New to EPI - totally overwhelmed

[smilejinks595]

Hi All,

Firstly, thank you so much for this group, website, forum and information. I think we are very lucky to have a compassionate Internist Specialist Vet who helped us get here, but so much of all this is trial and error we are feeling a touch overwhelmed.

Rory is 6.5 yr old Australian Cattle Dog/German Shepherd/Husky. He should be around 69/70lb healthy, and is currently 53lb. He was diagnosed with IMPA (immune mediated polyarthritus) early 2024 - he is on Prednisone 10mg twice a day and Leflunomide 100mg/day for this. He had anaemia and started losing weight late last summer. Anaemia recovered quickly. Weight continued to drop. We got a diagnosis of EPI mid-December. TLI = 7.2, B12 = 280. Rory was put on Diane’s Enzyme x6 and B12 supplement. At the time of diagnosis we did not have a huge problem with diarrhea often, but definitely pale, mucus laden and too many times a day. Rory also has PIMA now (non-regenerative anemia) which we don’t believe is a common connection to EPI. The steroid and Leflunomide were increased to assist in this, and while it has slightly improved, he still has PIMA.
Unfortunately, Rory had a terrible reaction to the enzyme which caused sores and massive infection in his mouth. He was on antibiotics for a week and received fluids at emergency hospital as well as pain killers. At that point we stopped the enzyme and were prescribed PancrePlus Tablets (vet adviced 2 per meal / 3 meals a day). This was last week.
Rory has continued to steadily lose 1 pound every 2 wks. His poops are more solid, better in colour, but still 4-5 times a day. He is agitated and constantly pacing - always famished (not aggressive).
Our biggest question, apart from just general help and advice from anyone kind enough to have read this far, is should we be crushing the pills? We haven’t been because we were under the impression it would cause possible ulcers again, but I read a thread on here that stated it was vital to crush the tablets.
I’m so sorry if these points have been covered before, and if our issues seem basic. Our boy is wasting away in front of us and we’re worried that even with a diagnosis we don’t seem to be getting anywhere.

[Olesia711]

Hi Rachel,

I am so sorry you are going through all of this with Rory. My dog, Izzy, who was the reason the Epi4Dogs foundation was started not only had EPI, but she too developed IMHA (immune mediated hemolytic anemia)... so i kind of understand what you are dealing with .... not fun. Izzy also was on Leflunomide, and pred, but that didn't really get her out of the woods, they added cyclosporine, and i had to take her off sucralafate and put her on slippery elm instead cuz the sucralafatedramatically increased her blood sugar (she was also a diabetic, had low thyroid and had juvenile incontinence for her entire life)

Anyway... yes, the pills often don't do much until they are crushed, BUT if she had that violent of a reaction to the powder my guess is to skip the pills and talk to your vet about either prescribing CREON (it's a human drug for EPI) that can use way less enzymes (10,000 to 25,000 USP units of Lipase vs 71,000 USP units of Lipase in the powder/pills.) And CREON can do tis because the enzymes are enteric coated. SO you open the capsule, sprinkle the little pellets directly onto "moist" food and NEVER incubate these pellets on the food like you need to do with the powdered enzymes to avoid mouth sores, but rather serve the food with the enteric coated pellets immediately. We typically start with CREON 10,000, but often times have to increase to using 1+1/2 CREON to 2 CREON capsules... with some dogs they need to use CREON 25,000... but we like to start at the lower end to see exactly ow much is really needed.
Please share this with your vet

OR..

You can buy enteric coated empty gel caps and just pour the powdered enzymes (use only half the dose you normally would) into the empty enteric coated gel caps. Give your dog these capsules when she eats her meal... just make sure she swallows the capsules and not chew it.. You can read all about it here: https://epi4dogs.com/cost-savings-enzyme-tip/ . please share this with your vet.

OR

You can order enteric coated enzymes in little pellets in a capsule off the internet.... same as CREON only non-prescription called Micrazym
https://www.amazon.com/AVVA-Pharm%D0%B0 ... B07GWMZSLN
Please share this with your vet

[Olesia711]

oh... and i wanted to also mentioned, the B12 is LOW.... is she getting B12 supplementation? Low B12 can also contribute to looser stools and agitation.

[Tuckaboo Pam]

Welcome, Rachel. So sorry for all Rory's issues. It's hard, at first.

A quick word about B12---Wonderlabs Pet Factor B12 is available on Amazon, or from Wonderlabs directly. That is what many of us use for our EPI dogs, as it seems to work better than other B12 pills.

If diarrhea becomes a problem, you are probably dealing with SID, and here is more information on that--- https://epi4dogs.com/sidsibo-in-brief/

Keep in touch, and ask all the questions! Pam & Nina


***A couple of things---please be sure you are feeding 150% of what Rory would eat if she was at her healthy weight, and divide it into three meals a day, if you can. If not, then two meals. I feed Nina at 6 am & 6pm. EPI dogs have been literally starving before the enzymes were added to their meal, so being anxious about food is a reasonable reaction. Good for you, getting him on the right track.

[smilejinks595]

Gosh, thank you so much Olesia711 and Pam!
Can’t tell you how relieved we are to have found this forum and for your kind responses.
We will absolutely talk to our vet about Creon urgently. We had assumed she would suggest enteric capsules (based on my research of dogs with the ulcer/sores reaction) but all of the Dr’s available had not come across the reaction before. She is very open to suggestions and research though, I think Rory just might be her first case of this kind.
Re his B12 - yes, sorry, he has been on a supplement since the initial tests (mid Dec) and when I asked at his appointment last week about re-checking those levels she said they normally wait 12 wks. But we will look into the Wonderlabs ones in the mean time.
We’re going to up both his calories, and the pill from 2 to 3 per meal. I think we can mix in this crushed pill much easier than Diane’s Enzymes, and will actually be able to manage doing it with a small amount of food that I can ensure he swallows first without chewing (if that makes sense).
Again, thank you so much! The relief at knowing there are such experts available - so kindly willing to share their expertise - is huge..

[Olesia711]

you are very welcome and please keep us posted! Also... please let your vet know that we mostly follow Texas A&M Gastro Lab protocols here at EPi4Dogs and that we have a LOT of EPI research listed under various tabs on this website that your vet is welcome to read . Because we work with the researchers, we tend to have a access to the latest research out there on EPI.... so our info is pretty current

Oh... and last but not least, be sure to share anything we suggest to you with our vet. IN the end, the dogs that respond best are the ones that have everyone working together on their case

[smilejinks595]

Thank you! I definitely will share everything with her. In fact, I will email her the link tomorrow.
I have another question (and I apologize because you must all answer the same questions quite often and I’m sure you have lives to live!) but I’m curious and desperate to get on top of all this…

Knowing that all EPI dogs have SID/SIBO of some sort, I’m guessing we can assume that Rory’s is fairly under control. He’s on Farmers Dog (previously beef and turkey recipes, but we have now changed to just turkey). The vet gave us Royal Canin RX Gastro Low fat wet food to add to the Farmers Dog to increase calories. He has tolerated it well, his poops remain solid and no mucus. I know that ‘low fat’ is generally a hold over from previous theories, so not required, and might actually hinder him putting on weight. So I guess I have 2 question actually, lol!
Should we continue as we are diet wise given we have little evidence of SID/SIBO? (For context, Rory had gastro issues and poor poops for years until we settled on Farmers Dog. Including on raw food. He has also been on a probiotic for 2ish years).
Secondly, given his solid poops why are we not able to get him to put on weight? His B12 was low, and he’s only been on the supplement for 5 wks. Is that likely the biggest cause? Surely if the enzyme had been working, he shouldn’t have lost 2 lbs during his first month on the enzyme?

Please don’t worry about replying - I am just so happy to be in touch with people who actually have such great knowledge - and want to learn all I can. Thank you, again!

[smilejinks595]

Some pics for context. It’s hard to show/see just how underweight he is because he has a long coat.

[jilbert57]

Beautiful pup!

Go ahead and finish the cans of RC gastro LF you have but unless he needs low fat no reason for it, nor prescription. Can you just feed another meal a day of Farmers Dog?
You can also introduce cold pressed virgin coconut oil for added calories. Start with 1 teaspoon and see if it causes bad guts. 4 things need to be satisfied before they start weight gain: Enzymes, Diet, Antibiotic and B12.
If any of those are off it can cause issues.

Jill

[Tuckaboo Pam]

Did we mention you should feed him **150%** of the amount you would feed at his IDEAL weight, broken up into at least two meals? Sometimes I suggest something, and then I forget I've done so...sorry if that's the case.

As far as your gratitude goes, it is sweet of you to express it, but remember we were all in your shoes in the beginning. One day you will be responding to anxious dog people who have just received the diagnosis, too. This is a wonderful community, and you are correct---some people are actual experts, and others (me!) are EPI dog moms & dads who enjoy helping by sharing our personal experiences.
Take it easy---Pam