New to EPI

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.
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Beth313
Member
Posts: 2
Country: Canada
Pet name: Tucker
My name: Beth

New to EPI

Post by Beth313 » 30 Jan 2023, 14:59

My dog 14month old German Shepherd/Husky cross Tucker was diagnosed with EPI earlier this month. He had been having symptoms (weight loss, loose yellow stool, poor coat, eating everything including poop)since August/22 and had lost 10lbs by Oct. Our vet has a clinic 3hrs away, as well as a mobile vet clinic that comes to our small community about every 6-8 weeks. Although EPI was on the vets radar since Sept, he wanted to rule out other possibilities and only did the TLI test (which had to be sent to a lab 12 hrs away) at my insistence in Dec. Unrelated, in October, poor Tucker had to have a sliver removed from his eye and his front dew claws removed as well (after an injury - separate incident from the eye sliver from a shrub) and it was at that time that I insisted on trying the enzymes even before he could get tested.( I was getting up 2-3x/night to let him out to poop.) He was prescribed 1 VioKase Tablet orally 2x/day with 2c food/meal.(switched from Purina Pro Plan Puppy to Hills Science Diet Sensitive Stomach) Stool improved somewhat with less frequency. Later that week, he was vomiting with blood in it. Vet was notified and prescribed something to coat his stomach. I decided to do my own research re: giving enzymes, and started crushing the enzymes and incubating the wet food.(no more issues with vomiting/blood) Tucker started maintaining his weight, so I increased his feedings to 4x/day, 2 tablets per meal - 1 1/4c per meal, then 3tablets/meal. He then got the official diagnosis - TLI 0.1, b12 within normal range. I have since switched to Pantanex 1tsp/meal and although his body condition looks about normal now his poop still isn't where is should be. Next appt Feb 12, we are going to test him for SIBO/SID as well as doing food allergy testing. Am I on the right track? Is there anything else I need to bring to my vet? ( I think EPI is also new to him)Any suggestions would be welcome. Tucker has always acted like a normal, happy puppy, full of energy, that never changed despite the weight loss and cow patty poop. Re: cost - 1kg Pantanex with shipping/import fees to Canada w/exchange= $401 Canadian, Hills Science Diet Sensitive Stomach food $105/13kg bag
Tucker is a German Shepherd/Alaskan-type Husky cross who was rescued from an Arctic community in Northwest Territories, Canada. He was diagnosed with EPI Jan.5/23 at 14 months old - TLI 0.1

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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: New to EPI

Post by Olesia711 » 30 Jan 2023, 18:44

Ahh, thank you so much for contacting us about Tucker and for the information you provided. And thank you to you and your vet for getting the TLI test done. YOu are halfway there now to getting Tucker feeling better :)

A couple of things came to my attention.

1. When you say the B12 test results were normal.... please find out the exact results. Unfortunately with B12, EPI dogs NEED to be in the upper mid-range, normal is often not good enough. Sometimes, even if you are doing everything right, if the B12 is not optimal, then the dog will continue to falter.

2. Good move to get away from the enzyme pills, as you discovered, although the right stuff, they need to be crushed and incubated, so you are better off using the powder.
Fast forward to the Pan-tenex you are using. Right stuff but i suspect if you use a different application technique you'll find much improvement.
With the Pantenex, i know they claim that it is 10x, but the lipase USP units is 71,000... please try giving the ratio of 3/4 (with wet food) tsp to 1 level tsp (with dry food) of Pan-tenex with 1 cu of food. Enzymes are to be given according to the volume of food, not per meal. .. Be sure to add enough liquid (room temp water is fine) to moisten the food so that the enzymes have something to stick to, mix and let incubate for about 20 minutes. then serve. HOpefully this will improve the poo condition.

3. REgarding the cost of Pan-tenex with shipping.... OMG!!!! that is a lot of money. We know how difficult and expensive it is for Canadians caring for EPI dogs.
I looked up the price and Pan-Tenex is $238.00 = 4 Jars (35.2 Ounces/1 Kilogram) with customs it comes to $401 UGH! EnzymeDiane for 1 kilo of Enzymes is $303 for 6x which is equivalent (35.2 Ounces/1 Kilogram). If you find that the change in the Pan-tenex dosing doesn't work out, then i would try half a kilo (500 grams) of EnzymeDiane's 6x at $156 to see if that works better. Some folks claim that EnzymeDiane's enzymes work better for their EPI dog, while others claim that Pan-tenex works better for their dog.... SO..... you might have to try this.

There are other options, like CREON, but i would first try the increased technique with the Pan-tenex and/or EnzymeDiane's 6x.

4. FYI.. You CANNOT test for SID. They used to think that the Folate test results (when the B12 blood test is done) would indicate SID, but have since discovered that ALL dogs with EPI have SID (small intestinal dysbiosis).
https://epi4dogs.com/microbiomemicrobiota-research/
At this date, we don't know how to get rid of SID in EPI dogs. SO our goal is to do our best to keep it in good control. Trust me, Tucker has SID. ONce you get a better handle on the right amount of enzymes for Tucker, if you are still seeing sloppy stools, then most likely you are dealing with out of control SID. EPI dogs don't have enough bacteria in their gut flora AND they also don't have enough of a diversity of bacteria in their gut flora. The recommendation in managing SID is as follows:

a. try a prebiotic first (this feeds bacteria) many of us try SLippery ELm powder https://epi4dogs.com/slippery-elm/ it is a mucilage and we think coats the small intestinal lining preventing bad metabolites to get thru. And it also has some prebiotic properties (SCFA: Butyrate) . It's cheap and often (although not always) it helps a lot. If this doesn't work... then

b. try for a synergistic effect with both prebiotics and probiotics (some of the probiotics that we suggest, but what works really depends on your individual dog's gut flora) are products like: Proviable, Visbiome, Mercola Complete Probiotics, VetriScience Mega Probiotics. Recently someone wrote on the forum, from Canada, a pre+probiotic that they are using and it sounds like an excellent product.... might want to read thru some of the forum messages.

c. if all of the above fails, then you will need your vet to try a course of Tylan, 45 days, twice daily ... do NOT use Metronidazole. Metronidazole will kill ALL the bacteria and the problem is that some of the strains can never be replenished no matter how many probiotics you give the dog. WIth Tylan you do not kill all the bacteria, but rather only inhibit the reproduction of more.

d. We try to do everything we can to avoid putting an EPI dog on any antibiotic, many times the problem is the diet. Many EPI dogs do not do well with prescription kibble, (unless needed for another health condition) and if a commercial food has more than 4% fiber content, or a lot of peas or lentils in it... this usually doesn't bode well for EPI dogs SID. We strongly suggest starting with a low fiber content food, 3.5% usually works better than 4% for most dogs and avoid foods with pea splitting ingredients or if peas/lentils is one of the top 3 to 4 ingredients.... further down the line (and if not repeated a lot) seems to be okay with many of our dogs. If the dog does fine on low fiber food, once stable, then try introducing a little fiber, like your own cooked rice, as see if the poos is still okay..... this will help you determine if your EPI dog while on enzymes can tolerate fiber. The problem with Fiber and EPI dogs is that fiber can inhibit the efficacy of the enzymes from anywhere between 0% to 50% and we have no idea which EPI dog is affected by how much.. This is why we tell folks to "start" with a low fiber/grain free food first and then work from there.

Regarding the Feb 12th apt.... personally i would maybe hold off on the allergy/food sensitivity testing until after you try the above suggestions...... although IBD (food sensitivities) is pretty common with a lot of EPI dogs. However, the issues that Tucker is currently having just might be that a few things need to be slightly tweaked. ... or he does have a food sensitivity. Just out of curiosity, when the vet ran the B12(Cobalamin) test.... was the Folate score below 7.7 ? if so, then TUcker might be dealing with small intestinal proximal disease which often is some sort of food sensitivity.....and can often be like IBD....

Please share everything we are suggesting to you with your vet.... and if he/she would like, please have him/her check out our EPI research section
https://epi4dogs.com/epi-research/
.... which has a lot of the most current EPI research and findings.... that has yet to be well known........

Sorry for the long winded response.....but i hope there are some points in it that helps you and Tucker
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.........

Jane&Clyde
Member
Posts: 157
Country: United States
Pet name: Clyde
My name: Jane

Re: New to EPI

Post by Jane&Clyde » 30 Jan 2023, 18:56

Welcome to the board. You are in great hands with Olesia. Please note that the amount of enzymes that she suggested is per cup of food. The enzymes are not dosed on a "per meal" basis.

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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: New to EPI

Post by Olesia711 » 30 Jan 2023, 19:19

thanks JAne... geesh... i can't believe i forgot to include per cup of food..... i'll go back in and add that :)
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.........

Beth313
Member
Posts: 2
Country: Canada
Pet name: Tucker
My name: Beth

Re: New to EPI

Post by Beth313 » 30 Jan 2023, 21:08

Thank you Olesia and Jane for your responses, they were very informative, and I will take the info with me to the vet.

I do have another question about preparing the food - I've seen a video online preparing food/enymes for a few days at a time, put it in the fridge, take out and let it warm up to room temp for each feeding. Can you prepare meals ahead?
Tucker is a German Shepherd/Alaskan-type Husky cross who was rescued from an Arctic community in Northwest Territories, Canada. He was diagnosed with EPI Jan.5/23 at 14 months old - TLI 0.1

User avatar
Olesia711
Founder & Research Director
Posts: 3857
Location: North Carolina
Country: United States
State: North Carolina
Pet name: Izzy
My name: olesia

Re: New to EPI

Post by Olesia711 » 30 Jan 2023, 22:30

that is not the best method. SOme dogs do fine with refrigerated food & enzymes then brought up to room temperature naturally....... but many EPI dogs do not do well with this method, and it can encourage SID to get worse.

My personal opinion is that you are better off just preparing the food with the enzymes as needed.

IN the beginning you want to feed 150% of what is normally required, to replenish the weight that was lost..... BUT... you also should feed in smaller portions and in multiple meals through the day & evening..... usually 3 or 4 smaller meals work well. Plus it is easier on the gut. SO in the beginning it is a real pain in the butt to have to always prepare everything properly. BUT......... once all or most of the weight is gained back, and the dog is stable, you can reduce the feeding back down to two a day, and preparing the food with the enzymes is much easier.
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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