Need Advice for My German Shepherd, Ryder, Diagnosed 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.
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WorriedShepherdMom
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Country: United States
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Pet name: Ryder
My name: Sarah

Need Advice for My German Shepherd, Ryder, Diagnosed with EPI

Post by WorriedShepherdMom » 02 Jun 2023, 01:54

Hello everyone,

I've recently joined the EPI4Dogs forum seeking guidance and support for my German Shepherd, Ryder, who was diagnosed with EPI (Exocrine Pancreatic Insufficiency) on May 10, 2023. His diagnosis was confirmed when his TLI test results came back at 1 ug/L and his Cobalamin B12 levels were 150 pg/mL. Prior to the diagnosis, we observed alarming signs like significant weight loss, increased appetite, abnormal interest in other dogs' feces, loose stool, itching, and hair loss.

Currently, Ryder's treatment regimen includes Enzyme Diane 8x powder (2 tsp mixed with water, incubated with 2 cups of food morning and night), Nutramax B12 Supplement (1 chewable twice a day), Nutramax Proviable pill, and he's halfway through his course of Metronidazole 500 mg.

Despite our efforts, Ryder's health has been declining. We thought we saw some improvement after the first enzyme supplement treatment, but his loose stool returned shortly after. He's constantly itching, shedding excessively, and seems to have developed conjunctivitis. We have a vet appointment scheduled for June 8th.

Another concerning behavior is Ryder's sudden lack of aggression towards other dogs, which is highly uncharacteristic for him. Additionally, he has started to lay in the bathtub, a place he used to be terrified of.

I have photos documenting his condition, but I wasn't sure whether they're appropriate to post here. Please let me know if they would be helpful.

We're feeling lost and are eager to understand if we're missing anything in his treatment. Is there anything more we could be doing? Are there cases where the dog's health deteriorates before showing signs of improvement? Any advice or shared experiences would be greatly appreciated.

Thank you so much for your time.

Best,
Sarah
(Very Concerned Dog Mom)

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Olesia711
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Re: Need Advice for My German Shepherd, Ryder, Diagnosed with EPI

Post by Olesia711 » 02 Jun 2023, 12:29

Hi Sarah, so so SO sorry to hear that Ryder is not responding as expected to the EPI treatment.

With EPI, there is a recommended standard treatment BUT... as you will discover, withe these EPI dogs, many times we have to adjust/tweak the recommended treatment so that it beset addresses the individual dog.

FIRST... what you are describing, where intially there was improvement and then things went downhill... this sounds very typical.... and if this is due to EPI, then what is going on is that the enzymes ARE working, but shortly after administering the enzymes, it kind of shakes loose all the build up SID (small intestinal dysbiosis) that ALL dogs with EPI have. SO, what you are seeing is most likely SID. PLEASE, PLEASE PLEASE tell your vet you want to stop Metronidazole immediately and try Tylan (Tylosin Tartrate Antibiotic Soluble powder). Only in very few cases does the Metro work on SID- -Metro is old school anti for dysbiosis. The current and preferred antibiotic is Tylan.

If your vet gives you a hard time about Tylan, please have him read our SID/SIBO page... specifically:
https://epi4dogs.com/antibiotics/
.... or contact Texas A&M Gastrointestinal LAb and talk to Dr. Joerg Steiner directly regarding taking Tylan for SID vs. Metro.

All the other symptoms you are describing could also be related to SID... even laying at the bottom of the tub for coolness... he just might be feeling very miserable. MAny dogs with SID feel sickly.... but on the flip side, there are some that act like nothing is wrong.... it all depends on the individual dog.

The other thing is the 2 tsp of 8x with water.
Let's clarify. ..........
I know it says to mix the enzymes in water, but some folks use way too much water. A better description is to first add enough water to the food to moisten the food and then add the enzymes to the food, mix well and let sit for 20 minutes .. then serve.

Next... this may be way too much enzymes for 2 cups of food for your dog. 8x is stronger than 6x.... in general.... you want to start with 1/2 to 3/4 tsp of 8x per 1 cup of food (if kibble).... if feeing wet food, then start with just 1/2 tsp of enzymes per 1 cup of wet food.

And the last thing is the hardest.... you will want to try these adjustments one-at-a-time.
The FIRST thing i would do is call the vet and tell them you want to swap out the Metro for Tylan ASAP.

See if that improves things (Tylan usually works fairly fast)
If no improvement at all within a few days, then reduce the enzymes.......

Of course if your vet can't get you they Tylan ASAP, then start with the reduced enzymes as your first step....

That is good that you have a vet appt on the 8th for the conjunctivitus.... and also just have the vet check him over.
ALl the above information i gave you is uner the assumption that his current reaction is EPI related, which i strongly suspect it is... BUT..........still have the vet check him over, just in case something else is going on.

BTW... you can get Tylan from Chewy with your vet's approval.
Here is the link:
https://www.chewy.com/tylan-tylosin-tartrate-soluble-powder/dp/173768

Please keep us posted!
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.........

Chance
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Pet name: Chance
My name: Andrea

Re: Need Advice for My German Shepherd, Ryder, Diagnosed with EPI

Post by Chance » 02 Jun 2023, 12:51

I'm very sorry to hear that Ryder is struggling so much. 😔 it is sooo stressful when they are unwell and can't tell us why.

I'm not sure I can help, but I am glad you are going back to the vet. Given the symptoms, perhaps they would take him sooner?

A few possibilities...but maybe not high likelihood; but based on experience with my own dog.

The Cobalaquin: although this does work with many EPI dogs, it doesn't work on all. I had my dog on injections, before switching to Wonderlabs B12. That switch was a very costly mistake in every sense of the word! Within a few weeks, Chance started going downhill at an alarming rate. His B12 levels had hit the floor! He was switched back to injections. The next day, after getting his first injection again, he was a new dog. Bi weekly injections seemed the best at keeping his levels close to high range normal.

Next possible: enzyme Diane is a wonderful product, and it does work. However it does have a fair amount of lactose in it. Most dogs don't have issue with this lactose, but some do! Again, Chance is one of them. He's always been the most sensitive lactose dection device on the planet! He did have a problem, which we resolved by giving lactaid pills(lactase enzyme) just before eating meal. That got things better quickly.

Metronidazole: if he has diarrhea so bad, even while on it, perhaps Metro isn't the drug of choice for him? It's also harsh antibiotic, that kills all gut bacteria indiscriminately. Most people here use Tylosin (which inhibits, rather than kills bacteria). Most dogs do very well with this. (Again, Chance had to be the exception 🙄). I find high potency probiotics work much better, along with occasional use of calcium bentonite clay. (It took 5 attempts for me to find the right probiotic for him...so it can be an exercise in patience! But once I found the right one, along with the clay, I FINALLY got him stable. The dog that was impossible to stabilize has not had one antibiotic in 6 months...which is HUGE for him)!
Chance was my 4 legged soul mate. My mobility assist service dog. Pure yellow Lab, 75 lbs. After struggling with weight all his life, finally dx with EPI. cTLI < 1, folate and B12 very low. Fed Raw. Maintained with Creon, Garden of Life probiotic and intermittent calcium bentonite clay. (Tylosin was a big nightmare for him)!

Rylee is Chance's successor; also pure Yellow/Fox red Lab. Started with symptoms at 8 weeks. At 6 months of age, also prescribed Creon due to suspected EPI (due to passing large amounts of undigested food). Currently suspected of blockages in pancreatic ducts. She is maintained VERY nicely on Creon and probiotics. Also raw fed.

WorriedShepherdMom
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Posts: 2
Country: United States
State: Nevada
Pet name: Ryder
My name: Sarah

Re: Need Advice for My German Shepherd, Ryder, Diagnosed with EPI

Post by WorriedShepherdMom » 02 Jun 2023, 21:01

Thank you guys so much,

Your responses to my post about Ryder brought me to tears. I'm overwhelmed by your empathy, your understanding, and the time you took to share your advice and experiences.

Andrea, your explanation about SID and the role of Metronidazole was enlightening. It's been so hard seeing Ryder decline and not knowing how to help him. I appreciate your suggestions immensely. I'll discuss swapping Metronidazole for Tylan with our vet as soon as possible. I'm grateful for the resources you provided to back up this suggestion, it will be very helpful during our discussion.

Your advice about administering the Enzyme Diane 8x has given me a new perspective. I realize now that I might have been using too much water and giving him too much of the supplement. I'm going to adjust how I'm administering it and monitor how Ryder responds.

Olesia, your thoughts about the Cobalaquin supplement resonated with me. It’s something I hadn’t even considered, but now I will bring this up with our vet and discuss the possibility of switching Ryder to B12 injections.

The possibility that Ryder might be lactose intolerant and having issues with the Enzyme Diane was a revelation. I had no idea that this could be a problem. I appreciate your advice to consider giving him lactaid pills before meals.

I've noted your experiences with Metronidazole and the success you've had with high potency probiotics and calcium bentonite clay. It gives me hope to hear about the progress Chance has made. I really hope we can achieve similar results with Ryder soon.

Both of your messages have given me new direction and hope. It's comforting to know that we are not alone in this journey. I'll keep you updated on Ryder's progress. Thank you again, from the bottom of my heart, for your support and advice.

Again thank you both so much!

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Olesia711
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Re: Need Advice for My German Shepherd, Ryder, Diagnosed with EPI

Post by Olesia711 » 03 Jun 2023, 12:06

Hi Sarah..... just wanted to further address a few things...... first, your head must have been swimming with so much information that both Andrea and i shared with you. When first starting the EPI journey, it can be very over-whelming..... but the biggest thing to remember is that we all start with the standard protocol recommendations..... but then, depending on the individual dog- sometimes you do not see the expected results. Please know that things will eventually work out, .... it is just that your dog is one of many that now needs certain aspects of the recommended protocol to be "tweaked".

In your response you mixed up my recommendations with Andrea's. In short.... my recommendations are the "punch list" that we go thru when the recommended protocol from the vet is not working out as expected. Like swapping out Metro for Tylan, how to prepare the enzymes with the food, the B12 issue.

For example.... let me give you the long version of B12 background: , many vets now prescribe Cobalaquin B12, which is good, but sometimes EPI dogs just don't respond as expected to it... we prefer to recommend WOnderlabs Pet Factor B12 because it is made with Methylcobalamin vs. Cyanocobalamin and Pet Factor B12 also include porcine intrinsic factor which helps facilitate oral b12 into the blood stream (even though old B12 research claims that the intrinsic factor needs to be species specific, which we have proven not the case repeatedly with hundreds of individual cases). The B12 injections do not need intrinsic factor as it is not in oral form. For many years, research said only B12 injections work, we kept proving over and over again with actual cases that oral methylcobalamin B12 with intrinsic factor works, as a matter of fact, many times, the oral methylcobalamin B12 works better than the B12 injections. There is even a small handful of dogs that do not thrive at all with the B12 injections and flourished only when given the oral methylcobalamin B12. Finally TAMU did a study with oral B12 and (they used Cyanocobalamin B12) and found that oral B12 is just as effective as B12 shots. SO now the researchers and vets do recommend oral B12....and they recommend the oral B12 that was used in the TAMU study, which is Cobalaquin..... However.... even with all the many great stories, examples and scientific proof of how well the oral B12 works, and often surpasses the B12 injections..... there are exceptions.... i swear with these EPI dogs nothing is 100% hence exceptions... Like Andrea's dog Chance. Chance bombed on the oral B12 and did not do well until they switched him to injectable B12.

SOOOoooooo i just wanted to share this with you so that you don;t lose hope if things don't work out in the beginning... because first you come home and do what the vet says, if things don't work out.... we at Epi4Dogs have a punch list of things for you to "tweak" one at a time to find what works best for your EPI dog that we have worked out over the course of running this website/forum/research for 15 years.... but even then, sometimes, things still don't work out, but we have members who had to try unusual things that finally worked for them and will share their stories, like Andrea did, on what worked for them in unusual cases. There are no guarantees what exactly will work for your dog, and that is why, like Jill mentioned, start keeping an EPI log
https://epi4dogs.com/epi-log/
as it will help you identify what works and what doesn't... But in the end....if you follow and try our suggestions, in consecutive order, one-at-a-time.... you will find the right balance of recommendations that work best for Ryder.

For right now, i strongly suggest not using the bentonite clay simply because you have to be very careful with it. First try getting things under better control via prebiotics (try slippery elm powder)
https://epi4dogs.com/slippery-elm/
Typically we recommend that if the above doesn't work, then try using a quality probiotic (which may or may not work but worth trying): Proviable, VetriScience Mega Probiotics, Mercola Complete Probiotic, Kepro for Pets.
HOWEVER...... in Ryder's case, i would bypass fooling around with any probiotics at this point since they may or may not work, and instead go right to a course of Tylan (twice a day with food/45 days)
https://epi4dogs.com/antibiotics/
ALso....if Ryder is dealing with acid reflux responses, regurg, etc.... all EPI dogs have damaged or inefficient bile acid functionality.... in which case talk to your vet about giving Ryder Omeprazole.

PHEW! sorry for the long winded post..................but i hope this helps give you a better understanding of why not to get too disheartened if things don't work out as expected in the beginning.... it will eventually with modifications.....and we will do our best to help you get there..............
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.........

Chance
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Posts: 405
Country: Canada
Pet name: Chance
My name: Andrea

Re: Need Advice for My German Shepherd, Ryder, Diagnosed with EPI

Post by Chance » 03 Jun 2023, 22:37

I do agree that one has to be careful with bentonite clay. However There's decent documentation to show that it's been used with success for certain things. There's no way that Chance was ever going to get stable without it. He'd still be off and on antibiotics without it. (It's not a bad idea to use antibiotics now to help get things controlled now. But I would not say clay is to be avoided completely).

It is worth noting that Calcium bentonite is safer than sodium bentonite clays. Sodium bentonite clay is used in industrial uses, including to create water tight barriers. So it's not as safe for ingestion. (It has been used some in topical applications). Calcium bentonite clay is safer for ingestion, provided you get one that is certified for internal use. (Many intended for topical use only are not necessary mined with all impurities removed. Thus not something I would be comfortable with).

I will also note that I never used a lot. The recommended dose for RX clay is 1/8th tsp per 10 lbs twice a day. Chance is close to 75 lbs, and I used 1/2 tsp ONCE a day. So much lower than indicated there.

I used it religiously (1/2 tsp daily) for 2 weeks. After that I did 3 days on, 3 days off. I did that for a bit, before going to 5 days off, 3 days on. That, together with the high potency probiotic has helped get him stable, without any antibiotics at all in close to 6 months.

Here's a couple of articles of using it for gut bacteria. On is in mice. The other was pigs, reducing c. Diff and e coli; and potentially boosting lactobacillus and bifidobacterium (good bacteria). (There's also Isolated articles about it used for IBS in humans, and reducing certain bad bacteria in humans. Admittedly not dogs, but I don't think its too much of a stretch to say it could have similar effects).

https://pubmed.ncbi.nlm.nih.gov/29412464/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4546348/

There are MANY other articles and semi reputable sites that talk about it. This is just a couple of examples
Chance was my 4 legged soul mate. My mobility assist service dog. Pure yellow Lab, 75 lbs. After struggling with weight all his life, finally dx with EPI. cTLI < 1, folate and B12 very low. Fed Raw. Maintained with Creon, Garden of Life probiotic and intermittent calcium bentonite clay. (Tylosin was a big nightmare for him)!

Rylee is Chance's successor; also pure Yellow/Fox red Lab. Started with symptoms at 8 weeks. At 6 months of age, also prescribed Creon due to suspected EPI (due to passing large amounts of undigested food). Currently suspected of blockages in pancreatic ducts. She is maintained VERY nicely on Creon and probiotics. Also raw fed.

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Olesia711
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Re: Need Advice for My German Shepherd, Ryder, Diagnosed with EPI

Post by Olesia711 » 07 Jun 2023, 14:03

hi Andrea,

Thanks for including these research abstract/articles regarding bentonite clay ... i finally got around to reading the attachments today.. Very interesting! But also drives home my point of using this clay with caution for an EPI dog, although i am glad that you found that it works for Chance, and in your case i personally would continue using it.

As you well know, we often have to resort to trial and error with these dogs. First we give suggestions of what typically works for "most" our EPI patients, but that is no guarantee that a recommendation will work for every EPI patient.... hence the trial and error which can be tedious, but once you find something that works, OMG, it's like a little miracle.

With regards to the bentonite clay, again, in and of itself, it is fairly harmless but should not be used consecutively long term... one should take a break from using it, just like what it sounds like you (Andrea) are doing.

The problem with clay and EPI dogs is that yes, the clay certainly does absorb certain toxins (and a godsend when needed when something toxic is consumed!), but it also absorbs SCFAs.... Some SCFAs are very much needed, like Butyrate (Firmicutes Phylum) needed and in short supply in our EPI dogs. This actually helps control dysbiosis. And our EPI dogs are grossly depleted in soluble fats too, even after given enzymes and this clay reduces this. So we NEED to make sure our dogs get enough SCFAs and sufficient fat too to help them with EPI and their inherent depletion.

ALSO..... unique to the EPI population... EPI dogs they have too many lactobacillus and bifidobacterium bacterium in their feces output! Please note the specific study one on EPI dogs fecal gut flora.
https://epi4dogs.com/microbiomemicrobiota-research/
.
.....but again, every single EPI dog (and any dog for that matter) has their own unique bacterium composition... this could also be the underlying reason why so many probiotics simply don't work on EPI dogs (too much Lactobaccillus or not a good mix for that particular dog's gut flora composition) . But by chance, if you find a probiotic that works (and we list some of the more successful ones)... it is well worth trying first BEFORE reaching for an antibiotic.

ALso, regarding Lactobaccilllus bacterium....what many folks don't realize is that there are hundreds of Lactobaccillum "strains"... and not all are good for the EPI dog.

SO the premise of the clay benefits :
The mechanism for the reduction in diarrhea is likely due to increases in the numbers of Bifidobacteria and Lactobacillus and decreases in Clostridia and E. coli in the small intestine of pigs fed clays.

..........Doesn't really apply to the general EPI population, even though the decrease in Clostridia and E. Coli would be great. BUT, again, if it is working for Chance, then that is great. I know of a very small handful of others that it has worked for, however more often than not, it doesn't really work well with EPI dogs. It is just not something i can recommend as one of the top options.... however, i do welcome it to "try.. with caution" if all else fails.....
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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Myah's Mom
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Re: Need Advice for My German Shepherd, Ryder, Diagnosed with EPI

Post by Myah's Mom » 22 Jun 2023, 03:34

Board members generally give good advice. Work with a vet experienced in EPI, if you can.

Emotionally, I'm just going to say it's only been a month post-diagnosis. Give it time, and try not to stress (easier said than done). I just posted Myah's 10 year old story, realizing some may have a rougher road. Reading posts like this take me back to how I felt at the time, much like you.

If your fur baby can keep food down, and poop it out reasonably formed, you're on the right track. Little tweaks here and there and you guys will get there.

Keep the faith!

randyguzman
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Pet name: Môn
My name: randy guzman

Re: Need Advice for My German Shepherd, Ryder, Diagnosed with EPI

Post by randyguzman » 11 Jul 2023, 05:53

Hi Sarah,
Based on the symptoms you have described, it's possible that Ryder may have additional health issues that are contributing to his declining health. The itching, hair loss, and conjunctivitis could be related to allergies, skin conditions, or other underlying health issues. It's important to work with your veterinarian to rule out any other potential causes and to develop a comprehensive treatment plan that addresses all of Ryder's health issues.

In terms of his EPI treatment, it's possible that Ryder may need adjustments to his enzyme replacement therapy dosage It's also possible that he may need additional medications or supplements to manage his symptoms and improve his overall health.

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