New EPI Dog Mom

[MyahsMom]

Goodness! I am almost in tears having finally found a site that has real people dealing with the real issues of EPI and helping each other through the process. My girl Myah, a "mutt" rescued off the streets 9/21 and recently diagnosed with EPI 6/6/23, is a trooper and I'm doing everything I can to help her with this terrible disease. I'm trying to read everything I can get my hands on and cannot wait until she's stable and I can get into a "normal" feeding routine with her.
I currently have her Pancreved/Pan-tenex and she still needs 1.5 - 2 tsp with B12 (Cobalequin) but they haven't recheck her levels, yet, to see where we're at.
I have tylan powder but have stopped using that and am not sure if I should keep her on it. The vet said if the diarrhea subsided to take her off, which I did, but she still has bouts occasionally. I'm currently feeding her a raw diet and trying to traverse the amount with enzyme dosage, plus looking into what additional supplements she will need for a balanced diet. It's a lot of work, as I am sure you all know.
Just yesterday, because of this website, I found frozen beef pancreas in my area and I was so excited to go pick it up. Any advice on feeding raw beef pancreas (GreenTripe) and giving enzymes? Can you give pancreas and enzymes at the same timeor just one or the other? I've heard you can stop the enzymes if you're feeding pancreas but I don't know what to trust.
She constantly wants to eat everything and had managed to gobble up a couple of baby birds that fell out of their nest recently. It didn't make her sick and, actually, she seemed to have better stools after! I guess there's no fresher diet... poor birds.
Anyhow, rather than ramble on about all the things I'm sure each of you has already gone through, I will just say I am so happy to be here and welcome any and all advice. And, if any of you are in AZ, I would love to connect with someone in person and pick their brain.

[Tuckaboo Pam]

Goodness! I am almost in tears having finally found a site that has real people dealing with the real issues of EPI and helping each other through the process. My girl Myah, a "mutt" rescued off the streets 9/21 and recently diagnosed with EPI 6/6/23, is a trooper and I'm doing everything I can to help her with this terrible disease. I'm trying to read everything I can get my hands on and cannot wait until she's stable and I can get into a "normal" feeding routine with her.
I currently have her Pancreved/Pan-tenex and she still needs 1.5 - 2 tsp with B12 (Cobalequin) but they haven't recheck her levels, yet, to see where we're at.
I have tylan powder but have stopped using that and am not sure if I should keep her on it. The vet said if the diarrhea subsided to take her off, which I did, but she still has bouts occasionally. I'm currently feeding her a raw diet and trying to traverse the amount with enzyme dosage, plus looking into what additional supplements she will need for a balanced diet. It's a lot of work, as I am sure you all know.
Just yesterday, because of this website, I found frozen beef pancreas in my area and I was so excited to go pick it up. Any advice on feeding raw beef pancreas (GreenTripe) and giving enzymes? Can you give pancreas and enzymes at the same timeor just one or the other? I've heard you can stop the enzymes if you're feeding pancreas but I don't know what to trust.
She constantly wants to eat everything and had managed to gobble up a couple of baby birds that fell out of their nest recently. It didn't make her sick and, actually, she seemed to have better stools after! I guess there's no fresher diet... poor birds.
Anyhow, rather than ramble on about all the things I'm sure each of you has already gone through, I will just say I am so happy to be here and welcome any and all advice. And, if any of you are in AZ, I would love to connect with someone in person and pick their brain.

Hello, and a warm welcome to you and your "mutt" Myah! You have come to the right place, and I have to say I remember feeling exactly like you when I found this group. I am a regular member, who joined four years ago, and through some ups & some downs, this group has helped me get my "mutt", Tucker, stabilized and healthy.

For starters, it is always helpful if you are are able to to post your test results, as there are some people who are able to read & analyze them. I am not one of those people. I just wanted to welcome you right away & to tell you that we're glad you and Myah are here.

Two things you said jumped out at me. 1) EPI dogs need porcine enzymes, from pigs, so the beef is not the right kind...also, you want to just start out with basics so if you need to do some tweaking it's easier to keep track, and 2) Tylan is given in a 45 day course, and at the end of the course a slow weaning has to take place.

Here is a standard response I've copied from a post I made to someone awhile back---Some of it may be redundant, so apologies. ALSO, I wasn't active on the forum for a few months, just recently found time to be back. If anything is outdated, a staff member will correct me.

"Could you possibly post the test results from Myah's fasting blood test, as well as telling us a bit more about her?

How much does she weigh, and how much SHOULD she weigh? What were/are her symptoms?

I have been involved with the forum for 4 years, and in that time my Tucker has gone from a 60 pound weakling, to a robust 95 pounder. I feed him mainly https://www.amazon.sg/Elite-Herding-Buf ... B07QD2QVM3 , but I have also fed him https://smile.amazon.com/Taste-Wild-Pac ... 483&sr=8-6. Both are popular forum choices for EPI dogs.

There are four cornerstones to treatment:

ENZYMES Many of us use https://enzymediane.com/ 6X. 1 teaspoon enzymes/1 cup kibble, add room temp liquid & let sit 20-30 minutes. EVERYTHING she eats has to have enzymes with it. Treats may have to go, for awhile.

DIET Grain free & less than 4% fiber. Some, but not all, EPI dogs do poorly when they are fed poultry. Feed 150% the amount you would feed at her IDEAL weight, divided into 3, or preferably, 4 meals.

B12 Needs to be above normal, 600+. Tucker's score was 666, but I supplement him anyway. They just tinkle it out if they get too much. https://www.wonderlabs.com/itemleft.php ... gSEALw_wcB

SID All EPI dogs have it. May be controlled with slippery elm, slippery elm + probiotics, and/or Tylan antibiotic. Good info on this tab https://epi4dogs.com/sidsibo-in-brief/

Keep a journal, and once you gather all your goodies, make only one change at a time. We have all had to tweak our routine, because each dog is different.

Feel free to ask as many questions as you have, and stay on the same thread here. You may want to share the forum with your vet, too. You've come to the right place, where you and Myah will get lots of help!

Take Care---Pam & Tucker"

[Olesia711]

hi Trudy and welcome to you and Myah,

Thank you for writing in about Myah... and for asking all the questions, Myah is a lucky rescue to have you as her human caregiver .

In the beginning EPI sounds very confusing to manage simply because you have to juggle 4 things all at once (the enzymes, the diet, the B12 and managing SID/SIBO (dysbiosis) and although we follow a general protocol, many times, we have to "tweak" the protocol to best serve each individual EPI dog...

But once you get the hang of it, you will find that managing Myah's EPI will come to be second nature and not that difficult or confusing.

First, the enzymes you are using are fine (Pancreved or Pantenex) although many of us prefer EnzymeDiane (the 6x is comparable to what you are now using.

The raw enzymes.... are and should be beef. Never use raw pig pancreas because of possible bacteria. Some dogs do well on the raw beef pancreas, others do not. Overall the best enzymes are the powdered enzymes that are made from pig pancreas.
WHat i would do first is try giving a little bit of the raw pancreas with the powdered enzymes... if well tolerated, then try reducing the amount of powdered enzymes to and increase the raw to see how well it is tolerated. By tolerated, i mean watch the poos....

here is some info on how to use the raw: https://epi4dogs.com/enzymes-in-brief/

FEEDING RAW PANCREAS: If you would like to try using raw pancreas; fresh beef, pork or lamb pancreas are recommended. Raw BEEF Pancreas is available for purchase in the USA at http://www.hare-today.com/ or http://www.greentripe.com/ . or Sirius Natural Pet Foods . There is also an amazing selection of raw pancreas at: https://www.mypetcarnivore.com/ . If you are in the U.K. you can look into http://rawtogo.co.uk/ . One to three or four ounces of raw pancreas can replace one teaspoon of pancreatic extract. Raw pancreas may be frozen in cubes for future use and thawed naturally, but never heat on the stove or in the microwave.

First puree the raw pancreas and (for your convenience) then freeze it in 1 ounce packets (or an ice try should work). Once you figure out how many ounces of raw pancreas your dog responds best to per 1 cup of food….(whether it is 1, 2 ,3 or 4 ounces of the raw pancreas)….. let the proper amount of frozen raw pureed pancreas thaw naturally (DO NOT HEAT !) …. and mix in with the food. It appears to usually work best when allowed to “incubate”… we suggest 15 – 20 minutes… but some do fine with less time, and some seem to need a few minutes more and others need no incubation time. In the beginning there will be some trial and error until you figure out what works best for your dog.

If possible beef or lamb raw pancreas is recommended over pork pancreas because of the “possibility” of the transmission of pseudorabies, although rare.
http://en.wikipedia.org/wiki/Pseudorabies

Also… raw pancreas is not all the same. Each and every gland has a different potency of enzymes. This is not just species to species. The potency can vary from one farm animal to another farm animal as well. If you use 1 ounce of raw pancreas with the batch you are currently using the next batch may need to be tweaked. Fresh pancreas has a shelf life (in the freezer) of up to 3 months.

Adding enzymes to a raw fed meal:
Since raw food is harder to measure by the cup since the densities of different meat/bones will require different levels of enzymes, it is easiest to go by weight rather than amount! ” To add the enzymes, you can either puree a portion of the raw meat and add the enzymes to that pureed slurry and pour over the remainder of the raw food, let sit for 20 minutes and serve, or you can add the enzymes to something like yogurt/kefir and either add to the food as mentioned above, or serve the enzymed slurry first ahead of the meal. Try both to see which works best with your EPI dog. (Thank you Cait for these great suggestions!)

Next... the typical ratio of powdered enzymes to kibble is 1 level tsp enzymes per 1 cup of kibble, moistened and let sit for 20 minutes, then serve.
HOWEVER... with raw food, mince the raw food, and start with 1/2 tsp to 3/4 tsp of enzymes with room temp raw food. NEVER mix enzymes in anything hot... it will kill the enzymes. Mixing powdered enzymes in cold stuff will inactivate the enzymes... try to do everything in room temp.

Regarding the Tylan antibiotic powder. no, No, NO! Do not stop if things look like they are improving.... Give Tylan powder for 45 days, twice a day, around a meal. here is the dosing chart- -it is done according to weight.
https://epi4dogs.com/antibiotics/.

WIth an EPI dog, in the beginning they are VERY hungry. Their bodies have been starved. Please feed approx 150% of what Trudy would normally require until she either gains back all her weight or her ravenous appetite subsides. BUT do not feed all this food in 1 or 2 meals... best to feed more food, but feed more meals, but the meals should be smaller. So feed in maybe 3 or 4 meals a day. We used to feed a meal 1 hr before bedtime, just to get in that extra meal .

Please post her test results. that will help us.
Also, once your dog is clinically EPI, there is not a reason to retest with the TLI test.
BUT.... if the B12 is not upper midrange, and i am assuming Myah's is not, the B12 test if the one you do want to repeat to see if you were able to bring the B12 levels up. ONce they are up, then you and your vet need to decide what the "maintenance" dose of B12 will be going forward. With EPI dogs, it is a chronic condition, so B12 will be life long... but usually on a small maintenance dose once the level is brought up.

Looking forward to hearing back from you and please feel free to ask any more questions you might have.

[Tuckaboo Pam]

Thanks, Olesia. See, I did not know you couldn't feed pig pancreas, but it makes perfect sense.---P

[MyahsMom]

For starters, it is always helpful if you are are able to to post your test results, as there are some people who are able to read & analyze them. I am not one of those people. I just wanted to welcome you right away & to tell you that we're glad you and Myah are here.

I have just requested the test results from my vet and am waiting to hear back. Hopefully, I can get a copy today and post later. It is so great to hear that there are people on here who can read the results and give input. My vet, although I'm sure generally knowledgable about EPI, seemed just a bit flippant when I explained that I had been research "natural" treatments (raw diet, slippery elm, etc) and commented that I shouldn't feed raw and that the enzymes/B12 would be fine. I'll admit, I'm a bit stubborn, overly analytical, and I research just about everything, especially when it comes to my fur-babies and their wellbeing.

Two things you said jumped out at me. 1) EPI dogs need porcine enzymes, from pigs, so the beef is not the right kind...also, you want to just start out with basics so if you need to do some tweaking it's easier to keep track, and 2) Tylan is given in a 45 day course, and at the end of the course a slow weaning has to take place.

I do still have the Tylan power and did see the other comment about beef pancreas, which has worked wonderfully thus far, but also just ordered the slippery elm. For clarification, if I use slippery elm do you still need tylan?

Here is a standard response I've copied from a post I made to someone awhile back---Some of it may be redundant, so apologies. ALSO, I wasn't active on the forum for a few months, just recently found time to be back. If anything is outdated, a staff member will correct me.

"Could you possibly post the test results from Myah's fasting blood test, as well as telling us a bit more about her?
Hoping to get blood results ASAP.
As for Myah, as I mentioned she was a stray. I would with a rescue organization and we were called in to trap her as she was hanging out in a residential neighborhood. Long story short, she was trapped and was being released to a rescue home and she jumped a 6-foot wall trying to escape so we had to retrap her and then she came to me to foster - which obviously failed. She was labeled what we call a Mexican Street Dog because her DNA results show she is 21 different breeds (true mutt) with the major ones being chihuahua (although she's a 40-ish lb dog), GSD, Chow Chow, and Cattle Dog.

How much does she weigh, and how much SHOULD she weigh? What were/are her symptoms?
Prior to the EPI diagnosis, she weighted about 43 lbs, during the process of diagnosis, she lost 7 lbs in about 6 wks and was 36 lbs. She is currently sitting at 40 lbs, which is her ideal weight.
The initial symptoms started the end of April this year (2023) and were general diarrhea, which the vet checked for giardia, etc, and prescribed antibiotics (5/15/23 - metronidazole) which didn't help and she had 2 rounds of 10 days on that. By the end of May when she wasn't getting better and the stools continued to get more voluminous/yellow/greasy, I was doing research and the only thing I kept finding was yellow stool could mean lover/gall bladder issues so I finally told my vet I wanted a full blood test on her and they did what they called a gastro panel, which included the TLI and other results. The first result to come back was the low B12, that's when she prescribed the Cobalaquin and Tylan powder while we waited for TAMU to get the TLI results. When those came back, I was told she has a "1" TLI and it should be above 5 and she was prescribed the enzymes. At that point, I was very relieved but an issue happened that delayed the deliver of the order I placed for the enzymes and 3 days after diagnosis she started vomiting on top of diarrhea and I took her to the ER Vet who gave her an injection to stop her nasuea which helped. In my desperation I went on Amazon and (thank God) found the Pan-tenex which was delivered the next day and just with the initial dose, her diarrhea stopped (intermittently) and I was relieved.
Currently, after the vet told me I didn't need to change her diet (which was wrong) I tried giving her the normal kibble she had in the past (Blue Buffalo Chicken & Brown Rice) and that started the diarrhea again. I then tried a home cooked diet of hamburger, rice, peas, carrots, spinach and ground flax seeds. She did ok with that but after a few days the stools got softer again. Since then I have had her on the raw diet and she has done very well with it so far. Every now and again she has yellowish but firm stool or brown but soft with minor diarrhea. WHEW What a process, and 'm still tweaking it now that I have the Beef pancreas.

I have been involved with the forum for 4 years, and in that time my Tucker has gone from a 60 pound weakling, to a robust 95 pounder. I feed him mainly https://www.amazon.sg/Elite-Herding-Buf ... B07QD2QVM3 , but I have also fed him https://smile.amazon.com/Taste-Wild-Pac ... 483&sr=8-6. Both are popular forum choices for EPI dogs.

I can't tell which kibble you're using as the URL links are incomplete. Can you share the names of them so I can look into them. I would LOVE to not have to do the raw diet, mainly for convenience, if I'm honest, but will do whatever is best for Myah.

There are four cornerstones to treatment:

ENZYMES Many of us use https://enzymediane.com/ 6X. 1 teaspoon enzymes/1 cup kibble, add room temp liquid & let sit 20-30 minutes. EVERYTHING she eats has to have enzymes with it. Treats may have to go, for awhile.
I was happy to find out about Enzyme Diane and will order from that site once I need more. I love supporting small businesses, especially if they are giving back to their audience (EPI pets)

DIET Grain free & less than 4% fiber. Some, but not all, EPI dogs do poorly when they are fed poultry. Feed 150% the amount you would feed at her IDEAL weight, divided into 3, or preferably, 4 meals.

My challenge has been the 3 times a day smaller portions since I work out of the house and am gone 9 - 12 hrs but I will see how I can tweak that. Also, with a raw diet and the need to bring everything to room temp, it's about a 45 -90 min process and that's a lot.

B12 Needs to be above normal, 600+. Tucker's score was 666, but I supplement him anyway. They just tinkle it out if they get too much. https://www.wonderlabs.com/itemleft.php ... gSEALw_wcB

I just ordered the WonderLabs B12 and will use that once the Cobalequin is gone.

SID All EPI dogs have it. May be controlled with slippery elm, slippery elm + probiotics, and/or Tylan antibiotic. Good info on this tab https://epi4dogs.com/sidsibo-in-brief/
Thanks, I'll read through that. She does get Purina FortiFlora probiotic but would love any suggestions of other probiotics others use and recommend.

Keep a journal, and once you gather all your goodies, make only one change at a time. We have all had to tweak our routine, because each dog is different.

Feel free to ask as many questions as you have, and stay on the same thread here. You may want to share the forum with your vet, too. You've come to the right place, where you and Myah will get lots of help!
THANK YOU SO MUCH!!!
Take Care---Pam & Tucker"

[MyahsMom]

Thank you so much Olesia, I will go through all this wonderful information and post more questions as they come up. You and Pam are awesome and I appreciate you taking the time to share your knowledge and information. I will talk to my vet about continuing the Tylan power, but there was a comment about the slipper elm, is that in addition to or in placement of?? Also, do you have any recommendations for pre/probiotics? I currently use Purina FortFlora powder packets but would love something that comes in larger quantities or even more "natural" like kefir or yogurts but not sure if/how she will handle those.

hi Trudy and welcome to you and Myah,


Looking forward to hearing back from you and please feel free to ask any more questions you might have.

[Olesia711]

Hi Trudy,

What we typically recommend is to try slippery elm first (it is a mucilage and has prebiotic properties) to see if this is enough to help get the SID/SIBO (dysbiosis) under better control.

If you don't see the poos start to firm up after a few days... try increasing/decreasing the slippery elm.. if still no positive change (use the SE dosing guide here-based on weight https://epi4dogs.com/slippery-elm/ ... if the slippery elm is a bust.... then go to Tylan.

Since you already started the Tylan, do not stop and go with it short term. Continue with the Tylan for 45 days/twice day around food so Myah doesn't feel pukey from the Tylan powder. OR..... if you only used the Tylan for 3 or 5 days..... (very minimally) and find that slippery elm and raw pancreas with a reduced ratio of powdered enzymes work... then you might not need to do the Tylan for 45 days.... however... unfortunatley SID has a way of getting back out of control........
In the end, the best way to handle SID... is to find an a diet that optimally suits your dog's unique EPI gut flora....

About halfway thru the 45 day course of the Tylan... introduce the SLippery elm powder... or you can try a pre+probiotic.... We like to recommend (but it all depends on the individual dogs gut flora which pre+probiotic they will best respond to) Proviable, or Visbiome, or VetriScience Mega Probiotics, some do well on Ven Beek Natural, and there is a new live pre+probiotic call Kepro for Pets
https://keproforpets.com/
that is almost the same as Visbiome but it addresses a larger bacterium target whereas Visbiome is more targeted.

In the end, probiotics may or may not work. but worth trying.

All that yogurt, kefir (which IMHO is better than yogurt) is good, but you just can't consume enough for any major benefit.

[MyahsMom]

These are Myah's test results.

[Olesia711]

hi Trudy,

Yes, Myah definitely has EPI and low B12. Your vet was correct i n prescribing enzymes (although not sure if your vet prescribed the right kind of enzymes) and B12.... although, as discussed in the above posts.... there are less expensive (than prescription porcine enzymes)....but appropriate porcine enzymes.... that you already honed in on.

REgearding the Slippery Elm.... yes you can give it with Tylan.... BUT.... when first starting out.... we suggest SLippery Elm first... if it doesn't work, then go to the Tylan. However... as i explained above... you already started Tylan, so i would just continue with the Tylan (unless you have only given it for a mere few days)..... anyway.... just give Tylan without SLippery Elm to see if Tylan improves the poo, gut flora, etc.

HOWEVER.... hang on to the Slippery Elm cause with these EPI dogs.... they always have SID/SIBO (dysbiosis) and our goal is to keep it under good control... which is sometimes easier said than done and a lot of times, these EPI dogs have "set-backs" with loose stools.... and very often (later on as you learn to manage EPI) you will find you do not always have to resort to Tylan to get the dysbiosis under better control, but sometimes all you have to do is give slippery elm powder for a few days/week/+ and once the poo firms up consistently you can reduce or stop giving the slippery elm powder. SOme people have found that their dogs does best on a small dose of slippery elm powder with every meal... others just use it short term to fix the issue. On the flip side sometimes it just doesn't work and some of these dogs need to be on Tylan and then some cannot get off the Tylan but rather stay on a very small maintenance dose of Tylan for life.

As you can see. this can be a crazy journey.... what method works best will be determined by you .... trying these suggestions, keeping notes and then determining which method works best for Myah.

Bet your head is spinning right about now, eh?!

I know this is overwhelming in the beginning... but the trick is... to understand that to best manage EPI, you have to treat the WHOLE dog and figure out what is the right balance of the recommended protocol that works best for Myah.

1. This is why we suggest keeping a journal.
2. In the very beginning, you implement everything at once: Enzymes, B12, a low fiber food, and address SID/SIBO if needed with prebiotics (this is why we suggest Slippery ELm 1st), or prebiotics+probiotics, or treat with Tylan antibiotics.
3. if things are not improving as expected.... THEN you start tweaking things one at a time. This is where we at EPi4Dogs can really help you

REgarding the raw food. I personally and strongly believe in feeding all or some real food... if possible.
Many EPI'rs find great success with raw food, probably because the natural enzymes are somewhat still preserved. i tried all raw and personally didn't care for it (had 3 dogs on it, the EPI dog and 2nd dog did fine, the 3rd dog got very sick and had to be treated by the vet)

SO... because there can still be some bad bacteria in raw that may or may not affect your dog, i personally like to cook/bake meats at a low temp to add to my dog's meal. i also cook and mash all the veggies that i give my dog. fruit i serve as is .

If feeding ALL home made / raw food, be very sure to give a quality vitamin AND bone material.
With EPI dogs ALWAYS be sure to include EFAs (or fish oil) i personally like Welactin liquid fish oil. EPI dogs are greatly depleted in fat soluble vitamins, but aside from the fish oil, ALWAYS talk to your vet about how much of these other fat soluble vitamins to prescribe. Please see our study on it:
2018 (Aug 22) EPI Vitamin Research ... on this page: https://epi4dogs.com/epi-research/

I tend to feed mostly homemade with a little kibble (i currently have a dog that needs a prescription food)

DOn't try to cover the right amount of probiotics via a large amount of kefir... it probably would be too much dairy for Myah or any dog... but giving her a tablespoon of Kefir... would be great...
If you need to give probiotics, Forti Flora might be okay, but we tend to recommend Proviable, Visbiome, VetriScience Mega Probiotics, Kepro for Pets, Van Beek Natural...... it all depends on the composition of Myahs gut flora and which one will best agree with her gut.

Although we recommend/suggest probiotics with prebiotics.... as we know for a fact that prebiotics work, but probiotics may or may not work simply because we have no idea which one would agree with your dog's gut flora... i remember trying 5 different probiotics and none of them worked for my gal... i finally ended up never using any and she did fine... soooooooooo..... it all depends on the individual EPI dog.

What does seem to work in the end....is finding the right diet...for your individual EPI dog.... but that is not as easy as it sounds.... SOOOOOO... for now...start with the basics, which you are doing, keep a journal / EPI log: https://epi4dogs.com/epi-log/
and then after a few weeks if you are not seeing ANY improvement... please let us know..... cause that simply means that something needs to be adjusted... and that is what we are really good at and can really help you with.

Oh, and back to the raw food... if it is working for Myah... then i would stick with it ... regarding room temperature... if you could very lightly heat the raw food at extremely low temp???.... to room temp... and THEN add the enzymes.... maybe this would help shorten the time for you?

[MyahsMom]

hi Trudy,

Yes, Myah definitely has EPI and low B12. Your vet was correct i n prescribing enzymes (although not sure if your vet prescribed the right kind of enzymes) and B12.... although, as discussed in the above posts.... there are less expensive (than prescription porcine enzymes)....but appropriate porcine enzymes.... that you already honed in on.

REgearding the Slippery Elm.... yes you can give it with Tylan.... BUT.... when first starting out.... we suggest SLippery Elm first... if it doesn't work, then go to the Tylan. However... as i explained above... you already started Tylan, so i would just continue with the Tylan (unless you have only given it for a mere few days)..... anyway.... just give Tylan without SLippery Elm to see if Tylan improves the poo, gut flora, etc.

HOWEVER.... hang on to the Slippery Elm cause with these EPI dogs.... they always have SID/SIBO (dysbiosis) and our goal is to keep it under good control... which is sometimes easier said than done and a lot of times, these EPI dogs have "set-backs" with loose stools.... and very often (later on as you learn to manage EPI) you will find you do not always have to resort to Tylan to get the dysbiosis under better control, but sometimes all you have to do is give slippery elm powder for a few days/week/+ and once the poo firms up consistently you can reduce or stop giving the slippery elm powder. SOme people have found that their dogs does best on a small dose of slippery elm powder with every meal... others just use it short term to fix the issue. On the flip side sometimes it just doesn't work and some of these dogs need to be on Tylan and then some cannot get off the Tylan but rather stay on a very small maintenance dose of Tylan for life.

I only gave the Tylan for a few weeks as directed by the vet and had stopped a few weeks back. I just got the slippery elm yesterday and started using it today, we'll see how it does.

As you can see. this can be a crazy journey.... what method works best will be determined by you .... trying these suggestions, keeping notes and then determining which method works best for Myah.

Bet your head is spinning right about now, eh?!
Definitely and it has been since her diagnosis!

I know this is overwhelming in the beginning... but the trick is... to understand that to best manage EPI, you have to treat the WHOLE dog and figure out what is the right balance of the recommended protocol that works best for Myah.

1. This is why we suggest keeping a journal.
2. In the very beginning, you implement everything at once: Enzymes, B12, a low fiber food, and address SID/SIBO if needed with prebiotics (this is why we suggest Slippery ELm 1st), or prebiotics+probiotics, or treat with Tylan antibiotics.
3. if things are not improving as expected.... THEN you start tweaking things one at a time. This is where we at EPi4Dogs can really help you

And I am so glad I found you all. It's been a godsend with all the information you have. It's still taking a while for me to navigate all the information but I am so glad to be here and have so much at my fingertips.

REgarding the raw food. I personally and strongly believe in feeding all or some real food... if possible.
Many EPI'rs find great success with raw food, probably because the natural enzymes are somewhat still preserved. i tried all raw and personally didn't care for it (had 3 dogs on it, the EPI dog and 2nd dog did fine, the 3rd dog got very sick and had to be treated by the vet)

SO... because there can still be some bad bacteria in raw that may or may not affect your dog, i personally like to cook/bake meats at a low temp to add to my dog's meal. i also cook and mash all the veggies that i give my dog. fruit i serve as is .

If feeding ALL home made / raw food, be very sure to give a quality vitamin AND bone material.
With EPI dogs ALWAYS be sure to include EFAs (or fish oil) i personally like Welactin liquid fish oil. EPI dogs are greatly depleted in fat soluble vitamins, but aside from the fish oil, ALWAYS talk to your vet about how much of these other fat soluble vitamins to prescribe. Please see our study on it:
2018 (Aug 22) EPI Vitamin Research ... on this page: https://epi4dogs.com/epi-research/

I also have 3 dogs and it is a challenge and time-consuming as I mentioned before. Keeping Myah away from the kibble/cooked food from my other two is not an easy job because she wants to eat everything. I ordered one of the kibble brands recommended and hope that it works for Myah, if it does that will make it a lot easier as it takes her longer to eat kibble.
The raw just turns to "meat soup" when I add the enzymes and let it sit so she literally laps it up in less than 30 seconds. I have to separate it into 2 bowls and put a goofball in the bowls to slow her down. I have also been concerned that I'm not giving her all the "balanced" vitamins and minerals she needs. I do add coconut oil, sardines, and spinach but would just prefer a kibble I can wet and add home cooked mix ins with the enzymes and call it good. I'm all about ease at this point as I'm tired of the 40+ min routine just to feed her. That said, if that is what she needs, I will make it work.

I tend to feed mostly homemade with a little kibble (i currently have a dog that needs a prescription food)

DOn't try to cover the right amount of probiotics via a large amount of kefir... it probably would be too much dairy for Myah or any dog... but giving her a tablespoon of Kefir... would be great...
If you need to give probiotics, Forti Flora might be okay, but we tend to recommend Proviable, Visbiome, VetriScience Mega Probiotics, Kepro for Pets, Van Beek Natural...... it all depends on the composition of Myahs gut flora and which one will best agree with her gut.

Although we recommend/suggest probiotics with prebiotics.... as we know for a fact that prebiotics work, but probiotics may or may not work simply because we have no idea which one would agree with your dog's gut flora... i remember trying 5 different probiotics and none of them worked for my gal... i finally ended up never using any and she did fine... soooooooooo..... it all depends on the individual EPI dog.

What does seem to work in the end....is finding the right diet...for your individual EPI dog.... but that is not as easy as it sounds.... SOOOOOO... for now...start with the basics, which you are doing, keep a journal / EPI log: https://epi4dogs.com/epi-log/
and then after a few weeks if you are not seeing ANY improvement... please let us know..... cause that simply means that something needs to be adjusted... and that is what we are really good at and can really help you with.

Oh, and back to the raw food... if it is working for Myah... then i would stick with it ... regarding room temperature... if you could very lightly heat the raw food at extremely low temp???.... to room temp... and THEN add the enzymes.... maybe this would help shorten the time for you?

Thank you for all your help, it is invaluable. I will keep tweaking and journaling things to see what ends up working best and go from there.

One final question, since her EPI diagnosis she seems to have bouts with hairloss around her eyes and muzzle. I've used antihistamines and castor oil to sooth it but it will go away for a while and then come back. I'm not sure if this is EPI related (malnutition) or something else? I have her next vet appt in August and will bring that up to them then if it hasn't cleared up.