EPI * Exocrine Pancreatic Insufficiency

Hello EPI Family!

Today was our first appointment with the vet after being diagnosed. Test results and course of treatment are listed below.

Let the journey begin! Firm poop and healthy weight for all!

HI Shannon.  Welcome.  Looks like your vet is on top of this, which is good.  Couple things.  Anti's for SIBO should be given for a min. of 30 days, not 14.  Most vets will want to treat for the lower amts, but it usually doesn't clear up and you would have to start over again.  Maybe talk to him about it?

You say 2 tsp enzyme 2X day.  Is this for 2 c of food 2X day?  Also, make sure you soak w/ water and wait at least 20 min., some soak up to an hour.  Helps the digestion and prevents mouth sores.  Ask any questions and as you already have found out, post pics.  They love them here.

Hi Shannon, Great stuff. I have nothing to add on Karen's excellent enquiry and suggestion (I am just learning about incubation periods, which are very important) but I must say that Basia's cobalamin is very good, although at the lower end of the normal scale for a healthy dog, which is 250 -900. So, I am puzzled why your vet wants to to give B12 injections, once a week for 6 weeks. Personally, I would check this out with him because Angel's Cobalamin on diagnosis, last month, was only 30 and she is having fortnightly B12 injections. I believe the standard protocol for B12 injections is every two weeks for a set period and then once a month until cobalamin is stable, which you have covered.

With a 265 Cobalamin reading, Basia really might only require two weekly interval B12 injections, which would also save you money. I would discuss this with your vet.

Warmest best wishes to you both,

Julie & Angel

Hi Shannon,

Sounds like you are well on your way. You have had great suggestions already.... the only thing i ahve to add isto start keeping an EPI LOG .... so you will know what to teak and how much to tweak if you need to adjust http://www.epi4dogs.com/EPI%20Dog%20Log2.pdf

Hi Julie,

Regarding the B12.... usually even if the B12 is within the normal range but on the low side, it is advised to start the B12 injections. The protocal that most U.S. vets follow, and it appears that this is what Shannon's vet is doing..... is the Texas A&M University TAMU) B12 protocal for B12 injections with EPI dogs. In the U.S. Dr. Jorg Steiner's GI lab / department at TAMU is recognized as the premier lab for B12 (cobalamin and folate) testing. From what was explained to me (but i don't have a clue as any of the specifics:() , I guess lab testing B12 levels is rather difficult to perform accurately so it is best, if possible(and if you live in the U.S.)  and if one has a choice, to have it done at TAMU labs for accuracy. Also, a little side note, if done elsewhere, it is also advised to continue to do it elsewhere to have comparable benchmarks.

If you are interested in reading the Texas A&M University B12 protocal for EPI dogs ...Go to http://www.epi4dogs.com/b12.htm  and scroll halfway down the page for the TAMU B12 info (gosh, everything i refer to is always halfway down the page, eh?)

That is interesting that Angel is on bi-weekly. A long time ago i contacted an EPI canine researcher in the UK... he (or a group) did  a study on 1300 EPI dogs in the UK.... maybe something from that study resulted in the bi-weekly B12 recommendation. I so wish i still had his email and email address, but i don't ... i looked for it the other day, and for the life of me i can't remember his name.... and I only remember bits and pieces of his email.......*sigh*........ darn old age...................

Thanks for coming in on this, Olesia - I had no idea the UK followed  a slightly different protocol on this. I will read the Texas A&M into. UK's standard epi protocol is either B12 injections by-weekly or monthly.  The UK is generally more medically reserved than the US and I would have found it interesting to have read the UK epi research you mention  ....... I forgive you for losing the info!  

I think I will try a UK google search ..... it might still be available.

Julie,

I am really glad you brought up the UK protocol ... not only because maybe the US protocol is a wee bit different, but also because it reminded me of that email i got from theUK EPI researcher.... i wish i still had it so that i could confirm what i think I remember about his email because if i do remember correctly he sited some differences from the US and UK....but i just can';t remember the specifics... if it was in the treatment of the dogs or slight differences noticed in the actual dogs themselves ...... sometimes i just frustrate myself... but it is food for thought........

Excellent conversation on B12  - Thanks Karen, Angel and Olesia

• All the testing for Basia did go to TAMU. 
• It is 2 tsp to 2 c of food on the enzymes

I will discuss with the vet doing 30 days of the Metro

Thanks again everyone!

Hahahaha ...... hahahahah!!!!  I am cracking myself up looking at the babes expression!  WONDERFUL ILLUSTRATION OLESIA OF YOUR FRUSTRATION!!!!  I LOVE IT!!!!

Well, if you do remember ...... don't forget to share it with US!

Hey Shannon,

sounds like you are on the right path! I got the best poop results after grinding food and incubating for 45 + minutes! So if things aren't going like you hopped they would, you might try that! I wish you the best of luck. :o)

Well just read the Iams Low Residue bag and the top ingredients are Corn Grit and Rice

So please let me know what you recommend us switching to in a dry food

Seems like a lot use DVP or EVO

I'm using DVP-but the verdict's not out yet! :o) We're just on our third bag

Hi Shannon,

If you can, i'd change the food.... Basia may or may not do okay on the IAMs... because of the grain. .... so you might want to try something grain-free and you just might very well be pleasantly surprised. Most of us are pleased when we switch to grain-free. Not all, but most.

If you try the Dick van Patton foods.... some folks have trouble with the poultry version, so you just might want to try to venison/sweet potato or fish/sweet potato.

Some other choices are:

I personally like the EVO small red meat ....it is much higher in fat content than other... but once my Izzy became stable, i slowly increased her fat intake she did great. So we do not restrict her fat intake.

I also switch my grain-free foods around a lot.

Another grain-free kibble i personally like is Taste of the Wild. This and EVO small red meat are my dog's favorites.

And then to switch things around i also use Barking at the Moon, Blue Buffalo, and Wellness Core, Nature's Variety grain-free

Hi Shannon,

You are indeed lucky in that your vet seems to know a thing or two about EPI.  

You were given low residue because it has low ash and as most vets do not understand a lot about nutrition, they understand this makes sense.  While my Tara seems to be one of the exceptions, rather than the rule, we stabalized her on Eaglepack Holistic lamb and rice.  Then, they started increasing their prices to the point where it was getting ridiculous!  About 6 months ago, I switched to Taste of the Wild Vennison and Bison and guess what...No problems.  I've even been able to put my IBD dog on this food and the healthy rescue too!!!  As I'm feeding about 200 pounds of dogs, cost is an issue here and IMHO, this is the best food at the best price I've found.  That said, if you need to put your dogs food through a food processor, this is not the food to do it with... We were grinding Zeke's food (Corgi w/IBD and really bad teeth--Tara will not eat her food if it goes through the processor) and the processor doesn't make a dent in it...I actually need to use a sledge hammer for TOTW! Just an FYI...

Donna

Most of the recommendations came from the vet at the Animal Diagnostic Clinic (awesome place -  3 story hospital - You'd think it was for people) here in Dallas that did the testing and diagnosed the EPI

The food changes have come from reading all the great posts here in the forum and doing additional research - I have chosen on my own to switch to DVP Venison and Sweet Potato (Read alot about people having problems with the Poultry) - Currently letting incubate for 20 minutes at room temp

I'm also talking to her regular vet tomorrow about doing 30 days of Metro versus 14 days for the SIBO - I think she'll listen to my recommendations if I present it right - I think she's learning all the details in dealing with EPI along with me :o)  But I know she's been doing her research too so hopefully we can work hand in hand

So thanks for the all recommendations and keep fingers crossed!

Shannon,

Sounds great. and  Keep us posted!

~ ~ POOP PIC ~ ~

Look what Basia (Baa sha)  made for me!

IT HAS A SHAPE

Still golden but IT HAS A SHAPE

Only 4 days on treatment and IT HAS A SHAPE

BONUS - No accidents in the house this week!

YEA BASIA - THAT'S MY GIRL!

Looks Beautiful!!!!!!

Donna

BTW, the poop color can and does pick up the color of the kibble...Is this a low residue poop? I think chicken is the protein in it?.The venison is darker.

Donna

YEAH!!!!!!!!.  What a great looking poop.  A huge Congrats.:D

Lynn & girls.

In addition, I've talked to my vet tonight and she has agreed to 30 days of Metro!  She even gave me her home email to send poop pics.  I have to say I have the best vets!  Anyone ever need recommendations in Dallas just let me know - Hillside Vet , Dr. Ashley French - The rest of the vets are great too - She spent the weekend doing more reading on EPI - I love that we are working as a team!