EPI * Exocrine Pancreatic Insufficiency

Does anyone know a good alternative to Hills I/d tins.  Gem is needing them at the minute while we get her tummy settled down again but this is costing £160 every month for her food alone!  Obviously this is something we will do if we absolutely have to but wondered what other alternatives people have found to be good (and hopefully a little cheaper!) in the UK.  Gem is everything to us and if we have to keep paying this much we will find a way but hope there are alternatives.

Please can some of you UK EPI experts help us?  We want our happy puppy back

Gem last March before EPI

i used Hills hard food for a year I recently went to wolf king with good results. 

Karen, I love the photo of Gemma!  She's so pretty! I'm sure Debra or Julie will chime in here when they log-on!

Joanne, Karen is in the UK...Different meds and foods...You'll learn a lot here...I certainly did and now I'm all set when I travel to the UK or or Australia or wherever...

Ahh Karen... Gemma is just down right gorgeous! Great picture.

Val (from UK) uses something called Bakers....

Debra will chime in....as I know she tried a couple of different foods... one made the poop too crunchy but when she did half and half it worked...

And I think Julie uses prescription foods, but I am sure she also will chime in.....................

Of course, they all might not chime in until tomorrow....ya'll are 6 hours ahead of us aren't you?

hey there I am not sure how fast she wants to change food, but you can order this food online.  http://www.vetamerica.com/solid-gold-wolf-king-adult-dog-bison-and-salmon-33-lb.aspx

 i get mine from a store here in fl but it is real good food and real good reviews

Hi Karen ~

I used Hills i/d for a short period - once on epi diagnosis and when Angel incurred two blips. My honest opinion is that I don't like it and am sure that along with Angel's two year veggie dog food it was part of her food intorerance. It all came to a head recently and since I switched to Orijen -  http://www.orijenpetfoods.co.uk/ -  the results are remarkable! It is expensive but not nearly as much as Hills i/d - we compared price and amount of food required for Angel against a few known UK brands and Hills i/d came out worse for OTT cost.

To save time, I have copied a thread below where I mentioned to our Debra, in another topic, Orijen dog food - it is grain-free: -

Debra ~ just a thought to Holly, your sister might be interested in checking out Orijen dog food http://www.orijenpetfoods.co.uk/ It is grain, hormone and antibiotic free. It is Canadian but Orijen have a UK distributor and available stockists placed around the country from certain pet outlets. It won the pet food year award for 2010. After my trial pack, we picked up a large bag from Hitching. The pet grooming establishment swears by it and has seen amazing results from dogs that had a host of problems and told hubby of a story about a Golden retriever that had been through many dog foods to no avail - digestive problems to constant itching - but it all cleared up when he went on the Orijen. I really don't mean to be a verbal advertiser as there are other good foods on the market and I believe Karen said that dear Manfred didn't do well on it. I will say that it is expensive but the amount of food needed per body weight is less than most brands.

Second part

Hi Debra ~

Expense is certainly a forgiving issue. I worried myself over this, especially with Angel's EPI costs and feeding two dogs, and so worked out the cost of a few standard quality feeds per amount of food per body weight and activity levels. The cost of Orijen came out equal and better than some foods. It's just that the initial outlay is considerable. I ought to put X amount of money away each week to help the bulk expense when purchasing the 13.5 kg bag @ £46.99. For the amount Angel eats per day, 13.5 kg will last 33 days @ £1.42 per daily feed.

If you haven't already, you could check the feeding guidelines per body weight and compare it to the amount of food you and your sister are currently feeding.

I know have to dash but will say that it would perhaps work out even cheaper that my daily cost of £1.42 for you because Gemma won't need as much as Angel in relation to their breeds and body weight.

Hope this helps!

Warmest best wishes,

Julie & Angel

The top photo was Gem just before her 1st birthday this year.  This one is of her in October - and she has lost another 3kg since then!  Looking quite good on this pic though

This morning her pooh was dotted with undigested pancrex granules. Will see how she goes over the next day or so but thinking of asking the vet to try her on the Lypex granules.

And Ive looked at the food you suggested Julie.  Thanks!  That would be great if it agrees with Gem.  Ive ordered samples and information to show the Vet.

Hi honey... I'm Val from UK.

I did the vet prescription food for a while and didn't get on too well.

By acciident (Razzy ate another dogs food) I found Bakers Complete Chicken and Country Veg did pretty good for my girl.

It isn't grain free and it may not do for Gem but it's worth a try.

First thing is it MUST be soaked in HOT water, just enough to cover it (stick a plate on top and leave it to cool to room temp) mash it to soft and fluffy them add the enzymes and leave for 45 mins... stir well and feed. This is important because it's a hardish kibble and will pre-digest easier if well soaked.

As to Lypex... yes I do use it and it's convenient but I find for kibble Tryplase is better... I now use Lypex with raw because raw is the very easiest to digest.

For MY dog (and all dogs are different) I sprinkle 2 Tryplase capsules onto 7 oz Bakers after being well soaked. It seems to give Razzy a reasonable poop... you may need less because Razzy has had EPI for 3 years and now has NO enzyme preduction of her own.. but its tweak until it comes right.

Good luck and one word of advice... don't go for the really HARD kibbles. I did Hills Natures Best and Science Diet and I had to grind the kibble in a liquidiser before it would pre-digest properly.

Good luck

Karen~ Gemma is such a beautiful babe!   Val has just reminded me that I also soak the Orijen kibble, which are small, with tepid water about 5 minutes before adding enzymes, but you might want to leave it longer and follow Val's excellent soaking method. Orijen is also a hardish kibble. Val's enzyme incubation period for Bakers Complete is close to my 50 minute period, but I am using Total Zymes plant-based enzymes so disregard my inc. time, although you might need 45 min incubation as partial food composition in Orijen Adult is:

Partial contents:

Crude Protein 42%

Crude Fat 16%

Crude Fibre (Max) 3%

Carbohydrate (Max) 18%

If this agrees with Gem then it should help her gain weight, providing all the other EPI aspects are in place - good B12 level and right amount of  enzymes. You might want to feed her slightly above the feeding guidelines for a period, so as to help her gain weight.

If is the Orijen doesn't work for Gem, then Val made a good alternative suggestion and I dare say our Debra will chime in with the type of food she had her beautiful Bonnie on.

Good luck and let us know how it goes.

Warmest best wishes,

Julie & Angel

Hey....Thanks to all you gals from the UK for helping Karen and Gemma !!!!

And Karen... that is a FABULOUS picture of Gemma... especially with the water/stone background.... shows her black coat off real nice!

Sorry Val... I didn't mean to leave you off...I know you're from the UK, but I must have had a brain fart last night - They are happening more often too. 

Karen, I love the water picture of Gemma being a typical labby girl!

Such a pretty girl. Great backdrop.

Hi Karen,

Hill’s i/d is quite expensive especially when buying from the vet, I think I posted somewhere else about buying hills i/d on line. VetUK is £17.30 x 12 400grm tins. I believe you feed 3 a day??. For 28 days @ 3 cans a day would be 84 cans which would work out at £121.10 a saving of £38.90.

I’ve looked at Royal Canin digestive wet food but they don’t work out much cheaper. I did flirt with Denes rabbit and chicken for digestive disorders, they do three different size tins one of them is 12 cans x 400gm for £11.51.

To be honest I had Bon on Hills i/d at the beginning when she was first diagnosed and the cost was crippling even buying it off the net, afterwards even with SIBO/vomiting I didn’t use it again….the food I was using was Burns Chicken and brown rice http://www.burnspet.co.uk (it comes from your neck of the woods) it has only 7.5% fat…and was recommended for EPI/digestive disorders etc. Some dogs don’t do well on rice but Bon did ok with the brown it is a little easier to digest, it gave her the fibre she needed.

You will never put weight back on with Hills i/d. It’s used by vets during recuperation after surgery or digestive disorders …colic etc. I don’t think its sustainable monetary wise to keep them on it. And from what I remember her poops were soft due to the food and not lack of enzymes.

As others will tell you finding food is a nightmare…but you just have to read up, find one that fits most of the criteria, low fat, low fibre etc stand back and wait.

How long has it been since Gemma’s blip? If it’s been a couple of weeks and vomiting has now stopped, could you not reintroduce kibble slowly weaning her off Hills i/d?

James Wellbeloved make a senior/light food (low in fat)

Val has described treating the kibble spot on, you will have a mushy wettish food covered with enzymes which will be as easy to digest as the Hills i/d.

Re your comment that you saw some granules of the Pancrex in her poop…..were the little granules yellow?

This may not be the granules, but undigested fat; if it is that then you may need to up the enzymes a little.

Due to my inexperience in the beginning I was actually giving Bonnie her Lypex (don’t need to incubate) on Burns kibble and not soaking them and she digested them…although now I know better I am sure I could have got an even better poop by soaking her food.

I had found the orijen right up quite interesting but didn’t get to try it out.

By the way gorgeous photos of Gem

Hi Debra ~ I must tell you about Royal Canin. I researched quite a few foods and noticed that Royal Canin contains hydrolysed animal protein and crustaceans. I did a brief research on hydrolysed meats and it turned my stomach.

Here are the ingredients: 

Royal Canin:

Ingredients: rice, dehydrated poultry meat, animal fats, vegetable protein isolate, maize flour, vegetable fibres, minerals, hydrolysed animal proteins, vegetable oils (soya and copra), beet pulp, fish oil, sodium polyphosphate, yeast extract (source of manno-oligo-saccharides), L-lysine, taurine, DL-methionine, L-tyrosine, hydrolysed crustaceans (source of glucosamine), green tea and grape extracts (source of polyphenols), hydrolysed cartilage (source of chondroitin), marigold extract (source of lutein).

As I said, I don't like Hills for the same reason of hydrolysed contents - wonder if this is the reason for increased thirst in the dry formula ..... just a fleeting thought.  Strangely enough, for the very short periods I used Hills, Angel did gain weight and it helped her over the two blips and during early diagnosis.

I was unsure about the fat percentage in Orijen, but after hearing that it is no longer considered an EPI restriction, I thought I would give it a go, but do you think it is too high at 16%. ? I will say that I am amazed that T.Z is working on this amount of fat. I thought I might have a problem.

Warmest best wishes,

Julie & Angel

Bonnie had been on 18% fat in the beginning.....not knowing any different then and to be honest once the enzymes were introduced, her poops were good and she did put weight too....I changed her down to 7.5% thinking it would help her digestion better....and she lost weight. 

It's such a shame that hills is so expensive...as it is a gentle food, although having read how they come to the end product is rather mind blowing.

Sorry guys - 1) because its a yuky poop pic and 2) because its not very well focussed!  Must put my contacts in before taking pictures in a morning.

Debra - this is a close up of the bits in Gems poop.  The only things she has that look like that are the granules so thats why I thought it was them. Sometimes we get undigested grass in there and sometimes its much more yellow.

Gem is on Tylan now (although we have to mix up the oral suspension and add to her meat).

The Vet advised us to feed gem 3-4 tins of I/d a day!!!!! to get some weight back on her.  We have stuck at 3 for the last week (because that is over 1kg of meat a day and because it would cost a FORTUNE to feed 4 tins of Id a day)

Gem was on James Wellbeloved all her life prior to this and everytime we try her back on it now she pukes - even if we just give a very little bit.  We wondered about the James Wellbeloved lamb or turkey and vegetable as that is supposed to have no grain in? 

She hasn't been sick since the night before last now and has put on a little weight again but I dont know if that is true weight or the huge quantities of meat sat in her tummy. 

Its all so complicated and heartbreaking.  Does it ever get any easier?  We thought we were doing well but then came the "blip". I guess a lot of this is two steps forward and one step back.   I am trying very hard to remain positive for Gem and doing everything I can to help her as best I can - as is our Vet. 

Ive written huge lists now of things to discuss when we go for her B12 injection on Monday.  I might just go to tesco and get a box of bakers to try.  Do you think giving her some of that one meal a day and I/d the rest woudl be a good start?  Or just swap straight to the bakers?  Im thinking of that one first because I know I can get my hands on some without too much hassle - and because getting to places is tricky up here at the minute.

WHOA.... i wish I left my contacts  out of my eyes before looking at THAT poop pic :D:D:D.

Okay seriously....what jumps out at me is possible SIBO (see the slime in the upper left) and possibly this particular food food not agreeing with poor Gemma...

How long has Gemma been on the Tylan?  

Thoughts anyone else?????

Karen... to answer you question about trying other James Wellbeloved foods....to my way  of thinking is to  try a different brand completely first... the way i look at it is they manufacture the food all in one place... so what if it's the main ingredients in that food that is bothering her, not just the one particular flavor you were using..... of course my line of thinking may be all wrong too.....we just never know with these dogs.

And.... if you haven't ben on the Tylan that long... it just might take some time.... it did with my Izzy...............

Sorry for the choppy responses.... but i am painting the bathroom right now.. so I pop in for just a few minutes at a time (don't want the paint to start drying and getting gunky on the roller)

Mmmm... are you sure she hasn't got into anything?

They are pretty sneaky at finding or pinching things when you are not looking.

It's a bit yuck but don't feel too bad these things do happen.

You say she vomits if given the old kibble? Do you just give it or soak and pre-digest and add it to the meal?

I have never given Hills  I/D which is a tinned food and those often need less enzymes than regular kibble...I'd be thinking it could be SIBO but I would start by giving a day of very small meals to sooth the tummy... as many as you can get in the time you have.... keeping the correct ratio of enzyme to food......I wouldn't worry about weight loss I would consentrate on getting that poop right first.

If you want to try Bakers I would try and soak a little and add it to  a little of the the present food..  If it causes vomitting then back off. I never had any problem changing Razzy's diet so it's difficult to advise..... I would add a bit of new for 3 days then a bit more for three day etc. Until I had replaced the old with the new.

Not sure about your enzymes or the strength maybe they could be a problem... you could get just a few Tryplase from your vet and try them. Maybe 2 ounce of soaked kibble and 2 big tablespoons of i/D as a 'try it meal' with 1/2 a Tryplase capsule... pre-digested for 30 to 40 mins... stirr and serve.

It sounds a very small amount but I have a BIG shep (47kilos now) and when she was first dxed I fed her 4 tiny meals a day and tweaked the enzymes to get a good poop. It turned out that at that time she was good with 4oz Bakers soaked and 1 Tryplse capsule. Once I knew that I could increase and keep the ratio the same...ie:6 oz to 1 1/2 Capsules... 8 oz to 2 Tryplase... 12oz to 3 Tryplase... it made life very much easier.

Good luck.

Ok - answers to a few questions :-

Olesia - Gem has only been on the Tylan since Monday night.  I think I need to be more patient!

Val - we give her I/d three times a day - 1 tin (360g) at a time with 3.5 teaspoons of pancrex granules stirred in half an hour before.  She gets her Tylan stirred in just as we give her it too.  And she has her antacid (Ranitidine) one hour before food now.

- we are pretty sure she hasn't got into anything she shouldn't as we supervise her like a hawk because she went through a phase of trying to eat the pups pooh so we are the pooh police (or paparazzi!) now and rush out to pick it up as soon as anything appears from either.  We have also got rid of all plant life from the garden that they coudl eat - including pruning the hedgerow to remove blackberries, rosehips and the like. 

We are still keeping a daily food/medication and poop diary with some lovely photos and take it every time we go to the Vet.

Will go get some Bakers tomorrow morning. I need to ring the Vet for more Ranitidine so I might see if they can let us try Tryplase.

Thank you all for your helpful suggestions.  Please keep them coming.