FORGOTTEN ENZYMES

[daizyduh911]

Has anyone forgotten to give ezymes at one meal time?
Because of work I had to carry doggos pancreatic enzymes every day back and forth. I did great at it the first week the second week I forgot them only ONE DAY 12/5 which ment she didn't have them for dinner only that day.And she only eats twice a day. Ever since then she's had diarrhea gave her more rice it doesn't seem to help. She's already on cooked food before this. Any suggestions to help stabilize her?
She unfortunately was already unstable which is why with her nutrionist we switched her food. And I had just started the transition into the new one which is couscous and shrimp... when this happened. So she is back on her old meal plan. Which is White rice and Tilapia, Balance IT powder 4tsp daily, corn oil 1.5 tsp, salt 1/2 tsp daily, 1 tsp pancreatic ezymes(Epizyme) per meal, 1 proviable probiotic tab sprinkled on food only at breakfast, proin 25mg twice a day, 1 B12 pill every other day(her levels have been checked and it's fine this way). I also have Gut soothe from adored beast her regular vet approves it and nutrionist advises against it completely. So in hope that it will help I been doing 1/4 tsp only in the morning.
On the poop scale her poos are still at a 6. 2 days after she didn't have the enzymes it was at a 7 since then it's at a 6 and it's been a week.
We do realize the importance of the enzymes and how bad it was that i forgot them. Since then i realized i could have done emergency ones...info i obviously didn't have before that day.
Any suggestions to help stabilize her is greatly appreciated!

[Eddiespaghetti]

Let me start by saying one missed dose shouldn't cause long term diarrhea by itself. We all make mistakes, it should have only been an issue the next few hours after the missed enzymes, or up to 24 hours at most.
Now let's delve into the actual issue. While I do like nutritionists, I don't know if they have enough experience with EPI. That being said if the poo was already unstable, the two most common issues are; not enough enzymes or SIDs. There are a couple options to try here. Increase the enzymes, try 1.25-1.5 teaspoons. See if that makes a difference. If it is because of SIDs, you can try slippery elm or Tylan powder. Slippery elm is an OTC supplement while Tylan requires a prescription. Both work well for a lot of people here. If you go the slippery elm route, start with half of the recommended amount on the back of the tub and increase if there isn't a change. If you go the Tylan route, typically it is given for 45 days, followed by a weening period.
Another lesser popular choice, if you might just need a binder in their food. A reason a lot of commercial dog food has corn starch in it is because it is a cheap binder. You can ask your nutritionist about possibly adding one. It's the same way a lot of people on "juice cleanses" have liquid poos. This would be more of a long term thing to look into.

[daizyduh911]

Let me start by saying one missed dose shouldn't cause long term diarrhea by itself. We all make mistakes, it should have only been an issue the next few hours after the missed enzymes, or up to 24 hours at most.
Now let's delve into the actual issue. While I do like nutritionists, I don't know if they have enough experience with EPI. That being said if the poo was already unstable, the two most common issues are; not enough enzymes or SIDs. There are a couple options to try here. Increase the enzymes, try 1.25-1.5 teaspoons. See if that makes a difference. If it is because of SIDs, you can try slippery elm or Tylan powder. Slippery elm is an OTC supplement while Tylan requires a prescription. Both work well for a lot of people here. If you go the slippery elm route, start with half of the recommended amount on the back of the tub and increase if there isn't a change. If you go the Tylan route, typically it is given for 45 days, followed by a weening period.
Another lesser popular choice, if you might just need a binder in their food. A reason a lot of commercial dog food has corn starch in it is because it is a cheap binder. You can ask your nutritionist about possibly adding one. It's the same way a lot of people on "juice cleanses" have liquid poos. This would be more of a long term thing to look into.

Thank you! I'll do some reading on slippery elm and buy some today. I might just call the vet to give her something for the diarrhea at this point. The amount of money I have invested in the nutrionist was 100% worth it when Kai first got diagnosed. But I realize that maybe about 5months in she wasn't stable. Her poos were getting softer. Then couldnt communicate woth the nutrionist for almost 2 months and when we finally saw her again we decided to change the food because she said it sounded like she became intolerant to something. but then this happened. So I'm not even sure if I can switch her food at this point but I feel like I should because well that was a problem before. It's like being back a square one when she first got diagnosed.

[Olesia711]

Jeremy mentioned two of the main reasons for sloppy poo in an EPI dog, (1) not enough enzymes (2) SID.....HOWEVER..... very often SID is perpetuated by feeding a diet that does not agree with that particular EPI dog.

In running this EPI forum for 15 years..... there has not been 1 single nutritionist that provided an optimal diet for an EPI dog... not one.
Overall, the diets they recommend are spot on for balanced nutrition and health, but their failing comes in when they include a grain... and i cannot tell you how many times i have read yet again, where they recommend a fiber/grain that almost always gives our EPI dogs loose stools..

Please remove the couscous from the diet... and for now also remove the rice. If you need to include a starch, try baked sweet potato, white potato, turnip. Avoid rice, quinoa, oatmeal, wheat bulgar, etc, etc, etc.....

The reason why we recommend NOT using a grain (in the beginning) is because grain is loaded with fiber and fiber can reduce the efficacy of the needed enzymes from anywhere between 0% to 50%. The problem is that we do not know from one dog to the next which dog is affected by the fiber % and/or by how much. This is why we strongly recommend starting with a low fiber diet in the beginning. ONce the dog is stable... THEN we suggest to try grain... and the easiest grain for an EPI dog to try is usually white rice in which case we suggest doing what you are doing now... try giving a little home cooked rice to see how well your dog can or cannot tolerate it. IN your case, it sounds like you are dealing with uncontrolled SID (dysbiosis) that has been perpetuated by an incorrect diet and most probably its the grain in the diet.

As Jeremy suggested, you can try to get the SID under control first by adding a little slippery elm powder to the diet https://epi4dogs.com/ slippery elm has prebiotic properties. If this doesn't help... THEN talk to your vet about a course of Tylan antibiotic.... and in the meantime, so that this problem doesn't continue.... skip the grains in the food for now. Maybe at a later date, when your pup is doing well, you can try adding some grain then and see if it can be tolerated.... or not.

[daizyduh911]

Thank you so much!
So currently she's on and this is measured raw and dry:
260g enriched white rice
440g tilapia( I decreased it yesterday to 440g)
4 tsp Canine balance IT powder
1/2 tsp salt
1.5 tsp corn oil
2 proin (25mg)
1 proviable probiotic
1.5 tsp enzymes each meal
This is/was her plan for today and was going to keep it this way for at least 5 days.
So do you suggest I stop her Rice for lunch and dinner today? She's already had breakfast. Or just maybe add some sweet potatoes (ex) to ween her off the rice. The reason I'm going to give her lunch today is because I wanted her to have smaller meals for a few days until she seems more stable. I read the slippery elm and is there anywhere I can get that in store...like today?
If not I might just ask for the Tylan today. Nutrionist can't get back to me until Tuesday anyway. I had suggested to her that I think Kai is intolerant to a huge amount of Rice. She said no....I still have my suspicion. Thank you for responding and all the info. Thanks for sharing your knowledge on this! I have felt ridiculously overwhelmed and invalidated in my worries for Kai so I appreciate what you are doing.!

[Olesia711]

Hi Daisy,

Yes, eliminate the rice completely.
Bake a sweet potato, peel the skin and start with 1/4 cup of sweet mashed potato (which i am guessing is 50 grams)... and watch the poos....
if okay... then increase the baked, peeled, mashed sweet potato to 1/2 cup (or approximately 1 gram)

If the sweet potato doesn't agree with your dog, then try baked, skinned and mashed white potato.

and leave everything else as is............

let us know how this goes

[Eddiespaghetti]

If not I might just ask for the Tylan today. Nutrionist can't get back to me until Tuesday anyway. I had suggested to her that I think Kai is intolerant to a huge amount of Rice. She said no....I still have my suspicion. Thank you for responding and all the info. Thanks for sharing your knowledge on this! I have felt ridiculously overwhelmed and invalidated in my worries for Kai so I appreciate what you are doing.!

The nutritionist flat out said no Kai doesn't have an intolerance to rice? That was a choice they made.
On top of cutting out the grain for now, another thing to consider, is cutting back on the corn oil? Sometimes, dogs have a hard time processing pure oil. While they are typically well tolerated by dogs, that might not be EPI dogs. Honestly, I would switch to fish or coconut oil over corn, though I am not a doggie nutritionist.

[Olesia711]

Kai probably doesn't have an intolerance to rice..... HOWEVER.... what these nutritionists don't understand is that it has nothing to do with a rice intolerance, but rather the rice (or ANY grain) can destroy the efficacy of the enzymes in many of these EPI dogs.. and then it is like not giving and EPI dog enzymes to control the EPI.. or not giving enough enzymes to control the EPI.... hence the loose stools.

I know nutritionists mean well, when dealing with an EPI dog.... but unfortunately they only understand proper nutrition and don't get full picture of dealing with the "possible" interaction with certain foods with an EPI dog's medicine........................

[daizyduh911]

Hi I am back with an update on Kai. There's solid poo everyday since Sunday!
Thank you so much for your help! The only difference we first made was eliminating rice and I opted for eliminating corn oil as well. I was told the corn oil provided a specific benefit but I do not remember what it was.
So for now Sweet potato, tilapia, 4tsp Balance it powder, about 1/4 tsp salt, 1 proviable probiotic in the morning, and her proin daily. As for pancreatic enzymes I been doing 3/4 tsp at Breakfast and lunch, and 1 tsp at dinner. we are going to try to get her back to 2 meals a day again in about 2 weeks for now we will keep it at 3 small ones.
I have about a box and a half of the proviable I don't really know if it makes a difference but since slippery elm seems to be popular and successful here I was wondering on how I introduce that and does that mean I would eliminate the proviable?
And how do I go about switching her enzymes? I still have a full bottle of her epizyme but I was thinking of switching her to the enzyme diane. I will be placing an order with wonder labs and switch to their B12 as well (until mid Feb because I have a lot of B12 right now)
Again thank you so much. the rice to sweet potato was a HUGE difference in her. literally the most solid poo since Sep/Oct.

[Olesia711]

oh WOW!!!! this is AWESOME news and i am SOOOoooo glad you are now seeing normal poos.

1. With regards to the removal of the corn oil...EPI dogs are very depleted in soluble fats..... but corn oil is not the best. If you can, please start including fish oil, or EFA (essential fatty acids) or even coconut oil.... start with very little for a few days and work your way up to 1 tsp a day....
see: "2018 (Aug 22) EPI Vitamin Research" on this page: https://epi4dogs.com/epi-research/

2. with regards to "we are going to try to get her back to 2 meals a day again in about 2 weeks for now we will keep it at 3 small ones." continue with the 3 small meals until she has been delivering "normal" poos for about a month. Feeding too much in the meals too soon can set her back....

3. with regards to "I have about a box and a half of the proviable I don't really know if it makes a difference but since slippery elm seems to be popular and successful here I was wondering on how I introduce that and does that mean I would eliminate the proviable?" usually we start with SLippery Elm and if that doesn't work, then switch over to a pre+probiotic like Proviable. OR.... if/when a course of Tylan antibiotic is being given, that is when we also suggest starting a course of probiotic about 1/2 way thru the Tylan antibiotic course. SInce you are already giving Proviable... i would continue with it and as long as the poos remain normal, just keep the slippery elm on hand. If when the poos go sloppy again, THEN go ahead and give the SLippery Elm. Always try slippery Elm (if possible) before resorting to an antibiotic whenever SID (dysbiosis) acts up.

4. with regards to "And how do I go about switching her enzymes?" with the enzymes, as long as you are using the correct type of enzymes (porcine-based) then you can switch over 100% (all at once) from one enzyme product to another.

Again, so glad to hear that the removal of the rice made for much better poos