EPI * Exocrine Pancreatic Insufficiency

Congrats on the weight gain - Even if it is small, it means you're headed in the right direction

In transitioning Lulu from a raw BARF diet to kibble we've had mixed success. The transition began well or at least no worse until we switched to the new Hill's Hypoallergenic kibble which arrived on Monday but within 24 hours turned her formed but still soft poop into greasy blobs. We're guessing this is due to the relatively higher fat content (Eagle Pack Reduced Fat 9% Vs Hill's Hypoallergenic 19%).

You may need to increase the amount of enzymes you are using to adjust for the higher fat content

Question for everyone: what's the digestive period for the average woofer, 12/18/24 hours? Is it faster when battling EPI?? What are peoples' experiences with seeing how fast something goes in the front end and comes out the back end?

As Olesia suggested - to know for sure with Lulu - feed something she can't digest - I just give a whole carrot as manfred loves them and thinks they are treats - then watch for it to come out - you can't miss it

Hello Jemima, Craig and Miss Lulu -

I am horrible about sticking to the one change at a time rule.  I know it is what is best and have cussed myself more than once for not following the rule and then not knowing which change caused what - I can see Olesia shaking her finger at me now  

You are doing extremely well following the rules and I am not trying to sway you to the dark side... but you indicated you were going to pick up some Creon and well... don't you just love it when Christmas comes early    

I tried the "bookmark" idea with the carrot but during poop recon it was never to be seen again.  So I am always wondering the same thing as you about the poop input/output timeline.

Excellent news about the weight!

I already posted it somewhere around here in another thread but in case you did not see it - here is a picture of Scout and her pool from last summer - not quite pool weather here right now though.  Looks like your red long haired girl and mine could get together and have quite the pool party!  For some reason I have a sneaking suspicion that your girl is just as spoiled (or as I prefer to think of it "well loved") as mine! 

BTW Becky, we love the shot of Boss & Scout 'jawing'. Aren't long-haried GSDs gorgeous without collars. Lulu being a X red heeler of course ends up looking like a fox!

Scout actually reminds us of a red fox at times... she is by far the reddest GSD we have every had.  Collars can mess up the look of the fabulous manes of hair on coaties.  We try not to put one on either of ours unless they are leaving the property but that is because during their daily "jawing" and "smack down sessions"  I worry about possible entanglement.  I would love to see a picture of Miss Lulu in her custom swarovsky/silver collar!  Just have to make sure the word does not get out to Scout that such bling is available or she will want to trade in her camo collar for sure

I commented to DH that we did not have many photos of them jawing so he grabbed the camera last night.  Yup... just another quiet night putting your feet up to watch TV at our house.  I really should get it on video with the audio someday so that you can appreciate the full effect hmy:

Boss on the left - Scout on the right

Great jawing pictures Becky and Craig! I've never had much sucess with a carrot, but I believe Olesia to be right in that it's generally 12 hours to digest.

BTW, I think I have the "foxiest" dog!  Okay, someone sawed off the foxes legs, but I've always found Zeke pretty foxy looking! 

Gorgeous photo's, as usual.  Zeke is a very cute 'foxy dog' & Boss & Scout look as if they're having the best time wrestling around.  Love all the water pics.  Think I might have to try one of those pools for my girls next summer.  Looks like heaps of fun. 

Lynn & girls

Hi Jemima, Craig and Miss Lulupants,

Although I'm late as usual to respond, I thought I'd give you my 2 cents worth..

What are peoples' experiences with seeing how fast something goes in the front end and comes out the back end? With Kobe.. If I adjust his Creon levels or do anything which will result in upsetting his belly, I will see it within a few hours - I would say less than 12 hours for sure.

Similar to Lynn & Megg - Kobe is on Creon, although he is on the much higher dose of 25,000 (Forte). He recently had a relapse, so he is now back on the antibiotics which originally fixed his SIBO - This is now his 3rd round of it. We recently tried the Enzyplex as per the vets recommendation and a specialist here at Perth Veterinary Specialists http://perthvetspecialists.com.au

Kobe was diagnosed mid October 2009, and although we started the enzyme (Creon) therapy immediately, we saw no changes with his poop until we started the antibiotics.

Here are some teeth photos of my 2 - Poor Brandi gives him a good run even though she is so much smaller!

Wow Samantha, that's what I call a 'teeth photo'.  Fantastic pics.

Samantha - You win!  That is one set of chompers!  Scared me when I scrolled down and it popped onto the screen.  Kobe looks pretty good in the photo - not sure if it is current or not - but his coat just shines and his pearly whites just glisten.  Brandi does looks like she is giving Kobe a piece of her mind.  Love his markings... is it called bi-color?

Lynn - My two use their long hair to grab hold of each other when romping.  Your photo of Megg and Tess makes me think your two may also?  So Setters don't flash teeth at each other or is it just yours are good girls?  If you don't want to get a pool of your own you are more than welcome to bring the girls over to a pool party here!

Donna - Zeke is most definately foxy looking!  We have wild foxes around here and they are not that much taller than him.  Not much wilder either... we had a patch of wild strawberries growing nearby and I was been picking strawberries in one row and a couple rows over had a fox following along picking it's own. 

I love teeth like that!

Scout and Boss are beautiful and Scout is very red, I note she has nice crimpy ear fronds like Lu does.

Back to the poo front, massive soft poo this morning and a liquid one overnight. The poo this morning was like a B52 bombing raid on one of my plants, she just lined it up in the bomb sight and let the whole lot go!!  

She is back on the eagle pack and barf mix (soaked oats and psyllium added) and the most recent poop (just then) was soft but formed and a lot smaller so hopefully this will get better.

I'm currently using about twice as much enzyplex as manufacturers recommendation but the vet wants us to give it a really good go, so we'll try and get Madam stable on this diet and then see.

My gut feeling is that it will work up a certain point and then plateau so we'll see if I'm right or not.

As the morning poops are so large , I've decided to make her breakfast and lunch the largest meals (about 2/3 of her daily intake) and dinner one and dinner two smaller to see if that gets things moving through more regularly.

She had her B12 yesterday and today she's full of beans! as beany as beany can be.

Jemima

Thanks Lynn & Becky. Becky - Yep, his colour is referred to as bi or tri- colour. He is mainly black, with some grey on his chest and just above his chest, with the 'pencil' markings on all 4 paws. I'll post a pic of him as a puppy in the other one - That's when you can really see the colours!

Jemima - Sorry for asking this question when you may have already covered it.. Have you started administering Creon to Lulu?

Hello Jemima,

Sorry to hear your plant took a direct hit but glad to hear that she is at least feeling well.  Before we recently got Boss stable, he was sometimes pooping five times a day and  most of them were in the wee early morning hours to first half of the day even though his 3 meals were spaced throughout the day.  That is why I tried the carrot bookmark thing to try and correlate his input to output schedule but never could make any sense of it.  When we started the B12 shots and, most importantly, found the right balance of Creon for him, it changed.  Lately, not only has he been on a two poop a day schedule, he has not had the urgent need for it to be first thing upon waking.  I am sure you too will find the right balance for Miss Lulu.

Forgot to mention in earlier posts that it is wonderful you and your vet are working together to hep Miss Lulu, who is so keen to get better.  It sounds like she listens to your thoughts which is so important since you know Miss Lulu better than anyone else.  I hope she has time to spend here with us on the Forum 

Samantha,

no we haven't started Lu on the creon yet.

We are trying to change one thing at a time and as long as she's not now actively losing weight, we'll try the enzyplex alone and if it doesn't work/plateaus out (as I think it will) then we can say to the vet, let's give the creon a go and then when we do and there is (hopefully) improvement then we know its the creon.  

We're also trying to bring our vet along with us because they're learning about this too.

Becky, that pooing schedule sounds just like Lu, four to five times a day, three overnight and couple during the day then nothing from late afternoon till late at night as a special morning surprise for mummy (!)

Corn is the classic 'transit time' tracker for humans so I might try it for Lu. The bits of pine cones she eats in the park are good trackers too...

thanks again for all your info

Jemima

Sounds like you've got it all under control - A battleplan is what you need and it sounds (reads?) that you have one!

Quantity of poo - Since Kobe has/was(?) stable on just the Creon, his pooing schedule is the same as Boss' - 2 a day. Prior to that it would vary and be all over the place - Sometimes he would go 4 times from around noon to 5pm.. he just couldn't contain anything. 

It is definately frightening and frustrating at times, but if you keep an open mind and take the advise of these EPI experts in this forum they will help you along the way - They certainly did and still are with Kobe's battle.

Please do keep us updated on how things go with Lulu.

Well Becky unless you plan to make Scout start jawing with jealousy I wouldn't show her this...

And before you think we do spoil her too much I'll have you know that it was made by a wonderful artisan who supports rescue dogs (that and we found some leftover greenbacks from an overseas trip). Lulu can wear it again when she puts on a kilo or two!

Craig

Very beautiful collar on Miss Lulupants.  My girls both have fancy collars also.  Will take a pic. of them but they only wear them when going out.  My daughter has rescue greyhounds & my girls wear the fancy greyhound collars.  Lots of people stop us to admire them.  (Yep, the collars & the dogs :D)

Lynn & girls.

Hi Craig, Jemima and  Lulu.  I have been popping in now and then and following this.  Haven't had a lot of time to respond, will take a min. now.  First, sorry you have to be here.   But welcome.

Re the enzymes and 1 change at a time.  When making changes, the one at a time change pertains to different food, vitamins, supplements, etc.  It does not include enzymes, B12 and/or antibiotics or any other necessary medicines.  I do think you should try the creon sooner rather than later, as plant based supplements are not usually strong enough on their own.  There are others who have tried the plant based alone and upon commencing on the porcine enzymes (such as 6X, 8X, creon) the dogs turned around and put on the weight.  There are only a handful, if that, that can get by on the plant based supplement alone.  I really think if you try the creon, you will see a big turnaround, then once you figure out just how much you need, you will be on the way to stabilization.

Sorry I was late in chiming in.  And  this is just my opinion, but I really think it is something to do now, not waiting.

Oh, also have enjoyed the chompers on these guys. All the dogs look so good and just  love how they show them teeth playing.  Great pics.

Hi Jemima and Craig ~

Just catching up now on what your vet said: "The vet poned us at 8pm (that's dedication,thanks Chiew)! and Jemima had a good chat. We'll front up for the thursday B12 & weigh-in and then make a call on the Creon. JI think Jemima is right is suspecting that the plant-based Enzyplex is doing good but only so much. If we plateau on the stool front then we can add the Creon and see what exclusive difference tis makes."

Please don't wait, please talk to your vet, share this post and start Miss LuluPants on CREON. Enzyplex is only a digestive aid, it is not adequate treatment for EPI... EPI dogs need  replacement enzymes  to compensate for the enzymes destroyed by EPI.

Dogs with EPI need high potency concentration of porcine replacement enzymes of Amylase, Lipase and Protease.

Enzyplex doesn't even have Amylase AND it only goes by weight. This is not adequate.. And the longer the delay in treating an EPI dog with the appropriate medication to give the optimal benefit, the longer it will take  to stabilize the dog possibly inviting more damage.

Enzyplex Composition Each kg contains digestive enzymes

maltase 14 g,

protease 8 g,

lipase 24 g.

CREON 10 Composition : 150 mg Pancreatin

Amylase 8,000 PhEur units (BP Units) also equals 33,400 USP units

Lipase 10,000 PhEur units (BP Units) also equals 10,000 USP units

Protease 600 Ph Eur units (BP units) also equal 37,500 USP units

CREON 25 Composition : 300 mg Pancreatin

Amylase 18,000 PhEur units (BP Units) also equals 74,700 USP units

Lipase 25,000 PhEur units (BP Units) also equals 25,000 USP units

Protease 1,000 Ph Eur units (BP units) also equal 62,500 USP units

In the USA, the potency of the "powdered" prescription enzyme replacement supplements range from:

33,600 to 71,400 USP of Lipase (needed to digest fats and oils)

280,000 to 495,000 USP of Protease (needed to digest proteins)

280,000 to 495,000 USP of Amylase (needed to digest carbohydrates)

Although Enzyplex helps and you are heading in the right direction ...YEAH!...it is a good start but it will  not  adequate......

Powdered porcine enzymes are the recommended treatment for EPI.. In places where powdered enzymes are not available, CREON is then recommended.