Page 1 of 4

Diagnosis 72 hours ago - jack Russell X

Posted: 04 May 2019, 08:03
by Littlepickle
Our 5 year old Jack Russell cross rescue has just had a confirmed diagnosis of EPI 72 hours ago following an 8 week period of significant weight loss and this website has provided so much information in relation to both the disease process and the individual focus required to manage it.

History: Archer is a 5 year old Jack Russell cross (with what we will never know but appears to have some Beagle) who came int our family as a 12 week old puppy. By 5 months of age he had developed a significant front leg growth deformity (Carpus Valgus) which we have conservatively managed with Gabapentin and anti -inflammatories pending an eventual amputation. As an adult we have kept him lean at 9.4-9.8kg (he is larger than a pure breed JR) in order to reduce the weight on his leg - he has been on a grain free diet for the last 3.5 years. 8 weeks ago we made a change of brand grain free diet and approx 10 days later he began producing large volumes of faeces multiple time per day (semi formed at this stage). He also began experiencing 'leaking; from the anus of a yellow like substance that had a strange but non-offensive odour - this was obviously irritating and he began licking to the point of redness.

Vet visit Number 1: weight loss (8.9kg), ? anal glands (which were milked with no result) back home.
3 weeks later: weight loss evident (8.3kg) , continual anal leaking, multiple large volume faeces with a yellow colour but very little odour, otherwise happy / requesting walks: Vet suggested 7 days of withholding anti-inflammatories, 7 days of chicken and rice diet, feed 3 times per day, commence probiotics.

2 weeks later: weight loss continues (no scales - 700kms away from a vet on holidays), anal leaking continues. Very large volumes of yellow soft faeces (1.5 tea cups 3 times per day). Commenced feeding 3 hourly, continue with chicken and rice. 4 days later - rice and chicken appears to be coming out with faeces undigested. Otherwise happy and enjoying swimming in the ocean, digging at the beach and going for walks. Very hungry. Stopped rice and began feeding 2 hourly small portions of homemade chicken and broth.

Return to the city: Vet appointment (now 6 weeks after first symptom)weight now 7.8kg (ribs / spine and hip bones evident) Routine Bloods taken and formal scan booked for 8 days time (earliest appt) Faeces - volume reduced but remains yellow, soft and has a ? sausage like casing. Continue with 2 hour feeding of chicken and broth for a total volume of 450 grams per day!. Tried a small piece of cooked salmon which resulted in very leaky anus ( I assume fat) started daily weights.

7 weeks post symptoms: More wight loss 7,7kg, faeces continues as above. Still happy and cannot understand why he is not been taken for his usual long daily walks. 2 hourly feeding continues - I decide to take him back to the vet as not happy to wait for scan - more bloods, vet decides to complete a scan at the clinic : Evidence of inflammed bowel and fluid in the abdominal cavity, unable to view the pancreas. Decides at the last minute to test for EPI (this is a $200 test in Australia on top of the normal blood test costs). Before we knew the results the vet requested that we consider a 'novel protein' The only two we could come up with were Venison and Crocodile and I couldn't find any that afternoon.

Wednesday morning: Confirmed diagnosis and commenced Creon granules, Flagyl and probiotics on Thursday afternoon.

It is now Saturday and we are feeding 5 small meals per day with the enzymes - Poo volume has decreased and while still remains yellow it has lost the greasy 'sausage film'. no anal leakage. There does not appear to be any further weight loss. He is happy and bouncing around like his usual self.

If you got this far.. I have a few questions:

1. We have been advised to mix the Creon dose in with the food and leave to sit for 10 minutes - is this correct given that they are enteric coated granules not the powder used in the USA?
2. I have been using the chicken and pumpkin diet we have been on until we get a few days under our belt but will probably need to consider adding a small amount of fat - what should I use? how much? (current portions: 75% chicken, 20% Pumpkin and I am guessing no more than 5% fat from the cooked chicken )
3. I bring his meal up to room temperature using a little boiling water (before adding granules) to mimic what the temp of the gastric environment would be- ? required.
4. Currently feeding him 420 grams per day over 5 meals (will need to go to 4 on Monday)
5. At some stage I would like to use a commercial grain free 'kibble' in conjunction with homemade food - when should I consider introducing this ?
6. Plan on weekly weights, watching for signs of mouth ulcers etc.. Will also ask the vet about B12 levels and treatment of required

Thankfully I have Pet insurance....

All the best

Re: Diagnosis 72 hours ago - jack Russell X

Posted: 04 May 2019, 10:39
by jilbert57
Hi and welcome to the forum. Here is a link for managing EPI outside the US:

To my knowledge you don't need to incubate Creon. You can open the capsule, put on food then give to the pup. You are correct about the enteric costing.

Unless your pup has an existing condition that requires fat restriction, you are good feeding a normal amount of fat.

I would think you could introduce a grain free kibble with fiber under 4% to the current diet of chicken and pumpkin gradually. Here is a link to out diet page:

Please post test results of Tli, B12, and folate. To be complete you need the right food, B12 up over 600, enzymes and the antibiotic.

Please keep in mind all food needs enzymes

Re: Diagnosis 72 hours ago - jack Russell X

Posted: 04 May 2019, 22:31
by Riley's Mom
Welcome to the forum, so glad you found us.
Ahhh, the dreaded anal leakage. We had that before diagnosis. Along with all the other symptoms you described. I had been to the vet several times, but the anal leakage is what sent me back in desperation. I was lucky, my vet tested for EPI at that point.
Jill is right, no need to incubate the Creon since the granules are enteric coated. The US enzymes have to be incubated as it is a powder that is caustic and can cause mouth sores. Creon will not do that.
As you transition to kibble, look for a grain free, 4% fiber or less, no need to restrict fat unless there is a concurrent condition that requires it. Also look for a food that has no peas, or at least peas listed lower on the ingredient list. (Also, look for peas listed in more than one way, they are sneaky that way). Many EPI dogs don't do well with peas as well as peas are a poor protein source.
Keep a log or a journal, it will save your sanity as you try to figure out what is working and what is not. When you buy food, buy a small bag in case it doesn't work out well. You'll know if it isn't a good fit....the poops will tell you. The poops tell it all, you will become a "poopologist" like the rest of us :lol:
Keep us posted and ask questions as you have them.

Re: Diagnosis 72 hours ago - jack Russell X

Posted: 04 May 2019, 22:58
by Littlepickle
Thank you jilbert57 and Rileysmum:
Diagnostics: TLi = 1
I do not know the B12 and Folate levels and there is a pretty high chance that these have not been taken. We have a follow up appointment this Friday so will double check then.
Thanks for the update with the Creon: I have teenagers who will need to manage his medication and food whilst we are on 4-5 meals per day and this will make the process one step easier.
I will head to the pet store today to investigate the options of dry food noting the low fibre requirements and the avoidance of pea products (thanks for the 'heads up')

Thankfully he seems to have stopped eating his own poo!!! I feel like a scientist every time I go out there to investigate and dispose of it - today it is still yellow, formed and without the previous greasy/shiny look, although I note that he has obviously been eating grass/green leaves.

Rileysmum it was actually my diary notations and descriptions of the poo that I think assisted the vet with deciding to test.

Given that this appears to be a journey with a few steps forward and back on the pathway to stabilisation I am sure I will have plenty of questions moving forward.

Thank you

Re: Diagnosis 72 hours ago - jack Russell X

Posted: 05 May 2019, 04:51
by Jean
good morning Archer and ?

we are from UK and you definitely do NOT have to incubate Creon

you might want to look at an alternative enzyme ... ymes-dogs/

I can confirm that they are used widely in UK and Europe, and are available actually in Australia

you seem to be well up on EPI and I havent much else to add, but please ask ANYTHING,

If you have said this forgive me, are you supplementing B12


Re: Diagnosis 72 hours ago - jack Russell X

Posted: 05 May 2019, 12:45
by Madelon
Hi and welcome to our EPI family. I'm so glad you found us. First, here's a link to our Australia brochure on managing EPI - please note this brochure was done by one of our staff members who lives in Australia and had an EPI dog, however, recently as Jean stated Chemeyes now ships powdered enzymes to Australia which might be a less expensive alternative to the Creon. ... t-2016.pdf

Everyone has answered the question about incubating Creon. There are four cornerstones to properly managing EPI: Enzymes (already discussed above); B12 (EPI dogs need their B12 in the upper range of normal 600+ and supplementing is for life - a lot of us use WonderLabs Pet Factor B12 - they ship to Australia); Antibiotics (we recommend Tylan for 45 days and slowly wean off); Food (grain free 4% fiber or less - feed 150% of the food for the weight your dog should be until you reach goal weight).

As for when to try a commercial grain free food - you can do that at any time. Buy small bags until you find the right food for your dog.

If your vet did not test B12 I highly recommend getting that tested so you have a starting point. Keep a detailed log of everything you give and everything that comes out so you know what works and what doesn't.

Re: Diagnosis 72 hours ago - jack Russell X

Posted: 05 May 2019, 15:40
by Barb
Hello and welcome to our EPI family. You have done an excellent job of researching. Your pup is lucky to have you. I heartily endorse keeping a log. As you can see, it gives you so much valuable information. It saved our sanity.

You have received excellent advice already. Ask any questions that you have.


Re: Diagnosis 72 hours ago - jack Russell X

Posted: 06 May 2019, 03:12
by Littlepickle
Thanks for the advice so far.. things seem to be going okay.
Tolerating feeds and no loose poo.
Full of energy and asking for walks
No further weight loss (7.8kg) hopefully we see a rise at Friday's appointment.

Will post back with B12 situation once I have more information

Thank you

Re: Diagnosis 72 hours ago - jack Russell X

Posted: 06 May 2019, 04:10
by Jean
good to hear from you

Re: Diagnosis 72 hours ago - jack Russell X

Posted: 06 May 2019, 05:16
by Littlepickle
Here is our possible step back:
Medium bowel action this afternoon (small orange size in volume), Formed - yellow with ?purple colouring of slightly different consistency : did not have the appearance or consistency of 'normal' blood clots or old blood. Much of what I can find online tends to point to this being an 'urgent' review by a vet. Otherwise well and enjoyed a walk this afternoon.
In the absence of any further sysmptoms (or bowel actions) thinking I may 'watch and see'.