EPI * Exocrine Pancreatic Insufficiency

Hello, My name is Bonnie and I have a dog recently diagnosed with EPI.  My vet suggested that I go to a site called "balanceit.com" to come up with a "perfect meal plan for Hayley" which I did but did not find much help there not to mention the fact that they wanted anywhere from $10 to $30 for a receipe.  So, I turned to a friend who has so much knowledge about the holistic approach to the care for our pets as well as ourselves and she sent me to your site. 

I feed a prey model raw diet to all of my dogs and normally to all of my fosters (I am the co-founder of a german shepherd rescue in West TN) so it has been a challenge to find the "right diet plan for Hayley." 

My speciality or gift as some say is to take a skinny dog or a sick dog and to nurse them back to good health.  One of my recent success was a dog that had a fecal plug of worms, was grossly underweight as well as heartworm positive while working with this dog, my vet made the comment that she would like to see me put weight on and EPI dog without knowing it was an EPI dog ... I told her that she jinxed me when we found out that Hayley was indeed and EPI dog .. however I did manage to get 6 lbs on her in a 2 week period.

So I am here to learn from others the best way to approach and manage this disease.  Currently Hayley is being feed twice a day (I work a full time job), she gets a grain free kibble that is a fish & potato based kibble.  I give her a fish oil capsule twice daily, a B-12 pill (I know she needs the injection and have it ordered) twice daily,  a probiotic capsule twice daily and is on the Metronidazole twice a day .. this was started last Wed. .. for 15 days.  I found the tylan powder online, ordered it and have not started giving her it yet and today the Dr. Goodpet canine formula digestive enzymes came it  so I guess I will start that tonight.

Ok .. ready for input and suggestions, thanks

Hi Bonnie.  Welcome.  And thank you for doing what you do.  With an epi dog, you may get to use your gift more than you can imagine.  Congrats on the 6 lbs though already.

I am assuming you have not started the enzymes yet.  The usual starting dose is 1 tsp/c food.  I don't know about dr. Goodpet, never heard of it.  Ok.  Just looked it up.  It is a plant based enzyme.  What was the tli score on your dog and was the folate and b12 tested?  Before I go any further here, I will await the results, sorry.  And then I will continue.  As will others, I'm sure.  Just give us the background first.

WOW.... you are well on your way Bonnie!

So, my first question to you is what kind of ancreatic replacement powder are your giving the EPI dog and how are you preparing it with the food.

Are you grinding (or choppinginto small bits) the food so that the enzymes are touching themajority of the food.

Some feed raw food to an EPI dog.... with some, this has been the only way to achieve success.... and then ont he other hand, there will be an EPI dog who cannot handle raw.

That's the joy of owning an EPI dog... although we have a basic set of guidelines.... not everything recommended for an EPI dog is going to work for every EPI dog...............this is where all the tweaking comes in.

As far as diet goes, if the dog doesn't have a problem with raw.... excellent!I  When feeding an EPI dog raw food, they still need bone content, but reduce the recommended 20-25% bone content to about 10-12% bone content because  the majority oe EPI dogs cannot tolerate too much bone. Some cannot even handle this muchbone.....Some can handle mashed vegetables just fine, and others will have a poop blow-out... so this will be a trila and error thing for you and your dog. If you can, try to sneak in some organ meats... 10-15% is recommended... however, not all EPI can handle this either... another trial and error tidbit.

Regarding the b12 pills, trash 'em. They don't and can't work, unless you are giving "Metagenics Intrisi B12/Folate" pills... so far these are the only pill form of B12 that works because of the folate & intrinsic factor.

Hope this helps a wee bit.........

Hi and thanks for the answers.

I got a copy of the test results from my vet (mainly for my holistic friend to look at, lol) but here is what it shows:

TLI 0.7 (low).

And here is my question for you guys/gals before I call my vet to "ask more questions" ... Hayley had eaten that morning (she helped herself to a 3 small turkey necks .. counter surfing before I realized what she had done .. would have been more but ...) 

  1.  so how accurate would this test be?

   2.  the test results say to "repeat test ensuring that food is withheld for 12 hours", should that be done?

   3.  whatelse should we test .. I know you mentioned a couple other things but since I am at work, I can't remember what they were

  4.  the test was done at Antech Diagnostics Lab in Southaven, MS, should it be sent somewhere else?

Thanks

ahhh... i just noticed that you are planning to give your EPI dog "Dr. Goodpet canine formula digestive enzymes" ...my recommendation on this is if your dog is a positively confirmed with a TLI test EPI dog with TLI values below 2.5  (and i just read that it is) you need to treat the dog with the appropriate porcine-based enzyme treatment. Plant enzymes will help, but not enough, Your dog really needs the opportunity to get better. To-date plant enzymes have not been know to substantially help and manage EPI. We are hoping that this changes and that soon we can find the right mojo with plant enzymes so that dogs can indeed have this alternative available, but at this time, unless you are dealing with a pork allergy and the dog is unable to use pork enzymes, please consider using the proven correct medication to treat this condition.

If an EPI dog is not treated with the optimal porcine enzyme treatment, (pork-based) the dog is being placed at risk.

Many of us here buy generic pancreatin. We get it at a hugely discountedrate because it is purchsed in bulk from an American company and re-distributed to us.  Check it out: http://www.enzymediane.com/

At 0.7 Hayley still would register at EPI levels... however... the values may be somewhat skewed because she ate.... personally i wuold not repeat the test atthis time... i would waituntil after she stablizes and hasbeen stble for 3 months and THEN check it again.

Test B12 & Folate levels (this should be doen at Texas A&M University.... it will also indicate if she has SIBO if the folate is real high.

Antech is fine for TLI.... it's the Bq2 testing thatyou will ant to be done at Texas... it's real tricky to do anddo right and TAMU is the place for that.

Would you recommend testing for that before beginning the B-12 injections?

Also, which enzyme do you recommend that I order from ezymediane ..the 6x or 8x, thanks

will "save" the Dr. Goodpet enzyme for another "needy dog", lol

Hi Bonnie.  Ok.  See you do have confirmed epi.  Most of us start out at the 6X which is the equivilent of what your vet would order, but 1/3 or more cheaper.  3/4 tsp 8X = 1 tsp 6X.  So really, the choice is yours, you use less on the 8X, but most do use the 6X, not as much math, esp if you go by 1/4, 3/4 c food here and there.

As for the test, have them draw the blood (12 hour fast) and then give the shot.  This will be the truest reading.  I did that once, only waited about 3 days and wasted my money.  Make sure they test the folate also as most of these guys start off w/ SIBO due to all of the undigested food before dx and treatment.

I also see you feed raw to the dogs.  You can continue to do that if you desire since that is what Hayley is used to.  Or if Hayley does good on the food you are feeding now, you can continue w/ that.  Most epi dogs cannot tolerate the high bone content of the premix, so you may need to add a bit of the same meat or extra veggies or something if you do opt to go that way.  Ea dog is different.  It is what works for the dog and the owner.

Smaller meals more often in the beginning due help to stabilize better and also help w/ the weight gain.  I know you said you work and sounds like you probably have a few dogs, so if this isn't feasible, that's understandable.  But some do it by feeding in the morning, when they get home and then before bed.  Also, if sticking w/ the kibble, you can make up the night before and incubate 20-60 min (ea dog is different in what soak time is needed) and then stick in the fridge, pull out in the morning, float the bowl in the sink in hot water to get the chill out and set down and feed.  All done.  I have done it w/ the raw, also, mix it up, throw in the fridge if we are taking off and know we are gonna be close to his meal time upon coming home.  In the morning, you can again mix up the next meal, incubate, throw in the fridge andwhen you get home, it's ready again except for the warming up.  Again, ea is different and some dogs do fine on the cold from the fridge, others need it warmed.

Another thing that seems to work well for stabilizing is to keep it simple.  Only food and enzyme in the beginning until you are doing the happy poop dance, then add back things one at a time, keeping a journal, so you know what works and what doesn't.  Sometimes what they tolerated before they cannot tolerate now.  So by keeping it simple and adding back, waiting 3-5 days between ea addition, is very helpful.  You can download a journal from above.  It really does help.

There are  a lot of tricks to keep this simple and easy for you.  Just ask.  It is overwhelming in the beginning, but soon it is very normal. 

Off subject here, last winter we stayed in our fifth wheel in middle TN.  I love it down there.  Our plan is one day when the economy picks up we will be living down there.  There are a few epi doggies located around there.  I got to meet one of them last winter.  And then of course Olesia who is near the KY/IN border.  It's great meeting other epi'ers and talking w/ them.

Good luck and let us know how you are faring.  Ask any questions.

will "save" the Dr. Goodpet enzyme for another "needy dog", lol

Actually, I'm not familiar with that one, but for some people, once they got the good poops going, they were able to help w/ the weight gain by adding 1/4 tsp or so of prozyme ea meal w/ the right amount of the porcine one.  Prozyme is another plant based.  So you may be able to add it in also, if it helps.  Mine can't tolerate the plant based.  Also, until you get enzymes, adding some to the food won't hurt, will help some, not as much as the porcine ones, but it will help get a bit of nutrition going.  It could even firm her up some.

Hi Bonnie and welcome!  I'm just logging in here today and I see you've already been given some great advice...Most folks start with the Pancreatin 6X from Diane.  It's pretty equivilent to Viokase V, which  is vet prescribed pancreatic enzyme replacements. The general rule of thumb is to start off with 1 tsp per cup of kibble. You can work it up or down from there.  I use the 8 X, but this is only becuase my EPI gal, Tara, requires a lot of enzymes and she's not real keen about the stuff, so we figre less is more. 

As for restesting, I would not bother right now, but this is my opionion.  You may choose to do so at a later date, but with the score being so low, I don't know that it would make that much difference. I feel the same about the B12 as it is water soluable and the body just rids itself of any excess. If I were you, I'd work at starting the stabalization process, then consider re-testing.

If your good at putting weight on a dog, this should be a walk in the park for you!:D My Tara is a terrible eater and hates all food...Raw, kibble, cooked...You name it, we tried it. Today, 5 years after diagnosis, you'd never know she has EPI, but it took us a long time to get here...

Donna, Tara, Zoey and Zeke

Hi Bonnie and Hayley,

Welcome to you both, you have been given very good advice and information.  I look forward to hearing of Hayley's progress in the future.

Hi Bonnie and a warm welcome to this EPI family forum.

I would just like to say that in the interim until you receive your porcine enzymes, please double the dose of the plant-based enzymes and allow to incubate on the food for a minimum of 30 minutes, but you might need to incubate longer - perhaps 40 / 45 mins.  Just a point until you get your enzyme diane supply.

Warmest best wishes,

Julie & Angel

Thanks everyone for the sound advice and warm welcome.  Yes, I have 7 german shepherds of my own plus usually  2 to 3 fosters (normally heartworm positive dogs) and it keeps me quite busy as one can imagine but I would not have it anyother way. 

So, let me see if I am understanding this correctly .. testing the B-12 level and folate is or is not recommended at this time? 

Next question, switching from flagyl to Tylan .. w/o or with the above test?  My vet only gave me a 15 day supply of metronidazole.

Yes, I (and Hayley) would love for her to be able to go back to the raw diet .. I have to watch her if she is out while I am thawing or preparing the food for the others .. she loves to counter surf and we all know that bone and kibble are not a good combination in the gut even in a dog that has no "issues".  But for now, we are staying on the kibble .. although I am not sure which contributed to her weight gain while with me:dry:.

To clarify, currently Hayley is not getting a digestive enzyme yet I did manage a weight gain .. luck, determination on my part, who knows, so I can only imagine what will happen with the enzyme ... to me that is encouraging news.

I can certainly add a "third meal or nighttime snack" for Hayley since I am already giving another wgsd who has some funky liver numbers (yet is a good weight, active, loves to eat .. no signs of a dog with liver disease) his nightly oatmeal with extra virgin olive oil; what's one more "snack" to prepare, lol.

Hi Bonnie~

WOW... & GSDs+ you certainly are a GSDangel!

I personally would get tne B12 & folate test done. Dog must fast for 12-18 hrs and, if possible, have the Blood sent to Texas A&M (Jorg Steiner's lab) for testing. Testing B12 is tricky, and Texas A&M is the best in the U.S. to check out the protocol and/or share with your vet, scroll halfway down this page: http://www.epi4dogs.com/b12.htm

Both Tylan and Metronidazole are recommended for SIBO... but the reasons why Tylan is preferred in many cases is because "some" dogs, when kept on metronidazole for an extended time  as required for EPI SIBO (30 days)may cause some temporary "neurological-like" issues.  Also, sometimes if Metronidazole doesn't work, Tylan will and visa versa.  SO we like to suggest Tylan first for the 30 day round of anti's.

When you get the enzymes be sure to add room temperature warm water . For example, use; 1/3 cup of water, add in 1 level teaspoon of 6x pancreatic replacement enzymes from EnzymeDiane, mix well, add in your 1 cup of kibble, mix well again, let sit for 20 minutes, mixing often.

Feed

Also, if you were feeding (for example)  2 cups of food  twice a day..... adjust to 1.5  cups of food 4 times a day.... in other words (if you can) smaller meals, more often, but over all 150% of what the dog normally would get.  This is something you should do if you can until the dog starts to put on weight back on and you will know this when it stops finishing all of it's food...... that is when you know the body has replenished what it has lost and you can then cut back on the amount and the number of times you feed the dog.

Hope this helps a little bit!

Ok .. getting frustrated with my vet now ..  I called her today to ask about the B-12 test & folate test, she wanted to know why I felt it might be necessary ... so she wants me to go to another website called vets.com or something like that for advice and any questions I have  .. my normal vet if off this week and I can't wait till she gets back, her associate(the same one I'm dealing with) who is the one who saw Hayley just lacks Doc's savy & knowledge, sigh.

Please suggest to the associate vet to call Texas A&M Veterinary School for a consult to understand WHY an EPI dog should have a B12 test. B12 and SIBO are secondary conditions that accompany EPI . You might also want to mention to her that it happens anywhere between 50-70% of the time and THIS is why you would like the appropriate tests performed. If the dog has a B12 deficiency and does not receive the proper treatment, no matter how much enzymes you give the dog with his food... he will have issues and slowly slide backwards.............

The information on this website is a combination of documented scientific research performed by highly respected EPI researchers and vets who have dedicated their careers to the field of EPI ....

Dr. David A. Williams (he developed the TLI test),

Dr. Jorg Steiner ( her performs the B12 testing and worked under Dr. Williams),

Dr.Keith E. Murphy, and Dr. Leigh Anne Clark, both EPI geneticists ,who hail from Texas A&M University and are now heading up their own labs at Clemson University and doing the EPI genetic research with SNP technology.

.....along with much valued daily hands-on experience from actual EPI owners.

Hi Bonnie, 

A very warm welcome to you & Hayley.   I see you've already received some great advice.  This is a wonderful group of people who will help you every step of the way.   Please feel free to post some photo's when you can.  We all LOVE pics. here.  Again welcome. 

although I am not sure which contributed to her weight gain while with me.

Before I head out to class, just wanted to say, raw food does contain some natural enzymes.  It is easier digested than processed, which does destroy the natural enzymes.  I use about 1/2 the dosage of what it is on kibble, this I  worked down to when stabled.  That being said, you are right in staying the course for right now til stable as you don't want to make too many changes right away.  Just thought I'd mention that. 

Hi everyone, thanks for all the help and advice .. if I decide to switch Hayley back to a raw diet, does it need to be "ground raw with bones" in order for the supplement to work?  I am trying to picture how the enzyme will work on a chicken leg quarter .. bone & all ...  she really wants to eat what the other dogs are eating, lol

I also noticed that stress does play a big factor in this disease .. I changed Hayley's feeding place yesterday (long story .. hw+ wgsd having some problems) and last night her poop was soft again AND she drank more water than normal ... this is gonna be a challenge, isn't it?

if you choose to go back to the raw - I would highly recommend grinding it in order for the enzymes to contact as much of the food surface as possible during the incubation time. 

some dogs are more easily stressed than others - I think the results just show more readily in an EPI dog - this should calm down in time as Hayley begins to stabilize and heal