EPI Powder

[Cbarrett]

Hello, my name is Carolyn, and I am brand new to this forum. I am so thankful that I found it and hopefully gain some insight to treat my little furry four legged friend.

My dog Regina had pneumonia in early September and was put on the antibiotic Augmentin. She was on Augmentin for 3 weeks and right after she finished her medication she started vomiting after eating along with diarrhea. It took about 4 visits to the vet and the Texas Test to find that she now had EPI. We are using the PancreVed Powder and the cobalequin 12 tablets. The vomiting of her food has stopped but most of the time she will still vomit after drinking some water. We only provide a small amount of water and that sometimes helps.

We also are experiencing vomiting in the morning soon after she wakes up. She is on pro plan EN gastroenteric prescription dog food. I am wondering if she needs something that will hold her through the night. Looking for some suggestions.

Thank you in advance for the help. Again, we are new to the forum and new to the EPI challenge, so any advice is much appreciated.

WE are also using fecal transplant capsules from Animal Biome according to Regina's test performed by Animal Biome.

Here is a list of what we now give Regina
* PancreVed Powder 1/2 teaspoon over food. Leaving 15 minutes prior to giving her the food.
* Cobalequin 12 1 Tablet each day
* 20mg of omeprazole twice a day.
* Doggie Biome Gut Restore Supplement
* Pro Plan Veterinary EN Gastroenteric Both can and kibble.

[Eddiespaghetti]

Hello Carolyn. I wish we were meeting under better circumstances, but you have come to the right place.
Your are mostly on the right track with the enzymes and B12. Now a lot of directions for enzymes say to dose per meal. I don't want to say this is incorrect, but it should actually be per cup of food. You might want to consider increasing the enzymes if you don't see improvement.
Now we also need to work on the SIDs (short intestine dybiosis). This is basically an overgrowth of bacteria caused by the undigested food. There are two things to try here. Slippery elm and Tylan. Slippery elm is the easiest to acquire and try. Once you get it start with half the recommended dosage and work up if no improvement. A lot of people here had great results with it. I did not, which leads us to Tylan (tylosin) powder. You will need a prescription for this. If you go with tylosin, it is usually given twice a day for 45 days followed by a weening process.
As for food. Grain-free food is what EPI4dogs recommends for starting off. Grain can lower the efficacy of the enzymes. Your food being given should be okay. It should be okay in this regard, but hopefully once you get everything stabilized you won't need a prescription food.
As for the fecal transplant, I know it is helpful for some diseases I am just not sure about EPI. I am not saying to stop giving them. Once the EPI and SIDs are treated, they definitely shouldn't be needed.
I think I covered the basics, though feel free to ask any questions that come up. The staff here are incredibly helpful and knowledgeable on EPI. I should mention, I am not staff, I just try to help out when I can. I owe this forum and community my dog's life.

[Olesia711]

Hi Carolyn and and thanks for writing in about Regina.

So sorry to hear that she had pneumonia and then she was diagnosed with EPI.
The vomiting after drinking water can be nothing or it can be a concern.... so i have a few questions.

First, just to be on the safe side, have they ruled out Mega-E and or possible Diabetes... even though these are remote possibilities. ?
Next.. thanks for letting us know what you are giving Regina,... but how much food are you giving her to this ratio and how much does she weigh?

"Here is a list of what we now give Regina
* PancreVed Powder 1/2 teaspoon over food. Leaving 15 minutes prior to giving her the food.
* Cobalequin 12 1 Tablet each day
* 20mg of omeprazole twice a day.
* Doggie Biome Gut Restore Supplement
* Pro Plan Veterinary EN Gastroenteric Both can and kibble."

Regarding:
"she will still vomit after drinking some water"
1. is she drinking a lot of water? then let her drink often, but limit the amount as you are doing.
2. is she drinking too fast? Put a large rock in her bowl of water to slow her down.
3. is she drinking immediately after eating? if so put the water bowl away and make her wait 15 -20 minutes after a meal before allowing her to drink.

Regarding:
"vomiting in the morning soon after she wakes up" ... is it chunks of food, white bile or yellow bile?
1. sometimes they do this if the stomach is too empty. Give her a tiny snack of something (sometimes just a few bites) when she goes to bed.
2. change the food.

What are her poos like (color, frequency, loose or solid??)

Also with an EPI dog due to the excessive amount of weight they lost before diagnosis, you should try and feed them 150% of what they normally would get..... BUT.... you need to feed smaller portions of food... so try to feed 3 to 4 times a day, not just twice. (this is only temporary until things level out)

The "EN gastroenteric prescription dog food" is an excellent food and helps many a sick dog because it is loaded with prebiotics and this is the one thing that actually helps dogs with bad gut flora...... BUT......... unless there is another health reason besides EPI why your vet has opted to put Regina on this food, it is usually not the best for many EPI dogs..... and the reason is because it is also loaded with grain.

(sorry.... had to post here even though i wasn't finished cause we have possible tornado blowing thru and i didn't want to lose what i already typed...)

ANYway........ when first diagnosed with EPI we like to suggest "starting" with a low fiber (grain-free) food that does not use any grain but rather is made with sweet potato or white potato....and has 4% or less (is even better) of fiber content. THe reason for this is because fiber can inhibit the efficacy of the enzymes from anywhere between 0% to 50% and we have no idea which dog, if affected, is affected by what %. so.... it is often best to start with a low fiber food. Next AVOID foods that stuff their commercial food with peas or lentils as the first 4 ingredients in the product. If Peas or lentils are the 5th ingredient or further down, usually that's okay ... Also dog food companies for the past few years have been using lots of peas and some like to split the pea ingredients... if you see multiple (like 3 or more) pea ingredients, something like peas, pea flour, pea protein, yadda, yadda.... avoid that product. Too many peas are one of the worst carb/fiber for EPI dogs.... makes their SID/SIBO a lot worse. Some peas are usually okay, just not too much .

With regards to a prescription diet.... well intended, needed if there is another health condition, but if just for EPI usually not necessary... UNLESS you are also dealing with a food sensitivity. SO... if just EPI,,,, you can try any low fiber, no grain, very few peas if any dog food.

REgarding prescription low fat diets.... again.... this is a conundrum. As too much fat can increase gut dysbiosis.... so vets are correct with prescribing this... BUT... with EPI dogs.... dog food with normal amounts of fat is not only needed but also suggested because (1) EPI dogs NEED to replenish their bodies and fat is essential (2) normal amounts of fat actually help the dog's body process the enzymes better.

Long time ago, they used to think that EPI dogs needed low fat diets because they no longer digested fat very well.. but recent research has debunked this now that we give our dog digestive enzymes with Lipase in it (that, as stated above) is processed better with some fat in the meal.

So although low fat makes sense to feed a dog with gastro issues..... with an EPI dog, it is not the best choice.

As Jeremy wrote in the post above.... EPI dogs have SID/SIBO (dysbiois).... EPI + SID/SIBO. So far we do not know how to get rid of SID, BUT... our goal as EPI parents is to keep it under good control... which he nicely explained to you. Prebiotics , or Pre+Probiotics, or then Tylan. If that fails then a Fecal Transplant.

What i wanted to add to this is that even though all dogs with EPI have SID, a lot of times no matter how hard we try to get SID under good control, sometimes it just doesn't all work out as expected because it is that the food we are feeding the dog keeps perpetuating it.... sometimes finding the right diet is the final key to the puzzle of effectively managing EPI.

And last but not least, as Jeremy also pointed out.... sometimes it is nothing more than not enough (or sometimes too much) enzymes are being used. So if you can let us know how much food you are giving with everything, that will really help. And that the food is moistened too even though it sounds like you are doing a combo of wet and dry.... sometimes a tablespoon of water added is still needed.........

looking forward to hearing back from you.... and i do apologize for being so longggggggggg winded..