New EPI Diagnosis - Feeling Overwhlemed...

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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Sadie'sMom
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Posts: 18
Location: Wisconsin
Country: United States
State: Wisconsin
Pet name: Sadie
My name: Lisa

New EPI Diagnosis - Feeling Overwhlemed...

Post by Sadie'sMom » 30 Sep 2019, 13:58

Hi All:

First, I am thanking God right now that I found this website. I have read more information and learned more in the last 2 hours of reading than what I thought was possible. Thank you all, in advance, for whatever support you can give me right now. My story:

Our Sadie was just diagnosed with EPI on September 18th. It took a month of not knowing why she suddenly started having chronic diarrhea. She lost 10 pounds in the meantime (went from 49 to 39 pounds in a month!) We have the diagnosis - but not a lot of info on this disease. She was started on 3.5 scoops of Panzquin (per meal); did this for a week and no change This past Friday she was upped to 5 scoops. She takes 1 Proviable-Forte Sprinkle Capsule/day. She also tested positive for Clostridium, (which the vet said "many dogs have this"), so was started on metronidazole for 14 days (after 14 days we stopped, the diarrhea came back with a vengence, so 3 days later they said to give her another 2 weeks of Metro). She is on Hills Science Diet GI Biome for food.

The Panzquin is new (I guess) and it has the enzymes and Vitamin B12 that she needs. Not sure if anyone else is using this and if they have had success or not on it. I wasn't instructed on how to give this med, but through reading I have learned to give it with luke warm water (just enough to wet the food). I was using a bit of warmed chicken broth but the vet said NO to that (why??). I would let the Panzuin sit for 5 minutes and then feed Sadie. I'm now reading I should let the food sit for 20 minutes to let the enzyme work? Could this be what I am doing wrong and the reason Sadie isn't better?

Since upping the Panzquin to 5 scoops - her poop has improved....but, we will get 1 almost normal poop and then the next one is like "soft serve" - a bit of form, but mostly soft stuff. Any help or suggestions from anyone would be appreciated more than you know. She has TONS of energy - you wouldn't know a think is wrong with her. I spent all day yesterday crying because I just want her to feel better and her stool to be normal again.
Sadie - 3 years old. Golden Retriever/lab (mom is 100% golden, dad is 1/2 golden & 1/2 lab)
Sadie has a "big sister" named Bella, who is an English Setter. Sadie has boundless energy and would spend every minute of her life chasing a ball if it was up to her. Sadie's mom & dad just want her to feel better and are VERY happy to have found this forum to be a part of.

My favorite quote since we have been given Sadie's EPI diagnosis: “You never know how strong you are until being strong is the only choice you have.” —Bob Marley

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jilbert57
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Posts: 659
Country: United States
State: Washington

Re: New EPI Diagnosis - Feeling Overwhlemed...

Post by jilbert57 » 30 Sep 2019, 15:30

Welcome to you and Sadie. Do you have the test results for the Tli, B12 and folate you could post?
I looked up the Panzquin and it looks fine but in order for the oral B12 to be absorbed it needs to have the intrinsic Factor included. EPI dogs require B12 to be upper level so 600 or higher.
The ratio of enzyme to kibble is 1 level teaspoon enzyme per 1 level cup kibble. Add little room temperature water, stir and incubate 20 minutes. Stir again and serve.
In order for your pup to get stable usually requires the 4 cornerstones to be met:

Enzyme given with all food

Diet: usually grain free with 4% fiber or less
https://epi4dogs.com/dog-food-options/

Antibiotic- 45 day course. Tylan is used for longterm as it is easier on the system for long term. Metro can be used also. Some dogs react to Metro with neurological issues.

B12 with Intrinsic factor
https://epi4dogs.com/b12-in-brief-2/

Jill
My name is Jill and I live on the Hood Canal in Washington State. I have two dogs: Kiya is an aussie/blue heeler and is 13, TJ is a 4 year old Jack Russell. They keep me on my toes.
Mickey and his pancreatitis brought me to Epi4dogs.com site in 2012 to help manage it.

Mickey, Jack Russell. Chronic Pancreatitis. Dianes enzymes, 1/8t 3x/day with meals.
6/1999 - 8/2014

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Sadie'sMom
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Posts: 18
Location: Wisconsin
Country: United States
State: Wisconsin
Pet name: Sadie
My name: Lisa

Re: New EPI Diagnosis - Feeling Overwhlemed...

Post by Sadie'sMom » 30 Sep 2019, 15:52

Hi Jill:

THANK YOU for responding to me so quickly. I put all of the info on Sadie on the system - must have put it in the wrong place! I have put it on again, but in case it doesn't show up, here is her info:

C. perfringens Alpha Toxin (CPA) Gene RealPCR POSITIVE
C. perfringens Alpha Toxin (CPA) Gene Quantity 144928 THOUS/g
Fold Difference From Cutoff 483.09
GI panel: Cobalamin 159 (251-908); Folate 7.4 (7.7-24.4); TLI <1.0 (5.7-45.2); PLI 32 (</=200).
Blood Count: MPV- 13.6 (8.7-13.2).
BUN- 3 (7-27)
Cortisol: 6.5 ug/dL (1-5)

We are giving her 5 scoops (it was included with the med) with 1.5 cups of kibble. We were only incubating 5 minutes --- so will wait 20 minutes at next feeding. Can we use a low sodium chicken broth on her kibble to get her to eat (like 4-5 small spoonfuls)?

Thank you for the 4 cornerstone info - very helpful!

We are giving her Hills Science Diet GI Biome - it has 6.6% fat. Does that mean I should switch food? Or is that "close enough"? If I have to switch, do you have a suggestion?

I'm assuming I will need to get Tylan approved by my vet, correct?

If you need any other lab work info, I will be more than happy to provide it.

Jill, I am sitting here with tears in my eyes because you are helping me. Thank you so very much....

Lisa
Sadie - 3 years old. Golden Retriever/lab (mom is 100% golden, dad is 1/2 golden & 1/2 lab)
Sadie has a "big sister" named Bella, who is an English Setter. Sadie has boundless energy and would spend every minute of her life chasing a ball if it was up to her. Sadie's mom & dad just want her to feel better and are VERY happy to have found this forum to be a part of.

My favorite quote since we have been given Sadie's EPI diagnosis: “You never know how strong you are until being strong is the only choice you have.” —Bob Marley

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jilbert57
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Posts: 659
Country: United States
State: Washington

Re: New EPI Diagnosis - Feeling Overwhlemed...

Post by jilbert57 » 30 Sep 2019, 17:54

Hi Lisa, it is normal to be overwhelmed by all of this. Just do your best each and every day to help Sadie. You do not need to worry about the fat content. It is the grains in the food that can lower the efficacy of the enzymes. Please see the link in the above post about grain free diets.: dog food options.

Please try this. Take a teaspoon and use 1 -1/2
teaspoon of enzyme, level and 1.5 cups kibble. Incubate for 20 mins and feed. Can you put some chicken broth over the incubated food before you serve it?

Seems some places Tylan needs a script, you can google it and see. Otherwise you need a script from your vet.

There are a lot of us staff and members here to help with all questions, feel free to ask.

Jill
My name is Jill and I live on the Hood Canal in Washington State. I have two dogs: Kiya is an aussie/blue heeler and is 13, TJ is a 4 year old Jack Russell. They keep me on my toes.
Mickey and his pancreatitis brought me to Epi4dogs.com site in 2012 to help manage it.

Mickey, Jack Russell. Chronic Pancreatitis. Dianes enzymes, 1/8t 3x/day with meals.
6/1999 - 8/2014

Tuckaboo.
Member
Posts: 84
Country: United States
State: Florida
Pet name: Tucker

Re: New EPI Diagnosis - Feeling Overwhlemed...

Post by Tuckaboo. » 30 Sep 2019, 18:03

I'm new, too, but I'll chime in with this: I put homemade turkey bone broth on my Tucker's food, and he loves it. Room temperature liquid, so I put some broth from the frige mixed with some hot water. The B12 many on this site use is Wonderlabs Pet Factor---Amazon has it. Diane's Enzymes are way cheaper than anything your vet prescribes, but I'm sure you'll hear more about her from others. One question I have is, can you put your 5 scoops of enzymes into a measuring spoon, to see how much it is? Usually the dose is 1 teaspoon enzymes/ 1 cup food, but I wonder if yours is different because the B12 is mixed in. One last thing, yes, Tylan is a prescription. My dog thrives on the cocktail of enzymes, tylan, b12, turkey broth, and kibble. But it did take awhile. The more experienced EPI moms & dads on this forum will help you, and remember, the only stupid question is the one you don't ask. Best luck to you and your pup. ---Pam
Tucker is a shepherd mix, and has not had a blood test for EPI. In May 2019 we started on sulfasalazine to eliminate IBS as diagnosis. Symptoms returned at end of course, so started on Tylan alone...no luck, so added enzymes, and progress was shown. Currently taking Diane's Enzymes 4t/day, Wonderlab B12 capsules 2/day, and Tylan 1/2 t/day. No more coprophagia, he has gained 8 pounds, and he is a happy member of the family...no more grumpies with his much smaller brother & sisters, who do not have EPI.

Tuckaboo.
Member
Posts: 84
Country: United States
State: Florida
Pet name: Tucker

Re: New EPI Diagnosis - Feeling Overwhlemed...

Post by Tuckaboo. » 30 Sep 2019, 18:45

I'm always chiming in with what I've learned. I am so sorry if only staff is supposed to do this. ---Pam & Tucker
Tucker is a shepherd mix, and has not had a blood test for EPI. In May 2019 we started on sulfasalazine to eliminate IBS as diagnosis. Symptoms returned at end of course, so started on Tylan alone...no luck, so added enzymes, and progress was shown. Currently taking Diane's Enzymes 4t/day, Wonderlab B12 capsules 2/day, and Tylan 1/2 t/day. No more coprophagia, he has gained 8 pounds, and he is a happy member of the family...no more grumpies with his much smaller brother & sisters, who do not have EPI.

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jilbert57
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Posts: 659
Country: United States
State: Washington

Re: New EPI Diagnosis - Feeling Overwhlemed...

Post by jilbert57 » 30 Sep 2019, 22:45

Pam, members are welcome to share information anytime. You do fine answering :D

Jill
My name is Jill and I live on the Hood Canal in Washington State. I have two dogs: Kiya is an aussie/blue heeler and is 13, TJ is a 4 year old Jack Russell. They keep me on my toes.
Mickey and his pancreatitis brought me to Epi4dogs.com site in 2012 to help manage it.

Mickey, Jack Russell. Chronic Pancreatitis. Dianes enzymes, 1/8t 3x/day with meals.
6/1999 - 8/2014

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Sadie'sMom
Member
Posts: 18
Location: Wisconsin
Country: United States
State: Wisconsin
Pet name: Sadie
My name: Lisa

Re: New EPI Diagnosis - Feeling Overwhelmed...

Post by Sadie'sMom » 01 Oct 2019, 09:42

Good Morning Jill & Pam:

What a great way to wake up this morning and see your replies! Thank you both for taking the time to help us. :P :P

We got excited yesterday evening because Sadie had a normal poop (plus she only pooped 2 times yesterday versus 4)! Plus, last night was the first time in 2 MONTHS we didn't have to get up to let her out during the night (thank God!!) so that she didn't have an accident in her kennel. So we got hopeful that we had turned a corner. Well, then my husband took her outside this morning....and her poop was "soft serve" at best. So disappointing....

She is getting fed twice a day. 1.5 cups of kibble with 5 scoops of Panzquin, mixed with a small bit of lukewarm water - letting it incubate for 20 minutes and then serve. (Today is day 2 of doing the incubation correctly).

Jill: I read the Panzquin box - it says 1 teaspoon is 4 scoops. It says that is the "customary amount to use per meal" - but it doesn't give a specific amount of kibble to enzyme ratio. It also says that each teaspoon has 500 yg (??) of vitamin B12. I put the "yg" in quotes because the "y" is printed backwards?? You mentioned Sadie should have 600 of B12. Since we are giving her 5 scoops instead of 4 - are we sufficient on the B12 in your opinion? I don't know if it helps, but it also lists these ingredients: Lipase 71,400 USP units; Protease 388,000 UPS units and Amylase 460,000 USP units.

Jill/Pam: We are going to finish her antibiotic and then if she needs to be on this long term, I am going to ask my vet about Tylan. I read that Metro is a great antibiotic, but it can be hard on your stomach --- so then I sit here and wonder if the Metro is causing her loose stools??

Pam - it did help to hear you say that "it did take awhile" for things to work for Tucker. That gives me hope that we just need to give this more time in the hopes that she will "turn the corner" at some point in time. Thank you for your advice and help.

Sadie is on Hills Science Diet GI Biome, which has 6.6% fiber content. Everything I have read on this web page, plus with what you said below, it says stay below 4%. I am "nervous" about switching her food....but I also want to do whatever it takes to get her back to having a normal poop! To repeat myself - do you suggest we switch her kibble? And, if we do, I assume you would suggest that we wean her off the Hills and onto the new dog food, correct?

Jill --- am I hitting the 4 cornerstones with everything we are doing? Or is there something else you would suggest?

Thank you, thank you, thank you for everything you have helped with us thus far. I look forward to hear back from you, or anyone else that has a suggestion! We just want our fur baby better.

Hugs - Lisa
Sadie - 3 years old. Golden Retriever/lab (mom is 100% golden, dad is 1/2 golden & 1/2 lab)
Sadie has a "big sister" named Bella, who is an English Setter. Sadie has boundless energy and would spend every minute of her life chasing a ball if it was up to her. Sadie's mom & dad just want her to feel better and are VERY happy to have found this forum to be a part of.

My favorite quote since we have been given Sadie's EPI diagnosis: “You never know how strong you are until being strong is the only choice you have.” —Bob Marley

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jilbert57
Staff
Posts: 659
Country: United States
State: Washington

Re: New EPI Diagnosis - Feeling Overwhlemed...

Post by jilbert57 » 01 Oct 2019, 11:02

Good morning Lisa, the amount of enzymes is in direct correlation with the amount of kibble. If 4 scoops is 1 teaspoon and you are giving 1.5 c kibble, please give 6 scoops. Or better yet, give 1.5 level teaspoons. Too much enzyme can have the same effect as too little.

It could be the Metro causing gut issues. I would ask your vet for Tylan and give a 45 day course.

https://epi4dogs.com/antibiotics/

Yes, 6.6% fiber might be too high. Please look at the dog food options page and look at a grain free I would go without peas or pea fiber if possible. Slowly switch diets. Please run any changes by your vet.

Jill
My name is Jill and I live on the Hood Canal in Washington State. I have two dogs: Kiya is an aussie/blue heeler and is 13, TJ is a 4 year old Jack Russell. They keep me on my toes.
Mickey and his pancreatitis brought me to Epi4dogs.com site in 2012 to help manage it.

Mickey, Jack Russell. Chronic Pancreatitis. Dianes enzymes, 1/8t 3x/day with meals.
6/1999 - 8/2014

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Sadie'sMom
Member
Posts: 18
Location: Wisconsin
Country: United States
State: Wisconsin
Pet name: Sadie
My name: Lisa

Re: New EPI Diagnosis - Feeling Overwhlemed...

Post by Sadie'sMom » 01 Oct 2019, 12:10

Good Morning Jill:

Thank you, again, for responding so quickly. :)

My vet is following up with me tomorrow - so I will ask about the Tylan and see what she says and let you know. I will also ask her about increasing the Panzquin.

I just looked up the info on Hills SD food and the fiber content is actually 7.2% crude fiber (not 6.6% like the vet tech told me). So now I am definitely going to switch her food to something that has the 4% fiber content (I will run this past the vet as well).

Your opinion on something please: the vet said it is okay for us to put a couple of very small bits of grilled chicken (zero fat - no skin) in her food to get her to want to eat it. Do you agree this is something okay to do? They also said that we could give Sadie, for a treat, fresh green beans and/or carrots. I'm not sure she would even eat these - and I'm not going to give her anything new until we get her poop at 100% - but do you have an opinion on feeding her these 2 things?

Thank you.

Lisa
Sadie - 3 years old. Golden Retriever/lab (mom is 100% golden, dad is 1/2 golden & 1/2 lab)
Sadie has a "big sister" named Bella, who is an English Setter. Sadie has boundless energy and would spend every minute of her life chasing a ball if it was up to her. Sadie's mom & dad just want her to feel better and are VERY happy to have found this forum to be a part of.

My favorite quote since we have been given Sadie's EPI diagnosis: “You never know how strong you are until being strong is the only choice you have.” —Bob Marley

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