EPI Confirmed - New Member VERY Confused

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.
Crazy4gsds
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Posts: 8
Country: United States
State: Georgia
Pet name: Judah
My name: Michele

EPI Confirmed - New Member VERY Confused

Post by Crazy4gsds » 01 Oct 2020, 21:23

I have a few questions but wanted to give some background. My 5.5 year male German Shepherd was confirmed with having EPI today. He didn't display some of the classic symptoms of EPI. For instance his stools weren't diarrhea but rather more soft serve and even formed 80%. Long story short we did X-rays, bloodwork, ultrasound - all were fine aside from the ultrasound revealed a lot of gas in his colon. We did a cTLI once bloodwork came back WNL.

On 8/7/20 we did a cTLI. TLI was 5.1 (low normal); B12 was 151 (very low) and folate was 12.5 (normal). Started him weekly B12 injection and on PancreVed 2 tsp 2x/day with 2+ cups of food each feeding. Started him on Farmina Digestive and am now transitioning to Farmina N&D. He was previously raw fed for 2 years. He was in week 2 of his B12 injections and continued to lose weight. I was officially freaking out because he had dropped to 73.5. He was losing 3 lbs every 4 days! Fast forward and the enzymes were added after his 2nd B12 injection. Pre EPI a few years ago his heaviest was 88 lbs. I should mention that he was a working dog and I competed with him in several sports so it was hard keeping weight on him. He consistently held steady at 83 lbs for 1.5 years but the rapid weight loss recently was very alarming. He was wasting away before my eyes. I was an emotional wreak to say the least and so worried about him.

On 9/28/20 we redid the cTLI. TLI was now 1.9 (EPI); B12 was 902 (high) and folate was 5.8 (low normal). He weighs a very healthy 86.4 lbs now in just 6-7 short weeks. I can't believe the transformation. We'll retest his B12 in another 3-4 weeks. He's off his weekly injections until then but I suspect we'll be adding them back maybe monthly depending on lab results.

1. Is there a test for genetic markers of EPI? I honestly feel there was a triggering event that compromised his pancreas and this is not genetic. I just can't prove it and the vet can't confirm it. His dam, sire, littermates (repeat breeding), half siblings etc...not one of them have displayed any symptoms. His symptoms only presented themselves recently when he was 5.
2. Does EPI (genetic) appear in younger puppies/dogs, older dogs or age doesn't really matter?
3. Would you neuter an EPI dog at this point? I absolutely cannot (in good conscience) have him used for breeding without knowing if this is truly genetic or a triggering event. This is probably the hardest pill to swallow and quite devastating to say the least.
4. How can the TLI numbers go from normal pancreatic function of 5.1 to 1.9 in a matter of 6 weeks while being on enzymes?
5. Should I be concerned by the huge B12 swing? I know you can't overdose on B12 and it's excreted out but I was more than surprised by the numbers from 9/28/20
6. Would you retest the TLI in a few months now that you have baseline of sorts?

I'm honestly having a hard time getting my head around this and would certainly appreciate any input.
Judah DX EPI 09/29/20 at 5 years of age
Test Results: 08/07/20 = TLI 5.1, B12 151, Folate 12.5.
Test Results: 09/28/20 = TLI 1.9, B12 902, Folate 5.8
Lowest weight was 73.5 lbs in 08/20 and is now up to 86.4 lbs currently
PancreVed 1 tsp per cup, Farmina Digestive/Farmina N&D Lamb Pumpkin & Blueberry, 1/4 c Answers Beef Kefir, Bimonthly B12 injections, Coconut Oil
Loves nothing more than training, running FastCat (FCAT) and playing UpDog (frisbee)
Was ranked the #3 fastest GSD running FCAT in 2019 with average speed of 28.24 mph; sidelined in 2020 with pandemic and iliposoas injury; back in action in 2021!

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Montgomery
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Posts: 418
Country: Canada
Pet name: Montgomery (I'm a CAT!)
My name: V

Re: EPI Confirmed - New Member VERY Confused

Post by Montgomery » 02 Oct 2020, 12:25

I can't answer a lot of these questions, but Montgomery's uncontrollable diarrhea began at eight days of age and continued until he was finally diagnosed at four years of age, so, yes, it can affect the very young as well as older animals.
Montgomery was born 20 March 2012. He eats extra lean ground chicken, lean ground pork and lean ground beef completed with Alnutrin and freeze-dried chicken liver, with hard-cooked egg. He gets two size zero capsules of Enzyme Diane's enzymes at each of his six meals, and a size four capsule of Tylan three times a day. He's a fierce little Spitfire with a roaring Merlin engine.

Tuckaboo Pam
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Posts: 1346
Country: United States
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Pet name: Tucker
My name: Pam H.

Re: EPing you want, because you will be getting a I Confirmed - New Member VERY Confused

Post by Tuckaboo Pam » 02 Oct 2020, 14:27

Hi Michele. Wow, a lot has happened in a short amount of time. I recently asked the question, could my Tucker's EPI have been slowly developing, and then had an accidental sugar overload bring it on full speed? The answer I got was YES. However, I am not knowledgeable enough to venture a guess about genetics. The staff here, though, will be able to answer all of your questions. Check back often, ask anything you like, and you will be getting tons of feedback. I guess the good news is, your good boy's got his health back, and that is good on you!---Pam & Tucker
Tucker was a shepherd/lab mix--- TLI 1.3, Folate 9.7, Cobalamin 666, Lipase 38. Took Diane's Enzymes 4 teaspoons/day, Wonderlabs B12 one capsule per day, and Tylan 1/16 teaspoon/ morning (to hold SID at bay). Taste of the Wild High Prairie, 1 1/2 cups/day, with a total of 4 cups of Fresh Pet. Stopped eating everything in sight, and went from 60 to 85 pounds! Tucker was my boyfriend, and my husband was OK with that. Tucker succumbed to hemangiosarcoma, but we cherished every day we had with that wonderful, beautiful boy. I will always, always miss my sweet big boy.

Crazy4gsds
Member
Posts: 8
Country: United States
State: Georgia
Pet name: Judah
My name: Michele

Re: EPI Confirmed - New Member VERY Confused

Post by Crazy4gsds » 03 Oct 2020, 09:02

Thank you! Yes, it's certainly been a lot in a short period of time between the weight loss, subsequent EPI and an iliopsoas tear. His pet insurance is loving us about now:)
Judah DX EPI 09/29/20 at 5 years of age
Test Results: 08/07/20 = TLI 5.1, B12 151, Folate 12.5.
Test Results: 09/28/20 = TLI 1.9, B12 902, Folate 5.8
Lowest weight was 73.5 lbs in 08/20 and is now up to 86.4 lbs currently
PancreVed 1 tsp per cup, Farmina Digestive/Farmina N&D Lamb Pumpkin & Blueberry, 1/4 c Answers Beef Kefir, Bimonthly B12 injections, Coconut Oil
Loves nothing more than training, running FastCat (FCAT) and playing UpDog (frisbee)
Was ranked the #3 fastest GSD running FCAT in 2019 with average speed of 28.24 mph; sidelined in 2020 with pandemic and iliposoas injury; back in action in 2021!

Tuckaboo Pam
Member
Posts: 1346
Country: United States
State: Florida
Pet name: Tucker
My name: Pam H.

Re: EPI Confirmed - New Member VERY Confused

Post by Tuckaboo Pam » 03 Oct 2020, 16:55

Hi Michele. I'm sitting here watching football, and I thought I would check in. I'm also curious to see how your questions are answered. Take Care. Go Gators!---Pam & Tucker
Tucker was a shepherd/lab mix--- TLI 1.3, Folate 9.7, Cobalamin 666, Lipase 38. Took Diane's Enzymes 4 teaspoons/day, Wonderlabs B12 one capsule per day, and Tylan 1/16 teaspoon/ morning (to hold SID at bay). Taste of the Wild High Prairie, 1 1/2 cups/day, with a total of 4 cups of Fresh Pet. Stopped eating everything in sight, and went from 60 to 85 pounds! Tucker was my boyfriend, and my husband was OK with that. Tucker succumbed to hemangiosarcoma, but we cherished every day we had with that wonderful, beautiful boy. I will always, always miss my sweet big boy.

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Madelon
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Location: Nashville, TN
Country: United States
State: Tennessee
Pet name: Doc

Re: EPI Confirmed - New Member VERY Confused

Post by Madelon » 03 Oct 2020, 17:26

Hi and welcome to our EPI family. I'm so glad you were able to get his weight back up so quickly - well done! Please know that B12 supplementing is for life it's just a matter of finding what works for your pup. A lot of us after doing the 6 weeks of shots switch to WonderLabs Pet Factor B12 pills - they contain intrinsic factor which helps with B12 absorption. If while waiting a month before retesting you notice ANY signs of the B12 dropping like weight loss, loose poop, lethargy, loss of appetite, please get a shot immediately or go ahead and switch to the pills.

I'll try to answer your questions the best I can - I copies them here so it would be easier.

1. Is there a test for genetic markers of EPI? I honestly feel there was a triggering event that compromised his pancreas and this is not genetic. I just can't prove it and the vet can't confirm it. His dam, sire, littermates (repeat breeding), half siblings etc...not one of them have displayed any symptoms. His symptoms only presented themselves recently when he was 5.
Yes there are some genetic markers that have been found, however, there is much much more to it. We believe there is an environmental/outside factor that can play a part as well. It is not uncommon to have litter mates, moms and dads without EPI, however, we have also had a few with several generations of EPI. Here's the link to our EPI research page if you'd like to read more details regarding the research that has been done so far https://epi4dogs.com/epi-research/

2. Does EPI (genetic) appear in younger puppies/dogs, older dogs or age doesn't really matter?
Age does not matter with EPI - we've had very young puppies, middle age dogs and seniors develop EPI

3. Would you neuter an EPI dog at this point? I absolutely cannot (in good conscience) have him used for breeding without knowing if this is truly genetic or a triggering event. This is probably the hardest pill to swallow and quite devastating to say the least.
YES! We do not recommend breeding a dog that has been confirmed EPI (we had planned on breeding our boy as well until he was diagnosed at 13mos old). We also do not recommend the parents being bred again.

4. How can the TLI numbers go from normal pancreatic function of 5.1 to 1.9 in a matter of 6 weeks while being on enzymes?
As an example, although mine was not as quick but mine dropped much more - my boy was first tested at 3mos old - his TLI was 16 - he was retested at 13mos old and his TLI was less than .4! It takes time for the pancreas to atrophy but the rate at which it happens there is no way to predict.

5. Should I be concerned by the huge B12 swing? I know you can't overdose on B12 and it's excreted out but I was more than surprised by the numbers from 9/28/20
I would not be concerned with the B12 number - EPI dogs need their B12 on the high side of normal 600+ - they are unable to maintain it on their own. The last time I had my dog's tested it was over 1,000.

6. Would you retest the TLI in a few months now that you have baseline of sorts?
NO. There is no reason to retest the TLI once you are confirmed EPI - the pancreas does not regenerate itself.

Has your vet talked to you about possible food sensitivities with the last folate score being on the low side? If not, you might talk to your vet about that. Keep a detailed log of everything you give and everything that comes out so you know what's working and what isn't. Please also know there is no reason you can't continue to compete with your dog - we've had lots of competition dogs with EPI and even police K-9's!
Madelon, owned by DOC. DOC dx EPI 5/2015 = TLI < .4, B12 406; Folate >24. DOC taught me so much and together we battled and overcame EPI, food sensitivies, environmental allergies but we lost the cancer battle. DOC was dx with hemangiosarcoma 5/2022 and crossed the rainbow bridge July 24, 2022. He is and always will be the love of my life, my soulmate, my heart dog.

Crazy4gsds
Member
Posts: 8
Country: United States
State: Georgia
Pet name: Judah
My name: Michele

Re: EPI Confirmed - New Member VERY Confused

Post by Crazy4gsds » 04 Oct 2020, 10:10

@Tuckaboo - thank you for checking in. The Gators had a good day yesterday! Haven't quite figured out if this is the correct way to respond to you :D
Judah DX EPI 09/29/20 at 5 years of age
Test Results: 08/07/20 = TLI 5.1, B12 151, Folate 12.5.
Test Results: 09/28/20 = TLI 1.9, B12 902, Folate 5.8
Lowest weight was 73.5 lbs in 08/20 and is now up to 86.4 lbs currently
PancreVed 1 tsp per cup, Farmina Digestive/Farmina N&D Lamb Pumpkin & Blueberry, 1/4 c Answers Beef Kefir, Bimonthly B12 injections, Coconut Oil
Loves nothing more than training, running FastCat (FCAT) and playing UpDog (frisbee)
Was ranked the #3 fastest GSD running FCAT in 2019 with average speed of 28.24 mph; sidelined in 2020 with pandemic and iliposoas injury; back in action in 2021!

Crazy4gsds
Member
Posts: 8
Country: United States
State: Georgia
Pet name: Judah
My name: Michele

Re: EPI Confirmed - New Member VERY Confused

Post by Crazy4gsds » 04 Oct 2020, 10:57

Thank you so much Madelon for answering my questions and providing info on EPI genetics link/research. I greatly appreciate it! I had my husband read your response so he could better understand things as well. The website is a plethora of information sooooo thank you!!! BTW - I also changed my AmazonSmile to Epi4Dogs Foundation :)

I know you can definitely relate since your boy was diagnosed at 13 mos and you had hopes of using him for breeding. The reality of never having a puppy from Judah and realizing that his lines end with him was devastating but it's the responsible thing to do. It's hard to find a DDR male that is stable temperament, social AND with great working ability. Judah has all of that AND he has EPI. Sniffle. Needless to say his breeder is quite concerned and has frozen semen from Judah's sire who has passed away. She just mentioned the other day after what was going on with Judah that she was hesitant to use it. I'll definitely let her know what you mentioned about not using dam or sire for breeding again. His dam passed away earlier this year.

I talked to the vet on Friday afternoon to let her know my concerns about stopping the B12 injections until his next retest in 3-4 weeks. I did not want a set back or regress with weight loss. She suggested that we can do injections every 2 weeks and then retest on week 4. He had an injection on 9/28 and will have another one on 10/12 and again on 10/26 after his blood draw/retest at week 4. I did buy the Wonderlabs B12 with Intrinsic Value but may hold off adding those until after his retest. The vet gave me 8 preloaded B12 syringes so I'm set on injections for a few months. What's your opinion on adding the B12 with Intrinsic Value capsules daily or would you wait until after the 4 week retest to see where the numbers were and then start adding the Wonderlabs?

No, nothing was mentioned about the folate being low normal. I saw it and had wondered how it went from 12.5 to 5.8 but was a bit shell shocked at the TLI score. With a low normal folate what should I be concerned about or looking for? I tried to find information on it but it pointed back to EPI. Sorry for the rudimentary question.

He hasn't displayed any sensitivities that I've noticed. He's currently on Farmina Digestive (3/4 cup) and transitioning to Farmina N&D Lamb, Pumpkin & Blueberry (1 1/2 cup) 2x per day for a total of 4.5 cups of food. I add beef kefir (1/4 cup) to his food, Flortiflora probiotic 1x per day and coconut oil (1 T). He also gets 1 T peanut butter (untreated) as well as Fruitable Pumpkin and Mango treats while I'm working through is iliposoas injury as a training treat for his exercises.

The Farmina Digestive only comes in a 15 lb bag which does not last long with a large GSD. The Farmina rep said the Digestive was used to settle things down and then used as a bridge to transition to another food in the Farmina line. She had mentioned feeding 3 - 3 3/4 cup of food but I spoke with her when he weighed 77 lbs and wasn't down to the 73.5 low. Now, that he's up to 86.4 lbs I'm wondering if I need to adjust???? I certainly don't want to overfeed him either. The recommended amount for an 88 lb dog on the bag is 3 3/4 cup (I think) up to 5.25 cups of food.

Farmina Digestive:
Crude fiber of 1.9%
Fat at 12%.
Protein 25%

Farmina N&D Lamb, Pumpkin and Blueberry:
Crude fiber of 2.9%
Fat at 18%.
Protein 28%

He has well formed stools that are brown (no longer yellow and softish), his stomach isn't making the noises that it was previously and he no longer has gas. He never lost his appetite or appeared lethargic during all of this. He's always been wide open so if he were lethargic it would definitely be noticeable. LOL! That's great news that I can still compete with him. He loves training and trialing. Above all he loves running FastCat and doing Up Dog. Sadly I think our Up Dog days are numbered with this iliopsoas injury but we'll still play frisbee in the yard and have fun. I'll re-evaluate FastCat once we're cleared by the sports physical therapist. The sudden explosive movements (like running or extending out) are the issue. Ugh.

I'll look forward to hearing your thoughts on the B12 and folate. Have a blessed Sunday.
Judah DX EPI 09/29/20 at 5 years of age
Test Results: 08/07/20 = TLI 5.1, B12 151, Folate 12.5.
Test Results: 09/28/20 = TLI 1.9, B12 902, Folate 5.8
Lowest weight was 73.5 lbs in 08/20 and is now up to 86.4 lbs currently
PancreVed 1 tsp per cup, Farmina Digestive/Farmina N&D Lamb Pumpkin & Blueberry, 1/4 c Answers Beef Kefir, Bimonthly B12 injections, Coconut Oil
Loves nothing more than training, running FastCat (FCAT) and playing UpDog (frisbee)
Was ranked the #3 fastest GSD running FCAT in 2019 with average speed of 28.24 mph; sidelined in 2020 with pandemic and iliposoas injury; back in action in 2021!

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Madelon
Staff
Posts: 1317
Location: Nashville, TN
Country: United States
State: Tennessee
Pet name: Doc

Re: EPI Confirmed - New Member VERY Confused

Post by Madelon » 04 Oct 2020, 14:56

Hi there! I'm glad the breeder is rethinking using the frozen sperm. My German Shepherd comes from a world champion working line (I actually didn't know it when I got him LOL) and there are kennels that have frozen his sperm and he was under contract to return to Germany once a year for two weeks to "sow his seeds" LOL (his sire is Drago Vom Patriot). There's just no way to know if another of his dogs would develop EPI or not so we err on the side of caution and recommend not breeding.

As for B12, if you're giving a shot every two weeks I would not add the pills - see how the level is when tested and watch for signs of the B12 dropping. Then if the level is good with a shot every two weeks you could just stick with that if you want or if the level drops you could either go back to weekly injections or try the pills without injections.

As for the folate, low folate indicates food sensitivities, which you said your dog was sensitive to numerous proteins which is why I suggested the hydrolyzed food. People often confuse allergies and sensitivities. However, if you've found a food that your dog can tolerate without itching and you have good poops I would stick with it. As for the amount to feed - if you've reached your goal weight then we suggest slowly reducing the amount of food but watch for weight loss. My boy requires a little more than what's recommended in order to maintain his weight - he has HIGH prey drive and is constantly chasing bugs, birds and balls LOL.

As for treats - we don't recommend giving treats until your dog is stable (weight gain and good poops), and everything they eat must be treated with enzymes unless it's close to an enzymed meal in order to avoid SID (small intestinal dysbios). Remember the pancreas is no longer producing enzymes to digest food so if you feed something without enzymes they won't digest it and it will cause issues at some point down the road.

You're doing a great job!
Madelon, owned by DOC. DOC dx EPI 5/2015 = TLI < .4, B12 406; Folate >24. DOC taught me so much and together we battled and overcame EPI, food sensitivies, environmental allergies but we lost the cancer battle. DOC was dx with hemangiosarcoma 5/2022 and crossed the rainbow bridge July 24, 2022. He is and always will be the love of my life, my soulmate, my heart dog.

Crazy4gsds
Member
Posts: 8
Country: United States
State: Georgia
Pet name: Judah
My name: Michele

Re: EPI Confirmed - New Member VERY Confused

Post by Crazy4gsds » 04 Oct 2020, 17:13

@Madelon - Drago was a very nice dog and a lot of breeders used him - he produced nicely. Too funny that you didn't know the quality of lines that Doc came from when you got him. Is Doc a bi-color like Drago or solid black? Maybe we should play the lottery in that we both ended up with dogs from very good lines that have EPI ;) I really don't know what the odds are but I know with Judah's siblings the breeding was only repeated once from the kennel that he came from so there's only a total of 10 full littermates between the two breedings. Now his dam was used for other breedings as was the sire. I know on the dam's side no EPI as I talk to the breeder frequently but on the sire's side I don't know any owners/breeder.

Thank you for the advise on the B12. That's exactly how I was leaning but just wasn't sure my rationale was sound since I'm so new to this.

Hmmmm...he's never had a sensitivity to food so I hope I didn't type something previously that indicated that? I had him on raw for a few years because I liked the product a lot and it was manufactured locally in GA. I was always switching his proteins on raw (pork, rabbit, beef, chicken, duck, salmon) - all of which he tolerated just fine. When he had his xrays and ultrasound done his stomach was very upset from the meds I'm guessing so at that time I opted to reset his gut because well at that point it really didn't matter with the diarrhea.

I took him off raw and switched to Farmina. I believe I may have done 1 week of metronidazole because I had hoarded some medication after he was sick from his ultrasound and xrays. Yes, we've had really good results with the Famina thus far so definitely not changing that at this point. I would like to get him back on raw BUT I really don't know a lot about raw and EPI. I'm just trying to get a handle on the EPI side of things. I really liked the kibble that he was before raw BUT quite honestly was really irritated at the company who manufactured his dry kibble for a bevy of reasons and I was bound and determined I was NOT going to use them. Soooooo I am super happy with weight gain, coat etc on the Farmina.

I'll continue to monitor his weight. He's at the vet's office weekly anyway for his hyrdrotherapy so I get a weekly weight check. It could be that he may need a bit more kibble because like your boy he's off the chain high drive. He's constantly in motion or whining to go do something...ANYTHING. Sound familiar? I know when we were actively training before his injury it was super hard to keep him stabilized at one weight. Perhaps that was an early sign but I don't know. He was just soooooo darn active and athletic.

Thank you for the vote of confidence. It's been a crash course in learning about EPI. I'm not exactly medically inclined but am certainly trying.
Judah DX EPI 09/29/20 at 5 years of age
Test Results: 08/07/20 = TLI 5.1, B12 151, Folate 12.5.
Test Results: 09/28/20 = TLI 1.9, B12 902, Folate 5.8
Lowest weight was 73.5 lbs in 08/20 and is now up to 86.4 lbs currently
PancreVed 1 tsp per cup, Farmina Digestive/Farmina N&D Lamb Pumpkin & Blueberry, 1/4 c Answers Beef Kefir, Bimonthly B12 injections, Coconut Oil
Loves nothing more than training, running FastCat (FCAT) and playing UpDog (frisbee)
Was ranked the #3 fastest GSD running FCAT in 2019 with average speed of 28.24 mph; sidelined in 2020 with pandemic and iliposoas injury; back in action in 2021!

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