Concerned and discouraged

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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Chris
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Posts: 7
Country: Canada
Pet name: Mochi

Concerned and discouraged

Post by Chris » 16 Apr 2022, 11:29

Our 2 yr old Husky/Border collie was recently diagnosed with EPI and we are still in the figuring out phase. I love this site but I am a little overwhelmed. He has lost over 20 pounds in the last 5 months. His TLI is less than 1. and Vit B12 is 193. There was no Folate done. We were recommended Hills Diet Light dog food which helped solidify slightly his poop but still soft swirls. He poops 3 +times a day.
We are giving him Bovine Enzymes 1 tsp/day divided in 2 meals. He takes Vit B 12 (1000) once a day.
He completed a course of Tylosin and is now on Prednisone 5 mg twice a day. There is still no change.
He is always hungry and resorts to eating his poop. I will value any information I can get while I am researching your web site.

Tuckaboo Pam
Member
Posts: 1345
Country: United States
State: Florida
Pet name: Tucker
My name: Pam H.

Re: Concerned and discouraged

Post by Tuckaboo Pam » 16 Apr 2022, 12:31

Chris wrote: 16 Apr 2022, 11:29 Our 2 yr old Husky/Border collie was recently diagnosed with EPI and we are still in the figuring out phase. I love this site but I am a little overwhelmed. He has lost over 20 pounds in the last 5 months. His TLI is less than 1. and Vit B12 is 193. There was no Folate done. We were recommended Hills Diet Light dog food which helped solidify slightly his poop but still soft swirls. He poops 3 +times a day.
We are giving him Bovine Enzymes 1 tsp/day divided in 2 meals. He takes Vit B 12 (1000) once a day.
He completed a course of Tylosin and is now on Prednisone 5 mg twice a day. There is still no change.
He is always hungry and resorts to eating his poop. I will value any information I can get while I am researching your web site.
Oh, Chris, I am sorry. I remember feeling just as you do, three years ago. Chin up, this group will help you set things straight.

A couple of questions/thoughts---

***Why are you using bovine enzymes? Most of us use PORCINE.
***Light food sounds like the opposite of what your boy needs.
***Did you give Tylosin (Tylan) for 45 days, and wean off it slowly? Here is our dosage chart Tylan (Tylosin Tartrate)---https://epi4dogs.com/antibiotics/ Abruptly stopping Tylan can cause loose stool.

In a nutshell--EPI treatment is composed of four cornerstones---

ENZYMES---MANY of us buy the from https://enzymediane.com/ I apologize if your dog is allergic to pork, but you didn't mention that. EVERYTHING that goes into his mouth must be enzymed. 1 teaspoon per one cup of kibble. Directions below.

DIET---Low fiber, less than 4%, grain free is good, as long as it is very low in peas & white potatoes. Even better if it has none. I feed https://www.sportdogfood.com/products/herding-dog from Chewy, Amazon, or the Sport Dog website. Whatever you feed, you will give 150% of the suggested amount for your dog's IDEAL weight. You want his weight to come back. Place kibble, enzymes, etc, in bowl, add room temperature liquid to moisten, and allow to sit for 20 minutes. The daily amount should be spread over three or four meals.

B12---Many of use supplement with https://www.wonderlabs.com/itemleft.php ... MKEALw_wcB This is given daily.

SID must be addressed. EPI dogs all have it. The current wisdom is to use slippery elm, starting with less than the recommended dose. https://www.wonderlabs.com/itemleft.php?itemnum=K97024 I prefer the capsules. I use NOW brand, from Amazon. If, after two weeks, you still have very soft poo, try adding a pinch from a capsule of Proviable, building up to the entire capsule over about a week. THEN, if all is still not well, probably go back to more Tylan, and let use help you with the dosage if it comes to that. https://epi4dogs.com/sidsibo-in-brief/

Of course, I do not know whether you can get all of these things shipped to Canada, but somebody will know that.

PLEASE post all the test results from your vet, and PLEASE PLEASE feel free to ask as many questions as you have. The staff is very knowledgeable, and very generous with their time.

You can do this!---Pam & Tucker
Tucker was a shepherd/lab mix--- TLI 1.3, Folate 9.7, Cobalamin 666, Lipase 38. Took Diane's Enzymes 4 teaspoons/day, Wonderlabs B12 one capsule per day, and Tylan 1/16 teaspoon/ morning (to hold SID at bay). Taste of the Wild High Prairie, 1 1/2 cups/day, with a total of 4 cups of Fresh Pet. Stopped eating everything in sight, and went from 60 to 85 pounds! Tucker was my boyfriend, and my husband was OK with that. Tucker succumbed to hemangiosarcoma, but we cherished every day we had with that wonderful, beautiful boy. I will always, always miss my sweet big boy.

Tuckaboo Pam
Member
Posts: 1345
Country: United States
State: Florida
Pet name: Tucker
My name: Pam H.

Re: Concerned and discouraged

Post by Tuckaboo Pam » 16 Apr 2022, 12:43

Chris, I keep editing & I'm not good at that, but I wanted to add---Tucker was a terrible poo eater. EPI dogs are literally starving, and they'll try anything to make themselves feel nourished. After Tucker was on The EPI protocol for awhile, he stopped the nasty habit. Hopefully, Mochi will start to feel better after a bit, and will stop, too. --P
Tucker was a shepherd/lab mix--- TLI 1.3, Folate 9.7, Cobalamin 666, Lipase 38. Took Diane's Enzymes 4 teaspoons/day, Wonderlabs B12 one capsule per day, and Tylan 1/16 teaspoon/ morning (to hold SID at bay). Taste of the Wild High Prairie, 1 1/2 cups/day, with a total of 4 cups of Fresh Pet. Stopped eating everything in sight, and went from 60 to 85 pounds! Tucker was my boyfriend, and my husband was OK with that. Tucker succumbed to hemangiosarcoma, but we cherished every day we had with that wonderful, beautiful boy. I will always, always miss my sweet big boy.

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Olesia711
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Posts: 3858
Location: North Carolina
Country: United States
State: North Carolina
Pet name: Izzy
My name: olesia

Re: Concerned and discouraged

Post by Olesia711 » 16 Apr 2022, 14:33

Hi Chris,

Thank you s much for writing us...... i strongly suspect that the problem is that you are WAYYYyyyyyyy under-dosing with the enzymes AND, as Pam pointed out, you are using bovine (beef) enzymes instead of the recommended porcine (pig) enzymes.

As a medium large dog, i am guessing (and approximating) that your dog would typically need to eat at least 3 cups of food a day.... and add (because of EPI), add another 1+1/2 cups for the EPI condition (until he gains back all or most of his weight). So... just going by this estimation, he needs 4+1/2 to 5 cups of food a day... that means 4+1/2 to5 tsps of PORCINE enzymes... the ration is 1 tsp enzymes per 1 cup food(kibble).

If you are giving bovine enzymes due to a severe pork allergy... then typically you will need to give double or even more bovine enzymes... which would equal approx about 10 tsp of bovine enzymes per 5 cups of food a day.

SO.............just based on the above, i suspect that the reason why you are not seeing ANY improvement and actually things getting worse is because it is like your dog is not being treated.

If you are giving raw bovine pancreas.... then the rule of thumb is: "One to three or four ounces of raw pancreas can replace one teaspoon of pancreatic extract."

Next, the very poor appetite most likely is due to the very VERY low B12 (cobalamin) test results. At this point.... you might want to give 1/2 capsule more of the B12 just for a few weeks to really up the B12 level.... OR... if you do not see ANY improvement in the appetite after you start giving the correct type or amount of enzymes... then ask your vet to do the B12 shots if you are doing pills... or if you are doing pills.... are you doing the WOnderlabs Pet Factor B12 pills... cause the Pet Factor B12 pills are made with Methylcobalamin instead of Cyanocobalamin like the shots and other brand of pills and some dogs just don't respond to Cyanocoblamin.... and the Methylcobalamin works better.... or the opposite can happen too!

In any case.... many of us here use EnzymeDiane porcine pancreatic powder https://enzymediane.com/product-categor ... zyme-list/

In the meantime..... my apologies that you are overwhelmed.... the below is a summation of the 4 aspects of dealing with EPI.... in one page... hopefully it will more easily explain what is going on.
https://epi4dogs.com/managing-epi/

i hope this helps a little and please keep in touch with us so that we can help you ... AND be sure to share with your vet everything that we suggest to you.
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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Chris
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Posts: 7
Country: Canada
Pet name: Mochi

Re: Concerned and discouraged

Post by Chris » 16 Apr 2022, 19:49

I can't express enough how I feel right now from your kind and encouraging responses. I feel like I now have a plan to go on. It was my vet who gave us the Bovine enzymes and we followed the instructions on the label. I will definitely be switching since Mochi does not have any Pork allergy. Should I start with the Pancreatin 6x ? I will be ordering the Slippery elm and continue with the Vit B 12. Also looking into the dog food.
The antibiotic was not a 45 day course. I will be following your suggestions for the " Fantastic" Four cornerstones. I am sad that my vet seems to be unaware of these important issues. I will be sharing this information with my vet clinic!! Changing to Hopeful and Encouraged
Thank you again :D
Chris

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jilbert57
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Posts: 2092
Country: United States
State: Washington

Re: Concerned and discouraged

Post by jilbert57 » 16 Apr 2022, 20:21

Hi Chris, sometimes you have to teach your vet as you learn if they are willing. Feel free to print any or all of the information on the site.
Yes the 6x enzymes are good.

Jill
My name is Jill and we live on the Hood Canal in Washington State. We currently have 2 Jack russells, TJ is 8 and Sadie is 2.

Mickey and his pancreatitis brought me to Epi4dogs.com site in 2012 to help manage it.
He lived from 6/99 - 8/2014

Mickey, Jack Russell. Chronic Pancreatitis. Dianes enzymes, 1/8t 3x/day with meals.

Tuckaboo Pam
Member
Posts: 1345
Country: United States
State: Florida
Pet name: Tucker
My name: Pam H.

Re: Concerned and discouraged

Post by Tuckaboo Pam » 16 Apr 2022, 20:38

Chris, my vet said she had never seen a case of EPI in 20 years, after I told her I suspected Tucker had it (from a Google search). She sent me to a vet who was knowledgeable, but after I joined the forum, even he was impressed by some of the information I shared with him. Here, you will find all the latest in research, and when you have a vet who is willing to learn along with you, you are in very good hands. --- Pam
Tucker was a shepherd/lab mix--- TLI 1.3, Folate 9.7, Cobalamin 666, Lipase 38. Took Diane's Enzymes 4 teaspoons/day, Wonderlabs B12 one capsule per day, and Tylan 1/16 teaspoon/ morning (to hold SID at bay). Taste of the Wild High Prairie, 1 1/2 cups/day, with a total of 4 cups of Fresh Pet. Stopped eating everything in sight, and went from 60 to 85 pounds! Tucker was my boyfriend, and my husband was OK with that. Tucker succumbed to hemangiosarcoma, but we cherished every day we had with that wonderful, beautiful boy. I will always, always miss my sweet big boy.

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Olesia711
Founder & Research Director
Posts: 3858
Location: North Carolina
Country: United States
State: North Carolina
Pet name: Izzy
My name: olesia

Re: Concerned and discouraged

Post by Olesia711 » 16 Apr 2022, 20:53

Hi Chris,

Don't be too hard on your vet, Some vets never see EPI cases and then when they do, the info they have is old. Luckily we at Epi4Dogs are involved with multiple veterinarian researchers that do work on EPI and consequently we have access and are aware of the most current EPI protocol... which does change as more and more research is done.

ALSO.... we have the largest database of canine EPI patients and because of this we have been lucky enough to observe "trends" that even the researchers don't get to see simply because of the number of EPI cases that have come thru Epi4Dogs over the course of 14+ years ....

We also very closely follow Texas A&M Gastrointestinal Lab protocol for EPI.

And YES!!!! start with the 6x....just let your vet know it is a generic form of enzymes like Viokase, Pancrezyme, etc., etc.

For now, hold off on the Tylan.... and FIRST "try" SLippery Elm powder and see if that helps, if the SLippery Elm doesn't (dose is by dog's weight https://epi4dogs.com/slippery-elm/ ) then talk to your vet about trying either Visbiome or Proviable probiotic... start with LESS than 1/2 the recommended dose and work your way up to a full dose of either of these probiotics over the course of a week or two. THEN if this doesn't help (along with the proper pig enzymes) ... THEN talk to your vet about doing a course of Tylan antibiotics https://epi4dogs.com/antibiotics/ twice a day with breakfast and dinner 45 days. What we now recommend is to try everything you can before using antibiotics.... and for SID (which ALL dogs with EPI have) you do not want to use Metronidazole...cause it kills everything.... whereas Tylan is a macrolide antibiotic and will hinder reproduction, but not kill everything like Metro...

What B12 are you using?

Also... with regards to the food.... typically we recommend EPI dogs to "start" with a low fiber content food...anything with NO grains, very little if any peas and or legumes. The reason for this is because fiber can inhibit the efficacy of the enzymes from anywhere between 0% to 50%.... and the problem is we have no idea which EPI dog is affected by how much... SO... because of this in the beginning of EPI treatment, it is just easiest to start with very low fiber content food... THEN afterwards.... you can try food with something like rice in it ... some EPI dogs do fine with this, others don't... it is determined by individual cases.

If you want... try the smallest bag possible of something like Taste of the Wild - Pacific Stream version...
https://www.chewy.com/taste-wild-pacifi ... /dp/181318 this has 3% fiber content.. a little peas but worth trying.... the smallest bag (5lbs) just to see if it agrees with him.

Hope this helps and PLEASE keep us posted!

Also... if interested.... let your vet know that we have tons of EPI research posted on this website .. that helps explain why we do a lot of what we do.
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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Montgomery
Member
Posts: 418
Country: Canada
Pet name: Montgomery (I'm a CAT!)
My name: V

Re: Concerned and discouraged

Post by Montgomery » 16 Apr 2022, 21:11

Tuckaboo Pam wrote: 16 Apr 2022, 12:31
Chris wrote: 16 Apr 2022, 11:29 Our 2 yr old Husky/Border collie was recently diagnosed with EPI and we are still in the figuring out phase. I love this site but I am a little overwhelmed. He has lost over 20 pounds in the last 5 months. His TLI is less than 1. and Vit B12 is 193. There was no Folate done. We were recommended Hills Diet Light dog food which helped solidify slightly his poop but still soft swirls. He poops 3 +times a day.
We are giving him Bovine Enzymes 1 tsp/day divided in 2 meals. He takes Vit B 12 (1000) once a day.
He completed a course of Tylosin and is now on Prednisone 5 mg twice a day. There is still no change.
He is always hungry and resorts to eating his poop. I will value any information I can get while I am researching your web site.
Oh, Chris, I am sorry. I remember feeling just as you do, three years ago. Chin up, this group will help you set things straight.

A couple of questions/thoughts---

***Why are you using bovine enzymes? Most of us use PORCINE.
***Light food sounds like the opposite of what your boy needs.
***Did you give Tylosin (Tylan) for 45 days, and wean off it slowly? Here is our dosage chart Tylan (Tylosin Tartrate)---https://epi4dogs.com/antibiotics/ Abruptly stopping Tylan can cause loose stool.

In a nutshell--EPI treatment is composed of four cornerstones---

ENZYMES---MANY of us buy the from https://enzymediane.com/ I apologize if your dog is allergic to pork, but you didn't mention that. EVERYTHING that goes into his mouth must be enzymed. 1 teaspoon per one cup of kibble. Directions below.

DIET---Low fiber, less than 4%, grain free is good, as long as it is very low in peas & white potatoes. Even better if it has none. I feed https://www.sportdogfood.com/products/herding-dog from Chewy, Amazon, or the Sport Dog website. Whatever you feed, you will give 150% of the suggested amount for your dog's IDEAL weight. You want his weight to come back. Place kibble, enzymes, etc, in bowl, add room temperature liquid to moisten, and allow to sit for 20 minutes. The daily amount should be spread over three or four meals.

B12---Many of use supplement with https://www.wonderlabs.com/itemleft.php ... MKEALw_wcB This is given daily.

SID must be addressed. EPI dogs all have it. The current wisdom is to use slippery elm, starting with less than the recommended dose. https://www.wonderlabs.com/itemleft.php?itemnum=K97024 I prefer the capsules. I use NOW brand, from Amazon. If, after two weeks, you still have very soft poo, try adding a pinch from a capsule of Proviable, building up to the entire capsule over about a week. THEN, if all is still not well, probably go back to more Tylan, and let use help you with the dosage if it comes to that. https://epi4dogs.com/sidsibo-in-brief/

Of course, I do not know whether you can get all of these things shipped to Canada, but somebody will know that.

PLEASE post all the test results from your vet, and PLEASE PLEASE feel free to ask as many questions as you have. The staff is very knowledgeable, and very generous with their time.

You can do this!---Pam & Tucker
Yes, you can get Enzyme Diane and Tylan in Canada. I don't know about Wonderlabs, but B12 shots are certainly an option, and very easy to administer. I order from Enzyme Diane and it's very easy, and arrives quickly. So far, it's been very reliable, although like anything these days, it's good to have a little extra around just in case. I get Tylan from the veterinarian and it isn't expensive.
Montgomery saw several veterinarians before he was diagnosed, including two with decades of experience. Thankfully, EPI isn't common. Once he was diagnosed, it took another half year before we really started to get him stable, so don't worry if things don't work immediately. Keep working at it and you'll get there!
Montgomery was born 20 March 2012. He eats extra lean ground chicken, lean ground pork and lean ground beef completed with Alnutrin and freeze-dried chicken liver, with hard-cooked egg. He gets two size zero capsules of Enzyme Diane's enzymes at each of his six meals, and a size four capsule of Tylan three times a day. He's a fierce little Spitfire with a roaring Merlin engine.

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Chris
Member
Posts: 7
Country: Canada
Pet name: Mochi

Re: Concerned and discouraged

Post by Chris » 17 Apr 2022, 21:45

Thank you again for all the support I am getting.
We are finishing a generic Vit B 12. I just ordered the ones by Wonderlabs with Folic Acid.
I am sad to say that Mochi was prescribed Metronidazole twice before he was diagnosed with EPI. I am assuming that this did not help at all.
I also ordered the Porcine Enzymes as well as the Slippery elm. In the meantime I am increasing the Bovine enzyme +++ while waiting for my order to arrive. Also switching slowly his dog food to grain free low fiber as suggested. Hoping that things will place itself sooner than later. It concerns me how much weight he has lost. I feel his bones.

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