The key to successfully managing EPI is first about implementing the recommended EPI 4-prong protocol (Enzymes, Diet, B12 if needed, Treatment for SID if needed) and second, making adjustments if needed so that the EPI protocol best serves your individual EPI pet. Perhaps the most important thing to know is that over 95+% of dogs diagnosed with EPI will live long, happy lives, by following this protocol. The Epi4dogs EPI Quick Guide explains "how, what and when" to manage the many variables of EPI. We hope you find this EPI Quick Guide useful and easy to understand.
Because there different EPI resources available in Australia... two of our Australian members, Andrea and Craig, have created a special EPI Quick Guide that is tailored to manage EPI in Australia with specifically what is available in Australia. (see second EPI Quick Guide below). Thank you Andrea and Craig!
1. ENZYMES: Use porcine pancreatin enzymes only. Use with every meal. No treats. Excessive heat (130F degrees and above destroys these enzymes, cold inhibits enzymatic activity. There are different types of porcine enzymes which will require different application techniques. Please read the Enzyme page for a list of different enzymes. Please read the DIET page to understand the application and interaction of different enzymes with food. Cost savings generic powder enzymes are available at: http://www.enzymediane.com/ ...OR.... to read about EPI expenses please read the Expense page.
For UK and Australian EPI'rs feel free to download the EPI Management PDFs specifically for your country Downloads
If you are in Australia, feel free to download the AUSTRALIAN EPI Quick Guide EPI Quick Guide
2. DIET: In the beginning, it is best to start with a diet (commercial kibble is fine) with 4% or less fiber content. Avoid foods with grain (unless hydrolyzed). Commercial foods usually work well if low in fiber content, look at "grain-free" labels BUT CAREFULLY READ the ingredients. Not all low-fiber food will agree with all EPI pets. No need to use low fat food unless there is another health condition that requires it. Until the pet is back up to a good weight, feed 150% of what is normally required for the dog's smaller portions in the beginning. See the Dog Food Options page at www.epi4dogs.com for some food ideas.
3. B12: Four out of five EPI dogs have low B12 levels at the time of EPI diagnosis and most EPI cats need B12 supplementation. Insufficient B12 levels will interfere with a pet's recovery. Please run a cobalamin (B12) blood test at the same time as the TLI blood test. Or consider treating for low B12 until the test can be run. TAMU protocol is B12 cyanocobalamin serum or B12 pills with comparable potency/dose may be tried. See the B12 page on the www.epi4dogs.com website for B12 dosing protocol. The B12 level is best in the upper mid-range, the low or low-normal range is often not sufficient enough. Once the B12 levels are sufficient, continue to maintain optimal levels via periodic B12 supplementation, determined by a re-test of the dog or cat's B12 level to get a benchmark read of that individual needs. B12 maintenance can be either periodic B12 injections (proper protocol) or B12 capsules. Epi4Dogs recommends B12 products Pet Factor B12 or Trinfac manufactured by www.Wonderlabs.com used by many EPI owners with success via confirmed re-testing the blood although no specific clinical trials at this time support this claim. There are no reported negative effects of B12 overdosing, if they do not need it, they will just excrete any excess. However, if they do need it, it can be the difference between optimal response to EPI treatment or never flourishing. Some of the signs of low B12 in an EPI pet are poor weight gain, "iffy" appetite, loose stools, acid reflux, poor coat, fearfulness, agitated behavior, lethargy, failure to thrive or, no sign at all.
4. SID: (small intestinal dysbiosis) formerly known as SIBO (small intestinal bacterial overgrowth) is present in most EPI patients when first diagnosed. The new protocol is to give the enzymes a week or two at the most, to see if this is enough to help the gut flora imbalance correct itself. The main objective is to get the SID under control. Try PreBiotics, if no relief, then you most likely will need to administer antibiotics. Tylosin tartrate 100mg (Tylan) powder is now the drug of choice given 30-45 days/ twice daily with breakfast and dinner. Although using antibiotics has it downside, it is the best tool we have for now. However, EPI research is underway in search of a better understanding of SID so that it may be addressed more appropriately. See the SID/SIBO page on www.epi4dogs.com for research supporting this recommendation, other options, and dosage according to the dog/cat's weight. Tylan is bitter tasting so some pets won't take it unless it is camouflaged in something. Some owners pour the designated amount into empty gel caps, others mix it in apple sauce, etc., or pour in a pouch of cream cheese. If improvement is not seen in the poo within 7-10 days, consider switching antibiotics from Tylan to Metronidazole for the remainder of a 30 day course, or try Oxytetracycline or Amoxicillin. Signs of SID can be yellow tinges to the stools, continued loose/soft stools, or "iffy" stools, intermittent sloppy stools, repeated mucus coating on stools, flatulence, lack of appetite, stomach noises, crankiness, lethargy, low or low normal B12, or no signs at all. Once SID is under control, if possible, try to find the underlying trigger of SID.... more often than not, it is that the diet is not optimal. Usually it is too much fiber in the food, but sometimes it is the carbohydrates or it is the wrong kind of fiber or carbohydrate. Often a food change is warranted.
And last but not least, EPI parents should keep an EPI Log. On the Downloads page at www.epi4dogs.com there is an actual example of one dog's EPI Log that will show what to record for the EPI patient and how to record the results- -which is determined by the stools; the frequency, the color, the volume and texture. "Stool-watching" will help determine if/when there is a need to make a change and then if the change made is helping or hindering. When initially implementing EPI treatment start the enzymes, low-fiber diet, B12 (if needed) and SID treatment if needed) all at once, but if results are not optimal, then start making one change at a time, watch the stools for 3-5 days before implementing another change. For 24/7 EPI support, questions or just to learn how others manage EPI please feel free to post (or lurk) on the epi4dogs FORUM on the www.epi4dogs.com website or Epi4Dogs Facebook page
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