Reagan - New to EPI

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.
soaringcl
Member
Posts: 5
Country: United States
State: Ohio
Pet name: Reagan
My name: Cheryl

Reagan - New to EPI

Post by soaringcl » 23 Jan 2023, 17:15

Our 2yr old female GSD is showing sigs of EPI.

Weight Loss 20lbs. 84.5lbs in June 2022 to 63.1lbs in Jan. 2023
Cow Puck stools frequently, yellow or clay color several times a day and night
Ravishing eating

We are waiting for the blood work to come in so see what our Vet says so we don't have any information on a diagnosis yet or what her blood counts are.

She is eating 1.5 cups of TOTW Pacific Stream and 1/2 of can of Science Diet I/D from our vet 4 times a day. She also gets 1 pk of FortiFlora SA Synbiotic Action and 1 hard boiled egg in the morning.

What types of questions should we be asking the vet when the blood work comes back?

Very worried for our girl. Any information will be greatly appreciated.

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Olesia711
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Posts: 4025
Location: North Carolina
Country: United States
State: North Carolina
Pet name: Izzy
My name: olesia

Re: Reagan - New to EPI

Post by Olesia711 » 23 Jan 2023, 19:44

Hi Cheryl and welcome to our forum, but so sorry that Reagan is struggling. However.... so thankful that you already had the cTLI test done to see if EPI is what Reagan is struggling with.

If it is EPI, ask for the actual test results... this will better help us help you.
Also... did you have the B12 test done at the same time? if so, ask for those actual test result values to.

If EPI, the vet will want to put Reagan on the proper pancreatic enzymes... They should be porcine enzymes, powder is best. Make sure the Lipase enzyme level is around 71,400.... do not go with a product that has Lipase enzymes at 9,000 USP units... in which case it is cost negative since you will have to use a lot more ..... Typically vets will prescribe a prescription enzyme like Viokase, PancrePlus, etc (there are lots of brands) but many of us use ENzymeDiane 6x https://enzymediane.com/ because it is food grade generic and you can save a ton of money. Some folks start with a prescription brand and then switch over once that runs out to a food grade/generic brand. ... but this is totally up to you,
here is our list of enzymes: https://epi4dogs.com/enzyme-list/
FOr powdered enzymes, Start with 1 level tsp of powdered enzymes per 1 cup kibble, add enough water to moisten the food, mix and let sit for 20 minutes (to avoid possible mouth sores) and then serve. if serving wet food, reduce the amount of enzymes to 1/2 tsp to 3/4 tsp per 1 cup wet food (since there is already a lot of moisture in the food)

Next... if EPI, ALL dogs with EPI have SID (small intestinal dysbiosis)... which has most of the same symptoms as EPI.... so if after say 3 or 5 days, you are doing everything right with the enzymes, but the dog still has loose stools, then most likely the enzymes are indeed working, but what you are seeing is the results of SID.... in which case your can try a prebiotic... or try slippery elm (a mucilage with prebiotic properties)... if this doesn't stop the loose stools, then talk to your vet about trying a probiotic with prebiotics. SOme of the brands we suggest, but it really depends on the individual dog's gut flora what will be most effective.... anyway... so some of the brands that we suggest are: Proviable, or Visbiome, (from your vet) or (you can try OTC) Mercola COmplete PRobiotics or VetriScience Mega Probiotics. But please know to ALWAYS 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. If this all fails to get SID under good control, then you will need to have a conversation with your vet about starting Reagan on a course of Tylan antibiotic... but try your best not to have to use an antibiotic if you can....... and do not let your vet prescribe Metronidazole (Flagyl) this is not good for dogs with chronic gastrointestinal dysbiosis. Our goal is to keep SID under good control... to-date we do not know how to eradicate SID.... but hopefully in the near future we will have a better handle on it!

Next you can talk to your vet about diet... or just manage diet on your own. EPI dogs usually do not do well on a prescription diet UNLESS there is another condition that needs to have a special diet (like a food sensitivity in which case we suggest trying a prescription hydrolysed food). We typically recommend "starting" with an over the counter diet that has less than 4% fiber content since fiber can inhibit the efficacy of the enzymes from anywhere between 0% to 50%.... and we have no idea which dog will be affected, if affected and by how much. also... start with a food that avoids splitting peas, lentils, legumes (using them more than once in varying forms) and avoid foods with peas, etc as one of the top 3 ingredients.... as this can encourage SID to get even further out of control. Lower fat diets are also not needed unless there is another health situation where you have to control fat intake.. or if SID is raging, you will also want to limit fat intake. However, once dog is stable, you can try adding rice to see if it is tolerable with your dog's digestive system.... in short to see if she can handle fiber, what kind and how much.

B12... over 80% of all dogs with EPI have insufficient B12. The B12 needs to be in the upper mid range (we like to recommend upper 500's to 600's)... normal or low normal B12 means your dog still needs to be supplemented. SOmetimes, even without the B12 blood test, vets will still put an EPI dog on B12 supplementation... since any excess B12 will just be peed out.. Typically sooner or later an EPI dog will eventually end up on B12. Please know that since EPI is a "chronic" condition...that the dog will need B12 supplementation for life... first to bring it up to upper mid range levels.... and then usually a reduced amount or frequency to "maintain" a good level. Without good B12, no matter how many things you do right with an EPI dog, if the B12 levels are not good, the dog will not flourish.

And last but probably the best tool you can ever have managing an EPI dog is to start keeping an EPI log (journal)... there are some good examples and templates here: https://epi4dogs.com/epi-log/
By keeping a log... and AFTER you initiate all the EPI protocol in the beginning (the enzymes, SID treatment as needed, B12, a diet that agrees with the dog) then make only one-change-at-a-time!!!! give the change 3 to 5 days, record the effects, even take poop pictures to show results...... by keeping a log like this it will really help you and your vet identify trends, what works with your dog and what doesn't.

Also.... always share with your vet anything and everything we suggest. Reagan will get the best care if everyone works together to help her :)

Hope this helps a little!
Olesia, was owned by Izzy, a 35lb Spanish Water Dog (SWD), Diagnosed at 1.5 years old - TLI results 1.. Izzy passed away on February 13, 2020 at 15 years old. She lived with EPI for 13+1/2 years. It was because of Izzy that Epi4Dogs was started... she was the inspiration. May her legacy of helping others with EPI continue for as long as needed.........

soaringcl
Member
Posts: 5
Country: United States
State: Ohio
Pet name: Reagan
My name: Cheryl

Re: Reagan - New to EPI

Post by soaringcl » 24 Jan 2023, 02:52

Thank you so much, hopefully we will get her on track. I have printed your response to take to the vet and we will discuss with her a regiment
for our baby girl. I will keep you posted as to the results of the blood work.

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Olesia711
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Posts: 4025
Location: North Carolina
Country: United States
State: North Carolina
Pet name: Izzy
My name: olesia

Re: Reagan - New to EPI

Post by Olesia711 » 24 Jan 2023, 10:05

You are very welcome.... and in case Reagan's results come back in the SEPI range 2.6 to 5.7 (not clinically EPI but something is amiss) and what we call SEPI (sub-clinical EPI) ..... some of these dogs will go on to develop full blown EPI, while others in this range never do go on to develop EPI. But, especially if on the lower end of SEPI and if the dog continues to display EPI symptoms, it is often best to still treat like EPI at least temporarily until another TLI test is done to see if it appears to be progressing towards EPI or not.

If Reagan's TLI numbers fall in this range, please feel free to contact us with any questions.... also..... here is a good read/explanation on some possibilities of why SEPI numbers may be happening............

https://epi4dogs.com/tli-test-not-quite-epi/

Please keep us posted!
Olesia, was owned by Izzy, a 35lb Spanish Water Dog (SWD), Diagnosed at 1.5 years old - TLI results 1.. Izzy passed away on February 13, 2020 at 15 years old. She lived with EPI for 13+1/2 years. It was because of Izzy that Epi4Dogs was started... she was the inspiration. May her legacy of helping others with EPI continue for as long as needed.........

soaringcl
Member
Posts: 5
Country: United States
State: Ohio
Pet name: Reagan
My name: Cheryl

Re: Reagan - New to EPI

Post by soaringcl » 31 Jan 2023, 09:03

We have received the Test Results for Reagan from the Gastrointestinal Laboratory at Texas A&M University. She has been diagnosed with EPI.
Her tests results are:

Cobalamin Fasting 251-908 ng/L 433 ng/L
Interpretation: Result is within the reference interval.

We asked the vet if she needed B12, she is wants to wait and see at the next blood draw what the B12 level is and then make a decision then.

Folate Fasting 7.7 - 24.4 ng/L 12.4 ng/L

TLI Fasting 5.7 - 45.2 ng/L <1 ng/L
Interpretation: Diagnostic for exocrine pancreatic insufficiency (EPI)

Pancreatic Lipase
Immunoreactivity Fasting <200 ng/L <30ng/L
Interpretation: Result within the reference interval. It is unlikely that this dog has clinically relevant pancreatitis. Investigate for other diseases that could cause the clinical signs observed.

Our vet has put her on Epizyme Powder 8oz. We go back for a recheck on 2/13/2023. She is going to do some research on the Powder from EnzymeDiane and will let us know at the next visit to change her over due to the cost.

She has also recommended that we change over to Non-Prescription:

Hills Adult Perfect Digestion - Salmon, Whole Oats and Brown Rice or Purina ProPlan Focus Adult Sensitive Sin & Stomach - Lamb & Oatmeal or Salmon & Rice.

She wants her back to her regular meals 2x a day.

We will keep you updated.

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Olesia711
Founder & Research Director
Posts: 4025
Location: North Carolina
Country: United States
State: North Carolina
Pet name: Izzy
My name: olesia

Re: Reagan - New to EPI

Post by Olesia711 » 31 Jan 2023, 10:34

Hi Cheryl.... thankfully you and your vet did test Reagan for EPI.... now that she is confirmed with EPI, you can treat her accordingly.

Regarding the B12 level of 433.... not good enough.... Please ask your vet to start B12 supplementation... either B12 shots (weekly) or B12 pills daily. The problem with waiting is that ALL dogs with EPI have SID (small intestinal dysbiosis)... SID munches away at any B12 stores in the body. Without B12 supplementation at this point, Reagan's B12 levels will continue to decline. Start off with the typical B12 supplementation and when ready to retest.... then if the B12 is high enough, you can reduce the B12 supplementation to simply a maintenance level.

the Epizyme powder is the right stuff :). give 1 level tsp of enzymes per 1 cup of food if kibble, ... if feeding wet food, reduce the amount of enzymes to 1/2 tsp to 3/4 tsp per cup of wet food.

Your vet is correct about switching over now to non-prescription.... HOWEVER, please start with a low fiber, very minimal if any peas in the diet.... avoid foods with grain.... start with this type of food and then if/when all is well.... THEN try adding some fiber (best to start with your own, something like cooked rice) and see how well it is tolerated. If well tolerated, then no need to stay on "grain-free" food...........
We have seen WAYYyyyy too many EPI dogs not get stabilized, vets and owners try all kinds of things, when the problem was that now that the dog is on enzymes, it can't have too much fiber in it's food..... cause fiber destroys often destroys the efficacy of the enzymes to one degree or another.... which just don't know which dog is affected by ow much........

Actually... if you have any of the TOTW Pacific Stream left over that she was on before.... go ahead and try giving it to her again, now that she is on enzymes. See if it agrees or not.. in smaller portions like you did before.

Also... depending on how much weight REagan has lost, you want her body to regain what it lost.... so we recommend feeding 150% of what she requires BUT feeding only two meals a day is stressful on the gut, especially one that is a mess. Again, in the beginning we strongly recommend feeding smaller portions but with more frequent meals, like 3 or 4 a day.

Hope this helps and please keep us posted!
Olesia, was owned by Izzy, a 35lb Spanish Water Dog (SWD), Diagnosed at 1.5 years old - TLI results 1.. Izzy passed away on February 13, 2020 at 15 years old. She lived with EPI for 13+1/2 years. It was because of Izzy that Epi4Dogs was started... she was the inspiration. May her legacy of helping others with EPI continue for as long as needed.........

soaringcl
Member
Posts: 5
Country: United States
State: Ohio
Pet name: Reagan
My name: Cheryl

Re: Reagan - New to EPI

Post by soaringcl » 31 Jan 2023, 17:41

I spoke to the our and sent her your response and she is in agreement with starting the B12 shots. We will start on Feb 13 when we go back to the vet for a check up. Will keep you posted. Thank you.

User avatar
Olesia711
Founder & Research Director
Posts: 4025
Location: North Carolina
Country: United States
State: North Carolina
Pet name: Izzy
My name: olesia

Re: Reagan - New to EPI

Post by Olesia711 » 31 Jan 2023, 18:50

EXCELLENT1!!! So glad you talked to your vet and you are going to start the B12 shots.
Olesia, was owned by Izzy, a 35lb Spanish Water Dog (SWD), Diagnosed at 1.5 years old - TLI results 1.. Izzy passed away on February 13, 2020 at 15 years old. She lived with EPI for 13+1/2 years. It was because of Izzy that Epi4Dogs was started... she was the inspiration. May her legacy of helping others with EPI continue for as long as needed.........

Barb
Staff
Posts: 918
Country: United States
State: New Jersey

Re: Reagan - New to EPI

Post by Barb » 03 Feb 2023, 15:36

A warm welcome to you and Reagan! You are in excellent hands with Olesia and she has given you wonderful advice. Once you get everything in balance with the treatment, you will see a marked improvement. Sometimes it takes trial and error until you find everything that works for your pup, but try not to get discouraged. It sounds like you have a good vet who is open and following the protocol.

Let us know how she does.

Barb

soaringcl
Member
Posts: 5
Country: United States
State: Ohio
Pet name: Reagan
My name: Cheryl

Re: Reagan - New to EPI

Post by soaringcl » 11 Feb 2023, 08:01

Thank you for your support. Reagan has started on her new regiment and is doing great. She visits the vet on Monday and we will be starting the B12 shots. We will keep you updated.

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