New to EPI: Phantom

[TaylorN]

Hi all, I work at an animal shelter and recently adopted an EPI dog that went months without enzymes under a previous owner. He is a black GSD mix and was 53lbs (already emaciated) upon entering the shelter. Within two weeks, he was at 42lbs, even when being given 6 cups a day. I adopted him and confirmed EPI via the TLI test.

On 11/28, he was started on a pancreatic enzyme concentrate powder by the brand covetrus - what my vet prescribed. They also had him on metronidazole for 5 days. I gave the recommended dose of 1tsp per cup of food. Within 3 days, I saw vast poop improvement and he had gained 2.5lbs in 5 days! However, I was running out of powder. After a week, I ordered the 6x from enzyme Diane and “Phantom” has been on this since 12/5.

Prior to starting any enzymes, I heard lots of tummy gurgling. It seemed to go away with the enzymes, however recently I have noticed some burping and odd swallowing motions after his meals. On 12/7, he threw up his breakfast and was stretching a lot as if trying to relieve some pressure. I am guessing he was gassy. Today, 12/8, he is doing much better, however the tummy gurgling has returned and the burping and swallowing continues.

I currently have him on the enzyme Diane 6x powder and 1 tablet of WonderLabs B12 as his B12 level was 208 ng/L at the time of testing for EPI. He is eating the adult dog Purina Pro Plan focus dry food, which is not grain free. It does have low fiber ~4% and moderate fat. My vet was hesitant to recommend grain free as she said it’s linked to heart issues in dogs. Thoughts?

Today I ordered the slippery elm powder by WonderLabs. I wanted to come onto this forum and see if anyone can add onto this / give suggestions.

Thanks in advance!

[jilbert57]

Welcome and thank you so much for adopting Phantom!
I suspect with B12 at 208 you should up the Wonderlabs to 1am and 1pm feedings. I would suggest the B12 shots but the oral might work. The Epi dogs B12 needs to be 600 or higher.

Your Phantom probably has SID/SIBO. You can try the SE that you ordered and if between that and enzymes it does not resolve, you might need a 45 day course of Tylan antibiotic twice a day.

Most Epi dogs do better grain free just look for one pea and legume free. The grains keep the enzymes from working at 100% .
I am including a couple links for you to look over. They should help.

https://epi4dogs.com/slippery-elm/

https://epi4dogs.com/b12-in-brief-2/

https://epi4dogs.com/taurine-grainfree-diets/

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

Jill

[Olesia711]

Hi Taylor and WOW!!! Poor Phantom.... he certainly wasn't taken care of until you (thank goodness!!!) came along. Thank you SO much for adopting him!

Your vet had him on the right stuff.. but unfortunately the way too expensive stuff! Glad you connected with EnzymeDiane. L

Like Jill suggested what Phantom is experiencing now is SID.... FYI, all dogs with EPI have SID to one degree or another.... and our objective is to keep it under good control....

Good that you ordered the SLippery Elm.... that is a prebiotic and mucilage that usually helps the imbalance in the gut improve. We may be doing another deeper study into Slippery Elm in the future as to why it seems to help dogs with SID (small intestinal dysbiosis)... for now they think that, at the very least, it's natural mucilage properties starts protecting the damaged gut barrier (damaged by SID) from any further bad metabolites getting thru, and that it also has prebiotic properties.... .Gut FLora is a big problem with EPI dogs. They do not have enough of a bacterial population in the gut.... and they also do not have enough variety of bacteria in the gut. Prebiotics feed the bacteria. So the SLippery ELm, should help.

If SE appears to help just not enough, then administer a pre+probiotic. At the present time, we are recommending Proviable probiotics from your vet. Start with less than half the recommended dose and work your way up to a full dose over the course of a week or two. Give this a few weeks (maybe 3 weeks) and hopefully you will start to see improvement (no repeated gas, upchucking, acid, loose stools, appetite issues, tummy ache/grumbling, etc) if you see improvement continue with the probiotic...

if you don't see any improvement at all with a pre+probiotic ...., then ask the vet for a course of Tylan/Tylosin Tartrate soluble powder antibiotic...
https://epi4dogs.com/antibiotics/
do NOT give Phantom metronidazole for any chronic gastrointestinal situation. New research came out from TAMU to not use Metro for chronic gastrointestinal issues, as it can kill some bacterial strains that can never be reintroduced no matter how many probiotics you give the dog...and there will forever be a gut problem. if an antibiotic has to be given (and often times it is needed), then give Tylan twice a day with breakfast and dinner for 45 days. Tylan does not kill all the bacteria like Metro does, but rather it is a macrolide antibiotic which means it "inhibits" the reproduction.... so it is a better antibiotic to give.

very glad to hear that you got the WOnderlabs B12 Phantom's B12 is very low

The food may or may not be ideal..... some EPI dogs do fine with grain in their food, but many do not. The problem is that grain can reduce the efficacy of the enzymes from anywhere from 0% to 50% and we don't know from one dog to the next what the % is.... this is why we suggest low fiber content food... mislabeled as "grain Free"... with EPI dogs, when first starting out, ... later when things settle out (or if a variety of grain free/low fiber food is not working) then we suggest trying a food with a little bit of rice..........also avoid food with multiple pea product in them, these really make a mess of the EPI gut.... one or two pea ingredients are fine if not one of the top 3 ingredients.... but stay away from too much peas/legumes....

And........... very important.. be sure to start with 1 level tsp of enzymes per 1 cup of food, add enough liquid to moisten the meal, wait 20 minutes then serve.
Once things become stable... then you can try reducing the amount of enzymes... start by reducing 1/8 tsp at a time... watch to poos, if all good, reduce by another 1/8 tsp... do this until you notice the poos are getting sloppy again, then you reduced too much and go back to the least measurement that still worked well.

Also.... in the beginning, try to feed 150% of the required calories BUT... not in just two meals, try to break it down into 3 or 4 meals a day. I used to feed the last meal just before bed time. YOU won't have to do this forever, just until most of the weight comes back on.... and then you can reduce the amount of meals back down to jsut two a day..

Again, thank you so much for opening up your heart and your home to Phantom!!!!!!

[TaylorN]

Thank you!! And yes, he was certainly neglected by the previous owner. I have worked at the shelter for 4 months and haven't struck a chord with any dog this way until Phantom, and I absolutely knew he had to come home with me. Someone found him wondering around and brought him in. He was not neutered. Turns out, he could be seen wondering around for months on end before the woman finally grabbed him and brought him in. A potential owner called to reclaim, however he would not give us his name or number. All he would say is that A) he didn't want to "waste $70 on reclaiming the dog, would rather spend the money elsewhere" and B) the dog "had a pancreas issue that needed medication." He would not release ANY other information, even when the receptionist asked for more information regarding the pancreas issue/what vet we could contact to get him on some medication. Simply put, if we were not going to give his dog back, we were not getting any more information out of him. It was clear to me that he did not care about this dog. The 3-day stray hold was TORTUROUS. I prayed he wouldn't show up to take him back. Fortunately, he never returned!

I knew nothing of EPI before this but thankfully, our spay/neuter vet on staff heard his story and, knowing he's a GSD mix, said he may have EPI. The shelter sent off bloodwork that was taking several days to come back (it was sent to TAMU - where I attend college, actually! How cool that they have done so much research on the subject!) however I had done my research and was quite certain he had it when considering his symptoms. I adopted him before we knew for sure.

I am up to speed on everything mentioned and am eager to start the slippery elm for the SID, though I do have a question regarding the grain free theory. How does one know if their dog is doing "well" with grain versus without? In other words, what is the standard of "doing well" for an EPI dog? Phantom is currently eating Purina Pro Plan focus, which includes grain but is 4.5% fiber, high protein, and 12% fat (if I remember correctly). When referencing this site's poop chart, his poop is a consistent score of 3, even with the SID issues. Not perfect, but consistent and quite close! Prior to the enzymes, his poop was a 6/7 score cow patty. He did gain 2.5lbs in his first 5 days on the enzymes and Purina Pro Plan. I will admit, I am hesitant to switch over to a grain-free diet unless absolutely necessary.

Also, do people continue the slippery elm for life, or just as needed? Or Both? LOL.

[Olesia711]

EPI Log 8-2017.pdf

(404.61 KiB) Downloaded 128 times

WOW!!!! You are his human guardian angel!!!!

Ahh the food...... we typically recommend starting with a grain free food (low fiber food) and record all the ingredient in case it doesn't seem to be working.... sometimes some folks have to try a few different brands of foods and often times when there is a continuous problem it is some itty bitty ingredient that is just not agreeing with the dog. Some times nothing works (diet) constant loose stools ...until the dog is placed on a hydrolyzed food, and then there are even other times when low fiber food doesn't work until a diet with a little rice is added....SOOOOOOOOOO as you can surmise, diet is a mixed bag and it all depends on the individual dog. Our recommendations are based on the reaction from the majority of the EPI population, but always remember that your dog may have a little different needs from other EPI dogs especially when it comes to diet.

... if you are seeing a #3 from 6-7.... then you are almost there and i wouldn't bother changing... or at least not yet. Over the years what i have noticed with thousands of EPI dogs is that when trying different foods, if the stool is 2 or 3 but the volume is large or just too in a day, that usually indicates that there are too many carbs/fibers in that particular diet.... so change the composition.

... OR..... another trick (before changing food ) is (for example) sometimes you are dealing with two different health conditions and the "other" health condition requires that you feed a diet that is not exactly optimal with EPI.... in which case you can compensate for the not so ideal EPI diet by adding a pinch more enzymes to the meal.
You can do this with a not so optimal diet.

... OR.... you can start keeping really good notes on all the ingredients in a food, so when you change food note all the similar and non-similar ingredients, and if the new food is helping or hindering yor dogs "out-put" You'd be amazed at how much we figure out of what is really going on by keeping an EPI log! (attached below).

Ahhh... SLippery Elm.... great stuff for most EPI dogs. SOme people keep their dogs on a maintenance dose forever... while other only need to give it on an as needed basis. Great thing about Slippery ELm is that if it is going to work, you will see results pretty quick (like within a day or a couple of days)... But be careful with SE... this is one of those things where more is not always better.... sometimes too much of a dose of Slippery ELm will actually give loose stools instead of fixing loose stools... again, it all depends on the dog.

Effectively managing EPI is all about finding the right balance of the recommended EPI protocol that works best for YOUR dog.... but once you do, most of the time EPI is very manageable

[Madelon]

Hi Taylor - welcome to our EPI family and THANK YOU THANK YOU THANK YOU for rescuing Phantom! You've been given GREAT advice so I won't muddy the waters as I know it can be a lot to take in. I will just let you know that my boy (solid black GSD) has been on 1/2tsp of SE AM and PM for about 3yrs now and I have no intention of stopping it. When I did his poop went south. I have also gone through oh so much with food sensitivities and diet changes which can be frustrating and overwhelming if you do decide at some point to change the food buy small bags until you find what works but one that a lot of us have had luck is Taste of the Wild or Sport Dog Food Elite.

Please keep us posted on how things are going.

[Tuckaboo Pam]

YEA, Taylor!!!! WELCOME. Rescues are the best, and what a handsome one Phantom is! Nothing to add, except that I have learned some helpful details by reading the signatures at the bottom of posts, where we tell an abridged story of where our EPI journey has taken us. That's all. Take care----Pam & Tucker

[TaylorN]

Thank you all! I am anxiously awaiting the SE arrival as Phantom’s poop has become a bit inconsistent. After seeing so many doing well on Sport Dog Elite, I am considering the switch. Where does everyone buy it? I am seeing $65-75 for a 30lb bag from Chewy, which is vastly more expensive than what I’m paying now for the low fiber Purina Pro Plan. It seems as though owners feed less on the Sport Dog Elite, however, which may even things out. If and when Phantom reaches 70lbs, it is estimating that I will be feeding 2 cups per day. Can anyone speak on this?

[TaylorN]

ALSO! Something I have been wondering is how long it takes a dog to bounce back from being malnourished. Phantom is a smaller GSD and should probably be 60-70lbs. He was 42lbs at the time I adopted him and gained 2.5lbs the first five days on enzymes. I have not had access to a scale since his check up on 12/3. During his first week, he did not run at all. Of course the vet said he has little to no muscle mass and needs to rebuild. If I am not actively engaging him, he is sleeping and has been for my 2 weeks of ownership. I can see his energy gradually increasing, albeit slowly, and he has started trotting around. He has been on enzymes for nearly 2 weeks now. Does anyone have experience with this? Prior to me adopting him, he was most likely without enzymes for MONTHS and has been starving for quite some time.

[Olesia711]

HI Taylor,

I used Sport Elite food for my EPI gal and she did great on it....and i purchased it from Chewy.... i tend to gravitate to Chewy for options because not only do they have good customer service, they have these neat little tools that you can use when looking for certain diets and you can look for grain free/ and pea free.... it's a very nice useful too!