EPI Info - Page 1

Hello,  I'm new here and am having a dilemma.  I was hoping someone might be able to help......I have a 3 year old German Shepherd that I adopted last year.  At that time he was a bit of a mess and needed some TLC.  He was thin, had diarrhea, ear infections and more.  Anyway, we were able to fix him up pretty fast and has been great most of the year until a few weeks ago. (right around the time we switched him to  Innova EVO a no grain high protein kibble (consequently also high in fat)  He became ill with vomiting, diarrhea, fever, lethargy and depression.  I started him on boiled meat & rice right away with little improvement. Took him to the vet and got subcutaneous fluids, antibiotics, anti nausea meds - all to no avail.  After a week of this I started him on  prescription royal canin digestive low fat (commonly used for pancreatitis & epi) After only 1 day - he had a firm stool. So, I kept him on this food for a while and when I was confident he was well I began weaning back to the EVO.  Immediately he began with the diarrhea. So, feeling very disappointed I put him back on the royal canin. Did fine again.  Recently did blood work and the pancreatic amylase was within normal range, but the pancreatic lipase was very low....definitely dosn't have pancreatitis.  I am starting to believe that he very well may have epi.   He has lost weight - slowly.  It's hard to tell because he's a big boy with thick hair, but you can feel the tops of his spine and hips and head is more boney.   I see a direct correlation between the high fat kibble and epi symptoms. I have found another diet for him ( Wellness Fish & Potato which is lower in fat)  and are in the weaning process and so far so good.  What do you guys think? Am I on to something?  I feel like the vet isn't taking me seriously.
Thanks!

I am curious as to where you got him from. Do you know anything about the sire or dam? If there is a similar history in either - or maybe the breeder might have some insight.

 Based on what you write here, the possibility sure exists that he has some sort of pancreatic dysfunction, including EPI. Why do you say your vet does not take you seriously when you have suggested this possibility?

The question is, what blood test did you have done that showed low lipase? Did you have the TLI done?  Have you tested and re-tested for parasites? If a low fat, low fiber diet helps and he has firm and formed stool, normal volume, normal color and does not continue to loose weight or look poor in coat, low energy etc.,  then carry on with that regimen. If he begins to have again or continues having trouble, then you can do a variety of things to help him, even if he has EPI. It is very common unfortunately. But the good news is with proper treatment he likely can live a normal life with some enzyme replacement. And there is a relatively low cost source for the enzyme replacement rather than having to pay a huge mark-up at the vet.

If you want to PM me, I will ask a lot of questions and make some suggestions on what to try first. The most important thing is to not start changing everything in his diet all at once. You must be patient and make one change, wait at least 3-7 days and then add or subtract or change something.

As well, just search the messages on this forum and you will find a lot of information as well. Some of it is correct, some not. So just read with a careful eye.

Good luck.

There is a chance, if the breeder was aware of his condition, that he was originally sold as a "special needs" puppy. I have heard of people wanting to pay less for a dog finding themselves unwilling and unable to manage the condition.

The breeder might possibly give you valuable information. Have you tried doing a pedigree search on either of the two names you got, the dams and sires (if you have two sets)?

I'm curious. Could you pass on the two names you got for your dog? You never know what you might find out.

It could be EPI but you would need to have a TLI test done to know for sure. The symptoms of EPI are: weight loss; nasty smelling, greasy diarrhea;  dry, flaking skin and dull coat; lack of energy; no appetite loss. Unfortunately, German Shepherds are more likely than other breeds to develop this problem. They also can develop other malabsorption problems (malabsorbtion of food). Sometimes a simple overgrowth of normal bacteria can cause EPI like symptoms. Bacterial overgrowth can have a number of causes, unfortunately.

As for your vet: if your vet doesn't take you seriously then I shouldn't have to tell you that you have a problem with this vet. Vomiting and fever are not usually symptoms of EPI as far as I know. Have the vomiting and fever resolved after antibiotics? Did your vet tell you that you would always have to feed this dog a prescription low fat dog food? IF so, what was the reason? What was the dog's initial diagnosis?  You should know the answers to these questions as you read this and if you don't, then you and your vet aren't communicating very well. Call your vet on Monday and ask for an explanation in words that you the pet owner can understand. You may have to make an appointment to do this. IF your vet cannot explain your dog's condition, the testing the vet has done, and the diagnosis and treatment so that you understand it, then consult another vet.

To read more about EPI from the Merck Veterinary Manual cut and paste this link:
http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/23404.htm&word=canine%2cEPI

I also just found this link on EPI, which puts it into layman's terms better than the Merck manual does.
http://www.marvistavet.com/html/exocrine_pancreatic_insufficie.html

Many dogs with malabsorption problems can live normal lives once their diet, enzymes and any related meds are properly managed. Keep looking for answers from the vet. Have you considered putting the dog back on the prescription RC food? It sounds like it was working.

I have done alot of research on both pancreatitis and epi and he does have the symptoms.  I am being proactive, going with what I've learned and what my gut is telling me.  I am looking for some back-up and reinforcement.  As for the vet - she is walking a thin line  with me anyway and when I have accumulated the facts I am going to speak to her about it in further detail if I even decide to keep her as a vet.  Her initial diagnosis was: dogs get sick just like we do - don't worry. There was no official diagnosis. She's being very conservative in her approach......He only vomited twice. The fever was reduced with fluids (probably due to dehydration from the diarrhea), and the antibiotics did not make a change (because he didn't have an infection).  His CBC was normal - again no sign of infection. It was my call to put him on the low-fat food. I have a friend and family member in the industry that reccommended/assisted with this.  It dosn't take a vet to tell me that he does better on lower fat food. And yes I have researched alot of food in depth.  Again, I am being proactive in my dog's health and examining every avenue as I want him to lead a normal healthy happy life.

As stated above, get the EPI  TLI test done and do Serum folate and cobalamin.  These three will help not only diagnose EPI but SIBO (Small intestinal bacterial overgrowth)  Often an EPI dog will have SIBO in addition to the EPI or SIBO can occur alone.  Both need to be treated.