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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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Vossiesmom
Member
Posts: 23
Country: Netherlands
Pet name: Vos
My name: Marie

New to the forum

Post by Vossiesmom » 22 Feb 2023, 07:25

Hi all!

My name is Marie and (one of) Vos' mom(s). We live in the Netherlands.
Vos has recently been diagnosed with EPI. Which felt like a big relief, because for 6 months we saw her getting skinnier and skinnier, putting her through a lot of stress and vet visits... It was heartbreaking to see and we felt so powerless.
I am happy to have found this amazing website, it makes me feel more confident in getting Vossie back to good health!

A quick (but long) recap of what led up to the EPI diagnosis:
- November 2021: we adopted Vos from Greece, when she was 7 months old. At this point she was 11,3 kg. She was doing really well, up to when we got her Propalin for light incontinence (Vos was sterilized at 5 months, most likely causing it). I feel like this was the point were Vos' poop was consistently getting soft and at one point she even had blood in it. We immediately stopped using it and made an appointment at the vet.
- June 2022: to help get Vos' poop get better and help her gain weight, the vet advised us to indeed stop with Propalin and to change her food from Opti life (grain free) to Hill's biome. This kibble has probiotics in it (but also grains, in hindsight :roll: ). At first the consistency of her poop was getting better, but she was also not putting on any weight.
- October 2022: Vos' was not doing well: she had lost 0,5 kg and she was lethargic for a few days. The vet tranfered her food to Hill's Growth (puppy kibble with extra nutricients) and Hill's Convalescence paté. The new food didn't digest well at all, Vos' poop were very soft and smelt sour. Vos also got several blood tests in this period, results were showing that some liver levels were too high (bile acid looked good).
An echo ('ultrasound' in English?) was done to see if they could see anything wrong with her liver (and other organs), but everything looked fine. They did advise us to go back to Hill's biome, because the high fat was difficult to digest. Then did a diarrhea profile, but everything looked good.
- December 2022: went back to get Vos vaccinated. Vos seemed to be doing good, but was still losing weight. They advised us to give her puppy kibble, to help gain weight. When I went to pick this up and saw that they put us back on Hill's Growth (which Vos didn't digest well a few months earlier) I (finally) decided to check the ingredients. First ingredient was corn. Then check the old biome bag: also grains. I felt stupid, because with everything else we buy for her we check if it's grain free...
It felt like we were going in a loop and we decided to take matters in our own hands. We found a nice grain free puppy kibble from Edgard and Cooper (chicken&duck), Vos seemed to be doing really well on this for a while. Then she did get soft poopies again and we started adding pro-biotics to her diet.
- February 2023: called the adoption organization to hear if they know about any dogs that have these symptoms (losing weight + very very good appetite). They suggested testing her for (tick)diseases that occur in South Europe and also getting her tested for EPI. We immediately made an appointment with the vet to get these things tested and Vos ended up testing 'mildly positive' for Babesia and Ehrlichia (we need to do a follow up blood test in a month for this) and also her TLI was <1!
At this point Vos weight had dropped to 9,2 kg, causing the vet to put everything in emergency mode and transferred this case to the animal hospital. This pas Monday we had an appointment there and she got diagnosed with EPI(!!!).

We started her on Zymoral and for the first time since forever her morning poop is dark brown, solid and dense! The afternoon and evening poop are softer and orange again (the colour of her kibble), but still not the enormous amounts from before and the feel much heavier too. I even think that her fur is shinier already! She does have some more acid reflux/regurgitation, so I also ordered slippery elm to help her with that.

Some other info:
- Diet: 3 times a day 100 grams of Edgard and Cooper, 2 grams of Alphamix supplement (has B12, pre-and probiotics and a lot of other good stuff, https://dogchef.s3.eu-west-3.amazonaws.com/files/Alphamix_21_07_vecto.pdf), 2 tsp of salmon oil
- Vos is in a Leishmania research program, and has so far tested negative on this disease (three times)

There were some things that I'd love to hear your thoughts on:
* The doctor wants us to transfer her food to Hill's low fat i/d kibble. It does contain corn and rice, so it's not really grain free... After two not so good experiences with Hill's we're not happy to transfer to this brand again. Does anyone on this forum have experience with this brand? Or other thoughts about corn and rice in the diet of an EPI doggo.
* The uruem an liver levels were also not so good, which can be because she is basically underfed. But it can also mean that she has 'liver shunt'. The doctor suggested to do an echo and then also exclude tumors as a cause for the pancreas to not work. The doctor did say that it is very unlikely for such a young dog to have a tumor. I am not entirely sure about this and I think I'd like to wait for the blood check (in a month) to see if the liver levels and uruem have bettered. The last time Vos had an echo it was 30 minutes of torture for her, she was so stressed out. So for the liver I wouldn't want to do it right away. But I wouldn't forgive myself she does have a tumor on her pancreas and we waited too long...
* B12 were a normal level, which seems odd for this disease. The Alphamix supplement we give her does contain some B12.
* On this website I read about incubating the enzymes. I have been putting them on the kibble, add some lukewarm water and waited for at least 20 minutes. Is it also possible to incubate the enzymes just in water, wait 20 minutes and then add to the kibble? Or do the enzyme need to incubate into the food? Asking because right now her kibble because very mushy (although Vos doesn't seem to mind).

This has become a very long message, woops!!

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jilbert57
Staff
Posts: 2092
Country: United States
State: Washington

Re: New to the forum

Post by jilbert57 » 24 Feb 2023, 13:58

Hi Marie, I have a few things. First the grains in the food interfere with the efficacy of the enzymes. The food is best grain free and avoid peas and legumes. I used I/D with Mickey but he had pancreatitis NOT EPI. Unless an underlying condition is present no need for Rx diet nor low fat with EPI.
The enzymes need food present when you incubate them. You can try mixing the enzymes with room temp yogurt or grain free food, stir and let that incubate. Then you can stir this in with the kibble coating it all kibble. But if the poop goes south you need to just incubate on the kibble. You can wipe the lips or feed ice cubes after to discourage any enzymes staying on skin.

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.

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Vossiesmom
Member
Posts: 23
Country: Netherlands
Pet name: Vos
My name: Marie

Re: New to the forum

Post by Vossiesmom » 25 Feb 2023, 06:22

Hi Jill,

Thank you for clearing some things up!
Good to know why the grains are not a good idea with the enzymes. We just ordered Taste of the Wild (High Prairie) kibble. Curious to see how that will go.
Definitely gonna try mixing the enzymes first with some yoghurt/kibble and the ice cubes are also a great tip!

Very happy to have found this forum!:)

Marie

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jilbert57
Staff
Posts: 2092
Country: United States
State: Washington

Re: New to the forum

Post by jilbert57 » 25 Feb 2023, 09:56

Marie, what was Vos' B12? An EPI animals B12 needs to be in the upper range of normal, around 600 and up. You might need an oral supplement added in.

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.

User avatar
Vossiesmom
Member
Posts: 23
Country: Netherlands
Pet name: Vos
My name: Marie

Re: New to the forum

Post by Vossiesmom » 28 Feb 2023, 09:48

Good to know that Jill! They haven't shared the exact numbers with me yet (just that they are 'normal'), but I requested sharing the results with me. I'll post them here once they've done that.

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Vossiesmom
Member
Posts: 23
Country: Netherlands
Pet name: Vos
My name: Marie

Re: New to the forum

Post by Vossiesmom » 28 Feb 2023, 12:36

Just got the results:
B12 was 481 pmol/l. According to idexx normal is between 173 - 599 pmol/l.
With that standard it would be in the upper range of normal.
But maybe there is a different scale used in the US... Or something with conversion...

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jilbert57
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Posts: 2092
Country: United States
State: Washington

Re: New to the forum

Post by jilbert57 » 01 Mar 2023, 09:55

Hi Marie. Our B12 in the states is the same measurement.
Here is the range from TAMU:

Cobalamin Folate
Canine 251 – 908 ng/L 7.7 – 24.4 µg/L
Feline 290 – 1,500 ng/L 9.7 – 21.6 µg/L

so according to TAMU reference it would need to be higher.

Someone else hopefully weigh in but I would probably add in a daily B12 supplement.

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.

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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: New to the forum

Post by Olesia711 » 02 Mar 2023, 22:44

Hi Marie,'

SO glad Jill has been helping you out.... i typically get notification that there are posts on the EPI forum, but i have not receive any... so i checked tonight, and OMG.... so many posts that i have not addressed :(

SO... i agree with Jill, i would supplement with B12. look for a product that has 1000mcg B12... these are the B12 dosing instructions:
https://epi4dogs.com/b12-protocol/
I am not sure what B12 products are available to you where you live..but B12 pills are fine as long as you get a product that has 1000mcg B12.

Regarding "The doctor wants us to transfer her food to Hill's low fat i/d kibble. It does contain corn and rice, so it's not really grain free... After two not so good experiences with Hill's we're not happy to transfer to this brand again. Does anyone on this forum have experience with this brand? Or other thoughts about corn and rice in the diet of an EPI doggo." Unless some other health condition requires her to be on a low fat diet, i would NOT put her on a low fat diet.. this is an old protocol.

Regarding "The uruem and liver levels were also not so good, which can be because she is basically underfed. But it can also mean that she has 'liver shunt'. ....." if it is just the ALT liver value that is high, this could be nothing more than SID (small intestinal dysbiosis) that is out of control and ALL dog with EPI have SID to one degree or another.... but if it is both the ALT + AST liver values.... then something more is going on...........
I do not know what you mean by "uruem"......
I do hope it is not liver shunt either :(


REgarding the B12... it is low normal and NOT good enough........

Regarding "Is it also possible to incubate the enzymes just in water,...." the enzymes will just float around... best to add just enough water to the dry food to moisten the food enough for the powdered enzymes to stick, no need for the food to be swimming in liquid. BUT....... what kind of enzymes are you using?????

If you are using powdered enzymes.... you mix in the food and let incubate for 20 minutes as you are doing....
BUT... if you are using enteric coated enzymes.... you DO NOT mix in the food, and you do not incubate.

Can you please share with us what brand of enzymes are you using AND how much are you giving with how much food?

ALSO... for the weight gain,,,,, with an EPI dog, you feed them 150% of what they normally would require, but you feed more meals but make them smaller meals throughout the day...
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.........

User avatar
Vossiesmom
Member
Posts: 23
Country: Netherlands
Pet name: Vos
My name: Marie

Re: New to the forum

Post by Vossiesmom » 03 Mar 2023, 12:37

jilbert57 wrote: 01 Mar 2023, 09:55 Hi Marie. Our B12 in the states is the same measurement.
Here is the range from TAMU:

Cobalamin Folate
Canine 251 – 908 ng/L 7.7 – 24.4 µg/L
Feline 290 – 1,500 ng/L 9.7 – 21.6 µg/L

so according to TAMU reference it would need to be higher.

Someone else hopefully weigh in but I would probably add in a daily B12 supplement.

Jill

Hi Jill,

Good to know this! We're looking into finding a good B12 and will start with that asap.

Marie

User avatar
Vossiesmom
Member
Posts: 23
Country: Netherlands
Pet name: Vos
My name: Marie

Re: New to the forum

Post by Vossiesmom » 03 Mar 2023, 13:23

Olesia711 wrote: 02 Mar 2023, 22:44 Hi Marie,'

SO glad Jill has been helping you out.... i typically get notification that there are posts on the EPI forum, but i have not receive any... so i checked tonight, and OMG.... so many posts that i have not addressed :(

SO... i agree with Jill, i would supplement with B12. look for a product that has 1000mcg B12... these are the B12 dosing instructions:
https://epi4dogs.com/b12-protocol/
I am not sure what B12 products are available to you where you live..but B12 pills are fine as long as you get a product that has 1000mcg B12.

Regarding "The doctor wants us to transfer her food to Hill's low fat i/d kibble. It does contain corn and rice, so it's not really grain free... After two not so good experiences with Hill's we're not happy to transfer to this brand again. Does anyone on this forum have experience with this brand? Or other thoughts about corn and rice in the diet of an EPI doggo." Unless some other health condition requires her to be on a low fat diet, i would NOT put her on a low fat diet.. this is an old protocol.

Regarding "The uruem and liver levels were also not so good, which can be because she is basically underfed. But it can also mean that she has 'liver shunt'. ....." if it is just the ALT liver value that is high, this could be nothing more than SID (small intestinal dysbiosis) that is out of control and ALL dog with EPI have SID to one degree or another.... but if it is both the ALT + AST liver values.... then something more is going on...........
I do not know what you mean by "uruem"......
I do hope it is not liver shunt either :(


REgarding the B12... it is low normal and NOT good enough........

Regarding "Is it also possible to incubate the enzymes just in water,...." the enzymes will just float around... best to add just enough water to the dry food to moisten the food enough for the powdered enzymes to stick, no need for the food to be swimming in liquid. BUT....... what kind of enzymes are you using?????

If you are using powdered enzymes.... you mix in the food and let incubate for 20 minutes as you are doing....
BUT... if you are using enteric coated enzymes.... you DO NOT mix in the food, and you do not incubate.

Can you please share with us what brand of enzymes are you using AND how much are you giving with how much food?

ALSO... for the weight gain,,,,, with an EPI dog, you feed them 150% of what they normally would require, but you feed more meals but make them smaller meals throughout the day...

Hi Olesia,

Thanks for responding to all this!
B12: Over here there's not too many good options for B12, but I think we're gonna try to order from Wonderlabs and stock up on some Slippery Elm too while we're at it. And maybe some pro-biotics too.

Food transfer: we ended up transferring Vos to Taste of the Wild (High Prairie), after looking up some things at the forum. Sucks to have to double check/doubt a lot of what the vet suggests, but I'm getting that this has been the experience of a loooot of people here...
It makes me very grateful for the incredible amount of good information and help on this forum and site!

Enzymes: we started just moistening the kibble and then adding enzymes, that makes a big difference! Vos uses Zymoral, powdered enzymes.
Assuming 1 cup of kibble = 113 grams (the internet says so), we give Vos 1 cup of kibble with 1 level tsp of enzymes.

Weight gain: we started feeding Vos and extra meal in between, so she's on 4 meals a day, which is a bit over 150% of the normal requirement. In the past week she already gained some weight and her energy is getting back to how it was before the summer. It has been great to see how playful and social she actually is :D

Marie

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