EPI * Exocrine Pancreatic Insufficiency

Hello All, Lulu (aka Miss Lulupants) is a 2 year old 'Red Shepherd' (Australian Red Heeler x Long-haired GSD) who lives in Adelaide, South Australia. Lulu is super-smart and very pretty (everybody says so). Her parents are oddly named big dogs called Jemima & Craig.

We first noticed that she had big voluminous super soft stools in November 2009 but as this was around the same time that she was on large doses of Clavulox for an infected grass seed wound, the ‘funny tummy’ was put down to that. She continued to have large, loose, yellowy, smelly stools and was losing weight and was hungrier than before. The weight loss, gradual but undoubted continued with an apparent remission in February 2010 when she was put on a course of Metrogyl for three weeks. But as soon as the Metrogyl stopped, the large etc stools came back and the weight loss continued. She was just under 19kg in October/November 2009 and is now just 16.6kg!

Taking her back to the vet in March 2010, they did a fecal test and said that it was likely to be EPI. The TLI blood test was done (she was fasted for 12 hours beforehand) and came back with a score of <1.0

We haven’t had a B12/Folate test done but she has been getting cobalamin injections weekly and has had three injections so far. The vet has put her on a one month course of Metrogyl (Flagyl) (200mg twice daily which is a low dose we think) for 30 days for SIBO and explained to us about SIBO and the effects of it.

We are giving her Enzyplex at the moment, 2 scoops (1 scoop =6g) per meal. We're feeding her the pre prepared BARF raw diet (1 sachet 3 times a day, sometimes 4 sachets a day). We have been adding extra raw veg and some soaked oats and psyllium with each. We soak the oats in warm water, add the meat, psyllium, enzymes and raw vegetables and mix it all thoroughly. We’ve been letting the mix stand for at least half an hour at room temperature. We have been making up one day's meals the night before, letting it stand for half an hour (or more) refrigerating it and then letting it come to room temperature before giving it to her.

She is ravenously hungry, all the time and there is still poop eating going on. We have to be really vigilant in removing the poop otherwise she will eat it. We are not giving her regular kibble because she does not seem to be able to digest it at all at the moment and if we do feed kibble (even a tiny bit) the poop goes softer and there is undigested fat in it. In the last three-four days the poop has been alternating between much smaller (less volume) firmer and well formed and softer, bulkier and less formed. She has been doing about four to five poops a day but the overall volume and each poop is getting smaller. It’s still yellow and smelly though.

She has been having a lot of farting/gassy/gurgly tummy and her tummy has felt quite tight after meals. The gas seems to be getting less in the past few days to a week .

Being half cattle dog she is a very energetic, bouncy and alert dog and in this last week she has been noticeably less energetic and wanting to be closer to us, not fearful but sleeping on our feet or right near us, wanting cuddles, tummy rubs and so on.

The food/enzymes she is on at the moment seem to have improved poop quality is still going between good and not good (but at least it isn’t disastrous now). Perhaps we should set up a PQI (Poop Quality index)? Half-joking.

Since finding this wonderful forum we've learnt that plant -based supplements like Enzyplex are not enough. 'Creon' is the local (and only) porcine treatment available. We discussed this with our vet this afternoon and she's going to do some more research. She suggested not changing too much right now given the early stages and in an attempt to reduce variables. She also suggested easing Lulu off the Barf and onto the kibble we have just ordered - Royal Canin Hypoallergenic which appears to have been specifically tested for EPI http://www.royalcanin.us/products/productdetail.aspx?ID=69 . Hopefully this arrives tomorrow as no vet had it in stock locally and we ordered it online. The vet is doing some research and will advise more on Tuesday of next week by which time we will have changed Lulu's diet.

If we can stabilise one element we can then move onto the next. Lulu was 17.3kg (40.8 pounds) last week and has lost another 700g (3.7 pounds) with today's weigh-in at 16.6kg. That's 10g (1/4 pound) per day which is at least a bit better than what we averaged was 55g/10.2 pounds per day. But it's still heading south and of course we're worried and want it stabile.

We are feeding her (at least) 150% of what she was being fed previously. We’re trying to work this out and get our girl healthy and bouncy again.

One thing, we're wondering though if we should keep feeding oats (they are a grain after all) and about fat content of food, the BARF is about 12-14% but the kangaroo one is less, about 4% and am wondering if that is worth a go although 'roo may not be good for other reasons. Any experiences fellow Australians?

And yes we are feeling a bit overwhelmed but are distracting ourselves with research and determined to stop the weight drop! Any and all advice would be greatly appreciated and warmly received.

Jemima & Craig (Lulu's Parents) 

Hi Jemima & Craig and Lulu.

Good heavens... Lulu is absolutely BEAUTIFUL!

I can't help much with the diet or enzymes because our UK food and med is different.... BUT... many here use Creon and it seems to be very good... much better than plant based enzymes. Very often turning to porcine enzymes is the turning point for these dogs.

I don't know about the Barf diet either but I understand that with pre-made diets you need to add MORE minced raw meat because EPI dogs cannot tolerate as much bone as normal dogs and the bone ratio is lowered by adding more raw meat.

Most vets seem to be wary of raw diets even here in UK but it does suit MANY EPI dogs (including my own Razzy. I make her raw at home because she has several food allergies)

If the kibble you ordered suits Lulu then go with it... if not then don't be afraid to use your own judgement... much of getting EPI under control is learning that YOU know your dog best and in the end YOU have to make the choices on a day to day basis.

I'm not sure about the oats as I have never used them... at first I stayed with a very unsuitable kibble to get Razzy stable because she couldn't tolerate anything else... then we went to raw feeding for a year.... now we give kibble for breakfast and raw for dinner and supper. It has been a three and a half year learning curve but my darling is now fit and well and living a good life.... although age is starting to give her hip problems we cope very well and EPI is just a way of life that means we need enzymes for her digestion.

Hang in there... I'm sure others will come in with great tips and advice.... oh, and welcome to the family. Its sad you need to be here but its a good place to fight the good fight with the monster called EPI

Val.

Well Hello Miss Lulupants!  You sure are one very pretty girl and I bet you are very smart also!

Hi Jemima and Craig,

Welcome to the group!  This is not a group folk "want" to be a part of but without it many of us would be lost.  It sounds like you are experienced EPI'ers already except for missing one very important piece of the puzzle... Creon!  We started off with Creon 10 but had better luck switching to Creon 25 and now just  recently have found that two Creon 25's seem to be the perfect dose with each meal for our boy Boss.  That and the B12 injections have made a world of difference in his poop volume and frequency... just twice a day like a normal dog    Hopefully you will be able to get some soon as I would bet you will see a big difference once you do!

Hi Jemima, Carig and Miss Lulupants (I just love her nickname!!)

And a very warm welcome to you all.... and YES indeed....Miss Lulupants is definitely  a cutie!!!!!

Well, first i have to say i am very impressed.....you have already researched and are taking a lot of the right steps.

The biggest thing that jumps out at me, which you already know, of is that the Enzyplex  is the wrong enzymse treatment for EPI.

And there is a possibility that if that is the problem ... that the food you are feeding her is just fine. .... or not..... (welcome to the crazy world of EPI!!!)  But the only way we can tell is via "one-change-at-a-time" and wait, watch & record results.... and then make the next change.

Do you have any idea how long it will take your vet to research the CREON?   The reason why I am asking is because, if possible, and if fairly quickly... this is the first change i would try to do in your situation......switch to CREON.

If it would help any, please go to our FILES section (instructions are at the top of the FORUM home page).... select the "International EPI Products used "  print and share the Australia section with your vet... and/or go to the enzymes page

http://www.epi4dogs.com/enzymesdigestion.htm

 and print and share this with yuor vet.... we have a CREON section in it.  We also have a few members here from Australia. Lynn hopefully will chime in.. she uses CREON... with success.  As so many others here on the FORUM since pancreatin powder is not available world-wide.

The next change I would look at is eliminating oats from the diet.... especially since you are already giving psyllium and veggies too.  That might be just too much fiber. Some EPI dogs can take more fiber than others..... but the easiest way to figure how much is to slowly add fiber to the diet.

Many dogs do really well on the hydrolyzed prescription diets.... and then some don't ... (are you sensing a trend here :D?  ) But there really  is a good possibility that you may not have to change foods if you don't want to.... once you start using the proper enzymes................

Hi, Gemma, Craig & Miss Lulupants (what a great name). 

A very warm welcome to our EPI family.  I am also from Australia (Melbourne) & my English Setter Megg has had epi for just on 3 years now.  We were very lucky to have a vet who was familiar with epi, & he prescribed us Creon capsules (along with enzyplex) from day 1.  While enzyplex powder should help, it is only a plant enzyme (supplement) & will definately not work on it's own.  Most dogs just seem to continue losing weight until they start on Creon capsules.  You can buy them from your local pharmacy (we get ours from Chemist warehouse).   We use Creon 10000 & they have worked very well for us (most people use the 10000 strength).  Megg has one capsule per meal & no prescription is needed.    She weighs 27kgs. 

There is some good information in our files about Creon 10000 which I'm sure you'll find interesting. 

Again welcome & I'm sure Miss Lulupants will be thriving again in no time.  She looks gorgeous in her photo;  very pretty indeed.

Lynn & girls. 

Welcome Craig and Jemima and the one and only Miss Lulupants (one very gorgous looking furbaby)

Again, so sorry Miss Lulu has been diagnosed with EPI, however on the up side, you've found this forum so soon.  As you've already seen, there is a wealth of information and experience here.  Its pretty daunting being presented with this to deal with, however from what I've read of your post, you've really done your homework and you have vets who are willing to learn along with you.

Add my 'Yes' to starting the Creon too, that is the way to go and you will surely see a difference in the poop department.

Don't worry about describing poops, it comes with the territory.....we even post poop pics!!!

If you take some photos of the poops before using Creon an then take some afterwards you will have a good idea of how it changed....  I used to take photos before and after any change I made to Bonnie's diet/medication etc.  It was certainly a good way of scoring the poop...............and not forgetting the 'Happy Poop Dance' when we get a good one....Oh yes, we do that too!!  

So welcome to the crazy world of EPI and I'm so glad you found us.

PS More photos of Miss Lulupants

Hello and wlcome Craig & Jemima and Miss Lulupants!! (count me in for loving the name)! 

She is just beautiful!!!  Our motto here is "whatever works"!! As we all know, every EPI dog is different in what they respond to...We all wish there was a cookie cutter that we could stamp on every dog and swear to god it works, but that's not the case and if it was, there wouldn't be a need for a forum such as this.

Myself, I've been itching to try Creon, but I stabalized my Tara (after years) on Pancreatin and I'm too terrified to rock that stable boat, you know??  As long as she continues to do well (I put 35 pounds on her), I'm sticking to it!!

Thank you all for your advice, it's absolutely invaluable

Lynn, quick question, what probiotics do you use? I was giving Lu the Inner Health dairy free but have just run out and wanted to start her on some again so that her little system has all the support it needs.

We're hanging out for this super kibble to arrive so we can give it a go. I saw that Craig posted a link to the product description, it's designed specifically for EPI dogs and also has ingredients for skin support.  I found a research paper on it where it was given to GSD's with EPI and skin conditions and apparently works very well for that combination of conditions as well.

I took oats out of her food and the results are coming through, big soft sloppy again, so looks like the oats were (if not being digested) actually kind of holding things together, slowing down the moving through the gut and giving form to the poop.

Her full name is actually Princess Lulu Pants (she doesn't use her full title in daily life), that's why she has ruby red Swarovski crystals and silver studs in her handmade collar, only the very best for the Princess Pants! 

Hi Jemima & Craig,

Sorry I called you Gemma earlier.  Away with the fairies (lol). 

We use 'Blackmores' Acidolphilus Bifidus for Megg.  One capsule per day.  You can buy them either at the supermarket, pharmacy or health food shop.  Have found it works well & she tolerates it fine. 

As to the Creon, sooooo pleased that you are buying it now in preparation for your Vets visit on Tuesday. 

Please continue to ask as many questions as you can think of.  We are certainly not experts, but many of us have lived with this condition for a few years now & we can share our experiences.  It is all so scarey at first, & I'm the first to admit that I was a massive sook.  If it wasn't for many of these wonderful people here, I don't know where we would be right now.   You & Miss Lulupants have found a great place to be for help & support. 

Lynn & girls.

I LOVE this line in your signature....

Lulu is super-smart and very pretty (everybody says so - including her!).

Some of these lady dogs are SUCH LADIES!

My 'very high class' Razzy makes me feel like a peasant serving a Countess

Don't yer just love em?

I'm glad to see you are managing to get sorted and making some excellent decisions... the early days are so stressful its sometimes hard to see a clear path anywhere. I was a total wreck and in the end Razzy had to steal her friends kibble dinner to make me see THAT was the right one for HER!

It was about the only kibble I hadn't tried and I was getting desperate, it took Razzy's good sense to put me right... (peasants, eh? They never do see the obvious! :dry:)

Yet in some strange way, EPI was the making of Razzy. Bless her heart she is now the dog she always should have been and the behaviour problems are well behind her.

Val

Ah!!!!!!!, & she definately is so pretty.  Beautiful photo's of a beautiful Miss Lulupants. (love saying that name). 

Hi Jemima and Craig,

Welcome to you and Princess Lulu Pants.  How nice that we have another member of royalty to join the Countess Razzy!

You are on the right track and things will come together and good poops and weight gain will follow. My boy was so scrawny but he ended up putting on a total of 39 lbs and is now trying to lose a few - want to keep the big boy lean.

She is a very pretty girl and I think a tiara would look lovely with her bejeweled collar!

WOW... playing with the water  is a great shot and don't they look different when those pearly teeth show?

I only have one pic like that of when Razzy and Benji were playing way back as youngsters... but Razzy doesn't look much like a Countess in THAT pic...:)

Oh My........... what BIG teeth Miss Lulupants has.... biting the water!

And Miss Royal Razzy............showing her "royalty" to  Benji... eh?!

LOVE THE PICTURES!!!!!

Jemima ~

Regarding "I took oats out of her food and the results are coming through, big soft sloppy again, so looks like the oats were (ifnot being digested) actually kind of holding things together, slowing down the moving through the gut and giving form to the poop." Good to know!!! Some EPI dogs DO need a wee bit of fiber... and oats have some of the water soluble properties which does exactly what you described... so if you decide to stay with homecooked.... just add it back to her diet ...  Although frustrating....This is how we figure out things with an EPI dogs (especially the diet part... because one EPI dog's dietery needs can be so different from the next EPI dog).

I don't recall anyone trying the Eagle pack holistic diet for their dog.... so we will be waiting for your report on how Ms. Lulupants does on it. 

Val, that's one laid-back in-command my-mouth-is-bigger-than-your-mouth kinda smile on Razzy. Our little Lulu gave a royal bugger-off to a 35kg GSD at the park yesterday so she can't be feeling too bad comparatively (and she won :-))  

It's 11pm now and she's a bit tired from the beach, more than usual but that's to be expected. The first meal of raw+Eagle Pack RFF went down well, no tunny rumbles as yet. We'll be watching the weight with interest next week. If we can slow the loss, we'll be happy. She's a cracker. Here's one of her in fatter times...

And thanks to Donna & Debra, we look forward to doing the 'Happy Poop Dance' (although we promise not to post a video). And Donna & Kathy, you stacked 35+ pounds onto Tara & Teddy, that's another couple of Lulus!

I'll leave Jemima to comment on the oats/home-cooked situation. Our last dog Bella (Border Collie x GSD) got pancreatitus at 2 yrs but after a brief yellow spell spent the next 14 years on a low-fat mince 'n rice diet that allowed her to out-last most of her contemporaries. But Bella, bless her, is another story for another time...

Ted's big mouth - yelling at me to throw the stick NOW!