EPI * Exocrine Pancreatic Insufficiency

 On the 1st of March 2010 Barney was dignosed with EPI.

Two days prior to this I came home from work and found Barney in a collapsed state and there were sloppy poops and blood all over the floor. I had seen him 2 hours before and he showed no signs of being poorly. We rushed to the vet who hospitalised him immediately. While he was in hospital they did several tests to find out what was wrong with him. All the tests came back negative apart from the EPI which was positive.

We were very anxious as we new nothing about this condition. The vet reassured us that with a course of Vitamin B12 injections and Lypex twice a day this would control his condition. She also told us he would have to have a prescription diet.

The Vet said she had never heard of a Border Collie having EPI.

She said that if we could source fresh bovine pancreas we could give him that and there would be no need for the Lypex. I have rang around and as yet have not been able to find someone who would supply fresh pancreas.  Has anyone ever done this ?

The vet also said Barney would have to have prescription food (no treats, nothing else) but on browsing through the forum this does not seem to be the case. I would be grateful for any suggestions.

Barney had his second injection on Monday and when he was weighed he had gained 1kg in a week but is still only 12kg at 20 months old.

Any do's or dont's will be greatly appreciated.

Hi Eileen and Barney,

So sorry you have to be here, but welcome!

Of course Border Collies get EPI, we have had some on this FORUM! This is one of the problems with EPI. Many vets still think that only GSD and Rough Coated Collies get it... wrong... ALL breeds get it... and it is becoming more and more prevalent.

If you can get your hands on fresh bovine pancreas... that "should" work. Most dogs respond well to it, but then again, things are not always straight forward with EPI... so with some EPI dogs... fresh bovine pancreas dosn't work.. but it is definitely worth a try!

"If you would like to try using raw pancreas;  beef, lamb or pork pancreas may be used. One to three or four ounces of raw pancreas canreplace one teaspoon of pancreatic extract. Raw pancreas may be frozenin cubes for future use and thawed naturally, but never heat on thestove or in the microwave." http://www.epi4dogs.com/enzymesdigestion.htm  Some advise aganist pork pancreas because of possible bacteria..

First thing i am going to recommend to you is to download an EPI LOG and start keeping track of EVERYTHING you give Barney and record the results. (this is one of the best tools in managing EPI) 

Scroll down on this page until you find it. It is a PDF File http://www.epi4dogs.com/downloads.htm

Next, when dealing with EPI, only make ONE change at a time, record what you do, record the results, and WAIT 3-5 days to observe results before you make the next change.

To deal with EPI, you need to manage 4 things. If one of these things is not addressed then your dog may not show optimal improvement, even if treated with the proper pancreatic replacement enzymes.

These are the 4 things you need to keep in balance to manage EPI.

• ENZYMES
• B12 Levels (tested via a fasted blood draw for B12 deficiency- cobalamin levels)
• SIBO (indicated via high Folate levels from B12 Deficiency test, or if there is gas and/or tummy grumbling and or/yellow mushy stools)
• DIET (usually low fiber. Most EPI dogs cannot tolerate grain. Many CAN tolerate fat although earlier research suggests only low fat diets for EPI dogs)

Regarding the DIET. Your vet is limiting your choices and there are many more options than just Prescription Diets.... BUT, although i personally have had bad luck with prescription diets for my EPI gal, as have others. There are still many many cases where prescription diets really helps the dog turn around, become stable and then you can make a diet change.

HOWEVER, because you found Barney in a collapsed state, and with blood all over the floor... this is highly suspicious that something else is going on in addition to just simple EPI.  A bacterial infection, possible major SIBO (small intestinal bacterial overgrowth)  IBD, low vitamin K.

Because of this, i would definitely follow your vets advice and give Barney a Prescription Diet for now.

I would also call the vet up ASAP and ask that Barney be put on antibiotics now... for SIBO (small intestinal bacterial overgrowth), if he is not on something already. Since you are in the UK, here are some antibiotic choices: (please share with your vet)

"In the U.K. many times Synulox and Metronidazole are used together when SIBO is present. At a shorter duration than the 28days that Metro or Tylosin are prescribed in the US. In the U.K. for a combo, use Metroinidazole for 14 days with Synulox for 28 days for heavy e.coli infection/SIBO.

Or Stomogyl antibiotics for 14 day course"

I want to get this out to you now, so I will post about changing Diet in another reply

Welcome Eileen and Barney,

Another member from good old blighty!

I am sorry you have to be here, but so pleased you found this forum, there is a wealth of information here.  You will find not all EPI dogs respond to the same thing (a real bummer!) however, there are many tips on managing EPI.  Its all a bit daunting in the beginning but becomes easier as time goes on.

Lypex - I too used Lypex with great success - How many do you use on each feed?

By the way where do you get your Lypex from - A few of us here use VETUK or Viovet on the internet, its massively cheaper than from the vets.

Is Barney insured?

Fresh pancreas...Hmmm thats a toughie, I don't think you will find anyone who will be able to supply it... our laws regulating offal is very strictly monitored by the Enviromental Agency.  The USA have better luck sourcing this than we do in the UK.

Daily Log - I would recommend you download a Daily Log (You'll find it on the tab named Downloads) and write down everything you do on a daily basis, this is invaluable especially in the beginning, if you change food, introduce medication...etc write it all down.... Wih EPI its a case of tweaking the food or enzymes (Lypex) to get the good poop.  You will find its all in the POOP:D

B12 injections - Very good of your vet to do this (Many of us found that the B12 levels were ignored and therefore compromised the digestive process) Do you know what the levels were - Its should read 'Cobalamine/Folate' - How long is he planning to give these out of interest?

Out of interest , has your vet treated an EPI dog before?  Please let her know she is welcome to look in on the Forum, she would be very welcome

Food - now there's a can of worms:dry: - How is Barney doing with the Hills Prescription food?  What do his poo's look like, soft, firm??

There are many different foods Dry/wet on the market but at this early stage I would be hesitant to advise a change just yet.. others may be able to advise with more experience.

Some of us found that feeding little and often aided the digesting of food - obviously if you're life style doesn't allow this then we all have do what we can.  I was able to feed three times a day.

Treats - You have read that some do feed treats and it may be possible in the future for Barney, but for now I wouldn't add treats just yet....when you do it will be trial and error..... some are able to give treats treated with enzymes, some make their own treats and some give treats just before they have their enzyme treated meal.... You will find a way when the time comes!

Drinking - Yep, thats normal and should settle down with time now he's having Lypex.

What I will say with experience with Hills prescription dry food is that Bonnie's thirst increased dramatically when I changed her to this.  No one could give me any reason for this, I even phoned Hills and they said they'd never heard of it before.  I had to change her food in the end and the thirst dramatically reduced.....thank goodness or we were in danger of drowning in pee:lol:. 

It's great news that Barney has put on weight so soon after starting Lypex. very encouraging indeed, some dogs take a while to gain weight....As I said before not all dogs respond to treatment the same way, some struggle to stabilise and some pick up as soon as treatment starts. 

Well, I'll let others welcome you and add their tips and advice.

Welcome again Eileen to our EPI family.  Don't forget to post some photos of Barney, we love photos!

Hi Eileen,

Having had experience with what antibiotics work with SIBO - I agree with the names of antibiotics Olesia has given you.  These are readily available and if you aren't insured you can get these on line with a written prescription from your vets to keep the costs down.

Hi Eileen and Barney, 

I'm going to sit back and let the more experienced EPI'ers give you their tremendous wealth of knowledge as I too am pretty new to all this,  but what I can say is you will not look back on finding this website, Gunner and I have been made to feel so welcome, and so much support has been given to Gunner and myself,  and the sense of humour on this forum just cracks me up and keeps you smiling   Welcome to the world of EPI, tweaking and poop monitoring  but I wouldn't change my four legged baby for any other, just wish I had that magic wand that we could all use and erase the EPI.  

Debra,  just read your comment  

Drinking - Yep, thats normal and should settle down with time now he's having Lypex.

What I will say with experience with Hills prescription dry food is that Bonnie's thirst increased dramatically when I changed her to this. No one could give me any reason for this, I even phoned Hills and they said they'd never heard of it before. I had to change her food in the end and the thirst dramatically reduced.....thank goodness or we were in danger of drowning in pee.

Gunner is on Hills as we are tweaking one thing at a time, this week antibiotics, but you did make me laugh as Gunner has been drinking so much it had me wondering!!!!  He has even taken to throwing the bowl round when his finished so that i know it needs filling up!!!!   I will now add to my EPI log  how much he is drinking per day.  Thanks x

Okay regarding Diets.

With an EPI dog, YES the diet has to be modified... but that is the last easy response to "diet".

Overall, once the EPI dog is receiving enzymes, the most important of the three enzymes, Lipase, Amylase and Protease, the most important enzyme is Lipase (for fat). 

Once the dog is receiving these replacement enzymes suchas Lypex. It "should" have absolutely no problem digesting normal amounts of fat in it's diet. As a matter of fact, according to research, it appears that EPI dogs that are given normal amounts of fat appear to achieve stability quicker than those on fat restricted diets....

However, as you will discover in treating an EPI dog. Not everything is simply standard with and EPI dog.

• Some dog are real easy to manage
  
• Other dogs are a constant challenge

In short, what seems to work best are low fiber diets (no more than 4% fiber).. or no grain. (however some EPI dogs REQUIRE some grain!).

To start off when initially treating an EPI dog, what we suggest is no-grain foods (or low fiber) and low fat.

Once the dog starts to eliminate normal looking poop, start adding fat to the diet to see if your EPI dog can handle normal amounts of fat so it won't have to deal with lack of fat issues (another thing to worry about *sigh*)

With an EPI dog, "most" seem to have the biggest difficulty with fiber from grains. This is why vets recommend Prescription Diets. Because the grain in these dog foods are hydrolyzed (processed in such a way that it breaks down the fiber so that it is more easily digested by the EPI dog, or pancreatic dog, or dog have gastrointestinal issues.

But this is definitely not the only option!

You will be able to give Barney (depending on how Barney reacts to various foods... hence keeping the EPI LOG - and this is something we all do... "trial and error" to find out what works for our individual dog) any variety of foods.

Some possibilities are:

• Grain free dry kibble commercial dog food
• Grain free canned commercial dog food
• Minimal Grain foods (canned or dry)
• Home-made cooked meals (must do research first to make sure it is balanced with proper vitamins, minerals & bone for Barney's weight, age and activity level)
• Raw food (again must do research first to make sure it is balanced with propervitamins, minerals & bone for Barney's weight, age and activity level)
• Combination of commercial food and home-perpared food

We have others here on the FORUM from the UK and I am sure they will chime in to tell you what they feed http://www.allaboutdogsandcats.com/images/dog_eating_cartoon.jpg" /> their EPI dogs

I used Burns Holistic Food and got good results from the Lamb and brown Rice (this particular one was for underweight dogs and had 15% fat), Bonnie did well on that with her Lypex, she was able to cope with the higher fat content.  Burns also do 7.5% fat in various kibble/flavours.  However when I tried the Salmon and Potatoe, I managed to make her constipated:lol:  Welcome to the crazy world of EPI!!!

If I think back to when we first entered this crazy world, if I'd got the enzymes right I probably could have stayed on the food I was feeding her.  I was changing food but hadn't got the enzymes right..... such a waste of money. (Bonnie was on Pancrex powder first and I didn't know about soaking food and incubating the enzymes - which you don't have to do with Lypex)

Thank you for taking the time to reply. 

We are in the same position - drowning in pee:)

I forgot to mention that barney was on antibiotics for 7 days.  Poops are now formed.

Vet has never treat a dog with EPI. She said she would try and get me some information, but I think that joining this forum was the best thing I could have done. Being able to comunicate with people who are going through the same as us.

Thank you very much I will keep you informed with Barney's progress and no doubt will be asking many more questions!!:dry:

Feel free anytime Eileen, we are only to happy to help a fellow EPI'er and you'll get used to us asking about poop and don't get scared off if we ask for a photo of a poop:lol:.......its all normal............HONEST!!!

Hello Eileen  and Barney and welcome, although sorry you need to be here...:(

I see Olesia and Debra (one of our good friends across the pond :D) have pretty much covered it, but I just wanted to pop in and welcome you!

You say Barney was on antibiotics for 7 days,  but just to let you know, often times, it's not enough to deal with SIBO.  Folks have had better sucess treating this for 30 days.

Hi there.

I'm from UK too and also use Lypex AND Tryplase.

For my Razzy I find Tryplase capsules that you pre-digest before feeding is best for her morning kibble... and Lypex is best and convenient for her evening  and supper of raw diet.

So there is wriggle room in treating this condition.

I couldn't use a vet diet unfortunately because it didn't suit the queen of allergy, but some do well so give it a chance and first tweak the amount of food up or down if poops go soft....although it sounds like you have hit the right note if poop is firm.

As to snacks I agree with the others that can and should come later when Barney has been stable for a few months. I give snacks right after a meal but Razzy is over 3 years into EPI and her digestive system has healed now.... giving me a bit more 'wriggle room'.

Keep us posted and keep up the good work.

Val

Hi Debra

Barney has 2 Lypex capsules every day 1 with his morning feed and 1 with his evening feed. Works out at £72 per month.  We are currently feeding him 3 times per day.

B12 - Dont know what his exact levels were but the vet said they were very low. Barney has to have 1 injection every week for 6 weeks then 1 every other week for 6 weeks then after 4 weeks 1 more injection.

Barney has 2 Lypex capsules every day 1 with his morning feed and 1 with his evening feed. Works out at £72 per month.  We are currently feeding him 3 times per day.

One Lypex morning and night but 3 meals?

Does that mean he has one meal without Lypex?

EVERY meal has to have enzymes so three meals = 3 Lypex.

Val

Hi Val

Barney does have one meal without Lypex. The vet said to do this. He has displayed no side effects and is gaining weight and poops are formed every time.

Hi Eileen,  not sure if you have Barney insured, Gunner is but his food isn't covered, I have found two brilliant companies online, loads cheaper,  just as an example they sell Lypex capsules for £42.89 for 60 capsules.  hope its ok to put the names on here?!!!!!      for food nutrecare.co.uk and enzymes pharmacy2u.co.uk  

Hayley

Hi Hayley

Waiting to hear from insurance???? Thanks for the info regarding food and enzymes.

Hi Eileen.  Wanted to welcome you.  A couple things that come to mind here, too.  I agree w/ Olesia, re the blood.  I would suspect something more than EPI as blood is not one of the signs.  It can and does happen now and then, but I'd suspect IBD also.  Sounds like what you are doing is working, though, so let's hope it was just one of those things.  Do you know what the tli score was?  Or how was he dx'd?  The reason I am asking, is no food should be given w/o enzymes, yet it seems to be working for you.  And yes, for SIBO, 30 days of anti's is the recommended amount of time.  Again, welcome and keep reading.  It is scary in the beginning, but we've all been there and do understand, so ask anything you want.

Hi Eileen~

Ahhh... only 7 days on antibiotic?  Please talk to your vet about possibly putting Barney back on anti's. Donna is correct ...7 days of any kind of anti's are not enough for SIBO... what will happen is things will appear okay for a ilttle while, and then little by little ...problems will start to arise.... from experience what we have noticed is that it is better to treat SIBO aggressively sooner rather than later....

Karen asked some excellent questions, especially as to how was Barney diagnosed with EPI. Did they do the TLI blood test? Or did they test the fat in the stools...because if they did the TLI test and the value was 2.5 or lower, than Barney definitely has EPI and as Val and Karen mentioned all meals should be treated with enzymes. If the fat in the stool test was done, it is not as accurate as the TLI test, so even if Barney tested positive for EPI... it is not 100% definitive that Barney has EPI.

Hi Eileen & Barney,

Just popped in here & saw that you & Barney are new.  Just wanted to say a very warm welcome to our group.    I see you've already had lots of great advice.  Please feel free to post some pics. of Barney whenever you can as we all love pics. here. 

Again, welcome to you both.

Lynn & girls.

Good Morning Eileen and Barney:

I'm sorry I didn't post sooner, but wanted to welcome you to the forum.  You've been given some great information so I won't repeat anything.  Please keep us posted...and as Lynn said, we'd love to see pictures.  By the way, your vet may not know of another Border Collie with EPI but no breed or mix, is exampt I'm afraid.