Newly diagnosed Pug

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.
User avatar
Olesia711
Founder
Posts: 1139
Location: North Carolina
Country: United States
State: North Carolina
Pet name: Izzy

Re: Newly diagnosed Pug

Post by Olesia711 » 30 Dec 2018, 15:57

Hi Joe and Ingrid,
So sorry to hear that Shadow has EPI, but please know, we will help you figure out what adjustments are needed to get Shadow to optimally respond to the EPi treatment.

#1 Get a different food. If you can get a refund that would be great. Unfortunately too much fiber can great inhibit the enzyme activity of the pancreatic enzymes that EPI dogs need to survive. It can mess up the efficacy from anywhere between 0% to 50%.... and we just don't know from one dog to the next, but the result is bad stools, gastro issues

Just a FYI.... the food you are currently feeding has a lot of (no offense) crap in it AND the fiber content is extraordinarily high.
(See below in red)

What you might want (initially) is middle of the road food that has a low fiber content usually something with 4% or less..., preferably made with sweet potato or potato or tapioca... initially try to avoid foods made with grain AND stay away from foods that use multiple "peas" sources.... Too many peas is another ingredient that really messes with EPI dog's system.... we have research to support this on the fiber page.


Nutritional Info
Ingredients

Chicken By-Product Meal, Brewers Rice, Chicken Fat, Powdered Cellulose, Rice Hulls, Corn, Wheat, Corn Gluten Meal, Natural Flavors, Wheat Gluten, Dried Plain Beet Pulp, Fish Oil, Monocalcium Phosphate, Grain Distillers Dried Yeast, Psyllium Seed Husk, Sodium Silico Aluminate, Potassium Chloride, Salt, Calcium Carbonate, Fructooligosaccharides, L-Lysine, Vegetable Oil, Dl-Methionine, Hydrolyzed Yeast, Taurine, Choline Chloride, Vitamins [Dl-Alpha Tocopherol Acetate (Source of Vitamin E), L-Ascorbyl-2-Polyphosphate (Source of Vitamin C), Biotin, D-Calcium Pantothenate, Vitamin A Acetate, Niacin Supplement, Pyridoxine Hydrochloride (Vitamin B6), Thiamine Mononitrate (Vitamin B1), Vitamin B12 Supplement, Riboflavin Supplement, Folic Acid, Vitamin D3 Supplement], Marigold Extract (Tagetes Erecta L.), Trace Minerals [Zinc Proteinate, Zinc Oxide, Ferrous Sulfate, Manganese Proteinate, Manganous Oxide, Copper Sulfate, Calcium Iodate, Sodium Selenite, Copper Proteinate], Rosemary Extract, Preserved with Mixed Tocopherols and Citric Acid.

Guaranteed Analysis
Crude Protein 21.0% min
Crude Fat 14.0% min
Crude Fiber 12.5% max
Moisture 10.0% max
Eicosapentaenoic Acid (EPA) 0.18% min
Docosahexaenoic Acid (DHA) 0.08% min


#2 Next... for those poor sore lips and mouth, if you have any vitamin E capsules, pop one with a pin and squeeze the vitamin e oil on the lips etc, it will help with the healing.... and then when feeding, do some of the following things to stop this from happening again.
1. add a pinch more water to the food mixed with the enzymes.... this will help reduce the caustic properties.... the food needs to be moist enough so that the enzymes do not remain dry
2. let the food with the enzymes incubate 10-15 minutes longer than the typical 20 minutes
3. be sure to start with the ratio of 1 level tsp enzymes per 1 cup of food (if dry) add enough water , if canned food reduce the enzymes to about 1/2-3/4 tsp per cup of wet food.
4. rinse the mouth out with a squirt bottle of water after Shadow is done eating
5. or give Shadow a few ice cubes to "lick" after a meal.
6. some folks will gently wipe the inside of the mouth out with a warm washcloth
7. you can try reducing the enzymes by 1/8 tsp- -but this is do not think is the best thing to try in the beginning........
8. mixing the enzymes in yogurt is a good idea...and then mixing the yogurt in the food, but still let it incubate for 20-30/+ minutes.

#3 I am confused about the Tylan you are giving (Tylosin 2700g/tsp - 1/10 teaspoon).... normally in the USA we give Tylan (Tylosin Tartrate 100 grams- -made by Elanco is the common one) with breakfast and dinner..... some people can mix the tylan in the food, but with some dogs (like mine) she will NOT eat her food as the Tylan has a very nasty taste. I ahve to camouflage the tylan by putting it in an empty gel cap, tucking that gel cap in a blob of cream cheese and giving it this way. There is a dosing chart (geared towards 100gram of Tylan powder) on this page https://epi4dogs.com/antibiotics/.
The dosage is decided by the weight of the dog.
Can you share with us the brand name of the Tylan you are giving??? Or double check that it is 2700 grams, not 100grams????

#4. Has your vet said anything about B12??? 4 out of 5 EPI dogs require B12 supplementation. Either shots of high dose oral B12.

#5. keep and EPI log, this will help you figure out what does and does not work for Shadow in managing his EPI.... you can download an EPI log template from here: https://epi4dogs.com/epi-log/

#6. Please know that EPI is manageable.... once you find the right balance of things. As an example.... my gal was diagnosed with EPI when she was 1+1/2 yr old....... that was 12 yrs ago.... she is now 13 +1/2 yrs old and still doing well.


And last but not least, please be sure to share with your vet everything we suggest to 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.........

Barb
Staff
Posts: 423
Country: United States
State: New Jersey

Re: Newly diagnosed Pug

Post by Barb » 30 Dec 2018, 17:35

Hello, and welcome! Shadow is adorable.

Yes, I am glad someone addressed the dosage of enzymes.....1 teaspoon per cup of kibble to start.

Not all dogs get ulcers or redness, but ours sure did, even though he is a large German Shepherd. What we did was lengthen the incubation time, as someone mentioned. We actually lengthened it to an hour before the ulcers went away. Then after Kolby finally got used to the enzymes, we were able to decrease to 45 minutes and left it there for quite a while. Now he can handle 20 - 30 minutes, but it took many years. You might also want to use a squirt bottle of water to rinse Shadow's mouth after eating so there isn't enzyme residue on the gums. We discovered the flat plate by accident. Trying to get Kolby to eat, we found that he would eat the enzymed food off our fingers, then off a spoon, so we figured it had something to do with putting his muzzle into the food that bothered him and we tried the flat plate. Voila! Worked like a charm.

Let us know what other questions you have.

Barb

User avatar
Madelon
President
Posts: 878
Location: Nashville, TN
Country: United States
State: Tennessee
Pet name: Doc

Re: Newly diagnosed Pug

Post by Madelon » 30 Dec 2018, 21:10

Hi and welcome to our EPI family. You've been given great suggestions from some of our most experienced members. With regard to the sores, in some cases some dogs are just harder to get sorted with the enzymes than others - another trick to try is to toss a few kibbles in the water bowl for your dog to "bob" for after eating which will help rinse the mouth. I recently had a member whose dog's mouth was bleeding pretty badly from the sores and the only thing that helped was to grind the kibble - I don't suggest this unless absolutely necessary so just keep in the back of your mind if all else fails.
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

User avatar
Bruinwar
Member
Posts: 9
Country: United States
State: Michigan

Re: Newly diagnosed Pug

Post by Bruinwar » 31 Dec 2018, 09:38

Thank you all so much for all of your advice !
Shadow ate her breakie this morning- 1/2 tsp Pancrezyme powder, incubated, on 1/2 cup moistened kibble. I topped it off with a little bone broth ( for dogs ) and a dollop of greek yougurt. She ate it all, but still has a sore looking snout. I will try the Vit E. I am getting off the prescription royal canin and tranition back to her previos kibble ( Crave ) which has a 3.5% fiber content. I need to go down and look at the bag for the pea content.
I do have a question about capsules- are they effective ?? It seems so much less caustic to the mouth.
Also, our primary vet poo-pooed my suggestion that this was EPI and didn't want to test for it. ( I had read about this condition, and Shadow had all the symptoms ) He had said it is very rare except for German Sheperds. It wasn't until we insisted on blood work which showed through the roof liver enzymes, which led to a referral to an internist. I'm not sure how confident I am about him ( our primary )managing her care for EPI. Do most of you have follow up care with a regular vet ?
Thank you !
Ingrid

User avatar
Jean
Staff
Posts: 891
Location: South Liverpool
Country: United Kingdom - England
Pet name: Kara
My name: Jean

Re: Newly diagnosed Pug

Post by Jean » 31 Dec 2018, 12:42

i will let the guys answer about the capsules

we use them over here but they are different

tell your vet we have EVERY breed represented here from the smallest Chi to a Spanish Mastiff, and all in between, we have on EPI4DOGS 3700 members

and there are various other groups on social media for EPI

Its sure not rare anymore sadly, but we are on top of it

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

User avatar
Olesia711
Founder
Posts: 1139
Location: North Carolina
Country: United States
State: North Carolina
Pet name: Izzy

Re: Newly diagnosed Pug

Post by Olesia711 » 31 Dec 2018, 13:57

Ingrid... when you mention capsules.... what exactly are you referring to?

1. Are you referring to putting the enzyme powder into empty gel caps???
2. or are you referring to enzyme tablets (which really dont work UNLESS you crush them and incubate them anyway, and in the end although this does work for some folks, by the time you are done using enough tablets, many times it is just cheaper to buy the enzyme powder.
3. or are you referring to getting CREON enteric coated enzymes in gel caps. These also will work... BUT.... this is a human drug so it is designed to work on a different gastric pH... so.... with our dogs, we have to try a few different techniques when giving CREON to see which technique will work with our dog.

Anyway... i personally would stick with the powder, it really is the best to use when available..... just try to weather thru this bout of sore mouth/lips and now that you know some trick to avoid mouth sores, this should not happen again.


Yes, most of us follow up with a regular vet. But many of us have gone thru multiple vets before we found one that REALLY works well with the EPI condition and our individual EPI dog. The rule of thumb is you don't need a vet that specialized in EPI, but rather you need a vet who will work with you.... someone that will listen to you and have indepth conversations with you, someone who is willing to "try" things that are not always taught in the medical journals but will read the most recent research we have to support what we are suggesting to you (that we encourage you to always share with your vet!)

Just an interesting observation, but some of the best EPI vets turn out to be those that have no experience at all with EPI- -but are so excited to have an EPI case that they do their own research and really, REALLY work with you to figure out what technique from the recommended EPI protocol works best for your dog- -and will listen and or suggest "tweaking" things a little until you find the right balance to managing Shadow's EPI.


Regarding the internists.... Some of the internists are absolutely fantastic, but some others have turned out to be not so good with EPI..... kind of like any profession.......

l have a concern about the Tylan you are giving...
I am guessing that Shadow maybe weighs somewhere around 30 lbs?????
if so... and if this was Tylan soluble powder 100 grams made by Elanco.....
if Shadow weighs 30lbs he should be getting approximately 1/8 of a teaspoon of 100 grams which is equivalent to 375 mg
if Shadow weighs 45 lbs he can take with 1/8 tsp of 100 grams or a pinch more or 500 mg twice a day
if Shadow weighs 55 lbs he can still take 1/8 tsp of 100 grams with a pinch more or 625 mg twice a day

However, you mentioned. that you are giving tylan 2700 grams.... that is a MUCH stronger dose

and you are giving 1/10 ????? Did i read this correctly

If my math is correct (and it may not be, so this would need to be verified by a pharmacist ...which you might want to check with)
If my math is correct.......that would be 270 grams twice a day which is about 540 grams which is way too much............
.
With Tylan you do have a lot of "forgiveness" when dosing, although you do not want to go too low/under dose.
Can you just double check (may be with the pharmacists) what the dosing values should be with this product that you are using and have them and figure out or double check what the right amount is according to the suggest Tylan dosing chart???
https://epi4dogs.com/antibiotics/

ALSO.... just want to make sure... this Tylan you are giving is NOT a liquid, but rather a very pale yellow powder.......... correct???
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.........

User avatar
Bruinwar
Member
Posts: 9
Country: United States
State: Michigan

Re: Newly diagnosed Pug

Post by Bruinwar » 31 Dec 2018, 16:21

Hello all,

First I want to thank everyone who's responded. We are truly overwhelmed by the response & are grateful we've found this community. There are a lot of questions & I am going to attempt to answer them all.

The Tylan: It is a pale yellow powder. The label (from the vet) says Tylosin/Tylan. The dosage that I listed is a direct copy/paste from the vet. The real life actual is a "a hefty pinch" twice a day. Shadow weighs 20 lbs.

The food: As Ingrid replied we've switched to Crave kibble & canned, all below 4% fiber.

Capsules: at least one community member had good luck with capsules so Ingrid purchased a capsule filler & empty capsules online.

B12: No, the vet(s) have brought not it up. We will talk to them about it soon.

Vitamin E: We purchased some today.

The EPI log: It is an excellent idea & we see the point of it. Data like that is very valuable. Unfortunately neither of us are good at keeping logs.

In closing I want to add the Shadow just completed eating her entire dinner. This was a 1/2 cup the canned Crave wet food with a 1/2 teaspoon of enzyme & a hefty pinch of Tylan. She seemed to enjoy it! Right now she is smacking her lips because of the coating of Vitamin E on them.

Regards,
Joe

User avatar
Olesia711
Founder
Posts: 1139
Location: North Carolina
Country: United States
State: North Carolina
Pet name: Izzy

Re: Newly diagnosed Pug

Post by Olesia711 » 31 Dec 2018, 17:41

hi Joe,

Thanks for getting back to me.


TYLAN
Okay..... since your vet bottled the Tylan powder for you directly from them i am going to "assume" it is the right stuff- -they usually stock Tylan by Elanco (which is the right stuff) and i am suspecting that they just cut and pasted info not the strength, but rather dosing info on the Tylan and it is Tylan 100 gram "strength" after all........ one teaspoon of Tylan (tylosin tartrate) is roughly 2.5-2.7 grams ( or 2500-2700 mg)... so this might be where that 2700 number is coming from.

I just got real concerned when i read the 2700 number. so sorry.

If Shadow weighs about 20 lbs.... then he get 1/16 of a tsp of Tylan...and to the naked eye, it sure does look like a pinch.
But if you and Ingrid want to measure it, take measuring teaspoons used for baking...... if you have 1/8 of a tsp .. great! Pour 1/8 of a tsp of Tylan powder onto a piece of paper. Form a little rectangle with the loose Tylan powder, and divide the pile of Tylan powder in half.... and then you have your 1/16 tsp of Tylan :)

Thanks for letting me know that it is a yellow powder, that is what the right stuff should look like (phew!) I was concerned you were using the liquid Tylan which is mostly for respiratory situations and the wrong stuff for SID.

FOOD
Good that you switched to Crave, the fiber content is 3.5%. Excellent.
There are peas in it, 4th and 5th ingredient..... but Shadow may be able to tolerate this amount just fine... and if not... you notice down the road.
THe best that we can do with these dogs when tring to find an ideal meal is simply "try it" :)

B12
Okay....this should have been mentioned.... almost all EPI dogs have an issue here (82% of all EPI dogs need B12 and as they age, they all need B12) and what happens if not treated is that initially they will improve but usually they will never optimally improve, and then there are some that just never improve until they do get B12 supplementation.

Talk to your vet about this. PLEASE show him/him the current research on B12 and dogs with CHRONIC conditions--these dogs need B12 levels to be in the mid-upper range (at least anywhere in the mid 500's-600's... many go much higher once on oral B12) .... and once you bring the level up, then you and your vet just have to decide on a maintenance regimen going forward.

There are 2 ways to address this.
1. work with you vet to give Shadow B12 shots
2. or see if your vet will agree to you using high dose oral B12. We suggest Wonderlabs Pet Factor B12 (Shadow would get half capsule daily) https://www.wonderlabs.com/itemleft.php?itemnum=K9688. We like this product because it appears to work better than other high dose oral b12 products, this product is made with 1000mcg Methylcobalamin B12, 800mcg Folate and 40 mg porcine Instrinsic factor.

CAPSULES
Since Ingrid already bought the capsules and machine.... sure.. go ahead and try it, i personally like to let the dog get used to the powder, but there is no harm in trying encapsulating the powder either... except.... just closely watch Shadow's poop out-put when putting the powder in capsules.... if you notice her poo getting worse, then try adding one more capsule filled powder to her meal.....

Happy New Year!!!!!!!!!!!
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.........

User avatar
Bri S
Member
Posts: 65
Country: United States
State: Washington
Pet name: Opal

Re: Newly diagnosed Pug

Post by Bri S » 04 Jan 2019, 12:01

Hello, I just wanted to say welcome and that it looks like you've got a TON of great information.

I too came upon this forum when my corgi was diagnosed with EPI in November and she has made great improvements much due to her vet being willing to make adjustments that worked for my dog (Opal) & the wonderful suggestions I have received on here.

You're in good hands!

- Bri & Opal
My name is Bri and I have a Corgi named Opal who was born on 09/05/17. We live in Washington State and Opal was diagnosed with EPI in September of 2018 shortly after she turned 1 year old. Opal currently takes the following daily: Pancreapowder Plus 1/16 TSP 3x day - Proviable DC Capsule Probiotic 1x day - WonderLabs Slippery Elm Prebiotic 1/16 TSP 1x day - WonderLabs B12 w/Intrinsict Factor 1x day - Tylan antibiotic 1/16 TSP 2x day - Eats Hills Prescription Diet Dog Food / Dry Kibble / Low Fat i/d 3 x day 3/4 cup

User avatar
Madelon
President
Posts: 878
Location: Nashville, TN
Country: United States
State: Tennessee
Pet name: Doc

Re: Newly diagnosed Pug

Post by Madelon » 07 Jan 2019, 20:38

Hi - I just wanted to pop in and see how things are going.
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

Post Reply

Who is online

Users browsing this forum: sapresley and 30 guests