New member and my pup needs help :(

[brevar]

Hello. I am new to this site and we are new to this EPI disease too. To share our story, it all started in mid June this summer, where our 13.5 year old black lab/beagle mix, Shamrock, started having a lot of diarrhea that wouldn't stop. After about a week of this, we took her to the Vet and had some blood work done, and found that she had lost 7 pounds in a little over a month. She weighed 54 pounds to begin with so that was quite a decline for her. Obviously, we became very concerned about this and began trying to figure out what was wrong with her. She began pooping more and more often (still a goopy mess) and we had just about every diagnostic test known to man or dog done on her, including multiple blood tests and x-rays, an ultrasound, fecal testing, an intestinal biopsy and an aspirated liver. The vets were sure that it was some kind of cancer. Everything came back negative and "everything looks fine" was what we got. That was great, of course, but what the heck was going on with her?? We still had no answers and it was starting to get scary. In our time of frustration and fear, my wife and I did what pretty much all of you probably do. We Googled her symptoms in a desperate hope of finding something out. I literally stumbled upon this Exocrine Pancreatic Insufficiency disease and, as I was researching it, thought that these symptoms matched up with what Shammy was going through. I emphasized in a phone call with our vet (Due to Covid-19, we can not physically enter our veternarian's office to have face to face contact with her) that i was not trying to play "internet vet", but could it be this EPI?? She considered it for about 10 seconds before dismissing the idea, because, well, she IS a 13 year old dog and this is a younger dog's disease, BUT ... I should have insisted on the blood test because a month later, 2 trips to the Pittsburgh Emergency Vet's office, a conversation with the Internist there, and the cTLI blood test, she was confirmed to have EPI! FINALLY! we got a diagnosis and a treatment plan! Fast forward 2 weeks to today ... our Shamrock has been up and down and we know that figuring this out takes time, but we feel that she is getting worse and not better. We have her on a soft, bland food mixed with the dry ID food that was recommended by the Internist, and we are giving her the PancrePlus powder. But when we first started giving her the powder, she didn't seem to take to it well because after about a week, she started getting very finicky with her food. Shamrock has NEVER been a picky eater and eats many things that we don't want her to as well. It got to the point where last Thursday, she actually refused to eat her dinner. We were terrified! After consulting with the Internist again over the phone, she suggested that we take her off all medications except for Prednisone (minor Inflammatory Bowel disease as well), B12 and the powder enzyme. However, she told us to administer the powder at a 1/4 teaspoon instead of the full teaspoon per meal, and mix it with a liquid ( I'm using beef broth) and give it to her via syringe after her meal so she doesn't associate the powder with eating as it was thought that she didn't take to the powder well. Eventually we are going to build her back up to the full teaspoon and I guess back on the food as well. That has been going fine but she has definitely been pooping more and it's getting goopy again. It was getting better there for a while at first.

Anyways .... like I said, we KNOW that this is going to take time to figure out and we have to play with some dosages and foods, but I guess I just wanted some support and insight from you guys because we feel sort of like we are flying blind here with very little guidance or instruction here. ANY help or advise would be appreciated!!

Thanks!

[Olesia711]

Thanks for sharing Shammy's journey with us, and we will try to help you as best we can.

I strongly suspect that what is going on is SID.....and THIS is why you are seeing "iffy" poos. ALL dogs with EPI have SID (small intestinal dysbiosis), and the ones that struggle with it most usually are the newly diagnosed EPI dogs. The rule of thumb is to keep SID under good control since we don't (yet) know how to eradicate it.

What we used to do is automatically place the dog on Tylosin Tartrate (Tylan) antibiotics. If your vet tries to give Shammy Metronidazole instead, PLEASE tell your vet you do not want your dog on Metronidazole (Flagyl) for SID! Most of the time it doesn't work or at the very least it does not work very effectively. Second it can do damage. If your vet questions this, PLEASE have them read the latest research on Metro
https://epi4dogs.com/sid-sibo-microbiome-research/
.... and why they are now advising vets to not use it for chronic gastrointestinal conditions.

Next ....the first recommended way to treat SID is with Prebiotics and/or Prebiotics with Probiotics. For now, one of the products recommended by EPI researchers is: Proviable
https://www.chewy.com/nutramax-proviabl ... /dp/101471
Start at half the recommended dose (capsules) and work your way up to a full dose within 5 days to a week.

The next recommended way to treat SID in an EPI dog (IF you do not see improvement happening within a few weeks on the Proviable or another prebiotic with probiotics in it)... THEN go back to your vet and insist on them prescribing Tylosin Tartrate, an antibitoic.
https://www.medi-vet.com/VetOne-Tylosin ... /19172.htm
Tylan needs to be given with breakfast and dinner for 45 days.

Regarding the reduced dose of enzymes..... "However, she told us to administer the powder at a 1/4 teaspoon instead of the full teaspoon per meal, and mix it with a liquid ( I'm using beef broth) and give it to her via syringe after her meal so she doesn't associate the powder with eating as it was thought that she didn't take to the powder well. Eventually we are going to build her back up to the full teaspoon and I guess back on the food as well. That has been going fine but she has definitely been pooping more and it's getting goopy again. ...... i know your vet meant well..... but this is not such a good plan because it is not enough enzymes to manage the EPI and unmanaged EPI will promote even worse SID (it becomes a vicious cycle).

Also, SHammy having issues about a week after starting the enzymes.... is pretty spot on for what happens with this dogs when SID starts acting up... usually the first week or two go beautifully and then everything falls apart... Many people think the enzymes aren't working or that their dogs has an aversion or allergy to the enzymes when it is actually neither.... it's SID. THere is something about once the enzymes tart taking effect initially, somehow that triggers SID to act up even more so.....

Your vet's idea of camouflaging the enzymes IS spot on though..... What you need to do is give the correct amount of enzymes, and these are some options:
1. mix in the food, and ALWAYS add enough liquid to moisten the enzymes with the food. Mix. Let sit for 20 minutes, Serve.
2. do the above and then put a enticing "topper" on the food, things like a few spoons of BBQ sauce, Parmesan CHeese SPrinkled on top of the food, or some real stinky canned cat food, or some tuna fish sprinkled on top etc.
3. if the above doesn't work, at all THEN try pouring the correct amount of enzymes needed into empty gel caps, and give these, (some will tuck these capsules in cream cheese or some sort of mushy meat) and give these after they eat some of their meal....
4. if none of the above works, we have more options, but this is enough to get you started. BUT do NOT reduce the enzymes...if reduced you ONLY reduce the enzymes, by either 1/8 to 1/4 of a tsp ..... in other words just a pinch... but this is very rarely done because it doesn't work well with the EPI...

Hope this helps answers some of your questions

[Tuckaboo Pam]

Hi Brent. Hang in there! WOW, Olesia gave you the full run down, and while it may have your head spinning right now, it will all become routine after a bit. Just know, we have all been where you are; this is doable, but it may take a little time. Shamrock is lucky to have you in his corner. Do yourself a favor, and ask every little question that pops into your head. Somebody, somewhere on this planet, may have come across a similar problem, and they will jump in & tell you what has worked for them. This is a wonderful group of people. Take Care---Pam & Tucker

[Barb]

Hi Brent,
Thank you for sharing Shammy's story. I'm sorry you are both going through this. Hang in there. The beginning stage is the hardest part.

One thing that really helped us was keeping a log/journal of everything we gave our pup, the amounts, and the resulting poos. You can download a blank form or keep a notebook so you have it all in one place, which is what we did. The journal helps you to see what is working and what needs to be adjusted.

I sympathize with you trying to get Shammy to eat the food with enzymes on it. Our Kolby hated the enzymes and would put his nose in the air and walk away from his dish when we first tried getting him to eat. One thing that helped for a while was hand-feeding him, so he didn't have to put his muzzle in the dish. Then we graduated to spoon feeding him, then we put his food on a flat plate, again so he wouldn't have to put his nose into the enzymed food. Eventually, he got hungry enough that he started to eat the food. I know how frustrating this is, so hang in there. Olesia already mentioned that you can't decrease the enzymes or they won't be effective. Please let us know how she is doing .....and ask all the questions you have. We have all been where you are and we understand what you are going through.

I am originally from Pittsburgh (the South Hills area) and I still have family there. I haven't lived there for many years, but I always like touching base with people who live there......a wonderful place.

Barb

[brevar]

Hello Barb! Thank you so much, and to everyone who has replied and shown support. We are actually living in Erie, Pa, and our vet here is great, but we did need to take Shammy down to Pittsburgh a couple of times because our general practioner just couldn't figure out what was going on and said there wasn't anything else they could do for her. That was scary. But we did get the Dx so now we have to keep working with the food and the powder to see what's working. Like I said, she did the same thing as your baby did. Turned her nose up to the food we gave her and refused to eat. That was scary too because she is the furthest thing from a picky eater. But we've been adjusting the dosages of the enzyme and got her some new foods to try too, and right now we have her on a mix of soft food and kibble, and she has been pooping a little better and less frequently so hopefully we are on an upswing. The important thing is that we HAVE to get weight on her because she is very thin right now! We will not give up and neither will she! By the way, we are doing the journal too with what we are feeding her, how much and what her bathrooms have been like and the times too! Just started it actually. So thank you all for the support and advise! We need it!

[Barb]

You are doing great. She is lucky to have you. The B12 should help with her appetite. It's funny how different each dog is. Some dogs guzzle down the enzymed food and don't even notice the enzymes. Others, like ours look at you like you are trying to poison them! How well I remember.

Keep up the good work. Things will get easier.

Barb

[Madelon]

Hi Brent - just wanted to pop in and see how your pup is doing. Are you supplementing B12 with shots or the WonderLabs pills? Supplementing B12 is for life with these dogs. I also wanted to mention in case you were unaware, you can get the enzymes much less expensive from EnzymeDiane https://enzymediane.com/. Please keep us posted on how things are going.