Any Advice or Suggestions

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miamunchkin
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Country: United States
State: California

Any Advice or Suggestions

Post by miamunchkin » 30 Aug 2018, 18:51

Hello everyone,

I posted on this forum a couple of weeks ago asking about a bad reaction Mia had to Viokase-V (possibly because they were high concentrations of porcine). Thank you again for all the advice at the time! It's really helped me these past weeks as I scramble to keep up with many new changes.

I wanted to lay out all that's been happening, and see if any one has any advice on what I'm doing and how Mia is reacting to certain things.

From July 24 to August 10th, Mia and I were in Wisconsin. On July 23rd, she had been diagnosed with EPI, and on July 28th, she finally was able to start her dosage of Viokase-V. After discovering that she wasn't reacting well too it, I gave her a very small dosage (less than half of 1/16th of a teaspoon). I did that for 4 days, and because she was still having diarrhea, and because I had heard that she could need enzymes on every piece of food she ate, I started putting less than a 1/16th of a teaspoon with every meal (she eats 4/3rd cups of food every couple of hours) for almost 3 days. However, her diarrhea became constant and her anal glands were getting out of control. Feeling like it simply wasn't an option anymore, I stopped giving her the porcine enzymes even though in total I had only given her less than a teaspoon in total over the past week.

Desperate, I read online somewhere that papain supplements (concentrated levels in papaya enzymes) were given to dogs to help with flatulence, etc. From August 3rd to the 10th, I started her giving her 1/16th of a teaspoon of papain twice a day, then with every meal. Even though I didn't have high hopes, I was surprised to find an improvement in her stool. It was thicker and darker, and when it came out, it held its form before turning to mush when I picked it up. However, papain only seems to help with the break down of proteins so it could never be the final solution.

We moved to California on August 17th. It's possible the stress of moving caused to have looser stool, or it could be that I had given her a higher dosage of papain (almost 1/2 a teaspoon with every meal) and started adding Slippery Elm. For 5-6 days, she had loose stool. I also had to switch her Omega-3 chews to a different brand, and her diarrhea became very runny. That same day, I took her to her first visit to her new primary care vet, who then gave us the referral we needed in order to get an appointment with the internal medicine specialist. She weighed 18.8 lbs at the primary care vet, which was a huge relief that she hadn't dropped weight from August 1st even with the looser stool and bouts of diarrhea. Up until then, Mia has been on a steady regime of 5mg of prednisone x 2, MWF with one pill of 1.75 mg of Chlorambucil, 125 mg of metronidazole, and a ton of probiotics. Every meal, she also gets 1/2 teaspoon of canned pumpkin.

After visiting with the internal medicine specialist, the doctor wanted to lower the dose of medicine to 5mg of prednisone x 1, start her on a new diet of fish and sweet potatoes (from a local, home-cooked meals for dogs business that she trusts and has been using for years) while taking her off of her HP diet, and starting her on Vivanex T.E.N., which is used to for humans who have extreme malabsorption issues. Eventually, the doctor wants to take her off the chlorambucil as well. Thankfully, at that time, she agreed with the Virginia internal medicine specialist that Mia did not have a liver shunt.

That night, I gave Mia some Vivanex T.E.N (a very small amount to see if she could tolerate it even though it's more broken down than even an HP diet would be), didn't give her her nightly dose of 5mg prednisone, and idiotically gave her a small try of her new Omega-3 Chews. The next 36 hours, she had terrible diarrhea, but no pain or vomiting or blood.

Confused about why her stool was so different from Wisconsin, on August 19th, I completely cut everything out of her diet except for her HP Diet food, watermelon juice (but none of the actual fruit, just me squeezing it out by hand), pumpkin, probiotics, medicine, spirulina, and down to 1/4 teaspoon of papain (from 1/2). I did that for 3 days and it returned back to "Wisconsin"-normal (a nice heavy lift without it falling apart so easily and a darker shade, but still nowhere near normal). Now she has been on only 5 mg of prednisone every day without any change to her stool. I thought it was important to start the change in diet before trying the Vivanex T.E.N. again.

On August 29th, I throughly mixed together 1 teaspoon of this new fish and sweet potatoes diet with about 3/8th of a teaspoon of papain. I then gave her a piece of sweet potato chunk to eat and then added the juices only (a couple teaspoons full) plus a couple more chunks of sweet potato to her HP Diet food. Her stomach made a few rumbling noises and when she went to the bathroom, her stool was much looser without it being pure liquid diarrhea. She's had sweet potato before without a problem so I don't think it's that. I tried again with her meal, but with only a teaspoon and no chunks at all. I'll keep trying again for the next 48 hours to see what happens.

If not she continues to have looser stool, should I stop or keep going to see if she builds a resistance? I ask because I started her on a selected protein diet from Royal Canin (rabbit) from July 10-July 22. She was able to get to 25% rabbit, 75% HP in those 9 days before she suddenly started having diarrhea. I think it's because she started learning how to pick out the rabbit, and she would eat just the rabbit bits of kibble and leave the HP diet food until much later once we started getting into the 27%/28% stage of transitioning her food. But because she was having diarrhea for several days, I was afraid of triggering a reaction and having her start to lose weight (at the time, she was barely topping 16.5 lbs). So I stopped transitioning the food, thinking to myself that I would start at a later date, once I have her IBD under control (she had just started her prednisone and chlorambucil early July).

However, I was just reading on this site though that there is something where people use a "sacrificial" novel protein while they are in the middle of trying to get her IBD under control, before moving on to another novel protein after the IBD is under control. Maybe I accidentally did that with the rabbit and shouldn't try again? Although I'm worried that I'll make the fish and sweet potato food into the 2nd "sacrificial protein" by accident if I stop transitioning it for her. Could that be a possibility if anyone knows? I wanted to see if maybe she would tolerate the Vivanex T.E.N. and give that a go to see if I could get her on that before trying to transition her diet.

I also used to give Mia tuna when we were in Korea, and she lived on the streets for at least a couple of weeks so I'm not sure what she could have eaten while she was living alone. I'm pretty sure she wouldn't have access to this particular type of cod, which is in the diet though so if type of fish is a factor, it should be a novel protein.

I'm also now worried that maybe it isn't her IBD at all that's giving her the diarrhea from these novel proteins, but it's the EPI instead. Maybe the HP diet food is easier for her pancreas to handle?

And California isn't allowing kangaroo products in the state so since that's not an option, I was thinking the duck novel protein in the Royal Canin Select Protein Diet as a possibility.

And maybe has anyone heard of anyone with a dog with EPI who has both a bovine and porcine allergy, and who found some alternative source of enzymes?

And if anyone has used Vivanex T.E.N. before, since it's broken down all the way to amino acids level, do you know if I should still have to mix it together with enzymes?

I have increased her dosage of B12 from .5 ml to 1 ml and from once a week, to every 2-3 days, and she has gotten so much more energetic. It's sweet to see her playing outside :)

This is pretty much the most recent happenings with Mia. This is finally the end of the post, and I thank you for taking the time to read it! It is a VERY, very long and detailed post; however, for years, vets have been saying that Mia's condition and symptoms are unusual and almost unheard of, so now that I know there are other people dealing with similar issues, I can't help but get as many fresh eyes on this as possible. Any and all advice is very much welcome!
Danielle

Mia is a 3-year-old Jindo-terrier mix. She was diagnosed with SIBO in April 2018, IBD in June 2018 and EPI in July 2018.
She currently eats Royal Canin HP Diet food, 4/3 cup every 2 or 3 hours until her conditions are under control. Plus some fruits and vegetables like watermelon and carrots.
Every 2-3 days, she gets 1 ml shot of B12. Every day, omega-3 (on temporary hold), spirulina, vitamin K.
Enzymes are Papain mixed in with canned sweet potato, spirulina, HP diet treats and kibble.
Right now, she is 18.8 pounds.

8/18/2018 Fasting Serum TLI 2.6 mcg/L, cholesterol level (too low to measure), Creatinine (low 0.4/0.5), Amylase (low 119/290), WBC (high 17.4/ 15.5)

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jilbert57
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Re: Any Advice or Suggestions

Post by jilbert57 » 30 Aug 2018, 19:09

Wow that is a lot of information. I am wondering if you are trying to go in too many directions at once. Can you please tell me what the cTli test result was for the EPI diagnosis? If your pup has Epi the plant enzymes are not strong enough. What is the HP diet? I am wondering if you can try Creon for the enzymes and maybe the hydrolyzed diet. Seems your pup is reactive to things but you maybe haven't pinpointed them all yet. Anything would need to be run by your vet.
My name is Jill and I live on the Hood Canal in Washington State. I have two dogs: Kiya is an aussie/blue heeler and is 12 yrs young. TJ is a 3 year old Jack Russell. They keep me on my toes.
Mickey and his pancreatitis brought me to Epi4dogs.com site in 2012 to help manage it.

Mickey, Jack Russell. Chronic Pancreatitis. Dianes enzymes, 1/8t 3x/day with meals.
6/1999 - 8/2014

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miamunchkin
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State: California

Re: Any Advice or Suggestions

Post by miamunchkin » 30 Aug 2018, 20:40

Thanks for getting back to me!

HP diet just stands for hydrolyzed protein so she's already on that, Creon is made out of porcine enzymes (the same thing as Viokase-V), and TLI is 2.6.

We've got a pretty good handle on what she's allergic, too, in terms of food (except for novel proteins like duck or kanga roo), but plant enzymes are her only option at this point unless there's something else available besides porcine and bovine.
Danielle

Mia is a 3-year-old Jindo-terrier mix. She was diagnosed with SIBO in April 2018, IBD in June 2018 and EPI in July 2018.
She currently eats Royal Canin HP Diet food, 4/3 cup every 2 or 3 hours until her conditions are under control. Plus some fruits and vegetables like watermelon and carrots.
Every 2-3 days, she gets 1 ml shot of B12. Every day, omega-3 (on temporary hold), spirulina, vitamin K.
Enzymes are Papain mixed in with canned sweet potato, spirulina, HP diet treats and kibble.
Right now, she is 18.8 pounds.

8/18/2018 Fasting Serum TLI 2.6 mcg/L, cholesterol level (too low to measure), Creatinine (low 0.4/0.5), Amylase (low 119/290), WBC (high 17.4/ 15.5)

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jilbert57
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Re: Any Advice or Suggestions

Post by jilbert57 » 30 Aug 2018, 21:38

I was thinking with the Creon being enteric coated it might help.
Thanks for responding to my questions.
My name is Jill and I live on the Hood Canal in Washington State. I have two dogs: Kiya is an aussie/blue heeler and is 12 yrs young. TJ is a 3 year old Jack Russell. They keep me on my toes.
Mickey and his pancreatitis brought me to Epi4dogs.com site in 2012 to help manage it.

Mickey, Jack Russell. Chronic Pancreatitis. Dianes enzymes, 1/8t 3x/day with meals.
6/1999 - 8/2014

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miamunchkin
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Country: United States
State: California

Re: Any Advice or Suggestions

Post by miamunchkin » 30 Aug 2018, 22:58

Thanks for pointing that out -- I didn't think of that at all. I'll definitely bring that up with the specialist. I had heard though from the first internal medicine specialist that enzymes not put directly into food aren't very effective? Or maybe he just meant the tablets.
Danielle

Mia is a 3-year-old Jindo-terrier mix. She was diagnosed with SIBO in April 2018, IBD in June 2018 and EPI in July 2018.
She currently eats Royal Canin HP Diet food, 4/3 cup every 2 or 3 hours until her conditions are under control. Plus some fruits and vegetables like watermelon and carrots.
Every 2-3 days, she gets 1 ml shot of B12. Every day, omega-3 (on temporary hold), spirulina, vitamin K.
Enzymes are Papain mixed in with canned sweet potato, spirulina, HP diet treats and kibble.
Right now, she is 18.8 pounds.

8/18/2018 Fasting Serum TLI 2.6 mcg/L, cholesterol level (too low to measure), Creatinine (low 0.4/0.5), Amylase (low 119/290), WBC (high 17.4/ 15.5)

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jilbert57
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Re: Any Advice or Suggestions

Post by jilbert57 » 30 Aug 2018, 23:05

Creon is very effective. It is widely used. Might be worth a go😊 If you look up the enzymes tab you can find the research on Creon. Good luck.
My name is Jill and I live on the Hood Canal in Washington State. I have two dogs: Kiya is an aussie/blue heeler and is 12 yrs young. TJ is a 3 year old Jack Russell. They keep me on my toes.
Mickey and his pancreatitis brought me to Epi4dogs.com site in 2012 to help manage it.

Mickey, Jack Russell. Chronic Pancreatitis. Dianes enzymes, 1/8t 3x/day with meals.
6/1999 - 8/2014

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miamunchkin
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Posts: 16
Country: United States
State: California

Re: Any Advice or Suggestions

Post by miamunchkin » 30 Aug 2018, 23:45

Definitely, I will! Thanks for your help :)
Danielle

Mia is a 3-year-old Jindo-terrier mix. She was diagnosed with SIBO in April 2018, IBD in June 2018 and EPI in July 2018.
She currently eats Royal Canin HP Diet food, 4/3 cup every 2 or 3 hours until her conditions are under control. Plus some fruits and vegetables like watermelon and carrots.
Every 2-3 days, she gets 1 ml shot of B12. Every day, omega-3 (on temporary hold), spirulina, vitamin K.
Enzymes are Papain mixed in with canned sweet potato, spirulina, HP diet treats and kibble.
Right now, she is 18.8 pounds.

8/18/2018 Fasting Serum TLI 2.6 mcg/L, cholesterol level (too low to measure), Creatinine (low 0.4/0.5), Amylase (low 119/290), WBC (high 17.4/ 15.5)

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Jean
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Pet name: Kara
My name: Jean

Re: Any Advice or Suggestions

Post by Jean » 31 Aug 2018, 03:33

for years we have had the odd person who's dog cannot tolerate porcine enzymes

my girl is intolerant of most proteins, but she strangely does tolerate porcine enzymes

have you had tests for intolerances, I am aware that there are tests in USA I will reach out to Maddy for you

there are folk who had no choice but to go towards plant enymes, and if this is what you have to do, then so be it

can you give us the test results you have for the blood tests you have had taken

Creon although enteric coated is porcine, and will react if your dog is intollerant

please ask away

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 use Panzym enzymes, Tylan and Chemeyes b12 capsules

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


Jeanx

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Riley's Mom
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Re: Any Advice or Suggestions

Post by Riley's Mom » 31 Aug 2018, 07:23

Good morning
I agree with Jill, maybe there are too many things going on right now and it's become hard to pinpoint what is working and what is not for your pup.
Creon is a good alternative to powered enzymes. Sometimes even if a dog has a pork allergy, they can tolerate it.

If it were me, I would take her routine back to the very basics, then slowly add things in one at a time (waiting 3-5 days between each change) keeping careful notes to help determine what is working and what is causing problems. Sometimes when our pups struggle, our first inclination is to throw everything at them to try to help, but too much all at once can muddy the waters. Keep it simple at first if you can.

I know it is very difficult to manage IBD and EPI at the same time, but the reality is that with EPI, your dog must have some type of enzymes or she can not digest what you feed her. What dose did you start with the Viokase-V initially? Because you have concurrent conditions, it may be hard to figure what is causing the loose stools, but certainly too low a dose of enzymes could be the culprit as well as the IBD.
I know your head must be spinning, remember to run anything we suggest by your vet.
Elisabeth

Riley is a 10 year old Labradoodle. She was diagnosed with EPI in 2014.
She currently eats Taste of the Wild, I cup in the morning, 2 cups in the evening, each meal with 1 Wonderlabs B12 sprinkled over her dinner. Enzymes are EnzymeDiane, 1 tsp per cup of food, mixed in home made bone broth. No other supplements or meds at this time.
Riley currently weighs about 44 pounds, which is pretty heavy for her.

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Olesia711
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Re: Any Advice or Suggestions

Post by Olesia711 » 01 Sep 2018, 16:23

Oh dear..... poor little Mia and Poor you too!!!! It is so discouraging to try so many things and not seem to figure out what will help our pups................................

Just reading these posts, i am wondering if the problem is not so much the enzymes, but rather SID. I see that your vet prescribed Metronidazole, but i cannot even begin to tell you now many dogs with EPI and of course SID could not get the SID under control when on the Metronidazole. ANd of course many thought that either the enzymes were not working or that the pup was having an allergic reaction to the pig enzymes- -and like you they switched to plant enzymes and in some cases it helped a little but not much or it appeared to help for a short period of time and then everything went downhill fast.....

Because of some of what you are saying is sounding very familiar to what a few others have dealt with in the past....things simply did not work out well until they until they started using Tylan instead of Metronidazole. and then switched back to pig pancreas vs. the plant pancreas.

the timing of this sounds about right too and so does the sequence of degrading events.... so, although i cannot guarantee this... i am just wondering if maybe you should try Tylan while still on plant enzymes, stay with the Hydrolyzed food cause your pup sounds like it really does have IBD and you are correct, do not keep changing proteins ....and stop most everything else that is not essential- -also you DO NOT want to jsut stop Prednisone,,,,ever- -needs to be withdrawn and if your vet put your pup on it for the IBD--you do not want to change course with pred UNLESS your vet advises you first!!!)

But..... regarding the other stuff like the fruits, veggies, etc- -stop it all.... and even stop the both the probiotics and prebiotics for now..... (can be added back later... maybe)...... Basically strip everything down, to simply:
  • Hydrolyzed food
    Enzymes
    B12
    Tylan
    Pred
give things time to settle down..... and then after a few weeks... try adding ONLY 1 thing at a time to see what the tolerance is for each item separately..

I know this is crazy, but we have had dogs here have reactions to the weirdest things.... like sunflower oil, soy, FOS, pumpkin... many times things that are supposedly good for the dog,... but you just don't know......so it can be a minefield.

AND then... just my observations .....but sometimes when a dog is highly sensitive to something... it starts to look like they are allergic to everything when in reality they are not.

Just a crazy personal example.... i thought for years my oldest dog was allergic to chicken... and chicken is everything, so you can imagine my issue trying to give him ONLY stuff without any chicken in it... well... after a few years.... i decided to try hi quality fresh free range chicken (for people) no antibiotics/chemicals, nor puffed up with broth fillers, etc..... i baked it, skinned it and OMG... he had no issues... that was over 10 years ago. (he is 15 now) and he still east free range home-prepared chicken and does fine! And for those few years, i drove myself nuts thinking he was allergic to chicken... he wasn't.. he was allergic to the crap they put in chicken!
Olesia, owned by Izzy, a 35lb Spanish Water Dog (SWD), Diagnosed at 1.5 years old - TLI results 1.3, Doing great 12+ years later! Once stable at 3+ months, was able to reduce enzymes to only 1/2 tsp of Enzymes (use EnzymeDiane's 6x) with each cup of food, but as she aged- -had to go back 1 tsp enzymes per cup of food. Fed various grain-free kibble+real meat, 6x pancreatin enzymes from EnzymeDiane., gave 1 tsp of coconut oil / fish oil daily .... until she developed Diabetes and she now cannot tolerate higher fat foods. Currently feed an 80% home-made diet of sweet potato, a lean meat/fish, 1/3 of a raw egg, fat free cottage cheese, fish oil+vitamins and bone meal with 20% Annamaet Lean & Grain Free kibble. This combo has regulated her Diabetes (takes Vetsulin) and EPI and is very well managed. In Feb 2013, Izzy developed a very serious condition called IMHA which she (thankfully) beat and is now in remission. This is when we discovered that she also developed Diabetes & Low Thyroid. Izzy was able to receive excellent care because of the generosity of folks on Epi4dogs! Izzy continues to wake up every day full of joy. I am not a vet. All of my suggestions/recommendations are based on personal experiences, observations, information gleaned from EPI researchers & pet parents alike, and EPI research. Please share with your vet everything we suggest.

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