Epi4Dogs

Hello all!

We just received our puppy’s diagnosis of EPI this morning from our vet. We have an 11 month old female German Shepherd named Fi who is the most sweet girl in the world. I wanted to ask a few questions to get our plan for managing EPI!

Short backstory: Fi started having diarrhea about 3 weeks ago, but she was also in heat so I assumed it was just hormonal. When it didn’t end after a week, we put her on boiled chicken and rice which helped for a few days, then it was back to cow-patty diarrhea. At the same time, her appetite was increasing and she was eating more than we had ever seen her eat while also losing weight, counter surfing, etc. At this point I scheduled a vet appointment, knowing that I would be getting an EPI test after researching her symptoms. The vet assumed it was just giardia (which I hoped as well), but I insisted on the EPI test and now I’m glad I did! I had pre-ordered a tester size from EnzymeDiane, so luckily we had it on hand as soon as we received the news from our vet this morning. I also learned that her vitamin B12 levels are low (<150), but my vet wants to wait and see if the enzymes/probiotics help Fi and retest her levels in about a month. She is also confirmed to have bacterial overgrowth in her intestines, but she is already on antibiotics since they were prescribed for suspected giardia on the day her bloodwork was sent out.

I am concerned about her going a month with low B12 levels, so I wanted to get more opinions on that. Is it possible that the enzymes and probiotics will restore her levels without the need for supplementation? In addition, will a 7-day course of antibiotics take care of her SIBO? I have also read that enzymes and probiotics alone can help with SIBO since they restore the natural balance.

We are planning to feed her 3 meals a day at 150% of what we normally give her to help her put weight back on (she is currently 52lbs, should be around 60). We still have her on chicken and rice, so should we slowly wean her back onto her kibble (Sportmix Wholesomes Large Breed Chicken and Rice - which luckily already fits the fiber range of <4%), or should we go ahead and switch her back so she’s getting more nutrients than boiled chicken and rice provide?

As far as feeding, I had a question or two about treats as well. Fi’s favorite treats are ice cubes already, luckily! But we do give her a Kong filled with frozen peanut butter every morning when we leave for work. Would this be okay as long as it is within about 20 minutes of her breakfast so she has enzymes in her system? Or should we mix some enzymes in with the peanut butter before freezing? And are bones okay for her to chew? We don’t really give her raw meaty bones or marrow bones, she normally likes to chew on knuckle bones or on antlers (no rawhide). Is it necessary to give enzymes with the bones, or are they okay to chew on with no enzymes?

As far as enzymes go, we are using Enzyme Diane’s Pancreatin 6x with 1tsp per cup of food, adding warm water to let it incubate for 20mins before feeding. For probiotics, she is currently on Pro-Vetoquinol which is also an anti-diarrheal so we are going to switch her to Pro-Viable DC. Has anyone else had good results with this product?

I think that covers most of my questions so far, sorry for the long post! This is somewhat overwhelming, but I’m glad I had a gut feeling so I was able to do lots of research before Fi was even diagnosed. Thanks so much in advance!!

Hi, Eleanor! It's Pam, in FL. Well, it sounds like you've got a really good jump on this EPI thing..Someone on staff will respond soon, and they will go over all the important points. I, too, did the research and took my ideas to my vet, who was also open to learning, but I have received so much help from the people here. You will, too. As far as food goes, I have read many times that chicken may not be the best protein for our epi pups. I have started feeding Tucker Sport Dog Food Elite, Buffalo & Sweet Potato. This has been a recent change, and his poo has never looked so good.
Well, I just wanted to say Hi, and welcome, and to tell you that you will be fine. You can look at the signature beneath the post, to read details about people & their doggies. Take care---Pam

Hi and welcome to our EPI family. Your pup is GORGEOUS!!!! Good on you for doing the research and insisting on the EPI test. The B12 is almost non-existent and is critical to properly managing EPI so it's concerning your vet said to wait a month. If it were my dog I would NOT wait! When my by was diagnosed his B12 was 406 and my vet said there was no need to supplement B12 - after reading the research here I knew he wouldn't get better without it so I went ahead and ordered the WonderLabs Pet Factor B12 pills and his B12 went to over 1000 and has stayed there for 5years.

There are 4 cornerstones to properly managing EPI:

ENZYMES: Glad you already got EnzymeDiane as it will save you A LOT in the long run. Use 1 level teaspoon per cup of kibble, mix in a little luke warm water then mix in kibble and incubate 20-30 minutes before serving.

B12: EPI dogs need their B12 on the high side of normal 600+ and supplementing is for life.

ANTIBIOTICS: In the beginning we recommend giving the proper dose of enzymes, B12 and food a few weeks to see if the gut corrects itself. If not and you still see signs of SID (small intestinal dysbiosis formerly called SIBO) then you can either try Slippery Elm Bark Powder or Tylan antibiotics. We don't recommend metronidazole because of the neurological side effects and it kills all of the bacteria in the gut. If you use Tylan we recommend it for 45 days and then slowly wean off.

FOOD: We recommend grain free with 4% fiber or less and avoid peas. Feed 150% of the food for the weight your dog should be not the weight your dog is but in smaller more frequent meals throughout the day. Grains and peas/legumes can interfere with the efficacy of the enzymes.

As for treats, we recommend no treats - not even a peanut butter kong - until your dog is stable (good poops, weight gain for a few months). Everything your dog eats needs to be treated with enzymes - some dogs once stable are able to handle a treat or a kong within close proximity to their enzymed meals and others like me can't tolerate anything but ice cubes. Bones are okay as long as they are not edible bones but honestly I would hold off until she is stable unless it is something like a Nylabone.

Keep a detailed journal of everything you give and the resulting poops. I would retest the B12 after a month of supplementing. Never apologize for questions or long posts - we've all been where you are and we are here to help!

Thank you so much for the replies!!

We will get her started on the B12 right away, I already had it in my Amazon cart so it’ll be here within a couple days! As for the Kong, I may premix some enzymes into a cup of peanut butter and use that to give her in the mornings and see how she does with it. We normally only give her about a tablespoon in there anyway, so it’s not very much. If she is still not showing improvement, we’ll stop the Kong first before we try anything else.

As for bones, I’ll go ahead and order her a nylabone to chew on until we get everything under control. I’m finding that most of them are flavored, is that okay? Since they’re not actually consuming anything, it’s just a flavor on the bone? She’s always liked natural bones, so I’m not used to buying artificial ones.

We will finish out her 7-day course of metronidazole for now since we already have it, but afterwards we’ll see how the enzymes, food, and B12 improve her bacterial balance! As for probiotics, should we stop giving them once she’s off the antibiotics? When will we know that she needs probiotics added to her meals? I want to make sure we keep good bacteria in her gut to prevent SID from returning in the future.

Thanks again!!

Welcome, your pup is gorgeous!

Hi again. Just remember everything your dog eats must have enzymes - I honestly don't know how much enzymes to use for a tablespoon of peanut butter but in my honest opinion I would not give the Kong with peanut butter right now as it could prevent her from getting stable. As for the probiotics, we recommend not giving them until your dog is stable because we now know that EPI dogs have too much of the common strain used in most probiotics and too much of a good thing can be a bad thing. If you want to continue to use them since you have them be sure to give 2 hours away from antibiotics as they cancel each other out. What they are finding out now is that prebiotics actually are more beneficial.

It's best in the beginning to keep things simple - enzymes, B12, food and antibiotics (if needed) until your dog is stable. Once your dog is stable (good solid poops and weight gain) for a few months, then you can try adding in one thing at a time and carefully watch for any changes in poop.

The flavored nylabones are fine as long as your dog doesn't have any food sensitivity issues. Mine is sensitive to chicken so I stay away from anything flavored with chicken.

Thank you so much for the additional information! Sounds like we’ll be cutting out her peanut butter Kong all together until she gets stable. Her course of antibiotics will only go until Wednesday morning, so will it be okay for her to not have anymore probiotics along with it?

As for her food, would it be a good idea to keep her on her current food (Sportmix Chicken and Rice) for now since we don’t want to change too many things at once, or should we switch to something without chicken in it? I have heard a lot of people recommend the Sport Dog Elite Buffalo recipe since it doesn’t have chicken or peas and meets the fiber guidelines.

She started her enzymes yesterday morning, but her stool has gone from somewhat formed diarrhea to watery diarrhea. Nothing other than adding the enzymes has changed. We also won’t be able to add B12 until Tuesday since I just ordered it, so maybe that’s the cause. I just don’t want her getting dehydrated because of the watery diarrhea.

Please advise! Thank you.

welcome from the UK

THE b12 you ordered, has it got the intrinsic factor in it ?

chicken and rice doesnt lie well with EPI dogs in the main, my girl couldnt tollerate it whatever

the food you mention seems reasoable but stick to grain free and 3% fibre

we could only feed lamb Kara couldnt tollerate anything else much

what about antibiotics for a rumbling tummy

keep a diary and record everything you do


jean

Hey Jean,

Yes, the B12 has the intrinsic factor! It is the WonderLabs Pet Factor B12 that I have seen recommended here quite a few times.

The food I mentioned is grain-free, with fiber content of only 3.3% so it is below the 4% max.

As for antibiotics, she is currently on a 7-day prescription of Metronidazole which I realize at this point isn't the best, but it's what we have so I'm going to finish the prescription.

We are keeping a diary of feeding times, what we feed her, and potty times along with descriptions of the stool for reference! My concern is that her stool has gotten worse since adding the enzymes, but maybe it's the lack of B12 since we haven't received it in the mail yet.

Thanks so much.

Hey there. I would go ahead and change the food to cut out the rice - they don't digest rice and it can stay in the gut undigested and cause issues. Buy small bags (until you know you have the right food) and transition slowly over 7 days.

Be sure you're using the right dose of enzymes - 1 level teaspoon per cup of kibble, mix in a little luke warm water and then mix in kibble and sit 20-30 minutes before feeding.

In the beginning with so many things not quite in balance it's hard to tell if it's the lack of B12 (although a big culprit), the food or the wrong antibiotic - or a combination of all three which is likely and/or if you've been giving the peanut butter Kong up until now that might not be helping things either.

I would not worry about the probiotic - just cut it out completely for now. I know it's frustrating and overwhelming but hang in there - we gotta the right balance of things in place before you will see improvement.

If I were you I would try some Slippery Elm Bark powder https://epi4dogs.com/slippery-elm/ . Have you asked the vet for Tylan?