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Cocker Specific Discussion => Health => Topic started by: Mari on December 17, 2020, 05:54:02 PM

Title: EPI, liver and bile duct inflammation
Post by: Mari on December 17, 2020, 05:54:02 PM
My perfectly healthy cocker is suddenly less healthy. She was diagnosed with exocrine pancreas insufficiency and cholangitis/cholangiohepatitis today. She is 14 and I know that health can change rapidly at this age, but it is still a shock when it happens. Thankfully she is happy and only really showing symptoms of the digestive problems. She has lost a little bit of weight, but she is active, playful and cuddly still. We started her on enzymes for the EPI as well as medicines to protect the liver and bile duct today. I am really hoping her liver values look better on the next blood test. And I really hope the enzymes can help get nutrition in her before she loses more weight. It is scary, but I have a really good vet who I trust and that helps.

I'd love to hear what experiences other cocker owners have with these conditions!
Title: Re: EPI, liver and bile duct inflammation
Post by: ejp on December 17, 2020, 06:32:10 PM
I was wondering if all was okay with you.  Sorry to hear that about your lovely girl  :luv: I know what you mean about how quickly things change with them.  I think they hide things so well we are unaware of what is going on with them.  As you say, she is still a happy girl, and hopefully you can get medication to support her system.  I know that Milk Thistle is a herbal support for the liver, but I am not an expert by any means.  Keep us posted, and sending you both a cyber hug. x
Title: Re: EPI, liver and bile duct inflammation
Post by: bizzylizzy on December 17, 2020, 07:11:03 PM
Sorry to read this Mari! sending  :bigarmhug: :bigarmhug: to you and ofcourse even more  :bigarmhug: to Laurie, hope that the treatment kicks in quickly and that she‘s feeling better soon. Tail wags from Humphrey!
 :luv: :luv:
Title: Re: EPI, liver and bile duct inflammation
Post by: AndyB on December 17, 2020, 09:02:39 PM
My boy Jazz had EPI and I received some wonderful advice from a COL member.  I actually researched the disease and made notes which I took to my vet, rather hesitantly, telling the vet his job.  However, he congratulated me on my research and confirmed that indeed Jazz did have EPI.  Jazz became diabetic about 18 months before I lost him, (in January 2018), and apparently EPI is very common in diabetic dogs.   He lost a lot of weight, it is very difficult to keep weight on a dog with EPI.   Very sadly I lost him two months before he was 14.  He had gone from almost 17 kg to 11 kg when he died.  He was quite a big cocker so not particularly a "fatty" at 17 kg.   See if you can find my posts.  Hopefully the lady who gave me amazing advice will see your post.
Title: Re: EPI, liver and bile duct inflammation
Post by: Jaysmumagain on December 18, 2020, 01:03:30 PM
Mari

I am sending all my and Ollie's love and hugs to you and darling Laurie.  Try and stay positive and glad to hear you have a good vet.

 :bigarmhug: :bigarmhug: :bigarmhug: very special hugs to Laurie
Title: Re: EPI, liver and bile duct inflammation
Post by: Mari on December 18, 2020, 04:45:16 PM
Thank you all for tail wags and hugs!  :luv:

I didn't feel nervous before Lauriës appointment yesterday, but I must have been because I was completely exhausted yesterday when we got home. I spent the evening on the sofa, only getting up to give Laurië her medicines, completely useless otherwise :005: The enzymes seem to help already so I am hopeful that the EPI can be managed. It's probably too soon to tell, but she poops less so that's a good sign  :D I have added an extra meal to get her back to normal weight (hopefully) and she is very pleased about that, nothing wrong with her appetite thankfully.

Ejp: Thank you, I will take a look at milk thistle! I have had some computer trouble lately, my keyboard is only working when it feels like it these days. So I have been reading posts, but been too lazy to actually write anything  ph34r

AndyB: Thank you for sharing your experience. Good job researching and good to hear your vet listened. I had my suspicion before going to the vet that the pancreas, liver or gall bladder was struggling. Didn't expect all three to be affected. But I am glad that we got a quick diagnosis for the EPI, I just hope the enzymes help her keep her weigh on. Sorry to hear about your loss and the struggles Jazz had. I guess it makes sense for EPI and diabetes to co-exist, it's all due to the pancreas malfunctioning after all, but what rotten luck to get both! I will take a look on the site for your posts and see what I can learn. Thanks for the tip!

Title: Re: EPI, liver and bile duct inflammation
Post by: Mari on December 19, 2020, 10:05:43 AM
If my neighbours happened to look out their window this morning, they probably saw me doing a victory dance around a perfectly ordinary dog poop  :lol2:  :dance04:
Title: Re: EPI, liver and bile duct inflammation
Post by: Mudmagnets on December 19, 2020, 10:43:00 AM
Thankfully no experience, but hoping you and your vet can help make Laurie comfortable and get her condition under control.  :luv:

Re the computer is the keyboard cordless and battery operated? I found with mine new batteries help when it starts misbehaving (missing out starts of words or suddenly not showing on screen what I was keying in for example)
Title: Re: EPI, liver and bile duct inflammation
Post by: Jaysmumagain on December 19, 2020, 11:26:38 AM
If my neighbours happened to look out their window this morning, they probably saw me doing a victory dance around a perfectly ordinary dog poop  :lol2:  :dance04:

You've even got me dances over here too :D
Title: Re: EPI, liver and bile duct inflammation
Post by: Mari on December 19, 2020, 01:49:59 PM
Thankfully no experience, but hoping you and your vet can help make Laurie comfortable and get her condition under control.  :luv:

Re the computer is the keyboard cordless and battery operated? I found with mine new batteries help when it starts misbehaving (missing out starts of words or suddenly not showing on screen what I was keying in for example)


Thank you!

It's a laptop unfortunately, and the usb port stopped working too so I can't connect an external keyboard. Probably need a new computer, but that will have to wait, vet bills are pretty high even with insurance. Luckily it still mostly works, its just more effort to type as I have three keys that only work if I press and hold them for a moment, I am used to typing fast  :005:
Title: Re: EPI, liver and bile duct inflammation
Post by: Mari on December 19, 2020, 01:52:27 PM

You've even got me dances over here too :D
:luv:
Title: Re: EPI, liver and bile duct inflammation
Post by: ejp on December 19, 2020, 09:02:49 PM
Woohoo a proper poo!   Cause for celebration indeed  :dance04:
Title: Re: EPI, liver and bile duct inflammation
Post by: phoenix on December 30, 2020, 11:31:58 AM
As Andyb mentioned,I’m the one who had a springer spaniel who developed epi at 4 yrs old, and passed away from  heart failure at 11.   As you know yourself, it is a manageable condition once you’ve got the enzymes working. Fantastic you’re there already,  happy poop dance day!  The other vital supplement is B12 with intrinsic factor. A high  level of 600 is needed. It makes a huge difference.
I learnt everything I know from a huge forum called Epi4dogs. Olesia Kennedy started it some years ago, and has researched everything with Texas A&M  university,  Journals, and collated information ., and the site Is recommended with the major US veterinary bodies.  Because epi is associated with German Shepherds, the majority of vets  don’t keep it on their radar for other breeds.
I don’t know anything about liver conditions ,  I truly hope that you get good results there too.
I’ll send you a pm when I’ve been out for a dog walk. It’s icy and cold  and I’m not looking forward to it.
Title: Re: EPI, liver and bile duct inflammation
Post by: Mari on December 30, 2020, 03:06:49 PM
Thank you! Will be reading all the advice I get and check the links!

Poos have continued to look mostly normal, so I am very happy about that. She is extremely hungry all the time though. I am feeding an extra meal and I think her weight has been stable since we started treatment. However, she is still hungry and whining for food long before every meal. I am hoping she will calm down if we can get her back to the weight she was before this happened. But I don't know if the hunger is an epi-dog thing. At least she has her appetite and is her cheerful waggy self.

It remains to be seen if the liver bounces back, next blood test mid-january will show us more. She doesn't have any clinical signs of liver damage I don't think, so I am carefully hoping the liver meds can work their magic and be discontinued after the next blood tests.
Title: Re: EPI, liver and bile duct inflammation
Post by: ejp on December 30, 2020, 05:26:27 PM
Lovely to hear that things are a little steadier Mari.  Stability is what you want.  Different issue entirely, and not sure if it will help, but anyway, Max had a cyst on his liver, and as his condition progress, his poop became more orange in colour.  Not wishing to alarm you, I am off the mindset that information helps. It was one of the ways I could monitor change.  That was also when I started to use red clover and milk thistle to support his system.  He wasn't on any medication as it wasn't fixable, and the vet had no issue with it.
Title: Re: EPI, liver and bile duct inflammation
Post by: Mari on December 30, 2020, 06:31:10 PM
Lovely to hear that things are a little steadier Mari.  Stability is what you want.  Different issue entirely, and not sure if it will help, but anyway, Max had a cyst on his liver, and as his condition progress, his poop became more orange in colour.  Not wishing to alarm you, I am off the mindset that information helps. It was one of the ways I could monitor change.  That was also when I started to use red clover and milk thistle to support his system.  He wasn't on any medication as it wasn't fixable, and the vet had no issue with it.

Thank you, I agree, information helps. Sorry to hear about Max and the cyst! I did think about the liver as soon as her poops turned yellow, so I was relieved that the vet thought EPI was the only problem. But then the blood sample revealed that the liver is unhappy too. If her liver values have not improved on the next blood test, we will do an ultrasound to see if there are any scary shapes in or around the liver.
Title: Re: EPI, liver and bile duct inflammation
Post by: Mari on January 07, 2021, 08:42:03 PM
New blood samples today. The liver looks happier so it seems the liver and bile duct meds are doing their job  :dance04: Vet wants us to continue another month before stopping them and checking if she can go without them. Very pleased with that. Laurië lost 100g over Christmas despite the enzymes helping her digestion. Trying to mix in a more digestible, energy-rich food to see if that helps keep her weight on. All in all pretty good news. The less good news is that she now has an incontinence issue. Ever since her spay surgery, she has occasionally leaked a few drops during heavy sleep, but now it is much more and every day. It's probably just due to her food being soaked and her water intake is higher. We got meds to try and help with this, but was warned it may not help. Might do a urine sample later, to be on the safe side but vet said there's no rush as her clinical exam was good and her blood sample normal. I was planning on getting to the appointment early and get the urine sample there, but on the way to the vet another car drove into the back of our car and that caused us to be late. It's been a day  :dunno: But all humans and pets are safe, Laurië's liver is happy, the car can be fixed  :blink:
Title: Re: EPI, liver and bile duct inflammation
Post by: bizzylizzy on January 07, 2021, 09:51:24 PM
That does sound good news Mari, so pleased for you and Laurie! The incontinence is a bit of a pain but probably something you‘re happy to manage, the main thing is that she‘s responding to treatment for the main problem.
Glad to hear that none of you were any the worse for your accident, - you always manage to see the positive side of things,   ;) well done! that‘s the best medicine!  :luv:
 :bigarmhug: to Laurie!
Title: Re: EPI, liver and bile duct inflammation
Post by: phoenix on January 08, 2021, 01:45:45 PM
Epi enzymes often cause increased thirst and urination. Marti couldn’t hold on for more than 2hrs in daytime. I bought a carpet shampoo machine.  She only dribbled a bit. It usually improves as they get used to the enzymes. Her urine tests were usually useless because they were too dilute.

Something else to think about is the occasional occurrence of A-typical Cushings disease,  which has inflammatory effects on organs including the liver and pancreas, and general musculature.  . Can cause urinary problems.  Some epi dogs have this condition,and the question is which came first, Epi or Atypical Cushings?
Title: Re: EPI, liver and bile duct inflammation
Post by: ejp on January 08, 2021, 04:18:17 PM
Good update, glad to hear such positive news.  I like the sound of your vet, seems interested and approachable.  Would pasta help to bulk Laurie up a bit, not sure if it would be a suitable food though.
Title: Re: EPI, liver and bile duct inflammation
Post by: phoenix on January 08, 2021, 05:13:19 PM
The advice for fattening up is to increase their normal food + enzymes by 50%, introducing a midday meal. If the poos are normal a little coconut oil helps with calories . The wheat flour in pasta can feed bad gut bacteria.
Title: Re: EPI, liver and bile duct inflammation
Post by: Mari on January 12, 2021, 01:22:13 PM
Thanks again for encouragement and advice! I have been a little overwhelmed the last week. Laurië has decided she does not want anything to do with her normal food. She has an appetite and will beg for food when we eat, but she refuses to touch the food in her bowl. She is loosing weight. I have resorted to mixing things in her food just to get her to eat some of it, but it is not enough. I am feeling very worried about this. She is happy and healthy in all other ways, the incontinence has even gotten better. But she is not eating enough. I have tried 3 different foods. She will not eat it when it is wet and has enzymes on. I have to find a way to make her eat again. It's so strange, she was happy to eat it for 3 weeks straight, and now she will not touch it  :'(
Title: Re: EPI, liver and bile duct inflammation
Post by: cazza on January 13, 2021, 05:55:24 AM
Good to hear of her progress, sorry to hear about the car but glad all were unharmed  :luv:

Can you try her on chicken and rice for a day and slowly introduce her food back in - just a thought

Hope she is back eating really soon x x
Title: Re: EPI, liver and bile duct inflammation
Post by: ejp on January 13, 2021, 06:06:13 PM
Well, good that she is happy in herself and the incontinence has eased.  What does she normally eat, is it a kibble? How restricted is her diet just now, wondering what other options you have to tempt her. 
Title: Re: EPI, liver and bile duct inflammation
Post by: phoenix on January 13, 2021, 09:15:08 PM
In brief, epi  occurs when the exocrine  pancreas system  necrotises/rots away, and can’t be improved.  Many people with cystic fibrosis suffer from it.  One of its roles is to produce digestive enzymes and aid digestion of vitamin B 12. Lipase which digests fats is the most important, plus amylase and protease.   So these are supplemented in every meal with pork pancreas enzymes as powder or in capsules. They taste vile, so  when Marti , like Laurie, refused them , I joined a global support website, epi4dogs dogs.  I’ve been messaging Mari.
 Our dogs  usually need grain free normal food. Powdered enzymes need cunning disguising, yogurt, fish, cat food etc.  Marti  went from starving  17kg  to healthy springer spaniel 24 kg.
Except in German Shepherds, it is rare, and few vets world wide are aware of it,   So two of our cocker members have experienced this, but maybe more,  as sometimes pancreatitis, which cockers are prone to,  leads into epi.  The symptoms are weight loss,  starving appetite,  sudden  fatty yellow/grey cowpat poops. Can’t pick them up, very embarrassing.
Elderly dogs like Lauri have complex conditions,  but if they can eat and digest the food with added enzymes,  they gain weight and can respond to their other issues.
  Sorry for the lecture notes, but  I passionately  try to spread knowledge of the condition.  It is so controllable, and dogs will live their normal lifespan. 
Title: Re: EPI, liver and bile duct inflammation
Post by: ejp on January 14, 2021, 10:32:13 PM
Thank you Phoneix, that is really interesting and I appreciate, very much, the time taken to post.  I love this kind of information. 
Title: Re: EPI, liver and bile duct inflammation
Post by: bizzylizzy on January 15, 2021, 07:08:43 AM
Thankyou Pheonix! I hope that we won‘t ever need it but its always very useful  to have information  like this, it could be a life saver.
Fingers and paws tightly crossed that Laurie can be persuaded to eat something soon!  :luv:
Title: Re: EPI, liver and bile duct inflammation
Post by: Mari on January 17, 2021, 11:25:31 AM
Love lecture notes! Knowledge is everything! It's "funny", I have followed a youtube vlogger for years now, she has cystic fibrosis and she always chants cheerfully: "don't forget to take your enzymes" whenever she films a meal. So now I sing that phrase every time I prepare a meal for Laurië.
She is still not eating enough. I am trying different things. Her normal veterinary-diet kibble is out, I have tried a number of different wet foods and a handful of kibble, from grain-free to supermarket junk food. She will eat some the first time I serve it, but then refuse.
I will be getting her b12 and probiotic supplements this week as well. I am very worried about her weight, she is such a small dog and she really does not have much to lose. She was down to 9,2 a few days ago. She should be closer to 10kg. She is still happy, cuddly, and playful, but her energy level is lower, for obvious reasons. I am very worried.
I knew about EPI superficially, you hear of it occurring in german shepherds. But I had never heard of an older dog developing it so suddenly. Laurië has never had pancreatitis or any other diseases that could predispose her to EPI. My vet says it's not unheard of for geriatric dogs to get it just because they are old and organs sometimes give up.
When I saw the pale, yellow, soft poohs I knew something was up with either liver, bile or pancreas. My vet was very quick to diagnose it based on my description of the poops and the dog not showing other signs of illness. Happy, skinny dogs - classical EPI.
The advice from phoenix and the epi4dogs forum is valuable. My vet is very good, I chose her because I know she is a nerd (in the best possible way) when it comes to internal medicine. But she has not lived with an epi dog. She knows what tests to run, what medicins to prescribe and what nutrition to recommend. The day-to-day of having a dog with epi is the type of expertise you get from other owners  :luv:
Title: Re: EPI, liver and bile duct inflammation
Post by: bizzylizzy on January 17, 2021, 11:38:15 AM
 :bigarmhug: :bigarmhug: and love  from us, wish I had some advice to give!  :luv:
Title: Re: EPI, liver and bile duct inflammation
Post by: Mari on January 17, 2021, 11:58:32 AM
:bigarmhug: :bigarmhug: and love  from us, wish I had some advice to give!  :luv:

 :luv: A forum like this, where people care and understand is a huge support.
Title: Re: EPI, liver and bile duct inflammation
Post by: ejp on January 17, 2021, 08:33:54 PM
Oh Mari  :bigarmhug: it's so difficult trying to get everything sorted and figure out what the best things is to do for your girl.  :luv: It's frustrating when she has become picky with food.  I really wish I had an answer for you, I don't know what to suggest.  At a risk of creating a rod for your own back, could you give her cooked dinners human style?  I am just thinking that a slow cooker would allow you to batch cook and freeze some different options, fish and veg, meat and veg.  But as I don't have any knowledge on the foods she can and cannot have, that may not be an option.  Hope you fine a compromise soon, x
PS, can't beat a nerd when you need research  ;)
Title: Re: EPI, liver and bile duct inflammation
Post by: Mari on January 24, 2021, 06:12:09 PM
Just a little update since you are all so wonderful and supportive  :luv:

Laurië is doing a little better. Her enzyme dosage has been adjusted down and we have changed the way we give them to her after getting advice online. She has also had a b12 injection, and we are swapping to enzymes that have b12 supplemented. She is still not eating enough, but she is eating one type of canned food now, so I'm hopeful we can get there. She is still happy, she has no idea I'm nervously counting kcal in a way I've never done before. I've never had to worry about too few before  :005: I am still worried about my little old lady and her weight loss, but at least she is eating so hopefully we are on the right track! She had fun on a nice walk in the sun today, and with her big coat on you can't even tell there is anything wrong. She just needs to eat more, that's all  :luv:

(https://i.ibb.co/6FgkXd3/Snapchat-1497610579.jpg)
Title: Re: EPI, liver and bile duct inflammation
Post by: Mudmagnets on January 24, 2021, 06:51:30 PM
Really pleased to read your update on your little lady, it must be very worrying for you.

I have just remembered  a bit of history on Branston regarding severe weight loss he suffered a couple of years back (it was due to him eating a food that did not suit him and) After much investigation The vet recommended a B12 Supplement that you sprinkle on food, it is called COBALAPLEX and is made by Protexin, I got it from VetUK here is the link to have a read up you may be able to get it from somewhere similar https://www.vetuk.co.uk/dog-supplements-cat-supplements-multi-vitamin-and-mineral-c-5_222/protexin-cobalaplex-for-cats-and-dogs-60-sprinkle-capsules-p-41030

 I don't if it would help your Laurie, but it certainly made a difference to Branston, a long story short but he is now a healthy weight - he was eating the dry food - (Tribal) good enough food vet said but it was not doing anything for him nourishment wise.
Title: Re: EPI, liver and bile duct inflammation
Post by: Mari on January 24, 2021, 07:10:00 PM
I will keep that supplement in mind, thanks! I actually recognise the brand so I know I can get it from the vet here, yay. We haven't really looked at supplements yet. She is still on liver and bile duct medicines, hormone pill for incontinence and I am struggling to get her joint supplements into the mix. I think maybe all the pills and the fuss is not helping her appetite. I do think she needs vit b and probiotics and prebiotics, but it's just difficult to add too much when she is barely willing to eat food as is. Right now Laurië is getting any food she will actually eat. Luckily the one she eats is an easily digestible option from the vet. Apparently, grain-free is better, but she would not eat any of the ones I tried for more that one day. It is so strange to have a picky dog. For over 14 years she has eaten everything and anything, but now she will sniff everything suspiciously and only eat one type of dog food. Still eats treats and human food though so I'm not sure what to make of it  :dunno:  :005:
Title: Re: EPI, liver and bile duct inflammation
Post by: bizzylizzy on January 24, 2021, 09:22:45 PM
 :luv: so glad to hear Laurie s feeling better although I can imagine how worrying it is. Its a good sign that she‘s happy to be out and about and is enjoying her walks. I do hope you can keep on top of it and find something that will really tempt her appetite, sorry I can‘t offer any advice other than to say follow your instincts and if she enjoys human food and it doesn‘t contain anything specifically harmful, I‘d be inclined to let her have it.
Sending lots of  :bigarmhug: :bigarmhug: and waggy tails to you both!
Title: Re: EPI, liver and bile duct inflammation
Post by: ejp on January 25, 2021, 06:39:34 PM
Oh that is a lovely photo, she does look well and happy.   :luv:  I am glad you are starting to get to grips with things, there will be a fair amount of trail and error I suspect.  Just chucking ideas out there, so feel free to ignore.  If she is happy to eat people food, could the medication be disguised in that and given as snacks in between doggy dinners?  Given that you are calorie counting in the opposite direction  :005: that might suit you both.  Going to take a little bit of time to get a routine again, but you are getting to grips with it, and there is a lot to take on board.  Stick with it, you are doing great.