EPI * Exocrine Pancreatic Insufficiency

Hi to everyone, I have been reading your posts over the past month and firstly want to say thank you for the wealth of information I have gathered and to Olesia for her help in getting me signed into the forum.  This past week has been the first week for Gunner my year old English Cocker Spaniel being confirmed with EPI.   Gunner hasn't been well since November and I have to say my vet has been absolutely fantastic. She suspected very early on that he may have EPI and has done everything and more to help him.  Gunner has had two TLI tests, one month apart and both confirmed low levels,  whilst we were waiting for the second test he was put on a Hills prescription diet with Tryplase powders added to each meal,  the transformation came within days, he started to put weight back on, normal poo and gone was the sad depressed look and lack of energy.   Monday the 15th of February was the first day of the rest of Gunner's life,  we now know that things will never be quite normal for him, but thank god we now have a diagnosis and thankfully only after a few weeks of him being so unwell.   I am so proud to have Gunner, he is such a loving , funny, mad ball of fluff and having learnt so much about EPI over the last month with the help of your site and my vet I now know what signs to look for, what not to do and best of all that we can cope and that with our help Gunner will have the nearest we can get to a normal life. .

Hi Hayley and welcome, although sorry you need to be here...  Once the wondering is over and the knowing begins, you just kind of resign yourself to doing what needs to be done and it becomes second nature...  Most EPI dogs are in fact very special...We have fought hard for their very lives, but they have fought just as hard.  While in fact some don't make it (as we sadly learned yet again today), they are all special in their couragous ability to want to live and that very desire to beat the odds, does make them very, very special indeed. 

Hi Hayley,

A very warm welcome to you & Gunner to our forum.  You certainly seem to be on the right track with a great Vet & things can only go forward from here.  Please feel free to ask as many questions as you like as there is always someone here who can answer you.  Also, would love to see some pics. of Gunner.  We all love photo's here & if you have any problems posting them, please let us know & we can  help you through it.  Sometimes, at first, it can be a bit tricky. 

My EPI girl is Megg & she is an English Setter.  She has had EPI for just on 3 years now & is thankfully doing well.  She also has those sad eyes & when she was a puppy, she would often get mistaken for a cocker spaniel.  I would get comments like,  oh, what a lovely little 'spaniel'. 'She is big, isn't she'.   Not knowing that she is a Setter.   I use to have a giggle.

Anyway, again welcome.  We are pleased you have found us.

Lynn & girls.

Hi Donna and Lynn thanks for the warm welcome, I am trying to load some pictures of Gunner but with my track history this may take some time!!!  or then again I may surprise myself.

Hi Haley,

I didn't get the photo, just a big red X where it should be...Someone let me know if it's me????

No Donna, I can't see it either.

Hayley, I've just looked through our files & found Franks instructions on posting photo's on the forum. I was hopeless at first, then Frank stepped in with these instructions, & now, as most here will know, I find it very easy (lol)

You will need to store your photo's in 'Photobucket' first, then go from there.

To add the photo from photobucket

* open a window that will have your Post a quick reply: on the epi4dog forum.

* open another window with photobucket open to your album.

* select the photo in photobucket. double click on it. new screen with just that photo appears.

* Put your cursor on that photo and a menu will appear. Click on "SHARE" click on "MORE OPTIONS"

* Select tab "GET LINK CODE". Go down to "DIRECT LINK FOR LAYOUT PAGES" Click the left mouse button in this

box, it should now highlight in blue. Right click on the blue highlighted bos and click on "COPY"

* Go to the window that has your post. Put the cursor where you want to insert the selected photo. Look for the two

lined box next to the smiley face and click on it. A little window appears saying "Enter the URL of the image".

Right click in box and click on paste then select OK. Your photo will appear in your post.

********************

Good luck. We can't wait to see your pics. of Gunner. If you still have problems, don't hesitate to let us know. It can be sorted.

Lynn & girls. 

Hi Hayley:

Welcome to you and Gunner...I'm glad you've found us.  I know that you already know this, but you are very fortunate to have such a great vet.  Please tell your vet that he or she is more than welcome to join the forum as well.  I'm so glad to hear that Gunner has responded so quickly and is doing well.  Keep us posted...and I know you'll get the picture thing worked out soon...Lynn is right...we love pictures here, 

HI Hayley and finally WELCOME!!!!!... amazingly Gunner the EPI dog is doing great, but getting you on to this FORUM took a week.... amazing, eh?!

Looking forward to seeing pictures of Gunner!

Hayley at 05:40PM on Feb 23, 2010

Hi to everyone, I have been reading your posts over the past month and firstly want to say thank you for the wealth of information I have gathered and to Olesia for her help in getting me signed into the forum.  This past week has been the first week for Gunner my year old English Cocker Spaniel being confirmed with EPI.   Gunner hasn't been well since November and I have to say my vet has been absolutely fantastic. She suspected very early on that he may have EPI and has done everything and more to help him.  Gunner has had two TLI tests, one month apart and both confirmed low levels,  whilst we were waiting for the second test he was put on a Hills prescription diet with Tryplase powders added to each meal,  the transformation came within days, he started to put weight back on, normal poo and gone was the sad depressed look and lack of energy.   Monday the 15th of February was the first day of the rest of Gunner's life,  we now know that things will never be quite normal for him, but thank god we now have a diagnosis and thankfully only after a few weeks of him being so unwell.   I am so proud to have Gunner, he is such a loving , funny, mad ball of fluff and having learnt so much about EPI over the last month with the help of your site and my vet I now know what signs to look for, what not to do and best of all that we can cope and that with our help Gunner will have the nearest we can get to a normal life. .

Hi Hayley. I am new to this forum...my dog Maisey was diagnosed with EPI on Monday. The vet has prescribed Tryplase. We are giving her 3 capsules a day on tinned Chappie. We have been given no guidance on how we are to mix this. Can you let me know how you prepare Gunner's meal. Maisy is a Border Terrier.

Hi Maisey's mom (you didn't sign your name)  and welcome, although sorry you need to be here...

I'm in the US and not farmiliar with the enzyme you are using, but we have several members here from the UK who can help.  I just wanted to welcome you and Maisey to our family.

Lucy and Maisy at 05:37PM on Mar 03, 2010

Hayley at 05:40PM on Feb 23, 2010

Hi to everyone, I have been reading your posts over the past month and firstly want to say thank you for the wealth of information I have gathered and to Olesia for her help in getting me signed into the forum.  This past week has been the first week for Gunner my year old English Cocker Spaniel being confirmed with EPI.   Gunner hasn't been well since November and I have to say my vet has been absolutely fantastic. She suspected very early on that he may have EPI and has done everything and more to help him.  Gunner has had two TLI tests, one month apart and both confirmed low levels,  whilst we were waiting for the second test he was put on a Hills prescription diet with Tryplase powders added to each meal,  the transformation came within days, he started to put weight back on, normal poo and gone was the sad depressed look and lack of energy.   Monday the 15th of February was the first day of the rest of Gunner's life,  we now know that things will never be quite normal for him, but thank god we now have a diagnosis and thankfully only after a few weeks of him being so unwell.   I am so proud to have Gunner, he is such a loving , funny, mad ball of fluff and having learnt so much about EPI over the last month with the help of your site and my vet I now know what signs to look for, what not to do and best of all that we can cope and that with our help Gunner will have the nearest we can get to a normal life. .

Hi Hayley. I am new to this forum...my dog Maisey was diagnosed with EPI on Monday. The vet has prescribed Tryplase. We are giving her 3 capsules a day on tinned Chappie. We have been given no guidance on how we are to mix this. Can you let me know how you prepare Gunner's meal. Maisy is a Border Terrier.

Hi Maisey's mum, sorry It has taken me a whilt to come back to you, we have had a very up and down week with Gunner, bless him, two trips and several calls to the vet later, he seems more stable and happier

My vet has told me to mix one Tryplase capsule per 100 grams of food, so dependant on how much Chappie you are giving her will depend on how many capsules. (same for wet or dry food, 1 capsule per 100g)   When I mix Gunner's I add a small amount of tin food to the bowl,  split open the capsules and add the powders  and then mix really really well, once I am sure that the powder has been mixed into the food I add the rest of the tin and mix again.  With the Tryplase you don't need to leave it before you feed, so once mixed you can give Maisey her food straight away,  the reason for mixing so well is that like other Enzymes, Tryplase is an irritant so can cause sores and bleeds in the mouth if not mixed properly, my vet also told me to wear gloves when I am mixing and handling them as they can irritate your skin. Have to add so far Gunners mouth has been fine x

 I would be really interested to hear how she does on the Chappie. Gunner is on Hill ZD at present but this is not specific enough to EPI so my vet wants to change him onto another food, there are four we can try, we have now ruled out 3 as even a quarter tin sends Gunner backwards,, we tried him on Hills ID on Monday and he ended up passing blood and really loose again, his back on Metronidazole antibiotics again, Lectade (like a rehydrate drink) plus his Tryplase we are sticking to this for at least 10 days, then we will try one more food, Royal Canine and if he reacts to that then my vet has suggested Chappie, the only reason it is the last resort is that it is not fortified with vitamins etc, but she said it is the lowest fat content food on the market other than prescription so she is happy to try it,  Fingers crossed we will find one that Gunner can tolerate bless him, he eats whatver he is given and takes whatever medicine is handed to him,  I know for sure that EPI dogs are truly amazing they put up with so much, yet then never cease to amaze.

I hope this helps with the Tryplase,  and if you think of anything else just ask, Gunner and I are new to this as well, but we have a fantastic vet who like the guys on this site has been fantastic in guiding us along the long winding path that we are now following

EPI seems to be very unheard of in the UK, so thank god for knowledgable vets and EPI4dogs.

Hayley and of course Gunner x

Hayley... I have a suggestion for you and Gunner.... try letting the Tryplase sit in the food for 30-40 minutes.... it might be the change you are looking for

Hi Hayley,

I am new here as well. Welcome to the forum!

I wondered why your vet recommended a food low in fat. Does your dog not tolerate fat?

I do not know if the UK has grain-free dog food. For many, a grain-free food works well too. I am in the US and use EVO. It is grain-free. It is high in protein, 42 %, and moderate on fat, 22%. Barnum does well on it.

Hi Olesia and DxdBarnum,

It doesn't appear that Gunner can tolerate much at the moment which I think is the reason for the vets recommendation to go for lower fat. Evo doesn't appear to be available over here, I went through the list of ingrediants of the Hills ZD with the vet on Wednesday as I wanted to know if the dry kibble had anything different in it to the tin, it appears the same, but that said the ZD isn't be best option for Gunner from an EPI point of view as it is not what the vets recommend, however I know all dogs are different and ZD seems to be the only food that doesn't send Gunner running to the loo!!!   I will definately try mixing the Trplase 30-40 mins before I feed him., its good to have your knowledge as the box they come in doesn't say anthing like that!!!!!!   I will just have to make sure Gunner is at least two rooms away as he is always more than ready for his food and hears a fork, bowl, tin, packet from miles away, it will be like torture to him having to wait for his food, but it has to be worth a go, he will have to have a tennis ball to play with to take his mind off it 

I have just got back from walking Gunner and his older sister Daisy (she's just turned 2 and lives with my Mum) thankfully he was ready for his walk and had the energy for chasing his ball and playing but that will be it now for the day, he will probably sleep and plod and have cudlles but I love taking him out as I know the change of scenery does him the world of good and lets him forget that he doesn't feel well I just make sure he gets plenty of rest when he gets home as he is wacked out.  His still not right, he was sick again in the early hours of this morning and his poo is still not formed, we don't have the cow pat look , but just too soft and then he will go again about half hour later and this is runny.  I have to call my vet tomorrow to let her know how he is and take it from there.  I have also brought a basket muzzle for him to wear in the garden, I hate the idea but when he is permanently hungry he will eat anything that isn't nailed down and I can't leave him on his own, so I will give it a go, i think however Gunner may have other ideas

By the way DxdBarnum we have three Leonbergers who walk the country park where we live, Gunner and Daisy love them, they are so gentle and it seems the bigger the dog the more out two love them.

Thanks again all for your help and advise.

Gunner & Hayley x

Hayley,

I can't remember... but was Gunner tested for B12 deficiency? 

Also, is he being treated for SIBO with antibiotics (any gas, tummy grumbling etc going on???)

If these either or both of these secondary conditions are at play, it will hunder Gunner from improving. PLease let us know!

Another thought........

Sometimes the prescription diets work with EPI dogs (beceause the grain in them is hydrolyzed) and other times it does  not work and the dog has diarrhea.

Maybe one way to figure this out is to ... try feeding Gunner home-made meals with enzymes just for a few days (because to REALLY feed homemade, you have to do a lot of research to make sure you have the right balance of nutrients, vitamins, minerals for Gunner's weight, age and  and activity level)... But try real meat with enzymes for maybe 2 days... to see if his stools improve..... if so... then it is the food... if not... then you will have to look elsewhere for answers.

Managing EPI is a "one thing at a time"   trial and error ...... but definitely let us know on the B12 and SIBO... these are common culprits...........

In the meantime..... B12 and/or  SIBO could al

Hi Olesia, yes Gunner was tested B12 along side his TL test, he had three lots of blood done in total and his B12 was fine he also had a stool sample test which came back clear,  but I will confirm with my vet if SIBO test was done and result, ,he is back on Metronidazole 150mg twice daily, he has been on these before,. last time for a month, is this a usual antibiotic that is used for SIBO, is it one you use in the US?    Gunner very rarely has gas, or rumbly tummy but last week this was one of the things we noticed, gas and smelly, I have started tonight with the tryplase sitting in his food, its been there 35mins so let the feast begin. 

I am really lucky in that I can talk to my vet and she explains and listens so I will have a good chat with her tomorrow and see where we are heading treatment wise. 

Thanks again for all your support, I will keep you posted.

Hayley x

Hello Hayley,

Just wanted to say Welcome.  I loved reading how you were switching out squeaky balls and regular balls for training rewards.  Great idea!  You are very fortunate to have a vet that is willing to listen, chat and work with you to do what is best for Gunner.  While that should be the norm with every vet... it does not seem to be the case.  Tylan is an antibiotic often used for SIBO but I do believe the Metro antibiotic is also sometimes used.   I hope you see improvement with Gunner soon!

Becky

Hello Hayley.

I use Tryplase capsules for my Razzy and found you don't have one capsule for all 100gms of food.

Tinned food is soft and has a high water content (as does raw food and some home cooked) so it takes less Tryplase to digest it than soaked kibble which is very highly concentrated and goes through a high heat treatment... so needs more enzyme (Tryplase) to digest it.

We have a word 'tweaking' which means giving more or less enzyme by tiny amounts until we get the right ratio for each particular food.... with capsules its easier to give one capsule to a bit more (or a bit less) food until the poop comes right. I'd start adding a tablespoon more if its tinned food...

If kibble then it depends on the type...ie: I serve 7oz of well soaked Bakers Complete pre-digested for 45 minutes with 2 capsules of Tryplase..... but I can serve 8oz of Chappie kibble, well soaked and pre-digested for 45 minutes with 2 capsules of Tryplace.

I tried Royal Canin Low Fat Digestive but it didn't suit Razzy at all... then I tried ALL the expensive Hills kibble and they didn't suit.... each dog is different you see... what suits one will not suit another.... in the end I got best results with Bakers or Chappie kibble in the morning and raw diet for dinner and supper.

Its a real headache sometimes getting the diet AND enzyme ratio spot on, but you can do it... if I did anyone can.

Val

Hi Val,  thanks for all the info,  I can see I have a lot to work on, but hopefully will get the hang of it sooner rather than later,  I am really interested in what you feed Razzy for dinner and supper ie raw, what sort of things do you give her?    I suppose one positive to EPI hunger is that Gunner will eat anything,  I know friends who have had to use prescription food short term for various reasons and their dogs refused to eat,  Gunner thankfully eats whatever is put in front of him and will then look for anything else on offer which is not a lot     I am determined to get this right,  I look like a lab assistant when I prepare his food,  gloves on,  capsules counted, anticbiotics at the ready and then measuring out kibble and tinned food so I am more than happy to tweak away until I get it right and Gunner has the best poop in town.    I have mastered the art of poop examination and description so with a little practise I will master the tweak as well, good job all the dog owners round here know us and know about his EPI, when I am standing there poop bag in hand looking and observing no one bats an eyelid,  some even come with me now to see how it compared to the day before ,

HI Hayley~

You've got people that help you check poop quality from the day before???? OH My... now that is some really friendly folks!

If Gunner is on Metronidazole, it is for SIBO.. and yes, we do use Metro in the US... but, glad Becky mentioned Tylan. If the SIBO doesn't seem to go away, sometimes some dogs don't respond well to one antibiotic and the vet has to try a different antibiotic.... or sometimes, the problem is that the dog was not on the antibiotics long enough... and then some other times, SIBO can be really difficult to get rid of and the vet has to use a combination of antibiotics.

(are you having fun yet??)

The stinky gas usually indicates SIBO.

If this round of metronidazole doesn't seem to get rid of the gas... talk to your vet about trying a different antibiotic... Please feel free to share what i have gathered and placed in our FILES here from other EPI members from the UK and how they dealt with SIBO:

"Many times Synulox and Metronidazole areused together when SIBO ispresent. At a shorter duration than the 28days that Metro or Tylosin are prescribed in the US.

Stomogyl antibiotics for 14 day course

Metroinidazole for 14 days with Synulox for 28 days for heavy e.coli infection/SIBO"

It could also be that Gunner needs the food changed,,,,,,,,,,,,,,,, (oh joy... as this can be a lot of "trial and error"  *sigh*......)

Keep notes, make only one change at a time... wait 3-5 days before making another change, whether it is altering the enzymes, the food or anti's....or anything

By the way, that is terrific that Gunner's B12 level is fine! If when the B12 test was done the Folate levels came back on the high side, that is what would also indicate SIBO.... no need for another test .