Newly diagnosed Epi-Next steps?

[kcarozza]

Yes, the 6x.
And per Olesia, one level tsp for each cup of food.
I am currently using her original food, Royal Canin GSD which is 5.5 fiber.
Was going to look into switching her food to lower fiber but didnt want to change/add too much at once.

[kcarozza]

Yes, 6x strength.
Food Royal Canin GSD.
Was thinking of trying lower fiber food but didnt want to add/change too much at once.

[Olesia711]

Kim,

Look at the bag that the 6x came in... and tell us what the Lipase USP units are on this batch.

Lipase levels can swing 20,000 USP units in one direction of another and not make a lick of difference, but every so often there is a dog that is highly sensitive... so we slightly adjust the amount. SO depending on your batch Lipase USP units.... this might be a consideration, although.... i would put this very low on the list of possibilities.

I more highly suspect that it is the fiber content in the current food is probably highly on the list of possibilities, but you did the right thing, to not change too many things at once.

What i suspect is going on, cause the time frame is about correct...That what you are seeing is out-of-control-SID (SID/SIBO/Dysbiosis) this almost always happens a few week AFTER the enzymes are started and everything has dramatically improved... and then a few weeks later many people complain and say it's like the enzymes stopped working... even though in your case you switched enzyme brands. What happens (although this is not the scientific explanation) is that many bad metabolites were accumulating in the body prior the EPI diagnosis and treatment.... then the enzymes arrive, are given and everything dramatically improve,.... but only for a short while... then a few weeks later what looks like "EPI" symptoms return.. however... it is not EPI symptoms but rather "SID"... it is almost like now that the enzymes have had time to really take effect in the body, it is kind of like the enzymes are now starting to shake loose all those bad metabolites that have accumulated overtime prior to treatment.

SO..... first let me know the strength of the Lipase of the 6x you have.
Then... are you currently feeding 2 cups of this 5.5% fiber content food????
Are you giving 2 level tsp of enzymes with the above food ???
By now (from 2/11) full strength Proviable should be fine and not the cause of the loose stools
The B12 will not cause loose stools.

SOOOOOOOOoo.... we are back to this is most likely out-of-control SID.... and the steps to fix it would be:
1. temporarily increase the amount of enzymes .. but 1st...PLEASE LET ME KNOW THE LIPASE STRENGTH ON YOUR BAG OF 6X
2. you can try adding slippery elm powder to introduce some prebiotics https://epi4dogs.com/slippery-elm/ to help improve the gut flora/SID
3. you are currently using Proviable.. .but if you are seeing sloppy poos, it's most likely not working.... you can try other probiotics... or
4. the next step in improving gut flora/out-of control SID would be to give Tylan but BEFORE giving antibiotics, in this case, if none of the above helps, i would next look at changing the food ... maybe "try" the smallest bag possible of this: https://www.chewy.com/farmina-nd-ocean- ... M0QAvD_BwE
5. If the food change doesn't help.... THEN I would try Tylan for 45 days/twice a day : https://epi4dogs.com/antibiotics/

BUT........ 1st... please let me know the strength if the Lipase in the 6x you are using now AND how enzymes you are giving per how much food.... we "might" be able to fix things here, but if not ... then go to the next steps.

[kcarozza]

As always, thank you for your detailed response.

The EnzymeDiane is 6x with the following numbers:
Lipase 76440
Amylase 484400
Protease 462000

Currently she is eating what I think is 150% of her Royal canine GSD food per the bag)--four meals/2 cups each. Each cup has one level tsp of enzyme.

Her poops before today were better but not toostie rolls looking like you mentioned before. She was pooping 3-4 times a day until this morning.

[Olesia711]

thanks for the additional information.

Okay... the Lipase enzyme level is EXCELLENT... the prescription brand you were using before to be classified as prescription, had to meet the Lipase 71,400 USP units threshold.. This 6x is 76,400.... you can't get better matched. REALLY good.

And you are giving the recommended amount of enzymes per cup of food, but since in the past, (with the 71,400 prescrip enzymes) you gave a heaping tsp per cup...then the first thing i would try is give the same of enzymes per cup of food with these 6x enzymes....(just in case this is the underlying issue) and watch the poos closely for a few days... see if you see ANY improvement in the poos, even slight improvement. And let us know.

HOWEVER....... i strongly suspect that what you are dealing with is typical SID, right poo description, right timing... etc, etc.

If the increased enzymes do nothing.... then.... you can either try giving SLippery Elm jsut to see if it will help since it is a prebiotic.... or.... even though this is where we would recommend Tylan (since a probiotic did nothing) however... in this case, my personal opinion would be to FIRST change the food to something with MUCH less fiber content. WOuld you be willing to try : (buy the smallest bag possible) https://www.chewy.com/farmina-nd-ocean- ... LAQAvD_BwE

Bearing in mind, if the food change fails, then you will have to request a course of Tylan... but best if you can accomplish improving the gut flora via slippery elm or a food change first

[kcarozza]

1. So you are saying to use 1 HEAPING tsp per cup of food ?

2. I bought the food from Chewy you just recommended.
-- Should I mix the two until she gets adjusted?
-- Should I still feed 150% per the bag recommendation?

3. Should I stop the proviable or keep trying it?

[Olesia711]

to answer your questions:
1. So you are saying to use 1 HEAPING tsp per cup of food ? YES, ONLY BECAUSE BOTH THE 6X ENZYMES AND YOUR PREVIOUS ENZYMES ARE VIRTUALLY THE SAME SAME POTENCY AND SINCE A "HEAPING TSP" WAS WORKING WITH THE PREVIOUS ENZYME... GO AHEAD AND GIVE THE SAME DOSE WITH THE 6X ENZYME

2. I bought the food from Chewy you just recommended. FINGERS CROSSED THAT THIS WORKS :)WITH EPI DOGS, FOOD AND PROBIOTICS ARE ALWAYS TRIAL AND ERROR!
-- Should I mix the two until she gets adjusted? YES, (DAY1) DO 25% NEW FOOD/75% OLD FOOD, (DAY2) DO 50% NEW FOOD/50% OLD FOOD (DAY3) DO 75% NEW FOOD/25% OLD FOOD (DAY4) 100% NEW FOOD.
-- Should I still feed 150% per the bag recommendation? YES.

3. Should I stop the proviable or keep trying it? MY THOUGHT IS THAT IT IS NOT HELPING.... BUT..... I WOULD CONTINUE UNTIL AFTER YOU ARE ON THE NEW FOOD 100% MAYBE FOR A WEEK OR TWO. MY REASONING FOR THIS IS YOU DON'T WANT TO MAKE MULTIPLE CHANGES ALL AT ONCE . IN THE FUTURE YOU MIGHT WANT TO TRY A DIFFERENT PROBIOTIC. ANDREA, WITH RYLEE SAID PROVIABLE FAILED FOR HER DOG, BUT SHE FOUND SUCCESS WITH GARDEN OF LIFE (WHICH IS A GOOD PRODUCT.

[kcarozza]

Thanks! Hope this works--will let you know

[Olesia711]

hi Kim,

I hope so too.

Unfortunately, there is a lot of trial and error with EPI, but once you find the right balance of treatment.... it's usually pretty easy to manage... except for SID flare-ups.... but you'll get the hang of those too

And of course, we will help you as best we can.

[kcarozza]

Olesia,

Just wanted to let you know that switching the food helped a lot! She is now on the Farmina full time. Poops are lessening in number, looking better, she is not as hungry so we are doing about 110% of food and she has gained her weight back!!

Will have B12 checked in May and see where we are.

I know things can change in a second but for now--I'll take it!