New Diagnosis, looking for help/advice

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.
Post Reply
khiggins

New Diagnosis, looking for help/advice

Post by khiggins » 26 Jan 2020, 11:29

Our dog Penny was diagnosed with EPI on Thursday. She’s a mixed breed dog (part boxer) and has been a light to our lives since we adopted her two and half years ago. Penny always had somewhat loose stools, but it was never really considered an issue outside of an occasional accident every few months. About a year ago, things got worse and she was treated for Pancreatitis. Things got back to “normal” until late this summer and she was again treated for very loose stools. By treatment, I mean she spent a couple of nights at the vet and was put on fluids. Follow up consisted of long-term Metronidazole taken daily. She was doing very well until early November when she has an unrelated (we think) issue that was likely encephalitis. We don’t think it was related to her current issues as our other dog had the same problem. Treatment consistent of antibiotics along with prednisone. She bounced back from that very well but came home with another care of diarrhea. This was treated and she was perfect in Mid-December. As they started to cut back on the meds, issues started again. She spent last weekend at the vet (received a steroid shot) and an EPI test was recommended. Penny was diagnosed as a result of a 2.5 reading. I’m not certain if she was fasted for this test. The EPA likely came from chronic pancreas issues.
The vet indicated that Penny probably has multiple things going on as he had been treating her for IBS since December. No official diagnosis for that and from reading this forum it feels like it could be Sibo? She is still on the Metron. He gave us some Viokase V to use for a few days while he orders a powdered product. He also gave us a bag of Tylosin on Friday 1/24/20. I asked about B12 and he said that was probably more of a secondary item. We also started on a probiotics a week ago when we thought we were dealing with ibd.
Penny had been on Hills Prescription Diet and we were trying Royal Canin Gastrointestinal starting last week. Her appetite wasn’t great, so he let us feed her some Hills Digestive Care soft. She ate that for a few days.
Penny stopped eating Friday night and has not had a bite since. I have been giving her pills by peanut butter for the last few months as that is the only way she will take them. This morning, I couldn’t even get her to take this (so no medication). Also, giving the Tylosin has been terrible. I’ve mixed it with non-flavored yogurt and forced it down her.
Penny has no appetite and very little energy. She sits around all day other than a short walk with me. She isn’t like most EPI dogs in that her weight had been fine until the last week or so as she has lost a few pounds. Her stool is essentially liquid and has been for a least two to three weeks.
I am supposed to follow up with the vet on Monday and feel like if she hasn’t eaten, he’s going to want to hospitalize her again. I feel like I am really at crossroad as to whether to continue. My dog is suffering, and we’ve spent thousands of dollars already. I really want to get her healthy, but also need to determine when to let her go.
My questions are:
• How have others been able to get their dogs to take medication? Hidden in food just doesn’t work for Penny.
• Should I push for a B12 injection? Her other bloodwork was okay, but they didn’t check for B12.
• If we continue and seek treatment, how soon can we expect to see some improvement.
• What’s the expected monthly cost to treat a 30 lb. dog.
• Does my story sound like a dog that can recover. I know that’s a difficult question?
• Any advice would be greatly appreciated.

Thanks!

User avatar
Patsy
Member
Posts: 264
Country: United Kingdom - England

Re: New Diagnosis, looking for help/advice

Post by Patsy » 26 Jan 2020, 12:57

Boxers are prone to gut trouble, but at least you have an epi diagnosis. Everyone on this forum joined when they and their dog or cat were absolutely desperate and tearful. For a start, your dog hasn’t lost much weight yet.. so don’t despair.

I’m in the UK, so I can’t comment on how much enzymes cost where you are, but the other folks will give you a rundown on where to get the best and cheapest products. Enzymes don’t have to bought from a vet who will charge much more for them.
You can also buy B12With intrinsic factor online.

Many vets are inexperienced with epi, and give incorrect advice, so the combined experience and medical knowledge on this website is invaluable. Other members would like to hear what amounts of drugs and enzyme the vet has advised.

I appreciate that she’s had pancreatitis before, and that you need a diet that is sympathetic to that. Not all the vets favourites, ie, Hills, are necessary for epi. Most of us use tasty normal, low fat commercial food . Otherwise will she eat scrambled eggs, white fish, minced chicken, pasta? I mentioned to someone else, that some dogs get sore throats and mouths from the enzymes, and refuse to swallow.. Is she drinking? If she isn’t, this may be possible.
I sure someone will chime in and add some answers to your questions.
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.

User avatar
jilbert57
Staff
Posts: 2088
Country: United States
State: Washington

Re: New Diagnosis, looking for help/advice

Post by jilbert57 » 26 Jan 2020, 13:35

Hi Keith, welcome to you and Penny. One of the first things I would do is address the B12. Here are some symptoms of low B12:





"Because B12 plays an important role in the body’s absorption of iron, insufficient levels of this vitamin can lead to anemia. Dogs with a B12 deficiency and/or anemia may have one or more of the following symptoms:


lack of energy
weakness
reduced interest in play
loss of appetite
diarrhea
weight loss
lack of muscle mass
confusion
seizures

I would have the serum cobalamin tested as EPI pups need to be maintained at the upper high end of the range, 600 or greater.

The enzymes are dosed on the amount of food your pup eats. 1 level teaspoon enzyme per 1 level cup kibble. Add small amount of room temperature water, stir and let set 15 to 20 minutes. A stinky topper can be added(tuna, parmesan cheese, etc..) The enzymes your vet will order will cost a lot more . Most folks here use enzymediane.com enzymes. She will visit if you have questions.

The diet is usually a grain free variety with 4% fiber or less. Try to keep peas, lentils/legumes out of the top ingredients.

The Tylan might be better than the metro as metro has a lot of its own side effects:

Some common side effects your dog may experience when using Metronidazole:

Nausea/Vomiting
Diarrhea
Drooling
Gagging/regurgitation
Fatigue
Loss of appetite
Blood in urine
Fever

Tylan is very easy on the animals and does not kill the good bacteria in the gut. Metro will kill good and bad.

Your pup should respond well to the EPI protocol with the 4 cornerstones being implemented:
Enzymes
Diet
Antibiotic
B12

https://epi4dogs.com/dog-food-options/

https://epi4dogs.com/antibiotics/

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.

Tuckaboo Pam
Member
Posts: 1345
Country: United States
State: Florida
Pet name: Tucker
My name: Pam H.

Re: New Diagnosis, looking for help/advice

Post by Tuckaboo Pam » 26 Jan 2020, 14:45

Keith---Here is how I can afford to keep Tucker, 70 pounds, on his EPI routine: WonderLabs B12 from Amazon, $30.00/180 pills, or 3 months supply for him. Tylan from Foy's Pigeon Supplies $39.00+ shipping, for 100 grams. Not sure how to divide that up, but it costs way less than the same thing from the vet & seems to last awhile, like a couple of months, AND Enzyme Diane for 6X enzymes. She recommends ordering a sample bag at first, but when you start buying the bigger bags you'll realize these are SO much cheaper than the ones you get from the vet; they are great enzymes, too. It sounds like you have way more going on than I have, and people who are more qualified can get to you on those things, but WOW, all that time in the animal hospital is crazy expensive! I give Tylan, which is bitter tasting, to one of my little dogs, and I have found that topping a small heap of Tylan with a spoonful of cottage cheese works best. She gets so busy lapping up the yummy stuff, she doesn't seem to notice the meds. For Tucker, my EPI boy, I place the enzymes, Tylan, & B12 in the dish, cover with kibble & pour room temp turkey bone broth on top, swish & marinate for 20 minutes. If I was having trouble getting meds in him, I think I'd look for capsules. Hold his mouth, place them in as far as I could, and close his mouth. He always swallows pills when I do this, but I have chosen to open the capsules he takes. I'm not sure why! You have been through the wringer with your pup, and I really feel for you. I would have to think hard about all those overnights in the clinic, but then again, the things we do for love! Take care---Pam
Tucker was a shepherd/lab mix--- TLI 1.3, Folate 9.7, Cobalamin 666, Lipase 38. Took Diane's Enzymes 4 teaspoons/day, Wonderlabs B12 one capsule per day, and Tylan 1/16 teaspoon/ morning (to hold SID at bay). Taste of the Wild High Prairie, 1 1/2 cups/day, with a total of 4 cups of Fresh Pet. Stopped eating everything in sight, and went from 60 to 85 pounds! Tucker was my boyfriend, and my husband was OK with that. Tucker succumbed to hemangiosarcoma, but we cherished every day we had with that wonderful, beautiful boy. I will always, always miss my sweet big boy.

khiggins

Re: New Diagnosis, looking for help/advice

Post by khiggins » 01 Feb 2020, 09:09

Thanks so much for the responses and information. Penny spent two nights at the vet and has been home since Wednesday. he had a B12 shot at my insistence. They said she could have another one in a week or two.

Meds: She has started with powdered enzyme that she will eat in her food!! She's been on that 4 days. She is receiving two metro pills a day and one dose of prednisone. We are giving tylan twice a day and I have to administer via a syringe which is not so fun. She is also getting a daily probiotic.

Food. We are giving her a combination of Hills Digestive care id (hard and soft) and Hills Heatlhy Advantage Vet Exclusive.

Penny is eating much better. She has lost some weight but looks better also! Her stools are still pretty loose (cow pie) but at least no longer liquid. At least we have seen some improvement.

We are giving this 30 days and so far I am hopeful we will get our dog back and heathly. I am a little concerned about all of the meds (anitbiotics), but I am trusting my vets. My only question for others at this point. Should I order a B12 supplment and start feeding it to her now or wait a week or two and give her another shot?

Thanks!

Tuckaboo Pam
Member
Posts: 1345
Country: United States
State: Florida
Pet name: Tucker
My name: Pam H.

Re: New Diagnosis, looking for help/advice

Post by Tuckaboo Pam » 01 Feb 2020, 16:09

Do you know why she is taking metro and tylan at the same time?
Tucker was a shepherd/lab mix--- TLI 1.3, Folate 9.7, Cobalamin 666, Lipase 38. Took Diane's Enzymes 4 teaspoons/day, Wonderlabs B12 one capsule per day, and Tylan 1/16 teaspoon/ morning (to hold SID at bay). Taste of the Wild High Prairie, 1 1/2 cups/day, with a total of 4 cups of Fresh Pet. Stopped eating everything in sight, and went from 60 to 85 pounds! Tucker was my boyfriend, and my husband was OK with that. Tucker succumbed to hemangiosarcoma, but we cherished every day we had with that wonderful, beautiful boy. I will always, always miss my sweet big boy.

User avatar
Madelon
Staff
Posts: 1317
Location: Nashville, TN
Country: United States
State: Tennessee
Pet name: Doc

Re: New Diagnosis, looking for help/advice

Post by Madelon » 01 Feb 2020, 22:19

Hi and welcome to our EPI family. First question - what was the B12 level at diagnosis and what was the Folate level at diagnosis? What food are you feeding? How much and how are you preparing and what dose are you using of enzymes? Sorry for the questions but it will help us be able to give better suggestions.

There are 4 cornerstones to properly managing EPI:

ENZYMES: Most of us use EnzymeDiane Pancreatin 6x - no prescription needed and is a 1/3 of the cost of the vet prescription enzymes. Recommended starting dose is 1 level teaspoon per cup of kibble, mix in a little luke warm water and then mix in kibble and sit 20-30 minutes before serving.

B12: Most EPI dogs have low B12 at diagnosis - they need their B12 to be 600 or higher - "normal range" is not good enough. Supplementing is for life as they cannot maintain their B12 on their own. You can either do shots or use the WonderLabs Pet Factor B12 pills.

ANTIBIOTICS: We now know that all EPI dogs have SID (small intestinal dysbiosis formerly called SIBO) but it's a matter of keeping it controlled with the EPI protocol. We recommend in the beginning to give the enzymes, B12 and food two weeks to see if the gut will correct itself. If not, you can either try Slippery Elm Bark powder or Tylan antibiotics (slowly wean off after 45 days).

FOOD: We recommend grain free, 4% fiber or less. Feed 150% for the weight your dog should be not the weight your dog is - but in smaller, more frequent meals throughout the day until you reach goal weight.

Keep a detailed journal of everything you give and the resulting poop and only make one change at a time. I know it seems overwhelming but I promise it will quickly become the new normal and we will be here with you to guide you along the way,
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.

User avatar
Madelon
Staff
Posts: 1317
Location: Nashville, TN
Country: United States
State: Tennessee
Pet name: Doc

Re: New Diagnosis, looking for help/advice

Post by Madelon » 01 Feb 2020, 22:20

Oh and as for prescription food - there's no need unless there's an underlying condition. If you truly feel your dog has IBD then we recommend Royal Canin Ultamino - it seems to work best for dogs that have EPI and IBD. If you're not sure about the IBD then I would just try one that is grain free, 4% fiber or less and avoid peas.
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.

Post Reply

Who is online

Users browsing this forum: No registered users and 103 guests