New Diagnosis and Treament Not 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.
ssmith
Member
Posts: 30
Country: United States
State: South Carolina
Pet name: Harmony

New Diagnosis and Treament Not Working

Post by ssmith » 18 Oct 2021, 09:34

Hey, I am new to the forum and honestly joined out of desperation for help. I have a two year old German Shepherd named Harmony, and she started having some issues around 3 months ago. First it started out as diarrhea, and it started when we changed her from puppy food to adult food. Our other female GSD Tsunami had some too but hers went away and Harmony's didn't. I took her to the vet, and they dewormed even though she tested negative and put her on metronidizole. It didn't work so they did an ultrasound and saw severe inflammation throughout her entire digestive tract. They thought Inflammatory Bowel Disease, so they put her on prednisone, tylosin powder, and an immuno suppresent (i dont remember the name). Her diarrhea still didn't go away and was that pale color of EPI stool. We went back to the vet and showed him pictures, and he switched his diagnosis to EPI (didn't run the test because he knew thats what it was, and I can't afford the test). I guess I should say I am a teen and am paying all her bills myself that have added up to 1,000. So the vet put her on pancreatic enzymes (1 scoop at each meal), kept her on tylosin, the immuno suppresent, and uped the prednisone. She still didn't respond to treatment and she is skin and bones at just 42 pounds when her sister is a little over 60. Her diet is currently Purina One Large Breed Formula mixed with one cup of cooked white rice, two big blobs of pure pumkin from a can, about one fourth a can of green beans, and a few chunks of sweet potatoes twice a day. I was told by the vet she needs fiber so this is what they planned out for her. Still no improvment. I took her back to the vet on Friday and she got a steriod shot because they did another ultrasound and there was still severe inflammation despite high doses of predinisone. He said it looks like she isn't absorbing anything. He also uped her enzymes to two scoops per meal, kept her on the immuno suppresent, tylosin powder, and added folic acid and B12 injections weekly. He told me to call him today hoping the steriod would help. I still havn't seen any improvement. He wants her on a hydrolized dog food (some kind of special vet food) but it is 100 dollars a bag for 25 pounds that would last maybe a month if i am lucky with how much she eats. Add her vet bills and meds and I am at 400 dollars a month which I can't afford. My baby is so thin, and I feel so badly. Should I bite the bullet for one month and buy the food to help jump start her to getting better and then switch her back to maybe something else thats cheaper? What am I doing wrong? Please help!

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Olesia711
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Posts: 3857
Location: North Carolina
Country: United States
State: North Carolina
Pet name: Izzy
My name: olesia

Re: New Diagnosis and Treament Not Working

Post by Olesia711 » 18 Oct 2021, 11:25

Hi Harmony's mom.... and thank you so much for contacting us. And HUGE praise to you, as a teen for taking on Harmony's health, care and health expenses... that is a LOT! We will try to help you as best we can. My responses will be prefaced by the fact that you are very limited in finances. But, i just want to say upfront.... although there are no guarantees....... before you lose heart, please know that we have seen situations like this before for a variety of reasons.... and usually, once you find the cause, these dogs start improving dramatically.

1. So... just a FYI.... you really should do the proper test to test for EPI... but i understand the lack of funds... so TEMPORARILY..... let's approach this as if your dog DOES have EPI.... but please do try to save up the money for this . Too many times some dogs were treated for EPI and in the end it turned out it wasn't EPI and the dog passed from something else that could have been treated....

2. First i would like you to do everything that you are doing right now BUT measure the pancreatic enzymes via 1 level tsp per 1 cup of food, add enough water to moisten the food with the enzymes, let sit for 20 minutes and then serve the food. Do this for at least 3 to 5 days and let us know if there is any improvement..........
(i am assuming you are giving pancreatic powder- -please let us know the brand name of the enzymes!!!!)

3. Next, if you see absolutely no improvement with the enzyme protocol i suggested above, ...... then i agree with your vet about the hydrolyzed food because many times when we see this type situation it is because the dog has IBD + EPI..... BUT.... since funds are limited... what i would suggest for you to try first is either of the following:
(a) just try a homemade meal with NO grain in it to see if it is the grain in Purina ProPlan and if that is why while on enzymes you are still seeing loose and pasty stools. Try a simple diet (temporarily) of 25% sweet potato and 75% meat and/or fish and just add in a cooked veggie like squash, or a small amount of cooked kale, or just include the green beans like you have been doing. NO GRAIN!
(b) buy a very small bag of something like Taste of the Wild "Pacific Stream" version food and Try this for a week and see if you notice ANY difference. Let us know what the poo looks like.

What i am trying to assess here is if the enzyme technique is not being done properly or if it is nothing more than the grain in the food perpetuating this issue. Unfortunately grain (fiber) can inhibit the efficacy of the enzymes from anywhere between 0% to 50% and we just don't know from one dog to the next who is going to be affected and by how much... hence the "no grain" to start with. HOWEVER... your vet is also correct, as dietary fiber IS one of the things that address/helps SID (small intestinal dysbiosis/ display with loose stools) which ALL dogs with EPI have... so the way we work around this is remove food that has grain in it since we cannot control the amount of fiber in that grain.... BUT... instead we actually add our own "controlled" amount of dietary fiber by way of of adding 1/8 to 1 tsp of (cheap) slippery elm powder (a prebiotic and mucilage natural dietary fiber) or a tsp of (cheap) canned pumpkin..... or... we also often straighten things out (if what you are seeing is out-of controlled SID) with certain (expensive) pre+probiotics, like Visbiome or Proviable... but there is a administration technique we use to avoid even more initial diarrhea.

If either implementing the proper enzyme technique or food with no grain doesn't work... then yes, please do try a hydrolyzed food... please suggest to your vet that the hydrolyzed food that appears to work better in many cases (althou not all cases) is the Royal Canin "Ultamino" hydrolyzed food....

4. Your vet is also correct about the B12 supplementation..... please give the B12. To save money, ask the vet if he can sell you the bottle of serum and teach you how to give the cyanocobalamin B12 at home.... later, if you want you can consider switching to Wonderlabs Pet Fact B12 pills made with Methylcobalamin, Folate & Intrinsic Factor... if you want to try giving a pill instead or if the cyanocobalamin doesn't appear to be worked as expected. MAny of these dogs with chronic gastrointestinal conditions have trouble with their B12 levels, not just dogs with EPI... so supplementing with B12 is a good next step.

please be sure to share what we are suggesting to you with your vet. The best treatment Harmony can receive will be with you, your vet and Epi4Dogs all working together to help Harmony.

Oh... and feel free to post poop pictures here...very often seeing the actual poo pictures really helps us better help you!
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.........

ssmith
Member
Posts: 30
Country: United States
State: South Carolina
Pet name: Harmony

Re: New Diagnosis and Treament Not Working

Post by ssmith » 18 Oct 2021, 12:36

Thank you so much for your help! I talked to her vet a few minutes ago and he is suggesting switching her food the Nature Balance Venison and Sweet Potatoe formula. If I am remembering correctly it doesn't have any grain in it. I am hoping that will help but if not I will just bite the bullet and buy the hydrolyzed food because my precious pup means the world to me and she needs to get better. I will find some way to make the money despite my chronic GI issues that I am dealing with right now.

As far as the enzymes, I am giving her Covetrus pancreatic enzymes. It comes with a scoop that is premeasured as a teaspoon. She is getting over a cup at each meal so that is why he uped it to two scoops per meal. I will let it sit 20 min before giving it to her to see that helps.

The B12 I am actually giving her the injections myself. He taught me how to do it and I am going to nursing school so it doesn't bother me at all. It is cheaper and I figured why not. I had done some research and seen that B12 can be a big issue in EPI dogs, so I was happy he wanted her on injections.

We are stopping all steriods as they are not doing anything and long term can be bad for her bone density. I am glad to have her off of those since they aren't working anyway.

She is still running around like her usual self despite her weight loss, so I am very thankful for that. I will attach some poo pics for you to see. The gray one is pre enzymes and yellow is after enzyme use. The last picture is just a pic of my sweet girl. She is such a little fighter. Again thank you so much for you help!
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Tuckaboo Pam
Member
Posts: 1345
Country: United States
State: Florida
Pet name: Tucker
My name: Pam H.

Re: New Diagnosis and Treament Not Working

Post by Tuckaboo Pam » 18 Oct 2021, 19:00

Hi, Harmony's mom. You are a trooper, and Harmony is gorgeous!!! Welcome to both of you.

I couldn't afford the fasting blood test for awhile, either, and things have worked out for me, with the help I got from this group. BUT, I was glad when I was able to have the blood work done.

WOW that looks like EPI poop to me.

I'm not sure how much your venison food will cost, but Taste of the Wild Pacific Stream is $52 for 28 pounds, and Tucker has done well on it. Oh, and you're probably going to want to switch to https://enzymediane.com/. You'll save quite a bit of money.

---Pam & Tucker
Tucker was a shepherd/lab mix--- TLI 1.3, Folate 9.7, Cobalamin 666, Lipase 38. Took Diane's Enzymes 4 teaspoons/day, Wonderlabs B12 one capsule per day, and Tylan 1/16 teaspoon/ morning (to hold SID at bay). Taste of the Wild High Prairie, 1 1/2 cups/day, with a total of 4 cups of Fresh Pet. Stopped eating everything in sight, and went from 60 to 85 pounds! Tucker was my boyfriend, and my husband was OK with that. Tucker succumbed to hemangiosarcoma, but we cherished every day we had with that wonderful, beautiful boy. I will always, always miss my sweet big boy.

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Olesia711
Founder & Research Director
Posts: 3857
Location: North Carolina
Country: United States
State: North Carolina
Pet name: Izzy
My name: olesia

Re: New Diagnosis and Treament Not Working

Post by Olesia711 » 18 Oct 2021, 19:40

Ahh pictures! Harmony sure is a cutie and that is good news that she is running around and having a good time......so... all we need to do is figure out a good treatment plan.

Your vet sounds like a real good vet... I personally like Natural Balance foods... and i appreciate that he suggested one of their grain free foods... however... the grain free venison one has 5% fiber content... and that is still too much fiber for many of our EPi dogs... they don't show any improvement until you use a less fiber content food.. THis is why i suggested Taste of the Wild "Pacific Stream" version cause as it is only 3% fiber content no grain food and inexpensive. BUT since your vet recommended Natural Balance.... and i am also wondering if he went with Venison to try something other than chicken or beef just in case this is partially IBD.... so my suggestion is to try the Natural Balance Sweet POtato and Bison.. as it has no grain and only 4% fiber content. https://www.naturalbalanceinc.com/dog-f ... tato-bison.... just buy the smallest bag possible to try..

The Covetrus enzymes is the right stuff... and again, your vet gave you a good suggestion to try 2 tsp per meal since you are feeding over 1 cup of food... Your vet appears to be right on target with this :).

SO... if the food switch doesn't work... and since you already have upped the enzymes and you are already trying Tylan.... i agree if the food switch doesn'twork... then DO try Hydrolyzed food.

Oh... while i am thinking of it... with the Tylan ... you are giving 1/8 to 1/4 tsp with breakfast and dinner... yes? Here are the Tylan dosing directions
https://epi4dogs.com/antibiotics/

Thanks for the poo picture.... that sure looks like typical EPI poo..... so if this IS EPI..... the only thing left that i think needs adjusting is the food, whether no grain/low fiber or you need a hydrolyzed food.

Please let us know what happens with the food change..... and again, share everything we suggest to you with your vet :)
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.........

ssmith
Member
Posts: 30
Country: United States
State: South Carolina
Pet name: Harmony

Re: New Diagnosis and Treament Not Working

Post by ssmith » 18 Oct 2021, 20:25

Again, thank you guys so much for your help! We are trying the Natural Balance food and if that fails then I will for sure give the the Taste of Wild Pacific Stream a try. It is cheaper than Natural Balance which would be a plus. The natural balance is going to cost 70 dollars for a 22 pound bag and honestly if I am paying that I mine as well pay for the Hydrolyzed food. I did get a discount for the first bag on Chewy but still... He said he recommended the venison one to switch it up from the chicken. He wanted her on a protein that is brand new to her to see how she responded....

Personally I am thrilled with this vet. We had our babies at a different vet when they were younger but were not happy with the care they received so we switched and that was the best thing I could have done. I am so glad he is giving me the good stuff and proper instructions for the enzymes and such. He has been so helpful and even ran a second ultrasound free of charge for me which I was beyond thankful for.

Yes, I am giving her the Tylan powder at dinner only and she is getting 1/8 teaspoon. The other medication I couldn't remember the name of is Azathioprine. I have no idea what it is for but my guess is IBD. He thinks she is EPI + IBD.

One last thing is she is a stick chewer. She spits a lot of splinters out but I know she swallows some. The vet said we need to figure out a way to make that stop very quickly because that is very bad for her but the problem is that she is an outside only doggo. Her and her sister play in the fenced in backyard all day and we have sticks everywhere because of the woods right behind our fence. Any tips of how to get her off sticks? I am guessing we are just going to have to walk the yard every day and pick up every last one.

User avatar
Olesia711
Founder & Research Director
Posts: 3857
Location: North Carolina
Country: United States
State: North Carolina
Pet name: Izzy
My name: olesia

Re: New Diagnosis and Treament Not Working

Post by Olesia711 » 18 Oct 2021, 23:22

that's what i was wondering regarding why he suggested venison... to switch it up from typical chicken or beef..... ask your vet if he thinks trying the bison would be okay instead of venison.... simply because of the fiber content.
Taste of the wild is fish... so that would be different.

Anyway.... your vet definitely sounds like a keeper...

They use Azathioprine for IBD, PLE and lots of other issues.... it is a very good drug.

The Tylan needs to be given twice a day. Technically every 12 hours, ut if not given with food it can make some dogs feel a little queasy... that is why we just tell people to give it with breakfast and dinner.... which is usually about 12 hours apart. So start giving the Tylan twice a day, not once... giving it only once a day could also be a contributing factor as to why you are not seeing improvement.

Yeah, try to pick up as many sticks as you can. What you can also do, is use a soft muzzle to make sure Harmony doesn't eat any "inappropriate" things while outside.... this is what i used on my dog... BUT.... the difference was that i only put it on my dog when she went outside, when she was in the house, i did not use it... so not sure if this is something you want to keep on her all the time when you are not out there with her:
Image
THese muzzles are cheap, like $10..... so it is not a big expense.
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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.........

ssmith
Member
Posts: 30
Country: United States
State: South Carolina
Pet name: Harmony

Re: New Diagnosis and Treament Not Working

Post by ssmith » 23 Oct 2021, 12:53

I am absolutely thrilled to say that I think my sweet girl is turning a corner for the better. After letting her enzymes sit for 20 min, the change in food, her B12 shots, and her higher dose of enzymes she has gained 4 pounds in a week! I am beyond thrilled, and so thankful for all of your help! I will be sure to keep you guys updated!

Tuckaboo Pam
Member
Posts: 1345
Country: United States
State: Florida
Pet name: Tucker
My name: Pam H.

Re: New Diagnosis and Treament Not Working

Post by Tuckaboo Pam » 23 Oct 2021, 14:42

This is WONDERFUL news!
Tucker was a shepherd/lab mix--- TLI 1.3, Folate 9.7, Cobalamin 666, Lipase 38. Took Diane's Enzymes 4 teaspoons/day, Wonderlabs B12 one capsule per day, and Tylan 1/16 teaspoon/ morning (to hold SID at bay). Taste of the Wild High Prairie, 1 1/2 cups/day, with a total of 4 cups of Fresh Pet. Stopped eating everything in sight, and went from 60 to 85 pounds! Tucker was my boyfriend, and my husband was OK with that. Tucker succumbed to hemangiosarcoma, but we cherished every day we had with that wonderful, beautiful boy. I will always, always miss my sweet big boy.

User avatar
Olesia711
Founder & Research Director
Posts: 3857
Location: North Carolina
Country: United States
State: North Carolina
Pet name: Izzy
My name: olesia

Re: New Diagnosis and Treament Not Working

Post by Olesia711 » 23 Oct 2021, 20:18

Great news!!! keep up the good work and please do 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.........

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