Caring for a Dog with EPI

Late in the summer of 2005 I picked up my Spanish Water Dog (SWD) puppy, Izzy, at Charlotte Airport in North Carolina. I imported her from the top breeder of SWDs in Spain because I was going to start a working dog line of Spanish Water Dogs. Her father, Gordo, was a famous SWD working dog champion. Izzy and her sibling, Carlos, were delightful little pups. My friend Shelley took Carlos, who was a little bit more well-mannered, whereas Izzy was quite energetic!

Izzy (left) and Carlos (right)

When Izzy was around a year old we thought she looked a little thin, but just attributed it to her having a growing spurt. Shortly thereafter, while giving her a bath, it became obvious this was not a growth spurt. For three months the vet ran all kinds of tests and found nothing wrong. But something was wrong– Izzy lost almost half her weight, started eliminating 5 to 10 times a day and had many accidents in the house. I increased her food intake from two to nine cups a day and she was still losing weight. Then she started eating her own feces– she was almost feral about it, her feces were large, pale and tan colored and looked like cow plops. When my vet heard me describe the feces, he said, “if it looks like a duck and quacks like a duck it just might be a duck… let’s test her for EPI!” When I asked him “what’s EPI?”, he responded “a condition that German Shepherd Dogs get”. At one year and three months old, my Izzy was diagnosed with EPI. She was the first of her breed to ever be recorded diagnosed with EPI. A few years later I traveled to Spain to address the SWD club about EPI, and since then more cases have been properly diagnosed.

What is EPI?

EPI is Exocrine Pancreatic Insufficiency, a primary or secondary health condition in dogs and cats where they no longer produce the necessary digestive enzymes from the acinar cells located in the exocrine part of the pancreas. These digestive enzymes are needed to digest nutrients from food.

These three main types of digestive enzymes are: amylase for digestion of carbohydrates (sugars & starches in grains, fruits & vegetables), protease and trypsin for digestion of protein, and lipase for the digestion of fats. Normally the lipase enzyme breaks down undigested triglycerides into fatty acids and monoglycerides, which are then solubilized by bile salts. Impaired fat digestion is not apparent until the lipase enzyme output is less than approximately 10% of the normal level. This is why we do not see any physical signs that something might be wrong until approximately 85-95% of the exocrine part of the pancreas has atrophied.

When these critical digestive enzymes are not sufficiently available to help digest nutrients from food, the body goes into starvation mode. Left untreated, the dog will eventually die from either organ failure or starvation, whichever happens first.

Possible signs exhibited after 85-95% of the pancreas is atrophied are:

  • Gradual wasting away with a voracious appetite
  • Eliminating feces more frequently with large yellow/tan/gray feces resembling cow-plops
  • Intermittent or watery diarrhea
  • Eating feces (coprophagia) or other inappropriate items
  • Vomiting, burping or acid reflux
  • Tummy noises/grumbling
  • Excessive flatulence
  • Personality changes

EPI Management

Can EPI be managed? YES! Once the EPI is under control EPI dogs can live just as long as any other dog and can do anything any other dog can do.

Fiona’s Dexter before and after EPI treatment                
Dexter pictures re- printed with permission from owner, Fiona &

If you suspect your dog has EPI, contact your vet and request a TLI (trypsin-like immunoreactivity) blood test. You will need to food-fast your dog for 12 hours prior to the blood being draw. It is advisable to also ask for a Cobalamin blood test to be done at the same time, as over 80% of EPI dogs also have insufficient B12 levels and will not optimally respond to treatment until their B12 levels are in the upper-mid range. Follow Texas A&M lab (TAMU) recommendations for the B12 protocol

If your dog tests positive for EPI you will need to start with the recommended protocol of managing the four aspects of treating EPI:

  1. Porcine Enzymes with every meal. For enzyme resources:
  2. Diet with low fiber content of 4% or less. For details:
  3. B12 (if needed for low B12) For details & research:
  4. Antibiotics (if needed for SID) For details, dosing and research:

Enzymes are usually needed for life and should be included in all meals. There are multiple types of enzymes that can be used, such as freeze dried powdered enzymes (prescription or generic), enteric-coated enzymes in capsules, enzyme tablets, or raw pancreas. In the USA, freeze dried powdered enzymes are preferred as they are most consistent in potency and easiest to ascertain proper dosage and administration.

Diet is a key component of effectively managing EPI, but this can vary from dog to dog. We suggest starting with a very low fiber food that does not have any grain in it. This usually works best for most, simply because fiber may, to some degree, inhibit the effectiveness of the enzymes. However, some EPI dogs will require slightly different diets, such as a hydrolyzed diet, or some will do better with a very limited amount of grain (rice) added. Many EPI dogs have difficulty with too many carbs in the formula or if there are too many peas in the diet composition. Because finding the right diet can be so tricky, we advise pet owners to start keeping an EPI Journal and record everything given and record the output results and any other reactions. Keeping a journal will greatly help the pet owner identify what does and doesn’t work for their EPI dog.

B12 insufficiency is a secondary condition of EPI that occurs in 4 out of 5 EPI dogs. The recommended protocol is six weeks of weekly simple serum B12 shots and then re-assess to determine how often B12 supplementation is needed to maintain upper mid-range B12 levels. Often pet owners will opt for B12 pills, however, OTC B12 pills usually do not work unless they also include the intrinsic factor. There is recent research that suggests that very high doses of oral B12 can correct low B12. However, it has also been observed that B12 pills without the intrinsic factor included in the pill do not always work on EPI dogs. In the small intestine, the B12 becomes bound to intrinsic factor which eventually allows the B12 to be absorbed into the portal blood. With EPI, we have no way of identifying which dog may have viable intrinsic factor or if it has been damaged. Because of this we will continue to recommend only oral B12 that has the intrinsic factor included in the pill.

SID is small intestinal dysbiosis. SID means there is an imbalance of the microbiota in the small intestine. This too is a secondary condition of EPI and almost always present when EPI is first diagnosed just because of the very nature of EPI. The current protocol is to give the enzymes, and change the diet first and give this a week to two to determine if this is all that is needed for the gut flora to correct its’s own microbiota imbalance. If after a few weeks, you see any of the SID signs repeatedly, such as: yellowish/light colored stools, continued loose/soft stools, intermittent sloppy stools, gelatinous stool coating, flatulence, lack of appetite, grumbling stomach noise, acid reflux, regurgitation, then it is time to have a discussion with your vet about starting your EPI dog on antibiotics to treat SID. The current drug of choice is Tylan (Tylosin tartrate 100 grams) given according to weight twice daily/every 12 hours for 30-45 days. This is the SID protocol suggested by Texas A&M Gastrointestinal Lab, Dr. Jorg Steiner. Finding the right diet for your EPI dog is probably the most effective way to limit future SID flare-ups.

Many times even when the recommended protocol is followed, these EPI dogs still do not optimally respond. This usually means that something needs to be adjusted. Once you find the right balance of treatment for your pup, the recovery is amazing. The success rate has been estimated at 95-97%.

My Izzy is now 12 years old, has managed EPI for 10+1/2 years and is as lively as ever.

More Information

Over the years, there have been a variety of assessments and theories about this condition, many that have since been debunked due to new research with improved technology.

Currently Epi4dogs is collaborating with Dr. David A. Williams and Dr. Patrick Barko of the College of Veterinary Medicine, University of Illinois at Urbana-Champaign. Together we are embarking upon a new research, the Maya Metabolomic Study in their Clinical Metabolomics and Microbiome Initiative to further investigate possible environmental factors that may be involved in EPI. Metabolomics is an emerging field in which a very large number of small chemicals can be analyzed from samples of body fluids and tissues. This new technology has the potential to identify previously undetectable abnormalities associated with the development of various diseases including EPI. We hope this new information will provide clues as to why this disease develops and what we can do to prevent it. We expect the findings to be published towards the end of 2017.

Epi4Dogs also recently collaborated with Dr. Jan Suchodolski at the Texas A&M Gastrointestinal Lab on a Microbiota Study of EPI dogs and have found some very unusual anomalies which will also be published later 2017 and presented at the 2017 ACVIM conference.

Epi4Dogs is not only dedicated to supporting non-invasive EPI research, but we also have the only EPI database in existence and are the largest EPI resource center with multiple current EPI research in our files. We work with both the veterinarian community and the pet owner. There is also an open EPI Forum 24/7 support group always available to help those struggling with EPI, along with social media, Twitter and Instagram.

If you would like to learn more about EPI please visit:

Olesia C. Kennedy, President
Epi4Dogs Foundation, Inc.

Helping Children Deal with the Loss of a Pet

Perhaps next to the sex “talk”, one of the most difficult discussions to have with a child is that of the death of a pet. A child’s first experience with death is often with the loss of a pet. The goldfish dies, the hamster stops spinning in his wheel. Whether the pet was euthanized, or died suddenly, the child’s emotions must be taken into consideration.

A parent, even in the midst of their own grief, must set the tone for their child.  Depending on the age of the child and their emotional makeup, their reaction may run the gamut from an explosive outburst of anger and denial to a shoulder shrug and a desire to be alone. All reactions are ok. There is no one way to grieve. A child may need to be held and consoled, or may need time and space alone to process the loss.

Expect surprising questions. When our dog was hit by a car and killed, my husband and I buried him in the yard before our son came home from school.  We wanted to spare him the trauma of seeing his beloved dog’s shattered body. When we told him the news, he wanted us to dig him up so that he could see him one more time. Instead, we collected pictures of Marbles and made an album of fun times.

We framed my son’s favorite picture of Marbles and put it on his nightstand, so that he was nearby at night.

Other rituals may also help bring closure not only for the child, but for the entire family. If you choose to have your dog cremated and buried in the yard, have the child make some kind of marker.  It could be as simple as a laminated drawing for a young child, or a cross or other marker constructed by an older child.  Perhaps the child could gather flowers to put on the grave or put the dog’s favorite toy on the site. A ceremony helps to anchor the fact that the dog is truly gone.

Even after a ceremony, a younger child may still ask, “where is Fido?”

After all, in cartoons, the characters die but are alive and active the next day on the screen. Separating real life from television is difficult, and the child will need to gently be told that Fido is gone forever. The initial grief may reappear several times before the understanding of forever is clear. In the days and weeks after Marbles death, our son would bound in from the school bus looking for her.  I could see the sadness come over his face when he realized there was no dog barking at his feet ready to play fetch.

Children, like adults, don’t grieve in a linear fashion.  There will be days that we all seem to be fine, and life goes on, but some trigger brings us back to our grief and we are blue. Look for those signs in your child. Take notice if they are acting out, or afraid to go to sleep, or spending time alone. That is the time to talk with them about the good times with your pet. Share your favorite stories and encourage your child to do the same.  I suggest writing a love letter to your pet. What better way to remember how precious and special your pet was to your child and the family?

Questions may come immediately, or over time. A child may ask, “Where did our dog go?”  Your answer may be consistent with your religious beliefs.  When our son asked that question we answered, “Marbles is in heaven. Wouldn’t you want dogs in heaven if you were God?”  For our son that was a very comforting answer since he had come to know heaven as a beautiful place filled with light and goodness.

When is a good time to get another dog?  That is different for every family.  But you will know.  You will feel your heart beginning to mend, you will need your afternoon walk with a leash in your hand, and your throwing arm is itching to pitch. That is when you realize that Charles Schultz was right when he said, “Happiness is a warm puppy.”

Lu Pierro is the author of All Dogs Go to Heaven, a Guided Grief Journal

Available on Amazon: ‪ 


How to Get Your Dog to Wear a Shirt

If you’re anything like the average dog owner out there today, chances are you’ve thought about putting your fluffy little four-legged friend in some funny dog shirts on occasion. It’s nothing to be ashamed of, we all think it from time to time.

Perhaps you want to take a funny picture for social media, or set up the ultimate holiday card for your relatives. Maybe you just think they’re cold, and could use an extra layer to help them get through the winter. Either way, we’re with you!

Have you ever actually tried to get your pooch into one of those dog shirts? Many people would say that you’re better off trying to crack a safe than you are trying to get your pup to get into a tee shirt. Some pooches scratch and bite until they worm their way out of them. Others simply freeze, and refuse to comply with their owners wishes.

The first piece of advice that we can offer you is to make sure that you take a careful look at sizing before you purchase. Every dog is different, and one of the most common mistakes that pet owners make is to assume that a certain dog will automatically take a certain size. Just because you may have the same breed of dog as someone you know doesn’t mean your pet would necessarily take the same size tee. Have you ever seen littler of puppies where you have both a giant and a runt? Chances are they won’t be taking the same size shirt when they grow up!

One piece of advice is to measure your dog accurately. Start by taking soft measuring tape or string and looping it around your pups chest. That will tell you how much room inside a shirt you’ll have to work with. Buying a shirt that is too baggy or too tight can cause the animal a great deal of discomfort, and make it more likely for them to reject the shirt.

The second thing you should keep in mind is to associate the shirt with something pleasant, like a hug, or a treat. If your pet has even a touch of defiance in their personality, they may initially resist being put into apparel. Like any other form of training, use positive reinforcement. Offering a treat and praise can go a long way towards helping your little buddy feel more comfortable. Once they come to associate it with something they like, it will become much less of a struggle.

Of course, if you really want to make them feel relaxed, you could always get in on the act with them. You know how they say that pets and their owners often look like? Now they can dress alike too. Not only will this make for the cutest picture possible, but it will let your furry friend know that you’re in it with them. 

Dogs have an innate ability read the emotions and moods of their masters, which is why above all else, you should always make things like this fun. The more fun you’re having, the more fun they’ll have!

We love the shirts at CrazyDog T-shirts, check ’em out they’re funny!

Good Dog! Product Test Report: The Buster Cube

We’ve had several calls and letters about this unusual toy over the past few months. So many, in fact, that I went out and bought one for my dogs.

The Buster® Cube was developed in Denmark by a man who works with dogs and treats canine behavior problems. The Cube looks like a die with six sides, one of which has a hole. The attraction for the dog is that as she roles the cube around with her nose or paws, kibble comes out of that hole. Oh joy!

To get the pieces of kibble inside the walls of the cube, just insert them in the hole. The cube is divided into several compartments so, if you shake it around, pieces of kibble will find a “home” in each of the sections. I used Charlee Bear® Dog Treats in my Buster Cube because they’re just the right size (small) and they’re low in calories.

You may already know that Fisher, my Alaskan Malamute, isn’t very playful. When we put the Buster Cube down on the floor for the dogs to play with, Fisher surprised us by claiming it. She immediately decided that this was her toy, and she wouldn’t let Mandy or Harley touch it. She’d keep her paw or head on the cube at all times to keep everyone away. Unfortunately, we eventually had to take it away from her because she was getting overprotective.

I brought the Buster Cube to the Good Dog! offices for Chief Test Dog Chops. I gave it to her at 9:00 a.m. and when I left for lunch around noon, she was still playing with it. The only time she left it alone was when we forced her to go outside. She’s used to working for her treats, so this was great. It kept her entertained.About hour five we got tired of hearing the treats in the Cube rattling around the office, and took the Buster Cube away from Chops. She tried to take it off my desk, and out of the box!

It took the dogs a while to figure out that they couldn’t get the food out with their tongues or by biting the cube open. My Buster Cube has a lot of teeth marks to prove it! The information that comes with the toy says that these are common reactions. Once they figured out how easy it was to get the food out by rolling the cube, both Fisher and Chops stopped biting at it.

One size cube fits all. In fact, small dogs have proven that solving the puzzle has more to do with how clever the pup is, rather than how big or strong she is. It’s a terrific toy that stimulates dogs mentally, helps use concentration skills, and gets rid of that excess energy. I’m all for that!

The Buster Cube is also meant to be an educational toy that helps alleviate some behavior problems. The printed insert claims that the Buster Cube can help solve or minimize behavior problems originating from fear, aggression or boredom.

It’s easy to see how it helps with boredom. But we’ve had some aggression problems with Fisher, and unfortunately this toy reinforced that behavior. She’s protective of her food with our other female dog, and this was no different. I guess that’s a normal reaction in homes with more than one dog, so maybe the problem could be solved by having a cube for each dog, rather than expecting them to share. (Or is that asking too much?!)

You can easily adjust the rate of speed that the food comes out of the cube by just turning the cylinder inside the hole. This changes the level of challenge to the dog.

You’ll be happy to know that the Buster Cube is dishwasher-safe. That helps if you use a greasy super-premium food.

If you’re looking for a gift for the dog that has everything, I highly recommend the Buster Cube. If Fisher likes it, and if it can keep Chops entertained hour after hour, you can bet that it’ll work for most dogs.

Wendy Houtz

Good Dog! Product Test Report: Wufer Ball

I was at PETCO the other day, talking with pet owners about toys. One couple told me they have relatives with two large Samoyeds. These dogs love to play with a bowling ball!

While that may be a little hard on the teeth, there’s a new alternative. It’s called the Wufer Ball. We received the Wufer Ball the day before I was supposed to leave for vacation, so Harley, the playful and curious one of my bunch, had already left for Grandma and Grandpa’s for the week. That left Fisher and Mandy to do the testing.

The Wufer Ball is a hollow, hard plastic ball about the size of a basketball (10” in diameter). It has a plastic screw plug that allows the ball to be filled with sand or gravel (the ball comes with gravel already inside), which causes the ball to go in “weird” directions. This is said to make your pet “confounded and challenged.” Unfortunately, Mandy and Fisher weren’t interested.

As you probably figured out if you’ve read the other toy reviews that I’ve done, Fisher isn’t much fun, anyway. Mandy likes to play, but she prefers toys that she can carry around. If your dog is big, curious and responds to noise and movement, the Wufer Ball is perfect.

The ball is made from recyclable HDPE (high density polyethylene) plastic and can be easily cleaned. It’s very durable, and virtually puncture-proof.

The Wufer Ball is the direct descendant of the Boomer Ball, which we first tested back in the September/October 1991 issue of Good Dog! The Boomer Ball (from a different company) came in four sizes, while the Wufer Ball is sold only in the 10” size.

Our test dogs who lived in a house on a hill enjoyed rolling the ball up the hill, then chasing it down the hill, barking all the way.

When Chops saw the Wufer Ball, she got all excited. She remembered the Boomer Ball, which she was allowed to play with just once a year. The reason she was allowed the ball only annually was that she gets too excited. She follows the ball, barking in a high-pitched shriek. In the house or out, it’s an irritating noise. Throw the ball for her, and she’ll run after it, barking. I think she wants to retrieve it, but the ball is so big she gets frustrated. So she barks at it. That game lasted as long as we could tolerate it, then the ball was put away.

One other word of caution: this ball is for outdoor use only. It’s heavy, with or without the gravel. In the house, it works like that bowling ball those Samoyeds liked.

Wendy Houtz