EPI * Exocrine Pancreatic Insufficiency

Hi, my name is Jessica.

Bella is a German Shepherd Dog. She will be 17 months old on May 23rd. Around the beginning of March, my family and I realized that Bella's stools were very loose. They were yellow, loose "pumps". At first, we thought maybe it was a diet change. We switched from a puppy food to an adult food without first gradually mixing. After some experiments with that, we realized that nothing was getting better. At the end of March/early April, she was scheduled for her checkup. She was due for a 3yr rabies shot, etc. We had told the vet about the stools, in which she took tests to see if it was parasites. They came back negative, so she told us to experiment with the food some more, and if nothing changed, to let her know. Mid-April we called again, and she put her on an antibiotic called Metronidazole. The vet said if that doesn't work, then we need to do some more tests. Well sure enough, it's May and Bella was diagnosed with EPI. She was once 67lbs, and today is down to 55lbs. It's a very sad experience. She begs me for food, and it breaks my heart because right now, there is nothing I can do until the medicine comes.

My family and I are a bit overwhelmed. It is a bit scary because Bella has brought much happiness to a family that has had lots of hardships (a very bad divorce). Bella had some issues after coming home from the breeder. She had a horrible case of worms, in which the breeder claimed she wormed her twice, in which she did not. After we got that situation taken care of, 2 months later, Bella got ahold of a cooked chicken bone. Since she was still very small, we took her to the emergency room for operation. The vet didn't think she would be able to pass the chicken bone.

She has had a very hard life, and according to the vet, we saved her. Now, she has EPI, and we are devastated. This site has given ME some hope; however, my dad feels she will not have the quality of life that a normal dog would have. The vet is coming tomorrow with the medicine, in which I will officially know the test results and what medicine she will be put on. (I will be sure to keep you guys updated). I am so upset though because my dad is going to talk to the vet about putting her down (if this is the best option for her right now). The vet also mentioned that the enzyme medicine is expensive. Approximately how much is it, and how often will my family be getting this? (every month? 2 months?).

On the phone, the vet mentioned something about problems with her liver now too. I will get official details tomorrow at 6pm eastern.

Any advice would be helpful! I plan on purchasing the magnet for my car to support EPI research.

Thanks in advance

Hi Jessica,  Welcome to you & Bella to our EPI forum.  I'm Lynn & my EPI girl is Megg.  She is an 8 yr. old English Setter.  She has had EPI for just over 3 years now & is doing well.  We are from Melbourne Australia & these very knowledgeable people here have helped me so much along the way & they will help you also.

I know it's all so very scarey in the beginning, but EPI dogs can & do live a normal life.  Of course there are some exceptions to the rule, but most do really well once they start on their enzymes.  These EPI dogs sadly need enzymes with every meal for the rest of their lives, but once they become stable, all seems to come together for them.   Yes, the enzymes can be expensive but if you are in the US, then most get their enzymes from a wonderful lady called Diane who buys them in bulk & sells them at a much reduced rate.  As I'm from Oz., I hope I have that bit right.  I'm sure others will chime in here & tell you about Diane's enzymes.  They are definately so much cheaper than the Vets. 

Believe me Jessica, these dogs do have quality of life.  Once their on enzymes, their poo's get better, they start absorbing all the nutrients in their food & put on weight.  Bella is only a baby.  She will improve very quickly.   I have two Setters, Megg, my English EPI girl, & Tess who is an Irish Setter.  No-one can tell which one has EPI which makes me very happy.

I'm sure you'll be hearing from others here so good luck & please feel free to post some pics. of Bella.  She sure looks a cutie. 

Again welcome, & please ask any questions that you can think.  Someone will always be able to answer you. 

Lynn & girls.

Hello Jessica... my name is Becky.  I am so sorry your Bella has been diagnosed with EPI.  But EPI is manageable and once stablized Bella can have a normal quality life. 

The first thing that she needs is enzymes so that she can absorb the nutrients from her food.  They can be expensive, especially when bought at the vet,  but many people here buy them online at significant savings from www.enzymediane.com     Please check into this!  A good starting point for most is around 1 tsp for each cup of food and later when stable many can cut that amount down to less.   The enzymes and food will need to be mixed with a small amount of room temperature water and then let sit to incubate for around 20-30 minutes.

The next important thing is finding a food that agrees with her... every dog is slighty different here, but most do best with a grain free kibble (or one with just a small amount of grain).   What food is she currently eating?

There are a few other things like the possible need to stay on antibiotics for 30 days... either the Metronidazole she was on or another mild one commonly used is Tylan.  Not all EPI dogs need this but some do to clear up SIBO (small intestine bacterial overgrowth) that can accompany EPI, especially in the beginning.

Please let us know when you have more details from the vet tomorrow and what other questions we can help you and  your family with.  Please give Bella some hugs from me... she looks adorable in her photo  

Hi Jessica.  It sounds like you are doing your research, which is good.  Bella has a disease which is very manageable in most cases and the cost can be controllable.  We have many dogs that go on to live long and happy lives with little setbacks.  They do agility, search and rescue, whatever they did prior to dx of EPI.  They travel to shows with no problems.

As to the cost, I'm going to estimate, with going with the generic enzymes from Diane, and if you are dealing with SIBO and low B12, it will maybe cost about $50/month, give or take a few.  The prescription enzymes from your vet will be considerably higher.  The generics are 1 kilo (about 2.2 lbs) for around $140 which should last anywhere from 3-5 months, depending on how much food Bella needs.  From the vet, it is sticker shock at around $160 for 12 oz.  The generics work just as well, if not better.  The antibiotics are not that expensive if needed and the B12, if needed, are very cheap if w/ a prescription and giving yourself, for around $10 should last about a year.

There is really no reason a dog cannot live with EPI.  Some dogs/owners may struggle in the beginning, most turn around very fast and are happy, healthy, active and nobody would know they have this disease.  Some just do not make it, but those are the rare cases.

One thing you really need is a vet who is willing to work with you.  If they know about this disease and what needs to be done, there is no reason that Bella, too, cannot go on to live a long and healthy life.

I do hope your vet is aware of this disease and will work with you, your dad and Bella.  I hear the pain in your post and it is very understandable.  Most of us were very overwhelmed by this disease, not knowing what it is, what to expect, what to do.  But, with TLC and going slow, it all becomes second nature, they thrive and other than feeding times when the food soaks instead of feeding right away, you forget they are sick, as they are so happy, healthy and active, it's hard to believe they have EPI.

Quite a few of the dogs here are now on diets, not the skinny minnies we once knew.   Mine is one of them.  We went from around 65 lbs to over 100 now.  Which is more than the vet wants him at by a min. of 5 lbs, 10 less she'd be happier with.  Hang in there, do your homework, make a list of questions to ask your vet to let them know you know that you have done your homework and are willing to do whatever it takes to make Bella one of the success stories.

Good luck.

Hi Jessica and Bella - this can all be very overwhelming in the beginning - but as the other girls have already told you - it is normally a very controllable condition and Bella can go on to live a very normal life.

My Manfred was diagnosed two years ago and is now officially on a diet too as he has gained a little too much weight this past winter -

There is a lot of very helpful information on this site that you, your father and your vet are all welcome to read.

Feel free to ask any questions - we'll help all we can

Here is a link to a very good article on EPI

http://www.globalspan.net/epi.htm

Hi Jessica,

I’m sorry that Bella has EPI but it is manageable and Bella can thrive. Lynn and Becky have both mentioned where you can get enzymes at a much reduced cost. I know itis difficult to see Bella losing weight but once you start the enzymes, perhaps continue on the antibiotic and have patience – which is the really hard part –you will get it under control. Everyone here will be more than happy to guide you.

My Teddy came from a shelter, I had no idea he had EPI and if you look at the pictures below, you wouldn’t know it either. He looks like a different dog than the one I brought home. These dogs can have a normal life. Please let us know what your vet says.

My scrawny boy the day I brought him home.

Less than 2 months on the enzymes and you can see he is filling out.

 This is after 5 months on the enzymes

hi Jessica,  My name is Gini, and I have an 11 yr old Jack Russell.  He is newly diagnosed, so I'm still in the beginning stages of managing his combo of food.  I can hear how upset you are, and I'm sure your Dad wants to do the right thing, but get him to read the stuff on this web site.  It's invaluable.

The people on here are knowledgeble, kind and very willing to help.  This is a very good tool. 

One of the keys to this is to find a vet who has dealt with EPI, and understands it.  The other key is to learn all YOU can, so you are knowledgeable as well.  Don't lose hope.  You can see from the photos that this problem can be managed very well.

Gini and Frasier 

Hi Jessica,

I am so sorry hear that Bella has EPI.  I can hear in your post how upsetting this has been for you and your family.

When my darling Bonnie was diagnosed at 7 months, my Mum felt the same as your Dad. I so wanted to give her a chance but Mum felt that the emotional strain and ultimately Bonnie's quality of life needed to be addressed.  I was lucky in that Bonnie was insured so the monetary side wasn't so much of an issue.  I still sourced alternative suppliers to help keep the money in the 'pot' though.

You will see from all these wonderful people here that there are many many success stories. You will also see here that my Bonnie was one of the very few unlucky ones.  Most of that was down to not being treated in the correct way as some vets have very little hands on knowledge.  I found this wonderful forum a little too late so weren't able to reap the benefit of the fantastic knowledge held here.

As Bonnie was so young I felt she deserved a chance of a life and thankfully eventually my family agreed.  I could have kept Bonnie going but as much as the decision was heartbreaking to make, I could see things weren't working out for her, her quality of life came first and it was apparent she was losing that.  My Mum said afterwards that she was trying to spare my pain if it didnt work out, for which I thank her for but if I wouldn't change anything, I would do it all again.

I've said the above as I understand both sides Jessica, I also understand the money side too but perhaps before your Dad makes any decisions he could perhaps look into how it could be managed by using the suppliers others here use.    

I will be thinking of you and sending prayers to you, Bella and your family

Hey, Just a thought Jessica,

Would your Dad come have a look at our forum?

Kathy - that was fantastic you could show the progress in Teddy to Jessica, he looks fantastic and a credit to you.

Thanks, Debra, but a good deal of the credit goes to all the people who shared info and guided me.

HI Jessica,

I hear the saddness in your voice...  Please, Please have your dad come take a look over here...My GSD, Tara, went from 49 pounds to 84.4 pounds and yes, she's on a diet to take some of that off as my vet is not amuzed that's she's about 10 pounds overweight... She's had EPI for about 4-5 years now and there is nothing she cannot do.  she's a frisbee fool, a guardian of the house and mentor for my other dogs...

As everyone here has said, it can be managed with generic enzymes and yes, my Tara uses Diane's generic with great (maybe too great) sucess!!!  This can be dealt with and we are all here to help...

First off, I just want to thank you all for the love and support of Bella, my family & I. You are all really great people, and you guys have given me more hope that anyone could think possible, so THANK YOU!

Secondly, Bella had a visit to the vet tonight. I got all the results of all her tests.

Her TLI was BELOW .4! Poor baby.

She had a normal B12 result = 437 pg/mL

Her Folate was high, at 16.4 ng/mL (this is because she's not getting the nutrients).

Also, her liver enzymes were high (558), which worries the vet because this is not common among EPI.

We are starting out on the medicine called "Pancrezyme" . She wanted to start her out on this, and if it works, then we will be allowed to switch to generics. But for right now, we are just seeing what works for Bella. Kind of like a trial and error. She is also on "Tylan" for SIBO, but only for 6 weeks. I think she said it's just to make sure. We are hoping for the best, and most certainly not giving up on her.

As for the quality of life, the vet said it could never hurt to try. It's too young to give up on her, and I think that convienced him a lot. The vet also said that if she is UNHAPPY, then that is when we will take important actions to do what is best for her, and put her down. I'm absolutely thrilled, because Bella is such a happy girl. Greets us at the door, wags her tail, barks at those "strange" neighbors she doesn't know, and has a toy pile the size of a mountain. It's almost impossible to tell she is even sick with EPI. The only reason why we noticed was because of the rapid weight loss, and abnormal stools. The vet was extremely happy with how early we caught this disease because it is better to catch it sooner rather than later. She is an awesome vet, and really truly does care for the dog, rather than collecting her money and leaving. She will do what is best, which is why I feel confident with whatever she says.

We are feeding Bella "Eukanuba Adult Large Breed" food, and the vet said thats perfectly fine to have. However, I see lots of people putting their dogs on special foods.. I guess we will just wait and see how everything goes..

The success stories on here are really what has given me any kind of hope for my poor baby. I truly appreciate every single one of you, and I'm so happy that none of you have given up on your dog. My dad said a guy a work was about to have his dog put down after being diagnosed with EPI, and someone took her off the table because it's such a sin to not give them a chance, so THANK you!

Bella as a little puppy..

Chowing down

Still a baby..she's saying "OK mommy! I'm ready for more:)"

Bella pre-EPI ..

Dear Jessica & Bella,

I have been worried about you and Bella and watching for your post all day.  THANK YOU for giving the update!  And THANK YOU for posting the new photos of Bella... she is stunning 

You have a great plan in place.  Get her going ASAP on the Pancrezyme and Tylan!   The best starting point is 1 tsp of enzyme per cup of food.  Mix the enzyme in a little room temp water and then add the kibble and then let set (incubate) for around 20 minutes... then stand back and watch Bella eat and absorb nutrients   Later you can switch to the generics... some vets are concerned that they might not work as well but no one here has had that experience so you should not have any problems with them.  Most EPI dogs do well with grain free or very little grain in their food so that is one thing you might look into changing in the very near future.  Not sure where you live but Taste of the Wild is one option and not too bad on price compared to some.  I am sure others will chime in with kibble choices also. Sometimes when enzymes are first started,  some pups start to pee a little more but that usually does not last too long... just so you know and don't panic.  Another important thing you should start doing is keeping a log of everything that goes in and out of Bella.  It is the best way to track what works for her.  You will find out very quickly that around here it is all about the poop!  That is the best way to monitor progress... unless Bella has learned to talk and she does look pretty darn smart  

Again, I am thrilled that you are giving Bella the TLC that she needs!  Please keep the updates coming!

Oops... forgot to mention that your vet does sound wonderful!  And it is great she recommended starting the Tylan for the 6 weeks to get the SIBO under control which can hamper improvement if left unchecked.

Whew.  Hi Jessica.  Soooo glad to hear this news!  Your vet sounds fantastic and looks like she did her research.  Not many vets know to use the antibiotics for 4-6 weeks for SIBO, yours did!  She sounds like a keeper.  Most of us did start on w/ prescription enzymes.  Then have switched over to generic due to the expense.  I am so happy for you guys.

Bella is a beautiful girl.  She is one lucky dog to have you on her side.

Remember to go slowly.  Make only  one change at a time, ie adding any supplements, changing foods, etc.  Necessary meds are ok to add at any time needed.

Again, congratulations.  Please keep us updated on Bella's progress.

Oh, one more thing.  I may be mistaken, but I am thinking that there were a few dogs whose prelim blood tests were off, but once starting to get nutrients, they all went back to normal.  So hang in there w/ the liver enzymes....

Hi Jessica and I just wanted to say that I'm THRILLED that you, your dad and your vet decided to give Bella a chance!!!  She is one very, very pretty girl well deserving of the name Bella! Yeah, Tara has a half sister named Bella and I know that it's italian for beautiful!  PERFECT!

As everyone here has said, take it slow, make only small changes one at a time and you'll have a fat girl in no time at all!!!  REmember, if you have any questions, we're here for you!!! Oh and please keep us updated on her progress and with lots of picturers too!!!

Yeah, my vet didn't think the generics would work either, but when I brought him the product data sheet from the Pancreatin (Diane's enzymes), he changed his mind and told me they should work fine and they do!

Thanks everyone

Bella had her first poop this morning, after being on the enzxymes and Tylan for 2 meals. (last night and this morning). It came out complete WATER.. Is this normal?

Also, she is still burping a lot. Is that normal?

Thank you for all the wonderful advice. You guys have no idea how much it means to me!!!!!

How did you make the food?  Enzymes/food ratio?  How did you give the tylan?  It may take some time to see a big improvement.

Our vet is a mobile vet, so she came right to the house. We made the food in front of her, and she said that was fine.

We put in 1 tsp in with her 1 cup of kibble, mixed in a little bit of room temperature water, and mixed it. We let it sit for 20 minutes before giving it to her (she sure could NOT wait for that food! lol). Also, we put the tylan on top and mixed it, but that was right before we gave her the food (we did not let that sit for 20 minutes too).

Bella is beautiful - so glad to hear the good news.

Your vet sounds wonderful and I think you are in good hands.

The poop you saw MIGHT have still been pre-enzyme - it's usually 12 to 15 hours transit time for a meal to travel through their system

The hardest part of all of this will be to have PATIENCE - it takes time for everything to come together.

The burping might be just from getting used to the enzymes - it is common in the beginning as the dogs adjust to them - excessive thirst is another common one - if you see Bella drinking lots and lots of water - don't worry - this is normal and will taper off as her body adjusts.

All dogs react differently - Bella MAY need a little longer incubation time for the food - you can try leaving the food to sit 30 or 40 minutes and see if that helps with the burping.

If it is easier - you can pre-mix her meals then put them in the fridge until meal time - some dogs like it cold.  If not, just float the bowl in hot water to warm it back up - DO NOT microwave