EPI * Exocrine Pancreatic Insufficiency

Hello All,

Our Dog Frosty, a 5 year old Westie, has been gradually losing weight and getting worse and worse diahrea for 4-5 months now.  He has declined from a fairly steady 18 lbs to 15 lbs in that amount of time.  It may not seem like much, but He's a small pooch.  His appetite has been pretty ravenous for the past couple of months.  He's been very gassy, had a rumbling stomach, and has just recently started eating his own stool. 

Well after about six visits to the vet, several expensive tests for various diseases, and several courses of antibiotics and antiparasitics, We've finally settled on EPI as the likely culprit.  He just had a cTLI test (I believe it was done at TAMU) which came back at 0.6.  Anywho, I have a few questions-

1. We are currently feeding him 1 can of Purina ProPlan sensitive stomache per day.  Has anyone else here had good or bad experiences with giving this food to their EPI dog?

2. The vet prescribed a bottle of PancreaPowder Plus.  I believe it's the same stuff as Pancrezyme.  We are supposed to give him 1tsp with every meal.  He usually eats 1/2 can in the morning and the other 1/2 can in the evening.  Anyway, I just started mixing in the enzyme powder last night, and this morning his stool was the right color brown, but MUCH MORE watery than normal.  Could this be a sign that we gave him too much enzyme powder for the ammnt of food in his meals?  Or is this a normal thing for dogs just starting enzyme treatment and adjusting to the difference in their food?

3. he hasn't been tested for b12 deficiency yet as far as I know.  Is this an expensive test?  Because our bank accnt is pretty beat up from all of the vet visits lately.  Is it urgent that we get this done ASAP?

Thanks in advance.

-Mike&Heather

Hi Mike, Heather, Frosty and welcome, although sorry you need to be here.

BTW, I think Frosty is a perfect name for a Westie!

In not all, but many cases of EPI, dogs have difficulty digesting grains and I believe Proplan has grain in it.  In the tab above called "diet", there is a list of several grain free commerical kibble to choose from.

Also, in addition to EPI, many (I think it's like 70 % of those diagnaosed) also have SIBO (small intestine Bacterial Overgrowth) and have B12 deficincies. If your dog has either one of these, you may never get the EPI under control.   For the SIBO, a 30 day course of Tylan or Flagyl is recommended.  May vets only put these dogs on it for 10 days and it often times it isn't long enough.

As for enzymes, the general rule of thumb is 1 tsp per cup of food to start with and then you can go up or down from there.  Many of us here (myself included) use the generic form of porcine enzymes, pancreatin and we purchase it here for a HUGE cost savings: http://www.enzymediane.com/  Diane purchases Pancreatin in bulk and repackages it and sells it to us in smaller packages. When Tara was first diagnosed, we had her on Viokase and the cost was out of this world!  We switched her to this product cold tturkey and with no problems!

Also, remember to make only one change at a time and give it several days before making another change.  Under the "brochure, log and more" tab above, you can download a log so that you can keep track of your changes. 

We love pictures here too!!! Hint, hint...

Forgot to mention...The enzymes should be intubated in the food for at least 20 minutes prior to feeding...This prevents mouth sores from the enzymes

Hi Mike and Heather ~

Welcome to the crazy world of EPI. Sorry you have to be here, but again, welcome!

B12 test    Poor Frosty.... i think it is just as frustrating for the dogs as it is the owners when they first encounter EPI. Many folks go thru the same expereince, spending tons of money trying to find out what is wrong with their dog. SO the short answer is if you did not have the B12 blood test done simultaneously when you had the cTLI test done... and because funds are understandably tight..... you can wait a while to do this test... It will cost you around another $100. What we can do is try process of eliminationto get your pup back on the right track... and see if we can find the right balance......if after a few weeks of trial and error... nothing appears to be working exactly 100% ... then i strongly recommend having the B12 test done sooner rather than later.

FOOD 1. We are currently feeding him 1 can of PurinaProPlan sensitive stomache per day.  Has anyone else here had good orbad experiences with giving this food to their EPI dog?

If there is any rice, corn, oatmeal, wheat or any other grain in the dog food... you might want to consider using something else, for now... once you get your dog stable you can always re0visit and determine how much grain your individual EPI dog can tolerate.

To start with, you will want to try a food with 4% or less fiber.... try to find one wih a fat content of 12-15% fat content  (later you can try to give a food with a higher fat content.....) but for now, try to keep it on the low side.  Check out some of these foods:

Some grain free (or minimal grain) products available (but not lmited to) are:

Champion Pet Foods Orijen Adult; http://www.orijen.ca/orijen/products/

Diamond Foods Taste of the Wild High Prairie, Taste of the Wild Wetlands; http://www.tasteofthewildpetfood.com/

Dick Van Patten Natural Balance L.I.D., Potato & Duck, Sweet Potato & Fish, Sweet Potato & Venison;     http://www.naturalbalance.net/dogformulas/home.html 

Fromm Family Foods Whitefish & Potato and Grain FreeSurf & Turf  http://www.frommfamily.com/products-fs-d.php 

Go Natural Grain Free  http://www.petcurean.com/  

Merrick Pet Care Grammy’s Pot Pie, Mediterranean Banquet, and Thanksgiving Dinner; http://www.merrickpetcare.com/store/

Natura Pet Products EVO Red Meat Small Bites, EVO Reduced Fat, and EVO 95% meat canned foods; http://www.evopet.com/

Nature’s Variety Instinct Chicken Meal and Duck Meal & Turkey Meal; http://www.naturesvariety.com/instinct_dog

Old Mother Hubbard Venison & Salmon Stew; http://www.oldmotherhubbard.com/products_cupboard.html

Wellness Core http://www.wellnesspetfood.com/dog_wellness_grain_index.html

Wellness Super5Mix Whitefish & Sweet Potato, Wellness Canned Venison & Sweet Potato, and Cupboard Creations Chicken Pot Pie. http://www.wellnesspetfood.com/dog_wellness_grain_index.html

If you are interested in looking at some lists of Grain Free food... please check out the following links:

 http://www.dogfoodproject.com/index.php?page=grain_free

ENZYME PREPARATION 2. The vet prescribed a bottle of PancreaPowderPlus.  I believe it's the same stuff as Pancrezyme.  We are supposed togive him 1tsp with every meal.  He usually eats 1/2 can in the morningand the other 1/2 can in the evening.  Anyway, I just started mixing inthe enzyme powder last night, and this morning his stool was the rightcolor brown, but MUCH MORE watery than normal.  Could this be a signthat we gave him too much enzyme powder for the ammnt of food in hismeals?

I think we have another Westie as a member here too.

My guess is "maybe" ... However since you only want to make one change at a time... and watche results for  3-5 days..... My suggestions is decide if you want to change food or if you want to try and reduce the enzymes.... Pick one and try it for a few days....

record the results in an EPI LOG (tryust me keeping records are invaluable when trying to find the right balance for an EPI dog)

Down load:  http://www.epi4dogs.com/EPI%20Dog%20Log2.pdf  or go to:  http://www.epi4dogs.com/brochurelogmore.htm  and down load the Log.

If you want to try and reduce the enzymes, because he is only getting a 1/2 can.... try reducing the level teaspoon by 1/8 teaspoon for 3-5 days.... if that improves it somewhat... try reducing it another level 1/8 of a teaspoon.... let us know if it is getting better or worse...

The other thing is... are you mixing approx 1/4 cup (or a little less) of room temperature water. mixing the enzymes in this water and THEN mixing in the canned dog food????? And letting the food and enzymes sit in room temperature for 20 minutes???? I personally would try this first before anyother changes if you are not already doing this.

Or is this a normal thing for dogs just starting enzyme treatment and adjusting to the difference in their food?  No.

hope this helps give you some things to think about... and let us know what you decide and what the results are.... once you find the right balance of EPI things (enzymes, diet, anit's & b12 if needed, proper preparation) it usually becomes second nature to take care of..... usually.....

oh.... one more thing... the gas & tummy grumbling... is usually indicative of SIBO.... as Donna said... with an EPI dog this is usually recommended to treat via a 30 day regimin of antibiotics. (Tylan or Metronidazole... Tylan being the preferred drug, less side effects) Anyway....talk to your vet about starting your pup  on a 30 day regimen of Tyaln ASAP.... too often if SIBO is not addressed fast and furiously at the beginning... it can lead to the yo-yo effect with SIBO....

Also... If the dog has SIBO,,, the enzymes may very well be the correct dosage... and working too..., however, the SIBO will interfere with your dog having optimal results from the enzymes ... so you might "think" the enzymes are not working.  This will also happen if your dog has a B12 deficiency..... that is why i said if things just don't seem to be working 100%... time for the B12 to be checked, because it too will interfere with progress. It can be a vicious cycle.

Thanks for all of the advice everyone.  It's pretty overwhelming having to control frosty's diet to this degree all of a sudden.  I miss the days of just dumping a handful of kibble in his bowl and being done with it.  My wife and I just want to make sure we're doing everything right for him.

Frosty seems a little better this evening.  He had two semi-solid bm's, so I guess the amount of enzyme we're giving him is close to what he needs.  ...Will keep a log from here on out.

FOOD:  It looks like the food we're giving him is a Salmon and rice formula, so we'll for sure try to find one of the brands that you all have suggested and switch it out asap.

ENZYME PREP:  I tried the "mix with 1/4 cup of water prior to adding to food" idea.  It turned his food to the consistency of runny oatmeal, kinda funny.  He's "drinking" his dinner as I type this. .

SIBO & B12:  He was recently on a week-long course of metronidazole and Fenbenidazole (or something).  We were treating him for in case he had Giardia.  We saw no improvement after the treatment, so we moved down the list of possible ailments to the cTLI test.  So I guess if there's no real improvement from the enzyme powder and food change within a week or two, we'll talk with the vet about a 30 day course of Tyalin.

Again, thank you for all of the advice.  We'll keep you posted about Frosty (and try to upload some pictures in a day or two).

-Mike&Heather

Hi Mike & Heather,

I see that you've already received some great advice already. 

Just wanted to pop in here & say a very warm welcome to our group.  Frostie sounds like a lovely

little dog.  Westies are soooooo cute.   If you have some photo's of him, then please feel free to upload

them here.  We all LOVE photo's.

Lynn & girls. 

Hi Mike and Heather,

If Frosty is drinking his food and is okay with it, that's a plus!!! Tara looked at me the first time like, "You expect me to eat that crap?"  She definately had issues with this...

Keep us posted and looking forward to the pictures!

Hi all,

Here is our dog Frosty before EPI:

And this is him with EPI: 

Ohhhh, What a handsome dude Frosty is!

We have several folks here with Westies and I'm sure they'll comment too!

WOW... Frosty is gorgeous !!

And I am sure you'll have your happy, bouncy boy back once he starts feeling better.. We have a thread here, "before and after" I think is what it is titled.... and interestingly enough.....in every picture of the dog at the onset of EPI, they have Frosty's same look.. (when he is in the tub) it is kind of a dejected look ..... you can almost tell just by the way they hold their body and the look in their eyes, the ydo not feel well........

By the way... what kind of camera did you take those pics with.... the clarity is fabulous!!! We do an EPI calendar here every year... to raise money for EPI research.....just a thought, but you might want to snap pictures of Frosty throughout the year with this in mind....

Also..... regarding:

"He was recently on a week-long course ofmetronidazole and Fenbenidazole (or something).  We were treating himfor in case he had Giardia.  We saw no improvement after the treatment,so we moved down the list of possible ailments to the cTLI test.  So Iguess if there's no real improvement from the enzyme powder and foodchange within a week or two, we'll talk with the vet about a 30 daycourse of Tyalin."

Because Frosty "He's been very gassy, had a rumbling stomach" experienced this and he is now a confirmed EPI dog... don't mess around with waiting  to treat "possible" SIBO..... trust me ...this is a strong indication that he has SIBO (small intestinal bacterial overgrowth)  and you want to tackle it with big guns as soon as you can...ask the vet for a 30 day prescription of Tylan as soon as you can.....

My vet,  when he just "suspected" EPI, automatically prescribed pancreatice replacement enzymes (Pancrezyme) and Tylan antibiotic for my Izzy, even before the test results come in from the cTLI test...... and even then...for us,  it took 2 weeks before we saw positive results (which was kind of a long time).

I know this might sound confusing..... but with EPI you start with

• Pancreatic Replacement Enzymes... determined by cTLI blood test
  
• Antibiotics (if SIBO is suspected).... if there is any tummy grumbling / gas...
  
• B12 shots (if B12 Deficiency if suspected).....determined by B12  deficiency blood test

After these 3 adjustments.... all other changes should be made 1 at a time..........

Yea, fixing their food does seem like a challenge... but trust me, only at the beginning, once you get Frosty stable, after a while, fixing his food will seem like a breeze... it is just the unknown and finding the right balance in the beginning that is the hassle.

And

Hi:

Donna and Olesia have given you some great information and there's truly nothing much I can add to that.  I just wanted to welcome you aboard and tell you what a beautiful boy Frosty is.   I had to chuckle at your comment about missing the days of just putting kibble in a dish.  I used to free feed my dogs and it was very easy, plus I knew that they always had food in their dishes when I was at work.  However, many years ago, I adopted a horribly abused gsd who had many, many health issues caused from his early abuse and neglect.  I learned at that time, that I could free feed during the day but had to start "fixing" dinner.  It's a practice I kept up, until I got Akira and after diagnoses, had to start "fixing" two meals a day with no food left down in-between.  At least I had a breaking in point lol.

Hi!   Just have to tell you how beautiful Frosty is!!!  OMG is he cute - I have to go back and look at the pics again - love them!!!   I hope he continues to get better and better - you are on the right road!    Jackie sends him hugs and licks!!

What a great name...Frosty.

What an absolute cutie.

I have a tender spot for Westies but sadly Razzy has an on running vendetta with them because one barked at her boyfriend when they were young.

You sound as though you are heading in the right direction... got get it!

You will have EPI under control soon and life can go on as 'nearly' normal again.

Val

Update:  well Frosty's stool has been back and forth for the past couple days.  We've had about 50% solid'n brown and 50% yellow'n runny.  It appears pretty random.  He doesn't seem to have the stomach rumbles and gas anymore though, so maybe there's no SIBO (finger's crossed).

 We switched his food yesterday to cans of "By Nature - Turkey & Bacon: 8% fat 1.5% fiber".  It's supposedly grain-free.  We couldn't find any of the suggested brands at the pet-store, so we just got the best thing we could find.  It's tough to find stuff that's grain-free at the big-box pet stores.  He seems to like it allright.

One thing we noticed is that he's urinating a lot more than before.  I understand this sometimes happens when you switch to a grain-free food?  Or maybe he's just getting used to the new stuff?

One question:  So, pardon my crudeness, but as I understand it, his food is basically synthetic vomit now.  Well my wife and I have noticed that Frosty's breath really stinks.  Does anyone have any creative ways of freshening their dog's breath after meals?

-Mike&Heather

Taya also has EPI.  She was diagnosed In July.  She had lost half her weight. She eats Hill's Science canned ID.  She eats 4oz food,with a 1/2 tsp. enzyme three times a day.I put the enzyme on her food 15 min. before she eats.  I also take a tsp of this food and put in in 1/3 cup of water and mix it well. She drinks this after she eats, it helps rinse her mouth and she has not had any problem with a sore mouth or bad breath.  Taya also get four drops of Vit. E on her fist feeding of the day.

Hope this helps and if you have any questions please let me know.

Hi Mike and Heather ~

Yea, it is indeed hard to find the grain-free foods at the big dog stores... sometimes there just isn't any grain free stuff at the big chain stores...but the pet boutique stores or even health food stores in the metropolitan areas carry the grain free. What big cities in VA do you live next to....I'll see what I can come up with in that area ... or the other thing you can do is pick one of the grain free food links, go to their site, and usually they have a tab that helps you locate "stores" in your area via your zip code.

Synthetic vomit...not crude... just accurate !  If you want....reduce the water just a wee bit so that it looks like oatmeal consistency, just maybe not runny oatmeal consistency...

The mroe peeing is most likely the enzymes causing more thirst initially (this happens a lot) causing Frosty to pee more often.

The stinky breath... .... the majority of us have been there.. pretty gross, eh? kind of like vomit.... ugh... Anyway, the good news is that most of the times, it goes away.... the bad news is that with some dogs it takes a few weeks and with other dogs it takes months... dog products with Chlorophyll have been known to help with this.

"We've had about 50% solid'n brown and 50%yellow'n runny.  It appears pretty random.  He doesn't seem to havethe stomach rumbles and gas anymore though, so maybe there's no SIBO(finger's crossed)." Unfortunately, this is wishful thinking.... SIBO is a sneaky lurking condition..... you have to have consistent tootsie roll poops with great color and texture (sounds like a darn art class, eh?!) for a consistent period of time before you can safely declare good riddance to SIBO... A regimen of 30 days of Tylan (antibiotic ) or Metro is usally the best protocol to adhere to to hopefully get rid of it. The problem with SIBO is if you don'[t get rid of it 100% as soon as possible, it keeps coming back and the more times it comes back (like back-to-back  / one right after another episode)   it seems like it gets ahrder to get rid of.

Since Frosty is having inconsistent poops  these are some of the most common possibilities (but there may be others) that popo into my mind:  

• 1. one thing that may be at play is that the enzymes are starting to take effect, but it is going to take some more time ... and possibly in conjunction with SIBO not being completely gone (My guess is that SIBO is part of Frosty's  picture because he had the tell-tale gas + tummy grumblin)
• 2. enzymes are working fully but SIBO in the background is interfering with optimal response
• 3. enzymes are working but Frosty may also need B12 shots (and the SIBO issue is also still going on)
• 4. needs more time to adjust to the food and enzymes and SIBO and or possibly B12

Keep updating us and we will help you figure this out.  Also... Let me nkow how you want to approah the grain free food issue. 

I talked with our vet today and he confirmed the possibility of Frosty having SIBO.  So we got a 30day supply of Tyalin.  Hopefully we've caught it in time to knock that sucker out of the park.  The vet also informed me that Frosty was recently tested for a B12 deficiency and the results were normal, so no worries there.  Frosty continues to improve little by little.  He's getting his energy back and having more and more solid bm's.  he also appears to already be urinating less.  Good news for our carpets.

About the food:  The food we have him on, while good, appears to be pretty rare.  We bought the last case of turkey&bacon formula that Petsmart had.  I'm a little worried that they may not keep it well stocked.  So does anyone know of a reliable source for good EPI food in the Northern VA area... specifically Leesburg?

Thanks again for everyone's advice.

-Mike&Heather

aaaawwww....  little Frosty.... adorable......  he'll do fine one you find the right combo of everything..... I had a terrible time with Pebbles....  for me it was adding b12 in a pill form with intrinsic factor ..... even tho I was giving B12 shots every 4 days.... she would loose it too fast.and in a constant cycle ...  but you'll find the right things for Frosty .... just listen to everyone on this site...... they save my Pebbies and she was at deaths door....  I never thought she would turn around....  now a little beauty...   and full of life !!  Prayers..

Mike and Heather:

Did you talk to the people at Petsmart to see if the dog food you bought is something that they are willing to keep in stock?  If not, some of the smaller pet food places might be interested in doing so.  Another thought might be that you could possibly order it online from Petsmart.com and bypass the shipping costs by having it shipped to the Petsmart store.  I'm not sure if Petsmart will do this but I know that some stores will and as long as they ship it to "their" store, no shipping costs are involved.  Or...you could contact the company who makes the pet food and ask them where you can find their product.