Peaches Journey

[littlegirl_peaches]

Peaches is 6.5 months and we've been to the Vet for tests for about 2 months now. Each day she gets thinner and less herself. We finally have results back from EPI test which show she has EPI. Her Trypsin was 1.0, cholesterol was 64, triglycerides were 20, chloride was low and phosorus was high.

She was treated with Metro.. (antibiotic) which made her stool pudding texture and nauseated. It didn't help at all. She's been on probiotics since I brought her home which likely helped and perhaps my helicopter furry parenting as I knew something was wrong months ago and we've been to the vet more than I've been at work it seems.

I ordered Thomas Lab's BioCase because the one my Vet wanted to prescribe is 300$ a month. That would be on top of the Raw diet she is has been one for about a month (another $120 to $200). The only reason she hasn't starved to death is I've been feeding her about every 4 hours small meals. She's getting about 1.5 to pounds of raw food a day. Yes that's right... and she weigh only 24 lbs now. Barely holding on to it. I'm hopeful the enzymes will work but it's scary out there.

I don't know how people afford it. I mean it's breaking my heart to watch her starve to death but I don't know how I can't keep a 500$ a month puppy for 10 to 15 years. Even with the cheaper enzymes it's about 80, on top of the 150 for food so that I can mostly handle. I mean it certainly wasn't in my planned retirement budget but I'm guessing it never is.
And does anyone just give over the counter B12 chewables to their pups? I could do shots but I'm curious as the Vets reports not absorbed well blah blah blah... Here's the irony, I have pernicious anemia so i can't absorb 12 or iron, I did shots for 10 years. I've had to have iron infusions etc. About 15 years ago a study was done to compare shots and sublingual and it turns out for most if not all it's the same efficacy. I stopped giving myself the shot the minute I read the study and switched over to a chewable. I've been normal every test which I have to do every year. So my point is... are the shots the 'only way' or just the way the Vets currently believe because no one has looked at it really? Do dogs pee out excess b12 like humans? I haven't read that but I haven't look yet for it either.

Do I have to or should I ask her to be tested for b12? I started her on a daily chewable for now and we'll test in a few months of doing th eezymes and see. I


How do people afford this? I mean realistically speaking... I don't want to give her up... I don't want to put her down but and it's a big one.. I don't know if I can afford her and still have a place to live.

[Olesia711]

OMG... just reading your post brings up so many emotions for me.... *sigh*.

First take a DEEP breath and know that this is treatable and once you learn the trick to managing EPI.... the cost is a LOT LESS than what you first suspected.

Okay, here goes.. bad new first:
1. The Thomas LAbs enzymes you bought .... although the correct porcine enzymes... the potency is WAYYYyyyy too low... and you will need to use a lot... that's why it was so "reasonable"... look at the back label and if it says (Lipase 9,000 USP units) then you will need to use anywhere between 4 to 6 tsps per 1 cup of food. (see a pic of the label i posted below)
THe best and most reasonable thing you can do is contact EnzymeDiane https://enzymediane.com/. THese are the right porcine enzymes AND at the right potency but at approximately 1/3 the cost of what your vet was selling you (which i strongly suspect was the right stuff!). What you want to get (for ease of measuring) is the 6x. You can get 1/2 kilo or a full kilo which is more than 3 times the amount of product that your vet was offering to sell you.
The ratio is 1 tsp per 1 cup of food, add liquid (water) enough to moisten the enzymes in with the food. Let site for 20 minutes (this helps avoid mouth sores) and then serve.

Next, you are CORRECT in assuming you can give your dog B12 pills. THey used to say that EPI dogs HAD to have B12 injections.... however, they have finally done clinical trials and realized that you can give an EPI dog high dose B12 pills. We strongly recommend Wonderlabs Pet Factor B12. 90 pills for $14.
https://www.wonderlabs.com/itemleft.php?itemnum=K9688 THese pills are made with 1000 mcg Methylcobalamin , 800 mcg Folate and 400 mg of Instrinsic Factor. These (for whatever reason)appear to work much better than 1000mcg Cyanocobalamin version of B12. Give one a day, for now. Technically, you are supposed to recheck the dog's B12 levels (maybe in a few months, 2 to 3 months-stop the pills for 1 weeks before doing the B12 blood test) after being on the pills daily... and see what the B12 level is. Then you will know if you have to continue giving the pills daily or maybe just 1 pill 3 times a week or so to "maintain" the upper mid-range B12 level.

Now we get to the the food. I saw that you mentioned that you read here to feed the dog 150% of what is normally required until they gain back most of their weight. Yes! Feed more but feed smaller portions... if you can 3 to 4 meals a day instead of just 2. and then once they are back to normal or almost, you can cut back on the amount and go back to feeding 2 times a day.

ALso.... start with a low fiber food... Something with less than 4% fiber content and start with food that do not have grain in them..... and avoid foods that are loaded with a too many types of legumes or peas or peas as one of the top 3 or 4 ingredients.... this kind of food usually does not agree with EPI dogs.... one food that seems to agree with many (but not all) EPI dogs is Taste of the WIld-Pacific Stream. Just buy the smallest bag possible to see if it agrees with your dog. Of course there are many other dog foods out there that might be agreeable... this is just one of many.

And last but not least... SID (small intestinal dysbiosis). We used to automatically prescribe antibiotics. Tylan (Tylosin Tartrate soluble powder) https://www.medi-vet.com/VetOne-Tylosin ... /19172.htm is the preferred antibiotic to use for SID in EPI dogs, not Metronidazole. HOWEVER, that being said.... new research has proven that although Tylan/Tylosin Tartrate works much better than Metronidazole, in the big picture, the best thing (if possible) is not to use an antibiotic, but rather first use a PREbiotic and if that doesn't work as well as expected then use a PREbiotic with a PRObiotic. THis takes longer to see results, but in the end it is a better scenario long term for the dog. However.... on the flip side, if the dog is having excessing loose stools that is going on and on and on.... THEN reach for the antibiotic. A prebiotic that works for many (although not all) is SLippery Elm powder (see the slippery ELm page: https://epi4dogs.com/slippery-elm/ . THe probiotic that is the better one at working on SID (or at least until they come up with a targeted probiotic instead of a "one-size-fits-all) is Proviable https://www.proviable.com/

I hope this helps!

[littlegirl_peaches]

Thanks for the reply. I try not to look too far into the future so I don't get overwhelmed with things. I did read that it may be possible to reduce the enzyme use and other special additions once the puppy is stabilized and gaining/maintaining weight etc. So for now it's a day at a time and we'll reevaluate in 3 months.

I hadn't read as far about the slippery elm sup. I'll have to check that out. Does it come in capsules or do you have to add it to the food bowl?

She's currently eating a mostly raw diet with about 4% or less fiber. 3 to 4 times a day = 1.5 to 2 pounds. Peaches thinks that is entirely not enough food. She poops about 6 to 8 times a day. If I'm not quick enough she has a dessert meal. She also now wears diapers because the gas is causing her to have accidents and it freaks her out and I'm tired of cleaning myself up. She won't go two feet from me unless I'm working on the computer and she can't get in my lap or I want to bathe her. We had to postpone spaying due to health concerns right now so we'll get to go through a heat cycle. Can't wait for that. I just hope it's really short or I get lucky and her health will delay it until we can get her fixed.

The Antibiotic was a huge mess as far as I am concerned likely did nothing and of course we did the gambit of parasite testing, etc etc etc. I also have her on a probiotic-- its not exactly what you listed but it's close. I have tried a couple of prebiotics, pectin, oat bran powder, psylum but they all did the same = unremarkable. Really the only thing that helped was adding some calcium to the raw. However, I'm now doing nothing special other than some Bone Broth and most of the time its soft formed unless I've given her treats. I can't say no when she looks like shes starving and acts like if she doesn't get fed she'll keel over any moment. One good outcome is I have lost some weight as I can't take the guilt of her staring at me while I eat. It's as if the food she just inhaled in under two mins was a starter course and comes to me for more. I have tried a slow feeder but it's not useful for raw and I tried a racquetball and other items but she either dumps the bowl which is messy and annoying or removes the item. She's too smart for me.

Anyhow, thanks for the information. I'll look into the probiotic when she's done with the one I have now and the slippery elm. Finally, I attached a copy of the BioCase info. Are you saying it needs to be 6x more than this?

Thank you,
Shasta

[Madelon]

Hi Shasta - welcome to you and Peaches. Oh my gosh sounds like you and Peaches have been through it as most of us have prior to diagnosis. Olesia gave you the best advice - she's our Founder, Director of Research and the Mother of all things EPI The only thing I will add is yes sometimes you can reduce the amount of enzymes once your dog is stable (goal weight reached, good poops for a few months), however some, like my boy, stay on the recommended starting dose. As for B12, please know that supplementing is for life! Do you by chance know what the Folate and B12 scores were when your dog was tested for EPI? They should have tested those at the same time.

If I were you, I would eliminate the probiotic you are giving - the reason is not all probiotics work for all dogs and not all probiotics are created equal. When first diagnosed with EPI it's best to stick to the four cornerstones only: enzymes, B12, antibiotics (if needed - or Slippery Elm), and Food. As far as the food goes, if feeding raw is too expensive you can look for a kibble that has 4% fiber or less - avoid or limit peas. Also be careful with feeding raw because of bacteria.

Keep a detailed journal of everything you give and the resulting poops - this will help you now and in the years to come to figure out what works and what doesn't. EPI can be overwhelming in the beginning until you get the exact right balance of the four cornerstones but it will soon become your new normal. These dogs go on to live long, happy, healthy lives and in most cases they tend to have a much stronger bond with you than a "normal" dog. Hang in there, ask any questions you have and we will be here to help guide you along

[Jean]

welcome from the UK

The first hurdle to get over when diagnosed is the cost

when Kara was diagnosed in 2010 she was taking 5 Lypex per meal, 5 times a day

So this cost £60.00 for 2.5 DAYS,

We fed Kara 5 times a day, all enzymed, because she was soooooo hungry and the recommendation was to feed 50% over and above what was on the bag of food for the weight the dog SHOULD be

So it cost a fortune

We found Tylan, and that worked for us, she had very bad gas issues, and projectile pooing, all over the floor, and the walls !

Once we found the protein that worked for us, and the enzyme that worked, which was cheaper, we turned a corner

And the costing came down to a manageble amount, and two meals a day, and a meal of mashed potato and scrambled egg before bed, all enzymed, she couldnt get through the night without this final meal without throwing up bile

the diary/jiurnal is absolutely imperitive

so I would look towards Tylan which is weight dosed

https://epi4dogs.com/antibiotics/

and b12 via Wonderlabs

https://www.wonderlabs.com/itemleft.php?itemnum=K9688

b12 is essential to an EPI dog's digestion

https://www.petmd.com/dog/wellness/evr_ ... py_for_epi

My Kara was stable for 9 years until we lost her to DM May 2019

so keep the faith


Jean

[Olesia711]

Hi Shasta,

Thank you for posting the ingredient listing of the BioCase you are giving Peaches.... that is the CORRECT potency of enzymes and the right type ... so no need to change to EnzymeDiane unless you work out the total cost of what you are using and each cost and figure out which product is more reasonable for you to use cost-wise.

Regarding the SLippery ELm.... the fact that you tried Psyllium and it did not work could indicate that the Slippery Elm also will not work.... they are both a mucilage and fiber.... but IMHO.... it is still worth a try since it is cheap and you may have used too much of the Psyllium. If you use too much of SLippery Elm (or any mucilage/fiber) it can cause the loose stools you are trying to fix. Read the Slippery Elm page dosing instructions.... a bottle of the powder from WOnderlabs is only $12. And you can use it too.... for loose stools... works in about 30 minutes
https://www.wonderlabs.com/itemleft.php?itemnum=K97024
In short it may or may not work for your pup.

The metronidazole CAN make some dogs worse with the loose stools.... Research is now advising NOT to use it but rather try other things first. (i will be including this research on the website shortly.
Since your dog has already been exposed to Metro (antibiotic)... i would definitely ask the vet now for Tylosin Tatrate as recommended in my earlier post. However, half way thru the 45 day/twice daily dose of Tylan.... THEN you need to start introducing a Probiotic, and according the the EPI veterinarian researcher, the best way a probiotic can work on SID is if the probiotic was specifically tailored for this condition, however, to date, they have not come up with targeted probiotics.... so what the researchers are recommending is Proviable as the only one (that they are familiar with) that does a better job then the rest. Translation... some probiotics may promote loose stools especially if they are the wrong composition.

Giving probiotics with Metro is useless, as Metronidazole is an antibiotic that kills ALL bacteria. Giving probiotic with Tylosin is not a problem because Tylosin is a macrolide antibiotic and DOES NOT kill all the bacteria, but rather reduces it (which in the long run is not good either.. this is why you need to add a probiotic with a prebiotic to build back some of the strains have been reduced. ). But ti keep it simple, we have told EVERYONE to give any probiotic at least 2 hours away from any antibiotic. Unfortunately, the research i jsut read this weekend states that once you stop Metronidazole, within a few weeks the gut flora goes back to what it was. Same problem, not fixed. With Tylosin, the gut flora does not bounce back to the way it was, but stays reduced, so i am guessing this is why things improve on Tylosin... however, as i stated above... in the long run, with SID, for good management you really need to increase the various strains of bacteria in the gut AND increase the numbers..... unfortunately every gut flora is different and different health conditions have different depleted strains of bacteria and need certain groups of bacteria introduced/replenished. This is why we suspect one-size fits all probiotics don't really work well for SID. Hopefully they will come up with a targeted probiotic sooner rather than later. BUt in the meantime... go with Proviable.. for now.

SO....My thought is the same as Madelon's... stop the probiotic you are giving now. Ask your vet to try Tylosin . Then ask vet for Proviable as a probiotic (i jsut noticed last nite that Proviable includes a Prebiotic in their Probiotic product, so this is very good.)

Aha!!!!! that guilt that you are dealing with... does this mean you are giving Peaches itty bitty tastes of food without enzymes????? If so, this could be a problem and why nothing appears to be working.... STOP all treats, snacks, etc. Give NOTHING unless it has enzymes on it.

Next... if Ms Peaches is that hungry.... give her (if you can with your schedule) a few more meals with enzymes during the day... jsut for now, until this excessive hunger starts to subside.... once you find the right balance of treating the EPI.

I hope this helps you. EPi is very manageable... BUT..... the trick is finding the right balance of the recommended EPI protocol and sometimes that is easier said than done.
Keeping a journal of what and how much you are giving Peaches and then recording the results (poos, gas, acid reflux, etc) REALLY helps you identify what works and what doesn't.

That is good that you found that calcium appears to help. When i fed home cooked.... i always gave UPCO porcine bone meal with every meal. https://www.amazon.com/UPCo-Bone-Meal-p ... B00MW8HFJM. Bone matter is extremely important but many people forget this little detail when feeding raw or homemade. SO glad that you are taking care of this!

[Jean]

can I ask what variety of Natural Instinct do you feed

[littlegirl_peaches]

can I ask what variety of Natural Instinct do you feed

Jean, Well, we got some of each, so beef, chicken and turkey to see if one did better than the other but they all do the same as far as I can tell. I had thought to change to all chicken but she has done better on lamb well until she got sick as far as her skin and coat. New shipment comes Tuesday and It's one more beef and the some chicken and I think I did a couple of turkey. I read somewhere you should vary the meat often. I am not sure if that's for dietary reasons or if the pups get bored. I can't imagine an EPI dog ever having that issue. I did change it so that I am getting it ever two weeks due to freezer space and so I can more easily change if needed.

[littlegirl_peaches]

....My thought is the same as Madelon's... stop the probiotic you are giving now. Ask your vet to try Tylosin . Then ask vet for Proviable as a probiotic (i just noticed last nite that Proviable includes a Prebiotic in their Probiotic product, so this is very good.)

Aha!!!!! that guilt that you are dealing with... does this mean you are giving Peaches itty bitty tastes of food without enzymes????? If so, this could be a problem and why nothing appears to be working.... STOP all treats, snacks, etc. Give NOTHING unless it has enzymes on it.

Next... if Ms Peaches is that hungry.... give her (if you can with your schedule) a few more meals with enzymes during the day... jsut for now, until this excessive hunger starts to subside.... once you find the right balance of treating the EPI.

Olesia,
Thanks for the response. I have some questions. Well first, we don't yet have the enzymes. I decided to wait until BioCase arrives 09/01,Tuesday. The only local option was the $150 for 4oz and I just can't do that given I had to increase her food to double order for now. I have already started the b12 and have been using Pre/probiotics since I got her at 12 weeks. Things went haywire at about 22 weeks. She took metro (antibiotic) starting on 8/3 I think it was 6 days thinking it might get a parasite while we waited for the fecal test which was neg. Then went from bad to worse. She started Darwin's on 8/11 and it was better a titch when I added calcium but not enough and I felt like it was just masking the issue that was still glaring. She went back for more bloodwork which turned out to be triglycerides, cholesterol mainly and on the 8/19 then based on those low results and her symptoms the cLI was run to rule out EPI. I started doing research on it and found Peaches had all the classic symptoms. Finally on 8/27 the results were back and her Trypsin was 1.0. So I suppose it's possible, she may only have pancreatitis and it will resolve itself or maybe that's wishful thinking. Ok, it probably is-- but I am still wanting to be in denial... Funny how that works.

So, we've not done a b12 test or anything to dx SIBO. Is that recommended, tests? Is this always an issue for EPI pups?

Like do I need a B12 and B9 and some to dx the SIBO? I thought we would do the b12 on October the end of September after she had been on the Enzymes for a month with the additional b12 etc.

I am aware too much fiber like slippery elm etc can do the opposite of it's desired effect but what i'm not clear on is how much to use. I did about two teaspoons at the top of my attempts down to 1 tsp. I know now likely nothing would have helped given the undx'd EPI was still running rampant.

And treats are all low fiber, protein based but no enzymes at this point... I was more speaking to the fact she's eating me out of home and yet when she comes begging and I know I have treats and so does she it's hard to say 'no'. Once the Enzymes are here... is there a way to say mix it in with the meal and when added the Enzymes then pull it out for later treat? or do the Enzymes need to be consumed directly after mixing?

I was reading and some have mentioned Zinc, Vitamin E and Iron. Is a Multivitamin recommended? or just specific items?

Starting Tuesday will be day one of the Peaches OneNote journaling. Keeping everything in one place and organized will be a challenge for me. Organization has never been a strong suit of mine.

For now, just getting through until the new shipment of Darwin's and the Enzymes.
Then if needed we can do the b12 level test and ask about Tylosin or test for SIBO and get some of the Proviable and Slippery Elm.

Thanks again. I can't imagine being the first. It's hard enough and there are resources at least and that helps. That and small bites.

Ok it's time to start Peaches dinner as she's sitting her staring at me wondering if I could move faster i'm sure!

[littlegirl_peaches]

welcome from the UK

The first hurdle to get over when diagnosed is the cost

when Kara was diagnosed in 2010 she was taking 5 Lypex per meal, 5 times a day

So this cost £60.00 for 2.5 DAYS,

We fed Kara 5 times a day, all enzymed, because she was soooooo hungry and the recommendation was to feed 50% over and above what was on the bag of food for the weight the dog SHOULD be

So it cost a fortune

We found Tylan, and that worked for us, she had very bad gas issues, and projectile pooing, all over the floor, and the walls !

Once we found the protein that worked for us, and the enzyme that worked, which was cheaper, we turned a corner

And the costing came down to a manageble amount, and two meals a day, and a meal of mashed potato and scrambled egg before bed, all enzymed, she couldnt get through the night without this final meal without throwing up bile

the diary/journal is absolutely imperitive

so I would look towards Tylan which is weight dosed

https://epi4dogs.com/antibiotics/

and b12 via Wonderlabs

https://www.wonderlabs.com/itemleft.php?itemnum=K9688

b12 is essential to an EPI dog's digestion

https://www.petmd.com/dog/wellness/evr_ ... py_for_epi

My Kara was stable for 9 years until we lost her to DM May 2019

so keep the faith

Jean

Thank you. It's always good to hear some else has been there and done that.