In need of advice

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.
Alex Renzie
Member
Posts: 4
Country: United Kingdom - England
Pet name: Winnie

In need of advice

Post by Alex Renzie » 05 May 2022, 11:32

Hi,
my wife and I adopted a 2 year old French Bulldog with EPI three days ago. Her name is Winnie and she is amazing. She was given up because the previous owners couldn't manage with her EPI and she was with the Dogs Trust for 4 months before we adopted her. She came in weighing 8.2 kg and they started feeding her with Purina Hypoallergenic wet food with Lypex, increasing the amount and frequency of meals over time because she wasn't putting on much weight. Finally they landed on 4 meals a day of 300g Purina Hypoallergenic wet food (1200g total/day) with one whole capsule of Lypex per meal and 1 capsule Cobalaplex every other day in her morning meal. They didn't try any other foods or enzymes. It was recommended we keep her on this regimen with the Purina food and Lypex and Cobalaplex.

She is still quite skinny (ribs and hip bones showing) and in all the time being fed 1200g daily of Purina Hypoallergenic wet food she has only gone up in weight to 9.2 kg. As you do, we read around extensively and considering her weight hasn't gone up much and her stools are sometimes firm but mostly loose we have our doubts that we should keep her on this regimen (the horrendous cost of the Purina food also being a small factor, but mainly that it doesn't look very nutritious and doesn't seem to do her much good).

Since her stools have been predominantly loose since we got her we added in 1/4 tsp of Slippery Elm into her meal this morning after which she had the firmest poo we've seen, but then after the 3rd meal today she was back to loose stool. The colour is always the slightly yellowish/clay colour.

We've looked at alternative foods (bearing in mind Winnie is also allergic to chicken) and have come up with a bit of a plan, but being first time EPI dog owners we thought it best to sense check on this forum to make sure what we want to do is actually a good idea.

Our plan:
1. Wait 3-4 more days and keep her on the current regimen with Purina to know how much of it is just down to nerves from being in a new home. Continue with 1/4 tsp slippery elm in her morning and evening meals.
2. Gradually switch her over to Pooch and Mutt's "FISH, POTATO & PEA WET FOOD" (ingredients below). Continue with 4x meals a day and 1 whole capsule of lypex per meal but while transitioning to the new food also gradually reduce down the portion size to arrive at 750g total/day (1200g a day seems like an insane amount for such a small dog and it just doesn't look like she is digesting much of it anyways). We would check her weight throughout to make sure she doesn't start losing any.
3. If that transition works out (from one wet food to another) and once she is doing well we want to reduce the meal frequency down to 3 times a day (for convenience and to cut down on the daily amount of Lypex).
4. We then want to try introducing kibble gradually to get to a half dry/half wet diet. Pooch and Mutt's "HEALTH & DIGESTION DRY FOOD" seems like a good option (ingredients below).

Here our questions:

- Does this sound like a good plan and like good new foods to try out? Anything we should do differently or watch out for?
- Could we introduce the new wet food and kibble at the same time or is that too many variables at once?
- Lypex is very expensive, so once she is stable on the new diet would it be fine to look at reducing the daily dose say to 2 capsule spread over 3 meals (she is currently on 4x what is recommended on the package)? Are there alternatives to Lypex in the UK that we should try?

Sorry for the long message and thank you in advance for any advice!

Best wishes,

Alex, Rebecca and Winnie



Pooch and Mutts "FISH, POTATO & PEA WET FOOD":
Ingredients/Composition: White fish (64%)(sustainable catch of the day), potato (6%), pea (6%), prebiotics (fructooligosaccharide) (0.5g/kg), seaweed.

Nutritional additives: Vitamins: Vitamin A: 3,6000 iu; vitamin D3: 300 iu, Zinc (as zinc Sulphate Monohydrate) 30mg, Iron (as Iron (II) Sulphate Monohydrate) 14.4mg, Manganese (as Manganous Sulphate Monohydrate) 2.4mg, Copper (as Copper (II) Sulphate Pentahydrate) 1.44mg. Analytical constituents: Crude protein 9%, crude fat 2%, crude fibre 2%, inorganic matter 2.5%, moisture 79%.

258 Kcal/Pack

Pooch and Mutts "HEALTH & DIGESTION DRY FOOD":
Composition: Freshly prepared salmon (25%), sweet potato (25%), dried salmon (17%), potato, peas,salmon oil (1.5%), salmon gravy (1.5%), alfalfa, beet pulp, linseed, parsley (0.08%), brewers yeast, psyllium (0.08%), cranberry (0.04%), glucosamine (260 mg/kg), chondroitin sulphate (160 mg/kg), minerals, vitamins, mannanoligosaccharides (prebiotic mos) (0.015%), fructooligosaccharides (prebiotic fos) (0.01%), yucca schidigera extract (0.01%).

Nutritional additives per kg:Vitamins: Vitamin A (as retinyl acetate) 18,000 I.U, vitamin D3 (as cholecalciferol) 1,800 I.U, vitamin E (as alpha tocopherol acetate) 400 mg, L-Carnitine 450mg, vitamin B1 1.2mg, vitamin B2 1.0mg, biotin 0.72mg.

Trace elements: cupric sulphate pentahydrate 58 mg, zinc sulphate monohydrate 133.5 mg, manganous sulphate monohydrate 105 mg, ferrous sulphate monohydrate 160 mg, calcium iodate anhydrous 1.6 mg, sodium selenite 0.6 mg.

Technological additives: Enterococcus faecium cernelle 68 (sf68; ncimb 10415) 1,000,000,000 cfu as an aid in the establishment, maintenance and restoration of a balanced gut flora in dogs.

Analytical constituents: Protein 24%, crude oils and fats 12% , crude fibres 3.8%, crude matter 6.5%, moisture 10%, omega 6 1.5%, omega 3 0.5%, calcium 1.1%, phosphorus 0.8%, sodium 0.1%.

Kcal/100g - 328.25

Food she is on currently:
https://www.purina.co.uk/dog/dog-food/p ... rgenic-wet
Food we want to transition her to:
https://www.poochandmutt.co.uk/products ... d-for-dogs
https://www.poochandmutt.co.uk/products ... n-dry-food

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Jean
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Posts: 1707
Location: South Liverpool
Country: United Kingdom - England
Pet name: Kara, lost 10th May 2019
My name: Jean

Re: In need of advice

Post by Jean » 05 May 2022, 12:27

Good evening we are from Liverpool where are you in UK ?

We had Kara on Lypex for nearly two years and it was just too expensive, we worked out that 1 Lypex would be enough for 100 grams of food (kibble)

https://epi4dogs.com/epi-quick-guides-outside-usa/

scroll down, you may need to consider more than 1 per meal which must be split open and sprinkled over the food, and because thay are microspheres they need something to make them stick to , we used a small amount of cat food, and mixed in

She was on 5 Lypex per meal at the start we could never get her lower that 3

all food must be enzymed so the mantra is food in Enzyme in, and it must be served immediately, no leaving to incubate

does she have any rumblings in her tummy ?

Kara was intolerant of chicken and poultry fat , we had her on Lamb based

https://www.petsathome.com/shop/en/pets ... ables-10kg for maybe 8 years

as to b12 supplements Chemeyes do b12 also

https://chemeyes.co.uk/product/vitamin-b12-capsules/

you do not need to use expensive food for an EPI dog but we do recommend grain free
My name is Jean we live in Liverpool in Uk

I am the Forum Director which I am very proud of

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


Jeanx

Alex Renzie
Member
Posts: 4
Country: United Kingdom - England
Pet name: Winnie

Re: In need of advice

Post by Alex Renzie » 05 May 2022, 16:51

Hi Jean,

Thank you for your message, very useful information. We are based in London :)

Interesting about the amount of Lypex per 100g of kibble. Would that be the same for wet food? Giving her more nutritious food at lower quantities but with the right amount of Lypex might work well then.

If you or anyone else here have any other thoughts on our plan to transition Winnie to a new diet please let us know. Would also be interested to know your thoughts on how long we should wait before trying an alternative to Lypex. After reading Anns very helpful guide we are keen to try Panzym once Winnie is stable on a new diet.

Thank you again!

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Jean
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Posts: 1707
Location: South Liverpool
Country: United Kingdom - England
Pet name: Kara, lost 10th May 2019
My name: Jean

Re: In need of advice

Post by Jean » 06 May 2022, 05:33

This was put together many moons ago, Panzym was one we used for maybe 8 years with total success

if you would like to talk by phone let me know


Jeanxxx
My name is Jean we live in Liverpool in Uk

I am the Forum Director which I am very proud of

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


Jeanx

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DocX
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Posts: 18
Country: United States
State: Massachusetts
Pet name: Mina
My name: Doc

Re: In need of advice

Post by DocX » 07 May 2022, 11:18

Hi Alex,

The TL/DR of what I am about to say is 'be careful about rocking the boat'.

My advice, which is based on having owned two dogs with major GI issues, is to be very careful about changing things if the current state of affairs is working or mostly working, and to change things very slowly, carefully, and one thing at a time.

It is true that the ingredients on hydrolyzed hypoallergenic diets do not look appetizing, but they are nutritionally complete. One of my dogs literally couldn't eat anything else for almost eight years, but never had any nutritional deficiencies. My current dog was diagnosed with EPI in February. She's eating a hydrolyzed hypoallergenic diet for two main reasons: 1) it's low-fiber and really easy to digest, so well-suited to an EPI dog and 2) my vet suspects she may have additional GI issues, and a hydrolyzed diet is the safest possible thing to feed her under these circumstances. It has been very helpful to be 100% certain that diet was not aggravating any other GI issues while I was troubleshooting.

I would urge you not to switch the hydrolyzed diet due to nutritional worries or because the ingredients look gross. Cost is a different issue (I understand - my dog weighs 33 kg!). Trying the kibble version of a hydrolyzed diet Winnie is mostly stable on, is less risk and less of a change than switching her to something entirely different. However, canned food is easier to digest and a bit easier to get enzymes optimized.

As you are trying to optimize caring for your dog, sometimes it will be really obvious when something isn't a good idea. For example, when I tried giving my dog a bit of canned pumpkin to 'firm up', it had dramatically opposite the desired effect. Other times, it's OK to wait a little to see if things stabilize. For instance, when I was weaning my dog off daily antibiotics, there were good days and bad days, but I waited it out because she was going between 'almost normal' and 'mushy, but can still pick up').

You might want to check with the rescue you adopted Winnie from re whether she did any antibiotics early on in her diagnosis. Small bowel bacterial overgrowth is really common in EPI. Some dogs will really benefit from a round of antibiotics to calm things down, and some dogs need a little bit of Tylosin every day to keep things under control.

Just a little sanity checking about how much enzyme you are giving Winnie currently:

One lypex capsule contains (units of activity) protease 1200, Lipase 30000 and Amylase 18750. One can of H/A contains 400 calories.

For every 400 calories I feed my dog, I give her three Pancreatin tablets, Each tablet contains 9,000 USP units lipase, 57,000 USP units protease, and 64,000 units amylase. So I give her 27,000 units of lipase, 171,000 units protease, and 192,000 units of amylase to digest 400 calories.

Many people on this board use a powder version of this rather than a tablet form. They give 1 tsp per cup of kibble (~400 calories), which contains 71,000 units lipase, 388,000 units protease, and 460,000 units amylase.

By eyeball, it looks like Winnie is getting a similar ballpark range of lipase per meal, but the protease and amylase are a lot lower than what many of us use. However, this may be because Lypex is enteric-coated, so enzyme will not be destroyed by stomach acid, in which case less enzyme would be appropriate. It's important to remember that too much enzyme can also be problematic.

Therefore, I'm also comparing Winnie's dose to a comparable dose of Creon 3000, which is enteric-coated, and many people like to use for their EPI dogs. Every Creon 300 capsule has 3,000 USP units of lipase; 9,500 USP units of protease; 15,000 USP amylase. My experience has been that one Creon 3000 is approximately equivalent to a Pancreatin tablet. So, if I gave my dog three Creon per meal, it would be 9000 units lipase, 28,500 units protease, and 45,000 units amylase. This suggests to me that roughly, an enteric capsule formulation allows you to get by with about 1/10 of the enzyme you would otherwise need, but I wonder if Winnie is still having trouble digesting the starch (needs amylase) and protein (needs protease) in her food.

I don't know if other enzyme formulations are available in the UK, but if they are, you might want to talk with your vet about fiddling with the dose. For what it's worth, my vet originally prescribed about half of what my dog actually needs per meal. Personally I would fiddle with that before trying to switch my dog's food.

This post is getting very long so I'm going to post now and hope other wise forum members will chime in and / or point out if I've made any egregious math errors and / or bad assumptions about equivalency of enteric coatings.

Best of luck. It is so stressful trying to figure out what works for your dog, and everyone here understands.

Doc & Mina

Alex Renzie
Member
Posts: 4
Country: United Kingdom - England
Pet name: Winnie

Re: In need of advice

Post by Alex Renzie » 08 May 2022, 06:29

Thank you for the very helpful responses! Not that easy to wrap ones head around quantities of enzymes in different supplements, so that breakdown is really useful.

We've upped her lypex and won't experiment with her food for the time being. Her stools are definitely smaller than a few days ago but still up and down in terms of how firm they are (almost normal sometimes, mushy but can still pick up most of the time). I think you're right though Doc in that the problem might not be the lipase, since that is high in Lypex and she barely has any fat in her diet anyways, but the amylase and protease. We've ordered panzym and will give that a go if we don't see any improvements in 2-3 weeks. She was on Lypex for 4 months at the shelter we adopted her from and from her vet notes her stools and weight have been up and down during that time. They upped the food quantity rather than optimising the enzymes by the looks of it so we are keen to get the enzymes right for the quantity of food she needs so she actually digests it and gets the calories. We've seen a lot of positive things being said about Panzym and it seems easy to get so keen to try that at some point.

If we do try something else I guess enteric capsule to powder is a bit of a change, so is that best done by slowly transitioning from one enzyme brand to the other? Is it fine to mix enzymes from different brands?

Winnie wasn't on any antibiotics as far as we can tell from her notes. Will give her previous vet a ring to check. We also found a vet with EPI experience nearby who works with a pet nutritionist, so will take her to have a check up ASAP and see if she might have SIBO. She did do a couple of "firmer then loose ones" since we've had her which might be a sign that it's not just EPI that she is struggling with at the moment.

It's been a steep learning curve for us and having the support here really helps. Thank you again!

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DocX
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Posts: 18
Country: United States
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Pet name: Mina
My name: Doc

Re: In need of advice

Post by DocX » 08 May 2022, 09:41

Hi Alex,

I'm really sorry, but I'm pretty sure I made an error yesterday in my enzyme calculations and I want to correct it ASAP. Olesia has a really helpful reference about different enzymes and units here (https://epi4dogs.com/enzyme-list/) which indicates that UPS and BP units are different (but apparently, only for amylase and protease, not for lipase!)

From the table:
CREON 10 Composition : 150 mg Pancreatin
Amylase 8,000 PhEur units (BP Units) also equals 33,400 USP units
Lipase 10,000 PhEur units (BP Units) also equals 10,000 USP units
Protease 600 Ph Eur units (BP units) also equal 37,500 USP units

Lypex is definitely measured in BP / EurPharm units so if dose of lypex is: protease 1200 BP, Lipase 30000 BP and Amylase 18750 BP, this corresponds to 1 lypex = 30,000 USP units lipase, 75,000 USP units of protease & 78,281 UPS units of amylase.

This looks fairly comparable to three Creon 3000 (9000 units lipase, 28,500 units protease, and 45,000 units amylase) or a Creon 10 (10,000 lipase, 37,500 protease, 33,400 amylase) per cup of kibble. If we assume that about 10% of a non-enteric-coated dose (71,000 units lipase, 388,000 units protease, and 460,000 units amylase) survives stomach acid, it's also reasonably close to what is recommended per cup of food for powdered enzyme. This is consistent with Jean's report that 1 lypex works for 100 g of kibble which is ~350-400 calories. It also better passes the general sanity test of 'Lypex box recommendations. I'm so sorry for the error.

Alex Renzie
Member
Posts: 4
Country: United Kingdom - England
Pet name: Winnie

Re: In need of advice

Post by Alex Renzie » 08 May 2022, 11:47

No worries, thank you for letting me know. Really doesn't make it easier that enzymes arnt measured in the same units! (I'm a scientist and it still blows my mind)

Tuckaboo Pam
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Posts: 1345
Country: United States
State: Florida
Pet name: Tucker
My name: Pam H.

Re: In need of advice

Post by Tuckaboo Pam » 08 May 2022, 15:03

I wonder if the ups and downs are due to SID, which goes hand in hand with EPI.

https://epi4dogs.com/sidsibo-management/

A high quality probiotic can be added after giving the slippery elm a couple of weeks. This may be enough to control the SID.

Many of us report the early poos being better than the ones that come later in the day.

I didn't read your entire thread, so apologies if you've already addressed this. And B12?

Oh, are you able to post your test results here?

Thanks---Pam
Tucker was a shepherd/lab mix--- TLI 1.3, Folate 9.7, Cobalamin 666, Lipase 38. Took Diane's Enzymes 4 teaspoons/day, Wonderlabs B12 one capsule per day, and Tylan 1/16 teaspoon/ morning (to hold SID at bay). Taste of the Wild High Prairie, 1 1/2 cups/day, with a total of 4 cups of Fresh Pet. Stopped eating everything in sight, and went from 60 to 85 pounds! Tucker was my boyfriend, and my husband was OK with that. Tucker succumbed to hemangiosarcoma, but we cherished every day we had with that wonderful, beautiful boy. I will always, always miss my sweet big boy.

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Montgomery
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Country: Canada
Pet name: Montgomery (I'm a CAT!)
My name: V

Re: In need of advice

Post by Montgomery » 08 May 2022, 16:48

You're awesome, knowingly adopting an animal with special needs, and uncommon ones at that. I wish I had some wonderful advice to add, but I don't. I just think it's great that you took this little one on, and I'm so glad you've found this forum; these people are amazing!
Montgomery was born 20 March 2012. He eats extra lean ground chicken, lean ground pork and lean ground beef completed with Alnutrin and freeze-dried chicken liver, with hard-cooked egg. He gets two size zero capsules of Enzyme Diane's enzymes at each of his six meals, and a size four capsule of Tylan three times a day. He's a fierce little Spitfire with a roaring Merlin engine.

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