New to EPI - totally overwhelmed

[Olesia711]

i 2nd and 3rd the suggest to start Tylan antibiotic since the Slippery ELm did not help with the lip smacking... and the fact that there is bad gas, tummy noises, yadda, yadda, yadda... definitely do Tylan. Just know that it is NASTY tasty and although some dogs don't mind the taste, others will not eat their food if you ix it in their meal..... so my suggestion is to put the right amount of Tylan needed into empty gel caps cover the caps with something palatable (cream cheese, sift canned dog food, etc) and give the Tylan this way.. it needs to be given twice a day, near a meal (to avoid an upset stomach) and given for 45 days.
here is some information on it: https://epi4dogs.com/antibiotics/

Also.... you can easily order it from Chewy as log as your vet approves the prescription.
https://www.chewy.com/tylan-tylosin-tar ... /dp/173768

[smilejinks595]

Thank you all!

Following an appointment last week, and blood & urine results, we are switching to B12 by injection. Unfortunately Rory has developed another massive infection in his mouth (sores, ulcers) and is on an antibiotic and pausing the enzyme. Given that it wasn’t possible for the enzyme to have gotten stuck in his mouth this time, our vet is thinking a possible porcine allergy - has anyone had a similar situation..? She’s not sure though, and is doing some research etc. Also, given that the smell and lip licking could have been the infection, she doesn’t want to start Tylan yet. Our poor boy just can’t seem to catch a break.

[Olesia711]

Ahhhh.... YES!!!!!!!!!! we have dealt with a few true porcine allergy situations.

Please share the following with your vet.

EPI dogs typically are recommended pancreatic replacement enzyme powders... with 71,400 USP units of Lipase, and approx 300,000-400,000 USP units of Amylase and Protease.
The reason why the Lipase is SOOooo high is because about 70% of the Lipase gets destroyed via digestive pH ( acids) before it get utilized.
HOWEVER, the reason why powder is considered the most effective even with approx 70% of it getting destroyed is because of the size of the powder particles getting thru and being utilized in the digestive system. (there is more science to this, but to explain it really gets into the weeds)

SO..... when a dog has a true pork allergy, we recommend to NOT stop the enzymes but rather switch to CREON (you can also try Micrazym from Amazon.. verey similar) .

CREON is also pancreatic replacement enzymes... BUT... the Lipase in CREON is only 10,000 USP units. The reason for this is that the enteric coating protects the enzymes from the digestive track pH (acid destroying) and these enzymes get to the digestive system all intact... approx 70% is NOT destroyed therefore the the 10,000 USP units all get there!

The best that we can figure out is that because so much less potency of "pork" enzymes is needed... that if the dog does have a true allergy/sensitivity to pork, that it is not enough to cause a reaction in the dog.

We have not scientifically proven this via research, (that is why we are "guessing at the reason why this works) but rather... case after case of EPI dogs that have a pork allergy that we recommended switching to enteric coated enzymes (CREON, Micrazym, etc) has worked.

Of course this present another problem... CREON etc is designed for humans to withstand a pH of 4 or 5, whereas the dog's stomach digestive pH is 1..... so...... we do have to play around with "how" we give the CREON, Micraym, Lypex, or other enteric coated enzymes. etc

First we suggest starting with a product with 10,000 USP units of Lipase, opening up the capsule and sprinkling the enteric coated pellets on top of moist food and serving immediately .. DO NOT INCUBATE!
If the poos go sloppy, then try giving the capsule whole with the food, if this still produces sloppy stools, try giving the capsule a few minutes just after a meal or before a meal.
If the above still produces sloppy poos... then we suggest increasing the enzymes... usually go to 1+1/2 capsule, or sometimes two 10,000 enteric coated capsules are needed.

Please share this with your vet. THere used to be some bru-ha-ha that enteric coated enzymes won't work, but Dr. Alex German first proved it back in 2012
https://bmcvetres.biomedcentral.com/art ... 6148-8-127
and then again Dr. Joerg Steiner & Jan Suchodolski did so at TAMU in 2018 https://pubmed.ncbi.nlm.nih.gov/30221800/

[smilejinks595]

This is incredibly helpful - thank you so so much. I will have it all printed and prepped for the internist. I think we have decided we need to switch him regardless of what they advise us (previously they said they had never dealt with Creon).
Unfortunately Rory’s sores and ulcers required an emergency visit yesterday (for the 3rd time). He was sedated and one of the ulcers which is actively bleeding and struggling to clot is the size of a quarter. His mouth in general has deteriorated greatly in 6 months (he had perfect teeth and gums last summer) and we were referred to a specialist oral surgeon. They suspect some necrosis in his gums too. This could be from the infections, but could also be his immune issues. Or too much bile from his stomach coming up into his mouth? We don’t know and I’m only speculating. If Creon doesn’t do the trick, I don’t know what else we can do.
Thank you so much for all your help - we honestly don’t know where else we could turn at this point. This forum and website is an absolute life-saver.

[Olesia711]

by giving CREON (or Micrazym) the digesting enzymes will not touch his mouth.... just be sure to either open the capsule and sprinkle the little pellets onto damp food and serve IMMEDIATELY (what you don't want to happen is for the enteric coating to dissolve in the moist food... you just want the food to be moist so that it is something the pellets can stick to) or.... just give the CREON capsule whole.

You also might want to share with your vet, that this enteric coated enzyme (CREON) which is used for humans with EPI.... is the same kind of product that the UK uses for dogs with EPI called "Lypex" Lypex is enteric coated little pellets. Unfortunately, we don't have Lypex here in the USA.

[Eddiespaghetti]

There is a 25,000 version of creon and micrazym as well. I have switched Eddie to micrazym and it has overall helped a lot. He gets (2) 10,000 capsules with each meal. Mind you, he is 16 pounds and gets about 3/4th cup a meal.

[Olesia711]

thanks Jeremy for the additional details... very helpful

[smilejinks595]

Thank you, ALL!
We have ordered Micrazym, and are so grateful for all the advice and support!
We will let you know how things go!
THANK YOU!

[Olesia711]

remember... you may have to play around with how much to give but Micrazym, CREON, etc will manage EPI....

Be sure to share all this with your vet

[Chance]

Creon is a human drug. And for some strange reason, it's not listed in the vets system listing all drugs. Apparently they can see almost all human medications, and pull up all information about it. But Creon is not one they can pull up. To get any info about it, they have to go to Dr. Google! Sometimes they want time to research it themselves before prescribing it.

I've dealt with 2 vets (one retired). I learned of Creon here, researched it then asked my vet. He asked for 48 hours to research it. After that time, he did prescribe it. (And I never looked back).

Next time around, with Rylee (new vet) she had done all her homework, listing all the various enzyme options and their monthly costs. I said there's one more....CREON. she couldn't find information on that at all and explained it's not in their drug information system. Anyway I had already told her about Chance, and told her he was maintained very well on that, and at lower costs! She basically said she's never seen EPI before, and never prescribed enzymes. Said she knew I has a lot more experience with it, so was going to leave it in my hands. She asked for pictures of Chance's prescription bottles, so she knew what to prescribe. From there she just kept in touch every week for a bit asking how things were, and what dose of Creon she was currently on.

So Anyway, it's not a drug they can readily find information on. So unless they are experienced with EPI and different enzymes, they may not have heard of it. But they can still prescribe it