EPI Experts please - Page 1

For those of you that have experience and knowledge in EPI, I wondered if I could get your thoughts on something.  My dog, 2 1/2 year old male, recently was suddenly sick for a month.  Many of his symptoms seem to fall in line with EPI.  He lost almost 20 pounds in 3 weeks.  He had vomitting (once a day) and diarrhea for a couple of weeks.  Now his vomitting has subsided, and his diarrhea is gone, but his stools are orangish colored plops...definitely not normal.  He is ravenous and is even trying to eat poop he hunts out in the yard...again, not normal.  Prior to this sickness, he has experienced on and off poop issues (once or twice a week or two he would have large yellow stools that were very loose and were covered with mucus).  Yes, he has had fecal and blood tests run; negative.   

My vet did run a TLI test and told me it was normal.  I spoke with a vet friend that said she thought EPI was still a concern, so I asked more about the test and read some vet materials from my friend.  I learned the dog is supposed to fast at least 12 hours prior to testing.  I wasn't told that so he would have eaten within 4-5 hours of the test.

His TLI test value was 10.  It looks like that is in the low normal range of the test, but he wasn't fasted for this.  I would think the value would be lower if fasted.  I plan to retest him with fasting the next time.

My question to you all ...for those of you that have EPI dogs, what were their values when they were tested when EPI was first suspected to be an issue? If a dog falls in the lower range but is still technically in range, do they eventaully progress to official EPI?  

 What food are you feeding him? Get some enzymes and add a tespoon to each wet meal. I use Panakare Plus make sure it is enzymes from Meat source not from vegitable stay away from high fat foods. If your feeding dry wet the food with warm water. let set for 15 minutes then mush it up by hand then add enzymes and mix and wait 10 miutes. Then feed. Fiests test # was.02. If your feeding canned forget the first part. I now feed Fiest Acanna Pacifica just as I staed above she is 77 pounds and a very good working girl. Also remember B12 shots twice a monthVERY IMPORTANT...

Agree with everything that Bob said.

Absolutely make sure that the enzymes are allowed to soak on the food for 20 minutes or longer if you don't pre-soak the kibble as Bob has mentioned above.
The enzymes will wreak havoc on the dog's esophagus if you do not.

Something that you may want to discuss with your vet even if the results don't come up positive for EPI is to treat it as though it does.
It may work in your dog's favor to get rid of the symptoms.

A good grain-free food that works well for this problem is Wellness Core Grain Free Reduced Fat Formula.
Grain free, higher protein and low fat.

You may also want to invest in a bottle of Tylan powder for flare ups.

Here is an excellent web site dedicated to EPI:
http://www.epi4dogs.com/

Best wishes to you and your dog!
--Steve

The guidelines for theTLI test are a 12 hour fast...your vet SHOULD have known this.  I would point out to him that the error was his for not telling you, and request that they re-run the test free of charge. 

Typically the TLI is done with the cobalamin/folate tests to determine if SIBO (small intestinal bacteria overgrowth) is also playing a role in the digestive problem.  SIBO generally goes hand-in-hand with EPI because of the poorly digested food in the GI tract.  However, some dogs can have SIBO without having EPI.  SIBO or other small intestinal disease can also cause borderline low TLI levels as the pancreas tries to compensate for the digestive disturbances (ie., lack of brush border enzymes)

As Steve suggested, check out the EPI4dogs site...it is recommended by JAVMA (Journal of American Veterinary Medical Assoc) as a source of information on EPI.

Your vet can also do a consult with the GI lab at Texas A&M GI Lab for assistance in diagnosis/treatment of difficult cases.

I would retest TLI and also run a cobalamin folate level test(that checks for SIBO).  i would also ask my vet to run a test for IgA deficiency.....  cornell will run those.  at least, that is where mine went.  My EPI boy presented differently from yours and actaully in retrospect had many symptoms prior to any poop /weight issues.  I would also do a fecal again at this time to have that out of the way at one visit.  I hate going back and going back for the sake of running for tests. 

I have a senior male that I sent in a sample for oneof the research projects a few years back.  I thought he was normal.  heh.  his TLI was six.  He has never needed porcine based enzymes, but has gotten prozyme most of his life.  he has always was a picky eater and did not tolerate chicken...  comes out liquid.  no biggie, it is a chicken issue.  I have a rescue girl that I ran a truckload of blood tests on when I got her to rule out all the problems I have already had with GSDs.  Her TLI was 26.  of course, she had other issues I wasn't looking for LOL.

The borderline TLI is treatable if it is symptomatic.  sometimes dogs are bordelrine and have no symptoms. You may have other issues with your dog that need to be ruled out.  IgA deficiency causes flattenign of the villi I believe and therefore digestive issues.  My EPI guy had both.  His weight loss started with a batch of timberwofl organics that got a voluntary recall.  Just what tipped his digestive system over the edge.

use the links that one of the other posters provided to get more info, but I would be retesting my dog tomorrow with a 12 hour fast.  If you do it with TAMU, they will phone consult with your vet for free.  Oh but you have to check when theyr un the tests so blood gets drawn and shipped at the right time for testing.  At least that was how it was when I was dealing with EPI.

if you get no answers, repost here, there are a lot of knowledgable people here that may catch that post that don't see this one.  also, possibly post the state you are in so vets might be recommended.  My vet just pissed me off regarding this issue and I really like her.

Best wishes,

Darcy

pancreatitus?
gall stones blocking the duct?

Thanks everyone for your knowledge. He doesn't have pancreatitis or any type of obstructions. He had x-rays done to rule that out.

I agree that she should have told me about fasting. She said she was sorry for miscommunication, although it wasn't miscommunication...no one told me! I would like it run again for free too, but then again, don't want to tick her off. I will have to ask her about the second test you all have mentioned for SIBO. I didn't know there was a test, and I'm fairly certain that wasn't run. So far he's had 2 fecal tests, 2 or 3 blood tests, x-rays, and he's been on Panacur, Metronidazole, and is still on Pepcid AC. She's been ruling things out.

He currently eats Canidae All Life Stages dry food with some canned food in each meal. I looked at the Wellness Core when I started trying to find more info, just in case. I also started him on Probiotics and now he is getting Omega 3 pills too, based on what my vet friend said.

It'll probably be a few days before I can get the test rerun...but this time I'm going to make sure everything is done correctly or else have my vet friend just do it.

Thanks everyone!

http://www.total-german-shepherd.com/EPIanddogs.html


I wrote the above article to help others that were struggling with this condition. I hope you find it helpful. 

You have to fast the dog for at least 12 hours before doing the TLI test. My dog's result came back at 4.9 which is borderline, however, she had all the symptoms of EPI.  The enzymes cannot be plant based for a confirmed EPI case they have to be porcine ( pork) based. The food my vet suggested at first was Royal Canin MediCal gastro intestinal high energy, both canned and kibble. The enzymes I use are from enzymediane.com.  if it weren't for her ( Diane ) Maya would not be alive today as her enzymes are 1/3 of the cost of the vets. I also joined a group called k9-epiglobal@yahoogroups.com once Maya was diagnosed.  Truly a great group of EPI dog owners that have been through hell and back with their EPI dogs

Don't be too alarmed if your dog has EPI.  You think at first you will never be able to get it right, but you do. It is the right food, the right amount of enzymes, and probiotics and B-12.

Please read the above link as it discusses the great importance of Vitamin B-12 with intrinsic factor. ( intrinsic factor is the enzyme that allows B-12 to be absorbed into the bloodstream without first being destroyed by stomach acids.
.

Could be IBD.  New info for EPI dogs in case it is, says not to use a reduced fat food, as they will be on enzymes.

I would look into the meds for IBD, Flagyl, Tylan powder and a Sulfur drug ending in izine or something. A good vet can look it up and put him on a very bland cooked diet if the EPI result is normal after fasting. Fast should be at least 12 hours with 18 being better per Texas A & M. Good Luck.

1GSD1
I too had heard that the requiredment for reduced fat food was being rethought for EPI dogs. It is now thought that with enzymes that can tolerate a moderate amount of fat in their diets which helps with weight gain and maintaining body condition. As with a lot of things with EPI dogs, it will ultimately rest with the individual dog , but if they can tolerate a moderate amount of fat in the diet it is much better. 

tedebear12 Defininitely get a re-test. Personally I wouldn't worry about 'ticking off' the vet, it is their responsibility to do their job properly and they didn't, the least they can do is admit their mistake and make it right. You effectively paid for a test that was rendered worthless.  If they do get ticked off there are always other vets. In any case if such a basic error can be made like this I would worry that a greater more life threatening error could be made at some time in the future. My confidence would have been shaken by this mistake.