# Feeding with EPI



## Ellimaybel (Mar 16, 2014)

Gunther is finally diagnosed with EPI. I have ordered 100 count of 425mg Pancrezyme for now. I plan on going to the powder when I have the money to do so, but am dealing with a busted radiator. Gunther is fed Wellness Core grain free kibble and I assume I will need to supplement in wet food once we start the enzymes. I'm on here to ask experienced people, how much food and how many times a day I will need to feed Gunther with what dosage of supplements? This is all brand new to me, and apparently neither one of the vets we use know too much about dosage. Any knowledgeable input would be much appreciated.


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## Heidigsd (Sep 4, 2004)

I am sorry to hear that Gunther has EPI 

I would highly recommend becoming a member of our EPI group: EPI in Snapshots - EPI * Exocrine Pancreatic Insufficiency

Most dogs seem to do better with the powder enzymes and I don't use the tablets either so I would ask the members of the EPI group. Or you can do a search in the forum to see if you can find the answer. For now I would crush the tablets before incubating them with the food. 

Do you know about Enzyme Diane, you can order his enzymes and they are less expensive than the Pancrezyme: Enzyme Diane -

Does Gunther need to gain weight? If yes, I would feed at least three meals per day and we usually recommend feeding 150% of his normal meals until he gains the weight back.

For now you can just add some warm water to his kibble and let it sit at least 20 min to avoid any mouth sores.


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## Ace GSD (May 30, 2014)

Im sorry to hear that Eli . I hope everything will get better for both of you.


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## Heidigsd (Sep 4, 2004)

Here is some good info on how much enzyme tablets to use: Topic: PancreaPlus Tabs - EPI * Exocrine Pancreatic Insufficiency


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## Ellimaybel (Mar 16, 2014)

Hey guys, that was all VERY helpful! This sounds like it's going to be much easier than I thought.


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## Ellimaybel (Mar 16, 2014)

Ace GSD said:


> Im sorry to hear that Eli . I hope everything will get better for both of you.


I'm ok with this actually. I would much rather it be EPI than something else. EPI is treatable and I can live with the knowledge that I can control what happens to him, versus nature alone being our enemy.


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## ken k (Apr 3, 2006)

you can tell by the poop and body weight as to whats going on, for the first 6 months i would weigh your pup once a week, in the beginning even a 1/2lb means a lot, you can adjust the enzymes accordingly , also look into enzyme Diane`s powder, I feed twice a day, and only use 1tsp per 2 1/2 cups of food, a little tap water, cold, and let sit for 30 min stirring a few times, every EPI dog is different, once you get the weight under control, you should be able to cut back on the enzymes, my Max has had EPI 6 years, and has maintained 98 to 100lbs, hes a large GSD, also note, in the GSD with EPI there seems to be a higher rate of bloat, and a more serious case of bloat, the clinical name escapes me right now, not trying to scare or worry you, but you should know


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## Doc (Jan 13, 2009)

I use ProZyme powder. 1/4 teaspoon per cup of kibble at every feeding. It works great for my dog.


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## my boy diesel (Mar 9, 2013)

our vet recommended a bland food for our epi dog
i think we used natural balance kibble with the enzymes 1/2 hr or so before the meal


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## Ute (Dec 6, 2013)

It's very reassuring to know that epi can be managed isn't it!. My Nena was diagnosed in March and since then she's put on 6 kg! I use Creon with her which is easy to use and can be given directly with the food (comes in capsules). As Ken said, every epi dog is different and you 'll have to be prepared to trial a bit. For us the journey has been quite straightforward so far, thank goodness, even though Nena also has allergy issues and the food choices are more limited. 

It sounds like Gunther is on a good food and the 150% advice is correct; fat and particularly fibre content need checking, fibre content shouldn't be over 4%. Having 3 or so smaller meals per day means Gunther's gut won't have to work too hard. If the enzyme levels are not quite right and not all of the food is digested there's a risk of bacterial overgrowth in the gut (sibo for short I think) and you should notice soft or runny poops and probably weight loss or stagnation. 

Another key element in getting things into balance again for Gunther is Vitamin B12. Has he had his levels tested? Dogs can't produce their own and if not absorbed properly from food it'll affect Gunther's uptake of the food in turn. There are injections for dogs with low levels and something called the TAMU protocol your vet may (or may not) know about - it's a kind of roadmap for getting epi dogs back into B12 balance. For all you need to know about epi have a look at epi4dogs.com and the relevant topics here. As Heidigsd suggests, being part of a group might be helpful for ongoing support and sharing experience. 

Best to you and Gunther!


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## Heidigsd (Sep 4, 2004)

Doc: What is your dogs TLI score if you don't mind. As far as I know Prozyme is not potent enough for an EPI dog, they need enzyme replacement therapy. But if yours does good on it that would be interesting


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## Heidigsd (Sep 4, 2004)

Elli: I wanted to mention one more thing which helped us a bunch when Nikki was first diagnosed. For now (I did it for about two years) I would keep a daily journal until Gunther is stable. Make a note of everything: enzymes, food, meds. 

It took us about two years to get everything under control but we had a hard time with Nikki not wanting to eat. We had to deal with SIBO, B12 and her diet and looking back at our notes was so helpful.

Pretty soon Gunther will join the "Chunky Monkey" club :wub:


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## Ellimaybel (Mar 16, 2014)

Can anyone explain to me why my vet keeps saying no to antibiotics for Gunther? She told me that the test showed a bacterial overgrowth and yet she keeps saying no to antibiotics. Should I insist on her prescribing some?


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## Heidigsd (Sep 4, 2004)

The same thing happened to us when Nikki was first diagnosed (we are no longer with this vet). As far as I know pretty much all EPI dogs are dealing with SIBO when first diagnosed.

We used Tylan with Nikki and it worked great, unfortunately once we took her off it came back so she is on it for life now 

What about his B12 level, was it checked?


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## Ellimaybel (Mar 16, 2014)

You know, I really don't know. However, I have caught the EPI pretty early since he isn't at the point of greasy yellow or stools yet. So perhaps his B12 levels haven't been affected yet. I'm going to insist on an antibiotic, since it is my dog and everything I have read about EPI says that it is part of the treatment.


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## ken k (Apr 3, 2006)

I caught my Max also in the very early stage of EPI, my vet didn't know that much about it EPI at the time, she's connected with a vetranain user group on the net, 12 hours after the blood test came back, she started him on the B12 shots, you might want to call around and find a vet that has treated EPI, catching it in the early stages and treating it correctly is very important,


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## Heidigsd (Sep 4, 2004)

Ellimaybel said:


> You know, I really don't know. However, I have caught the EPI pretty early since he isn't at the point of greasy yellow or stools yet. So perhaps his B12 levels haven't been affected yet. I'm going to insist on an antibiotic, since it is my dog and everything I have read about EPI says that it is part of the treatment.


I would find out if your vet ran the test and what the B12 numbers are. Our vet told me Nikki's B12 was normal which was true but it was "low normal" which isn't high enough for an EPI dog. Low B12 can also invite SIBO.

It didn't take long before Nikki's levels dropped even more and she ended up being deficient. We tried using the B12 pills many owners use to keep their dogs B12 levels up after her initial injections but they didn't work for her at all and she became deficient again. She is on weekly injections now.

B12 levels can drop rather quickly.


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## Ute (Dec 6, 2013)

Just to support what others have said and to encourage you to connect with an epi group or forum. You'll be able to share a wealth of experience and see that there's not necessarily one answer. Inicdentally we got away with no antibiotics for Nena. It seems that the immediate use of enzyme and B12 shots helped kickstart her digestion. She had terrible gas and tummy gurgling - clearly trying to clear stuff out of the gut when it couldn't. Once we were on the enzymes and a suitable diet things normalised pretty quickly. We also used some probiotics at the time, not sure how much it helped but it certainly didn't do any harm. And yes, the enzymes need to be proper strength i.e. animal based (usually porcine), not a plant-based supplement.


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## Doc (Jan 13, 2009)

I think the number were low but definitely determined to be EPI. I am not arguing or trying to conviemce anyone anything. My EPI dog was a rescue tightly bred show line He has responded to the plant based enzyme. So maybe mild cases can be treated with plant based enzymes. Don't tell me they don't work because they do. His weight has gone from 70 to 90 and he is active.


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## Heidigsd (Sep 4, 2004)

Doc said:


> I think the number were low but definitely determined to be EPI. I am not arguing or trying to conviemce anyone anything. My EPI dog was a rescue tightly bred show line He has responded to the plant based enzyme. So maybe mild cases can be treated with plant based enzymes. Don't tell me they don't work because they do. His weight has gone from 70 to 90 and he is active.


It was just a question because I was interested, no need to be hostile...sorry I asked


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## Doc (Jan 13, 2009)

I didn't mean to bite your head off - it wasn't meant to sound so blunt.


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## Ellimaybel (Mar 16, 2014)

So how many crushed tablets is too many in 1 day? I planned on feeding him 5 cans of wet food spread out over the day to start out with to see how he adjusts. I couldn't see a diet plan on those links.


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## Harry and Lola (Oct 26, 2013)

Welcome to the EPI world, I too have a GSD male diagnosed with EPI about a year ago now. As Heidigsd said, join the epi4dogs website as there are people experienced with managing their EPI dogs and you will learn all you need to.

The replacement enzymes I give Harry are CREON 10,000, they come in capsules and he is given 1 capsule before each meal. We don't have the variety of enzyme replacements here in Australia as you do in the US. My vet also didn't think he needed B12 shots as his B12 levels were normal, however I have discovered since that it is important their B12 levels are high not normal, so if you can do the once a week generic B12 shots for 6 weeks then give a Wonderlap B12 Intrinsic Value capsule everyday to keep the levels high.

With antibiotics, if she is not showing signs of SIBO, then there is really no need to go on antibiotics, however EPI and SIBO usually go hand in hand and for some dogs SIBO is present always, for other dogs SIBO only rears its ugly head occasionally. If she starts showing signs of SIBO, ask for a 40 to 45 days course of Tylosin Tylan.

I actually agree with you regarding EPI, I would rather manage a dog with EPI than some of the other horrible genetic diseases our breed are so prone to. It is definitely manageable and once you find what works for her, it won't be an issue.


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## Ellimaybel (Mar 16, 2014)

I went to the website but couldn't figure out how to join it. I have been adding the coconut oil back into his food hoping that can help fight the bacteria as well. I had taken it out when I didn't know what was wrong. His enzymes should arrive in the mail tomorrow so I'm hoping to figure this all out by then.


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## Ellimaybel (Mar 16, 2014)

Enzymes should be here in less than an hour and I still don't have an answer to one simple question. How many is too many in one day?????


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## Heidigsd (Sep 4, 2004)

Ellimaybel said:


> I went to the website but couldn't figure out how to join it. I have been adding the coconut oil back into his food hoping that can help fight the bacteria as well. I had taken it out when I didn't know what was wrong. His enzymes should arrive in the mail tomorrow so I'm hoping to figure this all out by then.


This should help you register with EPI4Dogs. On the right side where it says "Welcome to epi4dogs" click on "Register" to create an account: Forum - EPI * Exocrine Pancreatic Insufficiency

Here is the EPI group on FB if that helps: https://www.facebook.com/pages/epi4dogscom/424586920926094

Since I don't use the enzyme pills I really don't know how to answer your question. He has to have enzymes with each meal and I do know that "too little" or "too much" enzymes can cause bad poops. I would just start with feeding 3-4 meals per day.

With Nikki we had to make adjustments along the way and at one point she was getting 2 tsp of Viokase per meal for about a year or so. Since then we have been able to reduce her enzymes slowly to 1 tsp per meal. 

Sargent Hortons History -


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## Ellimaybel (Mar 16, 2014)

Heidigsd said:


> This should help you register with EPI4Dogs. On the right side where it says "Welcome to epi4dogs" click on "Register" to create an account: Forum - EPI * Exocrine Pancreatic Insufficiency
> 
> Here is the EPI group on FB if that helps: https://www.facebook.com/pages/epi4dogscom/424586920926094
> 
> ...


Ahhhhh lol. The link I was originally given didn't go to that page so now I've got it. Thanks  The 3-4 meals a day helps. Gives me a guideline to work with.


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## wyoung2153 (Feb 28, 2010)

Hope you are able to figure everything out and Gunther starts feeling better! Glad you finally figured out what was going on with him, I know you have been battling "something" with him for some time.


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## my boy diesel (Mar 9, 2013)

the enzymes are to be added to the meal so it pre digests it
it should look very mushy and liquidy by the time you are done soaking it


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## Heidigsd (Sep 4, 2004)

my boy diesel said:


> the enzymes are to be added to the meal so it pre digests it
> it should look very mushy and liquidy by the time you are done soaking it


Actually, we incubate the food to prevent mouth sores, you can read about it here under "Incubation"

DIET - EPI * Exocrine Pancreatic Insufficiency


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## Ellimaybel (Mar 16, 2014)

Hey all, thanks for everything! I got the reality of things from Diane. She is very knowledgeable, helpful, and personable. Between her website and phone call, the EPI forum, I have a ton of information to run with now. Thank you again everyone for your help!


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## Heidigsd (Sep 4, 2004)

Keep us posted how it's going and I hope he improves soon! :hug:


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## Ellimaybel (Mar 16, 2014)

Such a guessing game! Logging progress on his facebook page which is public under Gunther Gordon for anyone who is interested in following and offering any input. Don't want to clog up the Active Topics with daily experiments and updates. Also joined the Epi4dogs.com.


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## Ute (Dec 6, 2013)

I hope he'll make good progress soon.


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