Help !

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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Bev&Bodie
Member
Posts: 13
Country: Switzerland
Pet name: Bodie
My name: BevB

Help !

Post by Bev&Bodie » 20 Jun 2022, 12:51

Dear Epi4dogs Forum
A year on from Bodie‘s diagnosis we continue to ride the roller coaster. I don’t think I’ll ever see a normal poop again. However he is still with us, weight stable and no more ravenous than most other normal Labradors I know.
He’s 12 years old and developed EPI just before his 11th birthday. He takes a LOT of other meds for arthritis, chronic atopic dermatitis and a gall bladder (mucocele) issue.
He gets 4 small meals per day, 2 with Lypex and 2 with Almazyme Acut (powdered enzyme + turmeric and some other anti inflammatory natural adds). He eats Hills I/d low fat wet & dry mixed with plenty of water or broth and cooked Turkey + sweet potato or rice. Same every day. He gets a small daily dose of Tylosin to keep SIBO at bay (after months of ups and downs, metrodazinole etc). He gets B12 shots monthly and Cobalamine orally.
Generally quite stable but the poop is still loose, putty like and voluminous. No diet or enzyme has ever changed it despite overall him being in relatively good shape.
Any thoughts or suggestions from all of you out there? My vet says it’s as good as it will get…
Bev & Bodie

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jilbert57
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Posts: 1543
Country: United States
State: Washington

Re: Help !

Post by jilbert57 » 20 Jun 2022, 14:19

Have you tried him on a diet without grains? Grains can interfere with the efficacy of the enzymes to do their job. Also has the poop ever been normal since Epi?
I was going to say as the pets age they sometimes need a tad increase in enzymes.

Jill
My name is Jill and we live on the Hood Canal in Washington State. We currently have 2 Jack russells, TJ is 6 and Sadie is 8months.

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.

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Olesia711
Founder & Research Director
Posts: 2585
Location: North Carolina
Country: United States
State: North Carolina
Pet name: Izzy
My name: olesia

Re: Help !

Post by Olesia711 » 20 Jun 2022, 15:50

Hi and welcome to our EPI family and we will try to help you as best we can.

From what you wrote, i am going to list a few possibilities of what "might" be going on. Unfortunately with EPI dogs... we have some basic guidelines but very often things have to be "tweaked" to best agree with the individual EPI dog... so i am going to give you some suggestions to try, BUT try only one-thing-at-a-time.... observe the dog's poos for 3 to 5 days and assess whether or not the change was helpful or not... and then move on to the net change.

1. the first thing that jumps out at me is the food..... HILLS...... can you try a small bag of some other food that has less than 4% fiber content (i am not sure specifically which Hill's product you are using... if you can take a picture of the title i can look up the actual ingredients and composition. BUT.... like Jill suggested... many, many times for an EPI dog, they just can't handle too much fiber content cause fiber may destroy the efficacy of the enzymes from anywhere between 0% to 50%..... so..... if you can, buy a very small bag of food to try that is very low in fiber and/or carb content. (sometimes it is easier to make your own during the period when you are trying to figure out what is the problem. And, sadly, many other times, prescription foods just don't work with EPI dogs.... unless they have EPI + IBD and need a special diet.... then we suggest specific hydrolyzed diets.... which this also may be what is going on. BUt try a food change (slowly) first to see if that helps or hinders......

2. THe second thing that i am wondering about is the turkey..... a LOT of dogs cannot handle any "fowl" meat, whether chicken, turkey, duck, etc...... Have you tried a different protein, like beef or fish, rabbit, venison, etc? ? Some times dogs in general are over saturated with chicken which appears to be in everything made for dogs....... definitely worth trying a different protein source if changing the hills dog food to something with a lot less fiber content might help.

3. My next thought is the Lypex, are you giving enough?.... typically 1 enteric coated Lypex (30,000 per capsule) per 100 grams of food.. Approximately how much food are you giving in each meal?

4. I looked up the Almazyme acut and noticed these ingredients..... and if this is the correct product... this appears to have a low combination of animal and plant enzymes... so as an additional source of varied enzymes it is very good..... and as it also has a lot of other good things, like dandelion and turmeric which is known to help gastro issues ....

Composition:
Gelatin (pork) 40%, potato starch 28%,
yeast products 10%, animal by-products (pork pancreas) 5%, dandelion concentrate 5%, turmeric concentrate 1%, pineapple concentrate high-protein 1%, by-product from the processing of fresh fruit and vegetables ( melon juice / melon pulp).
astoral_Almazyme_acut_160g_DO_786_200x61_web_600x600.png
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HOWEVER.... aside from "Almazyme acut" being a good product with some really good ingredients for most dogs...... It "might" be that the turmeric is triggering the loose stools- -this happens with some dogs, so although this is a remote possibility... it might be worth stopping for a week to see if you notice any improvement in the poos. If not, then i would go ahead and add it back to the diet.

The B12 that Bodie is getting.... the injections.... be sure that they simple cyanocobalmin (or hydroxycobalamin) and not a multi-vitamin B12 shot.
Also.... what is the strength of the oral B12 that you are giving? Also, Check Bodie's weigh, and make sure that the B12 injections that he is getting is sufficient...
Image (i posted the B12 dosing protocol below)

Of course the loose stools could be from one of the other meds he is on which you can only control to a degree ... Have you looked into each drug individually and checked out the ingredients... SOmetimes some drugs or supplements are know to cause adverse affects in which case sometimes there is a better substitute you can give Bodie, but then sometimes there is nothing else you can switch to.

And, since this is on my mind cause we just dealt with two other EPI'rs and recommended this..... have you tried adding a very small amount of Raw Green Tripe to Bodie's diet? Is this something you could get where you live? Here in the USA we can order it, fresh..... not sure if available where you are.

Looking forward to hearing back from you!
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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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Bev&Bodie
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Posts: 13
Country: Switzerland
Pet name: Bodie
My name: BevB

Re: Help !

Post by Bev&Bodie » 20 Jun 2022, 16:08

Thank you for the suggestions really appreciate.
He’s getting Hills Canine I/d low fat 2.1% raw fiber. He gets around 75g per meal plus 120g complementary wet food 2x per day with 1 Lypex. His other 2 meals are small, around 30g of shredded chicken or turkey (poached) with sweet potato or rice. I’ve tried other protein sources - veal, lean beef, salmon but with those even worse. In these small meals he gets 10mg of Almazyme Acut.
I have tried other foods but it’s hard to find low fiber ones here in Switzerland.
Ive also tried doubling the Lypex in his main meals to no effect.
He only poops twice per day and has very good control generally
He also gets Benebac pet gel probiotics 2x2mg per day.
B12 shots are intramuscular true B12 not multi vitamin. He also gets 2 Cobalamine capsules per day, opened and added to his breakfast
The other meds no solution… there aren’t any viable subs and we are at minimum levels to keep him mobile - vet says no point controlling the EPI better if he can’t walk or is in pain from the arthritis… oral painkiller is minimized instead he gets monthly Librela shots
Fingers crossed 🤞
Bev

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Bev&Bodie
Member
Posts: 13
Country: Switzerland
Pet name: Bodie
My name: BevB

Re: Help !

Post by Bev&Bodie » 20 Jun 2022, 16:11

PS The Almazyme Acut is new - stools were loose before. In fact has helped a lot with his gas issues 😉

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Bev&Bodie
Member
Posts: 13
Country: Switzerland
Pet name: Bodie
My name: BevB

Re: Help !

Post by Bev&Bodie » 20 Jun 2022, 16:20

I will try again doubling the Lypex in his main meals and combining 1 Lypex with Almazyme in his small meals.
Big challenge is that Lypex here costs $75 for 60 capsules - I’d need 1 pack every 10 days at those levels so $175 per month. His other meds already cost $600 per month …

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Patsy
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Posts: 228
Country: United Kingdom - England

Re: Help !

Post by Patsy » 20 Jun 2022, 18:51

Hello from the UK. I used Lypex for a year until I found cheaper products. It worked well but for a large springer spaniel, proper weight meant to be 24 Kg, I used 2 per meal . So I would think that a Labrador would need three. Your description of the poop sounds like the enzymes need upping.
What other strong enzyme options have you got available? You don’t need to buy from your vet. Online pet pharmacies are cheaper.
I absolutely agree with other members advice that Hills I/d is unnecessary, and unsuitable. Normal grain free dog food should be fine. Fish and sweet potato avoids the poultry problem, though check the sneaky ingredients.
Springer spaniel Marti had Epi, PLE , MMM just to confuse me. She lived till 12yrs, chubby and happy despite eight years of epi.
Capsule enzymes suited her best. B12 supplements made her into a new dog!
After a cocker with PLN kidney disease, I now have two healthy rescues, a lively, suicidal , small ginger terrier, adopted with pneumonia, and gum disease needing nearly all his teeth out, and a fluffy grey toy poodle/terrier from Greece.

Tuckaboo Pam
Member
Posts: 1127
Country: United States
State: Florida
Pet name: Tucker
My name: Pam H.

Re: Help !

Post by Tuckaboo Pam » 20 Jun 2022, 19:01

Bev---I feel like you were here in the past; Bodie's name & picture seem so familiar.

When we have to start making changes, we are supposed to make one at a time, but for future reference here's my two cents---

I just want to say hang in there, and do what you can to keep that sweet boy up and running. I'd listen to staff members, especially the part about low fiber food. Another good poop bulking agent (for some dogs), is canned pumpkin, like a tablespoon a day, if you have that in Switzerland. It has fiber, but it's good fiber.

Instead of turkey, could you try a little ground beef or fish? Just to see if the turkey is part of the problem.

That's all I've got, but I'll be thinking about you and Bodie. Take Care---Pam
Tucker is a shepherd/lab mix; he has tested positive on the ScheBo test for EPI, as well as the fasting TLI. Results--- TLI 1.3, Folate 9.7, Cobalamin 666, Lipase 38. Currently taking Diane's Enzymes 4 teaspoons/day, Wonderlabs B12 one capsule per day, two capsules slippery elm/evening, 1 Proviable capsule/day, and Tylan 1/32 teaspoon/ morning (to hold SID at bay). Sport Dog Elite, herding dogs 4 cups/day, with a couple tablespoons of Fresh Pet mixed in, because everybody else gets some. No more poop eating, has gone from 60 to 95!!! pounds, and he is a happy member of the family, though a bit of a stinker, if you ask the other dogs. Tucker is my boyfriend, and my husband is OK with that.

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Olesia711
Founder & Research Director
Posts: 2585
Location: North Carolina
Country: United States
State: North Carolina
Pet name: Izzy
My name: olesia

Re: Help !

Post by Olesia711 » 20 Jun 2022, 20:04

hi Bev,

This is Olesia again, thanks for responding with more information.

Sounds like you have already tried much of what was on my list of possible issues. And thanks for letting me know that the Almazyme acut is new and actually helped..... glad to know that he is responding positively to the turmeric and i REALLY like the added dandelion ingredient!

I agree with Patsy to try (again) increasing the Lypex..... ... but i do understand dealing with the expense :(
Is there anyway you can break open the Lypex capsules and give a partial capsule with the lesser meals? in other words, every meal no matter how large or small is covered via some Lypex ?

and i whole heartedly agree with your vet.... your first concern is to keep Bodie comfortable and if he needs other drugs that may be responsible for the loose stools but helping him with pain and if there are no other substitute medications... then give them... as long as the EPI is in some control.... then other health conditions often take priority.

Sounds like the B12 is correct too.

You mentioned that the Almazyme acut helped with the gas, etc..... if the loose stools are not caused by something else, this could be a clue to the underlying issue. SID (small intestinal dysbiosis)... i know you mentioned that you give Bodie Tylan.... but it sounded like a maintenance dose. Maybe try giving him a full dose for 45 days and then taper off (see if this helps). The Tylan dosing chart is as follows:

Image

See if this helps. Also.... since you already tried various foods, and this seems to work best... but he still has loose stools.... ask your vet if they have any hydrolyzed food that you can "try" for a few days to see if it helps or not.....

The probiotic you are using has lots of Lactobacillus and FOS in it so that is good... but see if you can find a probiotic with Saccharomyces Boulardi in it....sometimes this particular probiotic strain helps where others fail.... as not all probiotics agree with all dogs.....

Hope something here helps!!!
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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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Bev&Bodie
Member
Posts: 13
Country: Switzerland
Pet name: Bodie
My name: BevB

Re: Help !

Post by Bev&Bodie » 26 Jun 2022, 07:41

Thank you Olesia and Pam
Over the last week I went a bit back to basics. Restricted Bodies diet to his dry & wet food with some sweet potato. Removed the chicken and rice. Doubled the Lypex per meal and continued with the Almazyme Acut as an extra and the probiotics.
While things aren’t „perfectly formed“ poop wise there is an improvement in firmness and a volume reduction.
So I’ll keep going !
Bev

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