At my wits end - help please

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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kholzer
Member
Posts: 14
Country: United States
State: Ohio
Pet name: Oliver
My name: Kat

At my wits end - help please

Post by kholzer » 19 Sep 2022, 18:14

Hi all,
I apologize in advance for the long winded post. Oliver was diagnosed with EPI earlier this year in April.

Other history:
Allergic to all foods except essentially potatoes, fish, pumpkin, eggs.
Daily medications since diagnosed with EPI:
PancrePlus 1 TSP
Slippery Elm 1/8 tsp
B12 Injection weekly
Omeprazole 20 mg
Benadryl - seasonal
Prednisone 1.25 mg daily

Prior to EPI - last year - he had a fun run with Lepto that was a missed diagnosis (we think that may have potentially triggered all of this or it was a fluke of a coincidence) but either way fast forward. The lepto caused us to also start Oli on Prednisone last year in September. So in total he has been on a fluctuation dosage of Prednisone for a year now.

Yes we tried to wean him. Multiple times, without success. He stops eating, starts showing signs of pain and discomfort.
The internal specialist that we saw that diagnosed the EPI finally (after I asked my old primary vet multiple times to test for it) said that Oli had chronic inflammation in his colon, had sludge in his gal bladder which was an incidental finding, and his adrenal glands were non existent -- from the long term prednisone usage.

I will add we did do an ACTH stim test and that came back negative during one of the times that we painfully weaned him from his prednisone. Due to the inability to get him off the Prednisone.

On his most recent round of lab work his ALT was in the 490 range, which we were concerned about his liver and the sludge finding in the gal bladder. So we again tried to decrease the prednisone because of the long term liver effects. The only other potential cause of this would have been back in July when he got into a bunch of treats that he was allergic to.
At this point for the past about 4-5 months he has been consistently down to 1.25mg of prednisone. Regardless of the interval that was the dosage for his 40-45Lbs depending on the month. As usual once we tried to wean he stopped wanting to eat. We redrew his lab work and the ALT decreased to the low 300's. The vet was happy with the steady decrease and gave us the ok to continue the 1.25 mg 1x daily.

However she also redrew his GI pannel and found his TL levels were still extremely low, his B12 was good though. We were also noticing very bad breathe in Oli. So she consulted with the Vet that diagnosed Oli and they both agreed to double his enzyme to 2 TSP with both of his meals (he is cut down recently to 1 cup a day because he is getting a little over weight now - my how the tides have changed). And we are increasing his Omeprazole to twice a day as well. The rationale the vet gave was the the high stomach acid may be breaking down and damaging the pancreatic enzymes. So decreasing those and increasing the enzyme will give him a boost.

Which is lovely. However. Now he REALLY doesn't want to eat. We were already struggling with him being sluggish with his food ever since last playing with the prednisone but now we are having to put scrambled egg in his food (don't worry we let it cool down) and he still only eats maybe 75% of his 1 cup of food. He won't even touch the food without the egg in it now. When before he was inhaling it no problem.
I'm not sure if the increase in the enzyme as well as the omeprazole is just making him full? Or if he just REALLY hates the enzyme. We had a hard time getting him to eat the stuff when we first started him on everything as well.

Any input or thoughts are so greatly appreciated and if you actually read all of this. You are an amazing person.
I just don't know what to do anymore.
We have tried salmon on his food already as well. Wet food as well.

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Montgomery
Member
Posts: 285
Country: Canada
Pet name: Montgomery (I'm a CAT!)
My name: V

Re: At my wits end - help please

Post by Montgomery » 19 Sep 2022, 19:55

Have you thought of putting his enzymes in capsules? I do that for Montgomery and it works very well. You can get empty gelatine capsules through your veterinarian, at a compounding pharmacy, or online. Give immediately before a meal, with a few good gulps of water from a syringe. He can likely smell the enzymes and is offended. Check him for mouth ulcers, because enzymes can cause these in some cases (this is why we encapsulate Montgomery's enzymes). Cats and dogs respond more to aroma than anything else. He likely goes for the egg because it's smelly. Nutritional yeast, tuna flakes, freeze-dried whitefish or sardines could be an extra incentive to eat.
One thing that really has seemed to help my little guy is red light therapy, which we do at home. It is painless and very easy.
Montgomery was born 20 March 2012. He eats extra lean ground chicken 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 Dr. Maggie at breakfast. He's a strong, fearless little Spitfire with a real Merlin engine.

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Patsy
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Posts: 240
Country: United Kingdom - England

Re: At my wits end - help please

Post by Patsy » 20 Sep 2022, 06:54

My dog refused food with enzyme powder. I tried a flat plate to dissipate the smell, and disguising it. I hand fed her. Then I used capsules which worked for her. The powder is caustic and lurks under floppy jowls, causing irritation. I’m in the the UK where we can buy ready made capsules.
On another point, how did you establish that he’s allergic to most meat protein foods? Was it with a test? Sometimes it’s just sensitivities due to a dogs poor dogs health, and the as the gut heals, the problem goes away.
When my dog was at her worst, I gave her anything she would eat as long as it made the enzymes and poop better. As she improved, I got a proper diet in place.
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.

maya193
Member
Posts: 75
Country: United States
State: Rhode Island
Pet name: Maya
My name: Debbie

Re: At my wits end - help please

Post by maya193 » 20 Sep 2022, 11:59

Have you tried tuna fish?? from a can...yes.....it has such a strong smell I'm wondering if that could help mask the enzymes.....just my 2 cents!
Maya is a belgian mal/german shep diagnosed with EPI on 10/12/21. TLI 1.2, B-12 196, Folate 4.8. Currently on Maximum K-9 raw diet, beef and vegetable, Enzyme Diane, Wonderlabs B-12 with IF, Proviable and Slippery Elm.

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kholzer
Member
Posts: 14
Country: United States
State: Ohio
Pet name: Oliver
My name: Kat

Re: At my wits end - help please

Post by kholzer » 20 Sep 2022, 18:47

So we tried a plate multiple times
It didn’t really help much, and tuna would help for a day or two then he wouldn’t want it anymore same with salmon. We did pumpkin as well.
He was checked for mouth sores and we check weekly, none found.
I had read that putting it in capsules decreases the effectiveness of the enzyme on the foods and with how low his TL is we didn’t want to risk that.
Also yes we ran a food allergy test on him thru our vet, it was a blood test.

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Montgomery
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Posts: 285
Country: Canada
Pet name: Montgomery (I'm a CAT!)
My name: V

Re: At my wits end - help please

Post by Montgomery » 20 Sep 2022, 22:55

The enzymes in the capsules are quite effective with Montgomery, and if we didn't do this, he would starve himself because every time he gets a whif of that enzyme, he recoils like I just showed him a sliced orange. If all else fails, it might be worth your consideration.
Montgomery was born 20 March 2012. He eats extra lean ground chicken 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 Dr. Maggie at breakfast. He's a strong, fearless little Spitfire with a real Merlin engine.

Jane&Clyde
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Posts: 138
Country: United States
Pet name: Clyde
My name: Jane

Re: At my wits end - help please

Post by Jane&Clyde » 21 Sep 2022, 01:38

Hello and welcome, Kat and Oliver!

Your post had a lot of info, which is great. I have a lot of thoughts flying around in my brain. Hopefully, I will be able to put them in writing coherently. I know very little about the Prednisone and liver issues, so I will be sticking to the EPI part.

First, Oliver's TLI score will not change significantly. Once an EPI dog, always an EPI dog. EPI isn't curable, but it can be managed effectively. Some dogs on here have lived healthily and happily for well over 10 years following diagnosis. The main reason to redo the whole GI panel is when pancreatitis is suspected. It can be necessary to recheck Vitamin B12. To get an accurate B12 result, the shots should not be given for 1 month prior to testing (1 week if using Wonderlabs Pet Factor B12 capsules daily instead of shots).

Lots of dogs on here have acid reflux and take omeprazole for it. I don't know of any who require extra enzymes due to the excess acid, so I have my doubts about your vet's rationale. It can cause as many problems giving too much enzymes as giving not enough. The starting enzyme dose should be 1 teaspoon per cup of dry food (1/2 to 3/4 teaspoon per cup of wet food). Sometimes there is a need for a little more if the dog's diet is not optimal. Using less enzymes may make the taste not as bad, so it may be easier to convince Oliver to eat.

Diet is very important for an EPI dog. We recommend a grain-free food with no more than 4% fiber, avoiding chicken, and limiting the amount of peas. Eating more smaller meals seems to help (3-4 per day). Could you tell us exactly what Oliver eats in a day and how much? Also, please let us know if the diet Oliver is eating is due to other issues than EPI (allergies, liver, etc.). Often, other conditions take a priority to EPI regarding diet.

What are Oliver's poops like? Feel free to post a picture. Until EPI, I never thought I would get so excited about seeing a pile of normal looking dog poop! If you don't want to post a picture, you can describe it or look at the poop chart that is linked at the bottom of the page and use that to tell us how firm the poop is. Color of poop? Any slime? Any tummy rumbling or excess gas? Etc.

Have you ever tried a probiotic? They help many dogs. The ones we recommend here are Dr. Mercola Complete, Visbiome, and Proviable. There is a fourth, but I can never remember what it is. The Dr. Mercola and Visbiome seem astronomically expensive, but many people find that they can use a lot less than the recommended dose. For example, my dog used 1/3 of the maintenance dose of the Dr. Mercola Complete. If you do try a probiotic, start with a small amount, then gradually increase because some dogs get diarrhea from probiotics.

If the correct amount of enzymes, an optimal diet for all of Oliver's conditions, continued B12 supplementation (usually needed for life), and a probiotic don't get the poop looking good, you could try a 45 day course of the antibiotic Tylan.

I hope you find some of this useful. If we can get Oliver's digestive system feeling better, hopefully he will eat better.

Barb
Staff
Posts: 835
Country: United States
State: New Jersey

Re: At my wits end - help please

Post by Barb » 21 Sep 2022, 08:18

Hello and welcome. The early stage of treatment is the hardest when you are trying to get everything in balance and worry about your pet. When you have a picky eater, it is doubly challenging.

I wanted to clarify something you said about the cTli testing. There is no need to repeat that testing. Once EPI has been diagnosed, those numbers will not affect the diagnosis. Once a dog has been diagnosed with EPI, it won't improve or go away. But it can be treated and managed with the enzymes. I don't want you to think you have to keep getting Oliver tested.

Our Kolby was a picky eater and it took us a long time to get him to accept the enzymes on his food. We fed him by hand for quite a while before we transferred to a spoon and then to a flat plate. Eventually, he got hungry enough to eat. I know it is frustrating.T wo things that helped us were adding more water to his food and allowing the enzymes to incubate a little longer than usual. Be careful about adding more enzymes. Too many enzymes can cause diarrhea .

Let us know how Oliver is doing.

Barb

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Jean
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Posts: 1614
Location: South Liverpool
Country: United Kingdom - England
Pet name: Kara, lost 10th May 2019
My name: Jean

Re: At my wits end - help please

Post by Jean » 21 Sep 2022, 09:14

Good morning/afternoon from the UK

Lepto is a very difficult thing to get over, often called Weils Disease from rat urine in water

My Kara had scramled egg and mashed potato most of her life as a late evening meal , she would haunt me if she didnt get it

Kara had liver issues which wasnt serious she just had a small liver and we had her on Milk Thistle which helps

as for enzymes, too much is as bad as too little, do only increase by the tinyest amount

acid reflux seems to be a problem and my Kara had it her whole life, we gave her a drug that was taken off the market sadly and then Omoprozole, it does help

I do sympathise Kara was intolerant of most proteins the only one we used was Lamb, and made sure there was no poultry fat in any food we gave her, all grain free

have you thought of parmesan cheese as a topper it might work but scrambled egg and mash is one to go for

What were the numbers on his B12 tests ?

please keep a daily diary of EVERYTHING

ask anything

jx
My name is Jean we live in Liverpool in Uk

I am the Forum Director which I am very proud of

My Kara born 21 July 2009 diagnosed with EPI by cTLI test August 2010 TLI = <1...folate 14 Cobalamin 408, shot down to 94, b12 injections every other day

Lowest weight 39 pounds

We used Panzym enzymes, Tylan and Chemeyes b12 capsules

Sadly, on 10th May 2019, we lost her to DM


Jeanx

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Montgomery
Member
Posts: 285
Country: Canada
Pet name: Montgomery (I'm a CAT!)
My name: V

Re: At my wits end - help please

Post by Montgomery » 21 Sep 2022, 19:58

Just a thought that popped into my head, but what about peanut butter powder? It's been de-fatted. You can sprinkle it as is or rehydrate it. Might make a good topper.
Montgomery was born 20 March 2012. He eats extra lean ground chicken 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 Dr. Maggie at breakfast. He's a strong, fearless little Spitfire with a real Merlin engine.

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