When Sarge was Diagnosed with EPI we had received some poor advice from our vet.  Not only did we get poor advice on the dosage of enzymes we were told the treatment does not always work and that he would never regain the weight he lost.  We believed the vet and for almost 4 months we followed the vets orders.  Give 2 Viokase V tablets per meal 2x per day.  We were not coached on what to feed or how to feed,  B12 levels and SIBO were never brought up.  Four months after treatment started Sarge was a mess.  He was so thin, he was becoming aggressive with food or anything he could get his mouth on.  We contacted the vet, he said these dogs rarely survive because the disease is hard to treat.  Again we trusted the vet.  We discussed putting Sarge to sleep because it was unfair to watch him starve and we were unable to count on his temperament.  I posted on a large kennel site about Sarge and if anyone had any info on EPI.  It was a last ditch effort.  I was contacted by a member of the K9-EPIGlobal list who pointed me in the right direction.  The k9-EPI Global list members and the welcome letter became my lifeline.  They made suggestions, we tried them, I got a new vet, He embraced anything I suggested and best of all he had treated EPI dogs before.

Below is what I did to break it down into terms that I could comprehend as things were moving so quickly.  This is also what I shared with my new vet.  I hope that this will help some to understand where to start.

My Letter To My Vet

Sarges Test results August 2005

 TLI .3                                     Normal range 5-35

Enzymes help this number this is the number that says how much the pancreas is actually working.  Anything below 2.5 is considered EPI.

Originally it was prescribed to have 2 tablets Viokase V with each meal –twice per day. Results loosing weight . Scavenging to survive.

 Dec 22^nd  2005 Increased to 7 tablets per meal 3 meals per day ( ½ cup pedigree  ½ cup Proplan Senior chicken and rice)  Tablets are being crushed and sprinkled on mixed well with warm water and sitting for 20 minutes to start digesting the food. Changingdiet to Pro Plan Sr chicken and rice as it is low in fiber and low in fat (older studies stated that a low fat below 12% diet was better… this is no longer suggested).  Fiberbeing number 1 to watch for. 

 Cobalamin 99                        Normal range 249-733

 Looking into Vitamin B12 shots to help this number and aid in digestion

 Make sure it is not a multivitamin or B complex because of lower concentrations of cobalamin.

 Typical dosage 1 dose every 2 weeks for 6 weeks than once per month. (Tx A&M)(protocol has changed)

Folate  15.5                 Normal Range 6.5-11.5

 Shows bacterial overgrowth in the small intestine (SIBO) 

 Tylan is suggested for 30 days at ¼ teaspoon twice per day on food for 30 days

Metronidazole which he has been on before is not suggested for long periods of time because of adverse reactions in some dogs when used for long periods of time.

As of December 20^th 2005 we have been completely frustrated with Sarge and his progress.  Sarge has been taking 2 Viokase V tablets with each meal.  He is eating 6 cups of Pedigree large breed per day 3 in the AM and 3 in the PM.  He has been having several treats each day ie. Dog biscuits, liver treats, and the like many times eating the whole container as he will find them.  Sarge is getting into everything.  He is getting aggressive-snarling and growling when you try to take anything he feels is food away. When he snaps out of these trance like states he will come to you pee on the floor and roll onto his back.  Sarge has always been a submissive dog.  Sarge is tearing apart book bags to get  food, eating lunch boxes, counter surfing, eating toilet paper right off the roll-dragging the end of the roll to a quiet place to lay down and just eating it. Knocking over the outside trash can is a new behavior.  He has learned to step on the release on the kitchen trash can.  Sarge does tend to eat the other dogs food on many occasions.  Any crumb in the car is not safe. Unopened boxes of crackers left on the counter are destroyed and consumed.  If a cupboard door is left ajar he will nose right in and take what he wants.  These behaviors have been getting worse as he is fighting to survive.  An increase in food was not helping.  Bowls of food were being left out to free feed but were not being touched.

 December 20^{th 2005.}  I posted on the Leerberg training site looking for help.  We were at our wits end worried about the safety of the kids and ourselves with this new aggression.  A woman emailed and said she had lots of info on EPI and suggested a yahoo support group, K9-EPIGlobal.  There are over 500 members (now over 1800 in 2011)all of whom have dogs with EPI.  It is a support group to help you get your dog through this disease.  Many have replied that this is normal and that the behaviors tend to go away as the treatment starts to work.  You should see a difference in 3-4 days. Members share their treatments with others and it seems no two EPI dogs are alike and therefore treatments are not alike but usually similar.  Members pointed out what EPI is and how it is controlled.  Approximately how much enzymes it takes to control EPIwere discussed. It was suggested 1 teaspoon per cup of food per feeding.  It was stated that 2 tablets of Viokase V were not nearly enough. He would need a minimum of 7 tablets per cup of food.  I  increased the pills to 7 crushed and soaked on the food in warm water for 20 minutes to activate them.  I am now feeding 3 times per day and no treats are allowed.  I am changing to Pro-Plan Senior Chicken and Rice.  This food is low in Fiber and low in Fat.  New evidence shows that foods low in fiber are best.  You should then look at foods that are low in fat.  Some feed Raw diets others feed kibble. Some do feed prescription diets- but watch for corn content as many GI foods are full of corn.

 Sarges stools have always been yellow and grainy like corn meal usually soft at the beginning and more firm at the end.  He has always had very large stools. What goes in comes out especially if your body does not absorb any nutrients.  After 1 day of increasing the enzymes the stools  looked more of a light tan and were formed.  There is still mucus on the stools –or a greasy coating on parts I am hoping that the Tylan andVitamin B 12 will help with this.  Many EPI dogs have chronic diarrhea.  Sarge has had this problem intermittently and was put on Metro for this condition along with someKaopectate before diagnosis.  Most of his stools are usually cow pies when he gets into something he should not have.

 Again after 1 day the behaviors are being curbed.  No toilet paper was eaten but searching for crumbs is still happening-which dog doesn’t do this?  I am feeding part of Sarges meal on a spoon then I give him the bowl.  I have found that hand feeding is helping curb the food aggression.  I am keeping the kids away from him while he is eating and not letting him feel threatened in anyway.

 Stress can be a factor in EPI and Sarge is a stressed dog to say the least.  He does have some separation anxiety but leaving him tethered inside the house on a lead when we are gone has helped.  He tends to bark a lot while we are gone and we have used a bark collar with great success but have not used it as of late.  Sarge was pacing before diagnosis.  This was one reason the first vet said he was skinny, he is active and never stops moving.

 Many dogs were described as hyperactive children and not acting like they were sick. However they had the loss in weight and the diarrhea.  Sarge never stops moving always pacing and wanting to play.  This was true till lately as he was getting to weak to want to play and was using his energy to survive. 

 Many dogs regain their weight but it is a slow process some dogs have setbacks and need to have enzymes or food adjusted.  It is not uncommon to have allergies with this condition.  Many dogs have hair loss from being deprived of nutrients.

 I thank you for your time and I hope this information will help not only my dog but others you may see.

 This was the letter I took in with me to Sarges new vet.  I did not want to leave anything out and this seemed to be the best way to organize it.  The vet was very impressed with the information.  I also included some info on studies from Texas A&M just in case he was not up on them.  He found them very interesting and admitted that they do not learn much in vet school about this disease.

Sarge’s Progress

SARGE GSD age 5 Diagnosed EPI Aug 2005 76.8#

Symptoms Skin and bones unable to gain weight eating 8 cups of food per day tried different foods –does not have chronic diarrhea however does have frequent cow pies.  Poops were HUGE and yellow seedy many times in a mucus casing

Treatment that did not work per vet recommendations: 2 Viokase V tablets 2x per day  with 4 cups Pedigree

TLI test was performed results: TLI .3 Cobalamin 99 Folate 15.5

From the diagnosis in August to December we experimented with different dog foods.  At one point we were up to 10 cups a day of Nutro High Energy food.  Sarge was down to 71 # at his lowest known weight.
 December 21 2005

Finally found help via K9-EPIGLOBAL.  Smaller poops, brown, less mucus/greasy, increased to 7 crushed Viokase V tablets 3x day with 1 cupPedigree (changing from this food) & 1 cup ProPlan Sr Chicken and Rice

 December 23^rd 2005 76.6#

Went to see a new vet and brought in letter above and a folder of information.  Vet was receptive to new ideas and treatments and had treated one other dog a boxer.  Started B-12 shots using the Texas A&M protocol to aid in digestion.

 December 26^th

Tylan and Pancreatin 6x enzymes arrive started Tylan (1/4 teaspoon 2x day) for 30 days started powdered Pancreatin 6x enzymes 1 teaspoon on 2 cupsProPlan Senior Chicken and Rice 3 x day. ( we used this dosage because we were already using about the equivalent of Viokase V tablets with success)

 December 30, 2005 78.8#

Smaller poops, Nice and firm good brown color no mucus or casing-Tylan is working to getting rid of SIBO

2 cups Proplan Sr Chicken & Rice 3x day, 1 tsp Pancreatin 6x Enzymesincubated for 20 minutes in warm water on the food, 1/4 tsp Tylan 2x per day for 30 days

Vitamin B shots given by vet.

 January 19, 2006 81.6#

Sarge continues to gain weight

 January 29, 2006

discontinued Tylan

 February 3, 2006

Weigh in 82.3#

April 2007

Sarge is now 89 pounds and looking fat.  We are now feeding 2 cups of ProPlan Sr Chicken and Rice and 1 tsp of Pancreatin 6x enzyme supplement 2 times per day incubating for 20 minutes with 1/8c warm water.  The third meal we slowly removed by having less and less food at that meal. B12 injections were discontinued after the 6 week period (please note this did not work and we had to start over, we continued the shots every 3 weeks as he could not hold the B12 level for 4 weeks).  If Sarge looks hungry we will give him the third meal.

September 2007

Sarge is not doing well.  He has lost his weight that he had gained.  The stools are sometimes firm and sometimes partially solid or firm then soft.  Had b12 levels retested, they are <150 which means they could not be read.  We are starting the Texas A&M protocol for b12 shots again.  1 per week for 6 weeks, 1 every other week for 6 weeks, once per month.  The stools are firming up again and he is regaining weight.  He is less stressed and is full of energy.  Upon further research you can not stop b12 shots.  Once they are low they are always low.  Thankfully this is a cheap fix.  A bottle of b12 from my vet cost $30 ( I have now found that I can get this filled a local pharmacy for $4 under their generic prescription plan) and I had to toss most of it away as it will expire before I get to use it all. Gave 30 days of Tylan for SIBO based on gas and mucus in stools.  This was only his second time on Tylan since diagnosis.

February 2010

Sarge continues to do well.  I have changed his food to Chicken Soup for the Dog Lovers Soul made by Diamond Brands.  He does well as long as I do not use the large breed food.  He continues to get 2 meals per day.

April 2011

I continue to do b12 shots about every 3 weeks, I have found that if I do the shots every 3 weeks he does not start getting in the trash can and scavenging for food.  I found that I can get a vial of b12 from the pharmacy at the grocery store for $4 on their $4 prescription plan.  It does require a prescription from the vet but it is less expensive.  It will take me 2 vials for the year.  I have changed Sarge to 4 Health dog food, small bites work best from Tractor Supply as Chicken Soup for the Dog Lovers Soul was constantly out of stock in the larger bags.  He is doing well on the change and needed little adjustment, although I went slow the first week since there was no change in stools I changed the rest over cold turkey.  The only difference is that if it sits longer with the enzymes and water he does better.  I now make a few days meals at a time and let them sit in the fridge.  Sarge is 10.5 years old and he does not need to gain any weight.  While old age is starting to take over he still thinks he is young.

January 2012

We are now dealing with what we think to be Degenerative Myopothy.  Sarge has the gene we found out with the EPI research blood work we sent in.  There is no cure for DM.  His bark is hoarse but he is still getting around on his own.  We will see where this leads us.   Did a round of Tylan this month as Sarge was having progressivly bad stools after a very stressful week at a kennel.  He would rather be home than in that situation. The tylan straightened out the stools to where they are firm and darker we are now playing with enzyme doses again and increasing b12 shots to every 2 weeks.  Every once in a while these dogs seem to bave a set back.  Thankfully Sarge has not had many.  This is the third time in 6 years that has been on Tylan for SIBO.  Not bad.  We will be adding a third meal again to try and get some more weight on him that he lost last month.  The poor old guy is now 11 years old.  It is still hard to believe that we made it this far.

April 2012

Sarge is at the Bridge at the age of 11.5 years old.  EPI became the least of our worries.  The Degenerative Myopothy,  loss of hearing and several other factors became to much for him.  May his spirit live on and help those that are dealing with EPI.