New EPI Diagnosis

[GabandSam]

Hi everyone,

We are so happy to have found Epi4Dogs. The information here is what helped us get our dog the help he needed. We had to really advocate to get the cTli test done on our mini schnoodle, Richie. After every other blood test was done.... the vet decided to do cTli. Richie boy had lost more than 25% of his body weight. We knew it was EPI but our vet wasn't too sure. Results came back <1, diagnosed with EPI. We are relieved to have answers but now we are trying to figure out life with an EPI doggo.

We are currently on another round of Tylosin (antibiotic), PancrePlus Enzymes, Royal Canin Hydrolized Protien kibble, and possibly going to try him on Omeprazole 10mg twice daily to help with "gurgle gut."

He normally weighs between 11.5-12lbs. He was under 8lbs when diagnosed. He is now hovering around 10.8lbs. Yay!

Some general questions I have....

1) We are trying to find a balance between bloat, and gaining weight. We feed 4 small meals a day but find he is bloated sometimes?
2) His poos are generally better in the morning, and get worse throughout the day. Any thoughts on this?
3) What counts as stabilization? How long should consistent poos be to be considered stable?
4) When is an appropriate time to start walks and hikes again? He is a very active doggie, and for the past few months we have not been walking or doing much movement with him. Our vet recommended cutting out walks and activity to help him rest and gain weight. He still seems tired throughout the day, but is also antsy to get outside and play in the snow... thoughts?
5) His belly is constantly rumbling and he has been throwing up a bit more. Have any of you found remedies for these specific symptoms?

Thanks again to everyone here! Richie, my husband, myself, and all of Richie's friends are so thankful for a supportive and caring community of EPI buddies.

Best,
Gabi (Richie's Mom)

[Tuckaboo Pam]

Hey Gabi! It's Pam in Florida. Welcome! Here's what I can help with:

1) Are you giving any probiotics?
2) Are you spreading the tylosin over two of his four meals, and have you had a chance to look at the dosing chart on this website, to make sure your vet's prescribed dose matches?
3) Gosh, let somebody smarter than me take this one. The condition is for life, and dependent on circumstances, so I'm not sure I'd use the word stabilized no matter how well Tucker is doing.
4) Let that boy play! He may be tired because he's depressed from not getting his daily exercise.
5) I'm not sure about this food, BUT---Olesia, Madelon, Barb, Jean, Jill, et al. will be reading this, too, and they know way more than I do---I'm a mom like you, who joined a year and a half ago. Keep checking back, and you will get the help you need.

We're so glad you are here!---Pam & Tucker

[Barb]

Hi Gabi! A warm welcome to you, your husband, and that adorable little Richie. Congratulations on the weight gain already.

The beginning stage is the hardest, so try not to feel too overwhelmed. It will get better once you have the food, enzymes, B12, and antibiotics balanced.

Which brings me to my first question: Did your pup have a test for B12 (cobalamin). You didn't mention it in your post. Often the B12 and Folate are tested with the cTLI test. Usually, our pups have low B12 when they are first diagnosed and this can give them the kind of symptoms you are talking about.....lack of energy, depression, sometimes a lack of appetite. Ask your vet if the b12 was tested and find out the numerical results. Supplementing B12 is easy. You or your vet can do weekly injections or you can get capsules from Wonderlabs , called Pet Factor, online. You don't need a prescription and the pills are very reasonable.

I assume when you say that Richie is bloated, you don't mean the state of emergency bloat. But I would mention it to your vet. We actually did have a dog that bloated and it was an emergency. One thing we did afterwards was to give him Gas-X(in gel cap form) after his evening meal to keep gas from forming. Your guy is very little, so I would check with your vet to see if this might be an option. Giving him smaller meals is definitely the right path.

Yes, Kolby's poos were better in the morning also. It might be the food, or it could be he gets into something out in the yard to "supplement" his diet, like grass or other goodies. Kolby also had "nervous or excited poos," like when he went for a walk or we had a lot of company. See if it continues.

When Richie's poos are good, his B12 is 600 plus, his SID is under control and the tummy rumblings are minimal for a good 3-4 months, you can probably say he is stabilized. Treating the EPI will become very routine and you won't worry as much.

And I agree with Pam. Let him play and do his normal activities. Once you know his B12 level, you will know if that is causing his tiredness and when you supplement it, it will help with the weight gain and with his energy.

One thing that really helped our sanity was keeping a log/journal. Record everything you give Richie, the amounts, and the resulting poos. This will give you lots of information and will tell you what is working and what might need to be adjusted.

You might also want to check out Enzyme Diane's website. She is a member here and supplies many of us with enzymes at much more reasonable rates than the commercial brands. She has an excellent product and is wonderful to work with. She also posts her phone number so you can talk to her and ask questions.

You are doing a great job. Hang in there.

Barb

[Willow&Jen]

I have no answers but I’m here to say we too have noticed that morning poops tend to look better than evening poops

[Olesia711]

Hi Gabi and welcome to you and Richie,..... what a cutie!!!!!

The the trick to managing EPI is all about finding the right balance of the recommended EPI protocol for YOUR dog and the easiest way to do this is by keeping an EPI log. After the initial implementation of the EPI protocol /meds....... if, after a reasonable amount of time, things are not almost back to normal.... THEN make one change at a time to your regimen, watch the poos, listen for tummy noises, burps, gas, etc, and record your observations for at least 3 days but more like 5 days, before you make the next change. This is how you determine if you need to increase/decrease, eliminate or add things to your EPI regimen.


With regards to your questions (re-listed below) , i too will try to answer some to the best of my ability.... but i do have a question for you. Noticed that Richie is on Hydrolyzed food...... did the vet put him on this food for a reason? Does he suspect Richie has a food sensitivity... OR... was Richie placed on this food prior to the EPI diagnosis with the assumption that maybe what was going on was a food sensitivity. The reason why i am asking is because it is possible that this food may or may not be agreeable with Richie and that might be why his poos are "iffy" still.

Another possibility, which does touch upon the lethargy and soft poo could be low B12 like Barb suggested. If you could let us know if blood was drawn and B12 tested, and exactly what the value was, that would be very helpful. The B12 test is called a Cobalamin Blood test. They often drawn the blood for this the same time they run the TLI test.

1) We are trying to find a balance between bloat, and gaining weight. We feed 4 small meals a day but find he is bloated sometimes? I am going to address this as if you are referring to a very full tummy and not actual bloat..... (1) is it possible that Richie is drinking too much water after his meal??? If not, i have two other possible thoughts. (2) Are you giving enough Tylan twice a day? see the chart on this page according to weight: https://epi4dogs.com/antibiotics/ (3) Are you giving approximately the right amount of enzymes with each meal based on the amount of food you are giving? I am assuming you are not giving any treats/snacks at this time... correct?
2) His poos are generally better in the morning, and get worse throughout the day. Any thoughts on this? This is common with some dogs..... as was mentioned earlier it most likely could be just that there is more excitement during the day vs. when he is sleeping and this triggers looser stools.... or it could be something he is getting into that he shouldn't without enzymes, etc.
3) What counts as stabilization? How long should consistent poos be to be considered stable? our generalization of this is about a month of consistently good fairly normal poos.
4) When is an appropriate time to start walks and hikes again? He is a very active doggie, and for the past few months we have not been walking or doing much movement with him. Our vet recommended cutting out walks and activity to help him rest and gain weight. He still seems tired throughout the day, but is also antsy to get outside and play in the snow... thoughts? DOn't let EPI stop little Richie from being a dog and playing outside... let him go on walks, hikes etc... just if you see him getting tired during these excursion, just shorten them a bit
5) His belly is constantly rumbling and he has been throwing up a bit more. Have any of you found remedies for these specific symptoms? SOund like uncontrolled SID.... which could be from not enough enzymes, needed B12, not enough TYlan, or pre/probiotics need to be introduced, or he would benefit from trying something like Omeprazole.
What i would suggest is to first try SLippery ELm powder(before trying Omeprazole). https://epi4dogs.com/slippery-elm/..... this is a natural mucilage with prebiotic properties. If this helps (firms up poo and the burping appears less) then what you are dealing with is indeed uncontrolled SID.... SOOOOoooo next step is what do you need to tweak to get it under better control (BTW, all dogs with EPI have SID... our objective is to just keep it in good control.).... if the slippery elm is enough to improve the poos and regurg. then that's all you need at this time... but if it helps but is not quite enough, the next step is to ask your vet for a quality pre+probiotic. At this time, our suggestion is the probiotic Proviable. You CAN give this with Tylan antibiotic because Tylan is a macrolide antibiotic and inhibits reproduction of bacteria, it does NOT kill all bacteria like Metronidazole.... so yes, you can give a probiotic with TYlan. I just still like to suggest giving any probiotic 2 hours away from any antibiotic if possible, just to keep things simple, although not technically necessary. IF the Slippery Elm doesn't help at all..... then ask the vet to try Omeprazole.

If the above helps but still not optimal.... THEN i would look at the food you are feeding..... if Richie does truly need a hydrolyzed food.... then i would ask the vet to swap out the brand you are using and ask to try Royal Canine "Ultamino" hydrolyzed food.... this particular hydrolyzed food (for whatever reason) appears to more readily work well with EPI dogs over other hydrolyzed food. Of course there are no promises that this will work, but worth trying if you need to change foods but still have to stay with a hydrolyzed food.

THere could also be many other reasons why Richie is not optimally responding to the EPI treatment.... but as you can see, it most likely is just a little "tweak" of one of the recommended EPI protocols....... and this is why we highly recommend keeping an EPI log....

We hope you will continue to post and let us know what you try and what the results are so that we can help you and your vet figure out how to best help Richie!

[GabandSam]

Wow! Thank you everyone for the replies. It is so incredibly helpful! I will go through each question to keep things straight. We are trying to find a vet that has a bit more experience with EPI dogs in our area, and so far we have been pretty lost and trying to figure things out on our own. It helps to have the feedback from this group.

Richie was prescribed hydrolyzed food PRIOR to an EPI diagnosis. We were desperate to find a solution and had no idea what EPI was. We have not transferred him off of the hydrolyzed food because we haven’t wanted to change too much at once. We would love to eventually find a different food for him. I have looked at the recommended foods on the site and want to try and switch. We just don’t know if he has a food sensitivity… It has been hard to differentiate what is EPI and what isn’t. Up until he got sick (August 2020), we was on Science Diet Small Paws(no prescription, just what we bought at Petco and he liked.)


1) We have been giving a probiotic with every feeding. It has been a very small amount. It has been the suggested DAILY amount given throughout the day. We are doing 4 small feedings throughout the day. We just started giving Tylosin again today. The vet had prescribed him for 10 days. It seemed to help. We then removed the tylosin and over the past few weeks his poo has gotten worse again. (good in the morning some days and worsens throughout the day). We lowered the amount of enzymes and that also seemed to help. Because he’s so small, it’s been challenging to make such small adjustments.

Currently: Tylosin 10mg twice a day… The chart says 25mg daily. I am hoping 20mg will be ok?

2) Interesting! I think more movement and being awake and playing definitely triggers looser stools. We will keep an eye on this….!
3) Thank you for this feedback!
4) Yay! Since I have read these replies we have been walking, playing fetch at the park, and it feels nice to see our dog being himself again.
5) We are on our last week of B12 injections. Our vet prescribed 4 weeks of injections. His count was borderline normal to low. We had two vets say different things. Vet 1=he needs b12 shots and vet 2=he does not need them. We decided to try it. We have not noticed a huge difference in his energy before or after the shot is given.

I just ordered slippery elm from wonder lab. I am confused on if probiotics should be given while tylosin is being given and how slippery elm plays into that?
While Richie is on tylosin twice daily, does he need probiotics and slippery elm? Or should he be on solely tylosin and then slowly add in the pre and probiotic?

[Madelon]

Hi Gabi! Welcome to our EPI family. You've been given great advice already and by the way your pup is adorable!

With regard to the food, I would go ahead and try to transition to another food. The hydrolyzed food contains rice which doesn't always agree with EPI dogs and since this was prescribed by the vet PRIOR to diagnosis of EPI in an effort to figure out what was going on, I would go ahead and try switching. Make the transition slowly over 7 days and buy small bags of whatever food you try until you find the right one. With EPI we recommend grain free with 4% fiber or less and avoid/limit peas and legumes.

You said the vet prescribed Tylan for 10 days. Please print out the information from this site and ask your vet for a longer prescription - Tylan should be given for 45 days and then SLOWLY wean off. We have seen over the years that when the Tylan is stopped cold turkey the SID can flare up. Also if the dosing chart says 25mg, please have your vet increase it to 25mg.

In the beginning of EPI we say it's best to keep things simple, just enzymes, food, B12 and something to address SID. If I were you, I would stop the probiotic for now, keep giving the Tylan and try adding the Slippery Elm bark powder. SE is a prebiotic and yes you can give it at the same time as you give the Tylan. You don't want to give a probiotic at the same time as an antibiotic (Tylan) as it cancels each other out. However, the prebiotic (SE) is okay to give at the same time. My boy is on a maintenance dose of Tylan 1/8tsp twice a day and he also gets 1/2tsp of SE twice a day at the same time. He's been on this routine for over a year now.

As for B12, once you are done with the shots, I highly recommend getting WonderLabs Pet Factor B12 (you can order SE from them as well and use code EPI4DOGS15 at checkout and get 15% off). EPI dogs need their B12 on the high side of normal 600+ and supplementing is for life with these dogs. Low B12 can affect mood, energy, appetite, weight gain. My vet did not think we needed B12 when Doc was diagnosed but after reading the research here I knew he did so I never did the shots and just ordered the pills - his B12 has been over 1,000 ever since, however, I did let my vet know what I was doing and he said it was fine as he'd pee out the extra.

Keep us posted on how things are going.