New to EPI - Looking for any help I can get!

[Barb645]

Good Morning, my name is Barb and Carli my German Shepherd mix was diagnosed with EPI on Oct 18th. I got her from a rescue group when she was one and she is now 5 years old. She was not in good shape when I got her but at one point she weighted 80 lbs. I started giving her PancrePlus enzymes on Oct 23rd. She seemed to get a little better for a while now has slid back a little to having softer stools. Her test results from Oct 15th were TLI 2.2, Pancreatic Lipase Imm. Fasting <30, Cobalamin <150, and folate 7.9. I feed her 1 and 1/2 to 1 and 3/4 cups of food 3x a day (sometimes I add a tablespoon of the same can food I feed dry) Science diet sensitive stomach and skin, chicken and barley for big dogs. She gets 1 tablet B12 (1000) a day and Purina Plan Pro pre and probiotic package daily. Recently we have had to add Omeprazole 2x daily 12 hours apart as she started vomiting after feeding. The first two weeks she added about 1/2 lb then this week she lost that weight. She is currently 71 lbs. I am not sure why she is losing weight she has been eliminating 2 to 3x a day, way less than before and although soft, it is formed. Any suggestions about what I can do to help her would be greatly appreciated.

In closing, I just want to say that all the information and posting on this site have been a lifesaver for me. I have been able to communicate with my vet since she has never treated an EPI dog before and try to help her understand some of what is needed. The B12 I have is from Chewy but I have ordered Wonderlabs and it is on its way. However the bottle says 2 a day and my vet said one. Any advise on that?

Thank you!

[Olesia711]

Hi Barb and welcome to you and Carli to our EPI family.

What you are describing is very typical.
Initial diagnosis, enzymes are prescribed and dog gets better for a few weeks .... but then... after a few weeks they start sliding backwards for no apparent reason and the symptoms start re-appearing.

What is happening is that SID/SIBO/Dysbiosis is rearing it's ugly head! All EPI dogs have SID to one degree or another. At this time, we don't know how to get rid of it, but our objective is to keep it under good control. I will share the step by step treatment to do this....... but it will also be good if you can identify the underlying cause and we will help you with this (this is done via process of elimination).

To treat out-of control SID/SIBO/Dysbiosis:
1. Try a prebiotic - if no positive response after a few days ....then..
2. Try a prebiotic +probiotic. if no positive response at all after 3 to 5 days... it is not going to work... then...
3. Ask the vet for a course of Tylan (Tylosin Tartrate)antibiotic / give according to weight/ give twice a day with food for 45 days. Dosing Schedule here: https://epi4dogs.com/antibiotics/ and you can order from Chewy need your vet's approval https://www.chewy.com/[url]tylan-tylosi ... /dp/173768[/url]... PLEASE do NOT let your vet prescribe Metronidazole (Flagyl). Unfortunately EPI dogs do not have enough bacteria in their gut flora nor do they have enough variety and Metro kills EVERYTHING and some bacterium strain may never come back no matter how many probiotics you give the dog. BUT, Tylan is a macrolide antibiotic and it does not kill everything but rather inhibits the reproduction of more bacterium. SO it is MUCH safer to give AND although both are broad antibiotics Tylan is more geared for the small intestine whereas Metro is more geared for the large intestine..and SID is a problem in the small intestine.
4. If underlying cause can not be figured out, and if you are not dealing with EPI + IBD, and if none of the above helps, talk to your vet about doing a FMT (Fecal Microbiome Transplant) this is simply an enema. DO NOT do FMT pills... to-date they are not very effective, so you'd be wasting your money.

HOWEVER................. Aside from the standard response above.... after reading your post.... i would first talk to your vet and ask your vet if you can try a different pre+probiotic like Visbiome or Proviable. if either of these also fail... then don't bother trying any other probiotics... just do the Tylan.

The other thing you need to look at is what is keeping SID out of control in Carli's gut..... i suspect it is the food. I will explain in another post

[Tuckaboo Pam]

Hi Barb, and welcome to you and Carli. We're glad you found us! A couple of questions---

How are you administering the enzymes, and how much are you giving at each meal? The more you can tell us about your routine, the better.

The food you are feeding---Has she always eaten this? Is there a reason other than EPI for this choice? EPI dogs may do better on food that does not contain any poultry or grains, with fiber at less than 4%, but sometimes there are other conditions to consider.

This page is full of information--- https://epi4dogs.com/diet-in-brief/ I use Taste of the Wild Pacific Stream, which I buy from Chewy, Grain-free food needs to have little or no peas and white potatoes, and like I said 4% fiber or less.

ALL EPI dogs have a condition called SID. Sometimes it flares, and that may be what you are dealing with. Maybe start out giving Carli some slippery elm from a health food store or Amazon. The dosage chart is on this page, and you give that amount twice a a day. https://epi4dogs.com/sidsibo-in-brief/ Start with less than recommended & build up. You should know if it's working within a few days, as her poo will look good & she'll feel better. If there is no improvement, ask your vet for a 45 day course of Tylan, which is also on the SID/SIBO page.

Wonderlabs Pet Factor B12 works best, and may be found from the company or from Amazon. EPI dogs need B12 of at least 600, so Carli definitely needs it. I have given both my EPI dogs a daily capsule.

PLEASE share this site with your vet. A lot of good research goes into the information included here.

And lastly, we have all been in your shoes. Getting things exactly right can take some tweaking, but the folks in this group will help you get there.

Take Care, and keep asking questions---Pam&Tucker&Nina

PS I see Olesia has responded, but I spent forever on this (I kept getting interrupted), so I'm still posting it!

[Olesia711]

Okay... what is perpetuating is SID/SIBO/Dysbiosis to be out of control. Although i suspect it is the food (Science diet sensitive stomach and skin, chicken and barley for big dogs) , let me first go thru a few things:

1. FIRST.. are you giving 1+1/2 or 1+3/4 tsp of enzymes per the 1+1/2 or 1+3/4 cups of food that you are feeding 3 times a day??? Need to make sure you are starting with approximately the right amount of enzymes... give or take.

2. Next, this comment "Omeprazole 2x daily 12 hours apart as she started vomiting after feeding" All dogs with EPI have issues with their secondary acid reflux functionality.. giving Omeprazole is appropriate, but this can also be an indication of SID/SIBO/Dysbiosis.... SOmetimes you may not have to give Omeprazole and can give SLippery ELm powder instead....sometimes this works.... sometimes not, but worth trying to avoid giving Omeprazole if you don't have to. However.. another note is that if you do get to the point of having to give Tylan.... you may find that then Omeprazole is not necessary.... or not. I swear everything with EPI dogs is all about "trying" different" things until you find what works for your dog!

3. Aside from all EPI dogs have SID anyway.... often times we can get it under good control once we figure out what are we doing that keep perpetuating it. It often is the diet. Once an EPI dogs is on enzymes, finding the right diet can drive you absolutely nuts!!! The problem is that the efficacy of the enzymes can be destroyed anywhere from 0% to 50% by fiber in the diet. OUr problem is that we have no idea which dog is affected by this and if they are affected by this then by how much??!!! We would have no idea unless we try all different kinds of food compositions. SOOOOoooooooo to keep it simple, we suggest "starting" with a food that has 4% or less fiber content in it AND select a food that does not have any grain it it (your diet selection has lots of grain in it: Science diet sensitive stomach and skin, chicken and barley for big dogs.
and it has peas in it... We advise to avoid food with multiple pea ingredients and peas that are listed in the top 3 ingredients as too much peas often aggravates SID.
BUT.... on the flip side, there is a small percentage of EPI dogs that do not do well until they are given food with grain in it... so as you can see, if things are not working out as expected, you can and will figure it out, but there is a lot of trial and error involved, and that is what we will help you with.

Also.... although Science Hill is a good food... for some reason (that we cannot figure out why!) many of our EPI dogs simply do NOT do well on any of the prescription foods. ... but do better on over the counter middle of the road food. Go figure !!

It is possible that this food is not agreeing with her so you might want to try a different food... but if food does not appear to be the problem, you can always go back to this food..

4. OR.... the other possibility is that the B12 you are currently giving is not doing the trick as there is no intrinsic factor included (this does make a huge difference with many of the dogs with oral B12). Glad you ordered Wonderlabs B12... try that and see if that appears to improve things.... but if not.... ask your vet to re-test the B12 levels in January (that would be 3 months from when she was diagnosed) to see if low B12 is perpetuating all these issues.... as it might be that she is not responding to oral B12 and may need B12 injections instead.... most dogs respond well to oral B12 and often do better on the oral B12... but there are always some who don't and need the B12 injections.... SOOOOOOOoo just keep this in the back of your mind. As her B12 was very low so you want to stay on top of this.

What we strongly recommend is for you to start keeping an EPI Log/Journal
https://epi4dogs.com/epi-log/
.... only make one-change-at a time and record every reaction to that one change... then move on to the next. Take poop pictures (this helps a LOT) to correspond with your notes. this will help both you and your vet to figure out what works and what doesn't work with your dog..... And PLEASE share everything we suggest to you with your vet.

[Barb645]

Thank you for all of the suggestions. I will start the wonderlabs B12 and see if that helps first. For the question of how much enzymes I am feeding at each meal I do 2 teaspoons with 1 and 1/2 to 1 and 3/4 cups of the dry food. I wet the food with warm water and then add the enzymes and stir really well to coat all the food. I then let it incubate 20 to 30 minutes. Usually 30. The food I am feeding her now was suggested by the vet. Before she was diagnosed she was on blue buffalo life protection. She really is not good with the enzymes so I sprinkle her probiotic over the top. She seems to be getting used to the taste but sometimes I still have to encourage her to eat. Also, my vet said we would retest for B12. Again, thank you for the suggestions.

[Olesia711]

hi Barb,

Thanks for letting us know how you are preparing the enzymes and how much you are giving per food... Your ratio's and techniques are correct. What you might want to do is "try" a different food just to see if that might be the problem. Since you are already giving her a food with grain... try something without grain and lower % to see if that makes any difference at all.

If you do decide to do this buy the smallest bag possible....just to try. Give 25% new food/75% old food first day. Then give 50% each next day. Then following day give 75% new food/25% old food and the 4th day give 100% new food..... and watch the poos, listen to the belly and see if this "appears to be more agreeable......

Here is one food that does not have any grain or pea's in it and the fiber content is low:
https://www.chewy.com/farmina-nd-prime- ... 00lwVIwV4z

[Barb645]

I have ordered the food you suggested and I will give it a try. I would like to order from enzyme Diane since the enzymes are very expensive. Would I order the 6x? Would the measurement be the same? I am also interested in the coated tablets since I must travel some for my job, do they work as well as the powder?

[Tuckaboo Pam]

I prefer the 6X from Diane, because the ratio is one teaspoon per one cup of food. A lot of people are talking about the tablets, so I am sure one of them will respond to that question. So glad you are here getting help.

[Olesia711]

yes, go with the 6x. Not only is it easier to work with when figuring out the dose... the 6x is equivalent to the prescription enzymes that the vet sold you

If you want something easy for when you travel, either encapsulate the 6x powdered enzymes into "enteric" coated empty gel caps (for information about this, go to this page: https://epi4dogs.com/cost-savings-enzyme-tip/

or

Order some Micrazyme enteric coated enzyme capsules from Amazon: https://www.amazon.com/AVVA-Pharm%D0%B0 ... B07GWMZSLN

[Barb645]

Good Morning Everyone! Another question, can the dogs absorb vitamins, probiotics, slippery elm, or antibiotics at any time or do these need to be given when they have food with the enzymes in it. Thank you