New to Epi- Crockett

[rebeccal]

Crockett is a 2 yr and 8 month black labrador Retriever, current weight 63.5lbs. He was diagnosed with hypertrophic osteodystrophy and hip dysplasia at 6 months of age. He has been in and out of the vet almost monthly for the past year with various GI illnesses and was just admitted to a major Veterinary hospital in New England twice in a 6 week period. Finally, he got a diagnosis of EPI. Attached is his lab results. We have just started with enzymes and b12. After basically 2 years of crazy we are just beginning to figure out our way through this new path.
We were told to start panakare plus at 3 tsp per meal but based on everything I am reading that sounds like a lot?

Now we also own his brother, should his brother be tested as well despite no current symptoms?

[jilbert57]

Hi and welcome!
The starting dose of enzyme to kibble is 1 level teaspoon per 1 cup kibble. Sprinkle enzyme on kibble and add a little room temperature water. Stir to wet the kibble and distribute the enzyme and let incubate 15 mins. Stir again then feed.
Crocketts B12 is low so it is important to get it up and stay over 600.

What is your pups diet? We usually recommend grain free with fiber 3.5% or less.

Most pups have Sid/sibo when diagnosed which can be helped with Slippery elm(prebiotic) or if needed an added probiotic. Sometimes an antibiotic(we recommend Tylan) is needed. SID is recognized by mucous poops, excess gas, acid reflux.

Jill

[rebeccal]

He is getting a home cooked meal 5 times a day formulated for him by a holistic vet/nutritionist. He gets 1 cup each meal right now.
He is also undergoing fmt through legacy Biome due to significant history of use of antibiotics including tylan, metronidazole, and clavamox over the last year. He is receiving probiotics. His med list currently includes omeprazole, pepcid, cerenia, denamarin, ursodiol. He was hospitalized in December with elevated liver enzymes in the 3k range.

[Olesia711]

ahhh... love the home-cooked meal, prepared by a holistic vet.
Couple of questions....
has vitamins & minerals been included??
when cooking/baking.... is this done at no more than 325 degrees? (slow cook vs. high heat)
are there grains in the home-prepared meal?

Once enzymes are started, fiber (from grain) can destroy the efficacy of the enzymes from anywhere between 0% and 50%....and unfortunately we have no idea which dog is affected by this and if affected by what %..... this is why we suggest when starting out with meals for an EPI dog... start with something with no grain in it.. AND try to keep the fiber content 4% or less. AND avoid lots of peas, lentils, etc. ONce the dog, starts delivering normal looking poops...THEN feel free to try foods with grains in it. See if your dog is fine with grains or not.

Since you are feeding home-prepared food.... the amount of enzymes included can be less... with home-made or raw food, we suggest starting with 3/4 tsp of enzymes per cup of home-made or raw food. Make sure the food is not in big chunks but ground/minced or very small pieces. YOu might even be able to only need 1/2 tsp of enzymes per cup of food, but best to start off with the higher amount and then reduce if needed.

As Jill mentioned, the B12 is extraordinarily low he REALLY needs to be on B12 ASAP!
I would ask the vet to start him on B12 shots..... immediately... and then, if you want switch to WOnderlabs Pet Factor B12 pills....
https://wonderlabs.com/PET-FACTOR-B-12? ... BAQAvD_BwE
The information for B12 dosing is here: https://epi4dogs.com/b12-protocol/

Question for you, i understand the acid reflux meds, but is there a reason that the vet has him on two kinds? omeprazole, pepcid, ???

[rebeccal]

Hi
So they have him on two kinds of acid reflux meds as one was not holding him all day at his sickest point. We are currently titrating him off off the meds to see what he actually needs now. We are using supplements for vitamins and minerals to make sure his diet is balanced yes.

Crockett will be starting b12 injections tomorrow, unfortunately we had to wait for it to arrive.

Should we test his littermate who is currently symptom free?

[Olesia711]

ahh... that explains it. thanks for sharing that with us.

SO..... no need to test the sibling UNLESS you notice any EPI symptoms.
Years ago they did a test of EPI GSD pups.... they bred 2 positively confirmed EPI dogs together and followed the pups for years afterwards, expecting all the pups to develop EPI. Surprisingly, they didn't!!!

Some tested positive for EPI, others didn't.....

[rebeccal]

Perfect. Thank you for all the information, Crockett got his first B12 injection today at home, I will be doing them weekly for the first 6 weeks per his internal medicine specialist.

[Chance]

Sorry, I'm a bit late to the party. Been a very long few days making dog food!

Anyway, welcome from another Lab lover! Not many Labs here. It seems to be slowly increasing in popularity among Labs though :/

You've gotten really good advice here already. And your vet is very good to start the B12 injections on that schedule! You'd be surprised at how many vets overlook the importance of B12. Mine at first said one B12 injection was all that was needed, as now that he's got digestive enzymes, he'll get what is needed from the food. He did learn rather quickly that this was very wrong. We do monthly injections here now. (Which reminds me, it's about that time again).

As Olesia mentioned, it helps a lot if there's no big chunks of anything in the food you make. Enzymes you buy are life saving, but a poor substitute compared to what mother nature provides. Larger chunks of meat often pass through undigested, regardless of enzymes given.

Acid reflux can be a very big problem leading up to the diagnosis. With my puppy, it was horrible. She had already had her 3rd GI bleed before the age of 4 months. It was then she was prescribed Omeprazole "indefinitely". Omeprazole did help stop the bleeding, and prevented more bleeds; but it did nothing to control the acid reflux symptoms. It was terrible! Finally diagnosed at 6 months (after pooping out her food for 2 months), and enzymes started, everything improved sooo much. The acid reflux was about 80% improved overnight, as was the amount of meat visible in the poop. After a couple of weeks, we tried increasing the enzymes, and presto; bo more issues at all with reflux!

I bought some gastro elm to help with the gradual weaning off the antacids. I think it helped a fair bit. I had to give about half the dose recommended, as full dose was too much. I gave that for maybe 6 to 8 weeks. After that, I really didn't need it anymore. She's been off all antacids for several months now; maintained quite well on enzymes and probiotics.

[rebeccal]

This has definitely been a transition for us. Crockett has been intermittently ill since 5 months when he was diagnosed with hypertrophic osteodystrophy. He is now 2 years and 8 months. After 5 total hospitalizations between HOD and GI symptoms we finally got diagnosed with EPI.

How do we know that he is getting too much enzymes? His stools were doing really well but today has much less output very thin in size and he has had increased nausea as evidenced by increased salivation and burping.

[Chance]

Enzymes can sometimes be a real trial and error. Some dogs tend to be quite forgiving with dose ranges. But others - such as mine - mdo have problem when there's too little or too much!

Most tend to have okay poops with too much. But some will get softer poops. Then people see softer poops and think....oooh needs more enzymes! And compounds the problem.

Acid reflux -- gulping, reverse sneezing, nausea, discomfort or even empty belly pukes are common symptoms of reflux. If that seems to start up with enzymes, or worsen after a meal, I would try reducing just a tad.

But gas, tummy rumbling and very foul smelling toots or burps can be a sign of SID/SIBO. If this is happening, usually increasing enzymes can help some as you work to get that controlled. So sometimes it's confusing, and difficult to know what to do.

With Chance, I had to battle that a couple of times! He did get a very bad case of SID, and vet refused to o help. So it got bad, until I did get another vet. I did increase the enzymes, which did help some, but it was still a battle. Got into the new vet, did blood and x rays, and antibiotics prescribed. His advice was to stay on the increased enzyme dose for another week, then try gradually going back. But 3 days in, it was very clear, we needed to cut back on enzymes immediately. The acid reflux became a bigger problem. Immediately cut back, and the next day he was much better.

But since you seem to indicate that this started with enzymes, I do wonder if a slight reduction is needed..