Newly diagnosed Epi-Next steps?

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.
kcarozza
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Posts: 10
Country: United States
State: Georgia
Pet name: Eve
My name: Kim

Newly diagnosed Epi-Next steps?

Post by kcarozza » 11 Feb 2025, 16:46

First of all, THANK YOU for this wonderful site--it was such a relief to find this after we got our dog's dx!

Background: Eve, (DOB 12-25-24), got her at 8 weeks old, pure breed GSD. Until 1/10/25, she was perfectly healthy..appropriate weight gain, healthy and regular appetite, playful spirit, good diet (Royal Canin GSD food), never had any diarrhea whatsoever or vomited in that first year. Only odd thing about her was that one of her ears never stood up.

My husband and I had never left her for any amount of time, but we went out of town 1/7/25 and my son watched her while we were gone. He knew and followed her routine but said she hardly ate while we were gone for those three days. The night after we got back she started having intense, odd looking and smelling diarrhea, which we now know is EPI related. I mention all this bc I read somewhere EPI could be triggered by stress (?).

Long story short, 2 weeks of the EPI cow patty poops, one 7 day round of metronidazole with probiotics, sonogram for blockage (neg) and vet suggested full blood panel. They mentioned EPI but in 20 yrs had only seen one case in their office. Note-I live in a metropolitan city outside of Atlanta.

Results: Folate 24, B 270 and TLI 1.2.

Note: while all of this was going on, she was STILL in great spirits, ready to play hard, never crabby or aggressive, although very hungry and thirsty

Started with 1 tsp VIOKASE (will be used DIANE enzymes moving forward---so expensive to use the other) on her Royal Canine GSD food with boiled chicken or pure dehyrdated chicken. Sometime put cheddar cheese or boiled egg. Within one week, poops improved and gradually have continued to do so. We feel she does best on one HEAPING tsp of Viokase per 2 cups of food, instead of just a level tsp. She has been eating 3 meals a day with 2 cups food/1 heaping tsp and then one night time snack of 1 cup food, 1/2 heaping tsp.

She poops about 4 times a day, where before this, it was 2 times a day.

She clearly has lost weight since the beginning of this and has not seemed to put on much in the last two weeks. I am taking her this week for a vet weigh in so I have scale consistency.

My question(s) is: What should next steps be? Should we retest her blood work, start B12, start a prebiotic, change her food to a lower fiber one?
At this point, we seem to finally have some "control" over this and I don't want to add something in the mix if I don't have to, but I worry bc she is so young, still growing, etc.

Any and all thoughts, suggestions, comments appreciated! :) --Kim

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Olesia711
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Re: Newly diagnosed Epi-Next steps?

Post by Olesia711 » 11 Feb 2025, 17:06

glad your dog was properly diagnosed with EPI.... but so sorry she now has EPI.

SOOOOOoooooo the very first thing you want to do is increase the enzymes for now. Since you are giving 2 cups of food per meal, give 2 level tsps of enzymes per meal. What you don't want to do is under-dose and further perpetuate SID/SIBO/Dysbiosis (something ALL dogs with EPI have that we have to try and keep in good control since we don't yet know how to get rid of SID/SIBO/Dysbiosis.

Once your sweetie is delivering nice normal tootsie roll poop a normal amount of times a day for about a month.... THEN you can try reducing the amount of enzymes needed to sustain... reduce by 1/8 of a tsp at a time... watch the poos for 3 -5 days... and keep reducing UNTIL you notice the poos are starting to get soft/sloppy/ then you know you have reduced the enzymes by one step too much and go back to what works.

For now, feed approximately 150% of what she normally would require for a dog her size... once she gains back all or most of the weight, then you most likely can go back to feeding normal amounts of food.

HOWEVER... do not try to stuff 150% of food in her in jsut two meals a day.... feed more, but feed smaller portions... try to feed 3 to 4 times a days instead of just 2 times. you only have to do multiple meals until she recovers.

Next... make sure she is getting B12 supplementation. Her b12 needs to be at minimum in the upper mid range. Once that is achieved DO NOT stop the B12 completely, but rather, you and your vet will need to then just put her on a B12 "maintenance" routine .

Going forward.... DO NOT let the vet prescribe anymore Metronidazole. Metro kills ALL the gut flora and that is the last thing an EPI dog needs. They not only do not have enough bacteria in the gut and they also do not have enough variety of bacteria in the gut flora.... :( SOOOOOoooo if and when (and this is a good possibility) you need an antibiotic for SID (if pre+probiotics don't work) then ask your vet for a 45 day/twice a day course of Tylan (Tylosin Tartrate antibiotic) to help get SID in check... Tylan is a macrolide antibiotic... it does not kill everything but rather jsut stop reproduction of more...

In the meantime.... talk to your vet about trying a pre+probiotic such as Visbiome or Proviable.... to maybe keep SID/SIBO/Dysbiosis from getting to far out of control.

In the end, EPI alone is pretty easy to manage...BUT... it is the SID/SIBO/Dysbiosis that causes the most "angst"!
If the SID/SIBO/Dysbiosis gets out of control (tummy noises, burping, lost of gas, not wanting to eat, loose stools, any of these symptoms) before reaching for Tylan...it might be the food that you will want to try changing next. Some EPI dogs cannot handle grain in their food. Grain/fiber can destroy the efficacy of the enzymes from anywhere between 0% and 50% and the problem is that we have no idea which dog is affected by this and if they are affected by this, by what %. SO... jsut keep this in the back of your mind too if SID gets out of control.

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.........

kcarozza
Member
Posts: 10
Country: United States
State: Georgia
Pet name: Eve
My name: Kim

Re: Newly diagnosed Epi-Next steps?

Post by kcarozza » 11 Feb 2025, 18:59

Thank you for all your input and quick response!

Re B12-if I do the Wonder Lab brand, the bottle says 2 caps for her weight which is 2000 mcg..is that the right dose per day ALL 7 days or only do for how many days a week?

And I should give the B12 for 12 weeks, stop a week, then test ?

Chance
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Re: Newly diagnosed Epi-Next steps?

Post by Chance » 12 Feb 2025, 01:31

I'm slightly confused about dates and how quickly this pup was diagnosed with EPI. If she was born on Christmas day, and symptoms started on New Years day, that put her at a week old? Then diagnosed at 2 to 3 weeks old?

I'm guessing perhaps a typo in the year of birth, maybe Christmas '23?? If it was actually this year, I am not certain if accurate testing could be done. She wouldn't have been weaned yet, and pancreas not yet developed enough. You'd expect a low TLI.

If it was last year, and she's a year old now, then testing should be quite accurate. In that case, I agree with increasing the enzymes, if you're giving 2 cups per meal. B12 is quite low. Ideally, I'd suggest a series of weekly injections for 6 weeks. After that, monthly injections should be good. If you do want to switch to Wonderlabs (it's more expensive than injections), you can try that. For most dogs, it's apparently good. But for mine, it wasn't absorbed at all. Testing, while on the capsules, showed results to be critically low. Switched back to injections, and made a huge difference! Testing later showed results at high range normal. The capsules, if you go that route, is to be given daily. Most likely need 2 caps daily.

I also suggest looking into a good probiotic. It can take trial and error finding one that works well for you. (Took me 5 attempts to find the right one for mine). Once I found the right probiotic, I knew quite quickly, and it's made a big difference!
Chance was my 4 legged soul mate. My mobility assist service dog. Pure yellow Lab, 75 lbs. After struggling with weight all his life, finally dx with EPI. cTLI < 1, folate and B12 very low. Fed Raw. Maintained with Creon, Garden of Life probiotic and intermittent calcium bentonite clay. (Tylosin was a big nightmare for him)!

Rylee is Chance's successor; also pure Yellow/Fox red Lab. Started with symptoms at 8 weeks. At 6 months of age, also prescribed Creon due to suspected EPI (due to passing large amounts of undigested food). Currently suspected of blockages in pancreatic ducts. She is maintained VERY nicely on Creon and probiotics. Also raw fed.

kcarozza
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Posts: 10
Country: United States
State: Georgia
Pet name: Eve
My name: Kim

Re: Newly diagnosed Epi-Next steps?

Post by kcarozza » 12 Feb 2025, 10:42

Thanks for the reply--and yes, I made an error on her DOB--it was 12/25/2023. :)

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Olesia711
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Location: North Carolina
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Re: Newly diagnosed Epi-Next steps?

Post by Olesia711 » 12 Feb 2025, 14:00

ahh... the B12... ignore the instructions on the Wonderlabs bottle.... go with the TAMU Gastro lab recommendations:
https://epi4dogs.com/b12-protocol/ (1 ug = 1 mcg )

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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.........

kcarozza
Member
Posts: 10
Country: United States
State: Georgia
Pet name: Eve
My name: Kim

Re: Newly diagnosed Epi-Next steps?

Post by kcarozza » 12 Feb 2025, 17:49

When I finish the Viokase, is it okay to just go directly to using Enzyme Diane 6x?

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Olesia711
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Posts: 4805
Location: North Carolina
Country: United States
State: North Carolina
Pet name: Izzy
My name: olesia

Re: Newly diagnosed Epi-Next steps?

Post by Olesia711 » 12 Feb 2025, 18:54

yes you can switch all at once from Viokase to Enzyme Diane.... when switching between enzyme brands, as long as they are similar in strength (USP units) there is no need to switch slowly ... just go 100% from one to another.
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.........

kcarozza
Member
Posts: 10
Country: United States
State: Georgia
Pet name: Eve
My name: Kim

started new protocol-poops not great

Post by kcarozza » 22 Feb 2025, 09:23

Good Morning...
Need some advice....

Switched to enzyme diane on 2/20 Thursday, started Proviable Forte on 2/11 and B12 wonderlabs on 2/14.

Her poops (which weren't perfect before) are coming out still a yellowish to light brown color and now coming out in "plops"...making a semi formed pile when they hit the ground.

I feel like the new enzymes caused it but not sure. Advice?

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jilbert57
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Re: Newly diagnosed Epi-Next steps?

Post by jilbert57 » 22 Feb 2025, 09:33

Hi Kim.
Just to make sure, you got 6x and not 8x strength?
What food are you feeding and how much enzyme per cup of food are you using?
Thanks

Jill
My name is Jill and we live on the Hood Canal in Washington State. We currently have 2 Jack russells, TJ is 9 and Sadie is 3.

Mickey and his pancreatitis brought me to Epi4dogs.com site in 2012 to help manage it.
He lived from 6/99 - 8/2014

Mickey, Jack Russell. Chronic Pancreatitis. Dianes enzymes, 1/8t 3x/day with meals.

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