New diagnosis and some questions!

[dirtyhandskev]

Hey all,

Glad to have found you guys. We are just beginning our EPI journey so I'd like to give some background and where we are and we we are trying to head!

Steve is a 20 month old Border Collie. We are very active and Steve comes to work with me every day (mechanic) and hangs out in the shop!

I've had Steve since 12 weeks and hes always been a healthy boy. I always fed him non-grain free food - Nulo and then later Stella and chewy. Steve's stool has never been the greatest, and usually always soft from what i can remember. But since September it's been bad. That was his first of many accidents in the house. I contacted my vet and let her know, but he was acting healthy otherwise and had just gotten his yearly distemper and worm shots ... so we figured it might be that. then it continued. then he got a staph infection, which we treated with an antibiotic, which again, we chalked his bad stools up to that.

After another month, i decided it was probably the food, and switched him up - and that's when it got really bad. loose yellow/light brown cow pies. lotssss of them. he started to noticeably loose weight - he went from 53 lbs to 46 lbs. i took a stool sample in thinking it was a parasite for sure - but a few days later it came back clean. So that leaves us at the past few weeks.

So i took him it for a CBC, chemistry, urine test, LTI test. In the mean time i switched him to a chicken and rice diet, and my doc prescribed me 'royal canine GI low fat' food to transition too. they also sent me home with a proviable DC probiotic, which i started to give him.

So the poops got better on the chicken and rice, but as I got into the food the quality went down again. it's now small yellow fatty dabs and lots of them. I did the probiotic as prescribed. (although reading here i should have weened him in, i put him on a pill a day plus the paste tube)

friday they told me all the tests came back good, except the LTI test. the LTI was low and the b12 was low (not sure how low, i requested this information) so they diagnosed him with EPI and prescribed me viokase or pancre plus. they also are setting me up for a b12 shot schedule and are going to show me how to administer it.

I found this site within a few hours and ordered some x6 from enzyme Diane and they are due here thursday.

He's a little bit extra sleepy, he poops alot (wakes me up every night) but other than that he's totally normal. I havent been exercising him as much because of the weight loss, but when i do he's all over it like nothing is wrong.

Today i decided to go get him some b12 tabs and pancreatin from the vitamin shoppe until his order arrives and we get him in for shots. currently his poop is bad (and smells terrrrrible) and is pooping a lot.

So im kind of in a holding pattern until the enzymes are here and we get him in for the shots. im currently feeding him the royal canin, which i dont really know anything about other than thats what the doc told me to buy. I think i might have given him too much probiotic and im wondering if i should reduce the amount im giving him (hes got two left) or should just keep it at a pill a day.

Overall im just exhausted but I am glad we finally have an answer of sorts. its been a long few months.

Sorry if this is rambling, but i figured i should start communicating my experience with people who get it and can give me good feedback. thanks for existing, this site has already provided a wealth of info for me.

-k

[Teila]

Hi Kevin

I too am a newbie to EPI and my recently diagnosed 13 week old puppy has not even arrived yet (still on the other side of the country with my sister but arriving on 14 January); I too have found this site and Forum an awesome resource.

Being a newbie and on a similar path to you, I just wanted to say G'Day and that you have come to the right place! I will leave the 'what to do now' with the awesome experienced team!

I do wish you and Steve all the best and will definitely follow-up on progress.

[Jane&Clyde]

Hello, Kevin, and welcome!

I'm so glad that you found us! The site, staff, and members hold a wealth of information.

Some basics about EPI: There are 4 aspects to controlling EPI...

1. FOOD: it should be grain free, have 4% fiber or less, and have as little peas and chicken as possible. If the only condition is EPI, Steve doesn't need a low fat or prescription diet. However, sometimes pancreatitis exists along with EPI, in which case he does need a low fat diet. Was a PLI test run at the same time as the other tests? If there is no pancreatitis, we can make suggestions for food. If there is, talk to Olesia. She's the real expert around here. When you start the enzymes, Steve should eat 150% of what he would eat at his ideal weight, divided into at least 3 meals, preferably more. Oh, and nothing in between meals, at this point...nothing without enzymes.

2. ENZYMES: the correct dose is 1 teaspoon per cup of dry food. Mix the food and enzymes with a little room temperature water and let it sit for 20-30 minutes before serving. You can look up how many of the pancreatin from the Vitamin Shoppe you need to equal a teaspoon of enzymes on EnzymesDiane website under "Emergency Enzymes".

3. B12: sounds like your vet has a plan for this.

4. ANTIBIOTICS (only if necessary): Tylan for 45 days, twice a day, then slowly wean off. Please do not let your vet prescribe Metronidazole.

As for the Proviable, if the stools didn't get any worse when you first started it, then it is probably fine to leave it as is. Some dogs get diarrhea from probiotics, but others don't. Most of us who use probiotics do it long term, not just initially, although you can probably cut down to just the capsule.

Feel free to ask any questions!

[dirtyhandskev]

thanks for the warm welcome you two!

Hello, Kevin, and welcome!

I'm so glad that you found us! The site, staff, and members hold a wealth of information.

Some basics about EPI: There are 4 aspects to controlling EPI...

1. FOOD: it should be grain free, have 4% fiber or less, and have as little peas and chicken as possible. If the only condition is EPI, Steve doesn't need a low fat or prescription diet. However, sometimes pancreatitis exists along with EPI, in which case he does need a low fat diet. Was a PLI test run at the same time as the other tests? If there is no pancreatitis, we can make suggestions for food. If there is, talk to Olesia. She's the real expert around here. When you start the enzymes, Steve should eat 150% of what he would eat at his ideal weight, divided into at least 3 meals, preferably more. Oh, and nothing in between meals, at this point...nothing without enzymes.

Im not sure if a PLI test was run. Basically the doctor said a bunch of very complicated things that i didn't really pretend to understand at the time and said 'uhuh' and paid them for it all. So now ive done some reading ill do a follow up with the doc and ask for all the paperwork and whatnot tomorrow so hopefully ill have an answer for you.

Also steve is very, very hungry. He was a grazer before this - i could fill a bowl and just leave it out and he'd eat when he was hungry. now hes got a bigggg appetite. I have been feeding him a little bit over 100% but not much just because ... well its going right through him pretty quickly. now that i have some enzymes im gonna start ramping that up, I'll feel better about it when the shipment arrives on thursday, i dont know how long these vitamin shoppe ones will last.

2. ENZYMES: the correct dose is 1 teaspoon per cup of dry food. Mix the food and enzymes with a little room temperature water and let it sit for 20-30 minutes before serving. You can look up how many of the pancreatin from the Vitamin Shoppe you need to equal a teaspoon of enzymes on EnzymesDiane website under "Emergency Enzymes".

i looked it up and its 7-9 pills. currently doing 7 per cup as im just getting him started, and then by thurs the enzymes will be here and ill jump to 1 teaspoon. im hearing conflicting info on the waiting 20 minutes or not thing. i dont mind im just kind of curious why i hear to do it / not to do it.

3. B12: sounds like your vet has a plan for this.

4. ANTIBIOTICS (only if necessary): Tylan for 45 days, twice a day, then slowly wean off. Please do not let your vet prescribe Metronidazole.

he's been on metronidazole before when he had giardia (pretty common here in the PNW) but she was cautious to throw him on it this time when i told her he had diarrhea again. i go to a smaller privately owned vet so shes super open about these things.

As for the Proviable, if the stools didn't get any worse when you first started it, then it is probably fine to leave it as is. Some dogs get diarrhea from probiotics, but others don't. Most of us who use probiotics do it long term, not just initially, although you can probably cut down to just the capsule.

he definitely has diarrhea, though i dont know if its from the probiotic or not. too many variables going on right now.

[Jean]

welcome from the UK

Can you remind us of the blood test results your vet took, and was the cTLI (EPI TEST) 12 hours FOOD fasted

Chicken and rice dont always work well for EPI dogs and they dont need prescription food unless there is another condition. My girl couldnt tolerate either

b12 is essential

https://www.petmd.com/dog/wellness/evr_ ... py_for_epi

you are not rambling

keep a notebook and take photos of the poop, record everything

Have you considered Enzyme Diane for enzymes

https://enzymediane.com/

The enzymes from The Vitamin Shoppe are the ones we suggest for emergency

Try to avoid Metronadazole it has side effects which can be neurological

Tylan is the one to go for and is weight dosed

https://epi4dogs.com/antibiotics/

we also recommend that you feed 50% over and above the recommended amount of food on the bag for the weight the dog SHOULD be over a few meals a day all enzymed, and a n evening meal of scrambled egg and mashed potato goes down well as its a long tim e till breakfast, all enzymed , no treats sadly, but a border collie and a ball go together very well

[ssmith]

I just wanted to jump in and answer the question of why enzymes sit for 20 min.

The enzymes straight out of the bottle can cause mouth sores for some dogs. There really is no way of knowing which dogs will and will not have that problem. At first I did not let Harmony's enzymes sit, and she did ok with no mouth sores. But after letting them sit now for 20 min before every meal (recommendation from someone on this site) I think it has helped her digest her food a little bit better....maybe not but it can't hurt.

[Jane&Clyde]

It sounds like you are getting a good plan in place.

I totally agree with your vet about not immediately jumping to antibiotics. The loose stools from EPI can often be gotten under control without them. Metronidazole is still used for conditions such as giardia, but it is not the antibiotic of choice for chronic gastrointestinal problems such as EPI/SID (small intestinal dysbiosis...unbalanced bacteria in the gut...all dogs with EPI have it to some extent).

You are right about increasing the food; until you start the enzymes, it would just cause more diarrhea and would provide only a little bit more nutritional value. That is why I suggested that you increase the food when you start the enzymes. After dogs with EPI stabilize and regain most of their weight, usually the food amount can be decreased. However, a lot of dogs with EPI will always need a bit more food than dogs without EPI. The starving all of the time reduces after stabilization, too.

[dirtyhandskev]

good news,

today steve had his first solid poop of probably the last 3-4 months. never thought i would be so happy to see poop.

[Jane&Clyde]

Yay! That's such wonderful news! And I think we all can relate to feeling excited about a pile of dog poop.

[dirtyhandskev]

so a PLI test was not done but here is the results from the TLI:

Clinic Notes / Specifics:
Free catch urine
Test Results Unit Lowest Value Highest Value
TLI <1.0 μg/L 5 35

Result Verified
Diagnostic for exocrine pancreatic insufficiency

Clinic Notes / Specifics:
Free catch urine
Test Results Unit Lowest Value Highest Value
COBALAMIN <150 pg/mL 251 908
FOLATE 7.6 ng/mL 7.7 24.4

A low B12 and folate concentration

**edit

sorry if the format is confusing it's just a copy paste. im guessing his TLI was sub 1.0, cobalamin sub 150, and folate 7.6