Another Newby with Questions

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.
Poppiesmom
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Country: United States
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Pet name: Poppie
My name: Erin

Another Newby with Questions

Post by Poppiesmom » 28 Jan 2023, 10:53

Hi!
First, I have to say - what an incredible resource and blessing this website/forum is! Thank you to all who have made this and work to help others in the same boat! It's been an invaluable resource. I am still combing through all of the information and forums and digesting the new reality for my sweet Popstar ( aka Poppie). She is an 11 year old rescue Lab/Shepherd mix. Funny thing is - as long as we have her she has had a squirrely tummy- now it all makes sense.

After almost 6 months of back and forth with the vet, I am grateful that I finally have an official diagnosis for her as of December - we did the TLI/Cobalamin test and her results were;
low colbalamin <150, low folate 6.19, TLI low 2.2
It was a bit frustrating because I had been asking about EPI since May and I felt that the vet was not even interested in exploring that option since it is "rare."
Whatever the case, here we are, a month into finding what works for Poppie and I would greatly value the insight of your experience and knowledge.

Loss of muscle mass was my first indicator earlier last year followed by an intolerance of a diet staple ( freeze dried lamb tripe in moderation) change in color to her poop ( light), an increase how often she pooped, increased weight loss ( 6 lbs since May), and she started eating her poop.

In November, before we had the official diagnosis, I had switched her diet to 150% of her dietary needs and broke her meals up into 3 smaller meals as opposed to 2. She was also already on Proviable forte 1x a day. We switched her to Proviable DC 2x a day as this seems to work better for her. Also, while waiting for our diagnosis appt, I managed to befriend a butcher that saved me fresh pig pancreas to feed her. (Ugh...gross...the things we do for our loves) I know this would be ideal in some ways because - fresh - but....consistency was going to be a challenge and not all pancreas are alike, so we switched to the powder- wow, that was s budgetary shocker!
We started her on Covetreus prescription pancreatic enzymes on Dec 20 - we started with 1/2 tsp over her (room temp) food and over the course of about a week, upped it to 1 tsp ( per info here - she eats approx 9oz with each meal). We also started her on Cobalaquin from the vet daily. I switched her to the wonderlabs B shortly after that ( 2 a day), realizing that folate was not included in the Cobalaquin and reading about digestibility.
Shortly after starting the enzymes, I added in slippery elm - 1 capsule 20-30 min before eating.

Overall, I feel like she has at the least stabilized. We just switched to Diane's enzymes a week ago and I actually think they are working better than the prescription stuff.
She is back to pooping more in her normal range - 2-3 x a day, color is still a guess - it also depends on what her protein source has been- she is raw fed and I notice that pork ( lean loin) is lighter than beef ( maybe the fat content?) but it is still stinkier than normal, she still drops at least 1 napalm bomb a day ( oh my goodness, this brings an entire new light to "dutch ovens" ) and we still have to watch her, as she still wants to eat her poop.
She hasn't gained weight, but she hasn't lost any more. Her overall energy is great though. She still has some days I can tell she is not feeling well, but she also gets the zoomies more now and overall seems like herself.
I am guessing I may need to add in the b12 injections?? I have been hesitant just because she already gets Adaquan injections monthly and HATES getting shots.
I plan to retest her, but am trying to wait til we find the right groove - she definitely wins the prize for most expensive dog ever, but we love her and will do what it takes to help her have quality of life.
I look forward to any insight/advise you can share on how I can tweek and maybe what I could be missing.
Thank you SO much!!
Erin & Poppie

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Olesia711
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Re: Another Newby with Questions

Post by Olesia711 » 28 Jan 2023, 12:25

Hi Erin and thanks for writing to us about Poppie's situation.

You are an incredible mom! As a newbie have already implemented some positive tips and tricks to managing EPI.

First, i'd like to go over the numbers.
Yes, she has EPI .... BUt her B12 is REALLY low. Glad you switched to Wonderlabs as they "usually" work better, but of course, not always. Make sure you are giving the right amount of B12 for Poppie as the protocol has recently changed (according to TAMU) https://epi4dogs.com/b12-protocol/ .... she should be getting 1 capsule daily. And give it at least 3 weeks to hopefully see an improvement. But if the Wonderlabs doesn't improve the B12 levels... and since she hates shots, before going the shot route, try hydroxycobalamin B12 pills.... just in case they work... but if they too fail, then yes, ask the vet to teach you how to give shots at home and try that.

However... before assuming that the B12 is causing the still sometimes sloppy poo (which this could be the case) , what i noticed is the Folate value of 6.19 which indicates small intestinal proximal disease... this can cover lots of different things, but with our dogs, the most common thing is some sort of food sensitivity might also going on, and often this suggests IBD. Oh joy... NOT! So Poppie might not be having ideal poos because something in her diet may not optimally agree with her. The best way (without getting invasive) that i know to handle this is to keep a journal, and write down EVERYTHING she ingests....all the ingredients in food, supplements, etc.... because this can be a real pain to identify food sensitivities.... make only 1 change at a time... watch the poos for 3 to 5 days, take pictures of the poo, and then move on to the next change. by keeping a journal, you ought to start seeing trends evolve around certain foods/supplements, especially if you take poop pictures to correspond with the individual changes.

Also.... the lighter poo can happen with different proteins (like pork).. often the poo changes color to some degree (lighter/darker) depending on the protein source. Beef, Buffalo, etc., will tend to produce darker poos, while fowl, light fish, pork, etc., will tend to produce lighter poos. So this might also be part of the equation.

And as you probably know from reading, that ALL dogs with EPI have SID to one degree or another. Our objective is to keep it under good control. SO here is the conundrum. normal amount of fat actually helps the enzymes work a little better, but on the flip side, fat can also trigger more SID imbalance.... so you kind of have to walk a tight rope depending on the situation.

That is excellent that you are feeding 150% but in smaller and more frequent meals.... the more frequent smaller meals can make a huge difference as you noticed .... and that is really great that you already figured out that Proviable DC 2x works better. For a newbie you are already doing a great job and on top of things!

About the SLippery Elm..... this may or may not be part of the problem. It is a mucilage and is great for "most" EPi dogs... .... it also has prebiotic properties which works and is great ...BUT... you have to be careful NOT to give too much cause too much of any prebiotic can trigger more loose stools. SO... we always suggest not giving SLippery ELm pills, but rather giving powder ... so that you can control the amount based on weight and reaction. PLease check out the dosing chart here: https://epi4dogs.com/slippery-elm/
Also.... what is the potency of the SLippery ELm pills you are giving?

Glad to hear that she is doing the zoomies- -that is always a positive!... but her sometimes not feeling so well, if i had to guess, my guess would be that her not feeling always great is probably due to SID....

I see where you increased the enzymes per her meals (9oz) but since she just started this journey......and reading her story.... my thought would be that the very first change you should try, (and give it a few days) .... is start giving her 1+1/8 tsp of enzymes per her 9 ounces of food. NO treats in-between.

If the extra enzymes don't help, and if after 3 weeks of Pet Factor doesn't do anything, and if the correct dosage of SLippery ELm doesn't change and she is STILL eating poo............THEN talk to your vet about trying Tylan antibiotic powder. However.... try to keep this as a last resort. If you are willing ... i would even try to do the EPI Log / food + supplement trials before doing the Tylan... if patience allows and if her poos aren't too bad..

Here is a link to the EPI Log examples/templates: https://epi4dogs.com/epi-log/
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.........

Poppiesmom
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Posts: 5
Country: United States
State: Florida
Pet name: Poppie
My name: Erin

Re: Another Newby with Questions

Post by Poppiesmom » 29 Jan 2023, 09:34

Oh my goodness- thanks- it's been so distressing ( as you all know) to watch her wither away. I give this wonderful website & forum all the credit for having such great information available! And I can't thank you enough for taking the time to respond to my questions, and so quickly. <3
I would love some clarification on when to re-test for B- I was reading 12 weeks ( I think) but then you mentioned if no change in 3 weeks in our conversation. I know it might not surprise you to find that Poppie also isn't fond of going to the vet. And is there a separate test for b serum or is it always attached to the TLI test?

And food - oh my gravy - yes- such a tightrope! Thank you for confirming my suspicion of SID being the biggest culprit right now. It's a roller coaster! The tracking template looks like an excellent tool - I am going to work on getting that going. I have been mentally tracking a lot of it and why I didn't think to log it escapes me. For her, I definitely think the fat content balance may be the biggest challenge. She also struggles with the organ meats- I have to microdose and she definitely doesn't do well with every day. I still need to pop over to the diet section and see what other tweeks I may need to consider with her raw diet.

Per your suggestion, starting last night we upped her enzymes- here's hoping that helps. The hard part now is no snackos in between meals. She was actually doing pretty well this week and then mommy caved to her sad sad eyes and I gave her my yogurt cup to finish mid morning a few days ago- I swear that set her off into sloppy poo land.
Currently, we are giving her Solary brand 400mg Slippery elm mixed with a little low sodium broth with the 2 main meals. I already had it on hand when I was reading about it. Funny you mentioned the powder, I had just ordered that after reading more here about it. It arrives later this week!
I am going to definitely work hard to try to find her balance without the antibiotics.
Thank you again for your expertise and insight!!

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Olesia711
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Re: Another Newby with Questions

Post by Olesia711 » 29 Jan 2023, 13:39

Hi Erin,

Glad that the Epi4Dogs website and community on the Forum is helpful! That's our goal to help others not struggle so much, if our EPI experiences can be of some help.

Regarding the B12 test (Cobalamin & Folate test) ... it can be done separate, you do not have to do the TLI test to also do the B12 test.
Ahh.... when to retest...Since you are doing to B12 pills daily...Texas A&M recommends a retest after 12 weeks on the B12 pills. And then retest to make sure the B12 pills are working. Also, very important: When retesting, if a dog is on B12 pills, you need to stop giving the pills 1 week prior to the blood being drawn for the B12 test. If a dog is on B12 shots, then you need to stop the shots 1 month prior to the blood being drawn for the B12 test.

Hmmm.... your mention of Poppie having trouble with organ meats... could be because organ meats are usually high in fat and cholesterol content. Although extremely healthy... some health conditions warrant avoiding/minimizing organ meats. And you really don't need more than 5% of organ meats in the diet. Also...if you are giving any raw pancreas... remember... that is also considered an organ meat.

the slippery elm powder in capsules that you are using, thanks for letting me know... that they are 400 mg... that's the typical potency. going forward, just open the capsules and give measured amounts (use baking measuring spoons) according to her weight based on the Slippery Elm recommendations here: https://epi4dogs.com/slippery-elm/ She may very well be able to take a whole capsule of slippery Elm, but best to start with the recommended measured dose and if all goes well... slowly increase and see if she does better or worse :)

Ahh keeping a journal.... you made me laugh, it brought back memories. When i first started on this journey... some of the poo "escapades" were so awful that i thought i certainly won't forget how THIS looked! Boy was i wrong, a week later, i couldn't remember which poo visual went with what "trial" i was doing.... i learned real quick how beneficial keeping a journal (especially with comparable poop pictures!!!!) was....

Just know you are doing a GREAT job already monitoring and managing EPI. And please don't lose heart if this take a lot of time to figure out... you WILL get there! Sometimes we figure out what the stressors are real quick, within a few weeks or months.... but these are cases that have actually taken a few years...but boy, when you finally identify the stressor/trigger it's like magic how well the dog then responds.
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.........

Chance
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Country: Canada
Pet name: Chance
My name: Andrea

Re: Another Newby with Questions

Post by Chance » 29 Jan 2023, 21:03

I think my dog wins the most expensive dog ever award 😁😵‍💫 it's a killer.

Watch the B12 levels. Wonderlabs works for many dogs. But not all. It did nothing for my dog. I started with injections, then switched. He became very ill, very weak. B12 levels plummeted. Had to go back to injections.

Timing of slippery elm: it coats the stomach and hinders absorption of nutrients and other supplements. It will reduce absorption of nutrients from food, and B12 supplements if given too close together. Especially if weight gain and B12 levels are an issue. It's generally recommended to give 2 hours apart. Slippery elm is not digestible, so it doesn't require digestive enzymes (thus does not need to be close to meals/enzymes). I don't give it regularly, but when I do, it's generally capsules between meals.

My dog also had very low folate levels, which I only learned about last month. I was told to start a Folate supplement ASAP. They advised real folate, incase he lacks enzymes to convert folic acid into folate. That's definitely made a difference. We also had to start a magnesium supplement. (We do know that he does not have IBD. But SIBO has been a struggle). I feed raw; but find that when SIBO is out of control, he does better with cooked food for a bit.

Folate can apparently "compete" with enzymes. So it's best not given close to enzymes. Magnesium on the other hand - if you give it, as I understand it, is best given with enzymes.

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Olesia711
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Re: Another Newby with Questions

Post by Olesia711 » 30 Jan 2023, 14:03

Andrea, so sorry that Chance didn't do well on the WOnderlabs Pet Factor B12 product.... not all EPI dogs respond accordingly to the WOnderlabs product, but if i had to guess, this only happens in about 5% of EPI dogs - - sounds like Chance falls in that 5%.

The majority of EPI dogs do best on this version/product compared to other B12's. However..... after reading your post, i now wonder if maybe the estimated 5% of EPi dogs that do not respond well to Pet Factor B12, may also have an issue with their Folate levels ?????? ....... this could be something to look at.

Also....interesting...... that after Chance was given additional Folate it helped with his SID..... over time, others who have written in with low Folate values and were told to supplement with Folate reported the same success as you are seeing in Chance. MIght have to suggest this to those who are having trouble keeping their dog's SID under good control who have not had a recent B12+Folate blood test done.... to have a conversation with their vet about this possibility.

Glad you are working with your vet on Chance's levels.....regarding the Folate and Magnesium levels..... as one has to be very careful not to give too much of something like magnesium to a dog. IT is a great supplement and can really help with digestive issues (and other things too!), but too much can also be very toxic, ... which can be hard to determine since magnesium is already included in most commercial foods and is also found in leafy greens when home-fed/raw-fed.... So ALWAYS best to only give supplemental magnesium under the guidance of a vet
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.........

ZeusMom
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My name: Kim

Re: Another Newby with Questions

Post by ZeusMom » 30 Jan 2023, 14:32

Hi, I haven't figured out yet how to start a post - so I am replying here. My now 16 month old German Shepherd, Zeus has been getting treatment and improving. But he is now very difficult at the vet - he has gotten 3 shots of 1 mL B12 the last three weeks. Due to the situation, we would like to give our own shots but I was thinking about trying the Wonder Labs capsules but hate to mess with what seems to be going well seeing that there is a chance he will not be a good patient for it. He has gained over 2 lbs in 2 weeks and has energy. Poop is decent. I don't really know what I am asking - maybe for advice on going the shots at home route vs. changing to the oral capsule route. The vet wants to give Zeus a blood draw test and put him under for that - he had to be sedated for the xray in the initial exam and I want to put off the blood draw as long as possible - he has progressively gotten worse with each visit. We are going to get Z a muzzle and give him some "doggy downers" perhaps that he was prescribed hoping that would help and then I can also be in the room for a blood draw - I am sorry to hijack this post. I would be giving him a shot in three days to keep up with his schedule and I think that is my best route. It seems that if he has "too much" he will only pee it out, if I am correct? Just wondering too about thoughts on having to get the follow up blood work done so soon. Thanks for any feedback!

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Olesia711
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Location: North Carolina
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Re: Another Newby with Questions

Post by Olesia711 » 30 Jan 2023, 18:56

hi,
I am going to start a new thread for you and Zeus as he deserves his own thread.... is will be titled "ZEUS, another newbie"
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.........

Poppiesmom
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Posts: 5
Country: United States
State: Florida
Pet name: Poppie
My name: Erin

Re: Another Newby with Questions

Post by Poppiesmom » 08 Feb 2023, 11:56

I wanted to update since we've done some tweeks.
I am grateful for the suggestion to up the enzymes - crazy how the additional 1/8 tsp has seemed to make a difference. We also got the Wonderlabs slippery elm powder and I have been slowly upping her dose to 3/4 of a scoop ( 1/4 was equivalent to the capsules I was giving) and the combo is showing improvement overall- YAY!. The poop chart you directed me to has been super helpful in gaging where her SIBO is and just in the last day or so, she is having well formed poop, less stinky and much fewer stinky farts. We are about to test if she is still trying to eat poop ( we've been picking it up to keep her from doing it).
No weight gain that we can see yet though - but no loss either.
Unfortunately we had a little second dinner setback last night and she didn't want breakfast this morning. Can we still give to food with pancreatic enzymes later or is the fact that I refrigerated it kill the current batch on there. The plan was to pull it out and let it come to room temp again before feeding - I hate to waste anything.
Also, raw feeders - what are the affordable proteins that you are having success with? Pork was a weekly staple in some muscle meals as well as a at least one bone meal a week ( we are balance over time) and I am realizing even the lean cuts, I am having to limit as I'm noticing the next day she doesn't feel great (there's that tightrope you were talking about). Currently, we are using chicken quarters with the bits of organ attached, stew beef, beef hearts, eggs, can sardines, can salmon, can jack makerel, ( all rinsed well, she refuses fresh fish) pork ribs, pork loin, turkey wings, turkey hearts, tiny amounts of freeze dried pork liver or beef liver a few x a week, or whatever organ meat I find at the time ( tiny amounts always - she has never tolerated organ meat but in tiny doses) and I am about to add in freeze dried beef tripe. and funny, actually looking back, it was May last year ( probably when her pancreas starting going south) feeding freeze dried lamb tripe - which was my first tell of the problem - I just didn't know it at the time ( Diarrhea- I just thought I got a bad batch) I was feeding ground turkey and bison as well but have noticed she doesn't do the ground meats as well.
Again - so thankful for this group and the wisdom here!!

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Olesia711
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Posts: 3858
Location: North Carolina
Country: United States
State: North Carolina
Pet name: Izzy
My name: olesia

Re: Another Newby with Questions

Post by Olesia711 » 08 Feb 2023, 12:49

oh gosh,
i just responded to you Erin and then accidently deleted it GRRRRRRRRRRRRRRRRRRRRRRRR!

SO.... i'll try this again.......

Thanks for the great update sounds like Poppie is doing well..... don't worry about the weight gain... that will come in time. SOme gain weight fast, some slow... but in general, i think raw fed tend to gain weight slower (healthy food vs. lots of fillers.....)

Regarding: "Can we still give to food with pancreatic enzymes later or is the fact that I refrigerated it kill the current batch on there. The plan was to pull it out and let it come to room temp again before feeding - I hate to waste anything."... Some EPI parents prepare food ahead of time for the day and refrigerate it with the enzymes...... and all is well... and yet others that have done this did not fare well.... SID got out of control.
Personally i don't like the refrigeration method, however, if you jsut want to salvage this one meal, i understand about not wanting to waste it.... so maybe go ahead and refrigerate (which doesn't kill the enzymes, but rather inactivates it ) and once it starts getting to room temp, maybe add 1/16 tsp of enzymes just in case the initial enzymes in this meal lost some of it's potency from incubating this morning, not being eaten and then being refrigerated and then allowed to sit some more to get to room temp before re-serving.

REgarding what other proteins.... you can always try venison and/or rabbit. ALso.... every so often you can swap out meat/fish protein for something like eggs or cottage cheese....if Poppie can tolerate these food items.

Thankfully you are keeping a log as this will help you identify what agrees with her or not..

I wonder if the reason why she doesn't tolerate the ground meats so well is maybe there is too much long chain (animal) fat in them? just wondering out loud..................

Thank you so much for the great update... glad to hear that Poppie is doing so much better................
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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