Hello and another EPI story from Germany

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.
hellomyfanwy
Member
Posts: 10
Country: Germany
Pet name: Floyd
My name: Corey

Hello and another EPI story from Germany

Post by hellomyfanwy » 07 Feb 2023, 02:36

Hello there,

I’m another newbie who is looking for help in regards to my almost two-year old mini aussie Floyd. We’re from Germany and it’s been quite a while since my last conversation in English. So please excuse any spelling and/or grammar mistakes :)

So here’s our story: Floyd’s been sick since May 2022. It all started with food allergies, so we switched his food around for quite some time. By July we thought we had finally figured out his diet, only to find out that he got a Parvo Infection. He had been given all his shots, so this came as quite a surprise and there was a time where we didn’t know whether we would take him home again from the vet. Well, Floyd’s quite tough and we were so happy to take him home after his 10 day stay at the clinic. However, after being discharged, he started to have constant acid reflux and bad diarrhea. For the first ten days after being discharged he still had to be on antibiotics. The vet told us that these symptoms were probably caused by his meds and will fade away once we’re done with the antibiotics. Well… they didn’t. Instead, his symptoms became kind of chronic and worse. In October we got his TLI and Elastase levels checked out. Both indicated an EPI, however his folate and B12 levels were quite above average (and still are to this date). We tried different enzyme products, but none of them helped. He kept losing weight and his acid reflux was out of control. Right now we are trying the German version of CREON (which is called KREON and basically the same). Before that, Floyd was on Lypex. Since he needed 3-4 capsules of Lypex per meal (he gets fed 4-5 times a day) and the costs of Lypex were massively high, we had to look for another option. Right now we haven’t been able to establish the right CREON dosis. We tried giving him 2x 35000 CREON and 2x 10000 CREON (per meal) and had to go up to 3x35000 & 2x10000. His stool is firm, yet has the wrong color (it’s light brown, kind of grayish/greenish). I know about SID and was wondering whether this might be what’s troubling him. However, the vets in our town (we’ve been to three different ones so far) aren’t convinced of the diagnostic tools for SID. We’re working with a nutritionist who’s been of great help so far. We feed him cooked rabbit and carrots (70/30) and prebiotics called SIVUMIXX. He stopped losing weight a few weeks ago, but hasn’t been able to gain any since. His current weight is about 11-11,1kg and he should be around 13-14kg. I know he hasn’t lost that much weight in comparison to other dogs with EPI, but I’m still quite worried.

I’ve been using this forum for a few weeks now and there are so many helpful people here, that I decided to share our story as well. And maybe there’s someone who knows what else we could try or had experienced the same troubles. Also, I was wondering whether the amount of CREON we’re using is actually too high?

Thanks for reading and greetings from Germany :)

Corey & Floyd

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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: Hello and another EPI story from Germany

Post by Olesia711 » 07 Feb 2023, 10:58

HI and welcome to our EPi family although i am sorry to hear that Floyd is struggling.
By the way, you English is GREAT!

The first thing that jumps out at me is that you are giving WAY too much CREON, especially if you are giving this amount with every meal. My thought is that you don't need so much CREON and WAY too much enzymes often triggers loose stools... In general, EPI dogs start with CREON 10,000 per meal and some have to increase that amount, usually up to CREON 25,000 per meal. Also... the way you give CREON/KREON often has an impact. (1) open the capsule, sprinkle pellets on top of "damp" food and serve immediately seems to work best for most... but some do better with (2) give CREON/KREON about 3 to 5 minutes with a bite of food to prior to a meal,... or a few have done best with(3) giving the CREON/KREON whole a few minutes after a meal a meal.....

the below is what i suspect is going on and what you should try step by step.
I will also include links to research for your vet to review to support what we are suggesting.

thank you for the details..... this helps us a lot ... such as the stools being "it’s light brown, kind of grayish/greenish" ....... the first thing that this indicates is short transit time. Short transit time is usually because of gut flora being imbalance....summed up.... he is dealing with out-of-control SID (small intestinal dysbiosis). Your vet is correct though, there is no accurate test to test for SID. SID is determined by symptoms and the underlying health condition.

It is very possible that it is not that Floyd needs so much enzymes, but rather that his SID is very much out of control. SYmptoms are similar, like diarrhea, acid reflux, etc. To-date, we don't know how to get rid of SID, but we do have a set protocol to address out of control SID and get it under better control. Also... please explain to your vet that they have recently discovered that ALL dogs with EPI have SID to one degree or another.

1. Talk to your vet about prescribing Floyd a prebiotic give this a few weeks to see if this improves things. ... Here we start with SLippery Elm powder, but not sure if you can get this in Germany, so you might have to try a different product with prebiotic properties) https://epi4dogs.com/slippery-elm/ ....if you see no improvement at all.... THEN
2. Talk to your vet about prescribing a prebiotic and a quality probiotic. .... if you still do not see any improvement ).... THEN
3. Talk to your vet about prescribing a 45 days course of Tylan (Tylosin Tartrate antibiotic) DO NOT let your vet give Metronidazole (flagyl)- -this not only does not help but can do damage too!!!!.. If your vet cannot get Tylan, then have your vet prescribe Oxytet (Oytetracycline)

https://epi4dogs.com/antibiotics/ (TYLAN). Our objective is to not use antibiotics if possible, and only try as a last resort. But sometimes you just have to use them for 45 days/twice a day with meals. THen some dogs, while taking pre+probitoics an get off the Tylan, while a few EPI dogs cannot in which case they are then placed on a "maintenance dose"

4.HOpefully the some or all of the above will abate the acid reflux..... it not, then talk to your vet about using an acid reflux med temporarily. Omeprazole is the acid reflux med of choice.... but there are others. Floyd's bile acid functionality is also not working properly this is part of the EPI condition.

https://epi4dogs.com/epi-research/ (specifically read " 2019 (Oct 31) Microbiota, Fecal Lactate & Bile Acids (EPI Dogs)", "June 2017: Dogs with Exocrine Pancreatic Insufficiency have
Dysbiosis and Abnormal Fecal Lactate and Bile Acid Concentrations", "2021 (Jun 28) Discovered correlation with certain Metabolites in EPI+SEPI dogs!"

https://epi4dogs.com/microbiomemicrobiota-research/ " The fecal microbiome of dogs with exocrine pancreatic insufficiency:


Everything mentioned above should be tried one at a time... give each "trial" 3 to 5 days or even a week before you determine if you are seeing any improvement.

And last but not least, start keeping a journal / EPI Log...
https://epi4dogs.com/epi-log/
record everything you try one at a time , record everything your dog ingests (how much, brand name, ingredients) and then record the results.

I hope this helps a litte. Please share everything we suggest with your vet... and feel free to ask any questions any time and do keep us posted.
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.........

hellomyfanwy
Member
Posts: 10
Country: Germany
Pet name: Floyd
My name: Corey

Re: Hello and another EPI story from Germany

Post by hellomyfanwy » 08 Feb 2023, 03:34

Olesia711 wrote: 07 Feb 2023, 10:58 HI and welcome to our EPi family although i am sorry to hear that Floyd is struggling.
By the way, you English is GREAT!

The first thing that jumps out at me is that you are giving WAY too much CREON, especially if you are giving this amount with every meal. My thought is that you don't need so much CREON and WAY too much enzymes often triggers loose stools... In general, EPI dogs start with CREON 10,000 per meal and some have to increase that amount, usually up to CREON 25,000 per meal. Also... the way you give CREON/KREON often has an impact. (1) open the capsule, sprinkle pellets on top of "damp" food and serve immediately seems to work best for most... but some do better with (2) give CREON/KREON about 3 to 5 minutes with a bite of food to prior to a meal,... or a few have done best with(3) giving the CREON/KREON whole a few minutes after a meal a meal.....

the below is what i suspect is going on and what you should try step by step.
I will also include links to research for your vet to review to support what we are suggesting.

thank you for the details..... this helps us a lot ... such as the stools being "it’s light brown, kind of grayish/greenish" ....... the first thing that this indicates is short transit time. Short transit time is usually because of gut flora being imbalance....summed up.... he is dealing with out-of-control SID (small intestinal dysbiosis). Your vet is correct though, there is no accurate test to test for SID. SID is determined by symptoms and the underlying health condition.

It is very possible that it is not that Floyd needs so much enzymes, but rather that his SID is very much out of control. SYmptoms are similar, like diarrhea, acid reflux, etc. To-date, we don't know how to get rid of SID, but we do have a set protocol to address out of control SID and get it under better control. Also... please explain to your vet that they have recently discovered that ALL dogs with EPI have SID to one degree or another.

1. Talk to your vet about prescribing Floyd a prebiotic give this a few weeks to see if this improves things. ... Here we start with SLippery Elm powder, but not sure if you can get this in Germany, so you might have to try a different product with prebiotic properties) https://epi4dogs.com/slippery-elm/ ....if you see no improvement at all.... THEN
2. Talk to your vet about prescribing a prebiotic and a quality probiotic. .... if you still do not see any improvement ).... THEN
3. Talk to your vet about prescribing a 45 days course of Tylan (Tylosin Tartrate antibiotic) DO NOT let your vet give Metronidazole (flagyl)- -this not only does not help but can do damage too!!!!.. If your vet cannot get Tylan, then have your vet prescribe Oxytet (Oytetracycline)

https://epi4dogs.com/antibiotics/ (TYLAN). Our objective is to not use antibiotics if possible, and only try as a last resort. But sometimes you just have to use them for 45 days/twice a day with meals. THen some dogs, while taking pre+probitoics an get off the Tylan, while a few EPI dogs cannot in which case they are then placed on a "maintenance dose"

4.HOpefully the some or all of the above will abate the acid reflux..... it not, then talk to your vet about using an acid reflux med temporarily. Omeprazole is the acid reflux med of choice.... but there are others. Floyd's bile acid functionality is also not working properly this is part of the EPI condition.

https://epi4dogs.com/epi-research/ (specifically read " 2019 (Oct 31) Microbiota, Fecal Lactate & Bile Acids (EPI Dogs)", "June 2017: Dogs with Exocrine Pancreatic Insufficiency have
Dysbiosis and Abnormal Fecal Lactate and Bile Acid Concentrations", "2021 (Jun 28) Discovered correlation with certain Metabolites in EPI+SEPI dogs!"

https://epi4dogs.com/microbiomemicrobiota-research/ " The fecal microbiome of dogs with exocrine pancreatic insufficiency:


Everything mentioned above should be tried one at a time... give each "trial" 3 to 5 days or even a week before you determine if you are seeing any improvement.

And last but not least, start keeping a journal / EPI Log...
https://epi4dogs.com/epi-log/
record everything you try one at a time , record everything your dog ingests (how much, brand name, ingredients) and then record the results.

I hope this helps a litte. Please share everything we suggest with your vet... and feel free to ask any questions any time and do keep us posted.
Thanks for your quick response and all the helpful hints and tips. While scrolling through the forum, I wondered whether the amount of CREON we're giving is too high. After your post, I started reducing the dosage. Today Floyd got 70000 USP Lipase (2x35000) 20min prior to his breakfast. I'll try reducing the dosage more and more. Since he needed 3 capsules of Lypex in the past, we started with 90000 USP Lipase when switching to CREON. Last week we tried different times of feeding the CREON (5min, 10min, now 15 to 20min prior to meal) and 10-20min seemed to be best for him. However, now that we're reducing the dosage, this may change. I'm a litte bit nervous about reducing the dosage so quickly, but I'm also eager to see what's going to happen next.

I'll talk to my vet about all the things you mentioned. Also, our nutritionist is suspecting Floyd to suffer from Leaky Gut Syndrom and is currently working on adjusting his diet.

We tried Slippery Elm in the past and it worked wonders for Floyd's acid reflux. At the same time it seemed to have an effect on his enzymes functioning correctly. I'll discuss it with my vet and see whether he thinks it would be a good idea to try this again. Floyd's also been on Omeprazol in the past, but it didn't have quite the effect we were aiming for (presumably due to the EPI).

I think you're absolutely right about the short transit time. I forgot to mention that Floyd poops 4-6 times a day, which is why there was talk about him possibly suffering from IBD/IBS as well.

Thanks again for your feedback and your support!

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

Re: Hello and another EPI story from Germany

Post by Olesia711 » 08 Feb 2023, 13:16

Hi Corey,
Thanks for your response. Because CREON/KREON is enteric coated..... much less enzymes are needed in an enteric coated product to maintain EPI versus the powdered enzymes that we use here in the USA.

However, that being said... different dogs need different dosages but it also depends on the CREON administration technique. SOunds like you are doing all the right things by "trying" different methods.

But, my guess is that a normal amount of enteric enzymes will work, but what you are seeing is the results of uncontrolled SID (small intestinal dysbiosis) and by giving such a high dose of enzymes, "maybe" you are covering up (to some of the degree) of the SID problem that all EPI dogs have.

REgarding "Also, our nutritionist is suspecting Floyd to suffer from Leaky Gut Syndrome and is currently working on adjusting his diet." I think your nutritionist is 100% correct. Years ago, they used to say dogs don't get "leaky gut syndrome".... then little by little through research they started changing their opinion..... now we know....that yes they do get Leaky gut syndrome and that when we say "SID" small intestinal dysbiosis..... it is the same as describing Leaky gut syndrome!

Here is a description: "Gut dysbiosis causes inappropriate production of an increased amount of zonulin with subsequent loss of the gut barrier function. This leads to the passage of luminal contents across the epithelial barrier and may cause the release of pro-inflammatory molecules that themselves cause increased permeability. THis is what is happening with our EPI dogs and SID.

I have been reading a lot lately about industrial food processing and food additives creating abnormalities in intestinal permeability such as an increase in tight junction leakage..... in other words.....exacerbating IBD, IBS, etc..... and if you read the details on what is happening....it's like reading about SID or Leaky Gut in dogs and humans. ANYWAY.... where i am going with this is talk to your vet/nutritionist about avoiding foods with synthetic emulsifiers in it for a start, and see if that might help a bit...........
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.........

hellomyfanwy
Member
Posts: 10
Country: Germany
Pet name: Floyd
My name: Corey

Re: Hello and another EPI story from Germany

Post by hellomyfanwy » 08 Feb 2023, 15:01

Olesia711 wrote: 08 Feb 2023, 13:16 Hi Corey,
Thanks for your response. Because CREON/KREON is enteric coated..... much less enzymes are needed in an enteric coated product to maintain EPI versus the powdered enzymes that we use here in the USA.

However, that being said... different dogs need different dosages but it also depends on the CREON administration technique. SOunds like you are doing all the right things by "trying" different methods.

But, my guess is that a normal amount of enteric enzymes will work, but what you are seeing is the results of uncontrolled SID (small intestinal dysbiosis) and by giving such a high dose of enzymes, "maybe" you are covering up (to some of the degree) of the SID problem that all EPI dogs have.

REgarding "Also, our nutritionist is suspecting Floyd to suffer from Leaky Gut Syndrome and is currently working on adjusting his diet." I think your nutritionist is 100% correct. Years ago, they used to say dogs don't get "leaky gut syndrome".... then little by little through research they started changing their opinion..... now we know....that yes they do get Leaky gut syndrome and that when we say "SID" small intestinal dysbiosis..... it is the same as describing Leaky gut syndrome!

Here is a description: "Gut dysbiosis causes inappropriate production of an increased amount of zonulin with subsequent loss of the gut barrier function. This leads to the passage of luminal contents across the epithelial barrier and may cause the release of pro-inflammatory molecules that themselves cause increased permeability. THis is what is happening with our EPI dogs and SID.

I have been reading a lot lately about industrial food processing and food additives creating abnormalities in intestinal permeability such as an increase in tight junction leakage..... in other words.....exacerbating IBD, IBS, etc..... and if you read the details on what is happening....it's like reading about SID or Leaky Gut in dogs and humans. ANYWAY.... where i am going with this is talk to your vet/nutritionist about avoiding foods with synthetic emulsifiers in it for a start, and see if that might help a bit...........
You‘re absolutely right about avoiding foods with synthetic emulsifiers. I started cooking Floyd‘s meals myself in October. He‘s been on a strict diet consisting of rabbit and carrots/parsnips ever since. There’s rarely any fat in his meals, which is why we will be trying to add some MCT oil to it once we have established the right amount of enzymes for him.
I first reduced his CREON dose to 2x35000 yesterday. This caused us to have quite a rough night. Floyd was up the entire night, breathing heavily and pacing from one spot to another. His tummy seemed to really bother him. Today we tried 55000 USP Lipase, but Floyd’s general well-being kept declining. He slept all day and we could see that something wasn’t quite right with him. He also started showing symptoms of acid reflux again. Therefore we decided to increase the amount of CREON to 90000 USP Lipase. He’s better now, but I think that you might be right about covering up the symptoms of SID with the high dose of CREON we’re using. I’ll give reducing the CREON another shot in a few days.

It’s so interesting to know that SID and Leaky Gut are actually the same thing. Thanks again for preparing all this information and for the time you’re taking to educate us/me. I finally feel like someone knows what they are doing. You’ve already been such a great help!

I also started documenting Floyd’s poops and I thought why not share some of them :)
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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: Hello and another EPI story from Germany

Post by Olesia711 » 08 Feb 2023, 15:29

hmmmmmmm....... after seeing to poo pics.... "maybe" focus on getting SID under better control first before trying to slowly reduce the amount of CREON........even though it still seems like way too much CREON.....go with what works.....for now............ and try to figure out how to get SID under better control.

I looked up the ingredients in
https://www.sivomixx.net/wp-content/uploads/2022/01/68014-97_Notice_SivoMixx_800_20220113_v6.pdf
i am assuming this is what you are using...... it is mostly lactobacillus which is good... but it might be that Floyd needs additional bacterial strains.....
have you or can you try adding SLippery Elm powder to the mix??? Can you get Slippery Elm powder in Germany?

Also..... these poo pics.... have you tried the raw chopped carrot trick in 1 meal and then watched for raw carrot pieces to show up in the poo so that you can have an idea of Floyd' transit time?

Also.... for the weight gain.... we usually suggest feeding 150% of what is normally required..... but you have to feed smaller portions and in more small meals through out the day..... what you might want to first try is try feeding what you are doing now only make the meals smaller and more frequent.... see if that improves the poo (sometimes this helps!)

THe other thing i noticed is that the poo color is light even when well formed...... this could be from either the food that you are feeding (light colored food = light colored poo) ....OR... it could be that something else could be going on... has Floyds liver values been checked?..... although sometimes when looking at pictures on the computer, the color is not actually the real color....

And last but not least.... the CREON..... is it expired? or has the bottle been opened for longer than a month? If so, this could also explain why you have to give so much cause the CREON potency has diminished to some degree.............
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.........

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

Re: Hello and another EPI story from Germany

Post by Olesia711 » 08 Feb 2023, 15:30

BTW..... a huge CONGRATS for being ahead of the curve with prepared food and food additives..........what a minefield!#@#!!!!
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.........

hellomyfanwy
Member
Posts: 10
Country: Germany
Pet name: Floyd
My name: Corey

Re: Hello and another EPI story from Germany

Post by hellomyfanwy » 10 Feb 2023, 02:12

Olesia711 wrote: 08 Feb 2023, 15:29 hmmmmmmm....... after seeing to poo pics.... "maybe" focus on getting SID under better control first before trying to slowly reduce the amount of CREON........even though it still seems like way too much CREON.....go with what works.....for now............ and try to figure out how to get SID under better control.

I looked up the ingredients in
https://www.sivomixx.net/wp-content/uploads/2022/01/68014-97_Notice_SivoMixx_800_20220113_v6.pdf
i am assuming this is what you are using...... it is mostly lactobacillus which is good... but it might be that Floyd needs additional bacterial strains.....
have you or can you try adding SLippery Elm powder to the mix??? Can you get Slippery Elm powder in Germany?

Also..... these poo pics.... have you tried the raw chopped carrot trick in 1 meal and then watched for raw carrot pieces to show up in the poo so that you can have an idea of Floyd' transit time?

Also.... for the weight gain.... we usually suggest feeding 150% of what is normally required..... but you have to feed smaller portions and in more small meals through out the day..... what you might want to first try is try feeding what you are doing now only make the meals smaller and more frequent.... see if that improves the poo (sometimes this helps!)

THe other thing i noticed is that the poo color is light even when well formed...... this could be from either the food that you are feeding (light colored food = light colored poo) ....OR... it could be that something else could be going on... has Floyds liver values been checked?..... although sometimes when looking at pictures on the computer, the color is not actually the real color....

And last but not least.... the CREON..... is it expired? or has the bottle been opened for longer than a month? If so, this could also explain why you have to give so much cause the CREON potency has diminished to some degree.............
We feed Floyd 4 times a day and about 130% of what he would usually get. He didn’t do well on 150%, which is why we reduced his overall portion a bit. I also try to sneak in a fifth meal from time to time. I take Floyd to work with me, which is why I can’t feed him more often than 4 times a day. On the weekends or when I’m off work he usually gets a fifth meal.

I think I‘ll keep the Creon on 3x35000 for the next week or so. After that, I’m off work for about 7 days. Here‘s what I think I might try during this time: For his breakfast, I‘ll try feeding him a lower dose of Creon, starting with 10000 USP and basically following the guide you put online. For his other meals, I‘ll keep the high dose of 3x35000 USP. Once I have established a lower dose for him, I‘ll try feeding him another meal with the new enzyme dose. His weight dropped from 11,1kg to 10,9kg this week and I’m hoping to avoid another weight drop by doing it this way. Also I’m kind of afraid that his overall well-being might otherwise decline again.
What‘s your opinion on that?

The rabbit meat is actually of quite a light colour, so you could be right about that being one of the reasons for his light poop colour. We checked all his vitals via blood testing in November and his liver and kidneys seemed to be okay. I‘ll talk to my vet about doing another bloodwork testing, so that we can rule out any possibility of another organ being the gist of his problems.

I bought the Creon 3 weeks ago, so it‘s been open ever since. It will expire by the end of 2024.

For the Sivomixx: Wow, thank for researching it! Do you have any recommendations for other bacteria he might need as well? I was also wondering whether I should change the time I’m feeding it. He gets 1/2 a package once a day with one of his meal. Would you recommend spreading it over all of his meals instead of just one?

Since I‘m documenting all his poos, here‘s another round of pictures for anyone who is interested in it :)
His poos look kinda „big“; this is because he gets psyllium with every meal.
I have slippery elm at home, but my vet and nutritionist didn’t recommend feeding the dry powder :/ Back when his acid reflux was really out of control, I cooked some sort of syrup with it and fed it 2h before his meals. It helped with the acid reflux, but seemingly influenced the enzymes from working properly. So we stopped feeding the syrup once his acid reflux got better.
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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: Hello and another EPI story from Germany

Post by Olesia711 » 11 Feb 2023, 11:45

Hi Corey,

If feeding 150% is too much, then stay with the 130%. The 150% is a guideline, but as you know, all these dogs have their very own unique gut flora composition, so we often have to adjust the protocol to what best agrees with the individual dog.

Regarding your new plan: "I think I‘ll keep the Creon on 3x35000 for the next week or so. After that, I’m off work for about 7 days. Here‘s what I think I might try during this time: For his breakfast, I‘ll try feeding him a lower dose of Creon, starting with 10000 USP and basically following the guide you put online. For his other meals, I‘ll keep the high dose of 3x35000 USP. Once I have established a lower dose for him, I‘ll try feeding him another meal with the new enzyme dose. His weight dropped from 11,1kg to 10,9kg this week and I’m hoping to avoid another weight drop by doing it this way. Also I’m kind of afraid that his overall well-being might otherwise decline again.
What‘s your opinion on that?"


My thought thought is that you might want to revise this. The problem with it is that i think it is possible that this might be too much of a reduction ... and not consistent.... what you might want to try instead is to reduce the enzymes in ALL the meals with a consistent dose... but start very slow.....
My suggestion is to give 2+1/2 capsules of the 35,000 USP units with every meal for about 3 to 5 days.... depending on how things go.... if okay... THEN reduce to 2 capsules of the 35,000 USP unit....

BUT in the meantime, i was talking about Floyd's situation with one of our enzyme distributors... and they too said thta an extremely high dose of enzymes will mask and underlying situation like SID, or like "leaky gut" that your vet is suggesting.

SOOooooooooooooo ..... might thought is that in this particular case you really want to focus on getting the SID under much better control.... and then (hopefully) the slow enzyme reduction should work.

I know that we like to reserve antibiotics to treat SID as a last resort..... and we strongly advise NOT to take Metronidazole, but rather use Tylan (Tylosin Tartrate)..... however.. in Europe and the UK.... you have access to Oxytetracycline (Oxytet)..... you might want to talk to your vet about "maybe" trying this to get a jump start on the gut flora.... and while do this, be sure to continue with a pre+probiotic. If i understand it correctly, Oxy is potent, but does not kill all the bacteria but rather inhibits reproduction... so short term (no accumulative effect) it should be acceptable like Tylan which also doesn't kill everything like Metro does. In any case talk to your vet able this.

If the rabbit meat is light in color, my guess is that this is why the poo is light in color too.

Ahh CREON expiration.... the bottle unopened is good until 2024.... but once opened.... after a few months of being opened, the full potency diminishes a little at a time..... so all the capsules are still good, but if you have an open bottle for about 6 months, just know that the capsules may have lost a little bit of the potency and you might have to give a few pellets more...........

Regarding the probiotic.... here in the USA there are some dysbiosis tests that you can have done.... like at TAMU Gastro LAb:
https://vetmed.tamu.edu/gilab/service/assays/canine-microbiota-dysbiosis-index/
in the end....the fix is still with pre+probiotics / Synergy effect, and if that fails, certain antibiotics may be warranted.... and/or sometimes you just have to change the food. Nowadays they are finding success with FMT ... a Fecal Microbial Transplant.
Here is a research study regarding fecal microbiome with the EPI dog:
https://epi4dogs.com/microbiomemicrobiota-research/

Also..... with our EPI dogs..... they all have issues with Bile acids....some we don't have to address cause it is not too bad, while others need to be treated...... and this too could be the underlying problem... but if you are going to have a Dysbiosis test run, you have to stop any acid reflux med until after the test.

There is a lot of research about this by Dr. Jan Suchodolski at TAMU on EPI, gut Flora, and Bile Acid issues. If there is any regurg (which it sounds like FLoyd had) , or what seems like acid reflux.... we typically recommend SLippery ELm powder first that i mentioned before.... BUT..... a lot of vets prescribe Omeprazole to address this. Maybe have your vet read the research by Dr. Suchodolski... however, if he seems to be better with the acid reflux situation, Omeprazole might not be needed.............

But, just in case......here is an excellent research by Dr. Suchodolski on the above.... specifically read "2019 (Oct 31) Microbiota, Fecal Lactate & Bile Acids (EPI Dogs)"
on this page:
https://epi4dogs.com/epi-research/

OR....... check out all his research publications... so much is directly related to our dogs and their gut flora!
https://vetmed.tamu.edu/gilab/staff/dr-jan-suchodolski/

REgarding other probiotics.... here are some of the ones we use in the USA:
PROVIABLE
https://www.proviable.com/proviable-dc-capsules-for-dogs

VISBIOME
https://visbiomevet.com/apps/help-center#what-ingredients-are-in-visbiome-vet

VETRISCIENCE MEGA PROBIOTICS
https://www.allivet.com/product/vetri-science-vetri-mega-probiotic-120-capsules/49803.html?msclkid=8ddcd001deb5149e010fb3e61b3c1f1f&utm_source=bing&utm_medium=cpc&utm_campaign=AT%20BP%20-%20Vetri-%20Science%202020&utm_term=vetri%20science%20vetri%20mega%20probiotic&utm_content=SKU%20-%2049803

If possible LIVE bacteria is viable and technically classified as better..... FYI Visbiome is live bacteria.....

Hope this helps a little!
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.........

hellomyfanwy
Member
Posts: 10
Country: Germany
Pet name: Floyd
My name: Corey

Re: Hello and another EPI story from Germany

Post by hellomyfanwy » 12 Feb 2023, 04:47

Olesia711 wrote: 11 Feb 2023, 11:45

My thought thought is that you might want to revise this. The problem with it is that i think it is possible that this might be too much of a reduction ... and not consistent.... what you might want to try instead is to reduce the enzymes in ALL the meals with a consistent dose... but start very slow.....
My suggestion is to give 2+1/2 capsules of the 35,000 USP units with every meal for about 3 to 5 days.... depending on how things go.... if okay... THEN reduce to 2 capsules of the 35,000 USP unit....

BUT in the meantime, i was talking about Floyd's situation with one of our enzyme distributors... and they too said thta an extremely high dose of enzymes will mask and underlying situation like SID, or like "leaky gut" that your vet is suggesting.
Thank you so much for your feedback. I'll keep that in mind! I won't try reducing the Creon in the next few days. I'm hoping that Floyd is able to get a bit better before I'll try again. Right now, he still seems to have a tummy ache or something else that is bothering him. I also noticed that he started smacking his lips again this night. His weight dropped to 10,9kg yesterday, so he lost another 200g.
I talked to my vet about SID/SIBO/Leaky Gut and from their point of view, one isn't the same as the other. I couldn't quite understand why that is, but they basically told me that there's a significant difference in treating Leaky Gut and SIBO. For Leaky Gut, they advised me to do a bowel cleanse to get rid of all the toxins and start a new round of pre-and probiotics after that. In case of SIBO, they wouldn't recommend to keep feeding him the SIVOMIXX . I asked them why, but they didn't have a clear explanation for me. They had me quite confused there.
Olesia711 wrote: 11 Feb 2023, 11:45 SOOooooooooooooo ..... might thought is that in this particular case you really want to focus on getting the SID under much better control.... and then (hopefully) the slow enzyme reduction should work.

I know that we like to reserve antibiotics to treat SID as a last resort..... and we strongly advise NOT to take Metronidazole, but rather use Tylan (Tylosin Tartrate)..... however.. in Europe and the UK.... you have access to Oxytetracycline (Oxytet)..... you might want to talk to your vet about "maybe" trying this to get a jump start on the gut flora.... and while do this, be sure to continue with a pre+probiotic. If i understand it correctly, Oxy is potent, but does not kill all the bacteria but rather inhibits reproduction... so short term (no accumulative effect) it should be acceptable like Tylan which also doesn't kill everything like Metro does. In any case talk to your vet able this.
My vet nutritionist actually told me about FMT before. She wanted to try something else first, since finding a healthy donor isn't that easy sometimes. Also, she wants to treat Floyd's bowel inflammation first.
Olesia711 wrote: 11 Feb 2023, 11:45 Ahh CREON expiration.... the bottle unopened is good until 2024.... but once opened.... after a few months of being opened, the full potency diminishes a little at a time..... so all the capsules are still good, but if you have an open bottle for about 6 months, just know that the capsules may have lost a little bit of the potency and you might have to give a few pellets more...........

Regarding the probiotic.... here in the USA there are some dysbiosis tests that you can have done.... like at TAMU Gastro LAb:
https://vetmed.tamu.edu/gilab/service/assays/canine-microbiota-dysbiosis-index/
in the end....the fix is still with pre+probiotics / Synergy effect, and if that fails, certain antibiotics may be warranted.... and/or sometimes you just have to change the food. Nowadays they are finding success with FMT ... a Fecal Microbial Transplant.
Here is a research study regarding fecal microbiome with the EPI dog:
https://epi4dogs.com/microbiomemicrobiota-research/

Also..... with our EPI dogs..... they all have issues with Bile acids....some we don't have to address cause it is not too bad, while others need to be treated...... and this too could be the underlying problem... but if you are going to have a Dysbiosis test run, you have to stop any acid reflux med until after the test.

There is a lot of research about this by Dr. Jan Suchodolski at TAMU on EPI, gut Flora, and Bile Acid issues. If there is any regurg (which it sounds like FLoyd had) , or what seems like acid reflux.... we typically recommend SLippery ELm powder first that i mentioned before.... BUT..... a lot of vets prescribe Omeprazole to address this. Maybe have your vet read the research by Dr. Suchodolski... however, if he seems to be better with the acid reflux situation, Omeprazole might not be needed.............

But, just in case......here is an excellent research by Dr. Suchodolski on the above.... specifically read "2019 (Oct 31) Microbiota, Fecal Lactate & Bile Acids (EPI Dogs)"
on this page:
https://epi4dogs.com/epi-research/

OR....... check out all his research publications... so much is directly related to our dogs and their gut flora!
https://vetmed.tamu.edu/gilab/staff/dr-jan-suchodolski/

REgarding other probiotics.... here are some of the ones we use in the USA:
PROVIABLE
https://www.proviable.com/proviable-dc-capsules-for-dogs

VISBIOME
https://visbiomevet.com/apps/help-center#what-ingredients-are-in-visbiome-vet

VETRISCIENCE MEGA PROBIOTICS
https://www.allivet.com/product/vetri-science-vetri-mega-probiotic-120-capsules/49803.html?msclkid=8ddcd001deb5149e010fb3e61b3c1f1f&utm_source=bing&utm_medium=cpc&utm_campaign=AT%20BP%20-%20Vetri-%20Science%202020&utm_term=vetri%20science%20vetri%20mega%20probiotic&utm_content=SKU%20-%2049803

If possible LIVE bacteria is viable and technically classified as better..... FYI Visbiome is live bacteria.....

Hope this helps a little!

Again, thank you so much for providing me with all this help and information. It will take some time to go through all of this, but I'm so happy and thankful that I found this forum. You already helped me more than any of the vets I've visited during the last few months.

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