Any Tips on Enzyme Dosage?

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.
afairbairn
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Posts: 14
Country: United States
State: Colorado
Pet name: Hana
My name: Andy

Any Tips on Enzyme Dosage?

Post by afairbairn » 12 Jun 2021, 09:58

So our 1 year old golden doodle Hana is on quite the journey. Since March she has been diagnosed with Myasthenia Gravis, Megaesophogus, EPI, and more recently MMM. Quite the lottery she has won. Before all of this she was about 47 lbs at her heaviest but had a history of diarrhea sessions for her whole life. At her low she was about 34 lbs and is currently 38-39 lbs. So I'm suspicious EPI has been around for a while. We have recently engaged an internist to help us navigate the waters as our general vet openly admits she needs help. Heres our current regimen:


Food: 4 cans of prescription hydrolyzed protein that was prescribed by the vet with the megaE diagnosis because of the texture and thinking that there were food allergies. This was before we knew about EPI
Enzyme Diane 6x: 1.25 teaspoons per can of wet food. We currently mash up the can of food, mix the powder in, form it into meatballs, and then lit sit for 20 minutes.
Tylan: we are on 1/8 teaspoon twice a day. My guess is maybe day 35 or so with the Tylan.
Prednisone: we had been on 60mg per day but internist reduced to 15mg day. This was added with the most recent MMM diagnosis when Hana couldn't open her mouth all the way. The mouth issues seem to have been resolved for the time being but as we started the Prednisone the weight gain has stopped.
Pyridostignine: 1/2 table 3 times a day to treat the myasthenia graves
Omeprazole: 2 tablets per day to help with
Synacore Powder: 1 packet per day of this pre/probiotic.
Stools: are not super great but not terrible. They are mostly formed but pretty soft. If you need to pick them up with a bag they pretty much just turn into mush.

So after the internist visit we did get some good news that the megaE seems to have improved. She wants us to slowly try to transition away from feeding Hana in meatball form and diminishing the amount of vertical time. Time will tell if that is one hurdle that may go away. The MG also seems to be managed, so that's good. And the jaw issues also seem to be resolving so hopefully we can get off the prednisone all together. Which leaves us with sorting out the EPI.

When we left she wants us to transition off the hydrolyzed protein diet and try Royal Canin Gastrointesitinal food. So we are slowly introducing a little bit of that into each meal. Right now we are doing 4 cans of her old food and have added 1/2 can of the new food per day. She also wanted us to try to increase the enzyme powder to 1.5 teaspoons per can of food. We are on day 3 of the increased enzyme amount and the poops have gone the wrong direction and have pretty much lost all shape what so ever. It seems like maybe 1.5 teaspoons is too much?

So my thinking is maybe I try 1-1/8 teaspoon per can of food and evaluate for 2-3 days. And then maybe add 1/8 teaspoon per meal if things aren't working out? Does anyone have any suggestions on a trial and error process to get the enzyme amount dialed in?

Thanks for any input.
Andy
Hana is a 1 year old golden doodle who was recently diagnosed with EPI on top of Myasthenia Gravis and Megaesophogus.

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jilbert57
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Country: United States
State: Washington

Re: Any Tips on Enzyme Dosage?

Post by jilbert57 » 12 Jun 2021, 10:34

Welcome. Too much enzyme can produce bad poops as well as not enough enzymes. Can you measure out 1 cup wet food and try 3/4 teaspoon of enzyme mixed up and incubated?
Not sure how much food is in 1 can of dog food.

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.

afairbairn
Member
Posts: 14
Country: United States
State: Colorado
Pet name: Hana
My name: Andy

Re: Any Tips on Enzyme Dosage?

Post by afairbairn » 12 Jun 2021, 11:18

If my spreadsheet worked correctly using 1.25 teaspoons per can is the same ratio as .75 teaspoons per cup.

Oh and one more thing I forgot to post. We have done six weeks of weekly b12 shots and are switching to one per month.
Hana is a 1 year old golden doodle who was recently diagnosed with EPI on top of Myasthenia Gravis and Megaesophogus.

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jilbert57
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Country: United States
State: Washington

Re: Any Tips on Enzyme Dosage?

Post by jilbert57 » 12 Jun 2021, 11:25

Great thanks.
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: Any Tips on Enzyme Dosage?

Post by Jean » 12 Jun 2021, 11:40

Hello from the UK

BLIMEE

we have had a couple of dogs on the forum with MEGA E, and it was stabilised by feeding then from a staircase, so thay are not standing straight , i.e. they are further down the stairs with their front paws above their belly

they also do a chair which the dog fits in to

https://www.baileychairs4dogs.com/, one of our staff had to use something similar with her 120 pound shepherd, not easy !

MMM I have come across in friends dog, and prednisone was prescribed

personally, I have not come across Myasthenia Gravis, this dog is so young to have all of this, and you are an angel

Enzyme Diane will talk to you about the correct doseage of enzyme, the rule of thumb is 1 teaspoon per 1 cup of kibble, less if its wet food, just give her a bell

Tylan is weight dosed, just scroll down

https://epi4dogs.com/antibiotics/

You are one amazing person and I will ask our founder to jump in with her knowledge

jeanx
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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Olesia711
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Location: North Carolina
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State: North Carolina
Pet name: Izzy
My name: olesia

Re: Any Tips on Enzyme Dosage?

Post by Olesia711 » 12 Jun 2021, 16:59

Hi Andy..... and WHOA... that is a lot of issues for your pup....and i thought MY Izzy had a ton to deal with (she had EPI, Diabetes, IMHA, Low Thyroid, Central Brain Vestibular Disease, juvenile Incontinence that lasted her entire life, and Rocky Mtn Spotted Fever. It was a long journey, BUT i am sharing this with you to let you know that i truly applaud you for caring for your very compromised pup, simply because as long as they are not in pain and well cared for, sometimes the most compromised pups turn out to be the best dog ever and your biggest joy. My Izzy (after dealing with all these damn health issues) starting with EPI at 1+1/2 yrs old lived until she was 15 years old and she was the funniest, happiest dog that greeted each day with joy and a list of antics that i swear i think she had secretly planned for the day just to make us laugh.

SO.....First and foremost, thank you SOOOOOOOOOOOOOoooooooooooooooooooooo much for giving Hana such wonderful care and love. She certainly found her human angel!

Here are some of my thoughts on some of the issues.

1. First, with the MegaE...... if you are interested......contact Washington State, as they were doing a study on Mega E treating with a new medication. I don't know where they are in the study, but contact them, share what you learn with your vet, because the short jest of this is that this medication, "liquid sildenafil" they think may permanently fix MegaE completely in some cases.
For information please contact Valorie Wiss, Clinical Studies Coordinator.
(Office: 509-335-0798, Cell: 509-432-5345 or vwiss@vetmed.wsu.edu).
If you talked to EnzymeDiane in the last 2 days, i just gave her this same info a couple of days ago....

2. Regarding the mushy poos with the increased enzymes... as explained, too much enzymes can produce loose stools just as easily as not enough.... and it can vary from dog to dog.

OUr "starting dose" rule of thumb" is for kibble, start with 1 level tsp of the powdered enzymes per 1 cup of food....
with wet food, start with approx 1/2 tsp to 2/4 tsp of powdered enzymes per cup of wet food..
and then adjust if needed up or down via, exactly like what you were thinking of, by 1/8 of a tsp every couple of days based on the poo output...

However... did you start the food transitioning at the same time as the increased enzymes? if so... the sloppy stools can either be from the new food you are adding in or too much enzymes.

I don't know if this would be appropriate to include in a MegaE diet.... but ask the vet if you can/should try a little slippery Elm powder... it is a mucilage, prebiotic. Often times this will add just enough of the right fiber (prebiotic) to an EPI diet to help combat SID (small intestinal dysbiosis which will often product sloppy stools) and the mucilage aspect will coat/soothe the intestines and researchers now are wondering if the reason why Slippery ELm helps "might" be because it may prevent bad metabolites from getting thru...... in any case, we really don't know why it works in many dogs (but not all) but it might benefit Hana- -but PLEASE ask your vet first if it is okay to give this to a dog with MegaE.
https://www.wonderlabs.com/itemleft.php?itemnum=K97024

If you can give the slippery Elm and if it does firm up the poo..... then that is an indication that it is the food that was not optimally agreeing with your dog.

However.. before trying Slippery Elm, i would first try adjusting down the enzymes and see if that does the trick or not, if not, then try slippery elm if your vet agrees.

If it is the food, we can try and guide you to something that might agree better with the EPI aspect of Hana's condition BUT again, you will need to get your vets approval on anything dietary we suggest because of the MegaE.

I hope this is somewhat helpful... PLEASE keep us posted.
Olesia, was owned by Izzy, a 35lb Spanish Water Dog (SWD), Diagnosed at 1.5 years old - TLI results 1.. Izzy passed away on February 13, 2020 at 15 years old. She lived with EPI for 13+1/2 years. It was because of Izzy that Epi4Dogs was started... she was the inspiration. May her legacy of helping others with EPI continue for as long as needed.........

afairbairn
Member
Posts: 14
Country: United States
State: Colorado
Pet name: Hana
My name: Andy

Re: Any Tips on Enzyme Dosage?

Post by afairbairn » 12 Jun 2021, 22:26

Thanks for all that info Olesia as well as your kind words or encouragement.

I'll definitely reach out to WSU and see what their study is about. Interestingly enough we were hopeful that the megaE may be resolving itself but then today ms Hana had a big ole throw up for the first time in awhile. So we need to be mindful of that and see where it leads. It still is clearly an issue.

My wife and I brainstormed a bit and came to the same conclusion that the food and enzyme change at the same time means you don't know what's doing what. So we are going back to just the old food. It seems like we are on the higher end of the enzyme dosage now so maybe we see where things go over the next few days then start adjusting down 1/8 teaspoon at a time. Do you think if you wait 2-3 days after a change that should be enough time to know if its working or not? I think the vets thinking was that with the amount of food she was eating she should have been gaining more weight so maybe more enzymes would get us those extra calories. Today was day 1 with just the old food and 1.5 teaspoons per 1.6 cups of wet food.

And I'll ask about slippery elm. We bought some and tried it for a bit but then stopped. Our general vet had us stop the slippery elm and put us on Synacore powder which is some kind of a pre/pro biotic. I'll run the slippery elm by the new specialist and see what she thinks about going back to it. She was also getting us connected with a nutritionist at the Univ of Georgia so we are certainly looking forward to any guidance they can give us.
Hana is a 1 year old golden doodle who was recently diagnosed with EPI on top of Myasthenia Gravis and Megaesophogus.

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Jean
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Posts: 1291
Location: South Liverpool
Country: United Kingdom - England
Pet name: Kara, lost 10th May 2019
My name: Jean

Re: Any Tips on Enzyme Dosage?

Post by Jean » 13 Jun 2021, 06:16

we have always recommended one change at a time for maybe 5 days and record everything

my journal was my best friend, it is basically a scrap book with pictures etc, and dialogue over the first 4 years

the info Olesia has give is really good, she is our researcher, founder, and my friend over 11 years, My Kara had EPI from 14 months old and was a joy to have in my life

you will get there Andy, and now you have a map to plot your journey and a lot of friends



Jx
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

Tuckaboo Pam
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Posts: 738
Country: United States
State: Florida
Pet name: Tucker
My name: Pam H.

Re: Any Tips on Enzyme Dosage?

Post by Tuckaboo Pam » 13 Jun 2021, 07:37

Andy---

I've read a lot of this thread, but I haven't read all of Olesia's usual response to new members (always amazingly generous with her knowledge), but I wanted to jump in about the Tylan. Just in case that wasn't addressed in some of what I left unread.

We use Tylan, therapeutically and routinely (Tucker does well with a smidgen daily, but occasionally SID flares & we have to do a 45 day treatment), and I just want to say that since you are on day 35, don't stop Tylan abruptly. When it is time to see if he can do without it, there is a gradual process to weaning him off, so please check back for directions on that.

To repeat what has been said, what a lucky pup you have, to have landed with such caring parents. Take care.

---Pam & Tucker
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 one capsule per day, slippery elm 1/8 teaspoon twice/day, and Tylan 1/16 teaspoon twice/day (to hold SID at bay). Sport Dog Elite, herding dogs 3 1/2 cups/day. No more poop eating, has gone from 60 to 80 pounds, 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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Olesia711
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Posts: 1987
Location: North Carolina
Country: United States
State: North Carolina
Pet name: Izzy
My name: olesia

Re: Any Tips on Enzyme Dosage?

Post by Olesia711 » 13 Jun 2021, 12:11

Hi Andy,

Good decision!..... go back to the old food and just play around with the enzyme dose FIRST..... i typically say at a minimum give it 3 days simply because dogs transit time food to poop can be anywhere from 12 hours to 72 hours.... but if you can give it 5 days like Jean suggested, that would be best. And then if it is not the enzymes causing the loose stools.... go ahead and do add the new food to "proof" it to make sure that it was the food that was the culprit.

REgarding Slippery Elm vs Synacore..... the Synacore has very good ingredients in it..... but that is the problem with ALL off the shelf Pre+Probiotics..... it is kind of a hit or miss thing because each dog has it's own unique gut flora population, and vets and the pet industry can only offer us one-size fits-all products.... and they don't all fit every dog's gut flora situation. Also...... certain types of fiber is what actually helps control SID (small intestinal dysbiosis).... and prebiotics are a fiber.... BUT.... too much of a prebiotic can also give gas, loose stools, etc..... so.... this is why some dogs actually develop loose stool from pre+probitoics.... and yet, in the end, pre+probiotics is what may actually help improve a gut flora population that is lacking (like in EPI dogs)..... it's a crazy balance you have to walk. ANyway... although there are no guarantees with Slippery ELm, you can at least control the amount of fiber you give, and if it helps but not enough, then you can move on to a pre+probiotic product.... in which case we suggest starting with less than half the dose and working your way up to the full recommended dose over the course of a week or two..... giving the gut a little time to get acclimated to the pre+probiotic. Also... with EPI... you have to be careful with how much fiber is given..... our dogs need it, but only certain types of fiber are better and only in limited doses.... and then you have to remember that with EPI dogs, when you give them enzymes,,,, the enzyme efficacy is also destroyed by fiber anywhere from 0% to 50%..... we jsut don't know how much destruction will take place from one dog on enzymes to the next.... if at all. This is why we "suggest" starting with a low fiber food (4% or less fiber content) with an EPI dog and see how things go... If all goes well.... after a bit try food with a little grain in it or add your own grain in limited amount (like rice) just to see how well or if your EPI dog now on enzyme can tolerate fiber........

So many things to juggle, eh?! Great thing is when tryin all this stuff, at least with EPI, if things go south, you can make adjustments and get back to normal.

Someday soon, i hope the researchers will come up with a more "targeted'" per+probiotic geared towards similar gut flora issues depending on the gastro health concern..... IMHO.... that is when we will really start seeing some progress.....................

SOOOOooooooooooo all this to say.... start keeping a journal/EPI Log..... like mentioned above... it will REALLY help you and your vet better help Hana feel better. Take pictures that show what happens to the poo after you make a change. You'd be amazed at sometimes it is the smallest, inert ingredient in something that is a trigger for the loose stools! But the good nes is, once you figure out what works and doesn't work for Hana.... maintaining her EPI will not be much trouble at all... it is just in the beginning when you are trying to figure out things that it can be real trying to say the least.............
Olesia, was owned by Izzy, a 35lb Spanish Water Dog (SWD), Diagnosed at 1.5 years old - TLI results 1.. Izzy passed away on February 13, 2020 at 15 years old. She lived with EPI for 13+1/2 years. It was because of Izzy that Epi4Dogs was started... she was the inspiration. May her legacy of helping others with EPI continue for as long as needed.........

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