Comparision

While writing my last post I came across some photos that I had taken over the last few months and thought it would be interesting to compare them side by side.

Taken June 16, 2009

YIKES! That is a skinny dog!

Taken August 3, 2009

Wow! She has filled out.

Taken October 14, 2009

A Fat E.P.I. Dog

After comparing these photos side by side I am shocked that she was ever that emaciated and amazed at the transformation she has made.

A Two and a half month summary

Well, what can I say other than luckily Piper has been very easy to stabilize so there has been little to report but the following is a summary of our progress.

August
Piper was doing very well on Taste of the Wild. She was being fed 2 cups of kibble with 1 tsp. of enzyme per meal, three times a day. She was looking like her old self again so we brought her to the vet where she weighed in at 61.9 pounds! Everyone in the office was very surprised to see her looking so well and they were shocked at her quick weight gain. We decided to cut down her kibble so she received 1C. of kibble for breakfast & lunch and 2C. at dinner (4c. per day). After a few days with no side effects I dropped her enzyme down 1/8 a tsp. Within 24 hours I started to notice a change in her bowl movements, “combination poop” and after a few days there was also a decrease in her appetite. She was only eating half of her lunch and dinner. Thanks to my charting system I also noticed that there was also a corresponding increase in wet burps and stinky gas. Under normal circumstances I would have increased the enzyme and waited a few days to see the affects but, we were leaving the following day for a vacation in the backwoods of Maine.

Piper watching Tom drive up to Embden Maine

It would be a stinky 5 hour car ride plus we would be in the middle of nowhere without medication. I put in a call to my vet and picked up a prescription of Metronidazole to take with us just in case it was the beginning of SIBO. I increased the enzyme back to the original ratio but that night when she had nasty stinking pudding poop I started the medication. Although the car ride was still a bit stinky at times, within 48 hours she was regular again and despite the stress of traveling to a new place her appetite increased and she was finishing off her meals again.

She even went for her first swim, Not such a big fan of the water, but atleast she tried.


Trying to keep one eye on the children in the house and one eye on the child in the raft .

For the most part she just enjoyed relaxing in the cool sand.

September
Piper finished the medication and was rock solid for the entire month. She even started to look a bit chunky despite the decreased in her kibble.

Playing in the yard this Spetember

October
Week 1
Tom and I had the opportunity to go away for a weekend so Piper was going to be staying at a kennel for a little spa treatment. A few days before we were getting ready to leave I realized she was overdue for a fecal. When I brought in the sample the vet technician who knows us well at this point, said that it was one of the best looking samples she has seen. I never thought I would be proud of dog poop … but I was!

Week Two
Although I have not had her weighed at the office she looks and feels solid so I had her stand on two bathroom scales at home and she weighed in at 68 pounds!

She isn't happy about it but she is such a good dog she does it anyway!

I do not want her to get too big so I wanted to cut back on her kibble. The last time we cut back I cut out her lunch (per my vet’s instruction) but she had issues and started to vomit due to an empty stomach. So, this time I increased her morning kibble by ½ a cup while decreasing her dinner by ½ a cup cutting out 1C. of kibble a day. So far she is doing wonderful & feeding two meals is a little more manageable. So, at this point we are just trying to find a healthy balance of kibble and enzyme so that she can maintain a healthy weight and become too plump!

A summary of week three through week six

Where to start? I had hoped to have the time to do a weekly summary at the end of each week but due to summer vacation I have not been able to keep up. So here is a brief summary of the last few weeks.

Week 3 and 4
Week three and four were weeks full of change for Piper. In the beginning she was being fed 1.5 C of Hills ID prescription diet four times day. We dropped the enzyme down from 1 ½ tsp to 1 3/8 of a tsp. without major issue. She did burp up once and had a tiny bit of tummy rumblings during the first 24 hours of the change but her “out-put” was perfect. So we gave her a few days to adjust and took a wait and watch attitude.
She adjusted well after the initial 24 hours so we continued to drop her enzyme in steps until she was down to 1 1/8th a tsp. per 1.5 C of kibble. The other issue that we had to deal with was cutting her feedings back from 4 to 3 times a day. Being a busy Mom of three my schedule is hardly ever the same from one day to the next and squeezing four feedings in was difficult. Three feedings a day is more manageable. So, we increased the amount of food per feeding to 2C with 1 ¼ tsp of enzyme and fed her 3 times daily.

Week 5
Going into week 5 we decided to start weaning her from the Hills ID prescription diet. From the reading that I had done I learned that it is best to switch to a grain free food which decreases the risk of small intestine bacterial overgrowth. The grain found in most kibble can be metabolized by harmful bacteria within the intestine allowing them to multiply and outgrow the beneficial bacteria within the dog’s intestine.
When looking for a new food for a dog that has been diagnosed with EPI it is recommended to find a grain free food low in fat (12% or less) and low in fiber (4% or less). After much research I decided to switch her over to Taste of the Wild Pacific Stream Canine formula. Although it contains a slightly higher percentage of fat (15%) this includes Omega-6 and Omega-3 Fatty Acids. When the percentage of fat is recalculated (leaving the Omega-6 and Omega 3 Fatty Acids out) it is closer to the recommended 12 percent. T.O.W also has the recommended low fiber content (3%). We took it very slow, decreasing the Hills kibble and adding the T.O.W. by a ¼ C. every two days. She was successfully weaned onto Taste of the Wild and eating 2C. three times a day with 1 ¼ tsp of enzyme. The next step will be decreasing the enzyme to the minimum required by her system to digest her kibble.

Week Two

Well week two was looking very promising. Piper’s poops have been rock solid and I was excited to take her into the vet on Thursday to have her first weigh in. After dropping the kids off at religious education I drove back to the house and loaded Piper in the car despite the raging monsoon. As we pulled up to the vet’s office Piper howling in protest, I noticed that there were no lights on in the office. I left Piper in the car and went into the office only to find out that due to all of the thunderstorms earlier that morning they were without power and I would not be able to have her weighed.
The good news is as of Thursday July 2nd we reduced the amount of enzyme she was receiving by 1/8th of a tsp. The bad news is she just puked on my kitchen floor. It was mostly a mix of mucous & water but still a bit disheartening. We have had on and off thunderstorms this afternoon and evening and she reacts poorly to these. As you can see from the picture, she usually hides on our bed panting and shaking, not what you want to wake up to at 3 am! I am hoping it is due to her neurosis and not the decrease in enzyme. Of course it was charted as soon as it occurred as well as the fact that she was upset due to the weather. I had planned a subsequent decrease on Sunday if she reacted well but I think I will wait and see if any other incidences occur. I hope to be able to report another decrease in enzyme as well as a weight gain in next weeks update.

Charting

In order to stabilize Piper I had to keep track of EVERYTHING going into as well as EVERYTHING that was coming out of her and the more details the better! My family dinner conversations have been less than appetizing, just ask my husband. There are so many factors that can affect the stabilization of an EPI dog, the amount of enzyme, the amount of time you soak their food, the amount and type of food. They say that the proof is in the pudding? Well, in Piper's case it is in the pooping. What color is it, what is its consistency and yes, what does it smell like.



Now the best advice I have been given has been to keep a journal and only every change one variable at a time. I started using a chart to keep track of the information but soon realized I needed more room and more details so, after several working drafts I came up with a method that works for me. Based on Piper's needs I have developed two charts. A weekly chart which allows me to write notes on food preparation, the time of her feedings, when she received her supplements, a description of her BM's as well as her behavior and her condition. This has come in handy when her BM's have been slightly off but I can look and see that the day before she hijacked one of the kid's snacks.



Although the weekly charting works well I didn't want to have a million pieces of paper floating around my kitchen. That was where my days of a C.N.A. came in handy. Based on an activities of daily living chart I constructed a chart that would give me a quick look at her progress over a month's time. The following are charts can be downloaded for your use.

WEEKLY EPI CHART
Click to
download

MONTHLY EPI CHART
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download

Week One - A Summary

I am happy to say we made it through the first week! It already seems like I have been doing this forever. We are very lucky that for the most part she is stabilizing quickly and we just have some fine tuning to do. For the most part she is having normal BM's with the exception of her evening poops which were just ever so slightly off. I am wondering if I was feeding her snacks and meals to close together and her body was processing them as one meal. So, adjustments were made! We are back to three meals but have increased the amount of food and we will give it a few days and see what we get. What I am truly amazed at is the difference in volume. Before the enzyme supplement not only were the “gifts” she left nasty looking and smelly but there was a lot. She would go approximately three times a day, roughly 2 C. at a time (this is of course an estimate I did NOT pull out the Pyrex and measure). She is now down to twice a day and less than a half a cup at a time! Of course, my neighbors think I have a dog poop fetish, each morning we go out to the corner of the yard and I coax her, “Do your business” as she gets ready to go I am trying to peer under all that tail hair so I can see how to chart her poop for the day. When she is done she gets a big cheer and we race for the house. I mark down EVERYTHING so that if there is a change in her behavior or physical condition it will jump out at me and I can figure out what change in her diet has affected her. It also helps to identify patterns both healthy and unhealthy. Once she has been stable for a while then I will be able to make the next change to her diet. At this point our goal is regular poop and weight gain. I hope in the future to decrease the amount of enzyme she is receiving.

The following is an example of a chart that I use to keep track of her progress. I have adapted it a few times to meet Piper’s personal needs. I am also trying to develop a monthly chart so that I do not have to hold onto all of the weekly charts.

One of the truly wonderful side affect of treating Piper’s EPI is that our lawn will finally be able to heal. This is a picture of our lawn with divots of grass missing because it was the only way in which to clean up the yard. If you wanted to get rid of the poop you had to sacrifice the grass.

Piper's First Diner ala Enzyme

Piper does not like to wait while her food digests in a bowl on the counter so I try to make 2 days worth of food at a time so that I always have it on hand. At this point she will eat it right out of the fridge and could care less that it is cold.

When treating a dog with E.P.I soaking their food is important and has two purposes.

1. It helps to physically break the food into smaller pieces increasing the surface area and allowing more the food to come into contact with the enzyme.


2. The warm water helps activate the powdered enzyme which is otherwise dormant. The enzyme powder actually consists of three distinct enzymes: Lipase, which chemically breaks down fats into fatty acids, Protease which breaks proteins down into amino acids and Amylase, which chemically breaks down carbohydrates into simple sugars. Once broken down Piper's body can then absorb them into her system.

It is important that you allow the enzyme enough time to break down and predigest the food. If the enzyme has not had enough time to react with the food your dog will not acquire the maximum nutrients, still may display the symptoms of E.P.I and there is a greater risk that it will cause oral ulcers and sores. Piper's food soaks for a total of 45 minutes.

Hair loss due to malnutrition

Just before we started the enzyme treatment I noticed that there were a few pink spots along Piper's muzzle. Within a day or two I noticed the top of her nose was also pink. She had started to loose her hair due to malnutrition. Like any other dog she was shedding but due to her condition her body was unable to replace the lost hair because she was unable to process the food she was eating. Her body could not unlock the nutrients required to synthesize new hair.

She may be thin but she has energy to burn

June 16, 2009

She was diagnosed and we were waiting for our enzymes to arrive in the mail. Although Piper had dramatic weight loss she still had energy to burn. I tried to keep her energy expenditure down to a minimum but, NOTHING would stop her from playing with her Frisbee, of course before she can have the Frisbee she must do a trick!

Piper's Weight Over Time

In the beginning Piper's weight was not an issue it was easily maintained as she grew. She started out in 2005 at 54 pounds and for two years grew at a steady pace. In 2007 I was having a difficult time keeping weight on her and she just seemed a bit slim, so we increased the amount of food she was receiving and she gained a few pounds. She held steady weighing in at 63.1 pounds for a year. She was never driven by food, would never touch food left out on the counter (anything on the floor or children sized furniture was fair game), if we were training at the kennel she would refuse treats and so she received a ton of praise instead.

She started to loose weight slowly in 2008 dropping to 58 pounds which was not noticeable because of all her hair. In early 2009 she dropped a pound but we assumed it was water weight or due to an increase in activity level. It wasn't until she started loosing weight drastically during the spring of 2009 that we were able to notice the weight loss. From April 27th to June 9th she dropped almost 10 pounds and was RAVENOUS all the time.



A year ago we could have left a steak on the counter and she would not have touched it, now nothing is safe. After feeding her dinner last night I went upstairs to check on the kids only to hear a crash in the kitchen. I ran downstairs only to find that she was cleaning off the dirty dishes in the kitchen sink. She is currently being fed a 1 1/4 C. of kibble (which is pretreated with enymes) three times a day and a 1/2C. of the treated kibble as a snack when she needs it. On June 9th she weighed in at 46 pounds.

Why start this blog?

Although this is a treatable disease dogs living with E.P.I have individual treatment plans that suit their personal physiology and their physiology changes with time, as her pancrease continues to atrophy adjustments will need to be made to accommodate her needs. That being said, it is helpful to keep a journal of what works and what doesn't work as well as pictures to show how she is progressing. I thought that a blog would be the best way to accomplish this.

Piper at 9 months old.

A summary of her history

Piper at 8 Months

Oh, where to begin? I guess we always just assumed Piper had a sensitive stomach. It started when she was just about two years old. She would get the runs and we assumed she had either gotten into a snack left out by one of the kids or she was eating her poop (a nasty habit she had from the start). It happened often enough that I knew the protocol by heart, the vet would prescribe Lomotil (an antidiarrhea medication) and antibiotics for bacterial overgrowth, she would be fed rice and boiled chicken for a few days and then slowly put back on her regular food and eventually everything would be fine. That is until the next time.

On September 6th 2008, she was almost 4 years old, I noticed she was a bit lethargic, she threw up and there was a trace amount of blood, then she started having bloody diarrhea. I slept on the floor by her kennel for the night and in the morning when there was still blood in her stool we took her to an ER vet where she was rehydrated, treated and released. We took her the following day to our vet where she was treated and a course of action was discussed. We decided that even though every fecal sample run had ALWAYS come back negative we would de-worm her and this would help ensure that she was not suffering from a parasite. She was dewormed in September and had the runs (or as we fondly called them pudding poop) in November. December came and went without an incident but, then in January it happened again. We tried everything from adding a meat tenderizer to her food, putting her on Metronidazole and even plant derived enzymes. When all else failed and she started to lose weight we put her on Hills Science Diet ID a a prescription food that would cover any food allergies she may have and it was easy to digest. At about $50.00 for a 20 pound bag I was a little frustrated when she had the runs AGAIN!

After reading a post about another dog with similar symptoms and her diagnosis with EPI, I took Piper to the vet and had the vet run a blood test called a trypsin-like immunoreativity (cTLI) which is the only way to properly diagnose this condition. While we were there I had them weigh her, she had dropped from 56 pounds at the end of April to 46 pounds in June. On June 12th 2009, when the results came back she was diagnosed with EPI. A healthy dog will have a range of 5-35 and Piper’s was less than 1. She was literally starving to death.

She was always hungry, so hungry in fact she would steal food off of the counters and eat items she otherwise would NEVER have touched - like strawberries.

Piper is pictured here guarding marshmallows for our s'mores. Now a days they wouldn't have lasted 30 seconds !

Piper is currently being treated for this disease and we hope to find just the right balance of enzymes, food and supplements so that she can live a long and healthy life with our family.