Max: New to EPI, multiple issues

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.
maxsmom
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Pet name: Max
My name: Laura

Max: New to EPI, multiple issues

Post by maxsmom » 25 Feb 2022, 17:38

Hi... Max, our 2 year old Black English Lab, was diagnosed with EPI about one month ago after a 2 week bout of diarrhea and rapid weight loss. We have been on enzymes, new food, b12 and Tylan for only 2 weeks and have already been back to the emergency vet for an aural hematoma due to a deep ear infection that the vet nor I had any inkling of, and another visit (where Max is currently) due to bacterial pneumonia likely from weeks of hacking due to acid reflux? I am at a loss... I know I keep reading that it takes some time to get an EPI dog on an enzyme protocol that works for them, but I did not expect ear issues and pneumonia as well. We could have bought my 16 year old a small car for the amount of money we have spent on Max in less than a month. I am not trying to put a price tag on him, but I am trying to figure out what lies ahead. I need some encouragement and/or a reality check. As soon as I feel like I am making good decisions with his care, something else goes wrong. Advice? Max has continued to lose weight (3 lbs) even after 2 weeks of enzymes and new diet. Here are my biggest questions: 1. What other autoimmune issues may occur with EPI dogs and how do we anticipate those? 2. How many meds should I throw at Max at the same time? For example: if I add slippery elm and/or omeprozole to his current regimen and he still has issues, how do I know what is causing the problem with so many meds on board? 3. What does acid reflux look like/sound like in dogs? (Max is currently "hacking" when he is active sometimes throwing up white foam). 4. Lastly, on average, how long does it typically take a dog to get stable on enzymes?

Max's current regimen: Royal Canin GI low fat wet food, 4 cans a day, 1.33 cans (18 oz) 3x daily with 2 tsps of enzymes (enzymediane), B12 tablet once daily, 1/8 tsp Tylan powder once daily

Any and all advice, encouragement, realities, would be so appreciated. I have been looking over this blog for 3 weeks now and I am so thankful that I have a place to come to for support and questions.

Laura (max's mom)

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Olesia711
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Re: Max: New to EPI, multiple issues

Post by Olesia711 » 25 Feb 2022, 20:27

Hi Laura,

SO sorry Max (and you!!!) are going through ALL of this.... .. You are certainly getting hit with a lot of different things all at once!

Regarding the ear issues and pneumonia ..... typically these are not directly EPI related.... although i do know that food allergies/sensitivities can trigger a real mess with a lot of gunk in the ears causing an infection.... so maybe this is part of the equation. Regarding the extreme hacking from acid reflux triggering pneumonia.... i have not heard of this with EPI dogs, but then again, i have learned never to say never.

So.... for now, i would like to focus on some of what i noticed in your post EPI related that you can address so that at least Max can hopefully start responding to the EPI treatment as expected.

1. You are not giving the Tylan properly... you need to give 1/8 of tsp with breakfast and then another 1/8 tsp again with dinner. ... (typically approx 12 hours apart give or take)... If Max is around 60lbs or more... then you need to be giving 1/4 of a tsp of Tylan twice a day.

2. I am confused by this statement "Royal Canin GI low fat wet food, 4 cans a day, 1.33 cans (18 oz) 3x daily" ......... If i am looking at the right product, the RC GI low fat food is 13.5 ounces per can..... if you are giving 4 cans a day... you should be giving at least approx 3 tsp of enzymes not 2 tsps of enzymes.... and if the stools are still sloppy, then you need to up the enzymes even further to 1 tsp per 1 cup of food.... with wet food we start at 1/2 to 3/4 tsp of enzymes per cup.... BUT.... in the beginning, some dogs simply need more enzymes... but then as time goes on and the dog stabilizes... many can often maintain EPI with a lesser dose of enzymes.

3. with EPI dogs in the beginning.... you need to feed approximately 150% of what the dog normally should require..... you do this until they gain back all or most of their weight. SOme EPI dogs will forever need a little more food than what another dog the same weight would require.... so .....from what i am reading you are not feeding Max enough

4. with EPI dogs..... feed small meals but more frequently... if i am reading your post correctly, you are feeing Max 3 times a day which is a good frequency.

5. is there a specific reason why your vet has Max on prescription food????? Does he have a sensitivity or other health issue? If not.... you should be able to feed him OTC food.

6. Most of these dogs, unless there is another health issue.... can eat over the counter food that is very low in fiber content (to start with) and this is where we suggest looking at grain free foods HOWEVER.... avoid commercial foods that use a lot of peas and lentils. We also suggest STARTING with a food low in fiber content like 4% or even less. The reason is because fiber can destroy the efficacy of the enzymes from anywhere between 0% to 50%.... making it appear like your dog is not responding to the enzymes. SO.... start with a low fiber food and then once you dog is delivering normal looking poos .. a normal amount of times a day (1 to 3 times).... and has been doing this for a month or so.. then try a little grain.... try some rice or try a food with rice in it.... and watch the poos.... see how much fiber your dog can handle, if any, on the enzymes.

7. that acid reflux ... could very well be a product of SID or EPI. supposedly 70% of all dogs that we think have too much acid (acid reflux) it is really not too much acid, but not enough of the right kind of acid. In any case.... we see this a lot with EPI dogs. They actually do have an issue with their secondary bile acid functionality... but more often than not, it is SID (small intestinal dysbiosis) (check out the EPI & bile acid research on this page: https://epi4dogs.com/epi-research/ ) but we only treat if needed.

SO.... how do we treat? Typically for SID we treat with prebiotics, then pre+probiotics, and if that doesn't work then Tylan. You are already doing the Tylan. SO... You can try Slippery Elm first for acid.....(https://epi4dogs.com/slippery-elm/) ....powder... or if that doesn't work, then try Omeprazole... talk to your vet about how much Omeprazole to give..... but there is a possibility that once you get the SID under control (via Tylan)... that this acid reflux issue may be alleviated.... but if not.... then do the slippery elm or try the omeprazole.

One thing i do want to mention... about half way thru the 45 day regimen of Tylan/twice a day.... talk to your vet about starting Max on a probiotic. either Proviable or Visbiome are the two probiotics that we are currently recommending at this time. When starting with ANY probiotic.... ALWAYS start off with less than half the recommended dose and working your way up to a full dose over the course of a week or two.

How long does it take to get stable on enzymes, etc.... it varies from one dog to the next... a few weeks to a few months.... and some (if they don't happen on the right diet, cause that is like the final piece of the puzzle... can take a real long time until you find the optimal diet for you dog!)

What other immune conditions can you expect...... either none, or some or a whole bunch. You just don't know from one dog to the next. I'd say the majority just deal with EPI..... the tougher cases are those that have to deal with EPI + IBD , with IBD being the pain in the butt. REgarding immune conditions, i would say a good portion of EPI dogs don't deal with multiple other immune situations.... but it does and can happen... you just don't know who will or will not have other health issues....................

i hope this helps a little!
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.........

Tuckaboo Pam
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Re: Max: New to EPI, multiple issues

Post by Tuckaboo Pam » 26 Feb 2022, 08:06

Hi, Laura. I know what you mean about the expense of having a dog with issues. I wanted a shepherd, but couldn't afford one, so I found Tucker, my then 10 weeks old shepherd/lab, adopted by someone who soon found they were going to have a baby & had to rehome him. He was $80.00, but then came the demodex, the ear infection the other varieties of parasites, and before three months we'd spent $2,000.00, not even knowing EPI was looming & waiting to show up in four years.

So, we love these guys, but we need to cut to the chase & get them well! I am just saying I feel your pain, and it sounds like you are on a good course. Olesia responded first, so you are lucky to have all the good advice in your first response. I will add that Tuck does well on Sport Dog Elite for Herding Dogs. https://www.sportdogfood.com/products/herding-dog

I just found out it has gone up in price on both Amazon & Chewy, but remains @ $81.00 directly from the company. So I've ordered two bags between writing on this post!

It may be worth your while to give it a try. Take Care---Pam & Tucker in FL
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.

maxsmom
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Pet name: Max
My name: Laura

Re: Max: New to EPI, multiple issues

Post by maxsmom » 27 Feb 2022, 14:37

Thank you Olesia as well as Pam and Tucker for your replies. I am so thankful.

Max's stomach is upset on his current antibiotics for bacterial pneumonia, so it will be hard to know what type of feeding/ezyme protocol will work until he is over his pneumonia.

I will use your advice once he is over his pneumonia and come back for more advice as well. Thank you for this site!

Laura

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Patsy
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Re: Max: New to EPI, multiple issues

Post by Patsy » 28 Feb 2022, 05:37

Hello Laura, it’s really hard at first. When the food gets digested and poops firm up even a little bit, you know that your dogs whole system is getting stronger to fight the other problems.
In case I’ve missed them, can you post any test results that you may have? Tli, B12, folate. It would be really helpful for people to give you specific help.
The ear sounds difficult, do they know what bacteria it is, is there a discharge or nasty smell? Which antibiotics are you having for it and the pneumonia? Some will mess up the guts. You will need a different one for gut infections , as they are specific to different germs.
I adopted a dog complete with pneumonia., caused by gum disease. He stank, had a hacking cough with bubbly phlegm. A month of antibiotics cured him and fortunately it it didn’t affect his heart. I think he had penicillin. Let’s hope your antibiotics are for that as well. The one Olesia has warned us not to use is metronidazole, with side effects.
Have you had advice for the acid flux? I can’t help there, but other folks can. I know it must be painful.
Labs adore food, so I hope he will enjoy going back to something tasty!
Springer spaniel Marti had Epi, PLE , MMM just to confuse me. She lived till 12yrs, chubby and happy despite eight years of epi.
Capsule enzymes suited her best. B12 supplements made her into a new dog!
After a cocker with PLN kidney disease, I now have two healthy rescues, a lively, suicidal , small ginger terrier, adopted with pneumonia, and gum disease needing nearly all his teeth out, and a fluffy grey toy poodle/terrier from Greece.

Tuckaboo Pam
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Re: Max: New to EPI, multiple issues

Post by Tuckaboo Pam » 01 Mar 2022, 16:44

Laura, I thought of you when I read this. I have been on the receiving end before, and it really helped me. --- Pam

https://www.epi4dogs.com/forum/viewtopic.php?f=2&t=1408
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.

maxsmom
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Country: United States
State: North Carolina
Pet name: Max
My name: Laura

Max: Silly Question

Post by maxsmom » 01 May 2022, 20:36

Hi! Max is so much better!!! His pneumonia is gone and he has gained back 10 of the 15 pounds he lost! yay!!!!

Silly Question: Max used to be on prescription GI food that was a wet canned food- super easy to mix enzymes in. Now Max has to be on a hydrolyzed protein dry food due to allergies. How do I mix the enzymes with dry kibble? Even if I wet the kibble and let it sit, it never gets soft. I understand that I need to add water (Max cannot have any other food due to allergies)... so the enzymes are really just dissolving in the water?

Thanks for feedback. And thanks again for this forum... so helpful to so many!

Laura and Max

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jilbert57
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Re: Max: New to EPI, multiple issues

Post by jilbert57 » 01 May 2022, 20:49

You use the ratio 1 cup kibble to 1 teaspoon of enzyme, add maybe 1/8cup room temp water and srir to coat. Let the mixture set around 20 minutes then stir before serving. If you want it mushy add a little more watervand let set a little longer. Which hydrolyzed food is it?

Jill
My name is Jill and we live on the Hood Canal in Washington State. We currently have 2 Jack russells, TJ is 8 and Sadie is 2.

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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Montgomery
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Re: Max: New to EPI, multiple issues

Post by Montgomery » 01 May 2022, 21:04

I'm going to apologize in advance because I got cat-bit in the thumb and it's hard to type, so if there are a lot of mistakes, that's why.
Hacking...Is it like a reverse-sneezing, snorting, gagging, pawing at the face, frothing at the mouth, hyperventillating sort of a thing? I don't know if dogs have the ability, like Montgomery does, to actually put their hands in their mouth and fling the froth out in an effort to clear it, but there was that. The only thing that would stop it in the moment was to syringe water down him. It took nine 3cc syringes on more than one occasion. His naturopath attributed this freaky thing to diet. We followed his nutritonal advice and have no further instances.
Montgomery was born 20 March 2012. He eats extra lean ground chicken, lean ground pork and lean ground beef completed with Alnutrin and freeze-dried chicken liver, with hard-cooked egg. He gets two size zero capsules of Enzyme Diane's enzymes at each of his six meals, and a size four capsule of Tylan three times a day. He's a fierce little Spitfire with a roaring Merlin engine.

maxsmom
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Country: United States
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Pet name: Max
My name: Laura

Re: Max: Silly Question

Post by maxsmom » 01 May 2022, 22:42

Jill,

Thanks for the reply... Max is on Royal Canin HP

Laura

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