EPI * Exocrine Pancreatic Insufficiency

managing EPI

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Joe
Member
Posts: 20

My female GSD Samantha (Sam) was born in Sept. 2010 and diagnosed with EPI in Nov. 2011. I have treated her since then with mixed results. About 6 months ago she started having all of her EPI symptoms again even though I was treating her and nothing had changed. She starting having sepage (sp) and bad gas as well as loose stools. We treated that with a pill that I can't remember now and it fixed the gas (mostly) and the sepage. But not the loose stools and weight loss. The vet couldn't figure it out either so we treated her for SIBO with Tylosin for 40 days. That showed a little better results for the first week and then it was back to the same issues (cow patty poops, loose stools, a lot of gas, dry coat, a lot of drinking, etc.) He recommended I take her to K-State and have her tested for a variety of other things as we had already ruled out addison's disease with a blood test. The vets at K-State also found no other problems with her besides the EPI. They recommended treatment of doubling the enzyme per meal (2 tablespoons for 1 cup of food), adding a multi-vitamin and using a liquid vitamin E once a day. That was almost 6 weeks ago and she has gained 2-3 pounds (from 60 to 63 ibs) since then which I am happy about but her stools are still mostly very loose and there is never a really good one anymore. She has smaller poops and less frequent which is probably why she is gaining a little weight. But, her mouth is terribly irratated and she hates to eat. She will only eat about a 1/2 cup and then has to come back in 10 or 15 minutes to finish it. I just want to know if anyone else has experienced anything like this and if there are any recommendations out there of changes to make or anything. Any help or information would be great! She is currently taking Pancreaplus Enzyme (2 tablespoons per meal), 3 meals/day with 1 cup Science Diet Sensitive Stomach, 1 multivitamin/day, 1 tablespoon liqui-E/day. At her best during treatment she got just over 70 ibs. Her low was about 50 ibs and right now she is 63 and heading slowly in the right direction. She has decent energy but still just seems to be pretty down a lot of times and her ribs still stick out way too much for my liking. I just want to improve her quality of life instead of just keeping her head above water. Thanks for any help you can offer!

May 3, 2013 at 1:13 PM Flag Quote & Reply

maddie ann
Member
Posts: 3110

Hi Joe

Welcome to you and Samantha i am reading through your post and the first thing that jumps out at me is that i see no mention of B12 - 82% of our dogs are dx with this and if it doenst affect them at Dx it affects them at later stages in there life.Has this ever been tested or treated we normally recommend a course of 6 weeks of injections at least because we need there levels to be 600+

The food unless the Samantha has another underlying condition we normally use a grain free diet with less than 4% fibre fat need not be restricted.

The enzymes again you need to be careful with these when we suggest a change we only do it by small amounts ie 1/8 th of a tsp...to much is as bad as to little.

Anyway i will be intrested in your response about the B12.

--

 ANN (UK)

 “Saving one dog will not change the world, but surely for that one dog, the world will change forever.”

Maddie DOB 01-10-2007 she is now  6 DX 04/11 .B12 140 now 644 TLI <1.00 Folate 14.2.

After 15 months on the B12 tablets with the intrisic factor she was retested and her b12 is now 902.

Weight was 22.3kg now 33.2kg (04-05-12) she is a small GSDbut she gained .(24lbs)

Feed a mixture of foods she does better on fibre 3% and below she has  b12 tablets daily (imported from the USAhttp://www.wonderlabs.com/itemleft.php?itemnum=6881) now changing to the uk version from http://www.chemeyes.co.uk/

organic virgin  coconut oil dailly. Use Panzym 1/4 a tsp per 200 grams of food .Got SIBO under control after antibiotics ( stormormgyl) used synbotic by protexin. a pre-probotic also given daily.

May 3, 2013 at 1:25 PM Flag Quote & Reply

Jean and Kara
Member
Posts: 5486

Hi and welcome from UK

 

http://www.vetdepot.com/product-labels/pancreplus-powder.pdf

 

I assume this is what you are using which is fine

 

can I confirm how much you are giving

 

you say 2 TABLESPOONS per meal do you mean TEASPOONS ?

 

2 tablespoons is way too much

 

do you have her results from when she was diagnosed?

 

I am also not a fan of prescription diets preferring grain free and low fibre,there is too much grain in the science diets for my liking

 

Kara only began to improve after we changed to grain free

 

I also agree with b12 injections if necessary,which the results will show

 

jeanx

--

 

 

Kara

 

From Liverpool England


born 21st July 2009


adopted at five months old 26th December 2009

 

EPI dx August 2010


tli<1.00 folate 8.3 cobalimin 611

Antibiotics  2 Oxytet antibiotics 3 times a day also if we cannot fit the Oxytet in she has Tylan 1/8th teaspoon before her meals as a maintenanance dose

Food- Ashenbank Lamb Casserole  twice daily equalling 3 cups per day possibly more

Zantac (ranitadine) 75 mg 30 minutes before each meal as too much acid was being produced, causing shedding of bowel lining

enzymes-Panzym 1 gram per meal twice daily ( 1/4 teaspoon )  plus one Lypex

B12 injection once every three weeks

one Chemeyes B12 with intrinsic factor of 40 daily

one Antepsin before bedtime

alergies to beef pork chicken and white fish confirmed by blood test

33.6 kilos in weight as of 5th May 2013

39 kilos as of 10th June 2014

 

"UNCONDITIONAL LOVE WAS INVENTED BY DOGS"

 

 


May 3, 2013 at 1:54 PM Flag Quote & Reply

Jill
Member
Posts: 1756

For the amount of enzyme you wrote( 2 Tablespoons per 1 cup food), do you mean Tablespoon or teaspoon? If you are using 2 Tablespoons 3xper day that is way past the recommended dose of 1 level teaspoon enzyme per 1cup of food. This might be the root of the irritated mouth . My Mickey uses 1/8 teaspoon per meal and still has red gums, so I use a syringe of clean water and shoot it in each cheek after the meal.

--

 

Mickey 6/99  17.5 lb  jack russell, chronic pancreatitis, hyperuricosuria

eating whatever he will eat at the time

2 #2 Dianes enzymes 6x premeal, Optagest mixed in also

 2.5 mg Amlodipine, .15mg soloxine am/pm, 100mg ursodiol started for gall bladder thinning 3/24

arthritis:  6.25mg tramadol 1x/day, 25mg gabapentin every 12 hrs,  Assisi soft loop used on back and elbow,started Yucca Intensive 2x/day 4/29/14

Denamarin once a day, 1/16 t tylan (150mg)  2x/day 

 Senilife started 12/14/13, Trixsyn

Optimmune and Dry eyes, 125mg amoxicillan started 4/11 for teeth problem(done) 

Kiya is Mickeys sister, 3/4 aussie, 1/4 blue heeler born 9/2006.  She thinks she is a 44 lb jack russell who tries to heel Mickey!!



 

 

 

 

 

May 3, 2013 at 1:56 PM Flag Quote & Reply

Jean and Kara
Member
Posts: 5486

looks like we were typing at the same time Jill with the same thoughts

 

jxxxxxxxx

--

 

 

Kara

 

From Liverpool England


born 21st July 2009


adopted at five months old 26th December 2009

 

EPI dx August 2010


tli<1.00 folate 8.3 cobalimin 611

Antibiotics  2 Oxytet antibiotics 3 times a day also if we cannot fit the Oxytet in she has Tylan 1/8th teaspoon before her meals as a maintenanance dose

Food- Ashenbank Lamb Casserole  twice daily equalling 3 cups per day possibly more

Zantac (ranitadine) 75 mg 30 minutes before each meal as too much acid was being produced, causing shedding of bowel lining

enzymes-Panzym 1 gram per meal twice daily ( 1/4 teaspoon )  plus one Lypex

B12 injection once every three weeks

one Chemeyes B12 with intrinsic factor of 40 daily

one Antepsin before bedtime

alergies to beef pork chicken and white fish confirmed by blood test

33.6 kilos in weight as of 5th May 2013

39 kilos as of 10th June 2014

 

"UNCONDITIONAL LOVE WAS INVENTED BY DOGS"

 

 


May 3, 2013 at 1:57 PM Flag Quote & Reply

Joe
Member
Posts: 20

maddie ann at May 3, 2013 at 1:25 PM

Hi Joe

Welcome to you and Samantha i am reading through your post and the first thing that jumps out at me is that i see no mention of B12 - 82% of our dogs are dx with this and if it doenst affect them at Dx it affects them at later stages in there life.Has this ever been tested or treated we normally recommend a course of 6 weeks of injections at least because we need there levels to be 600+

The food unless the Samantha has another underlying condition we normally use a grain free diet with less than 4% fibre fat need not be restricted.

The enzymes again you need to be careful with these when we suggest a change we only do it by small amounts ie 1/8 th of a tsp...to much is as bad as to little.

Anyway i will be intrested in your response about the B12.

Hi,

Thanks for the welcome and for responding so soon. I had been on this site quite a bit and knew how important everyone says the b12 was but every time i asked, my vets acted like it wasn't a big deal. finally, when i took her to the university they had her tested and i hoped it would be low but they said she had a pretty normal level, i don't quite remember what it was but i'll look and post it on here.

I'm really curious about changes to what she's eating as well. I know science diet is a good brand and quality food and all that but looking at what others have fed their dogs on this site it seems that a more natural food with the right percentages and ratios of everything might help. My old vet wasn't big on food like Blue Buffalo though because she said it hadn't been around long and they don't know enough about those natural foods, I don't know.

On the enzyme, I had always adjusted by small amounts in the past but when I got my treatment recommendation from the vets at the university they said to jump her up to 2 tablespoons/day at least temporarily. They wanted to start high and gradually bring it down. They said it had worked for a gsd brought in a couple weeks earlier and it does seem to be working for Sam as far as weight but her mouth is just a mess and her stools are so soft. I just have a feeling that maybe if something with the enzyme were different (brand, raw) something might change.

Thanks again for your help,

Joe

May 3, 2013 at 3:16 PM Flag Quote & Reply

Joe
Member
Posts: 20

Jean and Kara at May 3, 2013 at 1:54 PM

Hi and welcome from UK

 

http://www.vetdepot.com/product-labels/pancreplus-powder.pdf

 

I assume this is what you are using which is fine

 

can I confirm how much you are giving

 

you say 2 TABLESPOONS per meal do you mean TEASPOONS ?

 

2 tablespoons is way too much

 

do you have her results from when she was diagnosed?

 

I am also not a fan of prescription diets preferring grain free and low fibre,there is too much grain in the science diets for my liking

 

Kara only began to improve after we changed to grain free

 

I also agree with b12 injections if necessary,which the results will show

 

jeanx

Hi, thanks for the welcome. That is the enzyme I'm currently using and the only one I have used since she was diagnosed. I don't know if a change in brand or anything would help but the vets didn't think so. It is 2 table spoons, not tea spoons. I know that sounds crazy and I hate doing it. I haven't ever given her any less than 1 table spoon which is what I was at before they told me to double it temporarily and then if it started working, gradually draw down. Apparently it had worked for a gsd a couple weeks before I was there. It does seem to be helping Sam some as her stools are smaller and less frequent but still very soft. I really do think her food could be changed and that is something I want to look at it and find a really good option possibly. The tests did come back that her b12 levels were pretty normal which suprised me.

Thanks for your help!

Joe

May 3, 2013 at 3:24 PM Flag Quote & Reply

Joe
Member
Posts: 20

Jill at May 3, 2013 at 1:56 PM

For the amount of enzyme you wrote( 2 Tablespoons per 1 cup food), do you mean Tablespoon or teaspoon? If you are using 2 Tablespoons 3xper day that is way past the recommended dose of 1 level teaspoon enzyme per 1cup of food. This might be the root of the irritated mouth . My Mickey uses 1/8 teaspoon per meal and still has red gums, so I use a syringe of clean water and shoot it in each cheek after the meal.

Hi Jill,

I do use 2 tablespoons, not teaspoons. Its crazy but thats what the vets at ksu recommended temporarily and then draw down when she starts getting her food digesting. That is definately why her mouth is so sore and painful. That is a good idea with the syringe. I try to brush her teeth after and sometimes during each meal because her mouth hurts and she has trouble finishing it. That much enzyme probably even irritates her stomach I would think. I have thought about trying raw pancreas but it seems a little bit risky.

Thanks for your help!

Joe

May 3, 2013 at 3:29 PM Flag Quote & Reply

Jill
Member
Posts: 1756

Hi Joe- I am no vet for sure and do not want to contradict your vet but even the Pancrezyme bottle that is a prescription has the starting dose at 1 teaspoon per meal. I am 95% sure the sore mouth is caused by the amount of enzyme you are using. Too MUCH enzyme may cause mouth sores as well as BAD poops, just like tooLITTLE enzyme can cause BAD poops. Sorry I can't help more then to suggest you cut the enzyme amount to a lower level, but if you dog is used to that much I don't know what increments might be helpful. Mickey started out with 1 teaspoon per meal, and I reduced the amount by 1/8 teaspoon per meal and did that for 5 days, then went lower until I got to 1/8 teaspoon per meal 3 times a day. good luck

--

 

Mickey 6/99  17.5 lb  jack russell, chronic pancreatitis, hyperuricosuria

eating whatever he will eat at the time

2 #2 Dianes enzymes 6x premeal, Optagest mixed in also

 2.5 mg Amlodipine, .15mg soloxine am/pm, 100mg ursodiol started for gall bladder thinning 3/24

arthritis:  6.25mg tramadol 1x/day, 25mg gabapentin every 12 hrs,  Assisi soft loop used on back and elbow,started Yucca Intensive 2x/day 4/29/14

Denamarin once a day, 1/16 t tylan (150mg)  2x/day 

 Senilife started 12/14/13, Trixsyn

Optimmune and Dry eyes, 125mg amoxicillan started 4/11 for teeth problem(done) 

Kiya is Mickeys sister, 3/4 aussie, 1/4 blue heeler born 9/2006.  She thinks she is a 44 lb jack russell who tries to heel Mickey!!



 

 

 

 

 

May 3, 2013 at 4:53 PM Flag Quote & Reply

Paula
Member
Posts: 2633
Hi and welcome, though sorry things aren't looking good right now. Maya was eating Natural Balance a fish and sweet potato for several years. Even gained 20 lbs on it when first diagnosed. Then last month, all of a sudden she started having formed but 'poofy' stools. And a lot of it. And she started snacking on it again (like before diagnosis). I had to take her enzymes back up to a teaspoon per cup of food, which at least stopped the snacking, but SIBO had already taken hold. I changed her food to one that has 3% max fiber (down from 4.5% max) and she finally seems back to normal. I've even been able to reduce her enzymes again. So long story short, even though things are going smoothly with a certain protocol, things can change. I'm glad you will look into the B12 number. I really am a proponent of supplementing it. I hear you on your vets saying 'it worked for one dog' and its certainly worth a try, but one thing we've seen here is every dog is different. How long are you incubating the enzymes? Can you go a little longer to maybe help with the sore mouth?
--

Paula and Maya (bday 12/21/06) (diagnosed 10/26/10 TLI 1.5, B12 659 (ref:249-733), weight 52 lbs. After 30 days, retested B12/folate - B12 plummeted to 200, which greatly affected her personality. After following B12 protocol, currently giving semi-weekly B12 shots at home, plus daily WonderLabs Trinfac. Weight in July 2013: 75 lbs - the picture of health


May 3, 2013 at 5:34 PM Flag Quote & Reply

epi4dogs
Site Owner
Posts: 12668

HI Joe.... first.... go ahead and do the 2 tablespoons exactly like your vet recommended... for a short time ....... just to see if it helps firm up the poo... BUT do add enough luke warm  liquid to the food to make sure this large amount of enzymes are thoroughly mixed and make sure you then let the food sit for 20-30 minutes.... Ahh... sounds like poor baby has mouth sores... if you can..... rinse her mouth out after a meal and or... if she'll eat icecubes after her meal that would also help with the sores. Although this is not the norm.... every so often we do have an EPI dog that requires more than normal enzymes. I actually have 19 folks (so far) out of over 400 participants (who have participated in an EPI survey) that do indeed have to give their dog 2 tablespoons of enzymes per 1 cup of food....but on the flip side.... if you gave this amount to most EPI dogs... it would give them loose stools..... so try it but with close observations and then decide if this makes it better or worse.


POSSIBILITY #1 :Now.... that PancreaPlus has vitamins added.... is it rather fluffy powder??? If yes... then it is possible that for SAM might be one of those dogs that require 1.5 to 2 teaspoons  per cup (if this is the fluffy stuff) and this might be why she has the loose stools... SIBO may have kicked in from not getting enough enzymes.....if the fluffy powder, although the right dose the fluff ... when measured ... isn't p;acked enough so that she may not have been getting the right amount.


POSSIBILITY #2 Could very well be loose stools and not optimally improving because even if B12 is normal.. that is not good enough for an EPI dog... they need their B12 in the upper mid-range (somewhere near the 600 mark).... so be sure to double check the B12 levels.


POSSIBILITY #3 The food... Science Diet is a high quality diet... BUT.... not necessarily great for all EPI dogs.,... finding the right diet for these dog can drive you absolutely nuts!!! The problem is that one food may work great for one EPI dog, but the next EPI dog may do horribly on the same food.  So this also is a possibility of why Sam has never really bounced back to full health after properly being diagnosed with EPI and treated.   You may need to change the food.... please read the Diet page and then read the Fiber page.  The trick with EPI is finding the right balance of ingredients... the most important is the Fiber content and what type of fiber is included and how your dog's specific gut glora can or cannot handle or needs which type of food.  We make a generalization here on the forum and suggest to folks to start with a Low Fiber food that has 4% or less fiber content... AVOID (in the beginning) foods with grains in it such as rice, corn, wheat, oatmeal, etc.... look for foods made with sweet potato instead.  In the end... you still may need to certain amounts of  these grains in SAm's food.... but start simple first and avoid the grain..... just to see if your EPI dog is going to follow the general trend of EPI dogs and need "low-fiber" foods (in the grain free section).


POSSIBILITY #4  If she is farting a lot, has any yellow coloring in her stools, if you are hearing any noises in the tummy...... then she either has SIBO again or it has never left..... which means, she will need another course of antibiotics (make sure you are giving the right amount for the right durations-protocol is on the SIBO page) give the Tylan twice a day for 45 days... please share the Tylan protocol for SIBO from Texas A&M with your vet... it is on the SIBO page.  ALso.... talk to your vet about possibly starting a pre-probiotic regimen about halfway thru the antibiotic regimen to clear up the SIBO (if Sam has SIBO again) just be sure to give the probiotic  2-4 hours away from when you give the antibiotic (sometimes this helps SIBO from re-occuring once the antibiotic regimen is completed) .  Also... another "rare"  possibility is  that the Tylan just isn't working on Sam ... if you did have her on the right amount and for the proper long duration. If so..talk to your vet about then trying a different antibiotic like Metronidazole or if he can get Oxytetracycline... that would be great too.... just woith these other 2 anti's only give for twice daily for 30 days... i am sure your vet knows this for the Metro & Oxy dosing...


POSSIBILITY #5 Talk to your vet about the possibility of Sam having EPI + IBD (and this might explain the loose stools ... in which case your vet might want to try her on real hydrolyzed foods (these are prescription foods and i think there are only 3) Talk to your vet about this possibility..... OR.................... another possibility (amongst many) is that Sam might have EPI + PLE which would definitely display with loose stools... but this requires other special drugs.  If you are interested, read about PLE here  http://www.epi4dogs.com/plelymphangiectasia.htm and then maybe have a conversation with your vet to see if the thinks it is a possibility.......sometimes it is very hard to figure out what is going on when you have concurrent conditions.


And before you drive yourself bonkers..... if you are not doing this already... start keeping an EPI LOG (you can download a template of one from the download page) and start keeping reall good notes on everything you give Sam and what the result is (via poo frequency and condition of the poo). I know it is real hard to do... but try to only make one change at a time / watch the poo from 3-5 days... to see if the "change" helps or hurts... and then move on to the next change. Even take poop picutres and post near the entries (or post here on the forum) you'd be amazed at how telling the condition of the poo can be. And please share with your vet everything we are suggesting to you so that everyone is on the same page.


Hope this helps a little and PLEASE keep us posted.

--

Olesia, owned by Izzy-35lb SWD, Diagnosed at 1.5 years old - TLI results 1.3, Stable almost 8 yrs! Once stable, was able to reduce enzymes to only 1/2 tsp of Enzymes with each meal, but after almost 4 years of stabilization... had to increase the amount of enzymes to 3/4 teaspoon with each meal. Feed various grain-free kibble+real meat, 6x pancreatin enzymes from EnzymeDiane. I give 1 tsp of coconut oil one day and 1 tsp salmon oil next day, and also give canned sardines packed without salt or canned herring for extra omega oils.

In Feb 2013, Izzy developed a very serious condition called IMHA which she (thankfully) beat and is now in remission. We also discovered that now, at 8+ years old, she not only has EPI, but also Diabetes, Low Thyroid and High Cholesterol.  Izzy was able to receive excellent care because of the kindness of so many here on epi4dogs and  is currently  doing extra-ordinarily well. If anyone could spend a day with Izzy, they would never guess that she has any health problems!  Because of Izzy's concurrent conditions of Diabetes and High Cholesterol we had to make chnages to our daily EPI routine. We had to alter the fiber, type of fiber and the fat content  her diet. She now gets 1/2 Annamaet Lean kibble and 1/2 TOTW kibble with either lean pork loin meat, or chicken breast or tuna twice a day. She also receives  9 or 10 units of Vetsulin (depending on her blood glucose reading) a pork based insulin. We tried Novolin N a human synthetic RNA insulin.... but Izzy did not do well on it. And now we have to monitor her exercise.   It's been one heck of a journey... but aside from all that Izzy has gone thru with her health issues.... she continues to wake up every day full of joy and a great sense of humor!


May 3, 2013 at 6:16 PM Flag Quote & Reply

She's Got Moxi
Member
Posts: 1144

Hi! Welcome to the forum! You've found an awesome place with lots of experienced EPI parents who freely share their knowledge and experience.

 

Just want to add a little to what Jean and Ann have said about B12. You said the vet said levels were normal, and they probably are for a dog without EPI. But EPI dogs really need B12 to be on the high end of normal (600+), so knowing the actual number helps. B12 levels below 600 can prevent weight gain and leave pups vulnerable to SIBO.

 

If you're not already, start a log. Keep track of everything going in and coming out ;) Try to make one change at a time so you can hone in on what works and what doesn't.

 

So sorry Sam hasn't been doing well, but you've got lots of support here to help you help her.

--

Pat - mom to Moxi & Sadie (nonEPI) b 12/14/13

MOXI 7/16/12-8/15/13 Gone to the Rainbow Bridge too soon!  Parvo survivor - dx  EPI 3/19/2013 at 24#, got up to 41# before kidneys failed unrelated to EPI  Thank you for loving us, Moxi!      

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

http://www.drsfostersmith.com/product/prod_display.cfm?pcatid=10935

http://www.wonderlabs.com/itemleft.php?itemnum=6881

http://enzymediane.com/

MOXI'S JOURNEY IS DONE, BUT OUR ROAD GOES ON...

        

May 3, 2013 at 6:34 PM Flag Quote & Reply

Jean and Kara
Member
Posts: 5486

I think that its sad we are in the hands of the gods here, and we trust the vets word as gospel

 

I am a great believer in the log/diary and have kept mine in the loft and start a new one whenever we have any issues and trust me, we have had many

 

I had to laugh yesterday when Sandra one of our UK members and I were talking on the phone, and she has her own situation in a diary and Evas in another!!!!!!!

 

i love it that we are all pals over here

 

Sorry Sandra!!!!!!!!!!!!! 

 

anyway we started with a very high enzyme ratio and then added the antibiotics and B12 but it wasnt till we went grain free that we saw an improvement

 

at the moment I would keep to the commercial enzymes as you know exactly what is in them rather than fresh pancreas obviously if you then want to rethink that later then there are plenty of folk here who do it

 

and a tutorial on how to prepare, it would you believe

 

http://www.epi4dogs.com/apps/forums/topics/show/8719995-how-to-feed-raw-beef-pancreas-a-photo-tutorial-

 

there used to be pictures on this !

 

I am sure you will see a difference

 

this is what we had

 

German Shepherd Cured

 

people will be tired of this but it gives an idea of the difference

 

jxxx

 

jeanx

--

 

 

Kara

 

From Liverpool England


born 21st July 2009


adopted at five months old 26th December 2009

 

EPI dx August 2010


tli<1.00 folate 8.3 cobalimin 611

Antibiotics  2 Oxytet antibiotics 3 times a day also if we cannot fit the Oxytet in she has Tylan 1/8th teaspoon before her meals as a maintenanance dose

Food- Ashenbank Lamb Casserole  twice daily equalling 3 cups per day possibly more

Zantac (ranitadine) 75 mg 30 minutes before each meal as too much acid was being produced, causing shedding of bowel lining

enzymes-Panzym 1 gram per meal twice daily ( 1/4 teaspoon )  plus one Lypex

B12 injection once every three weeks

one Chemeyes B12 with intrinsic factor of 40 daily

one Antepsin before bedtime

alergies to beef pork chicken and white fish confirmed by blood test

33.6 kilos in weight as of 5th May 2013

39 kilos as of 10th June 2014

 

"UNCONDITIONAL LOVE WAS INVENTED BY DOGS"

 

 


May 4, 2013 at 4:05 AM Flag Quote & Reply

Joe
Member
Posts: 20

Jill at May 3, 2013 at 4:53 PM

Hi Joe- I am no vet for sure and do not want to contradict your vet but even the Pancrezyme bottle that is a prescription has the starting dose at 1 teaspoon per meal. I am 95% sure the sore mouth is caused by the amount of enzyme you are using. Too MUCH enzyme may cause mouth sores as well as BAD poops, just like tooLITTLE enzyme can cause BAD poops. Sorry I can't help more then to suggest you cut the enzyme amount to a lower level, but if you dog is used to that much I don't know what increments might be helpful. Mickey started out with 1 teaspoon per meal, and I reduced the amount by 1/8 teaspoon per meal and did that for 5 days, then went lower until I got to 1/8 teaspoon per meal 3 times a day. good luck

Hi Jill-I'm sure the enzyme is what is tearing up her mouth and I'm sure it doesn't feel good going through her body either. It is working and I will start drawing down the amount soon. I might do the 1/8 tsp a day like you but i'll ask the vet for sure. Thanks for your help!

 

May 6, 2013 at 11:38 AM Flag Quote & Reply

Joe
Member
Posts: 20

Paula at May 3, 2013 at 5:34 PM

Hi and welcome, though sorry things aren't looking good right now. Maya was eating Natural Balance a fish and sweet potato for several years. Even gained 20 lbs on it when first diagnosed. Then last month, all of a sudden she started having formed but 'poofy' stools. And a lot of it. And she started snacking on it again (like before diagnosis). I had to take her enzymes back up to a teaspoon per cup of food, which at least stopped the snacking, but SIBO had already taken hold. I changed her food to one that has 3% max fiber (down from 4.5% max) and she finally seems back to normal. I've even been able to reduce her enzymes again. So long story short, even though things are going smoothly with a certain protocol, things can change. I'm glad you will look into the B12 number. I really am a proponent of supplementing it. I hear you on your vets saying 'it worked for one dog' and its certainly worth a try, but one thing we've seen here is every dog is different. How long are you incubating the enzymes? Can you go a little longer to maybe help with the sore mouth?

Hi Paula-That sounds a lot like Sam's situation. I wish she was at a teaspoon per cup of food-its SO expensive right now getting 2 bottles of enzyme a month. I am definatley looking at the food situation and looking to move her to grain-free. I know people say to keep the fiber at 4 or lower, what is the significance of lowering the amount of fiber? I am waiting to hear back from the vet on exactly what her b12 was and depending on that I might have to demand some b12 shots, even though all the vets i talk to seem to not want to do it. I am incubating her enzymes 15-20 min and now i'm using a little more water and give her ice cubes after-it seems to help a little. Thanks again!

May 6, 2013 at 11:43 AM Flag Quote & Reply

Joe
Member
Posts: 20

epi4dogs at May 3, 2013 at 6:16 PM

HI Joe.... first.... go ahead and do the 2 tablespoons exactly like your vet recommended... for a short time ....... just to see if it helps firm up the poo... BUT do add enough luke warm  liquid to the food to make sure this large amount of enzymes are thoroughly mixed and make sure you then let the food sit for 20-30 minutes.... Ahh... sounds like poor baby has mouth sores... if you can..... rinse her mouth out after a meal and or... if she'll eat icecubes after her meal that would also help with the sores. Although this is not the norm.... every so often we do have an EPI dog that requires more than normal enzymes. I actually have 19 folks (so far) out of over 400 participants (who have participated in an EPI survey) that do indeed have to give their dog 2 tablespoons of enzymes per 1 cup of food....but on the flip side.... if you gave this amount to most EPI dogs... it would give them loose stools..... so try it but with close observations and then decide if this makes it better or worse.


POSSIBILITY #1 :Now.... that PancreaPlus has vitamins added.... is it rather fluffy powder??? If yes... then it is possible that for SAM might be one of those dogs that require 1.5 to 2 teaspoons  per cup (if this is the fluffy stuff) and this might be why she has the loose stools... SIBO may have kicked in from not getting enough enzymes.....if the fluffy powder, although the right dose the fluff ... when measured ... isn't p;acked enough so that she may not have been getting the right amount.


POSSIBILITY #2 Could very well be loose stools and not optimally improving because even if B12 is normal.. that is not good enough for an EPI dog... they need their B12 in the upper mid-range (somewhere near the 600 mark).... so be sure to double check the B12 levels.


POSSIBILITY #3 The food... Science Diet is a high quality diet... BUT.... not necessarily great for all EPI dogs.,... finding the right diet for these dog can drive you absolutely nuts!!! The problem is that one food may work great for one EPI dog, but the next EPI dog may do horribly on the same food.  So this also is a possibility of why Sam has never really bounced back to full health after properly being diagnosed with EPI and treated.   You may need to change the food.... please read the Diet page and then read the Fiber page.  The trick with EPI is finding the right balance of ingredients... the most important is the Fiber content and what type of fiber is included and how your dog's specific gut glora can or cannot handle or needs which type of food.  We make a generalization here on the forum and suggest to folks to start with a Low Fiber food that has 4% or less fiber content... AVOID (in the beginning) foods with grains in it such as rice, corn, wheat, oatmeal, etc.... look for foods made with sweet potato instead.  In the end... you still may need to certain amounts of  these grains in SAm's food.... but start simple first and avoid the grain..... just to see if your EPI dog is going to follow the general trend of EPI dogs and need "low-fiber" foods (in the grain free section).


POSSIBILITY #4  If she is farting a lot, has any yellow coloring in her stools, if you are hearing any noises in the tummy...... then she either has SIBO again or it has never left..... which means, she will need another course of antibiotics (make sure you are giving the right amount for the right durations-protocol is on the SIBO page) give the Tylan twice a day for 45 days... please share the Tylan protocol for SIBO from Texas A&M with your vet... it is on the SIBO page.  ALso.... talk to your vet about possibly starting a pre-probiotic regimen about halfway thru the antibiotic regimen to clear up the SIBO (if Sam has SIBO again) just be sure to give the probiotic  2-4 hours away from when you give the antibiotic (sometimes this helps SIBO from re-occuring once the antibiotic regimen is completed) .  Also... another "rare"  possibility is  that the Tylan just isn't working on Sam ... if you did have her on the right amount and for the proper long duration. If so..talk to your vet about then trying a different antibiotic like Metronidazole or if he can get Oxytetracycline... that would be great too.... just woith these other 2 anti's only give for twice daily for 30 days... i am sure your vet knows this for the Metro & Oxy dosing...


POSSIBILITY #5 Talk to your vet about the possibility of Sam having EPI + IBD (and this might explain the loose stools ... in which case your vet might want to try her on real hydrolyzed foods (these are prescription foods and i think there are only 3) Talk to your vet about this possibility..... OR.................... another possibility (amongst many) is that Sam might have EPI + PLE which would definitely display with loose stools... but this requires other special drugs.  If you are interested, read about PLE here  http://www.epi4dogs.com/plelymphangiectasia.htm and then maybe have a conversation with your vet to see if the thinks it is a possibility.......sometimes it is very hard to figure out what is going on when you have concurrent conditions.


And before you drive yourself bonkers..... if you are not doing this already... start keeping an EPI LOG (you can download a template of one from the download page) and start keeping reall good notes on everything you give Sam and what the result is (via poo frequency and condition of the poo). I know it is real hard to do... but try to only make one change at a time / watch the poo from 3-5 days... to see if the "change" helps or hurts... and then move on to the next change. Even take poop picutres and post near the entries (or post here on the forum) you'd be amazed at how telling the condition of the poo can be. And please share with your vet everything we are suggesting to you so that everyone is on the same page.


Hope this helps a little and PLEASE keep us posted.

Thank you for all the information! I definatley want to start changing her food to grain free and get the fiber content down to start. I did put her through the SIBO treatment with Tylon and even went longer than suggested and it just didn't do much. I will ask about the other anitbiotics because she has had noises in her stomach for a long time and the gas is just terrible. I am waiting on a call back to find out for sure what her b12 numbers were. I want my vet to give her some b12 shots if it is anywhere under the upper range. Her enzyme doesn't seem real fluffy but I have always had to give her at least 1 tablespoon per cup of food. I can't believe people here are able to do a teaspoon or less, that is amazing to me. One of the many things we did treat her for when we started trying to figure this all out was the IBD+EPI combo but that treatment didn't work so I think we threw that one out. I will look into the PLE and see what that is all about. I will start a log, I've always thought I needed to but haven't ever started. I monitor her all the time and try to keep it in my head but its easy to forget during the course of a week or month. Anyway, things seem to be going better with the increased enzyme as far as her weight. Also, the poops are less frequent and smaller, they are just so loose. I really think changing the diet, upping the b12 and trying a little different treatment on SIBO could do it, but you never know. Thank you again for all your help and suggestions!

May 6, 2013 at 11:56 AM Flag Quote & Reply

Joe
Member
Posts: 20

She's Got Moxi at May 3, 2013 at 6:34 PM

Hi! Welcome to the forum! You've found an awesome place with lots of experienced EPI parents who freely share their knowledge and experience.

 

Just want to add a little to what Jean and Ann have said about B12. You said the vet said levels were normal, and they probably are for a dog without EPI. But EPI dogs really need B12 to be on the high end of normal (600+), so knowing the actual number helps. B12 levels below 600 can prevent weight gain and leave pups vulnerable to SIBO.

 

If you're not already, start a log. Keep track of everything going in and coming out ;) Try to make one change at a time so you can hone in on what works and what doesn't.

 

So sorry Sam hasn't been doing well, but you've got lots of support here to help you help her.

Hi-thank you so much for your thoughts. I am currently checking her b12 levels to be sure and if they are anything lower than the upper end, I will be getting her some b12 shots. I will also be asking the vet about a different treatment for the SIBO because the last one didn't seem to work if thats what she has. I just started the log today so I hope that helps keep me organized and aware of patterns and different problems that could arise. Thank you for your help and support!

May 6, 2013 at 11:59 AM Flag Quote & Reply

Jean and Kara
Member
Posts: 5486

Joe

 

Kara didnt start to recover till we went grain free and that was nearly 2 years ago

 

people who give small amounts of enzymes have worked down to this if you get me, so please dont worry, I for one panicked badly at the start and now its just the way it is

 

At the start its all about getting the ratio of everything to get into sync

 

everything you need to know about fibre is here..............

 

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

 

 

jeanx

--

 

 

Kara

 

From Liverpool England


born 21st July 2009


adopted at five months old 26th December 2009

 

EPI dx August 2010


tli<1.00 folate 8.3 cobalimin 611

Antibiotics  2 Oxytet antibiotics 3 times a day also if we cannot fit the Oxytet in she has Tylan 1/8th teaspoon before her meals as a maintenanance dose

Food- Ashenbank Lamb Casserole  twice daily equalling 3 cups per day possibly more

Zantac (ranitadine) 75 mg 30 minutes before each meal as too much acid was being produced, causing shedding of bowel lining

enzymes-Panzym 1 gram per meal twice daily ( 1/4 teaspoon )  plus one Lypex

B12 injection once every three weeks

one Chemeyes B12 with intrinsic factor of 40 daily

one Antepsin before bedtime

alergies to beef pork chicken and white fish confirmed by blood test

33.6 kilos in weight as of 5th May 2013

39 kilos as of 10th June 2014

 

"UNCONDITIONAL LOVE WAS INVENTED BY DOGS"

 

 


May 6, 2013 at 12:05 PM Flag Quote & Reply

Joe
Member
Posts: 20

Jean and Kara at May 4, 2013 at 4:05 AM

I think that its sad we are in the hands of the gods here, and we trust the vets word as gospel

 

I am a great believer in the log/diary and have kept mine in the loft and start a new one whenever we have any issues and trust me, we have had many

 

I had to laugh yesterday when Sandra one of our UK members and I were talking on the phone, and she has her own situation in a diary and Evas in another!!!!!!!

 

i love it that we are all pals over here

 

Sorry Sandra!!!!!!!!!!!!! 

 

anyway we started with a very high enzyme ratio and then added the antibiotics and B12 but it wasnt till we went grain free that we saw an improvement

 

at the moment I would keep to the commercial enzymes as you know exactly what is in them rather than fresh pancreas obviously if you then want to rethink that later then there are plenty of folk here who do it

 

and a tutorial on how to prepare, it would you believe

 

http://www.epi4dogs.com/apps/forums/topics/show/8719995-how-to-feed-raw-beef-pancreas-a-photo-tutorial-

 

there used to be pictures on this !

 

I am sure you will see a difference

 

this is what we had

 

German Shepherd Cured

 

people will be tired of this but it gives an idea of the difference

 

jxxx

 

jeanx

The log is a great idea and I just started that today. I know it will help a lot in keeping me organized and finding patterns with her. I'm checking her b12 levels again and if its anything less than the high end I will be getting her b12 shots. Also, I will look at treating her SIBO with a different antibiotic than before and see it we have better results. Maybe the combo of b12 shots along with the antibiotic is what was missing last time. And the biggest thing I am looking at doing is switching her over to a grain free food with low fiber content. Her science diet is a good food but I think we need to go grain free-it is worth a try. Everything is going well now except the loose stools. She is gaining weight and the poops are less frequent and smaller so I just need to get that fixed. Thank you very much for your help!

May 6, 2013 at 12:05 PM Flag Quote & Reply

Paula
Member
Posts: 2633
I think/hope you will see a big difference when you switch to low-fiber. At the very beginning, when Maya had the blood draw, but we didn't yet have the result, I took her off the w/d prescription diet she was on (fiber, in non-EPI dogs, actually can form up the stool). Her poops improved even before we started the enzymes. I definitely think its a great place to start (along with the B12 - do you have that value yet?). If you want some guidance, at the top of the page is a tab called Dog Food Options; that will give you some foods that have worked for our dogs.
--

Paula and Maya (bday 12/21/06) (diagnosed 10/26/10 TLI 1.5, B12 659 (ref:249-733), weight 52 lbs. After 30 days, retested B12/folate - B12 plummeted to 200, which greatly affected her personality. After following B12 protocol, currently giving semi-weekly B12 shots at home, plus daily WonderLabs Trinfac. Weight in July 2013: 75 lbs - the picture of health


May 6, 2013 at 12:57 PM Flag Quote & Reply

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