Getting newly diagnosed EPI under control- 11 m/o GSD mix

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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Bowser's_Momma
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Pet name: Bowser

Getting newly diagnosed EPI under control- 11 m/o GSD mix

Post by Bowser's_Momma » 29 Apr 2019, 13:19

Hi All!

I have a GSD mix who was recently diagnosed with EPI. His name is Bowser, he is 11 months old, and weighs about 65 pounds. We have struggled with diet/digestive issues basically his whole life. (we initially thought he had food allergies and he was okay on a restricted diet until one day he wasn’t so our vet tested for EPI)

Bowser’s test results were as follows:
• TLI-2.3
• B12- 379
• Folate-4.5
• Positive for: Circovirus, Giardia, Coronavirus, C. perfringends Alpha Toxin

We have put him on the Royal Canin GI low fat food 4 cups 2x a day. (recommended for his adult weight 75lba is about 6 cups a day but I was told to up the feeding till he is no longer underweight) With each meal he gets Flagyl and he also gets Tylosin in his dinner. We started with the Tylosin 2x a day but after about a month our vet had us taper to one meal. (all of this is in addition to enzymes)

For about 2 weeks he was doing well with one tsp. of enzyme in each meal. Then his stools started to revert back to being soft and way too much volume. I decreased slightly and it made it worse and now I have upped it to 1 ½ tsp per meal and his stools are not getting any better. I know some people recommend 1 tsp per cup of food but the bottle I have says 1-2 tsp a meal and it’s a 10x concentrate of enzymes (its prescription) so I am not sure if that changes things since I’ve seen 6x and 8x recommended as well. Also, I was under the impression the amount of enzyme for a dog is more based on the dogs pancreatic function and less on the amount of food (meaning same amount of enzyme regardless of food amount, is this incorrect?)

Also: I tried B12 wonderlabs capsules emptying one into each meal for a couple of days and it didn’t seem to help.

Is there any way to know if I need to increase or decrease the enzyme further? Does the amount of water when mixing matter? How soon should B12 help the situation if that’s what’s missing?

Any help or advice would be greatly appreciated!

All the best,
Caroline and Bowser

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jilbert57
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Re: Getting newly diagnosed EPI under control- 11 m/o GSD mix

Post by jilbert57 » 29 Apr 2019, 14:37

Hi and welcome. If you were using 6x enzymes you would use 4 teaspoons per 4 cups kibble. I do not know conversion for 10x. Enzyme amount goes by amount of food given. Can you split the 8 cups of food into 3 meals a day instead of 2? Seems it might be better on the tummy. Also is there a reason for a prescription food and low fat? EPI dogs do not need low fat. Also unless you have concurrent conditions you don't need prescription food.

I might try upping the enzyme to 1.75 teaspoon or 2 for 4 cups food.
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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Bowser's_Momma
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Re: Getting newly diagnosed EPI under control- 11 m/o GSD mix

Post by Bowser's_Momma » 29 Apr 2019, 15:06

Thanks for the reply! I'm going to look into the concentration numbers for 6x and see what that comes out to in the 10x. As for the low fat, my vet did tell me that fiber is the most important thing to regulate but that low fat royal canin was one of a few foods which had documented vet approval (as far as the research she did) to treat EPI along with the Hills I/D and Purina E/N. I will definitely look into whether we should switch to a higher fat content. Thanks for the advice.

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Patsy
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Re: Getting newly diagnosed EPI under control- 11 m/o GSD mix

Post by Patsy » 29 Apr 2019, 16:26

Check this section and the following pages.

https://epi4dogs.com/diet-in-brief/
Most vets have limited time and inclination to study commercial food ingredients. They have a vested interest in Hills and RC, who have deals with the clinics. These foods are usually unsuitable for epi because of the high rice content. The exception is hydrolysed food for allergies.
You can also do a search on other members posts on popular foods.
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.

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Bowser's_Momma
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Re: Getting newly diagnosed EPI under control- 11 m/o GSD mix

Post by Bowser's_Momma » 29 Apr 2019, 16:36

Thank you! I will definitely look into a new food (and hopefully save money at the same time haha) I noticed on the EPI Seminar page that the Hills and Purina were recommended in the first presentation slideshow noting that fat in the 10-20% is a good range. Do you know if that info is still good or if even higher than that is recommended for fat content? Either way it looks like I need to switch from the low fat (only about 4-8% fat) I just want to make sure I cover all my bases for switching.

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Riley's Mom
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Re: Getting newly diagnosed EPI under control- 11 m/o GSD mix

Post by Riley's Mom » 29 Apr 2019, 17:46

Hi and welcome to the forum.
To answer your question about the dosage, it is based on the amount of food given at each meal. Which type of enzymes are you using? This info will help us help you better. Most of the prescription enzymes have the wrong dosage amounts on them. Heavy sigh....
It might be a good idea to compare the breakdown of the 10x compared to the 6x and 8x. This will help figure how much you need to use. Typically we advise a starting point of 1 tsp per cup of food for 6x, and 3/4 tsp per cup for 8x. Enzymes need to be with every meal, and as Jill suggested if you can break the meals into 3 or even 4 if schedule allows. It's easier for them to digest smaller meals.
The Wonderlabs B12 is a good product that many forum members use. Over 80% of EPI dogs need supplementation of B12 for life, so I'm glad you're addressing this. I don't think a few days is enough to make a determination about the effectiveness....there is a lot going on right now, once things settle you'll want to keep giving those.
You said in your first post your pup was positive for Circovirus, Giardia, Coronavirus, C. perfringends Alpha Toxin. Are these still present and active, or does the vet think they are under control? They certainly could be keeping things from settling.
I know it's a bit overwhelming right now, but EPI is manageable and we can help you get there. Hang in there and try not to change too many things at a time. Keep a log or journal and track the responses to any changes. Try to give 3-5 days for any change before you try anything new. If you change too much at once, you won't know which thing is good or which is not.
Keep us posted and ask questions as you have them.
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.

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Bowser's_Momma
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Pet name: Bowser

Re: Getting newly diagnosed EPI under control- 11 m/o GSD mix

Post by Bowser's_Momma » 30 Apr 2019, 09:44

We are currently using ZyPatt through my vet which it seems has the same potency as PancrePlus looking at the enzyme potency chart in the Seminar slide show on the main website. We had been using Pantenex (which I oddly haven't seen on this site yet but it's also the same concentration as PancrePlus and is $50 for 12 oz.) Looking at the numbers now its likely that the 10x concentration is a misnomer. So I am definitely going to increase the dose based on the recommendations. I will also see if I can make three meals a day work. Is it true that incubation is not necessary? We have been incubating for 15/20 min every meal but if we didnt have to incubate it would definitely make it easier to have more feedings throughout the day.

As for the B12 I agree it would likely take a while I just was unsure if it's too much for his body to adjust to while we are figuring out dosage which is why I backed off so I will definitely take your advice of adding it back once things seem to settle. As for the Circo etc. we are unsure if they are still present and active. My vet is keeping him on Tylosin and Flagyl because the stools haven't normalized and she did say it could take 8 to 12 weeks for his get to get rid of everything since there was so much going on. When I was thinking about it last night I feel like he was doing well while on probiotics but then he finished the course of them. Is that something people typically do long term?

Thank you for your advice and words of encouragement!

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Riley's Mom
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Re: Getting newly diagnosed EPI under control- 11 m/o GSD mix

Post by Riley's Mom » 30 Apr 2019, 21:00

Most US powdered enzymes require incubation. If you are coming from work and need to pop in quick (like at lunch), you could take your pre portioned meal with you and mix right before you leave work, then it would be ready to feed when you get home. Just a thought.
Some people have good luck with probiotics for their pups and some just never do. So if it was working, that is certainly something that could be helpful.
But I would caution you, your pup has a lot going on already with the Circo etc. as well as new EPI. Our advice is always to keep things as simple as possible in the beginning and slowly add things in as your pup stabilizes. As pet parents, we want to throw everything at the problem because we feel so helpless, but then we don't know what is working and what isn't.
So I would suggest to hit the basics, which are:
Enzymes, 1 level tsp per cup of food, incubate in lukewarm water or broth 15-20 minutes, stir and serve.
Diet: Recommended to feed grain free food, with fiber content 4% or less. Look for something with few peas or at least peas low down on the list of ingredients.
B12: Over 80% of EPI dogs require B12 supplementation for life. This can be done with injections or pills with intrinsic factor like the Wonderlabs ones you already have.
Antibiotics: As needed to address SID. You already have these on board....for the other things going on.
Once things begin to stabilize (good poop, normal amount of poop, no more weight loss, no stomach rumbling or gas) for a couple of months, is typically when to add things like probiotics etc in as needed.
Keep a journal or log, it will save your sanity as you figure out which things you are doing work and which don't.
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.

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Miss Maddie Moo
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Re: Getting newly diagnosed EPI under control- 11 m/o GSD mix

Post by Miss Maddie Moo » 01 May 2019, 07:25

Here is the enzyme comparison chart the important thing to look at is the Lipase numbers if i look at what i think is the product you are using it seems low to me.
Secondly the food is low fat we suggest that you do not restrict the fat in the food and as others have said we recommend a grain free food.
https://www.enzymediane.com/wp-content/ ... s-logo.pdf
Maddie DX April 2011 along with low B12 she was feed with a low fibre food below 3% , fat was not restricted ( she wasnt good on pea based foods ) She initially had a course of B12 shots weekly over a period of 6 months and then we used the B12 pills from Chemeyes in the UK . We used Panzym and slowly had to increase the dose as she aged when she was first DX she was 23kg but she gained weight quickly and got back to 33 kg .
Maddie gained her angel wings in Jan 2018 at the age of 10 to a condition unrelated to EPI.
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Madelon
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Re: Getting newly diagnosed EPI under control- 11 m/o GSD mix

Post by Madelon » 02 May 2019, 22:17

Hi Bowser's mom - welcome to our EPI family.

What stands out to me is the low folate level - Bowser's is 4.5 and the reference range is 7.7-24.4. Low folate can indicate Small Proximal Disease/IBD (Inflammatory Bowel Disease), often referred to as food sensitivities. I suspect this may be part of why you have been dealing with gut issues for so long as well as the EPI. I would talk to your vet about trying Royal Canin Ultamino - it is one of only a few truly hydrolyzed foods so it's broken down so much that your dog's body won't fight it. Here's a link to our page regarding this https://epi4dogs.com/ibd-allergies-food-intolerance/. I think everyone else has given you great advice on the basics of managing EPI, but unless the possible food sensitivity/IBD is addressed you won't see optimal results.
Madelon, owned by DOC. DOC dx EPI 5/2015 = TLI < .4, B12 406; Folate >24. DOC taught me so much and together we battled and overcame EPI, food sensitivies, environmental allergies but we lost the cancer battle. DOC was dx with hemangiosarcoma 5/2022 and crossed the rainbow bridge July 24, 2022. He is and always will be the love of my life, my soulmate, my heart dog.

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