Newly diagnosed

[Kira2020]

Hello, ill start by saying thank you if you read all of this. To say im overwhelmed is an understatement
My german shepherd girl, Kira, who is 3 years and 7 months has just come out of a horrendous time in hospital, 6 nights, hemorrhagic diarrhoea, refusal to eat (was tube fed), and incontinent. We thought we were going to lose her. She fought back. After the hospital got her well enough to be able to recover at home they had results that she has EPI and low folate, B12 ok though.

We have folate and pro enzorb (porcine enzymes) to give her.

She is 1 week out of hospital and its just been incredibly hard. She has days where she will eat well and therefore take her meds with the food. But others she retches, gurgles and flatly refuses to eat unless serioulsy high value food (cooked turkey, other meat). She will start dropping weight.

Granted we are slowly upping her exercise as she was so low energy (understandably) so she may not be hugely hungry but she has had cerenia(in case of nausea), pardale (in case of pain), and an appetite stimulant and we are still at the often refusal to eat. We have omprazole to try but im loathe as the vet said they could make her sick. And i feel in my heart they did a few years ago.

Yesterday morning we thought she was about to flare as her insides were grumbling for hours on end. I expected diarrhoea but instead she hasnt pooed for a day.

I know this is a long road, and she was a picky eater before but I really need some reassurance/advice being so new to this.

Weve changed her food to lower fat. Which going by her poo she is tolerating ok.

She has multiple health concerns, another very bad flare and we will question whether she has quality of life. I wont see her go through another hospital stay like that. She has severe behavioural issues so the stress alone is crippling-she is still decompressing bless her.

Thank you for reading.

[Tuckaboo Pam]

Rachel---Welcome to you and Kira. I am so sorry to hear that she has gone through such a bad time. Below I will copy & paste some of the basics, but could you please post the test results from your vet?

I wrote this in 2022, and while my life has changed a lot---I lost Tucker to cancer, and now I have Nina, who has EPI, the outline of treatment is still pretty much the same. Please substitute Kira for Belle, if I miss some in editing.

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

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

I have been involved with the forum for 3 1/2 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 Belle will get lots of help!

Take Care---Pam & Tucker
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, Wonderlabs B12 one capsule per day, two capsules slippery elm."

[Tuckaboo Pam]

I just wanted to get all that out of the way. If you are able to post the results, there are some very smart people in this group, and they will be able to interpret them, which will be more helpful. B12, for instance, for an EPI dog needs to be at least 600. Tucker's was 666, and I still supplemented him. It's a whole cocktail kind of thing for some dogs.

Was Kira fasted for twelve hours before her blood was drawn?

Our friend Jean is in the UK, and she may be able to hold your hand through all of this.

Also, in my previous copy/paste, I know I did not address Kira's dislike of her food right now, so please understand that someone else will do that. My post is just the basics, for starters. Every dog is different, and we have all gone through the tweaking process to get our pups health back on track.

Hang in there, Rachel. Take Care---Pam & Nina

[Kira2020]

Thank you so much. I will see if I can get her results and post.

[Olesia711]

Hi Rachel,

I just typed a LONG post to you and then accidentally deleted it... so upset with myself.

The very first thing i want to mention is to please have hope... the fact that Kira is a fighter is half the battle. Been there done that with my EPI dog, Izzy, the vet said they had no idea how to treat her cause she had too much going on .... but she too was a fighter too and after having EPI, Juvenile incontinence for years she then developed Central Brain inflammation, and Uveitus... a few years later she then contracted IMHA (50-80% mortality rate) and developed Diabetes and Low Thyroid... needless to say the vet was overwhelmed. She was hospitalized and not responding until i brought her home and then the long journey to recovery started. She lived for 8 more good years until she was 15.

I am just sharing this with you to let you know, that those that are fighters, no matter how much is stacked against them, often turn out to be the strongest survivors... so i hope this gives you a glimmer of hope.

I am so sorry that Kira had to deal with hemorrhagic diarrhoea... that is a tough one and can take a long time to bounce back from.... but glad to hear that she is home now.

Based on what you wrote.... it sure sounds like Kira is dealing with uncontrolled SID/SIBO/Dysbiosis. PLEASE mention this to your vet and if you can call your vet and request Tylan (Tylosin Tartrate) for 45 days/twice a day to treat this..ALL dogs with EPI have this to one degree or another.... BUT our objective is to keep it under good control... SID can and does cause pain in a lot of dogs and they often go off their food, their stomach makes lots of noises, they burp, regurgitate, fart... etc... If your vet cannot access or doesn't understand the value of Tylan (there is a lot of EPI research on Tylan here on this website and WHY it is used; the reason why you want Tylan is because it is a macrolide antibiotic and does NOT kill all the bacteria but rather inhibits reproduction. ) but if your vet doesn't give you Tylan, then strongly request Oxytet (Oxytetratcycline) for 30 days... DO NOT let your vet prescribe Metronidazole/Flagyl which kills every thing- -this is NOT a good drug for a dog with EPI cause they not only do not have enough bacterium in their gut but they also do not have enough of a variety of bacterium in their gut and Metro kills everything ....... Tylan is the go to drug to treat SID/SIBO/Dysbiosis in EPI dogs https://epi4dogs.com/antibiotics/

The Protexin Pro-Enzorb is the appropriate enzyme for EPI.... it is enteric coated enzymes... be sure to OPEN the capsule and sprinkle the little enteric pellets on top of "moist" food and then serve immediately... DO NOT mix in the food... as you do not want the coating to dissolve before it hits the gut.

The B12 if "okay" is not good enough. You want the B12 level to be upper mid range with an EPI dog (in the upper 500's -600;s ... or higher) The reason is because all dogs with EPI have SID/SIBO/Dysbiosis... and this "eats" away at the B12 stores.
Besides.... if you give a dog too much B12 they just pee out any excess. Please look at the B12 product that CHEMEYES in the UK carries... this is a good product for EPI dogs. https://chemeyes.co.uk/product/vitamin-b12-capsules/

I hope this helps a little..... oh, and please be sure to share with your vet everything we are suggesting.

[Eddiespaghetti]

Everyone else has you covered pretty well. I just want to jump in and say that, once you get her a little more stable. You will want to get her off the low fat food. EPI dogs do better on it, because they have a hard time breaking down fat. The less fat the better they do. This is where the enzymes come into play. They break down the fat and carbs for the dog. EPI dogs have a hard enough time gaining weight that you don't want to limit the fat.
With enzymes, most vets don't seem to quite understand how they work. You might need to increase from what they say. It seems they usually just read the bottle and repeat it back to you. If you post how much you give, we might be able to help.

[Chance]

Welcome to you and Kira!

I too would like to know the results of the testing. Folate low, so you'll want a Folate supplement. B12 "OK". BUT how OK? you want that near the higher range of normal. If it's not in the upper range, I'd suggest B12 as well.

Some of the symptoms you are describing screams acid reflux. This is not uncommon with EPI. The tummy might be uncomfortable, and the idea of eating is kinda scary. (I have an ulcer history myself. I couldn't think of eating when they were flared up)! I can understand being leary of Omeprazole. But what about Pepcid? It is an H2 blocker, rather than a PPI. Unlike Omeprazole, it does not have any magnesium...which can be hard on some.

How are the poops now? Have they improved much since enzymes?

With all of the problems Kira has had, coupled with the very low folate, I too wonder if there's an out of control SID/SIBO problem.

Has the vet given you anything like Tylosin? It does help most dogs with SID. And quite quickly. (Chance couldn't tolerate it at all...it was a big nightmare here. But most are fine with it).

[Moby_Skywalker]

Hi everyone,

I'm really sorry to hi-jack this post, but I was hoping someone could guide me in creating a new post. I don't see any tips or options to do so, except the ability to reply to an existing post. Unfortunately I'm on a phone, if that makes any difference.

Thanks in advance!

[Tuckaboo Pam]

Right here, go to "JUMP TO" Epi4dogs forum. (Bottom Right)

Directly above the word ANNOUNCEMENTS, in black, on the left, click onto New Topic. Give it a name, type & submit.

WELCOME to you!---Pam

[Sajjad655]

It sounds like many of you have experienced similar challenges when managing EPI in your dogs, especially regarding diet and poultry intolerance. Based on the shared experiences, it seems that finding the right balance of grain-free, low-fiber foods, and avoiding poultry, is crucial for managing EPI symptoms effectively. I appreciate the suggestion to feed 150% of the ideal weight in divided meals and keeping B12 levels above normal. I'll be mindful of these recommendations and will consider trying non-poultry-based diets like the HALO ELEVATE "red meat & sweet potato" option. It's helpful to know that some dogs can tolerate eggs despite poultry allergies, so I might experiment with that as well. Thanks to everyone for sharing their insights!