EPI * Exocrine Pancreatic Insufficiency

I was refered to this sight from others on the GSD forum.  My little guy, Kain a 3 year old GSD was diagnosed with EPI just yesterday and I have been scrmbling to get all my ducks in a row.  I was going to one vet and changed to another for his first appointment and am deeply disapointed.  They cannot answer any questions I have. I have to research everything on my own.  My guess is they simply do not know.  Needless to say, I will be switching yet again. Regardless, I just want others opinions on the correct medication to give him.  The dr prescribed pancrelipase which I assume is "Viocase".  I noticed there is a much more affordable "biocase" that is OFC and the only difference seems to be the Lipase USP Units (Fat Splitting) as it shows on a comparison chart I found. The Viocase has 71,400 where the Biocase has 56,840. Does this make a grand difference in the overall benefits to the dog?  The cost would be less than half to switch?  Also can anyone suggest any sites to purchase at a discounted price?  I simply don't have the money and the next step is to sell my car!  Next, i have him on Metronidazole right now, 400 mg 2 x per day- shouls we continue for 30 days as I have seen posted in various places? Lastly, The vet recommended Purina ED. I can't even find the food on the Purina sight, but what does everyone feed their friends with this problem?  I saw 4% fat and 12 % protein- Grain or no grain? I am so confused. Yesterday I spent the whole day crying and today I just want to get this fixed- but the right way.  They are sending me copies of all the bloodwork and I do have a call in to our old vet that moved out of the area. I know so many of you are dealing with this and I just hope you can help. Thanks, (By the way the little guy is obviously the black one in the picture), just a mear 50lbs right now.

Hi,

I'm new too, but I just wanted to say that the people here are very knowledgeable and helpful.  The advice I was given first thing was to take a deep breath, so I hope you can do that while you wait for the wonderful responses that are sure to follow.    I'm sure they'll walk you through all this.  They also have found ways to handle this more cheaply.  You're in good hands.

Laurie

hi and welcome and take a DEEP breath!!!

it will be okay... honest... we'll walk this EPI road with you...and once the shock wears off... you'll find that it is not so bad... but it is VERY over-whelming at the beginning.

to answer your immediate questions... yes it does make a difference. lipase digests the fat and that is the one yuo are most interested in being digested cuz that is what you dogs has the least of without the enzymes,,,so you do need to stay in range on the lipase usp units..... 56,840 is a little on the ow side... i personally would not use it... especially when starting out

what a lot of us do here is order generic enzymes from enzyme diane,,,,i buy the 6x. it's the same stuff as viokase or pancrezyme.... just not brand name. and diane buys it in bulk from american laboratories and passes the savings on to us.

for example you'll probably pay $150 for 12 ounces (or more) for viokase

you''' pay about $150 for 35 ounces of generic pancreatin from enzymediane....

so you are getting about 3 times as much enzyme for the same money.

here's the link ; http://www.enzymediane.com/

regarding the food.....this can be the trickest part because not all epi dogs respond the same to the same food.

my advice is to buy a SMALL bagor sample bag of grain frree food... although this is no guarantee that it will work for your dog....the one that most people are having good luck with and is eassily obtainable is

taste of the wild dog food.. try the pacific salmon.

most hardware stires carry it or else pet stores do.

okay i have more to say... but i broke my shoulder and can only type with one hand now... such a pain in the you know where... so i wanted to hurry up an answer you immediate concerns first.

now... for the rest of the story.

the reason why EPI is soooooooooooo overwhelming is simply because you have to find the right balance of thiongs for your individual dog... there are some basic guidelines... but if your dog is not optimalyy getting better... then things need to be tweaked until you find the right balance........ and that is where we come in.

we will help you

i will try to just give you the highlights to start with... you need to finf the right balance of the following to manage an EPI dog:

enzymes

diet

B12 (if needed)

Antibiotics for SIBO (if needed)

and the most important thing is to start keeping an EPI LOG!! you can download one from this page

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

record EVERYTHING you give your dog, brand name, amount, when given, how administered, etc

then record your dogs poop about 12 or so hours after the eat a meal, record volumelg/sm, color, texture etc.... the poop is the best non-invasive iindicator of how your dog is doing with hi/her EPI  condition.

at the beginning, you will want to feed 150% of whatr your dog normally requires....BUT.... feed in snaller meals just more often if you can. if you know feed twice a day..see if you can change that to 3 or 4 times a day..

be sure to read the diet page if nothing else... it is very important to pepare fodd properly with enzymes. heat destroys enzymes, cold inhibits it.

so...use slightly warm room temperature food and enzymes.

as a rule of thumb and as an example......use 1 level teaspoon of enzymes to 1 cup of kibble, mix in 1/4 cup of liquid (warm water0 to make sure the enzymes are spread around prperly, and to help prohibit possible mouth sores from the enzymes. mix. let sit for 20 minutes. mix again and then serve.

there are many variations of this,.. but try this and see if all goes well... if not... just get on-line here..tell us what theproblem is and we'll help you thru it.

if /when you can, please post what the test values were.... because treating epi is not just about enzymes, sometimes there are secondary conditions such as low b12 and/or SIBO  that needs to be treated also... if theyare in play..... in order for the dog to really get better..........

Damn! it seems Olesia and I are posting at the same time from different parts of the planet but no matter the more information the better. So I'll take the opportunity to request the following results when talking to your vet(s):

• cTLI score
• B12 level
• Folate level

Also feel free to upload a poop pic at any stage as it's a first-rate indicator of SIBO (soft cow-pat type, slimy/mucosal film around stools etc) and folk will be able to give you the benefit of their experience.

Lastly as Olesia said grain free is the recommended way to go for EPI for the majority of dogs at least initially until stable. Explore the links up above, there's a wealth of information and ask any question you like...

Craig

Hi (is it Joe?) and welcome to you and your pup. Olesia and Craig have already given you wonderful advice, so I will not repeat, just wanted to tell you to hang in there as this condition is very treatable and my GSD, Tara, has lived with EPI for many years and she just turned 7 last year even though she was dx'd at about a year old...We've actually had to put her on a diet because the vet was not amuzed with her plumpness...She went from under 50 pounds to a healthy 78 pounds, but it took awhile...When she hit 85.5 is when the vet put the breaks on it and ordered her on a diet!  So you see, there is a light at the end of this tunnel!

As far as vets not knowing a lot about this condition, well, they don't see it alot and there is a small chapter on it in the text book and that's about it!  If you have a vet who is at least willing to learn, is willing to come here and read the research from TAMU and respects you, then that's half the battle!!!

While diet is often the harderest part in this condition, generally a grain free diet is best, as Olesia suggested and many, many dogs here do great on the Taste of the Wild line...Another popular line is the Taste of the Wild line and the food in general is available at the "Tractor Supply" chains at a very reasonable price!  http://www.tasteofthewildpetfood.com/  Go to the find a store tab and type in your zip code to see if they sell it locally.  As Olesia said, buy small bags!!  When finding a food for Tara, I went through many and I never learned this lesson, but my local human society got tons of food donated by me! 

Do use the link Olesia provided you to purchase Pancreatin from Enzyme Diane!  We've used Pancreatin for years with absolutely no poroblems and Diane is a life saver for many of these dogs!!

Again, welcome, take a deep breath and we'll help you through this!

Hi - welcome to the forum.  Believe me - we all know the head reeling you are feeling right not.   Hang in there and def keep the log.   So much is going to change - the whole trick is to find your pups balance and since every pup is different it is not black and white.   BUT...I have faith you will find what works for your dog.   Rather than keep changing vets you may want to "interview" some first - see what experience they have with EPI.   Experience is not everything - the best vet you can find is open to working with you - to listening what you have when you bring them protocols from this site rather than poo poo'ing them.   Openness is the primary thing to look for in your vet.    

All questions are welcome here so ask away - and just know you will find the balance - it just takes a little time but I know it WILL happen!!!    This forum is amazing and I credit everyone here to bringing my Jackie to the healthy beautiful pup she is today.   There were times my vet would tell me one thing - but experience here told me otherwise - I followed my heart and boy am I ever grateful!   

Wow...thank you all for the info. I laughed then cried when Donna said Tara needed to go on a diet when she hit 85 lbs.  I hate to have a weight goal in mind, all he ever weighed was 66 lbs, but I would think 75 would be ideal, if not 80. He is nearly 27 inches at the shoulder and looks so thin compared to my female, who at 100 lbs is twice his size, (don't worry not overweight- just big boned as they say!)  I am Nicole, husband is Joe, but I will be posting.  I am going to get on the enzymediane website and view the meds. I will have a precription from the vet if required- but is the generic pancreatin an otc med?  35 oz would seem to get me through a month and a few days.  I feed Kain 4 cup a day, 1 cup each time. I stay home with our girls so fortunately I can tend to him and his needs.  If I would feed him the same I assume 1 teaspoon over the food and warm water mixed in 4 times per day?  But for the post the said to feed 150% of food- should I add a 5th feeding along with another teaspoonfulof powder or should I give 1 1/ 4 cups per feeding and stick with 4 feedings per day?  As far as the SIBO goes, I actually had Metronidazole prescribed for me when kain was young and had Giardia, I was pregnant the docs thought I might have had it so they prescribed to me and I didn't need to use it.  I asked the vet if it would be ok to give and he said yes. I have been treating him 2 X per day with 400 mg each time (he told me to cut a small part off of each tab). Since he started the stools vary from that cow patty like state to very soft but sometimes formed stools, other times they are the same.  Makes me think that he does have the SIBO but the vet I believe is either no smarter than me or simply is to old and doesn't care to research.  I was going to request a prescription for enough meds to complete a month as I have seen on here. I would assume it wouldn't do any harm if he doesn't have it. At least until they send me his results since they are too busy to give me the info over the phone.  My guess is they don't know how to read the bloodwork.  Lastly does taste of t he Wild have a website? And has anyone heard of the Purina ed that he wanted to put Kain on?  Thanks you all again.....

Just went on Diane's site- Is this the correct med that you all use...1 Kilo Pancreatin 6x Plus... what in the world is the difference between normal and fluffy that she is talking about in terms of the powder texture??? Does it really take a week to process plus shipping time? where does she ship from???? I hope you guys don't hate me for all the questions already...

Hi Nicole and welcome to the site!  Sorry you have to be here, but you'll find so many wonderful people with great advice!  And no one is going to hate you for questions!  Ask whatever you need!  No questions is stupid.  There are usually non-members hanging around reading the posts as well, so you never know if your question may be something they need answered as well.

I believe the food your Vet wants to prescribe is Purina EN.  Rsosina was on that for a while before her dx when we thought she had IBD or something.  The main thing about it is that it has a main ingredient of rice and it also as corn and wheat before any protein source which is chicken meal.  The fat content is moderat as well and higher than the starting recommendation for EPI stabilization.  I didn't feel that this food was good for Rosina and stopped using it since it wasn't working for her anyway.  Rose always came back with a Folate score suggesting SIBO and with SIBO, may suggest using grain free food.  So, no rice, wheat, corn, etc.  But every dog is different and there are many here who do better with some grain than with none.  I just felt that the fewer ingredients starting out was better until I figured out what was best for her.  The EN was pretty expensive too.  Rose was only 15 lbs and barely eating at that point, but she was still going through 5 cans/week.  I'm using Natural Balance LID canned and dry right now and it is much cheaper.  I know others use Taste of the Wild and I'm thinking about switching Rose over to the dry food.  There's a page about foods under diet with good dog food suggestions. 

As for the fluffy vs the normal enzymes...The fluffy stuff has added vitamins to it.  It is a small amount but it makes the enzymes bulkier.  I believe Diane has measured and weighed the fluffy and has come up the 1.75 tsps of fluffy is equal to 1 tsp of 6x normal.  Ask your vet if the added vitamins would be a problem.  Rosina was prescribed PancreaPowder from the vet when we first started and it had added vitamins.  When I switched to Diane's regular with no vitamins, there was no problem.  You'll still be getting the same weight of enzymes with the fluffy it will just look like it's more since it's so fluffy.  It usually takes a week for shipping.  Diane is in Ohio and usually ships Priority Mail unless you have asked for Express. 

Hope this helped!  Let us know if you have any more questions!  We're here to help you throught this and get your furbaby back on track!

Hi Nicole,

Of course we don't hate you!!!! As Michele said, we were all in your shoes at one point and completely understand the fear and trying to wrap your head around the whole thing!!!  The only stupid question here is the one that is not asked...   Pamela gave you the breakdown on the "fluffy" stuff from Diane and I believe the other stuff she has in the EU material, which works FINE, but is a bit smellier...It kinda of smells like cat pee but the dogs don't seem to mind it at all!!  Although some of us humans have a bit of an aversion to it!   American labs, which is lab tat produces Pancreatin for distribution to Diane, has had a bit of an issue lately getting American sourced glands, so they've had to use European glands and in the US, the glands are dried with alchohol, while the European ones are processed with acetone, thus the difference in the smell...Again, they are the same potency, so the choice is yours...Yes, the 6X would be a great place to start!

When Tara was first diagnosed, I was going through an $115 bottle in a litter over a week!  Ouch!!! Since being on the Pancreatin, a kilo, at about $150 last me about two months, so you can see the cost savings!!! Diane ships from Ohio and generally ships in the beginning of the week...It has never taken more than a week and generally, I have them in about 3-4 days...She's quite efficient!  In the interum, you could maybe see if your health food store carries Pancreatin 4X.  While not nearly as strong and you would need quite a bit more, it might be worth starting if you can find it.

Here is the link agian to the TOTW site.  http://www.tasteofthewildpetfood.com/  Go to the store finder and enter your zip code. If your vet gives you the numbers, here's how to read them for the cTLI test:  http://www.epi4dogs.com/tli.htm

And here is how to read the B12/Folate test:  http://www.epi4dogs.com/b12.htm  Hope this helps!

Hi

Being from the UK i cant make any comment on the US enzymes

Kara was not doing well at all until we went grain free she now has grain free duck and potato Oxytetracyline 2 three times a day and lypex capsules 3 on each meal she has

we are nearly down to one meal a day now which is brill we were on 4 at one time or even 5

This illness takes you by the throat and throws you round hard I have learned patience and believe me I am not patient

Each change you make whatever it is make a log or note it in your diary and every poop and photo or at least note it

again its the only way to stay sane

You cant make any targets at the moment only to keep going and BREATHE DEEPLY take every day as it comes

We have all been at the beginning of this and this forum is my lifeline for Kara I was so scared at the beginning

ASK ASK ASK

jXXX

Hi Nicole.  Hang in there.  It does get better.  My guy never got over 76 lbs at 2.5 years of age.  I was always running to the vet w/ him.  Every type of worm, giardia, coccidiosis, etc, he was dx'd w/ but never EPI til things got really bad.  It was a long journey for us after we finally had our answer, down to 65 or less.  I, too, thought around 80 lbs.would be good for him.   Was I wrong!  He finally hit that, then 90, then 100.5 this summer.  Vet wasn't too happy while I sat there smiling, she was not dampening my happiness!  She would like him between 90 and 95, I wanted extra just in case, after all, I always had a skinny dog, now I didn't, but I still remember those dark days.  Recently he injured his ACL, so I do have him on a diet, will try to get closer to 90 as I know it will be in his best interest, hips and such, even though I'm not happy about it, have to do what is best for him.  We started it a couple weeks ago, he has lost about 3 oz.  So may have to cut back a bit more, but he is now under 95, 94.9 to be exact.  He had a couple surgeries the last 5 months, so he had already lost a bit due to those, now I'm just going to help him out on my terms.  I hate this, but yes, it can and does happen w/ these guys no matter how dire it seems right now.  It does take time for some of them.  It took us 1 year after dx to finally find a food that worked for him, then a year to gain the weight.  Some turn around immediately, others of us, take our good old time. 

If you can feed 4 meals a day and that would be easier for you, do that, remember the 1/4 tsp enzyme, though.  If you can fit in 5, that's fine, too.  It is what works best for you and Kain. Kain will let you know when he doesn't need as much.  I know a couple of people who fed around the clock, small meals, in the beginning.  It is what makes this the easiest on you and how Kain tolerates things. 

And yes, if you are already on the metro and you think SIBO is going on, a min. of 30 days is the treatment for SIBO.  Some dogs need longer, some are longtermers, can never stop.  Any less will only let the bacteria grow more and it can be harder to nip in the bud.

Good luck.

Hi Nicole and Welcome to you and Kain,

We have all been where you are now and we know how distressing it is to see your pup not doing well.  Now that you have the diagnosis, you can start the treatment and Kain will be on his way to good health.  Everyone here will help you through and answer your questions with their good information and experience. 

I heartily recommend keeping a daily log as others have suggested.  It is an amazing source of information for you.  Kain's poops will be the evidence of how he is doing as well as how he acts, plays, eats, and relates to you, so everything that you record in the log can help you to figure out what is going on with him based on your observations.  We found it to be so valuable and it helped us to see immediately when something was not agreeing with Kolby and when something was. 

Please post the results of Kain's tests when you get them so folks can give you input here.  Sometimes  vets just don't have the experience with EPI--my vet is very good, but has only had 2 or 3 cases in 27 years, the last one being 9 years ago and the others sounded like they weren't under his treatment for very long.  So I relied heavily on this site and all the good people here and I printed out many of the protocols for my vet to read.  He was very open and read everything I gave him and I am sure it  will help if he ever has another case.  Another issue is that every EPI dog presents differently so each case is different.  His last case was "classic" as he called it, and the dog was like a text book case.  Kolby was not and had him puzzled for a while.  Because the people here see so many different cases,

I was convinced Kolby had EPI before we got the diagnosis, so we were reading and getting prepared, using this site.

One thing I was unclear about from your posts and I may have just missed it.  Are you giving Kain 1tsp enzyme per cup of kibble?  In one of your posts, it sounded like less than that.  Kolby, as you can see from his pic, is also a German Shepherd and at one point we were feeding him 7 and 1/2 cups a day spread out over 4 meals.  He could not seem to tolerate larger amounts of food.  His weight was in the high 50s.    He is now eating two meals a day, a total of 6 and 1/2 cups  and weighs in at 74 pounds.   So hang in there. 

You are doing a great job.  This is a roller coaster ride at the beginning.  You are bound to feel a little unbalanced.

Let us know how things are going.

Barb

Hello again Nicole and Joe and well done on some excellent question-asking, they'll all the right ones so I reckon you'll have the hang of this in no time. Once you get the right balance you'll almost forget you have an EPI dog, really.

The closest Purina food I could find was the one Pamela identified and had used for her Rosina, Purina EN. I nearly choked when I saw the ingredients, the first few are: Brewers rice, corn gluten meal, whole grain corn, chicken meal...one harsh rice product followed by two corn ones - yikes! Talk about making it difficult for a pup with EPI! As pet food ingredients are always listed in order of magnitude this equates to three grain bases before you get to the meat. But look, most vets are generalists and often reach for the nearest 'digestive' food they have (or are marketed by the reps)...

TOTW is great but there are many other grain free brands in the US if you can't get it, we use Canidae ALS grain free and it's a good product too but get samples. A dog's digestive cycle is  around 12-24 hours (but can vary), all differ but after 15hrs we can tell with our Lulu what did and didn't agree with her. As said the majority of EPI dogs do better on grain free so it's statistically the best place to start, you can always bulk it up later on if needs be.

And yes, regardless of the antibiotic 30 days is recommended minimum course. Metro works but not always and is harsher than Tylan (Tylosin) which you can read about here. Tylan is bitter to the taste but easier on the system, more useful for longer courses if necessary. It is administered by hiding in food or encapsulating the powder using gel/veg caps and a cheap $5 machine available from health food stores. 

Lastly no vet practice should be 'too busy' to give you any info over the phone or if they are should ring you back when not. Olesia has a jolly saying, 'It's your dog, your dollar'. Providing they haven't got you as a captive audience I'd be politely letting them know that's a service I expect from a professional practice. Sometimes I also give that look that Lulu gives to other dogs in the park when they get too close to her favourite toy. Some vets just love me...

Craig

Nichole:

Welcome to you, your husband and your critterkids.  Please post some pictures...the picture is small and hard to see with Kain or your girl for that matter.  You'll also find that we all love pictures here. 

Sit down, take a deep breath and relax...soon Kain will be doing wonderfully.  Yes, Taste of the Wild has a website and many different pet food places as well as even farm supply locations who sell it. http://www.tasteofthewildpetfood.com

I can't tell you how many times I've sat on the floor and cried because I have one of those dogs who not only has EPI...but just wasn't interested in food in general.  Most of us get our enzymes from Diane http://www.enzymediane.com  but started out with enzymes from our veterinarians...in my case Viocase-V.  My vet, who is wonderful and listens...said that no other enzymes were as stable.  I wanted to try the generic so ordered Pancreatin before my first bottle of Viocase-V was even half way gone.  I've used 8X strength from the start and a kilo lasts about 3 months...my first bottle of Viokase-V cost around 100.00 and it was only a 4 ouce bottle. 

If you want to increase the amount of food you're giving...and I agree that it's a good idea, I wouldn't add another meal, but instead try to increase the amount of each meal by just little bit to see if he'll eat more.  If not, then you can always try a 5th meal.  I need to do an enzyme comparison to suggest amounts but you can read the comparisons at Diane's site.  Akira gets a rounded teaspoon of enzymes per cup of food, per meal.  I feed her two cups of kibble twice a day and she gets 1/4-1/2 cup of teasers on top with a little hot water and then stirred well.  Since she's never been terribly interested in food and won't touch it at all with enzymes on it...I give enzymes in a meat baby food/water mixture right before I feed her.  It's not what is necessarily suggested but it's what works for us and she's a very healthy, over 100 lb gsd who is going on eight years old and was sadly, born with EPI. 

You've been given some great information...but I want y ou to know that we are a bunch of people who truly care.  Please feel free to ask questions any time. 

Linda at January 8, 2011 at 6:59 PM

Nichole:

Welcome to you, your husband and your critterkids.  Please post some pictures...the picture is small and hard to see with Kain or your girl for that matter.  You'll also find that we all love pictures here. 

Sit down, take a deep breath and relax...soon Kain will be doing wonderfully.  Yes, Taste of the Wild has a website and many different pet food places as well as even farm supply locations who sell it. http://www.tasteofthewildpetfood.com

I can't tell you how many times I've sat on the floor and cried because I have one of those dogs who not only has EPI...but just wasn't interested in food in general.  Most of us get our enzymes from Diane http://www.enzymediane.com  but started out with enzymes from our veterinarians...in my case Viocase-V.  My vet, who is wonderful and listens...said that no other enzymes were as stable.  I wanted to try the generic so ordered Pancreatin before my first bottle of Viocase-V was even half way gone.  I've used 8X strength from the start and a kilo lasts about 3 months...my first bottle of Viokase-V cost around 100.00 and it was only a 4 ouce bottle. 

If you want to increase the amount of food you're giving...and I agree that it's a good idea, I wouldn't add another meal, but instead try to increase the amount of each meal by just little bit to see if he'll eat more.  If not, then you can always try a 5th meal.  I need to do an enzyme comparison to suggest amounts but you can read the comparisons at Diane's site.  Akira gets a rounded teaspoon of enzymes per cup of food, per meal.  I feed her two cups of kibble twice a day and she gets 1/4-1/2 cup of teasers on top with a little hot water and then stirred well.  Since she's never been terribly interested in food and won't touch it at all with enzymes on it...I give enzymes in a meat baby food/water mixture right before I feed her.  It's not what is necessarily suggested but it's what works for us and she's a very healthy, over 100 lb gsd who is going on eight years old and was sadly, born with EPI. 

You've been given some great information...but I want y ou to know that we are a bunch of people who truly care.  Please feel free to ask questions any time. 

Ok, so yesterday I orderes the Pancreatin 6x for Kain. So I hope it will arrive by the end of the week and should since she is in Ohio and we are just in PA.  Tomorrow Joe will pick up Kain's food at the Tractor Supply Store which is far from our home, but close to his work, it is also on sale right now!!! His remainder amount of metronidazole was called in to the pharmacy and ready forr pick up today to complete his 30 days.  I feel a bit better knowing he will be starting treatment soon.  I am going to monitor the poops daily and also the food he eats and keep a weekly paper pre-printed from a spreadsheet I am working on hanging on the kitchen cabinet.  As far as the one posted response asked... how much of the enzymes am I feeding him- hopefully will get by weeks end and was thinking of increasing from the 4 meals- 1 cup per day to 5 meals 1 cup per day. Some days he will eat 5 cups for me but usually does not eat more than one cup at a time.  This is where I get confused as to how much of the enzymes to give if I do 5 cups... I know it seems to be a bit of trial and error but I'd like to start off at a safe point. Would 3/4 teaspoon be good or is that too small amount- should I try 1 teaspoon??? 

As if I don't have enough questions... Other than the dosing amount here are some others going on in my mind...

1.  What if Angel gets into kain's food. I will use caution and doubt she would but how harmful; is it if she does?

2.  I think I read somewhere that EVERYTHING they eat has to be coated with the powder, so....what if he grabs something that the twins throw on the floor and eats it?

and...

3.  Does this mean no treats unless they are mixed in the food or should we not feed treats at all?

4.  Right now I put a small amount of yogurt on Kain's food so he eats it cause despite all this he really is picky, Angel was the same way up until about 3.5 years and now she will eat just about anything!  Once Kain gets started he will finish but he really needs to be coaxed.  Is yogurt out of the question? I saw on Diane's site she had said that you can put some shredded cheese on top? 

5.  Are there any foods that should be totally restricted? (I mean other than the ones we all know to be harmful to even the healthiest dogs)...

Would loveto show more pictures but it asked for a URL- I don't have the pictures online- just in my documents section- no clue how to get them on here!!!!!!!!

Here's what I have learned. I'm sure others will have more to add. You certainly are headed in the right direction , in the right place, and asking the right questions.

1 tsp per cup is the recommended starting point, and what seems to work for most of us. I don't believe a little will hurt Angel. I think somewhere on here Diane talks about her dogs getting into a bag of enzymes with no ill effects. Food from the twins - I've seen on here that feeding a meal with enzymes immediately after the stolen food might help... On treats, the kibble I give Maya is able to absorb liquid without turning mushy. I prepare some, dry it (in a dehydrator at less that 130 degrees - the temp that will kill the enzymes), keep it in a baggie in the fridge and give it to her , very little at a time, as treats. It helps that she LOVES the enzyme (it's good and stinky!). Hopfeully, Kain will, too. It makes it a lot easier. However, the recommendation is to avoid all treats until Kain is stabilized. On yogurt, some use it successully. Others not. All dogs are different., is what I've learned. Things to avoid: fiber, grains, high fat at least at first. To upload pictures, follow the instructions on the Downloads tab at the top of this page.  I spend a lot of time reading the info on this site. Both the published reports under the various tabs and the threads. I learn a lot and, as they say, knowledge is power (or at least it makes us feel like we can control things).