pancreas insufficiency

Re: pancreas insufficiency

mariette asselbergs — Fri, 23 Dec 2011 18:45:13 GMT

Just a final up date on this case.

In October we managed to convince the owner to increase the amount of pancreas enzymes to double the dose she received before and from then on the dog not only started to gain weight , but also decreased stools. And most noticeably changed behaviour from inexhaustible hyperactivity to much calmer. "She can now quietly lie down while I am cooking" according to the owner. And the late night walk is just that, not franticly wanting to race around fetching sticks. She is still on weekly vit B12 injections given by the owner, and this keeps her blood levels at the low normal level. Owner also gives daily ginger powder over food, plus an extract of apple peal (?). They believe that this controls her diarrhoea which has not returned since October. Dog is now 32 KG (from 22 in July) and has a BCS of 3.

Mariette

Re: pancreas insufficiency

Bob Russell — Mon, 18 Jul 2011 15:31:56 GMT

Why would fresh pig pancreas have salmonella? My dogs eat the most vile things without problems. Fresh pancreas is cheap, easy to administer and in my experience works a heck of a lot better than very expensive supplements!

My bank manager would prefer me to supply supplements!

Re: pancreas insufficiency

SteveOwen — Sat, 16 Jul 2011 18:49:04 GMT

[quote user="Bob Russell"]

Get the owners to speak to the local butcher and see if they can get frozen pig pancreas. It is very cheap and can be thawed out and mixed with food. We have tried this in two patients in the last few years. One of them developed a bit of a weight problem (got fat!).

Environmentally friendly, cheap for owner so gets you brownie points even if it makes you no money directly. Ours move onto RC low fat food as well.

Warn owners that semi-frozen pancreas is pretty revolting stuff but the dog will love it! The low-fat diet should reduce the risk of diarrhoea.

[/quote]

Aaaaargh. Salmonella?! Mess?! Hassle?! Why would you use fresh pancreas when is an array of supplement products on the market.

Re: pancreas insufficiency

mariette asselbergs — Thu, 30 Jun 2011 14:23:04 GMT

Anthony, the problem of this dog is not diarrhoea, but weight loss combined with production of large amounts of normal consistency faeces.

She has had diarrhoea a few times in her life, and this was then always quite severe and resolved with antibiotic therapy (this was before she came to us).

She is on a duck and potatoe dry food diet which is fed to a 24 kg dog in quantities meant for a 50 kg dog, but the weight continues between 23 and 24 kgs, and she is skin and bones but otherwise lively and OK.

Mariette

Re: pancreas insufficiency

Anthony Todd — Wed, 29 Jun 2011 09:18:33 GMT

I can only comment, as a dinosaur, from my experience

1. IMHE most, if not the vast majority, of diarrhoeas without malaise are due to dietary sensitivity, in that some animals fed certain foods will always get diarrhoea for as long as they are fed the offending food or component of food. If after maximum of 2 weeks on [my favourite] boiled chicken or fish and water. Only if this is unsuccessful did I explore other possibilities.

I am encouraged in that Colin Burrows at Florida said that 90% of his diarrhoea referrals, not first opinion!!, were dietary sensitivity and elimination diets fixed them.

2. Diarrhoea, IMHE, is not influenced by quantity but certainly by quality and the dog quoted will not get diarrhoea no matter how much of a non-diarrhoea diet is fed but will get diarrhoea if a tiny amount of the "wrong" diet is fed.

3. Elimination diets are almost impossible for the client to grasp, let alone enforce which is the usual reason for failure consequently resulting in a wild goose chase for other causes. I can't count the number of attempts which failed because the owner "only gave him a little bit", or the animal fed from the other animal's bowl or went outside or "stayed with my grandmother" etc. etc.

4. Fat in any form is the usual suspect and usually guilty.

5. I wonder whether all or most of the adverse laboratory results are the result of chronic diarrhoea and not the cause?

6. If the diarrhoea stops the parameters and the dog return to normal.

7. Many alsations have a high calorific need, most labradors are "slow stokers" and require only just the label on the pack to gain weight!!

8. Thin normal dogs need more calories, fat dogs less.

Sorry if this is obvious, but often the obvious is forgotten or ignored. We had a cat come to us with chronic vomiting and which had been subject to over £2000 of tests including stomach wall biopsy.

It only vomited dried food so we changed it........

Re: pancreas insufficiency

mariette asselbergs — Tue, 28 Jun 2011 18:42:13 GMT

Ha, the dog is enrolled in the Liverpool trial and owner very happy.

I'll post results in 2 months' time

Mariette

Re: pancreas insufficiency

Cailyn Brown — Mon, 20 Jun 2011 06:58:14 GMT

Hi Mariette

Normal 0 false false false EN-US X-NONE X-NONE

I didn't have much knowledge, as right now I'm just assisting a vet in his clinic. But I'm trying hard to learn more about the treatment of some common diseases suffered by animals. After going through these discussions I also tried to get some info about the food habits of dog suffering from EPI and I would really like to mention. The food that should be given to the dog should contain the least fiber at least less that 4%. So grain-free kibble, home-cooked, raw food or a combination of both could be given by the pet owner. Also fat intake should be moderated by giving medium chain fats, such as coconut oil. Sometimes there is a Vitamin E deficiency and might need supplementation. Zinc supplements are also sometimes administered but only under a vet's guidance. Hope these information would help the pet owner while planning the diet for the poor dog.

Re: pancreas insufficiency

mariette asselbergs — Sun, 19 Jun 2011 20:11:02 GMT

Thanks very much Lynn, I will certainly try that. The owner is very motivated and this is his second dog with this condition. So he has years of experience with such dogs.

Mariette

Re: pancreas insufficiency

Lynne Faulconbridge — Sun, 19 Jun 2011 19:56:29 GMT

Hello

I am starting treatment for the same condition in a GSD and have discovered Liverpool Uni Internal Med Dept are doing a study on enteric coated pancreatic enzyme supplements. If you register your case and the dog fits the study criteria, the owner can be entitled to some free meds and free advice for management. Just thought this might help! If you Google Liverpool's Vet School the contact number is on there.

Lynne

Re: pancreas insufficiency

mariette asselbergs — Sun, 19 Jun 2011 08:48:41 GMT

Thanks again for all useful advice. The bacterial overgrowth sounds logical.and fits in with the owner's experience of the usefulness of tetroxy medication. And yes he does mix the capsule in with the food. The idea of the purina diet sounds good, because at the moment he is trying this almost fat free diet which has done well for the scour bit, but not for weight gain. I'll post results on this forum in due course.

Mariette

Re: pancreas insufficiency

Stephen Courtney — Sun, 19 Jun 2011 01:32:49 GMT

I'm quite keen on Purina diets, and the EN formulation is suitable for pancreatic insufficiency, among other GI indications. It is rich in medium chain triglyderides (coconut oils!) which are absorbed pretty directly and do not require pancreatic enzymes, but otherwise performs as a low fat , highly digestible , low residue hypoallergenic diet. This might assist weight gain.

And I would supplement with injectable B12 - weekly for 4 weeks then monthly. dose is pretty empirical - it's a water soluble vitamin so very hard to give too much! I'd give at least 2.5ml to a GSD.

Re: pancreas insufficiency

Ian Battersby — Sat, 18 Jun 2011 08:56:42 GMT

Hi Mariette,

sorry about the abreviations. You are spot on with your assumptions.

the maldigestion of food, provides more substrate for the enteric flora so an overgrowth is possible. as we all know bacterial flora are important for digestion.

I think Micheal raised the question about weather SIBO exists. It is a difficult condition to prove as duodenal juice culture and what is normal flora numbers for dogs etc has its issues. However in situations like EPI ( excess substrate within lumen), and partial obstructions secondary SIBO is likely to occur . So it can exist but not as frequent as we used to think and idiopathic SIBO that is a whole new ball game.

SIBO comes within the group of an antibiotic responsive diarrohea . so antibiotic responsive diarroheas will include SIBO ( primary if exists or secondary to other diseases) but also other conditions such as unbalanced enteric flora populations but not excessive numbers numbers or altered interactions between enteric flora and intestinal mucosal immune system or pathogens we are yet to identify.

Sorry to go alittle off tangent - hope that helps rather than confuse the issue.

Re: pancreas insufficiency

Anonymous — Fri, 17 Jun 2011 20:17:33 GMT

My own dog has just gone down with EPI, 14 day diarrhoea wt loss etc TLI 1 b12 low end folate high end etc. 9 mth old male akita

the protocol that I am using (and it seems to be working so far) is similar to previous posts.

sibo comes along side EPI in many cases and so oxytet 10mg/kg tid 30 days then reduce

probiotics

easily digestible food 150% maint level normal fat level

enzymes - I am currently using tryplase 1 capsule per 100g food mixed with a little water to coat the food (open the capsules) 3 meals per day

vit e supplements - tocopherol acetate from the chemist (bit pricey, £70 per 100ml, he is on 2ml per day) 30 days then drop dose

b12 inj weekly for 4 weeks then as needed monitor b12 level

if its uncontrolled I would guess that I would look at the SIBO side + diet. possibly change the enzyme amount ?

I am learning myself on this one as its always a bit different when its your own dog. I dont have much luck with my own pets, they always seem to fall apart.

I have seen reports of using pancreas material from the butchers but I would be concerned about bacterial infection etc especially in a gsd whose guts are already a bit unhappy.

also i have heard that slippery elm is useful to help control gi irritation secondary to the epi and sibo.

good luck

chris

Re: pancreas insufficiency

Michael Woodhouse — Fri, 17 Jun 2011 19:25:01 GMT

[quote user="mariette asselbergs"]

I know what is EPI, but what are SIBO, OTC or MTZ????

Can I guess "Secondary bacterial Overgrowth, Oxytetracyclin and Metrinidazole or am I totally wrong....?

[/quote]

Small intestinal bacterial overgrowth - if you believe in it! You are correct with the other two!

When you give the capsules you do open them and mix it with the food?

Re: pancreas insufficiency

mariette asselbergs — Fri, 17 Jun 2011 18:15:00 GMT

Thanks everybody, this is really helpful giving us some more options which we will certainly follow up.

But Ian, you lost me with this:

Dogs with EPI can suffer from a secondary SIBO which may be affecting digestion and weight gain so a course of OTC or MTZ would be appropiate.

I know what is EPI, but what are SIBO, OTC or MTZ????

Can I guess "Secondary bacterial Overgrowth, Oxytetracyclin and Metrinidazole or am I totally wrong....?

Thanks " />

Re: pancreas insufficiency

Ian Battersby — Fri, 17 Jun 2011 17:03:18 GMT

I would agree that if the B12 is low supplementaion may help.

B12 deficiencys can affect a number of different tissues including the marrow but also bowel function. There are case reports in humans showing intestinal villous atrophy that resolved by restoring B12 tissue levels

Vit B12 is absorbed once it is bound to intrinsic factor in the intestines. In the dogs intrinsic factor is produce both by the stomach and pancreas. In the cat only the pancreas. The reason for the low B12 will be lack of intrinsic factor so in the cat you need to definitely supplement long term as only the pancreas produces IF , In dogs the Stomach may produice enough but you may need to supplement long term e.g. once or twice a month. 0.02mg/kg s/c

So once blood levels are normal and you could stop B12 injections but if you do i would re check the B12 level 6-8 weeks later to ensure it hasn't dropped again. If it has then life long B 12 by injection would be advisable.

Dogs with EPI can suffer from a secondary SIBO which may be affecting digestion and weight gain so a course of OTC or MTZ would be appropiate.

Good luck;

Ian

Re: pancreas insufficiency

Hannah Wynne Richards — Fri, 17 Jun 2011 16:35:50 GMT

I'd use 2 and 1/2 ml of the 250 strength

Wynne

Re: pancreas insufficiency

Kate Richardson — Fri, 17 Jun 2011 16:00:19 GMT

I use Vitbee injections- weekly until B12 normalises then possibly monthly but monitor once intestinal function/absorption has improved. I usually use 0.5-1.0mls in a cat, but don't know off top of my head how much a gsd would need but sure formulary will have a dose.

Re: pancreas insufficiency

mariette asselbergs — Fri, 17 Jun 2011 15:32:55 GMT

Yes right Kate, when she came to us we did an gastro-profile and B12 was low, as you said. We thought that this would correct itself with the tryplase but haven't actually checked. What is the best way of supplementation?

Re: pancreas insufficiency

Kate Richardson — Fri, 17 Jun 2011 15:05:35 GMT

If she is not responding as well as you would expect and bloods/urine are otherwise unremarkable, check her B12 levels- often these can be low in these cases and the pancreatic enzyme supplements don't work as well so she may need B12 supplementation. Make sure she is on a highly digestible diet such as Hill id. Also consider a 4 week course of metronidazole- good for bacterial overgrowth but also has anti-inflammatory effects in the git as well.

Re: pancreas insufficiency

Emily Nightingale — Fri, 17 Jun 2011 14:53:02 GMT

Pancrex- powder or tablets is what I have used in the past.

Re: pancreas insufficiency

Bob Russell — Fri, 17 Jun 2011 14:35:33 GMT

Bovine pancreas is not available in the UK (BSE) unless things have changed but pig pancreas is readily available (pet friendly butchers less so!).

Re: pancreas insufficiency

mariette asselbergs — Fri, 17 Jun 2011 14:31:29 GMT

Ha, thats spot on Bob, this owner used to have a dog with the same problem "in the olden days" which he fed pig pancreases with very good result. For some reason he doesn't seem to be able to get them now, or maybe he thinks "modern medicines" are better. I will encourage him to try it again. Thanks!

Re: pancreas insufficiency

Bob Russell — Fri, 17 Jun 2011 14:26:47 GMT

Environmentally friendly, cheap for owner so gets you brownie points even if it makes you no money directly. Ours move onto RC low fat food as well.

Warn owners that semi-frozen pancreas is pretty revolting stuff but the dog will love it! The low-fat diet should reduce the risk of diarrhoea.