The key to successfully managing EPI is first about implementing the recommended EPI 4-prong protocol (Enzymes, Diet, Antibiotics (if needed) and B12 (if needed) .... 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. However, in trying to explain “when, how and what” adjustments to make it can be very confusing to someone just learning about EPI. So, at the urging of one of our wonderful epi4dogs members, Johnny (thank you Johnny!), we have put this EPI Quick Guide together in hopes that when first embarking on the EPI journey, this might make it easier 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, diet should be changed to a food (commercial kibble is fine) with 4% or less fiber content. Avoid foods with grain (unless hydrolyzed). Look in the grain-free section BUT CAREFULLY READ the ingredients. Not all low-fiber food will agree with all EPI pets. Do not use low fat food unless there is another health condition going on that requires it. Until your pet is back up to a good weight, feed 150% of what is normally required, feed smaller portions-more meals in the beginning. See the Dog Food Options page for some food ideas.
3. B12: Four out of five EPI dogs have low B12 levels at the time of EPI diagnosis (or soon after) and all EPI cats need B12 supplementation. Insufficient B12 levels will interfere with your pet’s ability to get better. Ask your vet to please run a cobalamin (B12) blood test at the same time as the TLI blood test. Or just talk to your vet about treating for low B12 with B12 cyanocobalamin serum injections per TAMU protocol. See the B12 page. The B12 level needs to be in the upper mid-range, normal is not sufficient. Once you have the B12 levels up, then you need to maintain the optimal levels via periodic supplementation, on a schedule determined by the dog or cat’s needs, either by B12 injections (proper protocol) or with B12 capsules containing intrinsic factor Trinfac used by many EPI owners with success via confirmed re-testing the blood although no specific clinical trials at this time to support this claim. The good thing about B12 is that you cannot overdose a pet on B12… if they do not need it, they will just pee out any excess. However, if they do need it, it can make a world of difference in their response to EPI treatment. Some of the signs of low B12 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/SIBO: (small intestinal dysbiosis) formerly known as SIBO (small intestinal bacterial overgrowth) is in almost all 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 to correct itself. If not, you will need to administer antibiotics. Tylosin (Tylan) powder is now the drug of choice given 30-45 days/ twice daily with breakfast and dinner. See the SID/SIBO page for research supporting this recommendation and the proper 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 you do not see improvement in the poo within 7-10 days, talk to your vet about switching from Tylan to Metronidazole, Oxytetracycline or Amoxycillin for the remainder of a 30 day course. Signs of SID/SIBO can be yellow tinges to the stools, continued loose/soft stools, or “iffy” stools, intermittent sloppy stools, mucus coating on stools, flatulence, lack of appetite, stomach noises, crankiness, lethargic, low or low-normal B12 ... or no signs at all.
And last but not least, start keeping an EPI Log. You can go to the Downloads page that has an actual example of one dog's EPI Log that will show you what to record for your EPI patient and then how to record the results- -which is determined by the poo: the frequency, the color, the volume and texture. “Poo-watching” will help you determine if/when you need to make a change and then if the change you made is helping or hurting. With EPI you initially start the enzymes, low-fiber diet, B12 and antibiotic (if needed) all at once… but if results are not optimal… then you start making one change at a time, watch the poo for 3-5 days before you implement another change. And of course, as always, if you have any questions, please feel free to post on the epi4dogs FORUM or the epi4dogs FACEBOOK page and talk with other EPI owners who will share their experiences and insights that may better help you with your EPI pet.
Copyright © 2015 epi4dogs