San Diego referral/ New epi dx with liver disease

[Beagleowner]

Hello,
Our 10 year old beagle has been recently diagnosed with EPI in San Diego area. Any referrals for an internal medicine vet?

TLI 1.9 ug/L.
Vitamin B12 <150 ng/L
folate 22.3 ug/L.
Stool ranges from 2-4 on fecal scoring system. Color is brown combined yellow.

We have been feeding him Royal Canine Ultamino with pancrezyme 1/2 teaspoons with each meal 3x a day. Metronidazole 250mg and proviable forte daily. He is on the metronidazole for the small intestinal bacterial growth due to the EPI. We are also giving vitamin B 12 injections weekly for 6 weeks and then once a month.

Our dog has elevated liver enzymes. ALT 495 U/L. ALP 631 U/L. We had an ultrasound performed to rule out tumors. Is liver disease common with EPI? Our vet has not been able to explain why our dog's urine specific gravity is so slow. He does drink quite a bit and urinates large amounts.

Thank you for your help,
Beagle owner

[jilbert57]

Hi and welcome to you and your beagle!

Here is a link to information on liver disease from the Epi site:

https://epi4dogs.com/liver-conditions/

It is not uncommon for a dogs liver enzymes to be elevated when diagnosed with Epi.

Here is a link from our site to vets familiar with Epi:

https://epi4dogs.com/recommended-vets/

The starting ratio for powdered enzymes to dry kibble is 1 level teaspoon enzyme per 1 cup kibble, add a little warm water, stir and let incubate around 20 minutes. Stir before serving.

The B12 level needs to be at the upper end, 600 or higher. Maybe look around and read up on articles and take them with you to the new vet

I will send a Quick Start guide for Epi you can print

https://epi4dogs.com/epi-quick-guide-usa/

Hope this helps.

Jill

[Beagleowner]

Thank you Jilbert57! I'm looking forward to reading your suggested links. This might be a silly question but how would you know if you dog received too much pancrezyme?

[jilbert57]

Hard to say. Too much enzyme as well as not enough enzyme can produce a less than good poop. That is why the 1 teaspoon enzyme to 1 cup kibble is the start point. The enzyme amount depends on how much kibble you feed.
What instructions were you given?

Jill

[Jean]

hello from the UK

how long has your dog had elevated liver numbers ?

my girl had liver issues, she was given milk thistle

this was something I read

https://www.honestpaws.com/blogs/pet-ca ... se-in-dogs

however, whatever you give, please run it past your vet, I would ask the vet to further expalin the results to you, and to find out why the gravity is slow

[Barb]

Hello and welcome to you and your beagle. You have received excellent advice already with the links Jill provided. It seems overwhelming at first, but once you get everything in balance, EPI is very manageable. Ask as many questions as you have. We have all been where you are with our pups. There really aren't any silly questions. At the beginning one of our vets told us to give our Kolby a few extra doses of enzymes to give him a boost at the beginning.......whoops.....that gave him very loose stools. So start with the 1 teaspoon per cup and see how that goes.

Many of us get our enzymes from Enzyme Diane, a member here, who provides enzymes at a much more reasonable cost than the commercial brands. You can go to her website enzymediane.com or you can speak to her personally. She publishes her phone number. Kolby has been on her enzymes for 10 years.

I encourage you to keep a log/journal. Record daily everything you give your pup, the amounts and the resulting poos. This will tell you what is working and what needs to be addressed.

Ask any questions you have.

Barb

[Madelon]

Hi there and welcome to our EPI family. I'm so sorry you have to be here but please know EPI is actually one of the better conditions a dog can have as it's completely manageable and they go on to live long, healthy, happy lives.

First, are you feeding RC Ultamino because your dog also has IBD? If you're feeding that because of the EPI, please know that unless there is another underlying medical condition like IBD, Diabetes, etc. there is no need for prescription food. There are four cornerstones to properly managing EPI: Enzymes, B12, Antibiotics and Food.

ENZYMES: The recommended starting dose is 1 level teaspoon per cup of kibble, mix in a little luke warm water, then mix in kibble and let sit 20-30 minutes before serving (this helps prevent mouth sores). Most of us use EnzymeDiane (www.enzymediane.com) as her enzymes are much less expensive than the prescription enzymes from the vet and hers are sourced and made here in the U.S. If you decide to try her enzymes, I suggest using the Pancreatin 6x as it's just the like the prescription ones you're currently using so there will be no need to adjust dosing amounts.

B12: Your little one's B12 is extremely low! EPI dogs need their B12 on the higher side of normal 600+. We recommend starting with the Texas A&M protocol for B12 - a shot once a week for 6 weeks, however, please do not stop supplementing after the 6 weeks. EPI dogs cannot maintain their B12 on their own so supplementing is for life you just need to find the right dose/frequency for your dog. Most of us switch to the WonderLabs Pet Factor B12 pills (www.wonderlabs.com) after following the shot protocol. These pills contain Intrinsic Factor which helps with the absorption of B12. Some of us, like me, did not do the shots and just used the pills. Every EPI dog is different and some respond just fine to the shots while others do better with the pills. I noticed you were going to go to once a month shots - after the last weekly shot - while waiting a month for the next shot keep a CLOSE eye on any changes in poop, mood, energy, appetite as that will be an indication that the B12 is dropping and you'll need the shot sooner or switch to the pills.

ANTIBIOTICS: If dealing with SID (small intestinal dysbiosis), we recommend a 45 day course of Tylan antibiotics and then slowly wean off. HOWEVER, when first diagnosed we suggest giving the right dose of enzymes, B12 and food about two weeks to see if the gut will correct itself without antibiotics. Metronidazole can have neurological side effects so you'll need to keep an eye on it - it also works in a different area of the gut than the Tylan.

FOOD: This can be the trickiest part of EPI. We recommend grain free with 4% fiber or less because grains and fiber can interfere with the efficacy of the enzymes. Try to avoid or limit peas and legumes. Feed 150% of the food for the weight your dog SHOULD be, not the weight they currently are, but in smaller more frequent meals throughout the day. There is no need to restrict fat or use prescription food unless there is another underlying medical condition that requires it.

Keep a detailed log of everything you give and the resulting poop. I even encourage poop pictures - it's the best way to compare how things are going as it's sometimes hard to remember exactly what shade of brown or yellow the poop was a week ago - LOL! Don't worry you'll soon understand with EPI dogs it's all about the poop!

We will be here to help guide you along the way so please know you are not alone on this journey

[Patsy]

Getting back to your first post, my experience was similar. She drank loads of water so her urine was too diluted to measure. Lipase levels were high, but this seemed to be part of enzyme use. With this, she lived till 12 yrs old and gentle heart failure in her sleep.
Some vets, especially younger ones, go by one readout of numbers, rather than looking at the general picture. They don’t understand that the dog that is malnourished by epi, is completely messed up, and it takes a while for the body to be renourished and normalised.
You have to be patient and just watch the poos. Internal ad skin issues heal first, then muscles, and lastly the fatty layer.
I agree that you could try transferring to normal food, grain free, low fibre.

[adriannemary91]

Hello from Spain!

You will find a lot of usefull information here to manage the EPI!

About the liver, our puppy Happy, still having the liver enzimes high. ( they are decreasing now) but they reach 1000. ( we had no exact reason for the high liver enzimes, could it be coirticoesteroids and the start of EPI)

We give her a help for the liver_ 1 pill of silarine ( silimarine)/ by day and it help.

=)