EPI * Exocrine Pancreatic Insufficiency

Gunnar is a 17 month old GSD. Although his lab results will not be back from Texas A&M University for a week, I am convinced he has EPI. I started noticing his "stomach trouble" after Christmas, and attributed it to too many Christmas treats. However, looking back I wish I would have been more observant. Clues everywhere, especially the fact that a flock of magpie birds started descending upon his poop and eating it immediately after he deposited it, about two weeks ago. On January 13, we went out for the evening for about 4 hours, and Gunnar pooped inside the house, which he NEVER does. Today he is pooping about every 2 hours, and has tried to eat it himself (a new development today).

On November 1 at the vet, he weighed 80 pounds. Today he weighed 74 pounds.

I want to get him onto enzyme treatment right away. I can notice he has declined even from yesterday. Should I go for an over the counter product in the short term until the TAMU results come back and my vet can prescribe something? If so does anyone have any suggestions for what product to purchase??

Thank you in advance for any help.

Hello -  I am sorry to read that your handsome boy Gunnar may have EPI.  If you want to try some enzymes while you wait for the test results you can order them, without a prescription and at a very reasonable cost compared to those purchased thru a vet, from:

http://www.enzymediane.com/

Gunnar at January 17, 2012 at 2:38 PM

Gunnar is a 17 month old GSD. Although his lab results will not be back from Texas A&M University for a week, I am convinced he has EPI. I started noticing his "stomach trouble" after Christmas, and attributed it to too many Christmas treats. However, looking back I wish I would have been more observant. Clues everywhere, especially the fact that a flock of magpie birds started descending upon his poop and eating it immediately after he deposited it, about two weeks ago. On January 13, we went out for the evening for about 4 hours, and Gunnar pooped inside the house, which he NEVER does. Today he is pooping about every 2 hours, and has tried to eat it himself (a new development today).

On November 1 at the vet, he weighed 80 pounds. Today he weighed 74 pounds.

I want to get him onto enzyme treatment right away. I can notice he has declined even from yesterday. Should I go for an over the counter product in the short term until the TAMU results come back and my vet can prescribe something? If so does anyone have any suggestions for what product to purchase??

Thank you in advance for any help.

Hello  and welcome.

Well done for spotting the pooh eating that is def a sign of undigested food if you follow this link hopefully this will help you i am from Uk so this is the only suggestion i can make but somebody  will be along with other suggestions in a short while. http://www.epi4dogs.com/enzymes.htm

The other thing i would suggest you do as well is change straight away to grain free food and increase his food to 150% feed more often 3-4 times a day if you can and make sure you break the food down by adding warm water this aids the digestion .

Once you get the results you may need B12 supplements and antibotics but hopefully you will get the results back within the next few days.

He is a beautiful dog you can tell he is still young.

Once you get the balance right you will see  the

weight will go back on ask as many questions as you want.

ANN

Hi,

 Becky gave you the link for Enzyme Diane, you can get a range of sizes from her, including a sample size.  She is wonderful with getting things out ASAP.  However, if you cannot wait for her enzymes to be delivered, make sure you try an animal (porcine) based enzyme, NOT a plant based.  The plant based is just not strong enough.  If you use something from a health food store, it may be a bit difficult to know how much to give, as often they come in capules.  I have used the NOW brand 4X enzymes or Source Naturals 8X myself in a pinch. 

If you do end up getting an over the counter, let us know and we can try and help as far as what may be a good place to start with how much to give.

Welcome to you and Gunnar!  He is a beautiful boy!  It definitely sounds like epi but the good news is that it sounds like you are catching it pretty early.  We all beat ourselves up after the dx about the "signs" we missed...they are easy to see in retrospect, but not so clear in the beginning.  And so many vets are not familiar with epi that it is often the last thing they test for, even with GSD who can be prone to this disease. 

I don't know how well versed in epi your vet is so he/she may or may not be up-to-date on the latest recommendations...and there's a lot to read here.  So the following is the quick things to get you started.

1.  In the Downloads section there is a log, which can be very helpful to keep, at least in the beginning.  It can help pinpoint what change you made had what effect.

2.  Keep in mind every dog's "transit time" (time from eating to pooping) is different and most likely the poop you see now is not the last meal  Generally it is 12 to 72 hours.  One way to find your dog's transit time  feed some raw carrot in a meal; when you see it come out figure out how long it's been...that will give you a good idea...makes it easier to know this and use the log.

3.  Most epi dogs need grain-free food, whether raw, cooked, kibble or canned.  There's a good list in the food section and we all talk about what we use.  All food has to have enzyme.  So best to not have treats for awhile until Gunnar is stable.

4.  So far not too bad of a weight loss (though I know it hurts to see them lose any weight)...we recommend feeding smaller more frequent meals in the beginning (if you schedule allows 4 meals/day is great, otherwise 3); and feed 150% of normal until you are back up to a goal weight and/or Gunnar starts leaving food.

5.  Hopefully they also tested for B12 (cobalamin).  Needs to be in the higher range of normal.  Some vets think anywhere in normal is fine, but need it in the higher end.  If below that start with weekly B12 shots.  Most vets will teach you to do at home and sell you the B12 and syringes which is a huge savings from taking them in for the shot.

6.  I would start with the enzymes now and www.enzymediane.com is a great place to obtain the enzymes.

So welcome again to you (name?) and Gunnar.  It is a bit of a frustrating and rocky road in the beginning but it does smooth out and lots of people here willing to share their experiences to help you both.  Each pup is different so we offer what works for us and you will find what works for Gunnar.

Feel free to ask lots of questions...it's how we all learned.  One last thing that can be helpful.  Some of these threads can get quite long and it can become difficult to go back and read everything.  In your profile you can add a "signature" as you see many of us have with the info on Gunnar, condition and treatment.  Helpful to include:  breed, age, test scores when you get them, enzymes used and amount, amount and type of food and any other medications/conditions.

Hello again - I went to get another cup of coffee and was thinking of your pup and then realized I had forgot to say welcome to the Forum.... bad me! 

There is tons and tons of good information here on the EPI4DOGS website.  If you have not already read it, a good starting point is a section titled "DETAILED  EFFECTIVE  EPI  MANAGEMENT" on the following linked page:

http://www.epi4dogs.com/

Again, welcome to the Forum!  

Hello everyone,

Thank you so much for the rapid responses! My vet e-mailed me a few minutes ago...told me to get Pancrezyme tablets 421 mg, as well as Pepcid AC 20 mg twice per day, and vitamin E 400 units per day. I quickly ordered the Pancrezyme prescription from VetRXdirect.com b/c I only had an hour to get it into FedEx for overnight delivery. Hopefully the Pancrezyme pills are the correct approach...my husband was really concerned about the powder and it's side effects. Now I will begin to research on the epi4dogs website, which I have found to be tremendously helpful.

The good news is the food that Gunnar has always been on is on the "grain free" list....Orijen.

BTW, my name is Allison. I'll create a signature, etc.

Thank you again everyone. If you have any feedback on the course of action so far, please let me know.

Allison

Welcome to you and Gunnar and good on you to get on this so quickly.  I was like you and was convinced that Cedar had EPI before she was tested so I asked my vet for some enzymes to start treatment before the test results were back.  If you're planning to order from Diane but don't want to wait for delivery, I bet your vet can put hands on some higher priced enzymes more quickly.  Our vet  didn't have any enzymes in stock so he called a human pharmacy and we started Cedar on Viokase the day that she was tested.  If you do that, let us know and we can help with dosing etc.  Our vet didn't know what dose or that the enzymes needed to be crushed and mixed and incubated so we didn't have much luck with the viokase until the folks on the Forum helped me out.  Our first enzyme order from Diane went MIA so we had a bit of a wait to receive it but most people receive theirs speedy quick.  If you do contact your vet again, perhaps ask about getting Gunnar a B12 shot as well.  If he doesn't need it, he'll pee it out and if he does, then you've gained some steps by starting it early.  Since Gunnar also has nasty poops, maybe your vet would be willing to start him on some Tylosin.  It's often prescribed for treatment of diarrhea anyway.  And then you're well on your way!

Hi Allison,

Again, welcome to this site.  It is a wonderful wealth of information.

I was curious when you said your husband was concerned about side effects of the powder?   Can I ask what specifically is his concern?

I do not use the tablet form myself, so hopefully others will chime in here.  I have 'heard' that the tablets are not always as effective as the powder for some folks.  I believe that some people are more successful when they crush the pills and incubate them.  Terry uses the tablets, she would be a good resource to tell you how she doses or prepares the meals.

Keep us posted about your boy,

Lisa

Star's Mom at January 17, 2012 at 3:18 PM

Hi,

 Becky gave you the link for Enzyme Diane, you can get a range of sizes from her, including a sample size.  She is wonderful with getting things out ASAP.  However, if you cannot wait for her enzymes to be delivered, make sure you try an animal (porcine) based enzyme, NOT a plant based.  The plant based is just not strong enough.  If you use something from a health food store, it may be a bit difficult to know how much to give, as often they come in capules.  I have used the NOW brand 4X enzymes or Source Naturals 8X myself in a pinch. 

If you do end up getting an over the counter, let us know and we can try and help as far as what may be a good place to start with how much to give.

 

Hi Star's mom,

I called my local health food store and they have the NOW and the Source Naturals porcine based pancreatin (sp?) enzyme. I am going to pick up up some of that while I wait for the prescription to be delivered hopefully tomorrow.

Thanks!

Allison

Hi, Alison. I'll reiterate the welcome to you and Gunnar. When I first found this forum, when Maya was diagnosed, I shared your concern about mouth burns with the powder, which proved to be completely unfounded. I soak the food for 30 minutes, during which I usually walk or otherwise distract Maya. We've never had a problem. There are people on the forum that use the tablets - the one who most quickly comes to mind is TerryBin. She will give you support on how to use them.  (If you don't hear from her, you can use the Advanced Search feature under the Forum tab.)

The powder is more commonly used (at least by the US-based members of this forum) for two primary reasons - cost and effectiveness. We are able to get reliable, high-quality enzymes through EnzymeDIane.com for 1/3 the cost that vets charge. More dogs are stabilized more quickly with the powder than with the tablets.

So glad you found this forum, full of caring, experienced EPIers. I'm sure Gunnar will be on the road to full health in no time. The hardest part is often the diagnosis, since many vets have never seen an EPI case, so you are already in good shape.

When you get the enzymes from the health food store, let us know that dosage of lipase, amylase and protease. We can then guide you on how much to add with Gunnar's food.

You really should talk to your vet about B12 injections (see the info under the B12 tab at the top). Most  EPI dogs need it and, if Gunnar doesn't, he'll just pee it out. Did your vet run cobalamin/folate tests along with the cTLi? EPI dogs need to be at the top of the B12 (cobalamin) range to thrive.  SIBO is also present in about 96% of dogs at diagnosis, so keep that in mind, if you don't see results, you could be battling SIBO, which requires a 30 day (minimum) course of antibiotics (Tylan (tylosin) being the anti of choice).

Terry does crush the tablets (see her signature info above) and we also crushed the viokase when we were using it in order to see any improvement at all.  We were also up to about 7 tabs/meal with Cedar and they were really expensive.  We were happy happy to receive our pancreatin powder from Diane.  We haven't noticed any untoward side effects from using the powder.  I make sure to wash my hands after preparing Cedar's food because it does get itchy if the powder stays on my skin, but that's just a common sense thing...they're digestive enzymes and aren't meant to be on your skin

Hi Allison,

A warm welcome to you and your stunning boy, Gunnar.  He sure is handsome.  It sounds like you have caught this pretty fast if it is EPI and it sounds like it is.  Just know that it is very manageable once you get the basics in balance.  You have come to the right place too.   There is so much good information and knowledge here because people have been treating their dogs for many years.    Remember, hindsight is always 20/20.  I knew nothing about EPI and missed signs that I would know now for sure.   We have all been there.  You were alert and noticed things and are already proactive.  So, well done! 

We buy our enzymes from Enzyme Diane also, but it sounds like you are going to get jump-started with a rush order from the vet first.  We did the same thing, although it took us quite a while to get over the sticker shock of purchasing from there.  Once you know for sure if you are dealing with EPI, you can easily order from more reasonable sources. 

Let us know the results and ask any questions you have in the mean time. 

Barb

Star's Mom at January 17, 2012 at 4:56 PM

Hi Allison,

Again, welcome to this site.  It is a wonderful wealth of information.

I was curious when you said your husband was concerned about side effects of the powder?   Can I ask what specifically is his concern?

 

I do not use the tablet form myself, so hopefully others will chime in here.  I have 'heard' that the tablets are not always as effective as the powder for some folks.  I believe that some people are more successful when they crush the pills and incubate them.  Terry uses the tablets, she would be a good resource to tell you how she doses or prepares the meals.

Keep us posted about your boy,

Lisa

Hi, I have read so much on this and other sites today I might be getting mixed up.... But my husband was concerned about the mouth burns and the exacting "safe handling" instructions, i.e. don't get it on your skin, etc. Seems to me I read something about the powder causing asthma attacks if you breathe it in...my husband has asthma. Also, it seems to make sense that the tablets would pass through the mouth and stomach without really doing anything and then disintegrate and do their magic in the small intestine, versus powder that would react in the mouth and stomach ??? Maybe the incubating takes care of that. If powder is the definite way to go, then I'm all about that. I purchased one bottle of the tablets but no big deal.

Allison

Hello and welcome!  Sorry for being late to the party.

I use the powder and yes, you can get 'burned lips' if you don't inucubate, but aside from that I haven't had any problems.  It's gotten so routine now that I've gotten up in the morning, fixed his food, set it to incubate, and went back to bed with no memory of ever having done it.  The powder is relatively 'heavy', so unless you drop something heavy into the container or maybe sneeze directly into it I doubt it would fly up to be inhaled.  I've gotten it on my skin and was fine, just rinsed it off and no problems.  Maybe if it was left there an extended period of time or if you have very sensitive skin I could see it causing problems, but otherwise I wouldn't worry too much.  It's really honestly not nearly as complicated or scary as it sounds, we go through our daily routine with hardly even a hiccup now.  It's really up to you, I haven't used the tablets (though I did have to buy and grind up pancreatin x6 tablets from a vitamin store once as an emergency supply) so I have no opinion one way or another on them, but hopefully I've reassured you a bit on the powder.   Welcome again and hope this helps!

We haven't had problems with any mouth sores, thank goodness. But we incubate for about 20 minutes, so I think letting it sit for a while does help with that.  As far as getting it on your skin, just wash your hands if it bothers you.  It does not bother me, but I know some people have said they get itchy from it.   I started by using the health food store capsules and opened them and sprinkled the powder on the food.  I didn't feel that it was excessively dusty or bothersome.  Now I order the kilo size of pancreatin, and that seems to be more dusty because of the larger quantity.  I usually open the package outside (it comes in a re-sealable  foil pouch) and put it into a canister.  I transfer some from the canister to my old Source Naturals bottles and use a measuring scoop from there. There is no dust with that smaller quantity and doesn't feel like I'm inhaling any.  I know with asthma you do have to be careful, but if you work from a small container maybe it would be ok.

Just be aware that the Source Naturals makes many different products and formulations, some with a bunch of other addititives.  You will want the Source Naturals Pancreatin 8X , that is the plain pancreatin.  The NOW brand seems easier to find, but it is less potent (4x) and you have to use more to get the same result.  But since you are only using it in the interim, that should be ok.

Good luck, let us know what you purchase and we can help with amounts to start with.

Lisa

Hi Allison and welcome to the forum - to you and your stunning Gunnar.   Glad to hear you are starting the pancreatin and that Gunnar is already on the grain free food - if it is EPI you should hopefully see some positive results.   Once you have a difinitive diagnosis, we can go from there.   Even if it is EPI it is manageable - we are all proof of that!     My best coming your way...

Hey Allison, just wanted to add that Kain did get mouth sores pretty bad, but after increasing the incubation time more like 40 minutes or so, I generally never see any. He has had mild lip symptoms, but this is most liekly a combination of the cold weather too.  Just don't let it set too long, I was waiting for over an hour at one point and in summer or if the heat is on bacteria will harbor a lot quicker.  No comment on the pill v the powder. No experience with the pill form, no problems with the powder, just getting it to the right amount per cup per dog was what was tricky for me.  As far as side effects, my little one has asthma episodes from time to time, but never any problems around the powder, much worse in smoke situations. 

Alyssa, could you please come to my house after you wake up and give Vito and Lizzie their food?  I'd love to go back to bed...pretty please with deer antlers on top??? (No I will not let you live that one down!!!)

Welcome Gunner and Allison !!! Everyone has covered what you need to get started... just do not panic ... you caught it very quickly !!! YEAH !!!   Kodi is our 2nd EPI pup. Our first GSD EPI girl Sadie lived to be 14 years old, 10 of which she had EPI. It is doable and after the routine is down... it becomes easy.. just like making the morning coffee or brushing your teeth !!   Each pup is different  you will see by the signatures....but start at the basics and keep a log of what goes in and what comes out...If you want to find out how long the 'Transit' time of the poo is....grate some raw carrot into the food  and watch for it ot come out the other end !!:D  . Then you will knoow how long you have to wait to start tweaking enzymes etc !! Gunner is stunning .. he 's one lucky pup to have an alert owner . Can't wait to see more pics !!

Welcome Allison and Gunner from Australia, although sorry you have to be here.

Good work on being so observant and getting onto it so quickly. I have found this forum to be so very helpful in our EPI journey