EPI * Exocrine Pancreatic Insufficiency

Hello,

I have a three year old Portuguese Water Dog that was just diagnosed with EPI.  Before Nike was diagnosed she weighed 43 lbs, her weight on the Friday - the day I took her in for the blood test was 31.4 lbs.  The results from her blood work were TLI = 1.4, B12 = 235 and Folate = 35. 

I am currently feeding Nike 1/2 a can of Royal Canin "Gastro" food mixed with 1/3 a cup of Royal Canin "Prevent" dry food and 1 tsp of Pancrease-V Powder.  I give her this 3 times a day right now in hopes of kick starting her weight gain and because I feel really guilty about the fact that she has basically been starving for the fast 3-4 months.  Nike also gets 250 mg Metronidazole twice a day.

Any suggestions or feedback would be greatly appreciated.  Some of my initial questions are:

1. Does everyone feed their dogs a special "Gastro" type food or will I eventually be able to switch back to a regular dry food eventually with the added enzyme powder?  I used to feed Nike Orijen dog food but switched when Nike started to get diarrhea.
2. About how long on average does it take for a dog to re-gain their weight?
3. How long should I keep Nike on the Metronidazole for?
4. What other options do others use for enzyme powder?
5. At what point do you start to decrease the dosage (1 tsp) at every meal or do you?

For right now I'm just happy that Nike no longer has diarrhea - she had it for a solid 3 months - it took her a couple of days on the enzymes for her stool to firm up  - and that she is no longer ravenously searching around the house for food.  I feel really guilty about scolding her over the last couple of months for jumping on the table or counter for food - she never did that until a couple of months ago.

Thanks in advance for your suggestions, information and answers.

Mitch

Hi There I noticed you are from Oakville . Ontario  Canada? I live in Nova Scotia . My dog Anja is also on  the same powder as Nike. And she is also on a gastro food. She was diagnosed Jan.26 2010. She also took a couple of days for poop to firm up when we first started. She has gained 11 lbs. since then but it was a bit of a rollercoaster ride. It really has only been the last six weeks or so that i would say she truly has stableized. I was a true poop inspector.  this forum has been a great help and support to me. Read all you can here and you and your vet can work together. Hang in there.

Wanda

Hi Mitch and welcome.  Don't feel guilty.  That is the first thing I want to touch on. We have all been there, done that.  Doesn't get you anywhere.   We do not know these guys are sick, we wonder what changed, bad habits, etc.  Now that you have your answer, you know what to do.

?1:  Some dogs eat the regular dog food, but mostly low-no grain, low fiber works best.  See link above for diet.  Taste of the Wild, DVP's are some of the common used ones.  Some feed raw and some home cook.  Whatever works for your dog.  Ea is different.  Stick w/ what you are using now, til stabilzation (no weight loss, good poops) for a month or so and then if you want, try to switch.  But again, if it isn't broke....

?2:  Ea dog is different.  Some regain fast, some may take a year or more.  Ea dog is different.

?3:  For SIBO, min. of 30 days.  Some may need a couple months, some long term.  But the min. is 30 days. 

?4: www.enzymediane.com   She sells the generic for about 1/3 of the price and most of us have no prob switching to them.

?5:  Ah, 1 tsp meal?  The recommended starting dose is 1 tsp/ c of food, not meal.  Most of us have the best luck starting there.  If in a few months the poop looks off, you can try going down maybe 1/8 tsp at a time, or you may have to go up.  But I'd start w/ the 1:1 and see how it goes.  Add water, enzyme, food and soak a min. of 20 min, up to 1 hour, to start digesting the food which Nike cannot anymore and it also helps prevents mouth sores.

Well, you may want to ignore 3&4 depending where you live.  If in the U.S., Canada or New Zealand, that is what works.  UK and Australia use different enzymes.  Guess I should have looked first.

Anyways, welcome and ask any questions.  Oh, do you know the guidelines of the lab for the B12?  Most I think are 250 or higher, and for EPI you want mid-high, so you may need to supplement w/ that also.  http://www.cvm.tamu.edu/gilab/research/cobalamin.shtml

Our friends had Portugese Water Dogs. They are great dogs.

Hello Mitch,

Welcome to the Forum, but I am sorry your Nike has been diagnosed with EPI.   It sounds like you are off to a good start on getting her stablized.  As Karen has mentioned, in the beginning it usually works best to start with 1 tsp per 1 cup of food.  Feeding more frequent meals as you have been doing is great.  Increasing the daily recommended food intake by 50% can also help early on.  The Metro antibiotic is best given for a minimum of 30 days to help with SIBO which commonly occurs with EPI as does low B12.  My GSD Boss used to eat various grain free kibbles (Orijen, EVO, Taste of the Wild).  He is currently on one of the prescripton kibbles, Hills Z/D.  Eventually (way in the future) I do plan on "trying" to return to a regular grain free.  But as you will learn with these pups, every one is different and it is all trial and error as to what works for each.  Good luck on your journey to find what works for Nike

p.s.  It also helps to keep a log of everything that goes in and out of Nike... you can see a pattern that really can help troubleshoot any setbacks.  Also only change one thing at a time and then wait a couple days before trying any other changes. 

Hi Mitch,

I'm still fairly new to this too (we're 7+ months since diagnosis) and it can be overwhelming at first, but you will eventually get comfy with it. Its tempting to try everything, but go slowly. The weight can take a while to gain back (ours it 1 pound short of her pre-illness weight). We initially started out with a Low Fat diet, because Sandy could not tolerate the Gastro, but the Gastro was also recommended. After about 3 months, and nominal weight gain, we added on a limited ingredient diet (Natural Balance, Fish & Potato) which I feel gets more essential oils & calorie density into the diet without overloading on fats (it was still well below the fat max. guidelines). We're 50/50 Low Fat and Natural Balance with some wet food too, and that seems to be working well and has allowed Sandy to gain a few more pounds. It was up & down for the first few months, so be prepared. Our dog was always lean, so the vet said she needed more calories than the max. recommended feeding guidelines. We waited 2 months before adding more food on though, but don't be afraid to feed more if things are stable. The portugese water dogs I know tend to be high energy, n'est pas?

If weight gain is problematic, speak to your vet about B12 injections. 250 is normal (range is 150-700). Folate normal range is 7-39. However, even at a somewhat low/normal, absorption can be improved with a series of injections. Our Sandy was at 200 at the time of diagnosis. After 3 months and very slow gain, the vet suggested we do a 2 month course of B12 injections - 2 weeks after finishing she was like a puppy again, and within that month after gained another 2 pounds.

As for the SIBO, did your vet do a fecal culture? We did one just prior to running the TLI, and since it came back OK, there really wasn't a need for more antibiotics. 30 days is the usual course, but it's not always warranted. If you're comfy leaving Nike on meds for a month, then I wouldn't spend the extra $$ on more tests. No doubt you've already spent a small fortune :-)

Re: other powder options - Did you check out Cross Border Pet Services online pet meds? I recently discovered them and they sell the Pancrease-V really cheap (1/2 what you'd pay at the vet). Olesia added it to the enzyme list, but it seems only a handful of Canadians know about it. We use it and have had good success. Initially 1tsp per cup of food, and after a few months of stability we gradually lowered it to 3/4 tsp. We've tried going lower without success, so as others say, it's trial and error.

Good luck to you both!

Hi Mitch. 

Just noticed that you're new here & wanted to say 'Welcome'.  I see you've already had lots of great advice from our wonderful members here.    Please don't feel guilty about the table surfing etc..  It happens with most of us & you didn't know why Nike was doing it.  My EPI girl Megg stole a whole cheese platter pre EPI diagnosis, that was set out for our dinner guests.  Doorbell rang, and like lightning, the platter was gone:)  They become very clever also when scrounging for food. Know exactly when to strike.   Thankfully that does subside. 

Again welcome & please feel free to add some pics. here.  Instructions on how to do this are in our files.

Lynn & girls.

Hi Mitch,        AGain, Welcome to our forum, and sorry that your Nike has become an EPI dog.   Life will get better for you and for Nike soon.   Take a deep breath and be patient and this will become much easier to manage.  

You have gotten some great advice here, and please feel free to ask anything.  We all want to see Nike strong and healthy again, and you happy again.

Hang in there,

Welcome to you Mich and Nike!

I see you've already been given great advice, so I'll just agree with the others here.

As for experience, I have never been able to cut Tara's enzymes back and she uses a rather large amount of 2 tsp 8X per 2 cups of food. All I can say is thank doG for Diane!!!! We tried the prescription diets in the beginning, but Tara wouldn't eat them, so they were of little help to us.  Thankfully, the have a refund policy if your dog doesn't eat them!!!   I would say to stick with what you are doing and what's working for Nike and when comfortable with where he's at, you can try some changes, but go slow.

Welcome Mitch and Nike from Welland, Ontario (not too far away)

The normal range for Cobalamin (B12) is 252-908 ng/L .... low B12 levels are an indication that there is a B12 deficiency - This range is from the American labs - ours here in Ontario - the minimum level is lower than this

Nike's B12 levels are VERY low and need to be taken care of -

This can be done by injection (most common treatment) OR by use of a B12 pill that also contains Intrinsic Factor

(click on the B12 tab at the top of the page for more info)

Don't let your vet tell you that 235 is an acceptable reading - this is way too low

Hi Mitch ~

I too would like to give yuo a very warm welcome and.... I have a Spanish Water Dog, Izzy, with EPI.

Every one has given you great advice to start with so i won't bore you to tears with my post (i tend to write a lot)

But what jumps out at me is exactly what Karen posted....

Nike may also need B12 injections.

When dealing with an EPI dog, many times secondary conditions also accompany them about 50-70% of the time....such as SIBO (which you are already treating Nike for with Metronidazole- -  talk to your vet about giving this for 30 days... or after 10 daysof Metronidazole, ask your vet if he/she would consider switching to Tylosin for the remainder 20 days... SIBO needs to be treated for at least 30 days...Tylan (Tylosin) usually doesn't have any side effects.

And then if an EPI dog has "low" or "low-normal" B12 levels... they need B12 injections. Check out and share with your vet the Texas A&M protocol for this: (scroll halfway down the page and print/bring to vet) http://www.epi4dogs.com/b12.htm

if Nike has low normal B12... the problem, with B12 levels is that they can plummet dramatically all of a sudden...and even if you are giving the dog enzymes, etc...if not treated, it will hinder the dog from getting better.

Someone mentioned an EPI LOG... excellent idea. Feel free to down load one from this page:

http://www.epi4dogs.com/downloads.htm

and... by the way... we'd love to see pictures of Nike... so feel free to post in your message. Instructions are:

Make sure you are at the EPI FORUM and in a thread where youare already signed in and getting ready to post a reply...then go to yourbrowser and:

1.go to http://photobucket.com/

2. Sign up (it's free)

3. upload a picture from your computer

4. once that picture is done uploading.... look on you screen (center-at thebottom) where you have a choice to cancel or save

5. Save

6. The next screen that show up will have that picture in an album...under theactual picture ..where it says "direct link" click on that box withcode in it

7.then go back to the EPI FORUM and in the message you are typing... rightabove the message box, there should be a little blue box in the tool bar

8. Click on the little blue box... a URL empty box should appear... paste that"Direct Link" code right in this URL box. hit enter and your pictureshould appear in your post.

Welcome to Nike and Mitch!  I got nothing to add, but didnt want to be left out in welcoming you to the forum.  Hope you get on top of things quickly....already taken the first best step by popping in here for advice.   I'd like to see some pics too!!

Hello, Mitch and Nike,

You're on the right track and you've had plenty of suggestions so I will just say welcome.

Hi Mitch...just know we all have been EXACTLY where u r right now...the guilt...the panic...the trying different things, the numerous poop runs during the night.  You got some great advice here and just know you found the PERFECT place to help both u and your Nike.    Hang in there - change one thing at a time otherwise u don't know what works or doesn't work for that matter.    The best to u and Nike...

Hi Mitch & Welcome

I am still quite new to this too but saw your question about wanting to get back to using a dry food.  Royal Canin also do a dry gastrointestinal diet.  I order from a website in the UK but I am sure this is available worldwide.

My GSD was diagnosed one month ago and he has been on Metronidazole for the past four weeks but we are to stop today so I'll let you know how it goes!. 

Regarding building up and putting on weight.  I was told to feed small regular meals (we are currently feeding three times a day as six hour intervals).  I cup dry mix gastrointestinal Royal Canin, with Wainwrights pure rice and turkey (or lamb) 250g tray adding a third to each dry feed.   We were advised to take the feeding easy and if all is going well increase slightly every 4-5 days, but were advised it could take up to six months to regain the weight. 

Best of luck.

Fiona & Wallace

Welcome Mitch and Nike!

I am fairly new too (7 months for one dog and one month for his half sister) but have nothing to add about treatment....all the advice here is spot on!  Please do not feel guilty.  We all do the best we can and since our puppies can't tell us verbally it is a guessing game.  Our first dog had diarrhea for months and our vet thought food allergy and we were treating for that.  She had mentioned other tests but wanted to wait.  How I wish I had questioned about the tests and possible other diagnosis!  But guilt solves nothing.  Important to focus on what we are all doing to help our fur-babies now. 

I know from experience and reading that weight gain is so very individual.  Pharaoh gained all his lost weight back in a little over a month.  Taiko (his half sister) was diagnosed in June and is much slower in her weight gain.  I think we all feel good when the weight loss stops and rejoice with each pound that is gained.

I laughed while taking photos of poop but found the feedback here very helpful, so feel free to post photos of both Nike and her poops!

Again, welcome...though none of us are happy that our dogs have this condition...this forum is a great community that will provide so much support.

Good Morning Everyone,

Firstly thank you all for your great advise and suggestions above - they are very much appreciated! - and secondly sorry for the late reply.

Nike seems to be doing well everyone looks at her and says she looks like she's gained weight (she has see below!) and her energy levels seems to have increased.

When Nike was diagnosed on July 2/10 she weighed 31.4 lbs, I have made a point of taking her with me to the vet each week to get her weighed , here are the results:

July 12 - 33.4 lbs

July 17 - 34.2 lbs

We started the B12 shots this past Friday (1mg / week for 4 weeks) and it did seem to make a difference with her stool.  Before the shot her stool would start firm but finish kinda soft and she would squat 2 or 3 time when she had to go - first squat was decently firm, second squat 30 seconds later less firm and if there was a third squat 30 seconds after that it was less firm again.  For the last couple of days she has only been squatting once and the entire movement has been firm - Oh how I look forward to being able to use a pooper scooper again instead of having to hose down the runny poop!!!  Her stool has firmed up nicely and she seems to be going once or twice per day.

A couple more questions,

I'm using the Pancrease-V powder my vet sells but it is expensive ($79) and only comes in 114g containers - any reason why I shouldn't order from Enzyme Diane?  Her enzymes are more potent than the -V Powder, any issue here (I have the comparison below)?

Pancrease-V Powder                                                              PANCREATIN 6x Powder European

Lipase = 67,200 USP                                                              Lipase = 80,640 USP

Protease = 280,000 USP                                                        Protease = 436,800 USP

Amylase = 280,000 USP                                                         Amylase = 616,000 USP

Nike has 12 days left in her 30 day SIBO treatment after that I would like to see how she is for a couple of weeks and then potentially and progressively work to get her off the canned Royal Canin "gastro" food and into a grain-free dry food - probably try to go back to the Orijen I used to feed her.

Since the start of the enzyme treatment Nike has developed a not so pleasant smell - I think it's her breath.  Is this normal?  What can I do to help make it better?

Thanks again for all the welcomes, suggestions and advise from the group.

Cheers,

Mitch & Nike

Hi Mike

Sounds like you are on the right track. I too wonder about switching to Diane's enzyme's . I am using the same powder as you. And am wondering if i change anything how it might effect her especially when the numbers aren't the same. Hopefully someone will chime in and let us know.

As for the smell ,Anja had it for 2 or 3 mos. and then it was gone. (thankfully). Some dogs get it and some don't. I noticed around that time she drank more too.  It is great when pooping is down to twice a day!! Anja was at her worse after Christmas right in the coldest part of winter running outside back and forth.

Good Luck

Wanda

Sorry i called you Mike Must have split the difference between Mitch and Nike!!!:roll: