EPI * Exocrine Pancreatic Insufficiency

Claire was started on Tylan yesterday for possible SIBO.  I would like to start giving her some probiotics but not sure what kind or the dosage.  I think I've seen Primal Defense used by some, is that a pill or powder?

Also, I was given a vets blessing yesterday to try Claire on home made food.  Dr Stewart had the day off and we saw a new vet.  While Dr S is very pro using the Rx foods, this vet said she has seen too many diabetic dogs thrive on home made food to dismiss it any longer.

I would like to add some FIsh Oil along with coconut oil, but here again haven't the slightest idea on how much to give.  She said all I really needed was a good vitamin and the addition of calcium corbonate, but did mention all of the above.

Hi Sue.... since you just started on the Tylan and gearing up to do homemade food (yeah!) i think I would hold off on adding probiotics and other supplements for a few days..... especially since Claire is a diabetic in addition to having EPI.....let Clair get acclimated to these new changes... if you can ... maybe wait 3-4 days... then i would start adding (one at a time) the most benign things.....like an all around vitamin.... wait a few days... and then add the probiotics.

The calcium i would add immediately to the food because it is part of the diet. When i made home-made food... i simply used NaturVet "Steamed Bone Meal" powder - -and i used half the required dosage for my dogs weight (to stay within EPI recommendations)....others may use a different brand. I used this one because it was from fresh USDA beef bone and tested to make sure all was BSE free.

Regarding the vitamins..... now there i really did my homework....and went with Vetri-Science Laboratories "Canine Plus" vitamins to make sure i was using a quality tested and proven product. I try to be very careful in my choice or recommendation of any "supplemnts"... because as I stated elsewhere.... too often for my liking... what some companies "claim" is in the bottle is simply not the truth......

Regarding the probiotics.... i personally would wait a week or two before introducing this..... my reasoning is because probiotics (even if a good product) can have or not have a positive effect on a specific dog... it all depends on the individual dog. I personally would recommend "trying" "Proviable" by Nutramax..... talk to your vet about this product. It can only be purchased via a Vet.  ,,, see if this agrees with Claire.

The reason why i am saying this is because this product meets the standards of a probiotic/prebiotic.... where as many of the others don't. It doesn't mean that the others won't work.... but when dealing with a dog with serious health issues... especially something like diabetes... you might want to be a little more careful in your selection because of Claire's situation.

this is a recent article that prompted me to start really examining what probiotic/prebiotic product to use:.

An inclusion of prebiotics such as fructo-oligosaccharides are logical although not yet proven. Basically, prebiotics are non-digestible food components (dietary fiber) that are being fermented by intestinal bacteria. This can lead to normalization of the intestinal microbiota. In a recent study the use of fructooligosaccharides (FOS) in the diet showed a lasting advantageous effect. While this has not been evaluated as of yet, other prebiotics, such as inulin or beet-pulp may also prove to be beneficial. This syndrome is also a potential target for probiotic therapy but one must be careful when administering probiotics. Per Dr. Jorg Steiner of Texas A&M University “...unrealistic expectations have been replaced with well-defined requirements for probiotics and controlled studies of their beneficial effects. Three key requirements for a probiotic for use in dogs are:

1) the probiotic must be safe;

2) the probiotic must be stable; and

3) the probiotic must be efficacious.

In a recent study, 8 veterinary and 5 human probiotics were evaluated and only 2 of the 13 products contained the strains and concentrations of those strains indicated on the label. Several of the products contained bacterial species that could potentially act as pathogens. Thus, in order to ensure safety, the probiotic product should adhere to strict production and storage requirements. The probiotic also must be stable throughout transport and storage until the product is being administered by the pet-owner. In order to ensure that a certain number of colonies are administered to the patient, the colonies in the product should neither proliferate nor die. (use a 3rd party lab to verify product “claims” such as http://www.consumerlab.com/)

Finally, a probiotic must be efficacious. In order to be efficacious, the bacteria must reach the intestinal lumen. This requires that the bacterial species being used in the formulation are both acid- and bile-acid resistant. Also, the bacterial species of the probiotic preparation should adhere to the intestinal mucosa to prolong the time of interaction. Finally, the presence of the probiotic species must have beneficial effects in the host. Several controlled studies have been conducted in dogs that also show that certain probiotics carry health benefits in dogs with gastrointestinal disorders.”

Regarding the fish oil / coconut oil..... (I use Jarrows coconut oil) i would start with the coconut oil.... but also as a "one change at a time" thingy. Since Claire is so small... i would first just try maybe 1/8 of a teaspoon added to the enzymed meal (cause it is an oil) and see how that goes for a few days... if okay... then try increasing it to 1/4 teaspoon.

If this goes well... THEN i would try the fish oil... (I left fish for 2nd trial and error simply because some dogs have fish allergies) .Also include with an enzymed meal - -  but try this on days when you are not using coconut oil.... because if you use both together... it just might be too much.

Anyway... i would start off with 125 mg of fish oil... and then increase to 250 once you know she can tolerate it.......actually... one of the research vets at the conference told me to specificy this and to suggest to folks to use EFAs not just fish oil... I personally use: Swanson's "EFA's" (Super EPA) for my dogs ..... and me.... again... simply because this product is 3rd party lab tested so i know what i am getting is what they claim on the bottle.........

Thanks for all the info Olesia.  We're not going to start anything for awhile...........They want me to give the Tylan a few days, see if she feels any better.  If the Tylan is helping then we'll leave her on the Wellness until we can get the diabetes under better control. If we can accomplish that, I will give her a reprieve from any changes before trying to introduce another new food.  I'm just looking into the future.

I thought maybe a probiotic would be helpful while on the Tylan, but until I can talk to the vet I won't add it.  I had hoped to hear from Dr Stewart today, see if she found anything from her post to VIN, but no word.  Maybe tomorrow...........

The waiting is so...................difficult.  You so badly want to fix it now, now wait 3 days, then another 3 days, while you know they're feeling awful.

Hi Sue.....  Wow, when I grow up I wanna be Olesia!!!!!  She is so informed (ie. smart) it makes my head hurt!!!!  I'm being serious!!!!!!   I can only tell you about the coconut oil....  We just get ours at the grocery storeand Butter gets 1/4 tsp a day.  We did start it slow tho....just like everything else....  I really hope the Tylan helps Claire.....man, I  know the waiting has got to be maddening for you!!!!  We're all thinking of you here (Darlene, me, Butterbean, Jellybean, Pooh and Scooter).....

Hi

for what its worth we have been on Tylan for a few weeks now and its made a difference to Kara

she is eating her food properly and looking good poops are perfect

we add a bit of honey as it is very bitter

so good luck

I wish I was like Olesia too sigh.................................

jxx

We are all very lucky that Olesia is willing to share her knowledge with us.  I try to research products before using them on Claire, but half of what you read isn't true, and to actually read through clinical findings??  I'm usually lost in the first paragraph.

It doesn't seem like Thanking you Olesia is enough, but it's all I can do.  I can't begin to tell you how much I appreciate your help.  There's no doubt in my mind your rewards will be great for all the help you've given us.

Love

Sue and Claire

Hahahahaha..... you would not believe how many times i sometimes have to read something... over and over again...walk away and come back and read it yet again.....but luckily i have some tools at my finger tips that help me out... like the Consumer Labs testing site (i've been snookered one too many times and have FINALLY learned to double check and sometimes even check yet again on a specific product.... and still i make mistakes!!!!) ... at the urging of my vet.  AND ...i belong to many, many veterinarian resources that i use (and i do like to read and do research)....AND many gastroenterologists and geneticists have graciously given me much of their time discussing EPI / helping me  have a better understanding of what goes on....

But my hope is that collectively, as a group, if we ALL contribute information..... maybe what we will notice is that the most applicable information at the time....bubbles up to the top. :D...... and the bad, ineffecitve information dies....  

Probably the two hardest things for me sharing and running this FORUM is

1. when new/recent information comes out and i have to dispell old "truths"..... because in tandem with this is the realization that absolutely NOTHING is absolute... things/research changes, diagnosis etc... everything is constantly evolving.....(and sometimes this is hard to explain)

2. the other problem is that people will try things and see a "positive" or "negative" result and then claim it as an absolute truth with an explanation as to why- - -when in reality the "why" may not be what they think it is and consequently mis-truths are spread...

anyway... the bottom line is that ya'll make the FORUM a place that i not only want to go to but that i enjoy going to and chatting with others.... and in the process, hopefully helping someone along the way... so thank YOU all for making this possible !!!!

Today was the best day Claire has had in weeks.  Her numbers are still high, but she feels good.  Wed evening she was so listless, Randy had to carry her upstairs. I was tempted to take her into the ER vet.  We are doing the "Happy Dance" tonight.

I would guess it's the Tylan that's made the difference. 

One thing that still amazes me.  Claire has always had a sour smell around her mouth and her breath was horrible. Even her bedding would take on a bad smell after a couple days.  We noticed the foul odor around her mouth was gone shortly after changing food, but the breath was still bad.  Tonight, she is full of kisses and the bad breath is gone...........completely...............What is up with that?  Is it the Tylan, and did she need to be on that ages ago??

Oh my goodness......   I am so glad to hear that Claire is doing better!!!!!!!   I dunno about the breath.....Butter's is always a bit on the "yeck" side.  I just attribute it to the EPI, enzyymes, being a chihuahua and , oh yeah, bird poop.....

I too noticed a difference with Kara after we started the Tylan  the

The nasty smell from her poops had gone

Sue... this is just terrific news!!! SO glad to hear that Claire is doing so well .

Hmmmmmmmmmm....... TYlan removing the bad smell .... unless the bad smell wan't the enzymes afterall.... but rather the bacteria in the stomach.  We just all tend to automatically attribute the stench to the enzymes (cause it does stink- -at least at the beginning)..... BUT maybe we focus on that too much.... I've always heard that "stinky breath" in a dog = gastro upset ...... but.... with EPI dogs... i just never think along those lines and just automatically assume it is the enzymes.....

Hmmmmmmmmmmmm.... lesson to self......never "assume"      

Anyway... this is GREAT news!!!!!!!!!

Talked to Dr Stewart again today.  She posted Claire's recent problems on the Veterinary Information Network (VIN), and was offered the following info:

What we're seeing in Claire is very common in EPI/diabetic dogs, and we'll probably never have real good control over the diabetes.   (Not sure how many times I need to hear that before I accept it, but I'll always keep searching to make it better for her)

Most of these dogs "appear" to have a good handle on the EPI, good stools, maintain their weight, but they wonder if something doesn't upset the EPI, which in turn throws the diabetes out of control for no apparent reason.  None of them felt I should change to a Rx enzyme, they did caution about buying in such a large quantity.  Where are you storing them, how often are they opened and exposed to the air, how consistent is the temp where I'm storing them. 

I held onto one of the plastic containers that her original Rx enzymes came in.  We fill that up and then I tightly wrap the remainder in plastic bag and then put them into a ziplock brown bag that protects from light. I then store them in a cupboard. The temp in my house fluctuates a lot because we don't have central air.  It has been a very hot summer??  So, in the future I will probably only buy 1/2 the amount.  I just purchased enzymes shortly before Claire was having all these problems.  I went with the 8x, because the 6x weren't available.  That concerns me now........and I'll need some help from you guys in figuring out how much to give.  I like the way Diane packs these now, two smaller bags.

To get her back on track they said to continue with small increases in insulin and wait 5-7 days before changing again.  Stop checking her levels every day, owners tend to check far more than necessary, see a couple bad numbers and start making adjustmens to soon which starts it snowballing all over again.  (Ah.............even a longer waiting game, but I will do as they tell me)

Thats about it from them............I told Dr S. about the bad breath being gone...............She said they sometimes use Tylan powder to treat gingivitis.  Claire's teeth don't look bad but I've not had them cleaned and I probably won't. I just about fell apart the day of her cataract surgery, I don't want her put under again..............ever..............(lol) So that may have solved the mystery of the nice fresh breath she has.

I know this is an EPI forum, but I also know there will be others who join with EPI/diabetic dogs.  Some of you folks are really on top of storing all this info and my hope is, as new pups and owners join who are dealing with both, maybe we can give them a huge head start.

Love

Sue and Claire

Hi Sue and Claire, very interesting posts. The scary thing with having a EPI/diabetic dog is when you give them there insulin (of course after they eat) and then they get sick, then you have a real threat of insulin shock! And it is even scarier when you have a job and are not there to see or know what it happening. So I can really sympathize with you. The beath thing is interesting as I can always tell if FoMoCo's sugar is high she has sweet breath, but when normal it is well "dog breath". So I will be interested in seeing what happens now that she has started on Tylan. I do check her glucose level twice a day since we started the enzymes. I do make adjustments but the are up or down on her dose by 1/4 unit. So it is a very small change but then they are very small dogs. I do it mostly because I do not want to go to work and worry about her if she is running a little low, I back off a fraction to lower the risk of her going into insulin shock while I am not there. I have now gone from feeding her every 4 hours to every 6, and it has cut down on the peaks in her sugar. I will watch it for a while and if she remains stabile, I will back off on her testing. But if I make a change in food etc. I will monitor it again twice a day just before I feed and give her the insulin for as you know every change can affect their sugar level. Hope some of this helps. So glad you Claire is feeling better, I love the good days and hate the bad!

Hi Sue and Claire,  Vicky and FoMoCo ~

Very very itneresting.... glad Claire appears to be feeling better.... and that IS interesting that they use Tylan for gingivitis ... well... i guess bacteria is bacteria!  And getting Claire back on track with "small increases in insulin and wait 5-7 days before changing again." again very interesting.

Vickey..... and that is also very interesting... "sweet breath" = high sugar, normal doggie breath=all is well. AND.... i find that real interesting that feeding her every 6 hours has cut down on the peaks in her sugar... is this because by going just a few hours longer without food allows for the sugar to drop a little more?

also... if okay with both of you... i would like to keep snippets of each of your posts and place in the Diabetic cnocurrent condition tab... just because it just may help someone else in the future ... pleae let me know if that would be okay either here or contact me via private email: olesia.kennedy@gmail.com 

Olesia

I would love to see a tab directed towards the diabetic/EPI dog.  Feel free to use any of the info I supply.

Forgot to mention this in previous post.  Asked Dr S. about adding probiotics............She suggested I wait a couple weeks before doing so.  She doesn't feel she'll need them initially and we should avoid any and all changes we can.  Pretty much what you said.....................

Olesia, by all means if we can help anyone else! Feel free! And yes I believe that cutting that one meal which was 4 hours from where her insulin bottoms to 6 hours is the reason why. Her glucose would stay fairly normal throughout the day but when I took it right before I gave her insulin it was always high, sometimes very high. I am even maintaining that lower reading at less insulin, I have dropped her to 2 units, ( was giving 2 ¼ to 2 ½ .) Also another way to tell is their blood sugar is getting very high or very low is inflammation of the eye membranes. (Documented by vets). But of course you still have to test them to know if they need insulin or sugar. Thanks for the update Claire, keep us posted!

Thanks Vickey... Managing EPI + Diabetes can be so difficult.... so i appreciate your permission to include this in the Concurrent tab (Diabetes) in hopes that maybe your observation and techinique managing the diabetes might help someone else!!!

And thanks Sue!!!!!!  I just realized you gave me permission too.... I am adding everything now to the bottom of the Concurrent Diabetes page (with a note about it at the top of the page!)

Thanks again!!!!!!!!!!!!!!!!!!!!!!1

vickey at August 17, 2011 at 12:03 AM

Olesia, by all means if we can help anyone else! Feel free! And yes I believe that cutting that one meal which was 4 hours from where her insulin bottoms to 6 hours is the reason why. Her glucose would stay fairly normal throughout the day but when I took it right before I gave her insulin it was always high, sometimes very high. I am even maintaining that lower reading at less insulin, I have dropped her to 2 units, ( was giving 2 ¼ to 2 ½ .) Also another way to tell is their blood sugar is getting very high or very low is inflammation of the eye membranes. (Documented by vets). But of course you still have to test them to know if they need insulin or sugar. Thanks for the update Claire, keep us posted!

 

Hi Vickey, new here and familiarizing myself with the layout.

the part about the inflamation of the eye membranes... do you mean the blood vessels in the whites of the eyes? I know I read about this somewhere and with Ruby it seems to be true, but now I can't find the info again and the docs I saw did not know of the connection to the bgs. Would love to read any links you might have.

Thanks, Tara