New to EPI

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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Elle05
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Posts: 6
Country: United States
State: Washington

New to EPI

Post by Elle05 » 02 Sep 2018, 00:53

Hello,

I adopted my 5 year old fur baby Chester about a month ago. He had EPI when I adopted him and I felt fine managing a chronic health issue as I had a dog that had diabetes and would get flares of acute pancreatitis. But when I got him home, later in the week after I had picked up his stool I noticed that all too familiar yellow and soft pile. His paperwork/vet records said he’s been well managed on prozyme (3/4 tsp per a cup). But the more I research I learn that he’s not getting all that he needs to from that supplement??? Which is probably why he’s always so hungry... I got him a b12 injection at the vet and had a new prescription of pancrezyme filled. I don’t love the food he’s on but because he’s having issues and his condition isn’t stabilized, I’m not exactly jumping to change that; for the record, his current food is the I/D sensitive digestion low fat. He also gets a daily probiotic (his previous owners, the ones who surrendered him had him on antibiotics for awhile). I am noticing that he’s quite itchy, no fleas and he gets treated for it, so I’m spraying him with oatmeal, no dander or rashes. He’s also been getting Pepsid for acid reflux. I also do the whole spritz food with water and then sprinkle the enzyme, shake the food to evenly distribute and wait about 30 min to give it to him

My questions are how was he stabilized on prozyme before?

Do you think his itching is because he’s lacking vital nutrients from his food?

How long will it take to stabilize him on this new medication (he gets 1 tsp per a cup of dry kibble)? He’s been on his new meds about a week. Do you think he needs more? He’s only ~15 lb Manchester terrier.

Thanks a ton for reading,
Elle
Chester is a 6 year old Manchester terrier adoptee (adopted at 5 with EPI) on porcine enzyme powder, B-12, Pepsid, Spirulina, Zinc and Salmon oil. He enjoys chasing squeaky things in Washington state and being an assistant to his foster siblings and Mobility Service dog trainees. Boy is this fellow tolerant of his insecure buddies!

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Jean
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Location: South Liverpool
Country: United Kingdom - England
Pet name: Kara
My name: Jean

Re: New to EPI

Post by Jean » 02 Sep 2018, 05:50

a huge welcome from us in UK

You got that right, Prozyme is only a plant supplement

to answer your final questions first,

it depends on their evaluation of stable , to us it means consistent properly formed poops, and weight gain

as for the itching , yes, I would say he is struggling with his skin not getting the proper nutrient, perhaps some coconut milk or oil rubbed into his skin, or maybe just a bath, he might feel dusty


he does not NEED low fat food and the prescription foods are expensive and sometimes have loads of grain

over the years (9 for me) we have found grain free works well, and that includes rice

also give 150% of the food for the weight he SHOULD be over a few meals if you can fit that into your daily routine

keep a diary, or log write EVERYTHING down

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

or keep a large notebook

only change one thing at a time, and record the outcome

you might want to look at Enzyme Diane

https://enzymediane.com/

although it does say supplement, it is the porcine requirement for an EPI animal

the other point is antibiotics, did the home you got him from have him on antibiotics

he could well have SIBO, Small Intestinal Bacterial Overgrowth, does his belly make noises, if so he may need a course of Tylan

also he should have a weekly injection of b12, Make sure its the generic dark pink in colour, we had 12 weeks

we are here 24/7 as we are all over the world

so ask away

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 use Panzym enzymes, Tylan and Chemeyes b12 capsules

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


Jeanx

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Madelon
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Posts: 871
Location: Nashville, TN
Country: United States
State: Tennessee
Pet name: Doc

Re: New to EPI

Post by Madelon » 02 Sep 2018, 12:52

Hi Elle and welcome to our EPI family. Your little Chester is a cutie pie :). As Jean said, we consider EPI dogs to be stable when they have good poops and weight gain for a few months.

There are four cornerstones to properly managing EPI: Enzymes (glad you have the rx enzymes as the ones you were using were not strong enough - starting dose is 1tsp per cup of kibble, mix in some luke warm water then mix kibble and sit 20-30 minutes before feeding. Most of us use Enzyme Diane Pancreatin 6x as it is MUCH less expensive than the rx enzymes from the vet); B12 (do you know what the current B12 level is? EPI dogs need their B12 in the upper range of normal 600+ - after following the 6 week protocol we recommend either continuing with the shots or switching to WonderLabs PetFactor B12 pills - it has intrinsic factor which helps with absorption - either way B12 supplementing is for life with these dogs); Antibiotics (if needed for treating SID we recommend Tylan for 45 days and slowly wean off); Food (grain free with 4% fiber or less - feed 150% of the food for the weight your dog should be but in smaller, more frequent meals throughout the day).

With regard to the food - if there's no other medical condition requiring rx food then I would go ahead and switch to grain free 4% fiber or less as we recommend.

We recommend using the proper protocol of food, enzymes and B12 for about 2 weeks to see if the gut flora will rebalance itself and give you good poops, which is partly why you should go ahead and switch the food. Then if you are still having bad poops you can try slippery elm bark powder or antibiotics.

Please let us know how things are going - we are here to answer any questions you may have as it takes a village to raise these pups :)
MADELON and Doc. DX EPI and SIBO: 5/22/2015
Test Results: (1st) 7/2014 = TLI 16.5, B12 894, Folate > 24; (2nd) 5/2015 = TLI < .4, B12 406; Folate >24; (3rd) 10/2015 TLI < .4; B12 >1000; Folate 14.4. Prior to DX: May 2014 (2mos) - DX coccidia/bladder infection; July 2014 (3mos) 1st EPI test = TLI 16.5, B12 894, Folate >24 - Dx SIBO not EPI; Feb 2015 thru May 2015 - weight loss only; May 2015 vomitted several times, diarrhea and eating poop. Regimen: 4 cups Sport Dog Food Elite Herding - Diane 6x 1tsp per cup; 1 WonderLab PetFactor B12 2x day; 1/2tsp Slippery Elm 2xday; Multivitamin; 1 Zyrtec 10mg 2x day; Salmon Oil

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Olesia711
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Location: North Carolina
Country: United States
State: North Carolina
Pet name: Izzy

Re: New to EPI

Post by Olesia711 » 02 Sep 2018, 15:58

Hi Elle and thank you so very much for adopting an EPI pup...... we will do our very best to help you get him on the right protocol.

BTW,,, he sure is a real cutie!!!! And the great thing with most of these EPI dogs.... is, for whatever reason, many of them become that "once-in-a-lifetime" companion.... you'd be amazed at how many of us will attest to this!!

Okay... Madelon and Jean explained the most important basics .... the trick to effectively managing EPI is the 4 aspects that were mentioned above AND learning what is the best balance of each of these 4 aspects so that your individual EPI pup has an optimal response :).

Dealing with EPI is like dealing with dominoes, everything affects another. In addition to what was mentioned above, my guess is that your little pup has battled uncontrolled SID not only because all EPI dog have SID but he was not given the proper enzymes which that in itself will encourage SID. I am glad it was mentioned to try EnzymeDiane
https://enzymediane.com/shop/ ... as many of us use her enzymes... most of us get the 6x- -that is most comparable in strength to the brand name porcine enzymes (pig enzymes not plant enzymes!). You pay approximately the same as the brand name enzymes HOWEVER, you get 3 times the amount of enzymes :):):)

Next... the food... although not every single EPI dog, but "most" EPI dogs do better with food without grains in it... so in the beginning we suggest trying a food with no grain in it and read the ingredients... try to go with a food that says 4% fiber content (many times even less fiber is better ... like 3.5% or 3%, etc). BUT start with just the smallest bag possible to see if it agrees with your pup.... just because 1 EPI dog goes great on one food is no guarantee that the next EPi dog will do as well on the same food. We give general guidelines, but after that it is all trial and error:
Guidelines are:
1. start with grain free- -look at fiber content, 4% or less usually works better

2. avoid foods that triple dip into pea ingredients (example, peas, pea protein, pea flour) = a lot of low-end cheap fillers

3. many of or dogs (but not all) seem to do better with a fish base food...so you might want to start with this just in case Chester dos better with fish... but like i said, no guarantees...

4. the B12.... over 80% of all EPI dogs need B12. Good thing is if not needed and supplemented, they'll pee out any extra.

5. About B12- - with EPI dogs, if they need B12, they must be on it for life- -too many vets make the assumption that once the B12 level is brought up they no longer require B12... WRONG! EPI is a lifelong chronic condition, so once the B12 levels are brought to upper mid-range, then you and your vet need to assess and going forward give "maintenance" B12 .. whether weekly, bi-weekly or monthly... but it should not be stopped.

6. SID.. UGH! before we suggested starting right away with antibiotics. Now we suggest doing the recommended protocol and give stuff a week or two to see if that is enough to get the SID (messed up gut flora) under good control.. .. if the stools are still sloppy after a few week, then the first adjustment you should consider is treating SID, what we now suggest is to try a prebiotic for a few days like SLippery Elm powder .. it is a prebiotic. it feeds the bacteria...which is what is needed. (see the SLippery Elm page https://epi4dogs.com/slippery-elm/ . SLippery Elm is cheap and usually very effective almost immediately. If you do not see any improvement after a few days on SLippery Elm.... THEN have a conversation with your vet about giving Chester Tylan antibiotic/twice a day for 45 days. Dosing instructions are in the SID section https://epi4dogs.com/antibiotics/.

And as Jean mentioned..... start keeping an EPI Log... it will save your sanity... because finding the right balance of the 4 aspects of EPI is just too much to remember... best to keep a record AND this log will also help you and your vet figure out what is really going on in CHester's little gut without doing any invasive tests and spending tons of money :)

Hope this helps a little,
Please feel free to ask any quesitons!
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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Elle05
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Posts: 6
Country: United States
State: Washington

Re: New to EPI

Post by Elle05 » 02 Sep 2018, 18:54

Hello,

Oh thank you for the replies! He was on a 45 day course of antibiotics just prior to the humane society (according to his records—he’s been on those twice).

As for food:
I do have this food as well(a brand new bag),
https://www.chewy.com/farmina-natural-d ... ional-Info

It’s low fiber ~2.9%, ~18% fat, no pea protein, low grain ~20% organic spelt and organic oats, low ash and made in the USA with USA sourced meats and fish.

I have a salmon oil omega 3 and 6 daily supplement oil.

This is his current daily food, https://www.chewy.com/hills-prescriptio ... /dp/140298

So the starting dose is 1 tsp per a cup of food?

I will definitely try the coconut oil.

I have pernicious anemia actually, ha. So I do monthly shots now because I can’t digest and process b-12 because I don’t have the intrinsic factor (min was 104 when I found out) but I’m going to get his levels tested now after about a week here.

Should I try grinding his food? It seems like the more evenly distributed across all of the food the better, otherwise the food doesn’t get digested?

Should I continue to put the prozyme on there as well?

A diary is a great tool! I’ll make sure to start one!

I have been giving him more smaller meals throughout the day and have been trying to give more food than normal. I put it in the slow feeder bowls because he was gulping down his food in less than a minute and I thought that probably didn’t help his tummy or his gas (which has 95% disappeared since then).

When he is stabilized, will it be less in amounts per a bowel movement? He uh, definitely goes quite a lot.
Chester is a 6 year old Manchester terrier adoptee (adopted at 5 with EPI) on porcine enzyme powder, B-12, Pepsid, Spirulina, Zinc and Salmon oil. He enjoys chasing squeaky things in Washington state and being an assistant to his foster siblings and Mobility Service dog trainees. Boy is this fellow tolerant of his insecure buddies!

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Olesia711
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Posts: 1117
Location: North Carolina
Country: United States
State: North Carolina
Pet name: Izzy

Re: New to EPI

Post by Olesia711 » 02 Sep 2018, 20:25

poor baby... if they had him om two 45-day courses of Tylan.... he's had bad SID... and it was not getting under good control and my guess is most likely because they did not have him on the right enzymes *sigh*..........

the food you have "sounds" like a very hi grade food, but it may or may not work for him because it is made with whole spelt and whole oats. what you can do is go out and buy a very small bag of Taste of the Wild "Pacific Stream" ... try this with the enzymes.... watch the poos closely (give it up to 3 to 5 days) before you make a decision if he appears to tolerate it well.... if he does tolerate it well.... after a few weeks, THEN try mixing 1/2 Farmina with 1/2 Taste of the Wild.... watch the poos closely, again for 3 to 5 days....don't laugh, but even take picture of the poo ... and compare if it appears that he is tolerating the Farmina or not... if yes... then after a few days give all Farmina and again watch the poos and see how he does.

This is the only way to really assess which foods will work with Chester and which foods won't.
The deal with the grain is that grain may inhibit the enzymes activity anywhere from 0% to 50%.... and the problem is that we just don't know how which dog will be affected..... This is why we suggest starting with food with no grain and low fiber content.

YES.... 1 tsp of pig enzymes per 1 cup of food... add approx 1/4 to 1/3 cup of room temp water, mix and let sit for 20 to 30 minutes, stir again and serve... some of us add stuff, like real meat to the meal :)

No you don't have to grind the meal..... but if you want to you are welcome to.. if you do decide to grind the food know that you only have to do it for a little while.... once the body settles, it is really not necessary at all.

No don't use the Prozyme, no need to once you have the proper "porcine" enzymes... just save it in case you ever run into an emergency and run out of the real enzymes.... jsut as a temporary backup.

EXCELLENT that you are feeding small multiple meals throughout the day.... you are correct, they are starving but cannot handle large amounts of food during a meal- -much better to feed smaller portions, just more meals and consequently by the end of the day, actually giving more food total :)

YES.... after they gain back most of their weight, they will often stop finishing everything in the bowl... and that is when you start cutting back on the amount of food. For example. my gal was 27lb when she was diagnosed. She was getting 9 cups of food and still losing weight, once i started the enzymes, i was able to give her 6 cups of food and over the course of 3 months she stabilized and i reduced the food to 4 cups- -fed 3 times a day, by the time a half year/+ passed, she was back to getting 1 cup of kibble (topped with lots of real meat) for breakfast and then again for dinner... only twice a day :) So as they improve, yes, the food amount and feedings decrease.....

AHHHhhhh so you know all about the intrinsic factor :) Many of us use Wonderlabs Trinfac (or Pet Factor B12) pills made with 1000mcg Methycobalamin + 800mcg Folate + 40 mg of Intrinsic Factor :) sometimes these pills even work better than the Cyanocobalamin shots..... but every so often, there will be a dog that does better on the shots. I swear it can be a real crap shoot...................
Hope this helps!!!
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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Madelon
President
Posts: 871
Location: Nashville, TN
Country: United States
State: Tennessee
Pet name: Doc

Re: New to EPI

Post by Madelon » 02 Sep 2018, 23:39

As usual Olesia has covered everything so I won't muddy the water any :) . I am one who grinds the food - I had the same thought as you did when first diagnosed so I started grinding food immediately and we are 3 1/2 yrs in and I still grind - why? - because if it ain't broke don't fix it - LOL. Be sure to keep your detailed journal of everything as it will help you figure out this EPI puzzle.
MADELON and Doc. DX EPI and SIBO: 5/22/2015
Test Results: (1st) 7/2014 = TLI 16.5, B12 894, Folate > 24; (2nd) 5/2015 = TLI < .4, B12 406; Folate >24; (3rd) 10/2015 TLI < .4; B12 >1000; Folate 14.4. Prior to DX: May 2014 (2mos) - DX coccidia/bladder infection; July 2014 (3mos) 1st EPI test = TLI 16.5, B12 894, Folate >24 - Dx SIBO not EPI; Feb 2015 thru May 2015 - weight loss only; May 2015 vomitted several times, diarrhea and eating poop. Regimen: 4 cups Sport Dog Food Elite Herding - Diane 6x 1tsp per cup; 1 WonderLab PetFactor B12 2x day; 1/2tsp Slippery Elm 2xday; Multivitamin; 1 Zyrtec 10mg 2x day; Salmon Oil

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jilbert57
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Posts: 910
Country: United States
State: Washington

Re: New to EPI

Post by jilbert57 » 03 Sep 2018, 09:46

Wow, everyone has covered it so far in the above posts so I just say welcome to the forum and thank you for adopting an EPI pup!
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 13, TJ is a 4 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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Riley's Mom
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Country: United States
State: Virginia

Re: New to EPI

Post by Riley's Mom » 03 Sep 2018, 09:59

I just wanted to add my welcome as well.
Thank you for taking in an EPI pup. As Olesia said, many of us have a super close relationship with our EPI pups and they have become that "once in a lifetime" pet.
Please ask questions as you have them, lots of activity on this forum and someone is almost always on or about to be....lol
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.

Barb
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Posts: 419
Country: United States
State: New Jersey

Re: New to EPI

Post by Barb » 03 Sep 2018, 15:00

What a lucky pup to be adopted by you!

It sounds like everything was covered beautifully, so I will just say Welcome! So glad you are giving a pup with EPI a chance for a normal, healthy life.

I heartily endorse keeping a log/journal. It saved our sanity.

Ask any questions you have.

Barb

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