New EPI Diagnosis - Feeling Overwhelmed...

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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jilbert57
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Re: New EPI Diagnosis - Feeling Overwhlemed...

Post by jilbert57 » 01 Oct 2019, 15:18

Hi Lisa, each and every piece of actual food Sadie eats needs to have enzymes to break it down. You might try feeding the green beans or chicken right after an enzymed meal, but as far as stand alone treats in the middle of the day, they would need to be with enzymes.

After your pup is stable for a month we have a section on homemade dehydrated treats made
with food that has been enzymed.

Please remember the enzymes are not a supplement, they are a necessity so Sadie can absorb the nutrients to live and thrive.

Please feel free to print off and share any information you would like with your vet.

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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Sadie'sMom
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Posts: 172
Location: Wisconsin
Country: United States
State: Wisconsin
Pet name: Sadie
My name: Lisa

Re: New EPI Diagnosis - Feeling Overwhlemed...

Post by Sadie'sMom » 01 Oct 2019, 15:34

Hi Jill:

Your continued help is so much appreciated.....

I think you actually answered a question I might have had. A few times after Sadie has finished eating, she seems like she might want a few more bites of food (I could be wrong). I'm guessing that even if we gave her 1/4 of a cup of additional dog food immediately after she eats, that she wouldn't get any benefit from it because it doesn't have the enzymes on it. If I am wrong on that, please correct me! I don't know if you know the answer to this or not --- but how long does the enzyme stay activated on Sadie's food? Meaning, if we fix her a bowl of food and she isn't hungry and won't eat, does it stay good for any length of time (like an hour?) or does it need to be consumed right away or it should be tossed? So far we haven't had that issue - but I'm sure it will happen sooner or later.

If we give Sadie a treat - say a Milkbone or a chewy - that hasn't been treated, is that "bad" for her? I know she won't get any nutrition from it, but will it have any negative effect on her (cause diarrhea for example)? However, we will DEFINITELY be doing the homemade dehydrated treats. I can't wait for her to stabilize so we can make these for her! :D

I feel like I am asking a million questions.....there is just so much to learn about this disease and we love her so much that all we want to do is what's best for her.

Thank you, Jill, for all of your help so far. I sincerely appreciate it more than you will ever know. And, yes, I will definitely be printing all of these sheets off for future reference and to discuss with our vet.

Lisa
Sadie is a Nova Scotia Duck Tolling Retriever ("Toller" for short). She eats Authority Grain Free Chicken & Pea kibble. To make sure she ingests the enzymes, we mix some No Sodium Chicken Broth and a small handful of meat - chicken, hamburger, pork - and stir it up with her dog food (she eats like a champ now!). With each meal she gets 5 scoops (1 1/4 tsp's) of Diane's Enzymes and a WonderLabs B-12 with Intrinsic factor. She gets 1 Proviable-DC probiotic per day. Diagnosed in September 2019 with EPI. She has some issues with dry skin we are dealing with now.

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jilbert57
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Re: New EPI Diagnosis - Feeling Overwhlemed...

Post by jilbert57 » 01 Oct 2019, 18:39

If that 1/4 c extra food is given within 15 or 20 minutes of her eating an enzymed meal you might be ok. Best just to add that amount to her meal and add 1/4 t more enzyme.

If you give food without enzymes it will be like when you were not using enzymes. It will probably be soft poop or cow patty with undigested food bits in it.

I know some folks put enzymed food in the fridge, I will have an answer soon.

***Here are instructions for food your dog does not eat that has been refrigerated:

"Let it come to room temperature on its own or put in Luke warm water or try feeding cold - some do ok with that"


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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Madelon
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Location: Nashville, TN
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State: Tennessee
Pet name: Doc

Re: New EPI Diagnosis - Feeling Overwhlemed...

Post by Madelon » 03 Oct 2019, 07:11

Hi Sadie's mom! Welcome to our EPI family. Sorry I'm so late responding. First, yes EPI is overwhelming in the beginning but it quickly becomes the new normal and we will be here to help guide you through it.

Okay, first you're doing a great job reading and absorbing all the information so I have no doubt you will have Saddie stable quickly. There are a few things that are going on that could inhibit Saddie from having her EPI managed properly: B12, Food and Enzymes.

There are four cornerstones to properly managing EPI: Enzymes (most of us use EnzymeDiane Pancreatin 6x as it is way less than prescription enzymes from the vet and her enzymes are sourced and made in the USA so no worries about things being in there that shouldn't - the dosing is based on the amount of food - 1 level tsp per cup of kibble, mix in luke warm water, then mix in kibble and let sit for 20-30 minutes before feeding); B12 (EPI dogs need their B12 on the high side of normal 600+ and supplementing is for life - most of us use the WonderLabs Pet Factor B12 as it has intrinsic factor which helps with B12 absorption and is very inexpensive); Antibiotics (if dealing with SID - small intestinal dysbiosis - a 45 day course of Tylan is recommended and slowly wean off after 45 days); Food (we recommend grain free 4% fiber or less - avoid or limit peas and other legumes - feed 150% of the food for the weight your dog should be but in smaller, more frequent meals throughout the day until the goal weight is reached).

To answer/address some specifics I read in your posts: there is no reason for prescription food unless there's an underlying medical condition other than EPI that requires it. The reason we recommend grain free and 4% fiber or less is because fiber and grains can inhibit the efficacy of the enzymes by as much as 50% BUT every EPI dog is different and some do better with a little grain or a little more fiber BUT most do not which is why we recommend to start with grain free and 4% fiber or less. I can tell you for many EPI dogs reducing the fiber even just half a percentage can make a huge difference in the poop.

With regard to the B12 - the B12 added to the enzymes is not going to be enough to bring Saddie's B12 levels up. Her's is quite low and low B12 can affect mood, weight gain, appetite, energy and allows SID to be out of control.

With regard to using chicken broth, if Saddie does not have any issues tolerating chicken then using the broth should be fine - just be sure it's room temperature or you can slightly heat it in the microwave BEFORE adding enzymes.

We recommend letting the enzymes and food sit for 20-30 minutes before serving to help prevent mouth sores but also because the enzymes start to activate when added to the warm liquid - however they also need the bile acid in the stomach to activate. If Saddie does not eat her entire meal you could pick it up and give it again but I would not give it more than an hour after in case of bacteria.

So, here are my recommendations:

First - As soon as possible I would either follow the 6 week protocol of B12 shots from Texas A&M (in our B12 section of the website) or get the WonderLabs Pet Factor B12 - B12 is CRITICAL to properly managing EPI.

Second - I would get a course of Tylan going - you can either get the prescription from your vet (please share with them the information on our SID page regarding Tylan) or you can order it from Foys Pet Supply without a prescription and follow the dosing instructions on our page. Be sure to use for the full 45 days and then SLOWLY wean off. Metronidazole kills both the good and bad bacteria in the gut and works in a different location of the gut whereas Tylan is much more gentle and only kills the bad bacteria in the gut. Research has shown Tylan to be more effective than Metronidazole and does not have the bad side effects like Metro.

Third - I would switch foods. If the food Sadie was on before this started falls within our parameters of grain free, 4% fiber or less I would go back to that. Just try to stay within those parameters and avoid or limit peas. Buy small bags until you know for sure Saddie can tolerate the food.

Fourth - Cut up a carrot and put it in Saddie's food - dogs don't digest carrots - make a note of the date and time of giving the carrot and then watch for it in the poop - this tells you the transition time. Often times we make the mistake of thinking the poop we are seeing is from the last meal fed and research shows that is not the case - it can be from a meal given 12 hours ago or up to 72 hours ago.

Fifth - Keep a detailed log of everything you give and the resulting poop.

Sixth - Keep us posted, ask any questions, remember to breathe and know you are not alone :)

Pam - THANK YOU FOR ALL OF YOUR RESPONSES TO QUESTIONS ON THE FORUM - YES YES YES YES - WE ENCOURAGE EVERYONE TO COMMENT WHETHER YOUR STAFF OR NOT, WHETHER YOU'RE NEW OR NOT - we all remember how overwhelmed and scared we were when our pups were first diagnosed so sharing your experience helps new members know it gets better AND sharing our experiences as to what worked for us is how we have been able to see patterns over the years that were later proven true through research!
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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Sadie'sMom
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Posts: 172
Location: Wisconsin
Country: United States
State: Wisconsin
Pet name: Sadie
My name: Lisa

Re: New EPI Diagnosis - Feeling Overwhlemed...

Post by Sadie'sMom » 03 Oct 2019, 09:47

Good Morning Madelon!

Wow, first, thank you for your post and all of your information! I would like to repeat what I told Olesia (who was helping me with a website issue I was having) this morning. Here goes:

My husband and I were overwhelmed when we first got Sadie’s diagnosis. After spending a lot of time crying (I was scared – how was I going to take care of a sick dog with a rare disease!!!) – I Googled “EPI dogs support group”) and your foundation was, of course, at the top. I have thanked God every single day that I have found this support group. The tremendous amount of information you have on your website is nothing short of incredible. I have printed off a TON of information for my husband to read (he hates computers – so I just print it off to make it easier).

I just want to express my sincere appreciation for your incredible organization that has provided the MUCH needed information that we could not have gotten anywhere else. I spoke with my doctor's office last night and they are in agreement with us using Diane’s enzymes instead of Panzquin – which is definitely going to save us a substantial amount of money. And we are going to get Sadie’s B12 from Wonderlabs. Again, these are two places we wouldn’t have known about if it wasn’t for your organization!! I, too, was very concerned about Sadie's B12 level - so will get that ordered today and get her going on a higher B12 level.

Now, for a bit of GREAT news. We read the list of 4% fiber foods on your site and decided to try Authority Grain Free Chicken & Pea (because it got great reviews and because we could pick it up at Petsmart the same day and get Sadie started on this food immediately). We are doing the taper method (as our vet requested) to get her off Hills SD and onto Authority. We fed Sadie last night (3/4ths Hills and 1/4 Authority) and this morning she had the best poop she has had in MONTHS (since the day she this all started)!!!! My husband and I were practically jumping up and down because this is the first positive thing that has happened for our girl - a firm, 95% normal poop!! We can't wait to get her 100% on Authority because it can only improve from here. Incredible how going from 7.2% fiber to 4% fiber made that much of a difference!!! :D :D :D (Had to add 3 smiley faces because we are so happy).

I am going to hold off on adding chicken broth because right now she is eating the food with no problem and will use that trick when/if it becomes necessary. But I'm glad to know we have it as an option. I read your article about the "carrot trick" and thought it was very interesting to say the least. I'm a bit scared to give her a carrot (things are so good right now - I don't want that to change) --- so when we get the courage up - we will try the carrot trick and let you know the results.

I will check with my vet about the Tylan and see what she says. I want to stay on her good side because she (and her staff) have been incredible with us. She has treated at least 1 pet with EPI in the past - so that makes us happy. BUT, I would like to get her off the Metro and onto the Tylan for all of the reasons you stated below. I will keep you updated on what she says on that too.

The only thing we have noticed is that Sadie seems to be scratching herself - especially the area around her tail. However, this is something that she has done since the day we rescued her at 6 months old - so 2.5 years ago. So it might not be anything - but I thought I should mention it in case you have any thoughts on it. Maybe she just has dry skin.

I realized last night you have a Facebook page and I plan on joining that as well as there was a lot of great information on there and it will be wonderful to have the support of other EPI dog parents!! :D

We would like to make a donation to your foundation for the love and support we have been shown so far (especially by Jill who immediately responded to my plea for help and has been a constant help every single day) and to everyone else in your organization and members who are helping us. Please let me know how to go about that.

I can not begin to imagine going through this "journey" with Sadie without having all of the information your group has and without all of the help and guidance by its staff members. I just wish I could thank you in person some day.

Lisa
Sadie is a Nova Scotia Duck Tolling Retriever ("Toller" for short). She eats Authority Grain Free Chicken & Pea kibble. To make sure she ingests the enzymes, we mix some No Sodium Chicken Broth and a small handful of meat - chicken, hamburger, pork - and stir it up with her dog food (she eats like a champ now!). With each meal she gets 5 scoops (1 1/4 tsp's) of Diane's Enzymes and a WonderLabs B-12 with Intrinsic factor. She gets 1 Proviable-DC probiotic per day. Diagnosed in September 2019 with EPI. She has some issues with dry skin we are dealing with now.

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Sadie'sMom
Member
Posts: 172
Location: Wisconsin
Country: United States
State: Wisconsin
Pet name: Sadie
My name: Lisa

Re: New EPI Diagnosis - Feeling Overwhlemed...

Post by Sadie'sMom » 03 Oct 2019, 18:07

Hi:

Need some help please! Sadie threw up twice today. We started her on new dog food last night - Authority Grain Free Chicken & Pea. We gave her 3/4ths her current food (Hills S.D.) and 1/4th Authority. This morning her poop was excellent. She had the same amount of food this morning - around 7 a.m. - and at 2:30 pm she threw up what looked like wet, undigested dog food - granular looking - consistency of corn meal. An hour later she threw up the same thing again.

Suggestions/help please!

Lisa
Sadie is a Nova Scotia Duck Tolling Retriever ("Toller" for short). She eats Authority Grain Free Chicken & Pea kibble. To make sure she ingests the enzymes, we mix some No Sodium Chicken Broth and a small handful of meat - chicken, hamburger, pork - and stir it up with her dog food (she eats like a champ now!). With each meal she gets 5 scoops (1 1/4 tsp's) of Diane's Enzymes and a WonderLabs B-12 with Intrinsic factor. She gets 1 Proviable-DC probiotic per day. Diagnosed in September 2019 with EPI. She has some issues with dry skin we are dealing with now.

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jilbert57
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Re: New EPI Diagnosis - Feeling Overwhlemed...

Post by jilbert57 » 03 Oct 2019, 18:55

Not so sure I would worry a lot about it
Is she acting sick? Was there any hair or junk in it or just grainy. If your pups are used to getting treats throughout the day maybe you can feed Sadie a small meal mid day, with enzyme. Maybe too long between food.

Regarding the mucous in the stool. The intestinal tract is lined with mucous to make pooping easier. Sometimes this is expelled with the feces.

Is she on Tylan yet?

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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Sadie'sMom
Member
Posts: 172
Location: Wisconsin
Country: United States
State: Wisconsin
Pet name: Sadie
My name: Lisa

Re: New EPI Diagnosis - Feeling Overwhlemed...

Post by Sadie'sMom » 03 Oct 2019, 19:03

Hi Jill:

Thank you for responding so quickly!

She isn't 100% perky - but was pretty normal all day.

Yes, there was some hair in her food - she has been licking her feet quite a bit lately.

We had been giving her 1.5 cups of food twice per day. Last night we increased that to 2 cups as we thought she should be getting a bit more food in the hopes of gaining some weight back. No,we haven't given her any treats since she was diagnosed - nothing except her kibble. We will start giving her a small meal mid day now with enzymes.

She is still on the Metro twice a day and the probiotic.

Do we go back to her dog food she was getting? Or do we continue with the taper adding in the Authority?

Thank you.

Lisa
Sadie is a Nova Scotia Duck Tolling Retriever ("Toller" for short). She eats Authority Grain Free Chicken & Pea kibble. To make sure she ingests the enzymes, we mix some No Sodium Chicken Broth and a small handful of meat - chicken, hamburger, pork - and stir it up with her dog food (she eats like a champ now!). With each meal she gets 5 scoops (1 1/4 tsp's) of Diane's Enzymes and a WonderLabs B-12 with Intrinsic factor. She gets 1 Proviable-DC probiotic per day. Diagnosed in September 2019 with EPI. She has some issues with dry skin we are dealing with now.

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jilbert57
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Posts: 2092
Country: United States
State: Washington

Re: New EPI Diagnosis - Feeling Overwhlemed...

Post by jilbert57 » 03 Oct 2019, 19:45

I would keep the ratio of new to old a couple days and then transition as usual.
Are you home during the day? If so I would go with the 3 feedings of the normal amount of food and enzyme. Sometimes it helps to spread the meals out.

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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Sadie'sMom
Member
Posts: 172
Location: Wisconsin
Country: United States
State: Wisconsin
Pet name: Sadie
My name: Lisa

Re: New EPI Diagnosis - Feeling Overwhlemed...

Post by Sadie'sMom » 03 Oct 2019, 19:53

Hi Jill:

I work, but my husband is retired and he can definitely do what you just said. We will keep the ratio the same for a few days and then start the taper again.

Thank you, again, for your support. :D

I will update you to let you know how she is doing.

Take care.

Lisa
Sadie is a Nova Scotia Duck Tolling Retriever ("Toller" for short). She eats Authority Grain Free Chicken & Pea kibble. To make sure she ingests the enzymes, we mix some No Sodium Chicken Broth and a small handful of meat - chicken, hamburger, pork - and stir it up with her dog food (she eats like a champ now!). With each meal she gets 5 scoops (1 1/4 tsp's) of Diane's Enzymes and a WonderLabs B-12 with Intrinsic factor. She gets 1 Proviable-DC probiotic per day. Diagnosed in September 2019 with EPI. She has some issues with dry skin we are dealing with now.

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