New member. 11 month old GSD with EPI

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.
Posts: 6
Country: United States
State: Virginia
Pet name: Freya

New member. 11 month old GSD with EPI

Post by Quixotic » 13 Dec 2020, 08:42

Good morning, all. As recommended from my German Shepherd forum, I have joined here after recently confirming my puppy's EPI diagnosis. Her name is Freya, she'll be a year old in just under two weeks, and her experience with this has been emotionally taxing for me (and obviously physically taxing for her).

Apologies for the huge first post, but I wanted to provide the entire timeline to keep the information in one place in case someone sees something my vet or I haven't yet seen. Her energy indoors has been significantly reduced over the past month, though she still fetches outdoors like everything is normal. NOW branded enzymes from Amazon have gotten her back to normal poop, but I have had multiple recommendations to seek a different, long-term solution.

Thank you for this place, and thank you for any advice you can provide us!

TL/DR: Looking for suggestions on enzyme potency and source. 6X? 8X? Enzyme Diane or other?

Background: Brought Freya home at 16 weeks (mid-April); two days after bringing her home, I took her to the vet to find her underweight (a little under 13 pounds) and with many ticks from 'breeder'; vet put her on 30 days of doxycycline 20 mg plus all the usual shots, started heartworm (HeartGard) and flea/tick (NexGard); UTI in early August, Cefpodoxime Proxetil 200 mg. Beginning July/August, finicky with food again and would sometimes only eat half a cup in a day (feeding Royal Canin GSD puppy). Regularly added a little bacon grease, plain Greek yogurt, or pumpkin to entice her to eat. Usual intake of 3-4 cups per day even with the additions, rarely more when a particularly busy exercise or play day.

October 16: Took to vet for biannual SNAP 4DX Plus test. Vet found whipworms. Provided Panacur C, 6 grams per meal (2x day) for six days (to repeat six days at three weeks, then six days at three months with retest). Changed heartworm meds to Interceptor. First night diarrhea. Prior, poops were solid, easy to pick up, and she went usually three times per day. Weighed 51.4 pounds.

October 18: Poops began more solid but ended softer, a little firmer than soft serve.

October 23: Began new regimen of Interceptor. Monthly NexGard also given.

November 6: Began second course of Panacur C, six grams each meal (2x day), for six days. Purchased from Amazon.

November 11: Last Panacur C given with evening meal. Through this point, poops had not returned to the firmness observed prior to October 16. Poops were softer but not liquid, pile rather than log. Horrible gas for next week.

November 13: Evening poop was a soft pile, pudding like in form. For the next four nights, between 3-5:30am, she whined to go out. Taking her out resulted in pudding poop. Same later at 7am, then the same three/four hours later. Kept adding a couple of tablespoons of alternating Greek yogurt or pumpkin, no change.

November 13-23: Pudding, puffy, greasy, stench poop. Usually five-six times per day, including double drops nearly every morning. Barely soft serve consistency.

November 18: Took stool sample to vet. Sample was clear.

November 20: Vet gave Metronidazole 500 mg for 15 days; Pro-Pectalin oral paste every 8 hours for two days; FortiFlora sachet for 30 days; Hill's Canine i/d food; told to slowly add boiled chicken and rice or other bland diet food to Hill's food. Significant reduction in gas after these meds began.

November 23-25: Liquid poop, cow patty style.

November 24: Weighed 47.6 pounds in the evening.

December 5: 46.6 pounds at weigh-in; Giardia test, negative; CBC panel (RETIC low at 5.8 K/uL; Cholesterol low at 76mg/dL; GLOB low at 2.4g/dL); urinalysis, clear/normal; rectal exam brief; fecal exam, clear

December 6: Fasted since 7pm prior evening, in around 10am; brought substantive stool sample from earlier in the morning for IDEXX COMP DIARRHEA PROFILE; blood draw for IDEXX GI Panel with Spec cPL; vet asked if I wanted additional anti-diarrheal medications, but I opted to wait for test results; began on NOW branded enzymes, Pancreatin 10X, with evening meal, prepared as recommended here and elsewhere.

December 9: Test confirmed Freya's numbers were consistent with EPI: TLI was .7 ug/L, Folate was >24 ug/L. First day of 'normal' poop--logs rather than pudding or patty.

December 12: Comprehensive diarrhea panel results received--all negative.

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Posts: 1884
Location: North Carolina
Country: United States
State: North Carolina
Pet name: Izzy
My name: olesia

Re: New member. 11 month old GSD with EPI

Post by Olesia711 » 13 Dec 2020, 12:52

Ahhh... Poor Freya.... she sure does have EPI and with some the typical signs .. Hopefully we can help you navigate Freya's EPI journey.

I know (personally) when you get the EPI diagnosis it can be daunting and very "will she be okay" and "how can we afford this".... so... i'd like to share my story and hopefully it will greatly help allay many concerns you might have.

My Izzy was diagnosed at 1 year + 5 months old.... she just passed away at 15 years old this past February. Once we got her EPI diagnosis, for us it took 3 months for her to become stable and after that, for all those years she was with us, her EPI was well managed with only a few setbacks with SID (small intestinal dysbiosis).

The first batch of enzymes were from the vet and my husband said we won't be able to afford the enzymes cost for the life of the dog... it was just too much.
Thankfully we changed to EnzymeDiane's enzymes...
1. we used (as many other do) 6x.... simply because that is the same standard potency that the prescription brand name enzymes are that vets prescribe.
2. You start with 1 level tsp of 6x per 1 cup of food (if dry/kibble or 3/4 tsp of enzymes with wet food).
3. Add enough water to moisten the enzymes with the food,
4. let sit for 20 minutes (to avoid any possible mouth sores AND it really does seem to help some dogs absorb the food nutrients better.

ONce Freya becomes stable (that means delivering normal looking poos (brown tootsie roll shape poo and at a normal daily frequency (1-3 times a day) ... THEN you can try reducing the amount of enzymes to see what the least amount is needed for her to maintain her EPI.

Our EPI dogs do NOT have enough bacteria in the gut nor do they have enough bacterial variety in the gut :(... this is SID!
If after the enzymes the poo gets better but then goes mushy.... this is out of control SID (small intestinal dysbiosis). All dogs with EPI have SID...this is VERY common. the latest protocol is to keep it in good control. and there is a step-by step protocol.... but before i get into it... DO NOT have your vet use any more Metronidazole on Freya... TAMU is advising against it for any chronic gastrointestinal issue like SID. The bad thing about Metronidazole is that is can kill some bacteria that can never be replaced in the body even if you give probiotics... This is the last thing an EPI dog needs....

THe current SID protocol is:
1. try prebiotics (to feed the bacteria and repopulate the gut (many of us use SLippery Elm powder )
2. if that doesn't work, then try pre+probiotics.... current recommendation for now is PROVIABLE
3. if the above doesn't help at all... THEN try Tylan (Tylosin Tartrate soluble powder antibiotic... this is a macrolide antibiotic and does not kill all the bacteria like Metronidazole does but rather inhibits the bacterial reproduction.....)

Over 80% of all dogs with EPI need B12 supplementation. You can either give shots or what many of us here do is give Wonderlabs Pet Factor B12 special B12 capsules (made with Methylcobalamin B12, Folate & Intrinsic Factor)
Please read the B12 tab to learn more about B12 and EPI dogs.

And this is the hardest part.....Many times, finding the right diet is the last piece of the puzzle. We recommend starting with a low fiber food (misnamed as "grain-free" ) anything with fiber content of 4% or less(less is often better) and something that does NOT have any grain in it or at least not one of the top 3 ingredients (grain can interfere with the efficacy if the enzymes from anywhere between 0% to 50%... this is why we recommend starting with a low fiber food in the beginning).... however.... if you want to try later can try a food with grain like rice in it to see if Freya is one of those dogs that are okay with some grain. .... ALSO.... avoid any product that uses a lot of pea ingredients... either as one of the top 3 ingredients or multiple types of peas (pea flour, pea protein, etc) ARE in the ingredients... too many peas DO NOT agree with EPI dogs (it actually encourages SID to become more uncontrolled). ....

start feeding Freya with approximately 150% of food that her body typically would require.... BUT.... feed smaller portions but in more meals throughout the day. 3 or 4 meals a day would be ideal.

THe above is the std EPI protocol... HOWEVER.... every EPI dog is unique, so we start with the above, and then sometimes things have to be tweaked a bit until you find the right balance of the recommended EPI protocol for Freya.

The best tool in the EPI tool box is to start keeping an EPI Log.... this will help you and your vet figure out what works best for Freya what you have to increase/reduce/add or eliminate :)

And last but not least, post anytime on this thread with any questions you may have.... one of our goals here at Epi4Dogs is to help others step by step when trying to navigate the EPI journey.

Hopefully this is enough to get you started and please know that EPI is manageable AND usually affordable, once you learn what helps or hinders Freya 's EPI.
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.........

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Kodis Mom
Posts: 55
Location: Custer, WA.
Country: United States
State: Washington

Re: New member. 11 month old GSD with EPI

Post by Kodis Mom » 13 Dec 2020, 17:06

Hi and welcome ! EPI is overwhelming in the beginning. We have all been there. So no question is silly, ask away ! Olesia gave you a great info, I will just say to keep a journal or log, trust me it will keep you sane ! My girl Kodi was diagnosed at 11 months also, she turned 10 years old in August 2020 and is doing well for a mature gal. Getting the diagnosis is sometimes the hardest part, but now you can move forward.
B. 8/19/2010 Diagnosed at 11 months.
Kodi is now on Natures Logic turkey and/or pork kibble, 2 cups with 2 teaspoons of enzymes, 1/8 teaspoon of ground coriander, 1/16 teaspoon of cinnamon and ground fennel seed (for tummy upsets) twice a day, plus one one B12 capsule from Wonderlabs. She has been very stable and on occasion needs a dose ofTylan.
She is our second GSD with EPI. It was not so scary this time ! And thank goodness for !

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Posts: 1188
Country: United States
State: Washington

Re: New member. 11 month old GSD with EPI

Post by jilbert57 » 13 Dec 2020, 17:31

Welcome to you and Freya. You do a great job of record keeping!
You have been good advice, just wanted to say hi.

My name is Jill and we live on the Hood Canal in Washington State. We currently have one pup. TJ is a 5 year old Jack Russell.

Mickey and his pancreatitis brought me to 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.

Posts: 627
Country: United States
State: New Jersey

Re: New member. 11 month old GSD with EPI

Post by Barb » 13 Dec 2020, 21:07

Hello and welcome to you and your pup. The beginning is the hardest stage. You are trying to learn everything and are watching your pup struggle. The good news is that now that you have a diagnosis, you are on your way to providing the treatment that Freya needs to become healthy. It gets easier!

I was going to recommend the daily log/journal also, but it sounds like you have that covered.

Hang in there and ask any questions you have.


Tuckaboo Pam
Posts: 591
Country: United States
State: Florida
Pet name: Tucker
My name: Pam H.

Re: New member. 11 month old GSD with EPI

Post by Tuckaboo Pam » 14 Dec 2020, 17:12

Hi, Quixotic (intriguing!), I'm Pam in FL, and my Tucker was diagnosed a year and a half ago. We have learned to make this condition more affordable, starting with EnzymeDiane, our EPI angel. I like the 6X, because the ratio is 1:1, a teaspoon of enzymes/ a cup of food. Interesting that your Freya had so many parasites when you got her. Tucker did, too, including demodex, and I have wondered if that somehow weakened his constitution, allowing for something like EPI to enter the picture down the road. We'll never know, but good for you, coming here for help. These ladies know SOOOO much about EPI and dogs, in general, and you can ask as many questions as you like. Nobody ever seems to get annoyed! Take care, and keep in touch----Pam & Tucker Oh, and in case you didn't notice, there is lots of valuable info in the signatures at the bottom of the posts.
Tucker is a shepherd/lab mix; he has tested positive on the ScheBo test for EPI, as well as the fasting TLI. Results--- TLI 1.3, Folate 9.7, Cobalamin 666, Lipase 38. Currently taking Diane's Enzymes 4 teaspoons/day, Wonderlab B12 capsules 2-3 per week, slippery elm 1/2 teaspoon/day, Proviable 1 capsule/day, and Tylan 1/16 teaspoon/day. Sport Dog Elite, herding dogs 4 cups/day. No more poop eating, his weight is steady, and he is a happy member of the family, though a bit of a stinker, if you ask the other dogs. Tucker is my boyfriend, and my husband is OK with that.

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Posts: 1261
Location: Nashville, TN
Country: United States
State: Tennessee
Pet name: Doc

Re: New member. 11 month old GSD with EPI

Post by Madelon » 14 Dec 2020, 18:01

Hi and welcome to you and Freya. You've been given great advice so I won't muddy the water by adding anything else except to reinforce although this seems overwhelming in the beginning it will quickly become your new normal and we'll be here to help in any way we can.
MADELON and Doc. DX EPI and SIBO: 5/22/2015
Test Results: (1st) 7/2014 = TLI 16.5, B12 894, Folate > 24; (2nd) 5/2015 = TLI < .4, B12 406; Folate >24; (3rd) 10/2015 TLI < .4; B12 >1000; Folate 14.4. Prior to DX: May 2014 (2mos) - DX coccidia/bladder infection; July 2014 (3mos) 1st EPI test = TLI 16.5, B12 894, Folate >24 - Dx SIBO not EPI; Feb 2015 thru May 2015 - weight loss only; May 2015 vomitted several times, diarrhea and eating poop. Regimen: 4 cups Sport Dog Food Elite Herding - Diane 6x 1tsp per cup; 1 WonderLab PetFactor B12 2x day; 1/2tsp Slippery Elm 2xday; Multivitamin; 1 Zyrtec 10mg 2x day; Salmon Oil

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Posts: 10
Country: United States
State: South Carolina
Pet name: Presley
My name: Roger

Re: New member. 11 month old GSD with EPI

Post by rog121 » 16 Dec 2020, 08:13

Hi and welcome...I am also a new member here.

My Presley, who is turning 2 years this month, was diagniosed last december. She has done pretty well but sometimes things pop up that I do not understand.

The information from this forum is great! I have learned so much reading through all of the posts. My vet has only shared some basic information, but the info you get here is more day to day and real life situations.

I just encourage you to ask the questions here. People share readily and it is appreciated.

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Posts: 51
Country: United States
State: Texas
Pet name: Nikki
My name: Michaela

Re: New member. 11 month old GSD with EPI

Post by Michaela » 16 Dec 2020, 08:29

Glad to see you decided to join us, you're in good hands!
Nikki was diagnosed with EPI in 2010
Royal Canin PD canned
Slippery Elm syrup for stomach issues
1 1/4 tsp Pan-Tenex enzymes with each meal
Weekly B12 shots, pills didn't work for her
Tylan for life

"If there ever comes a day when we can't be together, keep me in your heart, I'll stay there forever."

Posts: 6
Country: United States
State: Virginia
Pet name: Freya

Re: New member. 11 month old GSD with EPI

Post by Quixotic » 23 Dec 2020, 08:16

My puppy is an energetic puppy again!

I received the Pan-tenex enzymes on December 19th and started her on them with that evening's meal. To revisit--Freya's poops have been normal since a few days on the NOW branded enzymes. That thankfully hasn't changed. I had been following all of the recommendations prior to joining here (finding the appropriate amount of enzymes, multiple feedings per day, increase food intake, etc.), and it all seems to be paying off. She's put a little weight back on, and it's noticeable.

Regarding quantity, I started with one level teaspoon per meal (2 cup meal) and recently one heaping teaspoon for a larger portion. She's been doing great, pooping ~four times per day in logs or contained stacks. And her energy level has been back up, so I know she's feeling better.

The only thing I've noticed over the past few days is an increase in tummy gurgling, especially at night. She doesn't seem uncomfortable or anything, and she'll occasionally have a little gas (so funny how it surprises her!), but it isn't strong. Maybe just a new normal, you think? Or should I add some slippery elm to her meals and see if that settles things a bit?

Her one year birthday is on Christmas, and having her healthy again is the best gift I could have received.

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