New to EPI - Food Recommendations?

[mommabear]

Good Morning,

Our 1-year old mixed breed rescue Brownie Bear was just diagnosed yesterday with EPI... So, I am overwhelmed to say the least. But, so grateful to have found this organization and I'm doing my best to understand how to manage his care. My apologies if some of these questions have been answered in the forum. I am still processing & trying to get a handle on this all and what it means for us and our puppy.

We don't know our dog's breed - we think he is likely a combination of border collie, kelpie, & flat-coated retriever. He just turned 1 earlier this month. We fostered him from ~7 weeks old from a local humane society. He was a VERY sick puppy & had distemper, parvo, & a bacterial infection. But, the little guy was a fighter & made it through and we officially adopted him when he was ~5 months. Because all of the antibiotics wreaked havoc on his GI tract, he was placed on a GI prescription food in May 2024 and was the epitome of health until November 2024. We returned from a 2 week vacation to find him with terrible diarrhea & super skinny (he was 35 lbs, but 42 lbs & buff when we left)... and with constant leakage of a yellow greasy substance from his anus. Initial fecal & bloodwork (that didn't test pancreatic values) came back squeaky clean. So, our vet presumed that it was a food intolerance or sensitivity. Or imbalance of flora. So, tylin + probiotics + new prescription diet was prescribed. And then metronidozole + visbiome + prescription diet (all of which are high fiber by the way) - which now we understand are the worst for EPI. Fast forward 2 months and we've been through 4 different foods & 2 different vets... we fired our first one when her recommendation was to do an expensive ultrasound rather than order a more specific blood test to look more closely at his pancreas. I have had him on a bland diet of ground turkey & potato for the last 2 weeks. After this diagnosis yesterday, our new vet recommended shifting the ratio to 75% meat/25% potato, but this is not sustainable for his health or for my sanity to make homemade food (I work & have 3 small children). Stool not even close to normal, but at least brown which is a step in the right direction.

And the timing of this diagnosis couldn't be worse... we are going to be out of the country for 10 days starting next Friday & I feel terrible for putting this on the dogsitter... Gah!

So, here's what I've got so far... with questions embedded.
- ENZYMES: I ordered Epizyme and am waiting for that to arrive. I will look more closely at Enzyme Diane because I see that many people on this forum use that product. But I just wanted something fast through Chewy (& more affordable than Viocase which my vet initially recommended). Can anyone explain the difference between 6x & 8x? - We're continuing with the RxZyme supplement our vet gave us a week ago just to bide us over. But I am going to try to find some porcine pancreatin from a health store this morning to introduce that ASAP while I wait for the Epizyme to arrive.
- B12: I picked up 8 B12 shots yesterday from our vet, which we will administer weekly. And ordered coballaquin and will give that to him daily as well.
- PRE/PROBIOTICS: Also continuing Visbiome daily (since I bought a 3 month supply). Do you think that we should ask our vet for another prescription of Tylin? Even though he had both that & 2 courses of metronidazole a month ago? I also just ordered some slippery elm powder.
- DIET: I just cannot wrap my head around continuing to make him homemade food as well as the enzyme supplementation. I am already stretched super thin... I would sincerely appreciate recommendations for store-bought options that have worked well with your pups. I understand the requirements, but this would help me to shorten my stroke & start trialing new foods when we return from our trip.
- HAIR LOSS: recommendations for supplements and/or oils that have helped with itchiness? he has lost some hair around his eyes from scratching.

SO, SO, SO APPRECIATIVE of any and all insights & advice.

Rachel

[jilbert57]

Welcome Rachel, will you please post results of the cTli and B12 tests?
So you can get going:
1. Enzymes- 8x if stronger so you start with 3/4 teaspoon enzyme per 1 level cup kibble. Add maybe 1/8 cup room temp water to the kibble and enzymes and stir. Incubate for 20 minutes, stir and serve. All food is to be fixed this way.
6x is dosed at 1 level teaspoon per 1 cup kibble prepared as above.

2. B12-you are doing the correct thing

3.Pre/probiotic. Keep up Vidibiome and yes, get a 45 day course of Tylan to have on hand if needed. Hold off on giving it. Please NO more metronidizole. It kills both good and bad bacteria.

4. Diet - Folks have good luck with Taste of the Wild Pacific stream grain free. Others will chime in but you can usually get it locally.

5. Oils I use Pawsomely healthy Omega 3 capsules from Amazon.

Ask questions

Jill

[mommabear]

Thank you so much Jill.

These are his lab results from last Friday:
Fasting cTLI: <1
Pancreatic Lipase: <30
Cobalamin: 262
Folate: 7.7 (normal range referenced is 7.7-24.4),

Thoughts on how to incorporate the new food with his bland diet? Would you recommend starting slowly? Or half/half and let the enzymes do the work?

Thank you!!
Rachel

[jilbert57]

Thank you Rachel, I would do maybe 2 days of half homemade/ half kibble and prepare the foods with the enzymes and let incubate. Stir and serve. If the poop gets better after 2 days gradually reduce homemade with more kibble. I know you have a date to leave crunch.
His guts are so turmoiled maybe switching cold turkey with proper kibble and enzyme incubation that might be ok. Someone might second this.

Jill

[mommabear]

Thanks for the information! How would you recommend that I dose the enzymes for the combination of kibble & fresh food? I read somewhere that the fresh/canned food dose is less than for kibble. Is that true?

Thanks again!
Rachel

[jilbert57]

Yes canned or moist is usually 3/4 t enzyme per cup and kibble is 1 teaspoon enzyme per cup.

Is he needing to gain weight? How much homemade do you feed per meal? In cups

Jill

[mommabear]

Yes, he is 35 lbs & should be 42. Currently doing a generous 2 cups 2x a day. But, I'll try to incorporate the kibble tomorrow. So it would be 1 cup kibble, 1 cup wet - so 1 3/4 tsp of 6x?

Thanks!
Rachel

[jilbert57]

That should be a good start. Which kibble did you get?

Jill

[mommabear]

I got the one you recommended - Taste of the Wild Pacific stream grain free.

[Chance]

Wow, you have been through the wringer with this little one! That's an awful lot to go through for a young pup. Good for you adopting him and taking all this on.

Now that he's been officially diagnosed, things should begin to improve pretty quickly. You'll need the enzymes and B12, which will help a lot.

As long as it's *only* EPI, with no other gut conditions, food isn't really a big concern. Low fiber is recommended, as too much fiber can interfere with efficacy of the enzymes. Usually a food with fiber content of 4% or less is recommended.

I do homemade food; but just because I prefer it to over processed "food". But that's by no means a requirement! I take a couple of days every 5 or 6 weeks and pretty much kill myself getting everything done. All meals portioned and prepared ready to go! It's a LOT of work, and I HATE it! But once it's done, all I have to do is take a meal to thaw, and go. Once it's done, there's nothing to do until the next time lol. I use Balance.It as a guide uto help get everything as balanced as possible.

Whatever you feed will be easier once there's enzymes! No food will work great until that time. But it sounds like you have something on the way, so that's great!

Enzyme Diane is very good. It is quite popular! 6x and 8x are pretty much exactly the same. 8x is a little stronger. On average, 3/4 tsp of 8x is about equal to 1 tsp 6x. So you'd use less. But since your boy isn't overly large, I think you'd be fine with the 6x.

I know you are going to be a nervous wreck this week planning your vacation and getting the meals/enzymes worked out! But things will slowly start to fall into place.

Your vet was wise in recommending the Visbiome. It is a really good probiotic. It will help balance the gut bacteria a little better, especially with enzymes starting. But it is a very high potency probiotic. So it's one you need to start up slowly, and gradually start working your way up. Giving the full dose to start with would almost certainly cause a setback. So start with maybe 1/4 of the recommended dose, and slowly work your way up.