EPI Overwhelm

[ajlove]

Hi, All; I'm AJ, and my spunky pup with an EPI diagnosis is Juniper. She started showing symptoms right at two y/o (8/1/24), loose stool, and weight loss followed. It took two months and several different vets to get the diagnosis because of life factors like a planned more across several states and the unfortunate timing of our eleven y/o Aussie mix receiving a cancer diagnosis and declining so rapidly. By the time we finally got enzymes started, she was 22lbs down at 51lbs. We are a few days shy of a month on enzymes and B12 shots. I noticed improvement within the first week, and she's since been inconsistent with her stool. Less than 50% of the time, it's solid and seemingly worsening with the vet's recommendation to increase enzymes. I've read a few recommendations on here to lower the dose of enzymes, and I plan to start lessening on her next meal. I've also noticed an increase in loose stool with the addition of cooked sweet potatoes, so I keep going back to feeding her only Hill's prescription i/d. I've been trying to find Royal Canin i/d, but the company doesn't even have the product for distribution. We do three meals a day, 150% of which she has gained 8lbs. Her stomach gurgling isn't every day, but I still notice it sometimes. I've hesitated to change her diet, but I feel at a loss with her stools not normalizing for more than a day. I'd love some recommendations. Should I try adding whole foods like sweet potato, chicken, or salmon? Has anyone been able to find Royal Canin in recent months? Suggestions would be wonderful!

The vet we've been seeing doesn't know enough about EPI or the potential for SID/SIBO or IBS/IBD in addition. He hasn't said anything about CREON, and based on the other posts I've read, I think we should try it. I understand this is a trial and error situation, with every dog being different, and I appreciate any helpful information for Juniper.

I should add that we've been giving her Slippery Elm almost consistently for over a month. I put a 1/2 teaspoon in her first and last meal of the day. She was taking Proviable Forte before the diagnosis of EPI. Based on what I've read with helpful probiotics on the forum, I switched her to Proviable D-C. Her stool only seems to get looser with the probiotic, so admittedly, I have not been as consistent with adding it. I started to cut the pill in half today, and I'm hoping that might help.

[Chance]

Welcome AJ and Juniper! Juniper is a very pretty girl!

What enzymes are you currently giving? How are you giving them? You are correct that too much can also affect stool quality.

The sweet potato isn't a bad idea, but they are high in fiber, so you want to give that in moderation. Most EPI dogs do have an issue with fiber, so it's usually suggested to keep the overall fiber content fairly low.

Slippery elm is good. It's usually a help. Probiotics can be good, but every dog is different, and so is every probiotic. It took me 5 attempts to find the right probiotic. (Proviable was #4. It is has very good strains in it, but it's about the weakest one available. It didn't help here, but I think it's just not strong enough for mine. Probiotic #5 is a high potency probiotic, so for that we had to start slow and gradually build up. Once we got it built up, I knew pretty much right away it was going to be the one)!

Creon is a very good enzyme. It is what I have used with 2 dogs. It can take trial and error to find the perfect dose, but once you do, it's pretty good!

[Olesia711]

Hi AJ and Welcome to you and Juniper.

I too would like to know what type and brand of enzymes Juniper is on and how are you giving/preparing the enzymes with the food and how much food are you giving with how much enzymes.

Once we have that information we will be able to better help you... but just based on what you wrote.... and the fact that Juniper got better initially and then the loose stools started happening and now is happening no matter what you are trying.... i suspect that if the enzymes are the correct one and you are giving it properly... my guess is that what you are dealing with is SID/SIBO/Dysbiosis..

Typically we recommend prebiotics then pre+probiotics... but again, just going on what you wrote... and that Juniper does have tummy gurgling..... that also strongly points to SID.

At this point.... the very next step i would suggest is talk to your vet and tell him/her that you want Juniper on a course of Tylan (Tylosin Tartrate) antibiotic
https://www.chewy.com/tylan-tylosin-tar ... /dp/173768
.. twice a day for 45 days. https://epi4dogs.com/antibiotics/.
You can get it from Chewy, your vet simply has to approve it

[jilbert57]

Beautiful pup!
Great information given so far. I would like to add that if Juniper does not have a concurrent condition that would need prescription food you don't need it. The grains in both Royal Canin and Hills can interfere with the action of the enzymes and they won't work correctly. Epi dogs do best on a grain free diet(no peas or lentils) of 3.5% fiber or less. So if the other suggestions for the protocol fon't make healing come together look at diet.

https://epi4dogs.com/dog-food-options/

Jill

[Eddiespaghetti]

Vets without a lot of EPI experience usually say to increase enzymes. They use it as a medication, which more equals stronger. It can work that way, but it isn't always correct.
Based on what you are feeding and as Jilbert mentioned about grains. Increasing it isn't a bad idea. Creon can be hard to get in America, but we have recently found an alternative to it.
https://a.co/d/34x1Tpk
Eddie has been on this a couple days and everything is going well. You might need to give one or two capsules per meal.
Personally, I like the tylan route. It worked for Eddie wonderfully. As with any medication there is always chance for side effects and it isn't a cure all.

[ajlove]

Hi All! Thank you so much for the detailed responses and suggestions. I realized late last night I didn't add Juniper's protocol for meals with enzymes. She eats 2 cups 3 times a day with 1.5 teaspoons of enzymes. I soak her kibble for 10 minutes in water with Slippery Elm (.5 teaspoon per meal), then add the powder enzymes and let them sit for 15 minutes.

Juniper started on PancrePlus for the first two weeks, and then we switched to EnzymeDiane 6X. Should we be supplementing her enzymes with the prescription grade? Rather than relying only on the EnzymeDiane 6X.

Chance, I appreciate you sharing about your trials with probiotics. Did you start to notice improvement soon after the switch to #5?

Jill, thank you for the info about the prescription food. Before the vet's recommendation, she had been on grain-free food. I will figure out what we can switch to from the suggestions on here.

Eddie, thank you for sharing the alternative to Creon. I plan to start adding Creon to her meals.

Olesia, thank you for the details about Tylan. I placed an order through Chewy and hope the vet approves it soon.

I appreciate you all and this welcoming community!

[Eddiespaghetti]

Enzyme Diane and the prescriptions are pretty much the same. Though with 6X it is recommended to use 1 teaspoon per cup of food. That is where we usually have people start. Once stable you can start to back off the amount. With grains in the food you might need like 2.25 teaspoons. It's hard to say, while some dogs do fine with grains, a lot have issues. My new vet, wants me to tell everyone, grain free is fine but we need to make sure it has taurine. I guess that was one of the big issues from the grain free heart problems couple years ago.
When you say you plan to start adding Creon, what do you mean? It's an enzyme and you typically only need one type. Creon can replace enzyme Diane and vice versa. With Creon, micrazym you don't want to incubate the enzymes. Get the food prepped and either open the capsules, sprinkle it on and serve. Alternatively, you can give the capsules whole if you can get them to swallow it.
Efficacy wise, no enzymes need to be incubated. You will want to make sure they are moistened to prevent them sticking to the doggo's mouth and causing sores.

[Tuckaboo Pam]

I just want to add that when you check the ingredients of your grain free choices (I feed https://www.chewy.com/taste-wild-pacifi ... /dp/181326 ), making sure peas and white potatoes are far down the list, seems to mean that more of the the protein is coming from meat. This helps with the taurine problem.

Welcome, and we're so glad you're here!---Pam

[ajlove]

Hi again.

Thank you, Eddie, for clarifying the Creon confusion for me. Understood that it's not necessary since Enzyme Diane is sufficient. I have increased the enzymes due to her current food having grain in it. I plan to start switching her gradually this week. I also appreciate your vet's tip on the Taurine. For some reason, I thought the enzymes needed to be incubated for efficacy. I'm glad I was wrong, and now Juniper doesn't have to wait as long for her meals!

I still plan to inquire with the vet about starting Juniper on Tylan. I have noticed her stomach isn't gurgling as much in the past couple of days. But her stool hasn't improved.

Thank you, Pam!

I'm so grateful for this community!

[Chance]

Yes, as others have said, enzyme Diane us quite sufficient! You don't need anything else.

Yes, for probiotic #5, it didn't take long to realize I was onto something! It was high potency, so I started slow, at about 1/4 capsule per day. Then went to half a day, etc. I think it was when I hit about 3/4 capsule, I noticed improvement.

All the others I had been giving the others for over a month with either no improvement, or worsening symptoms.