Enzyme dose not working? What should I try next?

[lylzzf3841]

Previous post about a possible EPI diagnosis with TLI 6.7 - viewtopic.php?t=1980

In short, Leo has been on Enzyme Diane 6x for 3 days now, his stool didn't improve, and I somehow feel... it's getting progressively worse... I noticed he's also having more stomach gurgling, and definitely more gas after eating So this is what we're doing currently -

Morning:
1. 2 cups of Chicken breast, Salmon, rice, vegetables (wet food) with 1 1/2tsp of enzyme.
2. Tylan powder 1/8 tsp
3. Wonderlab B12 capsule
4. Joint supplements

Noon:
1. 2 cups of Chicken breast, Salmon, rice, vegetables (wet food) with 1 1/2tsp of enzyme.
2. Proviable DC pre+probiotics 1 capsule
3. 1/2 scoop of Slippery Elm powder (started today)

Evening:
1. 2 cups of Chicken breast, Salmon and rice (wet food) with 1 1/2tsp of enzyme.
2. Tylan powder 1/8 tsp

He still defecates 1-2 times per day. The color is mostly yellow/light brown-ish. His stool was mostly solid in the morning but loose at night before enzyme, but now it seems the stool is loose all the time, with undigested food. Could it because the Tylan dose is not strong enough? Or should I try increase the enzyme at this point?

One thing to note - he actually gained some weight back before starting the enzyme. Is it possible for EPI dog? I'm at a really confused stage where I'm not sure if enzyme is helping or am I doing too much at once and it's hurting him Any suggestions?

[jilbert57]

I would try removing the rice from the diet. I realize the cTli is in tweenerville but the grain might be the issue.
Addressing Diet(grain free 4% fiber or less), Enzymes and proper incubation, Antibiotic(for SID/SIBO) and B12 is needed.
Is the food you feed a certain canned food?

Jill

[Eddiespaghetti]

The reason grain free is recommended is, it can lower efficacy of the enzymes for some dogs. You will want to remove the grains or increase the enzymes to compensate.

[Olesia711]

Hi Uto and thanks for giving us the details of exactly what Leo is getting and for describing the results:

"Leo has been on Enzyme Diane 6x for 3 days now, his stool didn't improve, and I somehow feel... it's getting progressively worse... I noticed he's also having more stomach gurgling, and definitely more gas after eating"

This is very typical of SID, so i am guessing this is what you are dealing with. MANY times, people think the enzymes are not working, when in fact they are, but what is seen is the effects of out-of-control SID/SIBO (dysbiosis).

First, i agree with Jill's recommendation, remove the rice from the food (for now)... if you what to include a carb at this time, just supplement with a little bit of cooked mashed white potato or sweet potato....

Next and most important, based on what you described is most likely SID... and the amount of TYlan you are giving is way too low. Please up the Tylan to 1/4 tsp twice a day since Leo is around 75lbs. When not enough Tylan is given... SID can and does get worse, which is what it sounds like is happening with Leo.

Not sure if i shared this with you in the past, but when my dog was diagnosed with EPI, the vet prescribed enzymes. I gave the right kind and the right amount of enzymes with her meals, the food was correct and yet the loose stools continued for two whole weeks. My vet was wonderful, he called every night to see how she was doing... at the end of two weeks, he was frustrated that the loose stools continued and then prescribed the Tylan... within 24 hrs. her stools corrected. Here on the forum over the years, we have had other folks whose vet did prescribe Tylan but under-dosed the Tylan... and their dog also continued with the loose stools. ONce the Tylan dose was increased, then the stools were corrected.

Just sharing the above to give you an understanding why we are suggesting that the Tylan dose should be increased . Of course this may not be the answer, but at least this next step will not hurt and hopefully will help.

Please keep us posted!!!

[lylzzf3841]

Thank you all so much for the suggestions and great info!!

So my understanding about the grain-free food is that we don't want too much insoluble fiber in the food. But I thought 100g cooked white rice only have about 0.5g fiber, which is a lot lower than sweet potato. I always have the impression that white rice is most easily digested carbs we could find. Also because, for the past 8 years, every time Leo had diarrhea, white rice worked with him, and I do want his diet to contain carbs at the moment, because I think it'll help with the weight gain. But again... I could be all wrong about what's going on here because all my nutrients knowledge is more based off humans

About Tylan, yes I would really love to increase the dose to be aligned with EPI protocols. But the problem is... I'm running out of Tylan. My vet still thinks 1/8 tsp per 24h for 20days is the correct course, and that's what she gave me. I'm the one who adjust it to 1/8 tsp in the morning and 1/8 in the evening. Now he's been on Tylan for about a week, and I only got a few 1/8 tsp capsule left... I've been desperately seeking how I can get more Tylan from somewhere... Any suggestions?

There is another thing I noticed, is the acid reflux Leo seems to be having since the enzyme. He would sit there panting and licking his mouth for quite some time after each meal, and try to burp but not a lot air came out. I didn't know much about acid reflux sign in dogs so I didn't realize it, until this morning his voice becomes a bit coarse... Is there a way to address that? I've doing the mix and incubation (at least 20mins) process. Would it be helpful if incubating longer?

An update for Leo - his BM this morning is back to the stage where it's firm and solid in the beginning, but soft at the end. And the firm part is has more of a grey(?) color where the soft part is more light brown/yellow-ish... I'm not sure what's causing the color difference because he's been feeding the same thing throughout the day..

[Eddiespaghetti]

The first thing about EPI is throw everything that has worked out the window. It is such a weird disease by how it interacts with everything. How every dog seems to be completely different than each other when it comes to treatment.
It's amazing to me that grain can reduce the potency of enzymes, but it can. That is why EPI recommends going grain free at the beginning. Of course, you can compensate for the lack of potency with increased enzymes, but it is far easier to go grain free at the beginning. Once you get them stabilized you can experiment with what works.
As for the acid reflux, it is pretty common in the beginning. I am assuming it's because the pup has to get used to the enzymes? It usually goes away after a couple weeks. With the licking off the lips you just want to make sure they don't have sores inside their mouth. The enzymes can cause this if they are properly moistened. I know you are incubating, but might want to look to be safe. You can give famotidine or Omeprazole if it gets bad. Put it in cheese or something about 30 minutes before you feed them. It typically only needs to be giving once a day.

[Olesia711]

with regards to the lip licking.... this could be from the enzymes and one trick is to give the dog ices cubes after they eat as a kind of self-wash to remove any possible residual enzyme powder from the mouth... or wipe the inside of the mouth out with a warm wash cloth... or... if you can, just have them drink water after they eat.

OR.......... the lip licking can also be a sign of an upset stomach... when we see this with an EPI dog, the first suspect is that SID (dysbiosis) is getting out of control...... and needs to be addressed)

Also.... please check your inbox.... i sent you a private email.......................

[lylzzf3841]

So I finally was able to treat him with correct Tylan dose. He's been taking 1/4 tsp every 12h now for 2 days. I notice the stomach gurgling has definitely reduced, and he's passing less gas as well. I guess that's a big step forward.

But the thing is, his BM is still off. He mostly poops only once now, but still it starts pretty firm and solid, and at the end there is always one piece that's very very soft and loose. This morning he was even straining couple of times "try" to get that tiny last formless stool out. It looks almost like what he would do when having a large bowel diarrhea or colitis.

I have cut down the white rice intake and replace the calories with lean chicken meat. I feel that he is not getting any fiber at the moment apart from the one Proviable DC(contains FOS) and half scoop of Slippery Elm. Btw, he's on a very low fat diet because I'm not sure if he also has concurrent IBD or chronic colitis or something else. Before the enzyme treatment even a little bit of fat irritates him, The only exception is the period when he was on metronidazole, when he seemed to be able to consume anything without any issue.

So still, I'm at lost what we could try next... Can I try add some Hill's I/D or Biome to his diet today since it got lots of prebiotics in it? Or do we try increase the enzyme dose?

[Olesia711]

Hi Uto,


with regards to: correct Tylan dose. He's been taking 1/4 tsp every 12h now for 2 days. I notice the stomach gurgling has definitely reduced, and he's passing less gas as well. YES!!! this is a huge step in the right direction

with regards to the very end of the poo being a little soft (even runny) and (as in Leo's case) when the majority of the poo is fine, good color and the daily elimination frequency is normal... if the end part is soft.....it usually means that it wasn't in transit long enough. This usually happens when the gut flora is not balanced (SID/SIBO/dysbiosis)..... so.... things are starting to improve.... but......i think you need to
(1) give the Tylan more time..... AND.....
(2) your mention of (2) giving more prebiotics may help .... as this should help improve the gut flora BUT..... it is a fine balance of giving enough prebiotics but not too much, cause too much prebiotic can also prompt loose stools.
(3) you might want to "try" removing the rice completely and use baked, skinned, mash sweet potato or white potato instead.....
(4) or keep everything as is and "try" adding a tsp of canned pure pumpkin...(not the sweetened kind) for a good source of the right kind of fiber without over-doing it.
(5) or.... you can skip 2 thru 4 and try adding 1/8 tsp more enzymes per cup of food and see if this helps instead.

Decide which you want to try, do ONLY 1 change at a time..... AND keep an EPI journal so that you can track improvement or no improvement.

I am thrilled that you were able to increase the Tylan to 1/4 of a tsp.... and you have already seen improvement. Just from your posts it appears that Leo has dysbiosis that is finally starting to improve with the proper dose of Tylan.... but you do need to give it more time.

Another point i do want to mention.... typically we suggest that when one gets to the halfway mark of giving the Tylan (day 22 or 23rd) then start giving a pre+probiotic.... but since Leo is already on the Proviable... then please just continue giving the Proviable now as you are doing

[lylzzf3841]

Thank you Olesia for the suggestion! I think I'll start with adding tsp of pumpkin puree for now - it used to be part of his diet before all these so at least I know this is not something new to him.

I was actually just reviewing the notes/log I've been taking since he was brought to ER for that acute diarrhea episode, but I feel like it's mostly 1 step forward and 2 steps back Here's some of the timeline that worth mentioning, maybe someone can help me spot a pattern here -

12/2 - 3rd day of watery/bloody diarrhea, ER visit, 74lb.
12/3 - started on Panacur, metronidazole, Proviable DC. no BM
12/4 ~ 12/7 - 5 days of metronidazole, normal BM
12/10 - loose BM appeared again, TLI result back showing 6.7, first B12 shot
12/11 ~ 12/12 - loose BM
12/13 - First 1/8 tsp Tylan powder, BM solid in the morning and semi loose in the evening
12/15 - 80lbs, BM still half solid then loose.
12/16 - Started first Diane Enzyme. In creased stomach gurgling and gas.
12/17 ~ 12/18 - No noticeable change in BM, still loose. 2nd B12 shot on 12/18
12/19 - Very loose BM, straining. Started Slippery Elm 1/2 scoop.
12/20 - BM returned to semi solid, then loose.
12/21 ~ 12/22 - Bumped Tylan dose to 1/4 tsp every 12h. BM half solid then loose
12/23 - 82lb. BM half solid then loose, but straining at the end.

All of those are based on pretty much the same diet, salmon/cod/chicken, a little bit liver and rice.

One more thing I wanted to mention, there were 2 other supplements Leo was on - Wholistic Pet Organics Canine Complete and AnimalBiome Dog Probiotics - S. boulardii + FOS Probiotic. I noticed both of them have quite some prebiotics in it. I'm not entirely sure how much FOS Proviable and Slippery Elm offers. But I think there's a good chance that Leo is not taking as much as prebiotics as before...