Panzym - stopped working

Epi4Dogs Foundation Inc.’s mission is the advancement of science and education relating to EPI (Exocrine Pancreatic Insufficiency), yielding useful insights and positive outcomes in better managing EPI in dogs and cats. Our goals are to support and/or collaborate with veterinary EPI research and researchers, and to promote EPI awareness by educating the general public, pet owners, pet organizations, rescue and shelter organizations, veterinary schools and veterinarians.
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GGx
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Posts: 12
Country: United Kingdom - England
Pet name: Betty
My name: Gilly

Panzym - stopped working

Post by GGx » 05 Apr 2021, 07:29

Hi, I'm new to this group. I have an American Cocker Spaniel (Betty) who was diagnosed with EPI last year.

Betty's a bit unusual in that she's quite tubby. The only reason I even found out she had EPI was I was writing a book where a dog needed a specific illness. I stumbled on it and all of Betty's symptoms (apart from weight loss) fit the bill: coprophagia, pica, vomiting, diarrhoea, swollen tummy, rumblings & gas, fatigue.

Because she's tubby, the vet thought I was insane to suggest she test for EPI and didn't even bother telling me to starve her beforehand. Her TLI came back at 4.6 and the vet was shocked. We starved her, did the tests again and it came back at 2. The vet didn't really have a clue. She even retested Betty after she'd been on Panzym for a month expecting her TLI levels to have raised. When they didn't, she suggested we just forget it and leave her ... she didn't finish the sentence ... to die.

I changed vets and it was the new vet who explained that Panzym has no effect on the TLI levels, those never change, it simply allows her to digest food. After a year, I'm better informed than I was, but perhaps not as informed as I should be because Betty responded so well to the medication. For the last year, Betty has been on Panzym. 1tsp on every meal and a sprinkle on every treat - we don't feed her anything without enzymes. And she was doing really well. All her symptoms went away and she regained her energy.

But over the last fortnight - although we haven't changed anything - it's all started again. It's like overnight, we've gone back to square one. She's lethargic again, vomited yesterday and this morning, she pooped this:
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I'm not sure what to do now and even though my new vet seems better informed than the last, they still don't know much. Is it possible that a dog develops resistance to Panzym? Is it common for EPI dogs to suddenly stop responding to the powder?

ANY advice you can give would be so appreciated.

Thanks so much
Gilly

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jilbert57
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Posts: 1188
Country: United States
State: Washington

Re: Panzym - stopped working

Post by jilbert57 » 05 Apr 2021, 09:08

Good morning Gilly and welcome. Good job on getting your pup on the right track.
There are 4 cornerstones of Epi that need to be addressed when diagnosed.

Enzymes- the amount of enzymes is per cup of food, not per meal. We usually start with 1 level teaspoon per 1 cup kibble. Sprinkle enzyme over kibble, add a tad room temperature water, stir well and let set(incubate) for 15 to 20 mins. Then stir before serving.

Diet- recommended is grain free diet with little to no pea, lentil, pea fiber. 4% fiber or less.

Antibiotic- most pets have SID/SIBO in the intestine and needs an antibiotic to get rid of it. Tylan is recommended.

B-12- a pups B12 level needs to be at the upper range, around 600 or up.

Can you give some added information on diet, supplemental B12 or shots, enzyme preparation, etc?

I understand your disappointment at the setback. Sometimes as dogs age they need more enzyme.

Jill
My name is Jill and we live on the Hood Canal in Washington State. We currently have one pup. TJ is a 5 year old Jack Russell.

Mickey and his pancreatitis brought me to Epi4dogs.com site in 2012 to help manage it.
He lived from 6/99 - 8/2014

Mickey, Jack Russell. Chronic Pancreatitis. Dianes enzymes, 1/8t 3x/day with meals.

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Jean
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Location: South Liverpool
Country: United Kingdom - England
Pet name: Kara, lost 10th May 2019
My name: Jean

Re: Panzym - stopped working

Post by Jean » 06 Apr 2021, 07:14

Good morning from the UK, Liverpool

where are you ?and how old is Betty ?

that poop picture looks just like my Kara's when she was shedding her bowel due to a very bad Gut inballance called SIBO Small Intestinal Bacterial Overgrowth

My Kara was on Panzym for 7 years and thrived well

I am speechless at the vets lack of knowledge and crass attitude , and glad you have moved on

If they have been diagnosed with EPI by specifisc blood test their cTLI levels will NEVER increase, and saying to leave her to die. well.....

Panzym is a powder enzyme which tells you to give 1 gram i.e.1/4 teaspoon per 100 grams of kibble, what amount of, and what brand of food are you giving food do you give at a time, giving too much enzyme is as bad as not enough, however, as they get older they need more enzymes to digeat the food

I would be tempted to say to your vet that you have a friend who's dog had this type of poop and she was given Oxytetracycline, for 7 days ,no meat of any sort, just scrambled eggs, and mashed potato, Kara recovered well on that

Tylan isnt available in the UK at the moment

Did the vet suggeat any b12 supplementation

If you want to talk about this please let me know, I will be happy do do this


Jean
My name is Jean we live in Liverpool in Uk

My Kara born 21 July 2009 diagnosed with EPI by cTLI test August 2010 TLI = <1...folate 14 Cobalamin 408, shot down to 94, b12 injections every other day

Lowest weight 39 pounds

We used Panzym enzymes, Tylan and Chemeyes b12 capsules

Sadly, on 10th May 2019, we lost her to DM


Jeanx

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jilbert57
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Posts: 1188
Country: United States
State: Washington

Re: Panzym - stopped working

Post by jilbert57 » 06 Apr 2021, 09:46

Hi Betty, sorry I should have converted the cups and teaspoons to metric.
You are in good hands with Jean and the UK members.
It also helps to keep a daily journal:

https://epi4dogs.com/epi-log/

Jill
My name is Jill and we live on the Hood Canal in Washington State. We currently have one pup. TJ is a 5 year old Jack Russell.

Mickey and his pancreatitis brought me to Epi4dogs.com site in 2012 to help manage it.
He lived from 6/99 - 8/2014

Mickey, Jack Russell. Chronic Pancreatitis. Dianes enzymes, 1/8t 3x/day with meals.

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Patsy
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Country: United Kingdom - England

Re: Panzym - stopped working

Post by Patsy » 06 Apr 2021, 13:12

Hello to you and Betty, from Yorkshire. I too learnt to be pro-active with vets. That photo is not the epi poo. I would go along with Jean’s opinion. Shedding the bowel lining is slimy dark blood and gooey bits.
What food are you using?
My other thought is that I guess Betty is about 14kgs or so. I would reach out to Jean as to whether one teaspoon is too much per meal, since my dog was 24g and had one teaspoon. It is caustic stuff.
I would take your photo to the vet, or email it beforehand so they can look it up first. You could put a sample in a jam jar too.
It will be broadly called inflammatory bowel disease. It could be a virus or iinfection, a side effect of medication, or an auto-immune problem. Don’t agree to any invasive procedures before trying standard medication.
Do let us know what treatment the vet suggests. Other people on the forum have had this issue, and recovered.
If you think she has any pain, see the vet.
Springer spaniel Marti had Epi, PLE , MMM just to confuse me. She lived till 12yrs, chubby and happy despite eight years of epi.
Capsule enzymes suited her best. B12 supplements made her into a new dog!
After a cocker with PLN kidney disease, I now have two healthy rescues, a lively, suicidal , small ginger terrier, adopted with pneumonia, and gum disease needing nearly all his teeth out, and a fluffy grey toy poodle/terrier from Greece.

Tuckaboo Pam
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Posts: 591
Country: United States
State: Florida
Pet name: Tucker
My name: Pam H.

Re: Panzym - stopped working

Post by Tuckaboo Pam » 06 Apr 2021, 14:08

Don't let them prescribe metronidazole for IBD! My maltipoo took it, and now I have to give her tylan, slippery elm, and vitamin B12 twice every day, or else she squirts all over the place. Jean, and maybe Patsy, can offer guidance on getting Tylan in the UK. ---Pam
Tucker is a shepherd/lab mix; he has tested positive on the ScheBo test for EPI, as well as the fasting TLI. Results--- TLI 1.3, Folate 9.7, Cobalamin 666, Lipase 38. Currently taking Diane's Enzymes 4 teaspoons/day, Wonderlab B12 capsules 2-3 per week, slippery elm 1/2 teaspoon/day, Proviable 1 capsule/day, and Tylan 1/16 teaspoon/day. Sport Dog Elite, herding dogs 4 cups/day. No more poop eating, his weight is steady, and he is a happy member of the family, though a bit of a stinker, if you ask the other dogs. Tucker is my boyfriend, and my husband is OK with that.

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GGx
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Posts: 12
Country: United Kingdom - England
Pet name: Betty
My name: Gilly

Re: Panzym - stopped working

Post by GGx » 07 Apr 2021, 07:43

Hello Jill, Jean, Patsy, and Pam

Thanks so much for getting back to me, I can’t tell you what it means to get some proper help. I’m in Winchester, Hampshire. Betty is 5.

I have two Americockers. The most adorable and loving dogs anyone could wish for. Both a pair of cuddle-monsters who try to steal all the cuddles from each other! These are my hairy babies:
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Barney & Betty Cuddles.jpg
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Betty weighs 11 Kg. We’re always being told she’s overweight but we don’t overfeed her and she gets a lot of exercise. But she’s tired a lot and so sleeps as often as possible, so weight management is difficult. She’s nowhere near as active as Barney who’s 4 years older. But her tummy is often swollen so that makes her look fatter than she really is. When the swelling abates, her tummy looks quite flat.

Betty has 3/4 cup of kibble with 1/4 cup of wet food per meal (twice per day) and 1tsp Panzym on each meal. Her treats are also sprinkled with Panzym. I will measure this in grams and do some more precise calculations on the powder.

Q: Do you think I could be giving her too much Panzym if it’s on her treats as well? Can I give her treats in small amounts without adding powder? The vet said I needed to put it on every single tiny piece of food I feed her.

She is on Lily’s Kitchen Grain-Free kibble with a spoonful of wet Lily’s. I usually mix the Panzym into the wet food but I don’t let it sit. I specifically asked the vet about that (having read it online) and she said I didn’t need to with Panzym.

It has 3.5% fibres but some of that is pea. I have tried other grain-free foods (even raw - she refused to eat raw food) but everything I have tried exacerbates her vomiting and diarrhoea. With Lily’s she usually has nicely formed stools and rarely vomits. Up til now, Lily’s has been great.

No, the vet didn’t say anything about SIBO. The vet said her B12 levels were fine but she didn’t tell me the exact level or tell me that a dog with EPI should have a higher level. But then again a vet who tells you you might as well leave your dog to die isn’t going to bother researching EPI. I am now on my third vet. If you can believe it, the second was even worse!

I insisted on a specialist referral - apparently the best in my area - but even she didn’t mention higher B12 levels or SIBO. The lack of knowledge in my area is leaving me at a loss.

Q: Betty’s poop has returned to normal today. So now I don’t know what to do. Should I still get her treated for SIBO?


On another but related subject, Betty has some odd behaviours and I was told that EPI can affect brain function. She often refuses to walk in one direction, but will walk if you change direction:
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She often won’t climb up onto very low surfaces that she can easily reach:
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Betty Uppy-Up.jpg
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She barks at thin air, focussing on things we can’t see; I have videos of her staring at thin air, tail wagging with excitement, for hours. She likes to smell your breath and sits with her nose up against yours for long periods. And she listens to my vegetable beds… for hours:
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Q: She’s a very very strange dog with bizarre behaviours and always has been. Are odd behaviours common in EPI dogs or is this just Betty?

Again… thank you so much for the advice. It’s a pleasure to be here.

Gilly

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jilbert57
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Country: United States
State: Washington

Re: Panzym - stopped working

Post by jilbert57 » 07 Apr 2021, 11:52

Hi Gilly,
has she ever been checked for neurology issues? Some behavior you describe bring to mind possible neurological, but I am not a vet and don't mean to be alarming. Just giving possibilities.

Does she display any pain in the gut after eating like stretching, hunching the back, front feet down and rear up?

So your vet is correct that Betty needs enzyme on every bit of food she eats. Too much enzyme can have issues the same as too little enzyme.

Are you hearing loud gurgles, belching, gas passing? These are signs of SIBO/SID.

You are best with Patsy and Jean on the Panzym information.

Your pups are adorable.

Jill
My name is Jill and we live on the Hood Canal in Washington State. We currently have one pup. TJ is a 5 year old Jack Russell.

Mickey and his pancreatitis brought me to Epi4dogs.com site in 2012 to help manage it.
He lived from 6/99 - 8/2014

Mickey, Jack Russell. Chronic Pancreatitis. Dianes enzymes, 1/8t 3x/day with meals.

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GGx
Member
Posts: 12
Country: United Kingdom - England
Pet name: Betty
My name: Gilly

Re: Panzym - stopped working

Post by GGx » 07 Apr 2021, 12:57

Hi Jill,

No, I've discussed her behaviour with the vet and they seemed to think it might be related to the EPI: the brain not getting the nutrients it needs. I thought her behaviour might change with Panzym, but it hasn't. I have thought about neurology testing, the only reason I haven't pursued it is because I don't see any worrying symptoms.

She's a very happy dog in spite of the EPI and this odd behaviour doesn't have any negative side effects: she doesn't fit or seem spaced out or inattentive. During training sessions, she's uber alert and responds to commands instantly. She loves training and will come downstairs to join in if she hears me training Barney (Barney may have to have surgery that will leave him deaf so I'm teaching him to read). She's actually very attentive to her surroundings - just to very strange things like plants growing! We often say we think she sees dead people, which I know sounds extreme, but we've seen some bizarre things happen around her - but that's a long story for another day.

Yes! Lots of tummy rumbling over the last week (though that stopped when she first went on Panzym). But no, she doesn't appear to be in any pain at all. No strange stretching after eating. She does scratch sometimes - rubs her chin on the stairs but the vet tested her for allergies and came back with a list - mostly grasses and trees - which she's having immunotherapy injections for. Poor little lamb does go through the mill.

Thanks - they are such sweethearts. I took them to Chichester once and told my mum to count how many times we got approached and asked about them in one afternoon... 27!! I'm surprised it's not a more popular breed. Though I must say, we've had our share of health complications with both of them.

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jilbert57
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Country: United States
State: Washington

Re: Panzym - stopped working

Post by jilbert57 » 07 Apr 2021, 13:10

I am good with that! Being happy is what it is all about.
I would ask to have Betty's test results sent to you by .pdf. This might help.
I would say you need a longer course of antibiotics which I think Jean, Patsy and Olesia have said which one to ask for the SID/SIBO.

Just a question, when Betty is listening to the plants is she pressing her head against ihe object?

A less than optimum B12 level can cause symptoms of its own. So if I had to say anything it might be some symptoms might be presenting because not all the Epi protocol being implemented and not just the Epi label. Hope that makes sense.

Jill
My name is Jill and we live on the Hood Canal in Washington State. We currently have one pup. TJ is a 5 year old Jack Russell.

Mickey and his pancreatitis brought me to Epi4dogs.com site in 2012 to help manage it.
He lived from 6/99 - 8/2014

Mickey, Jack Russell. Chronic Pancreatitis. Dianes enzymes, 1/8t 3x/day with meals.

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