part. I'm not sure when you had the TLI ran, but if it was ran on Monday you may have results this coming Tuesday. Texas A&M runs the EPI tests on Tuesdays. They also have an EPI Research Study going for German Shepherds. It might be worth looking into as well if that's what the results show.

Wishing you all the best as I'm there with you, needing answers and wanting a good life for my furbaby.


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## yvonneglen (Sep 20, 2008)

DaniTy said:


> Waiting is the most difficult part. I'm not sure when you had the TLI ran, but if it was ran on Monday you may have results this coming Tuesday. Texas A&M runs the EPI tests on Tuesdays. They also have an EPI Research Study going for German Shepherds. It might be worth looking into as well if that's what the results show.
> 
> Wishing you all the best as I'm there with you, needing answers and wanting a good life for my furbaby.


Bacchus' bloods were taken on the 15th (Thursday) and I was told by the vet that she will call us Tuesday and for me to call Wednesday if I don't hear by then. Yeah, right you think I will wait until Wednesday to call. If I don't get a call Tuesday by 2 pm you can bet I will put a call in at 2:03 pm .

Good luck to you on Monday. Keep me posted on the results. Perhaps we can learn together as we go along, if need be.


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## DaniTy (Nov 3, 2009)

yvonneglen said:


> Bacchus' bloods were taken on the 15th (Thursday) and I was told by the vet that she will call us Tuesday and for me to call Wednesday if I don't hear by then. Yeah, right you think I will wait until Wednesday to call. If I don't get a call Tuesday by 2 pm you can bet I will put a call in at 2:03 pm .
> 
> Good luck to you on Monday. Keep me posted on the results. Perhaps we can learn together as we go along, if need be.


Yeah, when our vet in Kansas first tested, I was on the phone constantly to see if they had results. LOL Patience is a virtue that I lack!

Kaisa took a serious turn for the worse yesterday and I had to rush her to the Emergency Vet Clinic in Niceville. I'm so thankful for them. They were wonderful. She was hospitalized overnight, receiving IV fluids (sodium chloride) for dehydration and Hetastarch (to try to bring her protein level up some). She received fluids for a full 24 hours. They let me bring her home earlier this evening. She is still not eating but is considerably better than yesterday. Her total protein came backat 3.7 (normal is 5.2-8.2) and her lipase (one of the enzymes needed to break down protein) was practically non existent at <10 (normal is 200-1800). The wonderful vet we saw upon admittance and the one that covered through the night and today both agree that it is likely genetic EPI with SIBO as she is too young for it to be aquired. She's currently on metronidazole again and I expect the vet tomorrow to start her on the 30 days of Tylan.

I've been going rounds with her breeder who guarantees the health of her dogs for 5 years against crippling genetic health defects and is refusing to reimburse us for last night's hospitalization due to her giving us another sick pup to replace the one we purchased and had to put down (we weren't reimbursed for his diagostic testing or the cost of having him euthanized). I also plan to meet with the vet who was seeing her here that refused to do any further testing, didn't consult with our vets from KS, ignored their recommendations for diet change (I did that on my own) and refused to give me a 30 day supply of met when after her last 5 day course the cow patty stool started again within days of it being completed. I called last week because I thought Kaisa was getting skinnier and she was losing her appetite...they couldn't get me in til this Tuesday...which is when I started calling around for a new vet.


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## yvonneglen (Sep 20, 2008)

Oh wow, I am so sorry. What a bum breeder. Have you joined up the k9-epiglobal forum? That site is awesome. You should definitely join up ASAP. k9-EPIGLOBAL : Exocrine Pancreatic Insufficiency Dogs There is also a FB page too: EPI - Exocrine Pancreatic Insufficiency in Dogs | Facebook

My prayers to Kaisa.


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## goatdude (Mar 3, 2009)

I brought my dog into the Vet today for EPI testing blood work. The breeder I got her from has a similar "guarantee" that if the pup does not remain healthy they will replace with another dog. Problem with that is if they are breeding EPI dogs who wants another one? None of the costs are covered just a replacement dog that they choose for you.


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## LisaT (Feb 7, 2005)

DaniTy, I wouldn't bother with retesting the TLI. I would put your dog on enzymes and see if there is a response. 

EPI is not the only enzyme deficiency out there. For example, there's that low lipase, which can be seen in a non-EPI dog, which I completely don't understand. My Max is not EPI, but his lipase runs at about 55. He requires enzymes. If I treated according only to his blood tests, he would be a very sick boy. 

He did not test positive for SIBO either, yet his first time on antibiotics, he gained 10 pounds of much needed weight. Recently, another 6 pounds, and he's now at the weight he should have been at all these years. It took about 6 months of abx treatment this last round to get the last 6 pounds. 

Treat the dog, not the labs tests.


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## goatdude (Mar 3, 2009)

Why was he put on antibiotics if he did not have SIBO? Where did you get the lipase number? Thanks.


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## DaniTy (Nov 3, 2009)

yvonneglen said:


> Oh wow, I am so sorry. What a bum breeder. Have you joined up the k9-epiglobal forum? That site is awesome. You should definitely join up ASAP. k9-EPIGLOBAL : Exocrine Pancreatic Insufficiency Dogs There is also a FB page too: EPI - Exocrine Pancreatic Insufficiency in Dogs | Facebook
> 
> My prayers to Kaisa.


I will check them out. Right now I've been mostly plugged in at www.epi4dogs.com They've been a huge help and I plan to get the needed enzymes through their co-op, Enzyme Diane. A couple of the ladies are sending me some enzymes to get us through this financial belt squeeze until I can get the full 32oz.

Thanks for the new leads. Kaisa had her follow up appointment yesterday and was there for about 6 hours. They gave her more of the sodium chloride and hetastarch. They even got her to eat a little Purina EN, hand fed of course! I was finally able to get her to eat maybe 1/4 pound of raw turkey around midnight. Today though, she's not interested at all....but I'll keep trying. She's got a bit more of her spunk back but looking at her just breaks my heart. She's a total bag of bones.

Her total protein was still really low with her Albumin coming in at just 1.1, still. We sent off the serum the emergency vet clinic drew prior to her B12 injection for accurate results in the B12 and Folate tests, as well as blood from a fresh draw for the repeat cTLI and enough they could perform the B12 and Folate on it as well. I should be able to pick up her Tylosin tomorrow and in the interim she is back on Flagyl. She also tested positive for coccidia again, so we will be doing a two day treatment with a broad spectrum parasiticide to completely eliminate it.

Because her protein is so low, the main thing for us to watch for is fluid leaking into her tissues...


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## DaniTy (Nov 3, 2009)

LisaT said:


> DaniTy, I wouldn't bother with retesting the TLI. I would put your dog on enzymes and see if there is a response.
> 
> EPI is not the only enzyme deficiency out there. For example, there's that low lipase, which can be seen in a non-EPI dog, which I completely don't understand. My Max is not EPI, but his lipase runs at about 55. He requires enzymes. If I treated according only to his blood tests, he would be a very sick boy.
> 
> ...


Seriously?! If you've read through what has been going on, I have been treating my dog...not the lab tests. The vet here didn't do any lab tests and I still changed her food to grain free, low fat and low fiber as recommended for dogs with EPI/SIBO. I tried to get a 30 day supply of Flagyl to treat the SIBO and my vet wouldn't dispense it...gave me Prozyme instead, which is a plant based enzyme supplement...not an enzyme replacement. However, the original labs from Kansas still pointed to us catching EPI early and they recommended the diet change and repeat TLI (which the vet here did none of). I did everything I could do on my own without scripts from the vet and started looking for a new vet who would help me help my dog. Unfortunately Kaisa took a turn for the worse before her appointment time and again, I did what I had to do to save my dog. Yes, we did more testing because those lab tests do help put the pieces of the puzzle together and our new vet who we met with yesterday agrees that clinical presentation is indicative of EPI/SIBO and I already have the porcine based enzymes on the way and our new vet has ordered the tylosin. We are treating as if it is EPI/SIBO although we won't likely have the test results back until next week.


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## DaniTy (Nov 3, 2009)

goatdude said:


> Why was he put on antibiotics if he did not have SIBO? Where did you get the lipase number? Thanks.


I don't know about Lisa, but the lipase and amylase were part of the bloodwork the emergency vet clinic ran in-house as part of the serum chemisty panel.


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## LisaT (Feb 7, 2005)

No, sorry, I was using the information given in *this* thread. 

But you've got a low normal TLI, a low lipase, and signs consistent with malabsorption. When I posted there were several mentions of retesting, other meds, ER visit, etc., no mention of the other things. 

Btw, you can get Tylan online, if you continue to use it, it might be a cheaper alternative than the vet.


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## yvonneglen (Sep 20, 2008)

Well we find out today Bacchus' results and am counting the minutes that the office opens. Wish us luck.


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## jakeandrenee (Apr 30, 2010)

Good luck....


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## KMSlemons (Jun 30, 2010)

*Crosses fingers* for Bacchus. Good luck!


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## DaniTy (Nov 3, 2009)

yvonneglen said:


> Well we find out today Bacchus' results and am counting the minutes that the office opens. Wish us luck.


Have you heard anything? I'm hoping you get the news you need.

I just got Kaisa's results back.

Her cTLI was 3, her B12 <150, and Folate 10.8

Her Tylosin and the parasiticide came in today. I will also be handling her B12 shots here at home. The enzymes haven't arrived yet...delivery is guaranteed for tomorrow, but was hoping they'd be here today.

If you can check out the epi4dogs group, many of the owners there with EPI dogs get their enzymes from Enzyme Diane. There is a tab on her page that shows the amounts of her enzymes compared to those of the name brands. You can print it out and take it to your vet. It's much cheaper at $135 for 32 ounces than the Viokase V at $90 for 12 ounces. My vet checked it and thought it was great...so hopefully yours will too if it's needed.

Good luck!!!!


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## DaniTy (Nov 3, 2009)

goatdude said:


> That forum is very helpful.
> I'm getting Ruby in for the blood draw on Monday.
> Hoping for the best but from the description of the symptoms
> it looks like she may have EPI and possibly low B12
> ...


Just checking in to see how you and Ruby are doing....


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## DaniTy (Nov 3, 2009)

LisaT said:


> No, sorry, I was using the information given in *this* thread.
> 
> But you've got a low normal TLI, a low lipase, and signs consistent with malabsorption. When I posted there were several mentions of retesting, other meds, ER visit, etc., no mention of the other things.
> 
> Btw, you can get Tylan online, if you continue to use it, it might be a cheaper alternative than the vet.


 
My apologies. I thought I had included more information in this thread as I've been posting about it here, two other forums as well as going rounds with the breeder.

I did see tylosin online. The vet ordered me a whole bottle so I may have more than a 30 day supply. Which is fine because I know with the SIBO it can come back, so having it on hand won't be a bad thing.


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## goatdude (Mar 3, 2009)

DaniTy said:


> Just checking in to see how you and Ruby are doing....


We're just sitting here patiently waiting for the lab results. Thanks for asking!


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## DaniTy (Nov 3, 2009)

goatdude said:


> We're just sitting here patiently waiting for the lab results. Thanks for asking!


Hope you hear something soon.

And I just have to ask about your Leerburg icon...like him or poking fun?


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## yvonneglen (Sep 20, 2008)

DaniTy said:


> Have you heard anything? I'm hoping you get the news you need.
> 
> I just got Kaisa's results back.
> 
> ...


Glad that you're getting everything you need in order for you to help her feel better. So is that considered EPI? Or is it borderline?

We received Bacch's results today: 
· *TLI value:* 13.5% (was told that if he was EPI he should be under 2.5%)
· *Cobalmin value:* 450 (was told that this was “low-end to normal” not to worry about it ) What does that mean? Does that indicate he is borderline B-12 deficiency and a B-12 therapy should be implemented? Or should I not worry about it which is what I got out of this “specialist” (highly frustrating)
· *Folate value:* 17 (again was told by her that this is high but is* “nothing to worry about”*

I actually started a new thread because this one is getting too hard to follow for me at this time and now I have questions about SIBO instead of EPI...:crazy: So the subject matter changed for me but the frustration still continues....

Good luck to you. Sound like you have a well-rounded vet. Wish I can say the same for myself going on my second vet possibly a third now....


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## goatdude (Mar 3, 2009)

DaniTy said:


> Hope you hear something soon.
> 
> And I just have to ask about your Leerburg icon...like him or poking fun?


Just having a little fun . It's more his arrogance than anything else.


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## DaniTy (Nov 3, 2009)

yvonneglen said:


> Glad that you're getting everything you need in order for you to help her feel better. So is that considered EPI? Or is it borderline?
> 
> We received Bacch's results today:
> · *TLI value:* 13.5% (was told that if he was EPI he should be under 2.5%)
> ...


I'm glad it's not EPI. However, I'm sorry you are still left without answers. From what I have read, you may want to go ahead and try some B12 therapy for your dog. Because it's water soluble, whatever Bacch doesn't use, he will just pee out. One of those it might help, but won't hurt approaches.

Kaisa has been diagnosed EPI even with a TLI result of 3 because it's down from 4.9 on May 24th and her clinical presentation point she is going down the EPI road. We just got "lucky" and caught it early when her pre-op TP showed up low.


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## jaggirl47 (Jul 18, 2009)

yvonneglen said:


> Glad that you're getting everything you need in order for you to help her feel better. So is that considered EPI? Or is it borderline?
> 
> We received Bacch's results today:
> · *TLI value:* 13.5% (was told that if he was EPI he should be under 2.5%)
> ...


 
Normal folate values are 7.7-24.4 so 17 is right in the middle and is a good level.
Normal cobalamine is 251-908 so that is pretty normal as well.
As far as food, maybe I missed it but what are you feeding?
Also, what kind of Giardia test did the vet do? Also, have you talked to the vet about other malabsorption issues like IBD? It is also entirely possible for your dog to have SIBO and still test normal on folate. Only about 40% of dogs who have SIBO actually test positive for it.


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## yvonneglen (Sep 20, 2008)

jaggirl47 said:


> Normal folate values are 7.7-24.4 so 17 is right in the middle and is a good level.
> Normal cobalamine is 251-908 so that is pretty normal as well.
> As far as food, maybe I missed it but what are you feeding?
> Also, what kind of Giardia test did the vet do? Also, have you talked to the vet about other malabsorption issues like IBD? It is also entirely possible for your dog to have SIBO and still test normal on folate. Only about 40% of dogs who have SIBO actually test positive for it.


I am hearing different opinions when it comes to his values. Our internist said that Bacchus' cobalamine was on the low-end to normal and that his folate was high. Several people have commented that this equation (low end cobalamin with a high folate is in fact SIBO) equals a dog with SIBO??? IBD was mentioned. I think we have several issues going on here. I actually received a call from TAMU today from the email that I sent last night, so I was pretty chuffed about that (too bad I was not home). He said he was calling to chat with me about the results and to go over them with me.. So I will be calling tomorrow and whatever TAMU says that is what I AM GOING WITH...as they are the experts in this.

They did a stool sample for Giadia. Don't know what kind. My head is bursting with all these different test and I am on overload.

Bacchus right now is on Royal Canin G.S. 24 he eats "just about two cups a day" if I am lucky usually at night. In the AM I give him a can of Nutro meat (chicken with rice in chunks with gravy) he some times eats and sometimes not... He usually eats just 2 cups of kibble a day and that's it. I was giving him the Stelly & Chewy patties (beef which he loved) and tried duck and he won't go near the stuff. But the internist said no more raw food until we get his GI back on track.

I just received his thyroid panel and will be putting a call in to Dr. Dodds for a telephone consult as according to her numbers **IF** I did the calculations right I *think* he is borderline on his thyroid. But I am no doctor and don't even want to speculate.

Right now I am getting him off R.C..G.S. putting him on a grain free and a better canned meat with a 30 day round of tylan powder. No other foods will be given and I will see how he does. My "regular vet" has agreed to give him B-12 injections so we will see how he is doing 30 days from now.

That is the gameplan for now.....as it's ever changing. But I need to get my man back on track. His coat is also falling out (mostly from the tail now........freak never, ending)...


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## jaggirl47 (Jul 18, 2009)

Cobalamin and Folate

This should help. It is the TAMU website with the levels listed.


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## yvonneglen (Sep 20, 2008)

jaggirl47 said:


> Cobalamin and Folate
> 
> This should help. It is the TAMU website with the levels listed.


 
Yes, thank you jaggirl. I had printed that out already. But I just find the ranges soooo big and hard to interpret. So I am looking forward to speaking with TAMU tomorrow to see what they say about Bacchus' values.


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## Hansel & Gretel (Oct 26, 2010)

I am a newbie here. 

Thanks to everyone here as you have helped diagnose my GSD with EPI. I cannot thank you guys enough. This site is awesome!

My dog has been steadily loosing weight and had diarrhea for over a month. Our vet didn't know what was wrong. I did some research online and found this site and learned about EPI. I went back to the vet and asked for a TLI test (along wit ha CBC so we could make sure nothing else was wrong.)

Her TLI was 2.2. Her other blood work (according to the vet) was normal. She thinks Gretel does have EPI and wants to keep her on her present food and supplement with enzymes. 

I have two questions. What is the monthly cost for enzymes ordered online. The vet wants to prescribe them I would like a comparison.

She also wants to administer B12 as an injection. Does anyone give the dog OTC (people) B12?

Thanks again to everyone here. I am relieved that I figured out what was wrong with Gretel as she was wasting away to a bag of bones. But now I am nervous about treating this lifelong ailment and want to get her to gain weight back as quick as possible.

John


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## Rerun (Feb 27, 2006)

This is where most people get them when they get them online (myself included). I've been getting enzymes from her for 3 yrs give or take, after getting taken by the vet for the first year to the tune of $100/mo for enzymes.

http://www.enzymediane.com/usorders.htm

Akira averages 70 lbs, eats 2 x's a day. Each meal is 2 cups/dry food mixed with two teaspoons of the 6x strength enzymes. I order 1 kilo for her to the tune of $134 (includes s/h/packaging) approx every 6 months, give or take (I can't remember exactly how many months but I order probably twice a year).

Slight side note - she's been on the US material all these years, but given the shortage the last order had to be the European and although it smells awful she has done just as well on it and doesn't seem to notice the difference.

I don't give B12 shots, they've never been recommended for her nor is there anything that would cause me to think they are necessary for her. She is a perfectly normal healthy dog as long as she gets her enzymes. She eats all the same treats the other dogs eat and even occasional scraps of table food and snacks. If you didn't know she was an EPI dog you wouldn't have a clue that there was anything wrong.


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## Hansel & Gretel (Oct 26, 2010)

Thanks for the reply. I ordered a kilo and plan on following the same feeding that you use for Gretel as she was about 70 lbs before the onset of the diarrhea.

BTW, the vet said Rx for the enzymes was about $110/ month.

Thanks again, John


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## Rerun (Feb 27, 2006)

Ask your vet, but Akira was on a higher dose initially. I want to say 3 teaspoons per meal. You may have to play around with it a bit, and sometimes a diet change is in order. But to start with i would use at least 1 tsp of enzyme per cup of kibble, soak in warm water for 15 - 20 minutes minimum before feeding.


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## Hansel & Gretel (Oct 26, 2010)

I emailed the product and the intended dosage to my vet. The first vet I saw made no mention of EPI. When I called back the second time and asked to speak to a vet about Gretel's follow up since she wasn't improving the second vet_ was_ familiar with EPI.

I feel much better at this point about Gretel's condition. When I finally see her putting weight back on it will be a happy day. Right now she is a sad sight to look at and it's hard to even pet her as she is so bony.


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## Rerun (Feb 27, 2006)

I certainly understand. Akira lost 10 lbs in 3 wks while the vet and I were frantically trying to figure out what was happening to her. The EPI hit her hard and fast shortly after turning 3.


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## nickyc (Nov 1, 2014)

*Hi All*

I took in a GSD pup about 7 months ago and yesterday I had to put him down. It was the hardest thing I ever had to do. When we first got him at 8 weeks old he was a picky eater or so I thought. I took him to a vet and I was told he will eat when he get hungry enough. So I went away and two weeks later my pup was still not eating properly. I took him back and was told that it was his food and to change it to "Burns" brand dog food, the brand the vet was paid to sell. I gave it ago and it worked for about a week he ate well, but still saw no weight gain. One morning I woke and found my GSD was very week, so I rushed him off to a different vet and this new vet heard my story and looked and my dog and told me he had EPI. We did a blood test just to confirm this and she was right. This vet put him on a special diet and wow the difference my buddy was better than ever. Chasing anything and everything, but four weeks after treatment started, he began loosing weight again. So back to the vet and some more medication, but this time there was no improvement. I had had enough. I couldn't go on seeing my best friend like this. I asked the vet was there any hope of him having some bit of a happy pain and hunger free life. I was told that his pancreas was too far gone, we didn't catch it in time. So yesterday with my vet we made the call to ease Havoc's pain and now he is gone. What I am trying to get at here is if you are not happy with the answers your getting from your vet say so. I knew there was something wrong with my pup and I just followed what the vet said. If your not happy get a second opinion, if I had done this maybe I could have saved Havoc. When it comes to EPI catching it sooner rather than later is the key.


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## S!rWinston28 (Mar 31, 2015)

Mark444 said:


> My female dog will be 4 next month. Right after her first birthday, about 13 months old, she began having the runs and rapidly losing weight. We took her to the vet and they took some tests and determined she had no enzymes in her pancreas at all! She had a very bad case of EPI and would need the replacement enzyme for the rest of her life. We began purchasing BioCase V, from KV Equine. It costs a lot cheaper because it is the generic form of Viocase V. I give her regular kibble, Natural Choice for large breed dogs, wet it down, then drain the water out. I then put the powder on her food and mix it well. The directions say to let it sit for atleast 15 to 20 minutes. I find it is better to let it set for 30-45 minutes.
> She now looks great!! She is healthy and full of energy.


Hi! My little boy had a very similar case. On his first birthday he weighed 80-85 and a month and a half later he weighed 45. I was terrified and skipped work to take him to the vet. The vet said he also had no enzymes at all! We got the pancreas enzymes and he has been on them for about 7-8 months. He is up to 65ish. I am still very worried about his weight. Winston still has very runny stool and we have tried every antibiotic in the book as well as switching food. He is still very energetic but still super skinny. Anyone experience this? The vet said he isn't gaining weight due to the diarrhea/runny poops. I have tried everything I can think of. Any suggestions?? Any ideas will help!


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## carmspack (Feb 2, 2011)

quote "Winston still has very runny stool and we have tried every antibiotic in the book "

--- and all those anti biotics have wiped out the beneficial bacteria that the dog desperately needs .

so many threads on this including http://www.germanshepherds.com/forum/health-issues/666578-post-antibiotic-age.html and 

http://www.germanshepherds.com/foru...2-micro-biome-macro-important-germ-files.html

this may have been a vet created problem --- IATROGENIC 

to fix it will certainly take time -- Pancreatin Plus can get you started , Pancreatin Plus Enzymes - Natural Factors - Pancreatin 8X

quote "Sometimes a food allergy or an overabundance of bad bacteria has irritated or inflamed the pancreas, temporarily inhibiting enzyme production. In these situations, says Dr. Kovacs, it's important to put the dog on a pancreatic enzyme supplement for two months, allowing the stressed pancreas to heal. The dog should then be retested to confirm or rule out EPI.

In addition, Dr. Kovacs says, “It is also important to introduce good gut flora (bacteria) by adding yogurt, green tripe, or supplements such as Digest-All Plus (a blend of plant enzymes and probiotics). Good gut flora should continue to be maintained with supplements even after the inflamed or irritated pancreas has healed.” Dr. Kovacs has also noticed that some dogs with food allergies (especially dogs fed dry kibble) show rapid improvement when their diets are switched to raw or canned food. Raw meats contain natural enzymes, and fresh vegetables support the growth of good bacteria in the dog's gut..


Then you want to make sure that the diet offers trace and micro minerals which are necessary to activate enzyme activity . You can have a tank full of gas but no spark plugs no action. Minerals are like the spark plugs.
Zinc , one of the minerals in pumpkin seed (finely ground) and Vitamin E - full 8 compound supplementation as this
actually helps with the breakdown and metabolism of fats.


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## Momto2GSDs (Mar 22, 2012)

S!rWinston28 said:


> Hi! My little boy had a very similar case. On his first birthday he weighed 80-85 and a month and a half later he weighed 45. I was terrified and skipped work to take him to the vet. The vet said he also had no enzymes at all! We got the* pancreas enzymes *and he has been on them for about 7-8 months. He is up to 65ish. I am still very worried about his weight. Winston still has very runny stool and *we have tried every antibiotic in the book *aswell as *switching food.* He is still very energetic but still super skinny. Anyone experience this? The vet said he isn't gaining weight due to the diarrhea/runny poops. I have tried everything I can think of. Any suggestions?? Any ideas will help!


Hi S!rWinston and Welcome!

I hear ya! Our first GSD was near death with EPI! HORRIBLE disease! She would stay stable for a while but then would change and we had to try something new!

This is an old thread from 2014. 
I think you would get more responses if you started a new one for your dog. Also, in the "search" box above, type in "EPI" and also try typing in "Exocrine Pancreatic Insufficiency". There are several threads that you can gather more info from.
*
Have you tried different brands of pancreatic enzymes? 
What brand are you using?
Did he need B12 shots? 
Did the vet recommend a Zinc supplement?

Has the vet given him ProBiotics to repair his gut from all of these antibiotics?

Did you ever try The Honest Kitchen Dehydrated Food? 
Have you ever tried raw food or home cooked?
Have you ever tried raw green tripe?
Have you ever tried raw pancreas?
What brand kibble is he on now and what brands have you tried. 

Have you ever read this site? *http://epi4dogs.com/ (scroll down to mid page)

Carmspack makes some very good points!

Moms


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