New Diagnosis

[MelC]

Hello my dog Meg has been diagnosed recently with EPI and is being treated with lypex and antibiotics in case of infection. The vet says her B12 levels are ok. We are feeding her kibble and raw pancreas.

she lost over 4 kilograms before diagnosis.

Since being on treatment (approx 3 weeks) her poos have become less frequent and less volume but they are still soft. her weight gain has been small.

approximately every 3rd or 4th day she while go into herself and then vomit. (no obvious changes to her day and or diet)

It has been very emotionally draining (as I'm sure you all know)

any tips or advice regarding why she is still vomiting would be really appreciated.

thanks
Mel

[Olesia711]

ohh poor thing.....so sorry to hear that she is having tummy issues.

THe first thing though before i get into what is most likely causing this.... is to make sure that you are giving enough enzymes per volume of food
Check out the UK enzyme recommendations here: https://epi4dogs.com/epi-quick-guides-outside-usa/


What you are probably "seeing" is SID (small intestinal dysbiosis) rearing it's ugly head now that you are addressing the enzymes... even though SID is present in all dogs dealing with EPI........our objective is to get it under good control..... SOOOOOOOooo..

The newest protocol is not to automatically reach for Tylan (Tylosin Tartrate soluble powder antibiotic) but rather first treat with:
1. Prebiotics (this is food for bacteria)... many of us sue SLippery Elm powder https://epi4dogs.com/slippery-elm/ ... it works in most cases but then again not all EPI dogs respond effectively to it.... but well worth trying (cheap and natural) first as sometimes it is all that is needed.

2. If this doesn't work well enough... then next step is to try a pre+probiotic product. Our first recommendation is to talk to your vet about starting your dog on Proviable probiotics ..... but if your vet prefers another pre+probiotic that's find too. The only thing we STRONGLY suggest is to start any probiotic at less than 1/2 the recommended dose and then work your way up to a full dose over the course of a week or two.

3. If you do not see ANY positive improvement.... THEN it is time for your vet to prescribe (Tylan) Tylosin Tartrate Soluble Antibiotic powder. for 45 days/ twice daily with breakfast and dinner. https://epi4dogs.com/antibiotics/

4. Whatever you do DO NOT let your vet prescribe Metronidazole/Flagyl for any gastrointestinal upset..... Texas A&M, based on recent research is strongly pushing this because Metro can and does destroy bacteria and they have now proven that some of the good bacteria may never ever come back no matter how many times you try to reintroduce it into the system.... so stay away from Metro for gastro upset.

Especially since all EPI dogs have SID and they have now discovered that SID gut flora means that (1) there is not enough god bacteria in the gut AND (2) that there is not enough of a variety of good bacteria in the gut...... Tylsoin (Tylan) doesn't kill all the bacteria but rather it is a macrolide antibiotic and inhibits bacterial reproduction....while taking it..... and this is why Tylan is greatly preferred over Metronidazole... in addition to possible Metro toxicity.

Hopefully this helps and please keep us posted!

[MelC]

Thank you so much for your quick response. Really helpful advice regarding the antibiotics, concerningly she is on Metrobectin and was on those for a long time before diagnosis, are you advising I request a different one and worrying that this may have caused long term problems.

I will definitely look into the pre and probiotics fingers crossed they will help to settle her tummy.

do you have any thoughts on the raw prancreas?

thanks again

[Tuckaboo Pam]

Hi , it's Pam in Florida. Glad to meet you here on this awesome forum. I've heard it said that it's hard to determine the amount of enzymes you are providing when you feed raw pancreas, as opposed to powdered enzymes. When Tucker was first diagnosed, I looked into finding a source for pancreas, just based on the high price of enzymes from my vet. Many of us use EnzymeDiane, because she is reasonably priced, but I don't know if they are allowed to be bought in England. Jean can probably advise you. Take care----Pam

[Olesia711]

well, Metrobectin is indeed a metronidazole drug so going forward i would ask your vet not to use it anymore on your dog for gastrointestinal issues....specifically chronic gastrointestinal issues.

Regarding Giardia....my understanding is that Metro is the recommended drug for Giardia ... not sure if they will or even can effectively change the protocol for this. The Metro research just came out this fall time (sept or oct 2020).....

Just going forward, i wouldn't use Metro for any gastrointestinal issues unless there is not another choice.
Also..... year ago, Metronidazole is exactly what was used to treat SID in EPI dogs. Unfortunately, it often did not work at all. If the signs that you are seeing is SID related (and i suspect they are) then i would ask your vet to stop the Metro....and since your dog has already been treated with an antibiotic... in this case, i would alter the step-by-step protocol system just a little.

1. As your vet to swap out the Metro for Tylosin Tartrate (soluble powder)
2. about 2 to 3 weeks into giving the TYlosin.... then i would ask your vet to prescribe Proviable probiotic or a probiotic of his/her choice..
SInce tylan is a macrolide antibiotic, you can actually give it together with a probiotic however, this being said.... i personally amd still kind of old school and still like to recommend giving a probiotic 2 hours away from a antibiotic.

Please know that your vet might think Tylosin may not be available (in the UK, some times vets have difficulty sourcing it) but it IS available:
This is EXACTLY what we use:
https://www.vetimed.co.uk/en/pet/produc ... tion-100g/
https://www.farmacy.co.uk/tylan-soluble ... -100g/p523

(if questioned) , Tylan (Tylosin Tartrate soluble powder) was designed for pigs, chickens and honey bees but is now used on dogs & cats too.
Texas A&M Gastrointestinal Labs recommend it for small intestinal dysbiosis in dogs with EPI. Lots of research out there on this

Also.... "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” 8.Erythromycin or tylosin. https://onlinelibrary.wiley.com/doi/10.1111/jsap.13135

Raw Pancreas. Some people have used raw beef or lamb pancreas and it worked out just fine for the dog.... others have tried it and the dog did NOT like it so it did not work out. Here is some info on it:

https://epi4dogs.com/enzymes-in-brief/
FEEDING RAW PANCREAS: If you would like to try using raw pancreas; fresh beef, pork or lamb pancreas are recommended. Raw BEEF Pancreas is available for purchase in the USA at http://www.hare-today.com/ or http://www.greentripe.com/ , and new resource as of 2012 on the USA eastern coast is http://www.greencuisine4pets.com/products.htm . There is also an amazing selection of raw pancreas at: https://www.mypetcarnivore.com/ . If you are in the U.K. you can look into http://rawtogo.co.uk/ . One to three or four ounces of raw pancreas can replace one teaspoon of pancreatic extract. Raw pancreas may be frozen in cubes for future use and thawed naturally, but never heat on the stove or in the microwave.

If possible beef or lamb raw pancreas is recommended over pork pancreas because of the “possibility” of the transmission of pseudorabies, although rare.
http://en.wikipedia.org/wiki/Pseudorabies

Also… raw pancreas is not all the same. Each and every gland has a different potency of enzymes. This is not just species to species. The potency can vary from one farm animal to another farm animal as well. If you use 1 ounce of raw pancreas with the batch you are currently using the next batch may need to be tweaked. Fresh pancreas has a shelf life (in the freezer) of up to 3 months.

Adding enzymes to a raw fed meal:
Since raw food is harder to measure by the cup since the densities of different meat/bones will require different levels of enzymes, it is easiest to go by weight rather than amount! ” To add the enzymes, you can either puree a portion of the raw meat and add the enzymes to that pureed slurry and pour over the remainder of the raw food, let sit for 20 minutes and serve, or you can add the enzymes to something like yogurt/kefir and either add to the food as mentioned above, or serve the enzymed slurry first ahead of the meal. Try both to see which works best with your EPI dog. (Thank you Cait for these great suggestions!)

[Madelon]

Hi Mel - welcome to you and Meg. Olesia as always has given the best most knowledgable advice so I just wanted to welcome you to our EPI family. I highly recommend keeping a log of everything you give and the resulting poops - this will help you figure out what works and what doesn't. And please know we're here to help guide you through.

[MelC]

Thank you to all for your kind and helpful responses it is good to have experts here to ask as although well meaning I'm not convinced the vet has much specific knowledge on EPI.

Really appreciate your advice and just knowing that there is hopefully light at the end of the tunnel is fab, even if there are likely to be lots of bumps on the way.

I will certainly give your suggestions a try.

many thanks all

[Tuckaboo Pam]

There may be lots of bumps, or there may be only a few! ---PH

[MelC]

Thank you

[Olesia711]

regarding the vet not having that much experience with EPI..... if you like your vet, that is really not a problem... over the years, we (as an EPI community) have discovered that the very best vets to treat EPI dogs are those that no necessarily know everything, but those that are so excited to have an EPI case that they start doing their own research and try to work closely with the EPI parent.- - exchange ideas and try things!!!

The deal with EPI dogs is that even though there is a recommended treatment protocol.... not all EPI dogs respond accordingly..... so often things/recommendations have to be "tweaked" and that is where the willingly enthusiastic vet ends up the best EPI vet over others, even if they didn't have a clue about EPI when your dog first became their EPI patient