EPI * Exocrine Pancreatic Insufficiency

Hi, I just joined this forum after reading a referral on Facebook to this website.

I am seeking some help or suggestions from other dog owners who have pets diagnosed with EPI. As the title suggests, my 22 month old male GSD was recently diagnosed with EPI after having the blood test showing his TLI as 1 (Normal rates are 5.4 I believe).

The vet recommended I move him onto Eukanuba Low Residue (Highly digestible,low fibre) biscuits. These biscuits can only be obtained from a vet once EPI has been diagnosed. He is currently having 5 cups of biscuits a day, split into 2 meals. On top of the biscuits, the vet has prescribed Creon Forte (25,000 Unit). These are extracted from a pigs' pancrease and are a enzyme supplement.

Originally the dose of Creon started at 8 tablets per day. Because the 'number 2' situation was not improved I have slowly been increasing it. On Monday I increase it again to 12 tablets. The vet said that I should see achange within 24 hours. Unfortunately no change has been seen, so today I have increased the dose to 16. My vet mentioned that he has a border collie who has 10 a day, and considering my boy weights 40kg it would be significantly higher.

He is also on antiobiotics in the event that he has SIBO (Bacterical overgrowth). He is having 3 tablets a dayand has been on them for 1 week tomorrow. They begin with M.

I've been doing a bit of research myself, and have found that Creon come in a higher dose of 40,000. I am waiting for the vet to call me back this evening or tomorrow, to discuss changing over to the higher dose, as well as other possible explanations as to why there has been no real improvement. Although his stool output has decreased back to once or twice a day - which is good). My main concern is the consistency of the stool is not all that improved, as it isn't firm.

I know this is the trial and error stage and I really can't stand it!!

My questions are..

Has anyone used Creon as a supplement when dealing with canine EPI? I know internationally powders are used more?

What dose did you find met your pets requirements? (If you can listyour pets weight so I can compare that would be great).

I understand that all dogs are different, I'm just looking for some advise from other people who may have found themselves in this situation.

In summary:

TLI tests showed 1

2 meals a day consisting of 2.5 cups of Eukanuba Low Residue bikkies

Currently having 16 Creon capsules per day (As of today - Thursday). Am yet to see the results from the increase

Is also on antibiotics in the event of bacterial overgrowth (Met something).

Thanks,

Samantha.

HI Samantha and your pup, welcome to this site. You have come to the right place on this site and forum. I myself don't have a lot of knowledge of EPI or Creon. But you will find lots of others on here, that will have lots of knowledge and wil be able to answer all your questions and give you all the help you need. So ask as many questions as you like, relax and breath, we wil all get you through this one step at a time. May I first suggest you download a log and start keeping a record of everything you give your pup, it will be invaluable to help stabilise him.

Warm Wishes

Elly and Tyler

Hi Samantha.  Welcome to our group.  I'm sure you feel very over whelmed at the moment, but we have all been where you are & things do & will get better.  Where are you from????  I'm asking because you are using Creon capsules, the same as we use, & I'm from Melbourne Australia. 

I'm not sure if you are using the exact same product as us, but by the sounds of your post, it seems so.

Creon capsules come in three strengths. 5000, 10,000 & 25,000 (which is the forte).  

My EPI girl is my English Setter Megg & she weighs 26kg., so she is considerably lighter than your guy. 

Megg has had EPI now for almost 3 years and is doing well (thank goodness).   The amount of capsules your guy is taking seems very high, that is why I'm wondering if they are the same.  You did say 'tablets' earlier in your post, but then you said capsules.  My girl is taking capsules, but she only has one capsule with every meal plus she has a powder supplement called Enzyplex.  Other 'Aussies' who have EPI dogs, are giving their dogs one or 2 capsules, depending on their weight, but I have not heard of as many as you are giving.  Wendy, who has an EPI GSD, has only ever given her dog one capsule and hers is a big GSD.  Also we use a lesser strength than you.  We use the 10,000 strength.  These capsules are a 'for human' capsule. 

Please let us know if these capsules you are using are the same.

Again welcome. 

Lynn & girls.

Hi Samantha and welcome.  Just a thought here.  Lynn, if you are using the 10,000 strength and Samantha is using the 25000 strength, and most of you guys use 1-2 capsules 10,000/ meal, would the results be the same as the powder, too much can cause the same results as not enough?  Could that possibly be why there are no good results yet?  I am just wondering if Samantha just tried 1 capsule or 1/2 capsule and see what happens?  Since I am not familiar w/ the creon, this is just a thought and maybe Lynn could shed some lite on it?

Samantha, hope things turn around soon and you start doing the happy poop dance.  The M is probably metro, if you have that over there.  Was the B12 tested and what were those results?  Good luck.

Hi Karen,  I think 1/2 capsule would definately not be enough & at times I have gone to using 2 capsules;  We are fairly stable now & by using one capsule, we are getting nice firm, and as you say, tootsie roll poops.   Lots, in fact, probably all Aussies use Creon, as we cannot get the powdered enzymes here, but I have never heard of using so many and such a high strength.  I would imagine that it is the same as the powdered enzymes, & that too much would have the opposite effect. 

We feed Megg 3 times a day & she has one 10000 strength capsule with each meal plus one scoop of Enzyplex powder but the enzyplex is only a supplement, not a replacement.  Probably she could do without that as lots have discontinued it but while things are working for us, I am not game to change anything.   

I remember a girl from Queensland who has an EPI rough collie and she gives him 2 Creon 10000 strength capsules with each meal.  She feeds one whole & sprinkles one of the food.  I wonder what Samantha is doing?????  My Vet was always very ardamant about feeding the capsules whole but if you do sprinkle them, then you have to feed the dog immediately.  They contents of the capsule cannot sit on the food.  They are enteric coated, little micropheres & cannot be chewed either, therefore feeding whole is the best way to go.

Lynn

Hi Lynn.  I was thinking 1/2 of 25000 would be a bit more than 1 capsule of the strength you use, which is why I thought it.  Heading out to school, but hopefully you two can talk a bit and see what's what.  

Hi Karen,

Away with the fairies, as usual.  Yes, of course it would be a bit more.  Was forgetting for a minute about the 25000 strength.  I do remember one other member being prescribed the 25000 strength for a little dog (do you remember Catherine & Eddie Foo),  but when her specialist thought more about it, she told her to halve the capsule, then when they ran out, she bought the 10000 strength.  

Enjoy your day at school & love to Hondo & Molly.

Lynn & girls.

Hi Samatha and sorry you have to be here, but welcome!

I am glad that Lynn chimed  in regarding CREON....as folks with experience using it is limited...... Samatha.... what part of the world are you from? It might help us pinpoint what products are available for use with EPI.

Regarding the food..... honestly...at the beginning of treating an EPI dog..... the general consensus (in the beginning)  is to give food that is low in fat content of (approximately 12%) and fiber content (4% or less).  This does not have to be a prescription diet. Once we know where you are from... we may be able to come up with some suggstions for you on what is available where you are...........

There has been recent research suggestng that once you find the proper amount of enzymes to give you dog, and the poops (yeah, we just say "poop" here on the FORUM :wink are starting to look good.... you might want to consider trying foods with higher fat concentration.  It appears that many EPI dogs, once on enzymes, can indeed handle normal amounts of fat.... but this is something you try with little increased amounts of fat % later on........

Looking forward to hearing back from you........

Samatha... oh... i meant to mention... your GSD is gorgeous!  And please know, that we will help you every step of the way in getting your dog stable...... the bestpiece of advice I can give you right now to help you with the trial and errorstage is for you to down load a copy of the EPI LOG  http://www.epi4dogs.com/apps/forums/  it is located at the top of the FORUM homepage at the bottom of the "To Participate" section...... if you keep track of every little thing you give your furbaby..... you will figure out quickest what works and what doesn't.... and yes..... the trial and error stage can be taxing.... but once you figure out what works for your dog, you'll be amazed at how great things can go.

Hi Lynn & Karen,

Thanks so much for your quick replies.

I am over in Perth, WA. Sorry for the confusing post - Kobe my boy is having Creon capsules (25,000 aka Creon Forte). I give him the tablets whole - I don't break them apart and sprinkle them over his bikkies. I read a few different things about what is best, so decided to go with giving him the whole capsules because his food intake is dry so some may fly away!

That is a huge difference  Lynn - 16 for Kobe and 3 for Megg. And like you said, you are on the lower dose. Perhaps it is too much? If excessive use can cause a laxative type effect, then that could perhaps explain it. Today was the first day I gave him 16 and he is yet to go to the loo, so it will be interesting to see what transpires. A tootsie roll poop is welcome.

Apart from his stools being loose towards half way, he is fine in all other aspects. His personality has certainly gone back to normal. Prior to being diagnosed and me knowing that he wasn't feeling well was that he was being unusually clingy (More than usual if that's possible). He woke me up at 2am one morning crying and jumping. Since we've changed his diet he has been fine and is back to high spirits.. except for the poopy situation.

Karen - B12 wasn't tested, could that also be an issue? My vet didn't mention anything about that.

The antibiotics he is on are Metrogyl (400) - He is currently having 3 a day. I started them last Saturday and there are 21 in the bottle, so I have only a few days left now. This was given for the possibility of SIBO.

We have an appointment for a sore foot (Argh) at 12.15 tomorrow, so I'll certainly be compiling a list of questions.

Thanks so much for your help, it's greatly appreciated. Not many people have heard of EPI and certainly don't have first hand experience in it. It's great to hear from people managing the situation with their pets

hi - other karen here - it is VERY important to test the B12 levels

epi dogs need to maintain B12 levels in the mid to high range - low levels can prevent weight gain and cause many other problems

many of these dogs lose the ability to produce "intrinsic factor" - this is another function of the pancreas - so oral B12 supplements do NOT work - see the tab at the top of the page on B12 and read up on that

and it really does sound like you are giving way too much enzyme which is probably why the poops are still bad

Hi Karen,

Is it a common side effect that too much enzyme can cause runny poops? Excuse my ignornace, I am new to this and haven't had any contact with people other than the vet on this topic. I've done plenty of reading, but discussing it with people is different and more beneficial imo.

Hi Izzy,

Sorry I missed your posted - I must have been replying to Lynn when you popped yours up. I am in Perth, Australia.

Hi Samantha

Welcome to the group and I'm glad to see some have given you good tips.

YES... too much enzymes DO cause sloppy poops, just as too little do.

It's a puzzle that we all have to solve and to make it worse ALL DOGS ARE DIFFERENT!

Don't worry you will get there it just takes time and tweaking.

Val

Good morning Samantha.  Came straight to the computer this morning to see if there was a message from you.

Kobe is a lovely name and he looks like a beautiful boy.  

As others have said this morning, I feel sure that you are giving way too many capsules.  I know of a lot of people whose dogs are on Creon (10,000 strength) and they don't feed anymore than 2 capsules per meal, & your capsules are more than double the strength.   Also, it would be good to talk to your Vet about getting Kobe's B12 tested.  As Karen said, even with the correct dose of enzymes, you will not see improvement if B12 is low.  

Megg also started off with Metrogyl antibiotics but with advice I received from the group, I asked him for enough tablets for 30 days.  Apparently 7-14 days, which a lot of Vets prescribe, isn't enough.  Anyway, maybe discuss that also. 

It is all so very overwhelming isn't it.  Things do definately get better.  Megg was very slow at gaining her weight back, but I feel because my Vet was onto this from day 1, that she didn't lose too much.  I feel very lucky that my Vet recognised, & tested for EPI immediately.  

Regarding Creon capsules, Are you buying yours from the Vet or is he writing you out a script.???? The 25000 Forte strength need a script, whereas the 10000 & 5000 strength don't.  We buy ours at the 'Chemist Warehouse'. I'm sure you'd have one near you, but you can get them at any pharmacy.  Probably would have to phone & order them.  The one's we use, we don't need a script, and they are cheaper at Chemist Warehouse than any other pharmacy.   One girl use to buy them from her Vet and they charged her more than double the price, until she joined the group & found out. 

Good luck with your Vet visit tomorrow.  Please let us know how you go, & don't hesitate to ask any questions you think of.  We have all been where you are, & I, especially, was an absolute basket case in the first few weeks.   It does & will get better.  We will be having our 3 year anniversary in February & Megg is doing really well.  Can't believe how the time has flown by.

Almost forgot, we LOVE photo's here, so if you have some (sure you do) of Kobe, then please post them here.  If you have problems doing that, please let us know & we can help you through it.  I found it a bit confusing at first, but because I was so determined to put my pics up, (lol),  I learnt very quick. 

Lynn & girls.

Hi again Samantha. 

Just realised that you are feeding the lo-residue food 'dry'.  It's probably a good idea to soak the food first to make it all mushy, then feed.  Makes it more digestable that way.  I'm not very experienced with dry foods but maybe someone else will pop in here & help you out with that one. 

Lynn

Samantha:

Welcome to the forum...Kobe is very pretty.  As you've already seen, there's a great deal of information to read here and we're all happy to offer any help we can.  We'd love to see more pictures of your boy. 

I can't offer much because I have never used the products that you're using but Lynn has been wonderful in answering questions and giving input.  Did I miss your anwer about B12?  I'll read the posts again.  You're definately on the right track.   

HI Samantha and welcome although I'm sorry you need to be here...  Your pup is just lovely and we'd love to see more pictures! I  see your in most excellent hands with Lynn and as I live in the states, I have little to add with regard to enzymes, but I just wanted to say welcome!

Donna, Tara, Zoey and Zeke

Hi Lynn.  I do remember Catherine and Eddie Foo.  Do you know how they are doing?  I remember her first post, I cried.  It was a good post, but it was a tear jerker.  Hope they are doing well, still.

Hi Samantha.  When you go to the vet, is the B12 on the list of questions now?  Let us know what you come up w/ re the dosage you are using and let us know any improvements!  Hoping things look up soon for you guys.  Hang in there.

Morning All,

Thank you all for being so helpful and welcoming me to the forum.

Lynn - Yep, the vet is writing out a script. You're spot on with the price.. getting the tablets through the vet directly was going to cost me $110 for 100. I've put 400 through Chemist Warehouse and paid $67 each time, so it is considerably lower!

I'm still quite shocked about the difference in dose between our dogs. I'm hoping there will be a surprise for me when I go outside this morning.

Karen - Absolutely, B12 is on my list of questions to ask. As I'm not giving Kobe any breakfast today, I'm simply going to request his B12 is tested considering it has been more than 12 hours since he last ate. I didn't know that if it were too low due to his EPI that could cause issues with improvement.

I hope by the time we reach our 3 year anniversary I am still sane!