New to EPI - advice on managing a flare-up

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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Madelon
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Re: New to EPI - advice on managing a flare-up

Post by Madelon » 05 Sep 2020, 20:37

We do love the poop pictures! I'm glad you're in Olesia's hands because she is THE BEST! The only thing I might suggest to help you figure out the poops is grate or cut up some carrot and add it to the food - make a notation of the date and time you give the carrot - then watch for it in the poops - it could show up in multiple poops - but that will tell you your dog's transition time - so it will help you figure out if the change you've made is working or not. Often times people think the poop they are seeing is from the last feeding but it can be anywhere from 12-72hrs.
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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Olesia711
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Re: New to EPI - advice on managing a flare-up

Post by Olesia711 » 05 Sep 2020, 22:22

Hey Madelon, , Great suggestion about the chopped up carrot. THANKS!!!
Olesia, was owned by Izzy, a 35lb Spanish Water Dog (SWD), Diagnosed at 1.5 years old - TLI results 1.. Izzy passed away on February 13, 2020 at 15 years old. She lived with EPI for 13+1/2 years. It was because of Izzy that Epi4Dogs was started... she was the inspiration. May her legacy of helping others with EPI continue for as long as needed.........

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zerothehero
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Re: New to EPI - advice on managing a flare-up

Post by zerothehero » 15 Sep 2020, 19:34

Hi everyone. So with the re-addition of rice he’s been doing better. I really appreciate everyone’s advice. i’ve been feeding 3/4 can in the AM and PM with 6 crushed pancretabs, and 1/2 can with 5 halfway through the day. Poops all look good now! Got his results back today and it doesn’t look like EPI based on these results, so i don’t know what to do now. Normally I start slowly switching him back to his dry but I’m not sure if I should do that. This wet is costing me $40 a week though!! :shock:

Here are his results:
https://drive.google.com/file/d/1E-00CN ... p=drivesdk

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Olesia711
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Re: New to EPI - advice on managing a flare-up

Post by Olesia711 » 15 Sep 2020, 23:09

Hi ... Well, as we have already determined.... this is not with a test result of 37.... which on one hand is good news, but on the other hand it still leave you wondering what is going on. .

Since Zero is now doing reall good on the food that you have him currently on.... what i would suggest is to make a list of ALL the ingredients in this food... and list according to which ingredients are most prevalent (at the top of the list) to which ingredients are included to a lesser degree (bottom of the list).

Then i would try to find a less expensive food that "appears" to be similar. This might be one way for you to keep Zero on a similar diet that works, but may not cost you a zillion dollars. What i have noticed is that this particular diet contains INULIN in it, this is a prebiotic a dietary soluble fiber... they usually process this from chicory root and/or Jerusalem Artichoke. the ingredients in this food is:
Ingredients
"Meat By-Products, Water Sufficient For Processing, Barley, Chicken, Rice, Soy Protein Isolate, Glycerin, Vegetable Oil (Source Of Medium-Chain Triglycerides), Tricalcium Phosphate, Guar Gum, Inulin, Potassium Chloride, Calcium Sulfate, Fish Oil, Vitamin E Supplement, Magnesium Sulfate, Salt, L-Lysine Monohydrochloride, Zinc Sulfate, Ferrous Sulfate, Niacin (Vitamin B-3), Thiamine Mononitrate (Vitamin B-1), Copper Sulfate, Calcium Pantothenate (Vitamin B-5), Manganese Sulfate, Pyridoxine Hydrochloride (Vitamin B-6), Vitamin B-12 Supplement, Riboflavin Supplement (Vitamin B-2), Vitamin A Supplement, Folic Acid (Vitamin B-9), Vitamin D-3 Supplement, Biotin (Vitamin B-7), Potassium Iodide, Sodium Selenite. D259019."

I underlined some key ingredients.... Aside from Meat by products (which is scrap meat ) as the first ingredient.... the next ingredient is Barley which is a fiber used to move things thru the digestive system at a good pace. Then there is Rice as the 4th ingredient. Zero obviously can handle chicken as that is the 3rd ingredient. Instead of Vegetable oil as a MCT... you can use coconut oil (it's healthier) and then notice the Guar Gum the Inulin.... that is like adding SLippery Elm, guar gum is a mucilage with inulin which is a prebiotic..... this should give you an idea of what less expensive food to try... maybe the dry version of Purina ProPlan... but whatever you use... make sure it has prebiotics in it, and if not, add your own... BUT just know that with prebiotics, you use just a little because too much can give Zero (or anyone that uses to much) loose stools and gas.........

I do know you can buy already prepared "prebiotics" over the counter, but i have no idea how much or how little to give a dog........... but this is why many EPI caregiver use Slippery Elm because it is a mucilage and a prebiotic fiber which helps the gut repair itself.... and although it doesn't work on every single case, it does seem to work on the majority of dogs struggling with gut issues like SID or leaky gut...... but i would look at other foods that appear to have a similar composition if you cannot afford to keep Zero on this particular diet......even though he is now doing well on it.
Olesia, was owned by Izzy, a 35lb Spanish Water Dog (SWD), Diagnosed at 1.5 years old - TLI results 1.. Izzy passed away on February 13, 2020 at 15 years old. She lived with EPI for 13+1/2 years. It was because of Izzy that Epi4Dogs was started... she was the inspiration. May her legacy of helping others with EPI continue for as long as needed.........

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zerothehero
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Re: New to EPI - advice on managing a flare-up

Post by zerothehero » 16 Sep 2020, 10:21

Thanks for your quick response! What do you think about his folate levels? I had him off his oral B12 for one week before the test. (Test was done Wednesday 9/9.) After the test, I stopped using his old B12 and started giving him the new one with the intrinsic factor. Should I keep that up?

Also, I did buy the slippery elm like 2 weeks ago, but I didn't want to keep changing things up so I haven't started it yet. Right now he's still getting the other probiotic treat things I mentioned I got from the vet, that you said were good, but I think you also said they were a probiotic and slippery elm was a prebiotic? I'm actually not sure what the difference is! Does he need both a probiotic and a prebiotic?

So it sounds like you're saying I should find a similar food, but not worry about it having vegetable oil (supplement with coconut oil instead), or the guar gum and inulin (supplement with slippery elm instead). Do I have that right? Should I still continue with the enzymes? And should I still try to switch off of metronidazole and get him on the other one? When I had brought it up to my vet, he said it's "an older antibiotic not really used or recommended anymore," and basically dismissed the idea, so I would need to insist or switch vets. (Which I'm still considering anyway.)

I'm off to research some new dry foods. Where do you think I should go from here, as far as trying to diagnose what his actual issue is?

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Olesia711
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Re: New to EPI - advice on managing a flare-up

Post by Olesia711 » 16 Sep 2020, 11:41

1. the metronidazole is the drug that is an old drug...not Tylosin. ....... Tylosin was actually made for honeybees, chickens and pigs, but a few years ago they found that it works very well with dogs (and cats) ... and is now (finally) an approved antibiotic for dogs and cats.

January 2020: Tylosin (Tylosin Tartrate/Tylan) is now listed in WSAVA (THE WORLD SMALL ANIMAL VETERINARY ASSOCIATION) “List of Essential Medicines for Dogs and Cats”
https://onlinelibrary.wiley.com/doi/10.1111/jsap.13135 8.Erythromycin or tylosin ..... These macrolides are recommended for treatment of severe Campylobacter infections and chronic enteric infections responsive to antimicrobial therapy.

2. Probiotics are bacteria.... Prebiotics feed the bacteria. Probiotics need prebiotics to survive..... so at this juncture i would introduce a little SLippery Elm powder... see if it helps... Go to the SLippery Elm page for more info on SLIppery Elm.

3. Folate levels are high, which may indicate SID...even though if Zero was an EPI dog, we no longer use the Folate score as an indicator for SID in EPI dogs cause we now know that all dogs with EPI have SID to one degree or another..... this is yet another reason to ask the vet to please swap out the Metro and let you try Tylosin Tartrate soluble powder antibiotic, if after adding SLippery ELm.... you do not see any improvement. If you do see improvement but not near enough.... then the next step would be to ask to prescribe Tylosin.

4. The B12 is very good.... i would change the B12 regimen (wonderlab pills) to two or 3 pills only a week... jsut to maintain these good levels.... since it still appears that whatever is going on is probably a chronic condition, and with a chronic gastro condition, B12 levels need to be maintained. If this turns out to be just a health issue that gets resolved and is not chronic then you do not have top "maintain" upper B12 levels.....

5. "So it sounds like you're saying I should find a similar food, but not worry about it having vegetable oil (supplement with coconut oil instead)" yes.... you can always supplement a food with high quality organic , cold pressed or sometimes labeled "extra virgin" coconut oil. but go very light with this.... jsut a tiny bit... and watch the poos in case you are looking at possible pancreatitis where you need to keep fat content to a minimum... or some other condition that requires a low fat diet.

6. "Should I still continue with the enzymes?" Since this is not EPI, you should not technically need the enzymes... BUT.. sometimes with gastro issues it helps "temporarily" to give just a small amount of enzymes..... so this is something that you most likely don't need... but you might want to try reducing the dose every so many days ... watch the poo and see if this is something that might be needed temporarily or not... in other words, try weaning Zero off the enzymes.........

7. Yes... giving slippery elm is very similar to giving Guar Guar and Inulin... although to a much lesser degree.... this is why it is well worth trying SLippery ELm... BUT sometimes Slippery ELm just isn't enough to alter the gut flora/leaky gut -like issues..... and that is when other prebiotics with probiotics are beneficial... sometimes... YOu just have to be careful not to give too much or too little... and then there is the issue of the probiotics...one size does not sit every dog cause they all have individual gut flora compositions.... so until they come up with targeted probiotics.... the best we can do is "try" pre+probitoics with what is available and hope that it wlll help our dogs messed up gut.

The good news is.. is that this microbiome field (gut bugs/bacteria) is exploding and they are fast discovering new things about bacteria in the gut and ailments.

I hope this information is somewhat helpful... we don't have all the answers but rather we can share a step by step process with recommendations that often help..... but not always. Since every dog is an individual, the best that we can do is "try" our best to help with guidelines/suggestions that usually works , but on the flip side there are never any guarantees .....
Olesia, was owned by Izzy, a 35lb Spanish Water Dog (SWD), Diagnosed at 1.5 years old - TLI results 1.. Izzy passed away on February 13, 2020 at 15 years old. She lived with EPI for 13+1/2 years. It was because of Izzy that Epi4Dogs was started... she was the inspiration. May her legacy of helping others with EPI continue for as long as needed.........

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Olesia711
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Location: North Carolina
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My name: olesia

Re: New to EPI - advice on managing a flare-up

Post by Olesia711 » 16 Sep 2020, 12:25

here is a good visual regarding difference between pre and probiotics.
Image

also info on this is found on page: [url]https://epi4dogs.com/prebiotics-and-probiotics/[/
pre=probiotics.jpg
pre=probiotics.jpg (102.69 KiB) Viewed 2308 times
url]
Olesia, was owned by Izzy, a 35lb Spanish Water Dog (SWD), Diagnosed at 1.5 years old - TLI results 1.. Izzy passed away on February 13, 2020 at 15 years old. She lived with EPI for 13+1/2 years. It was because of Izzy that Epi4Dogs was started... she was the inspiration. May her legacy of helping others with EPI continue for as long as needed.........

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