Newly diagnosed with EPI, 15 week puppy

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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Posts: 8
Country: United States
State: New York
Pet name: Wade
My name: Kelly

Newly diagnosed with EPI, 15 week puppy

Post by kellyl » 29 Jun 2020, 16:09

Hi. My name is Kelly and I'm mom to Wade. Wade is a 15 week old Red Lab full breed puppy.

Our journey began at 9 weeks of age when we had our first sign of diarrhea. It has been an uphill battle ever since. With multiple phones calls to the vet and 2 ER visits because he always seems like he gets worse on the weekends. LOL. We've had 4 stool samples, that all came back negative. On 5/24 he was diagnosed with having Campylobacter overgrowth and was put on Metronidazole, Clindamycin and Proviable. We finished out these meds and didn't see much improvement, actually he was looking like skin and bones. On 6/20, he had another ER visit where they drew blood on him for the Texas GI panel. While we waited for results, he was put on a diet of chicken/rice/pumpkin and was taking Albon (as we thought he might have cocidia as two of his liter mates had that), back on another round of metronidazole and the probiotic. Mid-week, I finally saw a huge improvement of him activity wise. I felt like he was more alert, followed me all over the house, longer bursts of energy, etc. As it turned out on 6/26 when he was weighed he had actually gained 1 1/2 lbs. that week on that diet. However, on Friday 6/26, the Vet called us that the lab work results were consistent with EPI and also evidence of dysbiosis. His B12 level is normal with a Cobalamin Fasting 651mg/L. Wade was prescribed the Pancreazyme Powder (expensive, yikes) and Omeprazole and we were told to finish out the bottle of metronidazole until it's gone (I believe we have just a couple days left on that).

So many questions! LOL...
Food: The vet had prescribed us Hill Science Diet Gastro Biome dog food. We started that this weekend. After reading through some of this website, I see that he needs a low fiber, higher fat diet. This dog food does not fit that. We are thinking of trying the Hills Science Diet large breed puppy lamb/rice. Or the Royal Canine lab food as that fits under the 4% fiber recommendations and also has kibble designed for the lab who just swallows their food!

Feeding: Right now the vet has us giving him 1 cup of food, twice a day. I read here (love this site by the way), that we should be giving 4 small meals. I asked the vet and she agreed but I'm waiting to find out what the food/ratio of powder is? I have no idea.... We have been mixing the enzyme with room temperature water, but the vet said we could get canned dog food and mix the powder into that and then mix his kibble in. That way he eats all of it??

Acid reflux: It was described to us that the Omeprazole was being given is a proton pump inhibitor and that would decrease the acidity in his stomach and promote a good initial response to the treatment. Any recommendations on this? I would love to get Wade on as much natural stuff and away from antibiotics as possible if we can.

Treats: What does EPI mean for getting fed treats? We feel as though getting a treat especially during the training stages of being a puppy is huge (even if it's his own dog food) but can our dogs have them?

Any advice for new parents? I am so thankful that my google search found you all. I believe in the power of parents so much. My son was born with a cleft lip and palate and during my google search I was able to connect to a network of people that I've become amazing friends with and it's so nice to help out families in need. So I'm not new to the time and effort but just not used to it with my 4 legged kids! :)

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Shirl D.
Posts: 75
Country: United States
State: New York

Re: Newly diagnosed with EPI, 15 week puppy

Post by Shirl D. » 29 Jun 2020, 17:51

Hi Kelly, Welcome to the forum! First, take a look around the website when you get a chance. There's a lot of information, so it can be overwhelming, but it can also really help. A good place to start is the Quick Guide. It gives a brief rundown of the 4 cornerstones of treatment.
As for your questions:
Food: Most EPI dogs do not need a special veterinary diet, and actually, based on the experience of many members here, most do not do well on them. You are right that the one you are currently giving is not one we would recommend. Besides the fiber being well over the 4% max that most EPI dogs need, it also has rice in it, which most EPI dogs do not tolerate well at all. The Science Diet lamb/rice mix obviously has rice in it, too, so wouldn't be a recommended food. I didn't check out the Royal Canin you mentioned, but my suggestion would be to find a decent quality puppy food without rice, with as few peas and legumes as possible, and less than 4% fiber. There is a Dog Food Options page on the site that might give you some ideas, and gives some guidance as to what EPI dogs usually do better on. That being said, every dog is different and there have been some that do great with the veterinary diets and rice. Food can be really tricky to figure out. But, since MOST dogs don't do well on prescription diets, we generally recommend finding a non-prescription food to try, unless there is another medical issue that requires the prescription food. It doesn't sound like they suspect any other conditions that would need that from what you've written. Don't worry too much about the fat content. We don't want to restrict fat, but it doesn't have to be high in fat, either. You do want to make sure it is designed for a growing puppy, though, to provide all the puppy nutritional needs.

Feeding: Smaller, more frequent meals are ideal, because they are easier on the digestive system. Most of our dogs have weight to regain, so we recommend feeding more than the normal amount to aid in weight gain. I'm not sure about how much to feed a growing puppy with EPI. You may have to just go by how much weight he is gaining and whether he seems to be too thin. Maybe someone else will have more input on that aspect. Every meal needs enzymes. The starting recommendation is 1 teaspoon of enzymes to 1 cup of kibble. You absolutely can mix the enzymes into canned food instead of water and then mix it with the kibble. The only caveat is that the canned food should be room temperature. Heat will kill the enzymes, and cold will make them kind of inactive. I feed my dogs canned. When Pixie (my EPI girl) gets canned food that has been refrigerated, I put it in a bowl and heat it up for literally 10 seconds at the most, just to take the chill off it. I stir it up good to make sure there are no hot spots (I also stick my finger in to make sure it's not too hot - gross, I know), then I add the enzymes. The other thing to remember is that you want to make sure you have enough enzymes to digest all the food, including the canned. So, if you are adding more than a tablespoon or so of canned food you may need to add just a pinch more enzymes. The ratio for canned food is 3/4 teaspoon per cup of canned food, FYI. Have you been letting the food sit at least 20 minutes once the enzymes are added? This is a good idea to prevent mouth sores, which some dogs get and some don't. Better to be safe than sorry.
Acid Reflux: Some dogs have reflux, usually due to having SID (small intestinal dysbiosis). Virtually all EPI dogs have SID at diagnosis because of the nature of having undigested food in the system. This promotes bacterial imbalances (dysbiosis). In some dogs, this will straighten itself out with proper treatment. Some dogs need antibiotics. Wade is already on the metronidazole which is one of the meds used to treat SID. Hopefully he will be good to go once the metro is done. My thought on the Omeprazole is that, unless you are seeing signs of reflux and he seems uncomfortable from it, it's not necessary. I've never heard of it given to promote a good initial response to treatment. Most EPI dogs don't get it and still respond to treatment pretty well. One thing that can really help with SID and reflux is slippery elm bark. Take a look here for details:
Treats: Sorry, but they're pretty much a no-no right now. :( Everything he eats needs to have enzymes on them. We also need to get him stable (consistent good poops and gaining weight). To do this, we try to limit the number of variables that could affect him, and treats are one of those variables. Once he is stable, there are different options to try. Some dogs are very motivated by toys, so some people use toys as rewards, or attention/praise. If you can, hold off on treats and try to find a different reward while we get him to the point of good poops.

A couple more things: Enzymes...expensive Yikes is right...from the vet. Many of us use pancreatin from Pixie has been on them for 9 years, they were literally 1/3rd of the cost of the ones I first got from the vet, and they worked exactly the same.
Antibiotics: If Wade needs antibiotics for SID again, tylan is the preferred antibiotic for EPI dogs. It tends to work better for most of our dogs, and it is very safe. Metronidazole can have nasty side effects, especially if use for a long time. I personally wouldn't put him back on metro again soon since he's already had 2 rounds.
B12: Wade's B12 is at a good level now, but you should familiarize yourself with the signs of low B12 because the majority of our dogs need B12 supplementation at some point.

And one question: What are his poops like?

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Posts: 988
Location: Nashville, TN
Country: United States
State: Tennessee
Pet name: Doc

Re: Newly diagnosed with EPI, 15 week puppy

Post by Madelon » 29 Jun 2020, 19:25

Hi Kelly - welcome to you and that adorable little puppy Wade :)

Shirl gave you some great advice. A few things to add.

Enzymes - the recommended dose is 1 level tsp per cup of kibble, mix in a little luke warm water, and mix in kibble - sit 20-30 minutes before serving.

Treats - try getting Wade interested in ice chips/cubes - I did that with my boy even though he wasn't diagnosed with EPI - lucky I did cause to this day he can't tolerate any treats and has always thought of ice cubes as treats. In fact he will sit in front of the freezer drawer until you give him one :). Bonus is it helps with teething too :)

B12 - you will likely need to supplement at some point as most EPI dogs will develop low B12 if they don't have it at diagnosis so please talk to your vet about testing the B12 in the future and familiarize yourself with the symptoms of low B12.

Keep a detailed log of everything you give and everything that comes out so you know what's working and what isn't. Here's a link to an EPI log you can download and use.

Keep us posted and please ask any questions - we're here to help guide you through this journey :)
MADELON and Doc. DX EPI and SIBO: 5/22/2015
Test Results: (1st) 7/2014 = TLI 16.5, B12 894, Folate > 24; (2nd) 5/2015 = TLI < .4, B12 406; Folate >24; (3rd) 10/2015 TLI < .4; B12 >1000; Folate 14.4. Prior to DX: May 2014 (2mos) - DX coccidia/bladder infection; July 2014 (3mos) 1st EPI test = TLI 16.5, B12 894, Folate >24 - Dx SIBO not EPI; Feb 2015 thru May 2015 - weight loss only; May 2015 vomitted several times, diarrhea and eating poop. Regimen: 4 cups Sport Dog Food Elite Herding - Diane 6x 1tsp per cup; 1 WonderLab PetFactor B12 2x day; 1/2tsp Slippery Elm 2xday; Multivitamin; 1 Zyrtec 10mg 2x day; Salmon Oil

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Posts: 1048
Location: South Liverpool
Country: United Kingdom - England
Pet name: Kara, lost 10th May 2019
My name: Jean

Re: Newly diagnosed with EPI, 15 week puppy

Post by Jean » 30 Jun 2020, 09:12

huge welcome to you and Wade, God love him, I dont think he is the youngest

we are in UK so things are a little bit different here , but only as far as enzymes go

first of all, if you havent already, is to inform his breeder, they should remove the parents from their breeding programme, but noone can enforce that, but maybe his litter mates should be on watch, just a heads up for them

you might want to look at Enzyme Diane for discounted enzymes

fabulous endorsement from one of our members

just scroll down to V's input

Montgomery is a cat, but that makes no difference, I had an EPI cat in the 80's, she lived to 20

as a puppy he will need higher calorie puppy food. we recommend grain free, chcken doesnt seem to agree with them, and rice is the same

Royal Canin was a no no for my Kara, went straight through her, b12 is essential to digestion , so it might be as well to supplement as suggested

As far as treats use a squeaky ball for rewards and training, Kara loved her ball

just remember you have a team here, and friends who will listen and reply

My name is Jean we live in Liverpool in Uk

My Kara born 21 July 2009 diagnosed with EPI by cTLI test August 2010 TLI = <1...folate 14 Cobalamin 408, shot down to 94, b12 injections every other day

Lowest weight 39 pounds

We used Panzym enzymes, Tylan and Chemeyes b12 capsules

Sadly, on 10th May 2019, we lost her to DM


Posts: 487
Country: United States
State: New Jersey

Re: Newly diagnosed with EPI, 15 week puppy

Post by Barb » 30 Jun 2020, 21:17

Omigosh, Wade is adorable! A warm welcome to you and Wade. You have received excellent advice so far. I just wanted to welcome you and tell you to try not to feel too overwhelmed. The beginning is the hardest part, until you get everything balanced. It will get easier. Ask any questions you have.


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