EPI * Exocrine Pancreatic Insufficiency

I have a 20 month old spayed GSD that most would say "looks on the thin side".    Her weight maxed out at 66 lbs at nine months old.   She weighs 62 lbs now at 20 months.   You can feel her backbone as though it's an exoskeleton, her hip bones are visible and overall very bony feel to her.   We try to do a four mile walk every day but there are some days when she just can't handle it.   Now this is a young German Shepherd which should be running ME into the ground not the other way around.   

Diet has been a grain-free kibble (now on Orijen).   I supplement with a probiotic/enzyme tablet that I picked up at Petco and these do help with the stools.   Without the supplement the stool is very loose/runny and very light tan color.   Ruby's appetite has been poor - picky eater.  Now on Orijen her appetite has improved tremendously.   Her stool has darkened but time will tell if the kibble switch is really helping and if she will put on any weight or keep losing.

Aggression has been a real problem with this dog.   A thyroid panel was run by Hemopet and the results showed a low T3 and possible other medical issues that should be looked into but no direct thyroid/aggression link.

I'm hoping to find a solution that I can live with.

If you want to check Ruby for EPI you need to request a TLI Test

another possible thing to check would be B12 levels - low B12 can cause behaviour/personality issues

both require a 12hour fast

Welcome to the Forum Ron and Ruby.  What you describe in Ruby's condition will sound very familiar to most who come in here. I'm sure you can get lots of very good advice to get her on the right track.  My boy has fortunately been cleared for EPI and is now doing well, so I'm not the best person to give you solid advice, but I can givea wam welcome and a bit of moral support. Charlie Pete can also have behavioural issues. Not an easy road.  Very soon I'm sure someone will pop in that has more experience than I do to give you good advice. So check back often. Ruby  looks to be a beautiful girl. 

Hi Ron and a very warm welcome to you and yuor beautiful gal!

Reading your post... warning bells startedf going off in my head....what you are describing sounds very much like EPI with low B12 and SIBO... which is very typical.

As Karen suggested, if you can, the best thing would be to call your vet and request a cTLI test. It is a blood test that your dog will have to fast for. It costs approx $100 and while they are at it drawing the blood also ask your vet to draw enough to run a Cobalamin (B12) test.... These two tests will give you all the answers you need and then you will know exactly what you are dealing with and how to proceed instead of guessing.

Please share with your vet the following Texas A&M Protocol for both of these tests (scroll halfway down each page for the information). These blood samples should only be drawn and shipped on Mon, Tue or Wed.... so that the blood doesn't lay around in the lab all weekend and become useless.

http://www.epi4dogs.com/tli.htm

http://www.epi4dogs.com/b12.htm

See, Ron...I knew smart people would pop in wtih good advice! and here they are.

Hi Ron and welcome,

What you'lll need to do is get a fastling (12 hours) cTLI blood test run from your vet and have him draw enough blood to do a folate and B12. Also don't forget to run the test early in the week so that the blood doesn't sit in the lab over the weekend.

As far as the thyroid, many dogs with malabsorbtion issues (such as EPI) will come back with false positives on a regular T3/T4 test.  If in fact you are dealing with EPI have a full thyroid study done to ensure the thyroid really is the problem...

BTW, if anyone has already suggested these things. I appologize...I started this post over an hour ago, but had something come up and am just getting back to it now.

Let us know what you decide!

Ron ~

sorry... i have more to say......what i also wanted to mention to you is that the fact that the "supplement" helps... indicates to me that she has EPI.... but supplements are not strong enough to manage an EPI dog... You will need the appropriate porcine pancreatic replacement enzymes. They are expensive, however... if this is what is wrong with your dog, we can tell you where to purchase them for 1/3 the cost of Viokase, Pancrezyme, etc.

The fact that you dog is feeling tired, has a lack of appetitie AND starting to have a personality change is usually indicative of low B12.. This is a secondary condition that happens about 50% of the time with EPI dogs.  This is what the Cobalamin test is for.... it will give you her levels...and then if it is low or low-normal she will need B12 shots. There is also a protocol for that on a sliding scale method and then just maintenance.... and if this is the case... you will be amazed at the turn around your dog will show once you bring back up her B12 levels.

The tiredness can also be from her body honestly being tired from no longer absorbing the nbutrients from the food she is getting because she cannot produce the necessary enzymes needed to digest the food.... this is EPI... but again... if this is what is going on... you;ll be amazed at the turn around once she starts receiving the proper enzymes.

B y the way...the food you are feeding her is great stuff

And lastly, the fact that your dog is doing light tan mushy poops is usually indicative of SIBO. Small intestinal bacterial overgrowth.  For this, ask your vet to treat with Tylan (antibiotics) for 30 days... No less!  SIBO is also another secondary conditiont aht accompanies EPI about 70% of the time....But most times, you can get rid of it with the right antibiotics.  Also, when you run the Cobalamin test... they also test the Folate levels... if these come back high, then you will know for sure your dog has SIBO.

I strongly suspect the aggression is low B12 if and only becuase of all the other symptoms and the linkage of these conditions.

Testing will be Monday 8 am.   I have dropped off the literature on EPI with the vet along with the test / shipping procedures like I did when I had the thyroid test run and shipped to hemopet.

Ahhh Ron... Now that's what we like to read about... owners who schedule their dogs for these test to know for sure if this is what they are dealing with!

Keep us posted .... you should get the results in about a week.

Hi again Ron,

I see you did send the thyroid to Dr. Dodds.  Sorry. I still believe it would be worth revisiting if your pup does have EPI.  Tara's thyroid was off too when she was an emaciated 49 pounds, but now that she's a hefty 84, there are no more thyroid issues.  Aslo, if EPI is the culprit, many of us get our enzymes from here at a huge cost reduction:  http://www.enzymediane.com/  I don't know how I could afford this condition without her!!! I suppose the house would have been remortgaged by now...

Aggression is very common early on with EPI as these poor pups are STARVING... I'm glad that you are being agressive about getting to the bottom of this!

Hi Ron, first...she is BEAUTIFUL!!!   Everyone here has covered most of the detail but I just want to welcome you and say you found the perfect place to be.    It took me 3 vets before Jackie was diagnosed and by the time I found the 3rd vet I found this forum so I was really telling them what I wanted and Jackie has been stable for about a yr (except for yesterday - tiny blip).   I am so happy to hear she is scheduled for Monday and you gave them the info.   Sometimes half the battle is getting the vet to listen to you and work with you - sounds like you found a good one.  Once she is tested you will have a better idea on how to truly proceed.    Welcome again and I know you will be thoroughly happy with the vastness of info you find here...as well as the lightheartedness to get you through when sometimes thing aren't going the way you would hope.

Michele and Jackie!

Hello Ron,

Welcome to the Forum! You have been given EXCELLENT advice in the above posts! Ruby looks beautiful... I love GSDs! I have a feeling from what you posted, that after you have the above mentioned testing done, you will discover some medical reasons contributing to her problems. The good news is once treated you should see improvement both physically and emotionally. The not so good news is that after the medical issues have been addressed Ruby may still need help unlearning some of her negative reactions. So if you have not already found one, you may want to keep an eye out for trainers available in your area who are experienced in modifying agrressive behavor with positive techniques.  Good luck finding the answers to help your beautiful girl!

Hi Ron.

You earn 10 out of 10 for getting in there and having the tests done.

As to the aggression.... yes... I've been there, done that.... Razzy I now believe was born with a case of EPI and she was the most aggression PUPPY I have seen in 60 years with dogs.

She became worse by the day until at five years old she was suffering fear aggression really badly, snarling at dogs and even running away from people or hiding behind me if someone approached... then EPI burst over us with full impact.

The penny finally dropped that she had always had digestive problems and must have felt vulnerable because her pancreas was slowly dying and she wasn't absorbing certain vital nutrients... some that effect the brain.

Now nearly 4 years on she is MUCH better... I can walk her past dogs and let people stroke her... although dogs off lead that pester her still causes aggressive reaction. But much of this is learned from years of fear and feeling 'not quite right'... if only I had known about EPI all those years ago I could have saved her, but I didn't know it existed until it hit us.

Razzy is an exceptional case probably the worse I've ever heard of... she even attacked my old GSD... then ME... when she was only 6WEEKS old! My hubby's friend alway said there was something wrong in her head and he was right,,,, her baby brain was being starved of vital nutrients and no one knew because EPI simetimes doesn't show real symptoms until much of the pancreas has died.

So, if getting stable and healthy again can turn around THAT girl... there is hope for every other dog with EPI problems.

Val

Well, I'm glad I found this site and I appreciate all your help (and nice comments about Ruby).   Ruby is a great dog with potential so it's worth it to see if she has a medical problem.   This is my 6th GSD dating back to 1978.   None of the other dogs were like her as far as aggression or as bony as she is.   She is about the most intelligent of the lot though maybe except for my first 'shep, Brandy which was one smart, well-behaved dog.   If it does turn out to be EPI or B12 or SIBO (or a combination) we'll get it taken care of.   From what I have read so far she does show the symptoms of EPI and low B12 and probably has since about 6 months old.     Back then, last year, I never heard of EPI so I would have never thought of looking into it.   None of the Vets brought it up either but on the last visit for the thyroid blood work he did remark about how thin she was and was surprised that she had not gained weight in almost a year.

As for training boy do I have that covered.   Ruby's seen a couple "doggy shrinks" already and I am well-versed on counter-conditioning, reward-based training, positive reinforcement v.s. punishment, clicker training, desensitizing, etc.    My "breeder" when asked about her aggressiveness told me to use punishment "show her that you won't tolerate that behavior".    Well, OK, but what's the underlying cause?   Dogs don't just behave aggressively for no reason and they don't have the ability to think abstractly as humans do.   So I thought that punishing a dog for what it may not have any control over was cruel.   I did have good success with calming behaviors like sit stay when other dogs approach.   So let's see what the tests show. 

Hey Ron,

I too have been owned by GSD's for 35 years with my family and many years more as a child and I agree, the behavior is not normal...AS an aside, my Tara went the complete total polar direction in that she got herself terrified of everything and everyone...She, at 6 months was suppose to be the best Shutzund canditade in her class..

Our motto is every dog is different and they are in how they respond to treatment, meds and training.  EPI is not a "one size fits all" condition.

Howdy Ron and Ruby, beautiful name, beautiful pup. Good on you for taking decisive action, it's tempting and understanding to invest a little too much credence in poor advice when it comes from the vet, well-meaninng or otherwise. Well done you.

Prior to gettng your the results back I'd only add that there's no harm in starting B12 supplementation immediately after her blood is taken. Even if her levels turn out to have been OK she'll just pee out any excess vitamins. Your two main options are a B12 injection or supplement such as  Metagenics Intrinsi B12/Folate  tablets but of course subcutaneous injection is a more direct and effective route. If you haven'y already have a read of the B12 info at the top of this forum page. If you do have a B12 shot make sure it is the generic variety and not the multivitamin version.

Lastly, thanks for so eloquently stating the logic behind reward-based behavioural training (or rather the flawed counter-intuitive reasoning with punishment). There is always an underlying cause and to punish any pup instead of educating her is to my mind quite boggling. We have had great success with positive reinforcement training with our Lulu (cripes it works for me sometimes too) and I always love it when people in the park come up to us and ask how we got her to be so well-trained when actually she wants to do it and is rewarded and happy to do it. She leads by example and I'm thinking of making her a superhero training cape. Once ou get those nutrients flowing through Ruby again I bet you'll see a marked change.

Please post the results as soon as you have them. Good luck.

Craig

Hi Ron & Ruby,

Wow, looks like I have come in 'very late' here.  You've already had some great advice so I'll just say a very warm welcome to you & Ruby to our EPI forum.   Pleased you have found us.  Good news that you are having Ruby tested.   Always good to know what you're dealing with.   Must say that she is a very pretty girl. 

Again welcome.

Lynn & girls.

Ron... I think I am going to adopt you.. (I can say that because I'm old)

I too have a sound grounding with training sheps and others along the way... and although a frown or a sharp command may be needed with the bolshi ones...  mostly males... because being a female only 5 ft to a gnats ear and not much heavier than the dog is... the males always want to protect rather than obey me. Its a bit harder to convince them I'm the alpha of the pack..

With a fearful dog the only way forward is to give it confidence, NOT fuss and sympathy, but cheerful, happy..."its OK pal. There's nothing be afraid of ".... Its a shock when you get one like that after a string of happy-go-lucky sheps who think the world is for their entertainment.

Strange you should comment on Ruby being intelligent... Razzy is also one of the more intelligent sheps I've had. Maybe that is why feeling vulnerable made her so scared... she had the intelligence to figure out the dangers she  thought she saw around her. The easiest shep I ever trained was thick as two short planks... a big, beautiful male who looked like every persons dream of a shep, but really didn't have the intelligence fruit fly.

Dogs are wonderful, aren't they?

All so different and all end up stealing your damned heart away.

Razzy trained for two years with a 'dog shrink' and he did help a lot, he often pops over here to see how she's doing and has admitted that he didn't expect me to manage her fear aggression because she was the worst he'd ever seen. When we explained the EPI factor he was really interested and I think he has suggested that to other bad cases since.... maybe my girl will help some other poor fearful dog through him.

I'm sure you will have Ruby fit and healthy one way or another because you sound level headed and have that ability to 'think from the dogs point of view' but she may always retain a small inside fear because it was learned so early in her life. Just once in a while Razzy still shows fearfulness for no reason I can see, but I jolly her along and it soon passes.

Gawd.... even my kids didn't demand such dedication (or at least thats what they tell me)

Val

I will not offer any advice because I am new to this disease and forum. I can tell you that the people here are very knowledgeable and helpful. My dog Ulric was in the same situation, except for the behaviour, he has always been a sissy. With treatment and following some of the good suggestions on this board Ulric is now 73 pounds and looks good. So welcome and hang in there it does get better.

Just wanted to welcome you and say,  she is gorgeous.  Let us know how the tests go.