EPI * Exocrine Pancreatic Insufficiency

Hi Craig ~

Regarding" merit of one enzyme over the other preferably with conclusions accessible to lay-people like ourselves?"  Yep.. read any investigative research on EPI when comparing pant enzymes versus porcine enzymes..... HOWEVER. if you mean comparing one brand to another (like Pancreatin, CREON, Pancrezyme, Tryplase, Pancrezyme, Viokase, Biocase, etc, etc. etc.....) basically they all work the same........what you have to look for is

• The proper "potency" (or as close as possible proper potency) of all three enzmes (Lipase, Amylase & Protease)
• How it is packaged, pill form, loose powder or enteric coated capsules
• How you need to properly apply which product to the food and how to prepare the food to effecitvely take the enzymes

You can also go to the enyzme page on this website, and see a list of variable enzymes. If they differ a little bit in potency, that's fine... but when they are measured in weight vs. potency or if they dramatically differ.... then you need to make adjustments to another product or use.

Maltase is an enzyme that catalyzes the hydrolysis of the disaccharide maltose to the simple sugar glucose. This enzyme is foundin plants, bacteria, and yeast.

Amylase is an enzyme that breaks starch down into sugar. Amylase is present in human saliva, where it begins the chemical process of digestion. Foods that contain much starch but little sugar, such as rice and potato, taste slightly sweet as they are chewed because amylase turns some of their starch into sugar in the mouth. The pancreas also makes amylase (alpha amylase) to hydrolyse dietary starch intodisaccharides and trisaccharides which are converted by other enzymesto glucose to supply the body with energy. Plants and some bacteria also produce amylase.

Regarding "How do we convert grams to USP units in order to compare?" No can do :(... Grams is a weight measurement and UI, BP and PhEUR  are pharmeceutical measurements.....

Regarding "We have vets telling us they have successfully treated EPI with Enzyplex" i cannot speak for the successes... but i certainly can speak for the failures.  If you would like, later today i will email you PDF's of scienctific reportsby vresearch vets  that explain and prove via scientific studies that porcine supplements are what works for EPI dogs... not plant enzymes.

Ahh it's midnight? You must be pooped and certainly don't need to make your head swim with all this mind-boggling info now... i'll get the research reports out to you via private email and you can look at it all tomorrow and PLEASE share with your vet.

By the way, i just LOVE Miss Lulupant's collar.... that is a really nice design!!!

Also... many good vets around the world are just not overly familiar with how to effectively treat EPI... as it used to be an "obscure" condition and not something that is not thoroughly covered  in vet schools.... but that is now changing ....thank goodness!

Ahh gee... i almost forgot to tell you..".If there's no substantive improvement it is our intention to start her on Creon"  is perfect!!!

Hi Craig ~

You are probably pleasantly sleeping by now.... but i just wanted to let you know that i sent you 4  PDF files 3 about treating EPI and 1 about the approval of CREON.

Also.... i would like to commend you http://weblogs.sun-sentinel.com/news/weather/hurricane/blog/bowing.jpg" /> on your thoroughness and research efforts in trying to figure out what the best plan of treatment is for Miss Lulupants.

Love the teeth everyone!

Samantha.... Kobe's teeth... OMG... those are some might big choppers!!!!!!!!!!!

Becky... i love it, love it, love it.... when they play like this, cracked me up, especially the picture of Boss showing his teeth with Scout curling up her lip in a snarl....and your right... we need to video tape these moments for the full effect.....

....although.... I am quite confident that Samantha captured the FULL effect of Kobe's pearly whites:D

Donna... you better hope Zeke can't read computer messages... "sawed off  the foxes legs"  http://pediatrics.duke.edu/wysiwyg/images/Kyra-chuckling-to-herself8.jpg" /> you're so bad ...

Craig... heck now I'm jealous... that is a gorgeous collar!

Hello Jemima, Craig & Miss Lulu,

We will all be anxiously awaiting the news on your weigh in today and chat with your vet. 

Our vet had not heard of Creon either.  Back in early December when we started down this road, he had prescribed us a proven product, the powder enzyme called Pancrea.  But, to quote my DH, "Boss can be a real turd about eating".   We were at our wits end getting him to eat anything with the Pancrea on it and on December 30th I cried myself to sleep believing he was not going to make it... he was either going to starve eating food without any enzymes on it or or starve by refusing to eat the food with the enzymes on it.  When I found this Forum and read about the use of Creon capsules (and B12), it gave me hope again.  I  ordered some online and showed up at the vet with the box and all the details for him to read.  A comment was made, rightly so, about there being lots of bad information on the internet but he did review the information I provided and agreed it was worth a try.  The vets have all the information they have learned in vet school and their practices but I believe the additional information of what folk out in the trenches have experienced has a value also. I am glad our vet and us could work together to get Boss back on track, as I do value his guidance and now he has gained information that might be useful for other patients.  But to tell you the truth, had he not approved the use of Creon I would have gone rogue and given it a shot on my own.  While it sounds like you do not have any problems getting Miss Lulu to eat, it sounds like Australia has limited options available for enzymes.  I hope your vet reviews the information you have on Creon, agrees it is worth trying and then also has that new knowledge to help future patients even sooner. 

I hope you got a good nights rest and please let us know how things go today!

Regarding the collar - that is some serious Bling! Absolutely STUNNING!!!  

Lynn - I can't wait to see what your girls have also.  Scout is going to want to run away to Australia when she sees what all the girls are wearing over there!

Hi Craig,

Just checking in to see how you got on at the vets.

Oh oh... I told my DH, Rich, that he needed to look at the picture of Miss Lulu's fabulous collar. He usually spends his internet time reading sports, not here on the Forum. But he read through Miss Lulu's story and made the comment "they are probably going to think you all are getting a percentage of Creon sales from the way your selling it". Oops! Sorry, if it came across that way at all!

No, Becky, I don' t think you came across that way at all.  It is working for you, it is the only enzyme they have available in Australia, and you are touting what works for you!  That is what this is all about, sharing ideas on what works for our furkids.

"Boss can be a real turd about eating".. that made me giggle.

Becky, I agree with Karen in that it didn't come across that way at all. Creon works - It's working for Boss and Kobe at the moment. Although they are special boys who need the stronger stuff

Wow, That collar is some serious BLING! I LOVE it!!!    I always need to have a collar on the dogs becuase I have so many - one never knows when you are going to need to grab it...I love the rolled leather collars for the heavier coats...I had one for my pluch coat, Tess and I just bought one for my long coat, Zoey and it works wonderfully... Speaking of bling, I once bought Tara a silver hand made charm box with a tormelene <sp?> stone in it from an aution to benefit CorgiAid (a rescue group, thus a good cause).  The crafter said that tormelene held healing properties and as this was the time when I wasn't sure if Tara would make it or not, I figured it couldn't hurt...I put it on her collar and two days later it was gone...I remember hubby and I searching the yard (she hadn't been anywhere else) on our hands and knees for it, but we never found it....

Olesia, Zeke is used to folks asking what we did with his legs...

I love all the teeth pictures...Wow, they all look like they mean business, but we know it's all a front...

Whew... Thank goodness...  writing myself note "do not listen to DH" 

Hello All and a special hey to Olesia for sending that extra research through last night.

Lulu had her 4th B12 this evening and weighed in at 16.8kg (37 pounds), 200g (0.45 pounds) lighter than three days ago. So based on our limited experience and the consensus of you good folk yes the Enzyplex is helping but only up to a point bearing out what all of your own experiences have shown that it is only a supplement. We bought Creon 10000 earlier today in anticipation of the weigh-in (as an aside we've been purposefully weighing Lulu with her beautiful collar on, as that's how we began, but having weighed it separately tonight it comes in at a serious 200 grams of bling on its own so you can knock that off the top of Lulu's weight!)

Coincidentally I'm currently reading a very good book called 'A Modern Dog's Life' by Paul McGreevy (I'm a dog psychology tragic) which makes a passing remark about collars and their comfort factor which made sense (so we've been saving the bling for best). And 'Lu is so pretty without the bling (let's face it when you're pretty it doesn't matter how you wear your hair). You can have a look at Paul and his pals, beautiful Coolies, here 

But then it's not such a coincidence as it's all about observation and research i guess.

Back to business: Lulu starts Creon 10k tonight. Based on two pups on this forum weighing 17-27kg (37.5-59.5 pounds) and the human dog directions of 'at least one capsule per meal' we'll also start Lulu on 1 cap per meal. She's currently being fed 3 meals per day but our understanding is not necessarily the amount per day but the amount per meal that gets the enzyme-action happening in the right way (ie it's not cumulative). We'll also be continuing the B12 for the recommended 6 weeks then we might test levels to see how she's tracking and in the context of what will then be two weeks of Creon. We will continue with the Enzyplex supplement until she's stable.

So, if anyone has any adverse experiences of Creon 10k and 3 capsules per day (1 per meal) please let us know.

Once again many thanks to everyone for all the support and advice and we hope that one day we'll have enough knowledge to help someone else along the road to EPI-wellness.

Craig

That should have been 'Based on two pups on this forum weighing 12-27kg (26.5-59.5 pounds)..." Lulu is currently 16.8kg and should be around 19kg, somewhere in the middle.

Craig

Hi Craig & Jemima,

Soooooo pleased you are starting Miss Lulupants on Creon tonight.  My Megg is an English Setter & she weighs 26-27 kgs. She has one Creon 10000 strength capsule per meal & she has done really well on that (for 3 years now).  Some dogs do seems to need more, but Creon is a human med., & it says on the bottle that you need one capsule per meal which is all I have ever used & it has worked well for us.  My friend in Tasmania who has an EPI GSD, who weighs approx. 38gs., has also only ever needed one capsule per meal but from my experience here on the forum, some dogs do seem to need more.  I would not give your Lulupants anymore than one capsule per meal especially in the beginning.  She seems to weigh a good bit less than my Megg, so one capsule would most probably be fine for her.   Just remember to feed it to her whole & give it to her immediately before her meal.

Just really happy to you're starting Lulu on Creon.  I'm sure you'll notice a difference very soon.

Lynn & girls.

Hi Craig ~

YEAH!!!  Mis LuluPants gets CREON tonight.  Please keep us posted on how she does...what her poops look like (after she has CREON....(an elimination of about 12 hours give or take a few hours....afterwards) .

One CREON 10 capsule per meal sounds like the right place to start with this. Keep an EPI Log... and  record.. record... record...............EVERYTHING!!!!  If you have any questions about adminstering CREON 10.... check in with Lynn..... if you need more information about CREON... check in with Frank.

Regarding your comment "We'll also be continuing the B12 for the recommended 6 weeks then we might test levels to see how she's tracking and in the context of what will then be two weeks of Creon."  (two parts... checking B12 and checking TLI value)

1. You might want to hold off on re-checking her B12 levels until you reach the part where you start to give just monthly injections....that might be a better time to check if she is maintaining the B12.....

 please see Dr. Jor Steiner's (from Texas A&M University Gastro Lab) protocol recommendation for B12 administration (phew... that was a mouthful!):

"The dose regime is typically one dose weekly for six weeks, one dose every two weeks for six weeks, then dose monthly. Remeasure serum cobalamin concentrations (B12) one month after last administration."

2. Regarding re-checking TLI levels... excellent idea if this is what you mean by testing levels.... however.... hold off on re-testing TLI levels- -to positively confirm it is EPI and not a false positive reading- - until Miss Lulupants has been stable for about 2-3 months.  Stablization = consistent good poops.  It takes a whilte for things to calm down in their systems.

I just looked up "A Modern Dog's Life" and watched the video... Hmmmmm...make a lotof sense... Modern Society has indeed changed, sensories are now all different for the modern dog...... this is exactly the kind of material i am very interested in reading! Thanks for posting about it.... I plan on ordering a copy of the book this weekend!  If you are interested in dog behavior.... one of my favorite books (which really opened my mind up to think outside the box when trainnig) is "How Dogs Think, Understanding the Canine Mind" by Stanley Coren.

Keep us posted!

Good Morning Craig, Jemima & Miss Lulu,

I checked in on you first thing this morning (before coffee even!) and reading that you are starting the Creon has made my day!  You are probably like us with one of thickest files at the vet office because of all the information we have printed out for their reading.   Have you been keeping a log of all Lulu's input/output?  I printed out a copy of the one I kept on Boss, highlighted any big changes and gave it to the vet at weigh in's also.  Once he got used to the format he could quickly scan and see where we were on things.  Made our file even thicker!  We started Boss with one Creon 10 per meal and I think that is an excellent starting point for you also.  Hopefully it will be all Lulu needs.  With Boss we ended up increasing to one Creon 25 per meal and then from there increased to two Creon 25 per meal.  At the lower levels Boss had solid poop but we did not see reduction in frequency until we increased and then poop perfection was achieved   We have been using the Creon 10 for snack time lately.  Boss used to be on regular EVO kibble, then we had to go to the low fat EVO as it seems he had a problem for awhile with the higher fat content in the regular.  Eventually got him back to the regular EVO but then switched to the Hills Z/D due to feet licking/allergy problems.  So currently he gets 2 cups of that 3 times a day.  He is around 70 pounds which looks on the skinny side but is WAY better than the sickly looking 64 pounds he had dropped to this past December.  He should be around 75 pounds for his frame but has never weighed that much... yet - I still have hope for someday reaching that goal!  Please keep us posted how Lulu does as you get her going on the Creon.  Now off to get that coffee brewing  

Olesia, thanks for the B12 info. Will enter it in the fattening file.

Thanks Becky, yes our 'Log Log' is thickening up nicely thank you and hopefully Lulu's will too. Sorry, that's a bit crass but midnight approaches again. The dog's asleep at the foot of the bed and I now feel the need to sleep at the top. 

Craig

yes our 'Log Log' is thickening up nicely thank you and hopefully Lulu's will too    Oh that's a good one!

Looks like 'A Modern Dog's Life' by Paul McGreevy is available on Amazon but only the paper version so will have to wait for it to show up in the mail.   But "How Dogs Think, Understanding the Canine Mind" by Stanley Coren is available on Amazon in electronic form so have downloaded it onto the IPad for reading this morning with my coffee!  Thanks for the recommendations.

Lynn - Scout is still waiting for those pics of what style your girls are wearing...

Donna - That stone must have been very powerful .  She only had it for 2 days and she was healed!  How is Miss Tara doing on her diet?  I just love to hear about EPI dogs having to be put on diets to lose weight.

My local library doesn't have the Coren book and it's OOP. Poop. Perhaps Becky can mail me her iPad when she's finished with it 

Craig