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Forum Home > General Discussion > Why aren't the enzymes working?

DaxieSuperBud
Member
Posts: 10

Hi everyone.  I'm new to the forum, but have been reading posts for several months, as my doxie Daxel was diagnosed with EPI after a severe attack of pancreatitis on 12/3/2017.  I won't go into all the details now, because it has been 2 months of endless doctor and hospital visits, endless tests and ultrasounds and medications, so I'll just nutshell it:  Dax has been diagnosed with PLE, EPI, hypothyroidism, and diabetes.  He has lost 7 of his 23 lbs and went from being a headstrong, fierce little warrior to a skeletal, weak little guy. He's being treated for all of his conditions, but I am hoping to find answers to a few questions related to EPI specifically.

I've read information on diet and enzymes for EPI, but I'm not finding information on why diet/enzymes might not be working.  Dax is unfortunately one of the dogs who doesn't like the scent or taste of the enzymes.  He started on Viokase, at 3/4 tsp per cup of food, but right away, he wouldn't eat any food treated with the enzymes:  incubated, lightly incubated, heavily incubated.  I reduced the enzyme amount, reduced the incubation time, increased the incubation time, added water, omitted water.  I've tried adding tripe, sardines to mask the scent.  I've tried using his favorite foods, tried all sorts of new foods.  I've tried all the tricks I can think of, or have read about.  Nothing works.  As soon as the treated food gets near him, he starts 'nosing' it, which is his way of 'burying' the food.  I had read that different brands of enzymes taste differently, so my vet suggested Pancrezyme.  Same thing. 

As you can imagine, while all this is going on, he's losing weight.  So, while I didn't want to syringe feed him, I've started in hopes that he would be able to process his food again.  My question is this:  Now that I'm making sure enzyme-treated food is getting into his system, why aren't his stools improving?  His stools are still large, frequent, and appear the same as before.  I had assumed that adding enzymes would automatically help the food digest and expected to see some sign of improvement, but that isn't the case.  Are the enzymes being rendered useless by medications he's taking?  I'm using room temperature foods, not hot, not cold.  I am pureeing the enzymes into the wet food, though. Is that causing a problem?

I am using a recommended limited ingredient wet food, but I've tried dozens and have the same result.  I'm at a loss for what to do to help this guy, so I decided to post a summary to the group and go from there.  If anyone has any information on why dogs do not respond to enzymes in their food, I'd be grateful to learn more!  Thanks so much!

PS.  Dax is taking prednisone for the PLE, in combination with cyclosporine.  Once the cyclosporine was added, his overall appetite immediately dropped.  He would eat untreated food prior to the cyclosporine, but now isn't interested in any food.  He needs to get off of the prednisone (hence adding the cyclosporine) because of his diabetes, but his albumin level was dangerously low so it outranked the potential issues caused by high blood glucose.  It is difficult to tell which pathology is impacting what: Is his loss of appetite due to the diabetes or the cyclosporine or his declining health due to the EPI?  In my mind, I had hoped that syringe feeding enzyme-treated food would get him over that hurdle, and give us bandwidth to tackle the other issues.  But if he isn't absorbing nutrients from his food, then in the end, the rest of the treatments aren't going to make much difference. 


February 2, 2018 at 6:17 PM Flag Quote & Reply

Terry Bin
Member
Posts: 2061

I am so sorry to read this...sounds like you have been through a lot.  It is difficult to say with the multiple medical dx and meds what may be affecting him.  I have a couple of thoughts:  do you have the lab values for B12?  Low B12 can really affect appetite...on one hand they are starving but they turn their nose up to food.  An EPI pup needs to have their B12 (cobalamin) 600 or above.  Many times a vet will say the lab value is normal...and yes, in the normal range for a non-epi dog (could be as low as 250 and be considered normal).  If the B12 is low, even if they eat, their poops will look bad and they will not gain weight as they should.  So B12 is my first thought

Second thought is the food:  are there any grains in the ingredients.  Most EPI pups cannot tolerate any grain...even if it is prescription and/or limited ingredients but has grain you can see bad poops.

Third: in terms of enzymes.  Some dogs just won't eat food with enzymes, no matter what you do.  There are capsules, called Creon, that can be given before a meal (as a whole pill) and some dogs do better with that.

We use tablets that we grind (actually hit with a hammer) so it becomes a powder.  But the amount is way less than regular powdered enzymes plus I've never really picked up a strong smell from the tablets, whether or not they have been made into a powder...so might do better with either a Creon or a tablet.

I hope this helps.

--

Terry

Mom of three EPI Shiloh Shepherds: 

Pharaoh born Nov. 2007 and dx with epi December 2009.   Pharaoh weighed 62.4 lbs. (15 lb. weight loss) when diagnosed in 12/2009.

Weight 10/31/11 was 76.6; 85lbs on 9/22/12; 85.5 lbs. on 11/13/14.

Received six weeks of B12 shots Jan-Feb 2010 but his B12 on 8/10/2010 was only 232. So started weekly shots at home, which we continue to give. 

His older half sister is Taiko born Sept. 2006  and was dx with epi June 2010.  Since she has severe bilateral hip dysplasia she had always been on the thin side.  Taiko's weight was 70.7 lbs. in June 2010 (time of diagnosis; about a 10 lb. weight loss).

Weight on 10/31/11 was 80.4 and on 9/22/12 was 82.4 lbs.  Weight 11/13/14 was 83 lbs.  B12 was 211 in June 2010 so started six weeks of shots and was only 293 on 8/10/10.  She receives B12 shots weekly at home.  B12 in September 2014 was over 1,000.

Both are fed twice a day and we use Merrick BG brand: 1 1/2  cups kibble in the morning with 1/2 can dog food with 4 crushed tablets and in the evening 1 1/2 cups to 2 cups kibble with 1/2 can dog food  with 4 crushed tablets. 

Moku was born 4/15/14 does not have epi.  His grandfather is Taiko's and Pharaoh's father (through his mother).  On 11/05/14 his weight was 78 lbs, on 12/11/14 he was 85.7 and on his first birthday 15 April 2015: 90.2 lbs.

February 2, 2018 at 11:14 PM Flag Quote & Reply

Paige's Guardian
Member
Posts: 104

Sorry that your pup is not eating.  I agree with Terry and add a few suggestions.  Once you find a good grain free food, I would suggest sticking to that for some time rather than switching frequently.  Also, start using a journal and only change one thing at a time.  It will help in the long run to identify what was or is working and what is not. 

Keep us posted on his progress.


February 3, 2018 at 6:10 AM Flag Quote & Reply

Michaela
Member
Posts: 297

That is a lot of medical problems to deal with at once...so sorry :( I can tell you that Nikki hates the enzymes also and it's difficult getting her to eat some days, no matter what you add to hide the smell. We just recently switched from the Viokase to the Pancrezyme which seems to help a little bit, she really hates the Viokase. We have tried Diane's enzymes, she hated those and poops were not great. PancrePlus hurt her mouth but gave her great poops...sigh. We also tried Creon, seemed to work at first but ended up with diarrhea.

Nikki gets weekly B12 injectons, the pills didn't work for us and her B12 levels dropped like a rock and she didn't want to eat.

When she was first diagnosed she also suffered from SIBO, her poops improved after being on Tylan for a few days. We tried taking her off the Tylan twice and poops went south, so she is on it for life. Will keep fingers crossed that things will get better for you guys really soon and he starts to feel better.

--

My GSD "Nikki" was diagnosed with EPI on 12/08/2010, TLI 1.07.  Receives weekly B12 injections.

Royal Canin Ultamino - 1 cup three times a day, 1 tsp of Viokase w/each meal soaked for 20 minutes.  She weighs 62 lbs.

Tylan:  1/4 tsp twice a day

"Nikki" GSD 11/21/2009 (EPI, IBD, Food Allergies, Atopy)

"Heidi" GSD (02/10/1995 - 02/21/2009) RIP Sweet Girl



February 3, 2018 at 9:51 AM Flag Quote & Reply

Patsy
Member
Posts: 993

I think there are too many drugs! Is the cyclosporine really necessary? It has a lot of possible nasty side effects, and you say it affected  his appetite. i know its for auto immune problems, but the pred does that too. What dose are you on.. My dog had PLE temporarily, which messes everything up. We were given pred for a few months, and it went away gradually. Vet thought she had diabetes insipidus, but changed his mind, it was just part of the mess, and reduced to just a thirsty dog. So yours has the glucose related diabetes, what treatment is involved in that? I guess you have to use food without any cereals which is good for Epi too. What is it called? Have you avoided chicken? As you use wet food, i would have thought less enzymes are needed because of the high water content.

 

I agree with the others about insisting on a recent B12 test, which must be supplemented to score 600 for Epi, It's a powerful influence on the metabolism and brain. I've had to have it myself, the effect is amazing.

 

My dog loathed enzymes, so she went onto tablets and capsules, albeit in the UK. No smell, no problems.

 

 

--

Marti  Springer Spaniel, owned by Patsy, Sheffield, England.  She died age 12yrs 6mths  on 27/11/14 from heart failure. Diagnosed after three months, when she was 4 years old,she dropped from 24 kilos to 17 kg.  initially she also had protein losing enteropathy, treated with steroids, ,raw sores on back, obsessive thirst, bursting bowels and biadder, then stable after 2 years.   Developed another autoimmune problem with muscular myositis on head ( muscles wasted away, leaving gaunt hollows.)  She also suffered sometimes from  bottom end thrush, anal  gland infections, and recurrent SIBO treated with 4 weeks of oxytetracycline each time. 

Enzymes: Panzym caused mouth problems, resulting in tooth removal , as I didn't know at the time how caustic it was. I changed to one Lypex  then used VetUk Pancreatic Nutrient tablets, and one Chemeyes because it is half the strength, and I didn't need to use two vet uk ones. Then 3 Chemeyes or  2 pancreatic Nutrient  per meal. 

B12 injection monthly.  Trinfac B12 + intrinsic factor capsules from Chemeyes daily. Metacam for knee joints.  Also used Yumpro Bio pre/probiotics.

Food: picky eater,tinned  Chappie saved her life  till she would eat kibble again.  Eden Holistic, Millies Wolfheart and Lily's Kitchen all good,chicken and grain free.

Vets, one caring learner, who had  nervous breakdown, replaced by obnoxious vet , so I rang round  interviewing them to find someone I trusted and would work with us. Since losing Marti and Bob, I have changed again since the good vet us retired.

RIP Bobby the cocker , from PLN.  Present pet, Tinker the fluffy little grey Greek rescue dog. New addition, Jack ,  a neglected rescue terrier, looks like a fox cub and so happy to to be healthy and loved.

 


February 3, 2018 at 11:11 AM Flag Quote & Reply

maddie ann
Administrator
Posts: 3678

You have a hell of alot going on there we always say that you need to get the other conditions undercontrol and then work on the EPI...we have a section under other conditions...about PLE and i think that the diet is the main thing you need to control...but what type of diabetes are you dealing with.??? but i agree with what others have told you about B12 this can cause the whole non appetitie etc....the site owner has a diabetic dog as well and has resorted to home cooking keeping everthing lean....i would try creon you have a smalll dog and there is no taste...see if that works...1 creon 10 to 1 cup of food.( its what us humans would use)

--

 ANN (UK).

Maddie DOB 01-10-2007 she is now  10  DX 04/11 .B12 140 now 644 TLI <1.00 Folate 14.2.

After 15 months on the B12 tablets with the intrisic factor she was retested and her b12 was 902 which gave me the confidence to continue without injections.

Weight was 22.3kg now 33.2kg (04-05-12) she is a small GSDbut she gained .(24lbs)

Feed a mixture of foods she does better on fibre 3% and below she has  b12 tablets daily (imported from the USAhttp://www.wonderlabs.com/itemleft.php?itemnum=6881) now changing to the uk version from http://www.chemeyes.co.uk/

She has panzym altough over the years we have had to increase the dose she currently has 1/2 tsp per feed.


February 3, 2018 at 1:22 PM Flag Quote & Reply

DaxieSuperBud
Member
Posts: 10

Hi everyone.  Thank you so much for the replies!!  I don't know where to start.  Well, I'll start with the B12.  Yes, his B12 does run low and he gets weekly injections.  We asked the vet if we could start giving him the B12's at home and just picked up the supplies this morning.  As for diabetes: Diabetes Mellitus.  He receives 2 units of insulin in the morning and 2 units in the evening (12 hours apart).  He's on Humulin (NPH).  His albumin levels were critically low, from the PLE, so the vet has been treating it as the top priority.  And initially, he started to improve with the prednisone.  His energy came up, his appetite improved, but the BG started going over 600/700 so she added the cyclosporine.  It's role is to keep the albumin levels up, but since it isn't a steroid (like prednisone), it can be used long-term without raising BG.  So, that was the game plan.  The problem is that he doesn't seem to tolerate the cyclosporine.  He immediately stopped eating, his energy level dropped.  And, he's already lost so much weight since the initial pancreatitis attack that I feel we need to make sure he's getting nutritional support from his food.  So, I've been trying to deal with the EPI.  Thank you for all the suggestions on the diet---Definitely helpful.  I will switch him immediately to a fully grain-free diet.  Also, the note about chicken--  My Yorkie has an intolerance for chicken products so I never used them with any of the dog's food/treats.  However, with Dax being so sick, I actually gave him some chicken jerky this week because it was the only thing he'd voluntarily eat.  I felt so sorry for him, he's so sick, that I thought, "Well, at least he enjoys something".  Last night, after seeing his worsening stools, I commented, "Maybe the chicken is making it worse".  So, no more chicken products.  As for the enzymes, we contacted a butcher today to see about raw pancreas.  But, I'm going to try the Creon and other suggestions you've made for trying to work with his diet and the enzyme.  It's hard not to change things up quickly, when you see your pet going downhill so fast.  :(  Well, he has blood work next week to see where his albumin levels are and I'll definitely include a post with an update on Daxie Super Bud.  In the meantime, I'll try some of the suggestions you've shared and if you think of anything else, don't hesitate.   Again, thank you so very much for responding.  It means more than you can possibly know!

February 3, 2018 at 4:34 PM Flag Quote & Reply

Doc's Mom
Administrator
Posts: 3150

Hi there.  Sounds like you and your little one have been through quite a lot.  I am going to notify Olesia - the founder of Epi4Dogs so that she can chime in here as you have so many things going on.  She is a wealth of knowledge and may be able to offer some suggestions.

--

MADELON and DOC aka "BUBBY WUBBY"

Nashville, Tennessee

DOB: 4/3/2014 - Diagnosed EPI and SIBO: 5/22/2015
EPI Test Results: 1st test 7/2014 = TLI 16.5, B12 894, Folate > 24; 
2nd test 5/2015 = TLI < .4, B12 406; Folate >24; 3rd test 10/2015   TLI < .4; B12 >1000; Folate 14.4

Weight: 95 (highest 1/2015) - 76 (lowest 5/2015) - goal met 100lb (7/23/15) - 101.8LBS 12/3/15 - CHUNKY MONKEY

History prior to DX:  May/June 2014 (2mos old) - DX coccidia and bladder infection; July 2014 (3mos old) 1st EPI test = TLI 16.5, B12 894, Folate >24 - Diagnosed SIBO not EPI; Feb 2015 thru May 2015 - weight loss only; May  2015 vomitted several times, diarrhea and eating poop.

History since DX: has maintained weight between 95-101lbs since July 2015; extreme yeast and rod infection in ears; yeast infection paws (ongoing); bacterial eye infection; bacterial skin infection on legs; poops LIVE fly larvae; diagnosed with mild, focal superficial pyoderma (bacterial infection) - rare lesions on inner thighs; bacterial and yeast overgrowth lip folds; yeast overgrowth feet and left ear; metacarpal/metatarsal draining tracts/fistulae (infection and/or immune mediated disease; probable underlying allergy (food vs. environmental ); staphylococcus pseudintermedius infection in sores on paws; recurring metatarsal fistula - all issues resolved after NutriScan Food Sensitivity Test and switching foods.

NUTRISCAN Food Sensitivity Test (12/2015): reactive to chicken, turkey, white fish, wheat, white potato (mild), venison, soy (mild), pork (mild), duck (mild), corn - switching food based on test resolved all skin issues.

Serum Allergy Test (5/2016): Too many to mention

CURRENTLY :  6 cups Forza10 Legend Skin - Diane 6x 1tsp per cup; 1 WonderLab PetFactor B12 2x day; 2 scoops TotalBiotics 1x day; 600mg vitamin E; 1 Zyrtec 10mg 2x day; Milk Thistle during heartworm/flea/tick meds

I am not a vet.  All of my suggestions are based on my personal experiences, information gleaned from EPI research and information from other EPI owners.  Please always share anything and everything recommended on this forum with your vet

SO THANKfUL FOR OUR EPI4DOGS GUARDIAN ANGELS!!!!!!!!

YOUR PAWS LEFT PRINTS ON MY HEART (in loving memory of Bugsy aka Boo Boo - Boston Terrier 14yrs - not EPI but medically challenging and totally worth it)


February 3, 2018 at 5:08 PM Flag Quote & Reply

Doc's Mom
Administrator
Posts: 3150

Also one thing to consider - Olesia can speak to it more - but if your dog is really having a difficult time with the powder enzymes - you could try using Creon instead - they are enteric coated capsules.

--

MADELON and DOC aka "BUBBY WUBBY"

Nashville, Tennessee

DOB: 4/3/2014 - Diagnosed EPI and SIBO: 5/22/2015
EPI Test Results: 1st test 7/2014 = TLI 16.5, B12 894, Folate > 24; 
2nd test 5/2015 = TLI < .4, B12 406; Folate >24; 3rd test 10/2015   TLI < .4; B12 >1000; Folate 14.4

Weight: 95 (highest 1/2015) - 76 (lowest 5/2015) - goal met 100lb (7/23/15) - 101.8LBS 12/3/15 - CHUNKY MONKEY

History prior to DX:  May/June 2014 (2mos old) - DX coccidia and bladder infection; July 2014 (3mos old) 1st EPI test = TLI 16.5, B12 894, Folate >24 - Diagnosed SIBO not EPI; Feb 2015 thru May 2015 - weight loss only; May  2015 vomitted several times, diarrhea and eating poop.

History since DX: has maintained weight between 95-101lbs since July 2015; extreme yeast and rod infection in ears; yeast infection paws (ongoing); bacterial eye infection; bacterial skin infection on legs; poops LIVE fly larvae; diagnosed with mild, focal superficial pyoderma (bacterial infection) - rare lesions on inner thighs; bacterial and yeast overgrowth lip folds; yeast overgrowth feet and left ear; metacarpal/metatarsal draining tracts/fistulae (infection and/or immune mediated disease; probable underlying allergy (food vs. environmental ); staphylococcus pseudintermedius infection in sores on paws; recurring metatarsal fistula - all issues resolved after NutriScan Food Sensitivity Test and switching foods.

NUTRISCAN Food Sensitivity Test (12/2015): reactive to chicken, turkey, white fish, wheat, white potato (mild), venison, soy (mild), pork (mild), duck (mild), corn - switching food based on test resolved all skin issues.

Serum Allergy Test (5/2016): Too many to mention

CURRENTLY :  6 cups Forza10 Legend Skin - Diane 6x 1tsp per cup; 1 WonderLab PetFactor B12 2x day; 2 scoops TotalBiotics 1x day; 600mg vitamin E; 1 Zyrtec 10mg 2x day; Milk Thistle during heartworm/flea/tick meds

I am not a vet.  All of my suggestions are based on my personal experiences, information gleaned from EPI research and information from other EPI owners.  Please always share anything and everything recommended on this forum with your vet

SO THANKfUL FOR OUR EPI4DOGS GUARDIAN ANGELS!!!!!!!!

YOUR PAWS LEFT PRINTS ON MY HEART (in loving memory of Bugsy aka Boo Boo - Boston Terrier 14yrs - not EPI but medically challenging and totally worth it)


February 3, 2018 at 5:10 PM Flag Quote & Reply

Epi4Dogs
Site Owner
Posts: 17180

Hi Daxie's mom.... so so sorry your little fella is going thru so much..... but having an EPI + Diabetic + Low Thyroid + a dog that dealt with IMHA.... i feel for you and know how difficult it is to get everything working.


First..... with the PLE, your vet ireally is doing the best possible by your pup from what i understand.  Cyclosporine + Prednisone is the best first line of defense for PLE and with super low Albumin, that should be your first concern, then Diabetes and then EPI. 

Based on what you are saying.... i strongly suspect the enzymes are working BUT what you are seeing is not that the enzymes not working but rather SID is going on, which displays with all the same symptoms as EPI.   And just a FYI... the latest research indicates that all EPI dogs have SID going on to one degree or another.whether we see physical symptoms or not..... and the best we can do is manage it and jsut not let it get out of control. 


The first thing i would do is call your vet and ask him if he would consider to start treating your pup for SID... and please ask your vet to try with Tylan antibiotic (Tylosin Tartrate 100 grams powder)  have your vet read the SID/SIBO page for dosing instructions.


You can also try giving your pup a little bit of SLippery Elm powder... it is a dietary fiber with SCFAs that is agreeable with EPI dogs dealing with SID, agreeable with dogs with Diabetes and agreeable with dogs with PLE.... will even help soothe the PLE flare up in dogs.  Only get LOOSE Slippery Elm powder (can be found at health food stores, or order on line ) the Dosing instrucitons are: 

  Give Slippery Elm powder with breakfast and dinner meals. 1/8 tsp for dogs under 10lbs, ¼ tsp for dogs 10lbs to 30lbs, ½ tsp for dogs 30lbs to 80lbs, 3/4 tsp for dogs 80lbs to 100lbs, and 1 tsp for dog 100/+lbs. Mix in meal, add 1 to 2 tablespoons of water, mix and serve meal as you normally would. Incubating not necessary (sometimes even a lesser dose work better :))


ALSO  PLEASE have your vet read the latest EPI Veterinarian Seminar presentation by vet researchers on how to treat EPI  under the MORE tab, select EPI Seminar and check out Dr. Barko's presentation:    http://www.epi4dogs.com/Dr%20Barko%20Epi4Dogs%20Presentation%202017.pdf


It explains how they use Tylan for SID (rather than metronidazole).


Next... the inappetence.... because your pup is also Diabetic....and to help with the weight  AND the appetite and without jaking up the blood sugar.... ask your vet to research L-Carnitine (it's an amino acid) and ask ihim if he thinks it is worth trying..... and if he can help you with the right dose for your pup:

Dietary L-carnitine and Canine Diabetes

Evidence Based on Pathophysiological Rationale

L-Carnitine is a conditionally essential, vitamin-like nutrient that plays a pivotal role in fatty acid metabolism. Supplemental L-Carnitine suppresses acidosis and ketogenesis during starvation in dogs (Rodriguez et al., 1986). L-Carnitine supplementation at 50 ppm of diets fed to dogs enhances energy conversion from fatty acid oxidation and protects muscles from catabolism during weight loss (Gross et al., 1998; Sunvold et al., 1999; Center, 2001). Dogs with poorly controlled diabetes experience weight loss, altered fat metabolism, ketogenesis, and hepatic changes, and so are likely to benefit from dietary L-carnitine supplementation. The majority of diabetic dogs are middle-aged and older and can be expected to already have reduced lean body mass (Kealy et al., 2002) before the onset of diabetes-associated weight loss. Consequently, it is important to consider any dietary intervention, such as L-carnitine supplementation, that promotes maintenance of lean body mass in these animals.


CREON is another good option.... but as mentioned above..... you might find that once you get the SID under better control.... you might find that your dog may not have such an aversion to the enzymes.... (or not...) but if he still does... then i would definitely try CREON.......  Just thinking out loud here.... but if you want.... i can get you a few CREON capsules to try... jsut email me privately at ([email protected]) with your  mailing address and we can mail you a few to try - - to see if it makes things easier...... if they do help..... ask your vet if he  would lwrite you a script for CREON 10 (or 12) to use for your pup ... or at least until you can get him to (hopefully) eat food with the enyzme powder on it... if this is EPI "SID" related.


B12 was mentioned above and that is another good point as over 80% of all EPI dogs need B12,, however... if your pup is indeed getting B12... have the levels been checked sine?  it is posible that the cyanocobalamin version of B12 is not working or not working well with your pup.... This doesn't happen too often, but it does happen, and it seems to happen more with smaller dogs (i have no idea why)... in which case you might want to sk your vet to try a different version of B12 injections like hydroxycobalamin... OR..... try supplementing the current B12 shots with Wonderlabs oral "Pet Factor B12" which is made with Methycobalamin + Intrinsic Factor + Folate.  Many MANY of our EPI dogs with low B12 use these pills with great success.


I would typically suggest a food change too but you are dealing with so much right now that my thought is you might want to get the right controls in place first  and then later looks  at a food change as another thing to adjust for optimal results.  


Hpefully this helps a little.......

--

Olesia, owned by Izzy, a 35lb SWD, Diagnosed at 1.5 years old - TLI results 1.3, Stable 9+ yrs! Once stable, was able to reduce enzymes to only 1/2 tsp of Enzymes (use EnzymeDiane's 6x) with each meal, but after almost 4 years of stabilization... had to increase the amount of enzymes to 3/4 teaspoon with each meal. Fed various grain-free kibble+real meat, 6x pancreatin enzymes from EnzymeDiane., gave 1 tsp of coconut oil one day and 1 tsp salmon oil next day, and also give canned sardines packed without salt or canned herring for extra omega oils.... until she developed Diabetes and now cannot tolerate higher fat foods.

In Feb 2013, Izzy developed a very serious condition called IMHA which she (thankfully) beat and is now in remission. We also discovered that now, at 8+ years old, she not only has EPI, but also Diabetes, Low Thyroid and High Cholesterol.  Izzy was able to receive excellent care because of the kindness of so many here on epi4dogs and  is currently  doing extra-ordinarily well. If anyone could spend a day with Izzy, they would never guess that she has any health problems!  Because of Izzy's concurrent conditions of Diabetes and High Cholesterol we had to make changes to our daily EPI routine. We had to alter the fiber, type of fiber and the fat content her diet. She is now on an all home-made diet which she does best on and has even been able to reduce the insuline (Vetsulin:pork-based insulin) . Because of the diet change to all home-made i no longer worry about hypoglycemia or hyperglycemia- -she is much more even-keeled with a diet of sweet potato, a lean meat/fish, sometimes a free range egg, cottage cheese,  fish oil+vitamins and bone meal. We tried Novolin N a human synthetic RNA insulin.... but Izzy did not do well on it. aside from all of Izzy's health issues.... she continues to wake up every day full of joy and a great sense of humor!

I am not a vet.  All of my suggestions/recommendations are based on personal expereinces, observations, information gleaned from EPI research, and information shared with me by EPI researchers....that hopefully may help others. Please always share anything and everything recommended on this forum with your vet.

February 3, 2018 at 9:28 PM Flag Quote & Reply

Marilyn Marinelli
Member
Posts: 885

I will share with you what may help ease the problem with trying to give your dog enzyems the way you have been struggling with.   I use Creon 10,000 units (2 for each meal my dog gets) So that would be 2 Creon 10,000 per 2 cups of food.  This solved the problem for me when my dog was getting sores and I was allergic to the powdered form.  I just wet the pills very slightly place them in my hand and my dog takes them down like a treat.  I give the Creon capsules just before she is going to eat.  Works great for her and me.   You can get Creon 10,000 from CandaDrugs.com You will need a perscription from your vet for them  price is about $54.89 for one bottle of 100 capsules. I ask my vet to call in or fax a perscription for 1 year and get a few bottles at a time throughout the year.

The other place you can get Creon 10,000 from (without a perscription) is www.chemistwarehouse.com .   I just orderd Creon 10,000 capsules (100 capsules in a bottle)  Cost is $36.69    I ordered 3 bottles $110.07 pluse shipping and handlling $30.42   Total amount came out to $140.49 (3 bottles)   They take "PayPal"    

The other thing I would share with you is the B12...I found that when my dog was on shots it didn't work well for her at all . She would be fine for 1/2 a week then go down hill.   B12 has to be above normal like 600+ for an EPI dog.  I ordered B12 with intrinsic factor from www.wonderlab.com  (no perscription needed)  $17 per bottle.  Instrinsic factor is needed to help with the digestion.   This I did at first and had her B12 level checked every month for a little while then left it alone and it has been 7 years or so and she is doing fine all along. The B12 level has stayed up.     

Hope this helps to help you with all that you are dealing.   I wouldn't give your dog chicken either if you find that it is effecting him.  

February 4, 2018 at 12:24 AM Flag Quote & Reply

DaxieSuperBud
Member
Posts: 10

Greetings again everyone.  Thank you all so much for your kind words and helpful information.  We started Dax on a grain-free diet this afternoon and eliminated the treats and chicken he was eating voluntarily.  We did more reading on the best diet for PLE and found that a 'hydrolyzed protein' was recommended, with muscle-meats and organ meats.  So, tomorrow we'll be adding organ meat to the formula and we've located several good options for canned/store bought for when we may not have time to cook.  But for now, we are going to strive for consistency so we will be preparing his meals ourselves.  I discontinued the cyclosporine last night, even though I haven't talked with my vet, because he is still taking prednisone as he was prior to the cyclosporine.  He was improved today, but still weak.  My doctor had said we could try the liquid version of cyclosporine that is normally given to cats, but I haven't researched that yet to see if it would produce the same side effects.  I'm glad to have read about the various issues involved with B12!  Oddly enough, when he received his B12 injection on Monday, they didn't even check his counts when they did his blood work.  I had just 'assumed' they checked, but we logged on to his medical record tonight and realized they didn't even run that test!  So we have no idea what his B12 level was on Monday.  Thanks to your input, we know more about what to watch for.  I'll read up on SID and Tylan (sp) and approach my doctor about that, as well as some of the other information that was shared.  I'm printing everything out and my partner and I are going through the information carefully, so if I don't reference a recommendation in my reply, it is only because I'm going from memory---we are taking all the suggestions seriously!  Someone mentioned sending some Creon (what a wonderful, sweet offer!) but the post was followed by a post with a link to a non-prescription pharmacy.  Let me check into that and see what I can arrange. 

Unfortunately, a new issue has emerged.  We are sure Dax has developed Masticatory muscle myositis.  Just this week we had noticed his temples seemed sunken, but had 'assumed' (another assumption) that it was caused by the weight loss.  Dan was reading another post on the forum and it mentioned sunken temples and so we googled it and sure enough, it sounds like Dax has now developed myositis.  On the one hand, the treatment is prednisone.  On the other hand, if it leads to a tightening/clinching of the jaw that will impact his ability to eat.  So, I'll have to bring this to my doctor's attention Monday.  How can one little guy have so many problems?  On the bright side, the vet did test for Addison's and he *doesn't* have that...Nor liver problems, nor kidney. 

On another note, Dax absolutely hates taking his medicines, so that is a twice-a-day battle of the wills.  Thankfully, someone somewhere suggested putting the bitter pills in empty gelatin pill shells and that was a blessing.  He takes amoxicillin, metronidozole, an appetite stimulant, cerenia, thyroid med, prednisone (I think that's it), but he pushes his tongue up against the roof of his mouth and we can't get the pills down his throat.  So, Dan tries to hold his tongue down, and I try to push the pill over the top of his tongue, and it either works or it doesn't.  If it doesn't, he's able to quickly spit the pill back out.  If it does, he will sit and hold it at the back of his throat, then when we turn to get the next pill (we are able to put all meds into 3 capsules), he'll 'cough' and it pops right back out.  We've learned to watch whether he swallows or not.  If he just sits there without swallowing, we know he's planning to cough up the tablet.  So now we keep a little liquid food at the ready and squirt some into his mouth to force him to swallow.  He's a great dog, really, but waaaay too smart...

Thanks again everyone! 


 

February 4, 2018 at 1:58 AM Flag Quote & Reply

DaxieSuperBud
Member
Posts: 10

I thought I'd share a picture of our sick little guy.  You can see the myositis around his temples.  If you'd have seen him 12/2, you wouldn't think he was the same dog.  He was a beefy, bossy, 'strong like bull' kind of guy.  It's amazing how quickly all this has happened. 

February 4, 2018 at 2:22 AM Flag Quote & Reply

Patsy
Member
Posts: 993

Hello again....if you check my signature you will see that my Marti had MMM, the muscle wasting on the head , and gaunt hollows, so noticeable on short shiny fur.  This came after the PLE.    This all started  at least twelve years ago. It's auto immune , and my vet said to just carry on with the pred, MMM isn't going to kill her.   It never affected her jaws, she ate like a horse all her life and became slightly overweight for a springer spaniel.  The antibiotic collection you re using may be tricky.  Some folks have dogs that can't tolerate metro. (See metro toxicity).   In the uk  I only used oxytetracycline,  but we know now that tylan is better, though not usually available for us... Marti lived with Epi from 4 yrs old to 12, when her heart gently gave up. The list of letters she had, became a joke..EPI, PLE, MMM...

The list of problems a dog with severe problems from malnourishment is long. Like concentration camp victims, they have been starved, and recovery can be slow.  Given patience and digested food, this is the starting point.   Keep it simple, concentrating on the diabetes and Epi.  Avoid all vaccinations until better.  All drugs have side effects,  many don't mix,  start with the essentials.

It's emotionally draining, but when you get a decent poop, you'll be ecstatic!

--

Marti  Springer Spaniel, owned by Patsy, Sheffield, England.  She died age 12yrs 6mths  on 27/11/14 from heart failure. Diagnosed after three months, when she was 4 years old,she dropped from 24 kilos to 17 kg.  initially she also had protein losing enteropathy, treated with steroids, ,raw sores on back, obsessive thirst, bursting bowels and biadder, then stable after 2 years.   Developed another autoimmune problem with muscular myositis on head ( muscles wasted away, leaving gaunt hollows.)  She also suffered sometimes from  bottom end thrush, anal  gland infections, and recurrent SIBO treated with 4 weeks of oxytetracycline each time. 

Enzymes: Panzym caused mouth problems, resulting in tooth removal , as I didn't know at the time how caustic it was. I changed to one Lypex  then used VetUk Pancreatic Nutrient tablets, and one Chemeyes because it is half the strength, and I didn't need to use two vet uk ones. Then 3 Chemeyes or  2 pancreatic Nutrient  per meal. 

B12 injection monthly.  Trinfac B12 + intrinsic factor capsules from Chemeyes daily. Metacam for knee joints.  Also used Yumpro Bio pre/probiotics.

Food: picky eater,tinned  Chappie saved her life  till she would eat kibble again.  Eden Holistic, Millies Wolfheart and Lily's Kitchen all good,chicken and grain free.

Vets, one caring learner, who had  nervous breakdown, replaced by obnoxious vet , so I rang round  interviewing them to find someone I trusted and would work with us. Since losing Marti and Bob, I have changed again since the good vet us retired.

RIP Bobby the cocker , from PLN.  Present pet, Tinker the fluffy little grey Greek rescue dog. New addition, Jack ,  a neglected rescue terrier, looks like a fox cub and so happy to to be healthy and loved.

 


February 4, 2018 at 4:36 AM Flag Quote & Reply

DaxieSuperBud
Member
Posts: 10

Hi everyone.  I didn't know if I should start a new thread called 'Update on Daxie' or just respond via this thread, so if you have a preference, let me know.  Anyway, Dax had his appointment yesterday and his albumin is out of the danger zone.  It is still low, but improving.  I took a printed copy of all your comments/suggestions (I'd emailed a copy the day before the visit) and reviewed everything with the vet.  She said:  1)  Slippery Elm is akin to Metamucil and while she didn't think it would hurt him, didn't see it as being a big gain.  2)  Similar on the L-Carnitine--didn't think it would hurt but didn't see it doing much for his particular condition.  She said that we should probably keep things simple at this point and not add anything unnecessary until we are better stabilized.  3) The B12 has to be sent out, and since he's receiving weekly injections now, they don't test for it, so she doesn't really know what his numbers are and is assuming his levels are okay.  It sounds as though some of you had a different experience, however, so I'm wondering if we should go ahead and re-test?  4)  She agreed with the Tylan recommendation and put him on it immediately.  He's now off metronidazol.  5)  She agreed with the diet recommendations (she'd talked about it before but didn't stress its importance so I didn't connect the dots).  He's now on Pro Plan's Hydrolyzed Vegetarian canned formula.  She wants to try the vegetarian right now in order to reduce the number of allergens he may have to various proteins.

He really just started everything today so I don't have any news in the way of his stools.  I would like to get Creon, though, because he still won't eat food with enzymes on his own.  The other new thing is that she found a compounding pharmacy who will provide 'chlorambucil' for $100 per month.  The advertised price was between $30-$40 per tablet, around $1000 per month, which I just couldn't do.  I'm sure you all understand the financial cost of what he's been through.  She said the chlorambucil is about his only option to get off the prednisone (since he doesn't tolerate cyclosporine).  If he responds to the chlorambucil and the new food/Tylan, then maybe he will have a chance to recover and we can dial in the diabetes and thyroid.  We know that there is still a chance the underlying cause of the PLE is lymphoma, and if so, his prognosis isn't good.  She said that the chlorambucil is the top-tier treatment and if he doesn't respond, we'll pretty much have our answer as to the underlying cause.  But, one day at a time.  

He should be getting the chlorambucil in a few days and while I'm hopeful, I know it is a chemo-therapy type drug and am also concerned about what side effects it might have.  I'll post again once I know more.  Again, thank you all for your suggestions and thoughts.

February 7, 2018 at 12:31 AM Flag Quote & Reply

Jill
Administrator
Posts: 3728
You are doing a great job being proactive for your pup! It is nice to go to the vets already having done your research and being able to present your case. Please keep in mind that you are making a lot of changes so you might want to keep a daily journal. You can go to the downloads in the tabs above and print one out. Good luck.
--

   Jill-  Washington State

Mickey 6/21/99 - 8/29/2014 

17.5 lb  jack russell, chronic pancreatitis, hyperuricosuria,high blood pressure, hypothyroid, spinal stenosis

diet of  hard boiled eggs, macaroni,  RC Hepatic, mashed potato

2 #2 Dianes enzymes 6x premeal

 2.5 mg Amlodipine, .15mg soloxine am/pm, 100mg ursodiol started for gall bladder thinning

arthritis:  6.25mg tramadol 1x/day, 12.5mg gabapentin every 12 hrs,  Assisi soft loop used on back and elbow, 1- 540meq potassium citrate nightly

Denamarin once a day, 1/16 t tylan (150mg)  2x/day ,  Senilife started 12/14/13, Trixsyn sirup for arthritis, .1mg Adequan weekly by shot. 75mg Tylan 2x./day for SIBO

Optimmune for Dry eyes

 Kiya is Mickeys sister, 3/4 aussie, 1/4 blue heeler born 9/2006.  She thinks she is a 44 lb jack russell who tries to heel Mickey!!

TJ is the newest addition.  He is in the bottom picture with Kiya.  He was born 7/05/2015. 

I am not a vet, just a pet owner sharing what experiences I have had in helping my dogs with other pet owners.  If you have an emergency please call your vet.





February 7, 2018 at 9:57 AM Flag Quote & Reply

DaxieSuperBud
Member
Posts: 10

Thank you Jill.  I've started a 3-ring binder to keep track of everything, so keeping notes/journal is becoming a must.  His stools today weren't great, and I just die inside when I see the lack of progress.  Also, my vet kind of messed up the prescription for the food she's recommending (she put the wrong brand name on the prescription) but now that I'm looking into that in more detail I'm starting to get confused.  Firstly, the food she recommended doesn't seem to exist.  Second, she wants it to be vegetarian and I've been reading that most dogs aren't actually allergic to most protein sources, as opposed to grains, so now I'm concerned that we might be crossing wires and I need to make sure that the food is grain-free.  I swing from being guardedly optimistic to wanting to cry!   Nothing seems to be working where his food is concerned.  

February 7, 2018 at 12:56 PM Flag Quote & Reply

DaxieSuperBud
Member
Posts: 10

Btw, just to clarify...I have a really good doctor and she's very receptive to my partnering with her in this process.  Which isn't an automatic---I had another vet roll her eyes and say, 'Dr. Google' when I mentioned something I'd read (I no longer use her).  My new vet spends her own time, lunch breaks, doing additional research on all of this.  So if it ever sounds like I'm complaining, I'm not.  When I read my last post where I said I was getting confused and commented on the mix-up with prescription diet issue, it might have sounded like I was being critical.  I'm not---I was just relating what happened.  The last thing I'd want to do is alienate my vet.  She's tremendous!


February 7, 2018 at 1:46 PM Flag Quote & Reply

Judith
Member
Posts: 437

Hi Daxie's mom

Sorry you are dealing with so much. A recomendation on the hydrolyzed protein food is Royal Canin Ultamino, it is a dry food and agreed with my EPI boy and my girl who is allergic to lots of things. They do make a canned which is just hydrolyzed. Might be worth asking your vet for a script for that. Hope things improve soon


--

Nate 2 year old Pembroke Welsh Corgi. DOB 5/5/2014 

EPI and Addison's Disease and Idopathic Epilepsy

TLi 2.1 June 13, 2016 TLi 2.0

Coblamin and folate could not be done

Clinically diagnosed with Addison's disease on June 23, 2016

Diet 1.25 cup Royal Canin Ultamino every 12 hours 

2 Chemeyes capsules given with each meal

.45ml hydroxocobalamin (B12) once a week

.33ml Percorten-V every 28 days Addison's Disease

.5mg prednisolone in the morning for Addison's Disease

100mg Zonisamide every 12 hours for seizures

February 7, 2018 at 6:18 PM Flag Quote & Reply

Doc's Mom
Administrator
Posts: 3150

I'm so glad you have a vet that you are comfortable with and is open to learning with you - that's HUGE!!!!  As for not being allergic to proteins - not sure about that one - I did the NutriScan food sensitivity test and a blood serum food test and my boy can't tolerate chicken, venison, whitefish and a few others I can't remember.  When recommending a hydrolyzed food we usually do recommend trying Royal Canin Ultamino - there are two others I can't remember off the top of my head but a lot of foods that say they are hydrolized aren't TRULY hydrolized.  Glad you are keeping a journal of everything.  Sending you hugs and prayers for you and your little one!

--

MADELON and DOC aka "BUBBY WUBBY"

Nashville, Tennessee

DOB: 4/3/2014 - Diagnosed EPI and SIBO: 5/22/2015
EPI Test Results: 1st test 7/2014 = TLI 16.5, B12 894, Folate > 24; 
2nd test 5/2015 = TLI < .4, B12 406; Folate >24; 3rd test 10/2015   TLI < .4; B12 >1000; Folate 14.4

Weight: 95 (highest 1/2015) - 76 (lowest 5/2015) - goal met 100lb (7/23/15) - 101.8LBS 12/3/15 - CHUNKY MONKEY

History prior to DX:  May/June 2014 (2mos old) - DX coccidia and bladder infection; July 2014 (3mos old) 1st EPI test = TLI 16.5, B12 894, Folate >24 - Diagnosed SIBO not EPI; Feb 2015 thru May 2015 - weight loss only; May  2015 vomitted several times, diarrhea and eating poop.

History since DX: has maintained weight between 95-101lbs since July 2015; extreme yeast and rod infection in ears; yeast infection paws (ongoing); bacterial eye infection; bacterial skin infection on legs; poops LIVE fly larvae; diagnosed with mild, focal superficial pyoderma (bacterial infection) - rare lesions on inner thighs; bacterial and yeast overgrowth lip folds; yeast overgrowth feet and left ear; metacarpal/metatarsal draining tracts/fistulae (infection and/or immune mediated disease; probable underlying allergy (food vs. environmental ); staphylococcus pseudintermedius infection in sores on paws; recurring metatarsal fistula - all issues resolved after NutriScan Food Sensitivity Test and switching foods.

NUTRISCAN Food Sensitivity Test (12/2015): reactive to chicken, turkey, white fish, wheat, white potato (mild), venison, soy (mild), pork (mild), duck (mild), corn - switching food based on test resolved all skin issues.

Serum Allergy Test (5/2016): Too many to mention

CURRENTLY :  6 cups Forza10 Legend Skin - Diane 6x 1tsp per cup; 1 WonderLab PetFactor B12 2x day; 2 scoops TotalBiotics 1x day; 600mg vitamin E; 1 Zyrtec 10mg 2x day; Milk Thistle during heartworm/flea/tick meds

I am not a vet.  All of my suggestions are based on my personal experiences, information gleaned from EPI research and information from other EPI owners.  Please always share anything and everything recommended on this forum with your vet

SO THANKfUL FOR OUR EPI4DOGS GUARDIAN ANGELS!!!!!!!!

YOUR PAWS LEFT PRINTS ON MY HEART (in loving memory of Bugsy aka Boo Boo - Boston Terrier 14yrs - not EPI but medically challenging and totally worth it)


February 7, 2018 at 7:53 PM Flag Quote & Reply

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