New EPI Diagnosis - Help!

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.
JRussell
Member
Posts: 8
Country: United States
State: Maryland
Pet name: Howie
My name: Jamie

New EPI Diagnosis - Help!

Post by JRussell » 21 Dec 2021, 19:18

Hi everyone! I'm so glad I found this group, as my 8 month old Pembroke Welsh Corgi, Howie, was just diagnosed with EPI last week. Just to give you some background...the week before Thanksgiving Howie began having very frequent and loose diarrhea. I took him to the vet a few days later where he was prescribed Metronidazole and probiotics and I was told to keep him on a chicken and rice diet. No improvement, so switched to a prescription GI diet. No improvement, so was told to put him on an HP diet. His stool was even worse and was greasy. Eventually the vet told me to put him on Hill's prescription W/D diet (high fiber). This definitely helped firm his stools, but frequency remained the same, as well as other symptoms (lethargy, stool eating, weight loss despite a big appetite)continued. Last week, we did bloodwork and his .TLI Fasting level came back <1 resulting in an EPI diagnosis.

My vet recommended I purchase Viokase powder and give 1 teaspoon with every meal (morning and night). In addition, he is getting weekly vitamin B12 injections for the next 6 weeks, with a monthly maintenance after that depending on his response. His Cobalamin level was 457. She also recommended putting Howie on Hill's Prescription I/D GI diet dry food(low fat).

I finally received the Viokase today, and Howie will not eat his food with it. It seems to bother his mouth (although prior to getting sick he wasn't a very good eater anyway). I soaked his food and enzyme powder with warm water for a few minutes prior to feeding it to him, but I'm thinking that may have not been long enough. Is there any tips and tricks to help with him eating the enzymes? Or really with the management of EPI in general? Any foods you recommend or have had good luck with? Any and all advice is greatly appreciated!!! My vet is amazing, but she has only seen a handful of EPI cases in her career so I feel like we will be learning as we go. I just am trying to get my boy feeling back to his normal playful self!

Thank you in advance!!
Jamie
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Jane&Clyde
Member
Posts: 124
Country: United States
Pet name: Clyde
My name: Jane

Re: New EPI Diagnosis - Help!

Post by Jane&Clyde » 22 Dec 2021, 00:48

Hello, Jamie, and welcome to both you and Howie. You have come to the right place. The staff and members here have a wealth of experience and suggestions. I can help you with the basics of treating EPI. There are 4 cornerstones to treating EPI:

1. FOOD: The recommended diet is 4% or less fiber, grain free, with little to no peas. Avoiding chicken is also a good idea. If there are no other complications, a dog with EPI does not need a low fat diet or prescription food. The food that the most people seem to have the best results with is Sport Dog Elite Series Herding Dog formula. It's available on the Sportdogfood.com website, Chewy.com, or Amazon. If price is a concern, then a lot of dogs do well on Taste of the Wild, but ONLY the Pacific Stream or High Prairie versions because the others have too much fiber.

2. ENZYMES: The correct dosage is 1 teaspoon per cup of dry food, NOT 1 teaspoon per meal. Mix with the food and a little room temperature to lukewarm water. Let sit for 20-30 minutes. If the longer time doesn't aid with the mouth problems, you can try rinsing Howie's mouth out with a squirt bottle after eating or wiping his mouth out. If he won't eat the food with enzymes in it, you could try mixing the enzymes with something yummy that he will eat (piece of lunch meat, spoonful of wet dog food, etc.) or putting the enzymes in capsules. There are other alternatives if this doesn't work. Most of us here use enzymes from EnzymeDiane.com. Her 6x enzymes are the equivalent of prescription enzymes, but they are less expensive.

3. VITAMIN B12: It sounds like your vet is on the right track with this. If you ever want to try an oral supplement instead of the shots, the only product we recommend is Wonderlabs Pet Factor B12 with Intrinsic Factor, available on Wonderlabs.com or Amazon. It has a slightly different form of B12 than most oral supplements, plus has the intrinsic factor. These make the Wonderlabs product more effective than other oral supplements.

4. ANTIBIOTICS (only if needed): If Howie needs antibiotics in the future to help manage his EPI/SID (small intestinal dysbiosis...unbalanced bacteria in the gut...all dogs with EPI have this to some extent), please do not allow the vet to prescribe Metronidazole. The antibiotic of choice is Tylan, a 45 day course twice a day, then slowly weaned off.

I hope this helps a little. Feel free to ask any questions that you have. Howie sure is a cutie!

Tuckaboo Pam
Member
Posts: 1065
Country: United States
State: Florida
Pet name: Tucker
My name: Pam H.

Re: New EPI Diagnosis - Help!

Post by Tuckaboo Pam » 22 Dec 2021, 06:10

Hi, Jamie, and welcome to you & Howie.

Jane has done a very thorough job, advising you, so I'll just add--

Tucker's mouth hurts so badly sometimes, he'll stop eating mid-meal, which is NOT like him. I have started coating his snout & gums with aquafor or vaseline before he eats, which seems to help. He won't let me squirt him (he's a bit bigger than Howie & very strong), so I wet a paper towel & wipe him down as best I can after eating. This seems to do the trick.

Did Jane mention feeding 150% of the recommended kibble, until Howie gains his weight back? Also, I contacted Sport Dog about feeding herding formula to my smaller dogs(12 pounders), and they did not recommend it, but you can try a small bag if Howie is bigger. My recent shipment has been delayed, of course, so keep that in mind if you order it. Had to go directly to the company, because the other sites were out of it when I ordered.

In closing, please do not despair, as we have all been where you are now, and we came out on the other side.

Keep a journal, to help you remember the steps you have taken.
Ask any question you like, as there are many people on the forum with experience, and the stellar staff is incredibly knowledgeable.

Happy Holidays---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, Wonderlabs B12 one capsule per day, two capsules slippery elm/evening, 1 Proviable capsule/day, and Tylan 1/32 teaspoon/ morning (to hold SID at bay). Sport Dog Elite, herding dogs 4 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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jilbert57
Staff
Posts: 1452
Country: United States
State: Washington

Re: New EPI Diagnosis - Help!

Post by jilbert57 » 22 Dec 2021, 08:42

Jamie, Howie is adorable. You have been given great information. Feel free to ask any questions.

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.

JRussell
Member
Posts: 8
Country: United States
State: Maryland
Pet name: Howie
My name: Jamie

Re: New EPI Diagnosis - Help!

Post by JRussell » 22 Dec 2021, 12:13

Thank you all! I really appreciate the advice. I soaked his food with the enzymes for 30 minutes this morning and he definitely ate more than last night. He's still not loving it, but I did sprinkle some parmesan cheese on top (I read this sometimes help masks the smell for picky eaters)and it actually did seem to help some. I feel as if it may be a little trial and error until I find the right combination that works best for Howie!

Another thing I did want to ask...Since he has been sick the last few weeks he has started developing skin reactions. Around his eyes, his lips, his ears, his testicles (he was supposed to get neutered this month, but that is on hold until he is healthy!), basically any skin that doesn't have much hair on it becomes irritated and forms dry hard scabs. I can tell it is uncomfortable for him. The vet put him on antibiotics for it yesterday, which she was worried about doing because she didn't want to upset his GI tract anymore, but the skin irritations were not improving, so she felt we needed to do something. I know there is a possibility it could be food allergies, but my lab is on an HP diet for bad allergies and her symptoms are a lot different. I guess I'm wondering if any of your dogs with EPI have every experienced these skin issues? I'm hoping once he is actually receiving the proper nutrition that his skin will heal.

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jilbert57
Staff
Posts: 1452
Country: United States
State: Washington

Re: New EPI Diagnosis - Help!

Post by jilbert57 » 22 Dec 2021, 12:25

It is possible the enzymes now allowing for the proper digestion will take care of the skin issues. I got a powder called Coat Defense that has cleared up my pups itching issues.

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.

ssmith
Member
Posts: 29
Country: United States
State: South Carolina
Pet name: Harmony

Re: New EPI Diagnosis - Help!

Post by ssmith » 22 Dec 2021, 14:23

Could you please upload a picture of the skin reaction? My girl Harmony struggled with a reaction on her legs that our vet thought was an allergy of some sort as well. We tried bendryl, a ringworm medication, and washing her feet with a rinse everyday. Nothing was working so I experimented myself with her antibiotic. It turns out she was allergic to the Tylan antibiotic that is the top pick antibiotic for EPI pups. I have since had to take her off of it completely, but her sores are definitely still healing. I'm not sure if Howie is on Tylan, but I wonder if their skin reaction is similiar.

JRussell
Member
Posts: 8
Country: United States
State: Maryland
Pet name: Howie
My name: Jamie

Re: New EPI Diagnosis - Help!

Post by JRussell » 22 Dec 2021, 14:48

Here are some pictures. His one eye was always the worst, but the scabs have since fallen off...so I'm hoping that's a good sign and its starting to heal. It's hard to see, but they pretty much are hard, dry scabs in both ears, eyes, and testicles. His lips were the same but have since cleared up. He has never been on Tylan yet.

It's just odd to me that these skin issues occurred soon after he started having EPI symptoms, that's why it makes me think it is all related somehow...so I was just curious if any other EPI owners experienced the same thing.
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Tuckaboo Pam
Member
Posts: 1065
Country: United States
State: Florida
Pet name: Tucker
My name: Pam H.

Re: New EPI Diagnosis - Help!

Post by Tuckaboo Pam » 22 Dec 2021, 17:55

Has the vet ruled out demodex, or mange? Is he itchy?

I adopted Tucker when he was 10 weeks, and my eyesight not being great, it was a few weeks before someone pointed out his patchy hair loss, which was the first sign of demodex. It looked a bit like the area around Howie's eye. Some of his spots were scabby, and the vet took scrapings from those spots.

The cure was ivermectin.

Back to the enzymes, good job topping the meal with parmesan. Tuna is another idea. I make turkey wing broth every couple of weeks, and I use it in place of water when I make Tuck's meal.

---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, Wonderlabs B12 one capsule per day, two capsules slippery elm/evening, 1 Proviable capsule/day, and Tylan 1/32 teaspoon/ morning (to hold SID at bay). Sport Dog Elite, herding dogs 4 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.

ssmith
Member
Posts: 29
Country: United States
State: South Carolina
Pet name: Harmony

Re: New EPI Diagnosis - Help!

Post by ssmith » 23 Dec 2021, 11:34

Hmm, Harmony definitely had the patchy hair loss and pink/gray skin where the hair came out, but she didn't really have scabs. She also wasn't itchy, and the spots stayed on her legs/paws. I'm not reallly sure, but I would say if he does get put on Tylan I would watch the spots closely to see if they get worse.

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