Diagnosed with EPI today - Mouse

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.
Charmkins4
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Posts: 4
Country: United States
State: California
Pet name: Mouse
My name: Masha

Diagnosed with EPI today - Mouse

Post by Charmkins4 » 18 Sep 2020, 20:37

Hi everyone,

Sorry for the long post, but the situation is a bit complicated.

Here's the story of Mouse who was diagnosed with EPI today. Mouse was being neglected and abused by my neighbors. I was watching the situation for about 4 weeks trying to figure out what I could do to stop. Then suddenly, on August 30th, they moved and just left Mouse behind, so I took him in. Mouse is approximately 8 years old and is a Chihuahua or a Chihuahua mix. The day I found him, he was dirty, covered in fleas and weighted 4.2 lbs (he should be closer to 12). He was also weak, lethargic, and peeing and stooling constantly.

I cleaned him up, gave him a flea bath, and started a careful refeeding. He got a lot stronger, more energy, and walking around more. But the peeing and stooling continued. So a few days later, I took him to the vet where they diagnosed diabetes based on a urine test and they gave him a shot of insulin, as well as sent him home with insulin for me to give him twice a day. Within a few hours of the first dose, he was weak and having problems walking on one of his legs. After 24 more hours and 2 more insulin doses, he went in the hypoglycemic shock and was rushed to the emergency vet. He spent 5 days in the hospital. The critical care vet still believed he had diabetes, but each time he was restarted on insulin he became hypoglycemic so he was released without insulin while we waited for the results of his TLI test. The vet said this was the skinniest dog she has ever seen. He was sent home with clavamox, omneprazole, sucralfate, and urine test strips to monitor his glucose

He was discharged from the hospital on Monday. Today the TLI test came back and he tested positive for EPI, plus with the results from the test strips the critical care vet is also convinced that he is diabetic. The vet is amazing and called in a prescription immediately for PancrePlus and injectable B12 so Mouse didn't have to wait another week or 2 for his followup to start the medication.

BUT, I'm so confused and overwhelmed. First, she freaked me out by mentioning the mouth ulcers and bleeding side effect. Second, Mouse was prescribed 1/2tsp per feeding but as a (now almost) 5lb chihuahua, he is only eating a little more than a 1/4c of food per feeding/ 3-4 feeding per day. 1/2 tsp seems like a lot to get him to eat with this amount of food. I got him a grain-free, poultry-free food he likes (26% protein, 14% fat 3.5% fiber). (He hated all the prescription foods he tried). She also mentioned something about giving him the PancrePlus in a meatball before his food. I can't even figure that out.

I guess here are all my questions:
1. How would you use a meatball to give a powdered medication?
2. How much is the scoop that comes with the container? I think it's a 1/4 tsp, but I'm not sure.
2a. If I follow the vets guide, would Mouse get 2 scoops or one.
2. Is 1/2tsp too much to be putting on 1/4-1/3c of food?
3. What if he doesn't finish all his food? Did he get enough enzymes?
4. He prefers dry food. How do you get the enzyme to mix in so he doesn't hurt his mouth? (wet food has been a failure with him)
5. How quickly will he start gaining weight and or muscle?
6. Any suggestions or ideas on what to expect over the first few weeks?


Lastly to make this more complicated, I have fallen so in love with this dog, but I can not keep Mouse long-term. I already have a dog, cat, a son on virtual school, and a husband recovering from a spinal cord injury. My goal was to keep Mouse until he was stable enough to move to a more permanent foster or his forever home. I'm starting to wonder what stable or improved even look like for a case like this.

Please help this freaking out foster mom.
Thanks,
Masha

PS - I attached a picture of him the day I found him and then one from Monday when he came home from the hospital.
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jilbert57
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Re: Diagnosed with EPI today - Mouse

Post by jilbert57 » 19 Sep 2020, 08:46

Aww thanks so much for rescuing this cute pup!
If you have the test results will you please post?
I can help out some here.
The enzymes are dosed per amount of food . If you feed 1/4 c food, you use 1/4 teaspoon enzyme. 1/2 c food to 1/2 teaspoon enzyme, etc. Put the food in the bowl add enzyme. Add just enough warm room temp water to stir together to coat all pieces of food with enzyme. Set a timer for 20 minutes and let it incubate. Before serving stir again. After meal wipe face with wet towel. Maybe offer flavored ice chips. All food must be incubated with enzyme.

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

https://epi4dogs.com/epi-with-diabetes/

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.

Charmkins4
Member
Posts: 4
Country: United States
State: California
Pet name: Mouse
My name: Masha

Re: Diagnosed with EPI today - Mouse

Post by Charmkins4 » 19 Sep 2020, 15:46

Hi Jill,

Thanks so much for responding. I don't have his exact TLI number yet. I'll get all the specifics once I take Mouse to the internist in a week. The critical care vet just wanted to get him going as fast as possible for obvious reasons.

Everything you wrote makes sense, but one big question, what are flavored ice chips for a dog?

Thanks,
Masha

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

Re: Diagnosed with EPI today - Mouse

Post by Tuckaboo Pam » 19 Sep 2020, 17:53

Oh my goodness, Masha, you are an angel! I wonder, with such a small amount of enzymes, could you put them in a capsule & give it that way? Will he drink broth? If so, you could stir them into room temperature broth & have him drink it right before he eats (not ideal, but probably better than nothing). Or does he like yogurt/cottage cheese? Does he currently have mouth sores, or does the vet anticipate that he will get them from the enzymes? My vet told me to expect them, but it wasn't a problem for my dog. I think it's when the enzyme powder gets trapped up in their gums that happens. If they are mixed with some kind of liquid, they go right down. I don't have any knowledge that would help with the diabetes issue, but some people on this forum have dealt with it, and they will help you. Let me inject one more thing---those enzymes taste really bad. I inadvertently set a piece of food on the counter where I had early used some enzymes, and it was the worst thing I had ever tasted, so maybe that's why the vet said put them inside a meatball. I suppose you could split it open & press it inside, but then the marinating wouldn't be happening. Bless you for all you are going through.---Pam & Tucker
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.

Barb
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Posts: 918
Country: United States
State: New Jersey

Re: Diagnosed with EPI today - Mouse

Post by Barb » 19 Sep 2020, 18:07

Dear Masha,

You are so generous to open your home and heart to this poor pup. I do not have experience with diabetes, only EPI, but the owner of our site does and I am sure she will chime in to help you monitor both. It's a little tricky with both conditions, but Olesia has long term experience with both.

Did they originally do blood work to diagnose the diabetes? And do you have those results? If you can give us those results as well as the cTLI that Jill asked for, they will help us help you.

I think that getting the EPI managed is going to be easier than the diabetes. Jill gave you the basic measurements of enzymes to food. And the links to concurrent conditions on our website will help. And it is great that the vet started him on B12.

I recommend that you keep a log/journal of everything you feed your pup, the amounts and the resulting poos. It will help you to see what is working .It helped us to keep our sanity.

Thank you so much for fostering this boy with everything you have on your plate. You are his guardian angel.

Barb

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

Re: Diagnosed with EPI today - Mouse

Post by Tuckaboo Pam » 19 Sep 2020, 19:06

WAIT!!! The AMOUNT of food should be more than what you should feed a 5 pound chihuahua. I can't find the formula, but I believe you feed the amount for one that weighs 12 pounds (her ideal weight) plus 50% more. That sounds like too much, and I'm not sure. I can't find it. Can somebody please post the link to that page? Thank you!
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.

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jilbert57
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Re: Diagnosed with EPI today - Mouse

Post by jilbert57 » 19 Sep 2020, 21:12

The flavored ice cubes(very small amount of broth mixed in the water) van be used to help get rid of the enzyme mouth.

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.

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jilbert57
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Posts: 2088
Country: United States
State: Washington

Re: Diagnosed with EPI today - Mouse

Post by jilbert57 » 19 Sep 2020, 21:26

Pam, she is feeding 1/4 c 3 to 4 times a day or 1 cup kibble.
My 19 lb JRT ate 1/3 cup 3 times a day.

If she was feeding Victor Salmon and sweet potato for example, a 5lb dog says 1/2 c. , 10lb pup is 7/8 c, 15 lb is 1- 1/4.

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.

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Olesia711
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Location: North Carolina
Country: United States
State: North Carolina
Pet name: Izzy
My name: olesia

Re: Diagnosed with EPI today - Mouse

Post by Olesia711 » 19 Sep 2020, 22:23

Masha,
Hi. First thank you SOOOoooo much for opening up your heart and home and taking in this little dog that was abandoned and neglected. I managed an EPI dog for almost 14 years who also had Diabetes for 8 of those years..... not an easy journey.....

1. The first thing i noticed is that the vet only tested the urine to diagnose Diabetes and then proceeded to give you insulin to treat. At any time did the vet or maybe after the 5 day hospital stay.. did the vet go ahead and confirm the Diabetes diagnosis with a blood test? In order to correctly diagnose Diabetes,... this dog, Mouse, needs to have a blood test to accurately test his blood sugar levels. ..too much insulin would be causing Mouse to keep going hypoglycemic. And even with proper testing.... when first giving insulin, the amount is a little bit of science and a little bit of guess work too. Also... the best and most accurate way to monitor a diabetic dog by testing with a little blood monitor tool.

2. Next... not sure if anyone explained this to you or not.... but a diabetic dog needs to be given insulin twice a day.... breakfast and dinner... SAME time every day (although you actually have about a 30 minute leeway either)....

3. THen you need to feed approximately the SAME amount and type of food to go with the SAME amount of insulin given.

Of course all this needs to happen once you and your vet can figure out what the right amount of insulin is with the right amount and type of food. Lots of Trial & Error.... and as pet owner, the more information you can give your vet about how things are going is to keep a journal to share with the vet so that they can make a more informed decision on how best to proceed forward.

With an EPI dog we suggest feeding 150% and to be fed 3 to 4 times a day..... HOWEVER..... if Mouse is Diabetic, you SHOULD NOT do this.... (1) you cannot give too much food all at once (2) and usually giving them extra meals without insulin most often messes up the blood sugar. However... with Mouse going hypoglycemic so often, he may be an anomaly and need an extra in between meal with enzymes but not insulin..

WHen Mouse was in the hospital for 5 days.... what did they determine? Do you know if they checked his blood to confirm Diabetes? How much insulin and what kind of insulin are they recommending that Mouse gets... Did they go over what kind of food to feed him to take care of the Diabetes? Sorry for asking so many questions, but this is important information that is needed to help move forward in the best way possible.

Big picture.... with this combo condition... you will always need to give the Diabetes preference in treatment.

Okay.... Now I am going to go back now and re-read the posts....to see if i can answer/help you out with your other questions.
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
Founder & Research Director
Posts: 3857
Location: North Carolina
Country: United States
State: North Carolina
Pet name: Izzy
My name: olesia

Re: Diagnosed with EPI today - Mouse

Post by Olesia711 » 19 Sep 2020, 23:08

Hi Again Masha,

to hopefully help you further with some of your questions, i am cutting and pasting your questions here and will try to answer the questions that haven't been answered as best as i can (MY ANSWERS ARE IN RED):
guess here are all my questions:

1. How would you use a meatball to give a powdered medication? A meatball is made up of wet food or mushy ingredients that the dog will eat- -and you just add/mix the enzymes in this blob of food preferably in the middle of the meatball so that the outside of the meatball is just composed of something yummy the dog will like. HOWEVER... what we typically recommend is making the dry food moist (because of the powdered enzymes added) with something like tuna fish crumbled and sprinkled or add a few tsp of stinky cat food, If Mouse refused to eat food moistened, then you can try pouring the powdered enzymes into an empty gel cap and tucking the gel cap into a small blob of cream cheese and give the enzymes this way when he is about halfway thru eating the meal. The reason why we don't recommend giving the enzymes before he eats is because just in case he doesn't eat his meal (Jill answered how much enzymes to give) Another thought, is that you if can prepare his kibble, add enzymes and add just enough water or broth or some wet food to moisten the enzymes in the dry food you can toss of few pieces of dry kibble on top (do not mix in with the enzymes food underneath) and maybe this will help encourage him to eat if her really like dry crunchy food ....
2. How much is the scoop that comes with the container? I think it's a 1/4 tsp, but I'm not sure. Just use a measuring spoons - -forget the scoop. YOu measure by how much food you give not by a meal
2a. If I follow the vets guide, would Mouse get 2 scoops or one. Ratio is 1:1 tsp powdered enzymes per cup of food
2. Is 1/2tsp too much to be putting on 1/4-1/3c of food? technically we would recommend 1/4 tsp for 1/4 cup of food or 1/3 tsp for a 1/3 cup of food.... but 1/2 tsp might also be okay- -some dogs need a little more.... but on the flip side.... sometimes too much enzymes will trigger loose stools.
3. What if he doesn't finish all his food? Did he get enough enzymes? As long as the enzymes are mixed in the food with something added to make the kibble moist... what ever kibble he doesn't finish should also include some unfinished enzymes... so he will get enough food. Nothing to worry about.
4. He prefers dry food. How do you get the enzyme to mix in so he doesn't hurt his mouth? (wet food has been a failure with him) As mentioned above you have to mix the enzymes in food with some kind of moisture- -whether adding some wet food to mix in with the dry food or adding a little bit of liquid. ... or encapsulate the enzymes as mentioned above. To make sure his mouth is cleared of enzymes after the meal (if you have to use just a minimum of enzymes) then you can squirt his mouth out with a bottle of tepid water, or give him ice cubes to lick, play with after a meal, or wash out his mouth with a soft wash cloth after a meal.
5. How quickly will he start gaining weight and or muscle? Some start gaining weight in a few weeks, others take forever.... (can be up to a few years)
6. Any suggestions or ideas on what to expect over the first few weeks? A lot of Frustration ......

It takes a while to find the right balance of treating the Diabetes first and then focus on treating the EPI.

With Diabetes... if you have to feed a food that doesn't agree that well with the EPI condition... then the trick is to up the enzyme dosage a little bit.

THe best thing is to start keeping Mouse on a routine food & insulin/ twice a day/approximately same time each day with same food and same dose of insulin. My best suggestion would be to check out and join this site for the Diabetes part: http://www.k9diabetes.com/
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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