EPI * Exocrine Pancreatic Insufficiency

we have an 15 month old gsd that got EPI at 8 month old. she went on the enzyme powder initially it seemed to work but then tara would not eat the food in talk the vet suggested trying with the enzyme capsules initally this worked and tara gained weight up to 31kg but then for no apperant reason started with loose stools and always hungry she has been on alsorts of tablets and capsules increased to 12 a day but even though very hungry would not eat very much vet now advised to try hills zd perscripted diet and put back on the wet for of enzyme powder for a week to see if makes any difference up to now no difference but will not eat anythink and is loosing weight fast (can now see her ribs again) any one with any help advise or ideas please post as we are now extremly worried .thanks

Hi Robert,

Welcome to our EPI forum.   I'm sorry you are having problems with your EPI pup.  I know how hard it all is, especially at first.  My EPI girl is my English Setter Megg & she has had EPI for just over 3 years now.  Thankfully she is doing fine but not without many struggles in the beginning, as most of us have. 

I am not really familiar with the powdered enzymes as we are from Australia & we use Creon capsules which are an enteric coated capsule.  Are you from the U.K.?  If so, we have many members who will be familiar with the capsules you use & will be able to help out here.  Just a thought, has your pup been tested for SIBO & B12 deficiency? 

Both of these can cause weight loss or the inability to put on weight. 

I'm sure others will pop in here with advice so hang in there.  We will help you get this sorted. 

Again welcome;  pleased you have found us.

Lynn & girls.

Hi Robert.  i would talk to your vet about low B12 and SIBO.  Both of those can hinder appetite and cause weight loss.  Most of dogs dx'd w/EPI will also have these.  Here are some links, plus they are on this site-the tabs for SIBO and B12.

http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2002&PID=2580&Category=414

http://www.upei.ca/~cidd/Diseases/GI%20disorders/small%20intestinal%20bacterial%20overgrowth.htm

http://www.cvm.tamu.edu/gilab/research/cobalamin.shtml

The signs can vary.  For us, we get gas, loss of appetite, licking of paws, furniture, floor, etc, burps, not wanting to eat, soft stools, diarrhea (can be intermittent), loss of energy to some extent (doesn't want to play as hard/long), throwing up and more that I can't think of right now, with SIBO.  With low B12, loss of appetite, failure to gain weight, losing weight, etc.  Since they all go hand in hand, I'd definately check w/ your vet asap and see if either they will run the test and start you on anti's and injections as precaution, or just do the full treatment for both to be safe.

Good luck.  As Lynn said, others that are from the UK I am sure will be on soon to help you out.

Hi Robert,             Just wanted to welcome you to our site, and say that the advice you have gotten from Lynn and Karen is great.   I  agree, it sounds like SIBO  to me.    I suggest you get that checked ASAP.

And, hang in there and take a deep breath.   Since your pup (ooops, didnt get a name)  has been stable,  this should just be a small bump in the road.   Glad you found this site tho.  There are many experienced and helpful people here that are just waiting to help you.  It is what we do.

Since we now have 300 members (thanks for leting us know Donna) there will be someone who has walked your path before and can give good advice.   Which has already started.  

I personally have no experience with the tablets, but I do have experience with my Suzie refusing food.  She did this for several months in the beginning.   it was due to the smell of the powder enzymes.  I succeeded with Parmesan Cheese, sprinkled on just b-4 feeding.   Many have used sardines, green tripe, BBQ sauce, the list goes on and on.   Give some a try, but please get the SIBO test too.

Oh, and we love pictures here.   Feel free to post pics soon.

Hang in there,

Hi Robert and a very warm welcome to you.

I too agree with EVERYONE else... It very  likely can be low B12 and/or SIBO.

B12 and SIBO are both secondary conditions that often accompany EPI around 50-70% of the time  and, if so, even if you give the dog the necessary required enzymes......if they have either or both of thes secondary condition going on..... it will hamper the dog's improvement.

In addition to the good links Karen gave you, you can also read about it B12 Deficiency from research studies done on B12  and from Texas A&M University (along with their veterinarian protocol to share with your vet) on the B12 page http://www.epi4dogs.com/b12.htm

and SIBO research studies and recommendations on the SIBO page: http://www.epi4dogs.com/sibo.htm

Please feel free to read about B12 De

Thanks everyone for all your ideas and support  so far please keep posting we are back at the vets this week and will mention sibo / b12 to the vet but  she is already been on oxytetracycline 250mg and now changed to tribrissen 80mg. tara is now down to only eating 200grams of food  a day now any suggestions ???????????? we will try sardines and cheese etc but she moves away from her food bowl when we try to get her to eat. even tried hand feeding with little success.

many thanks

Hello Robert and Zara....a warm welcome to you.  My boy has been cleared for EPI but treated for SIBO and lost a lot of weight. Very scary to see him shrink down to a skinny frail boy. But he is now on the rebound....hope that Zara will be soon as well. (I hope I got her name right?)  There are so many great people here that have lots of great knowledge. Hope you check back often! 

HI Robert,

OMG, another Tara that doesn't like food...The wold cannot be that big!!!!   Anway, welcome to you from myself and my Tara, a GSD that isn't fond of food either...

I agree with everyone that you should check her B12 and SIBO...As far as food goes, I actually fostered a very humgry GSD rescue to help me teach Tara that food was okay...We failed at fostering and 6 years later we still have Zoey, the rescue.

The pills didn't work for her, only the powderd enzymes and B12 shots.  She's still on them years later and I always know when it time for a B12 as she starts dancing with her food bowl...The B12 really helps her appetite...

oops....Tara not Zara.  My apologies....it's a southern hemisphere, british colonies thing where Zara is a popular name.

just gave tara her 2nd meal with tripe on it quess what she refused it as normal here we go again what next ! ! !

HI Robert,

Where in the world are you from?  This can help us determine what's available to you.

Hi Donna

we are from lancashire  united kingdom

appreciate any help. ! ! !

Hi Robert,

I just want to welcome you and Tara. You have had good advice about the B12 and SIBO. As far as getting Tara to eat give her anything you think will appeal to her, doesn't matter what, she needs to eat. Perhaps some chicken, hamburg...

Hi Robert and boy oh boy so we feel for you... having a dog that doesn't want to eat  can be real difficult to deal with... and we'll try just about anything... sometimes within reason ... and well... okay... sometimes not so reasonable.......anythingt to get them to eat.. VERY frustrating!

Thanks for letting us know you are in England... that helps us a lot.  We have FILES here with gathered information from various parts of the world in treating EPI... since not everything is available every where. I am going to cut and paste for you here... what some of our members from the UK have found success with in treating their EPI dog:

1. The first thing i would suspect is low B12 .. many times this is indicative of lack of interest in food...

2. the next thing is SIBO... another cause for some dogs not wanting to eat... BUT in order to get rid of SIBO... you have to be sure to administer the correct anti (not all attack the same bacteria) and you have to keep the dog on it for the proper duration...... long............ please see below and discuss the options that have been successfully used in the UK for SIBO in other EPI dogs.

3. And then there are some dogs that are refusing the food because they just don't like the enzymes - - - so we try "enticers'. usually that works,

4,. but there are some dogs that even that doesn't work... and then we move onto a differently packaged  enzyme....for you in Elngladn... please share with your vet the use of Lypex or Pancrex granules (see below)

Anyone of the 3 scenarios could be what is going on with your Tara.

UNITED KINGDOM

Antibiotics in UK:

Many times Synulox and Metronidazole are used together when SIBO is present.At a shorter duration than the 28 days that Metro or Tylosin are prescribed in the US.

Stomogyl antibiotics for 14 day course

"I used Metroinidazole for 14 days with Synulox for 28 days for heavy e.coli infection/SIBO"

Overall veterinary community is more restrained than the United States in regards to antibiotic prescriptions

Enzymes in UK:  

http://www.nutrecare.co.uk/prod2.asp?ID=115&sub_cat=491

In the UK ,Lypex is commonly recommended. It is an enzymatic concentrate derived from the porcine pancreas gland, available in capsules, must be opened and sprinkled on food. Do not incubate on the food. The purified and concentrated pancreatic enzymes are made into micro-pellets and each pallet is enteric-coated. This gives 100% protection to the enzymes from the damaging degradative acids present in the stomach.

Lypex is an enteric coated enzyme capsule that is opened and sprinkled on food, mixed in gently and fed immediately. Rate of use is (for example with one EPI dog) 3/4 capsule on 7oz Bakers kibble soaked until soft.1/2 capsule sprinkled on 12oz raw.

Within ten minutes of the pellets passing the stomach to the alkaline environment of the small intestine the protective enteric coating dissolves and releases the protected enzymes to maximize digestion.(available in England andEurope).

(per Debra) Lypex is stronger 1 x per 100gm -  sprinkled on food and eaten immediately - NO INCUBATION required.

(perDebra) Tryplase as an alternative is ok (I've used that) cheaper...but it is a bit of false economy as depending on the dog, you can have up to 5/6 capsules per meal. (for a sdog German Shepherd size) ..capsules opened and sprinkled on food and incubated

Tryplase  is another pancreatic enzyme replacement that are capsules sprinkled on food. Tryplase needs to be pre-digested for about 30/40 mins because like most enzymes it is caustic at first and will cool as it works the food. Some can serve at once but most let it pre-digest to avoid the dog having a sore mouth..

Tryplase are capsules and must be opened and sprinkled on food... Rate for my EPI dog  is 1Tryplase capsule sprinkled on 12oz raw... pre-digest 40mins for best results. I use 1 1/2 capsules on 7oz Bakers soaked untilsoft...pre-digest 40 minutes for best results

My vets (Debra) uses Tryplase capsules or Pancrex EnzymePowder……Lypex isnot so widely known (first produced for humans then adjusted for animals) its probably more expensive, but then you use one capsule to4/5/6 tryplase.

Panzyme

Lipase 38,000 BP units/g

Amylase 32,500 BP units/g

Protease 2,100 BP units/g

Tryplace

 Amylase not less than 9000 B.P. Units

Lipase not less than 13,000 B.P. Units

Protease not less than 450 B.P. Units

(From Val) It looks like the Panzyme above is stronger than my Tryplase.

Could be you need to use less per meal... how much are you feeding?

And is the food home cooked or kibble?

Pancrex granules 300g

[MEPAN01]£44.31inc VAT http://www.myonlinevet.co.uk/Pancrex-granules-300g.html

 Pancrexgranules contain the same enzymes that the normal pancreas gland provides to help digest food and which are absent or deficient in animals with so-called ‘exocrine pancreatic enzyme insufficiency’.Formulated and originally intended for human use butfinding a useful role in helping care for animals too. Pancrex granules contain the pancreatic enzymes lipase, amylase and protease.These assist  the digestion of fat, carbohydrates and proteins. The enzymes in Pancrex granules are extracted from pig pancreas glands. Theuse of this product should only follow a veterinary diagnosis that itis needed by your pet. The granules are ‘enteric coated’ which means they must be given whole and swallowed unchewed to allow the intact coating to let them pass unharmed through the stomach’s acid environment and into the intestine where they have their effect.

Give at a dose rate recommended by your own vet.

Container of 300g.

If anyone is interested in obtaining RAW PIG PANCREAS in the UK to treat their EPI dog with... please contact Lesley Osborne at

http://rawtogo.co.uk/default.aspx

Raw To Go

The WarehouseMarket Street

Abergavenny

MonmouthshireNP7 5SD

Telephone: 01873 268086

GrainFreefood in UK (and/or grain foods that some in the UK use)

Orijen    http://www.orijenpetfoods.co.uk/

Bakers Complete with Chicken and Country Vegetable  (not completely grain-free but low grain)   http://www.bakerscomplete.co.uk/

Hills (hydrolyzed food- grain are processed & broken down to be absorbed by dogs with compromising conditions)

Arden Grange fish and potato (some have used for "sensitivities") www.vetuk.co.ukits

Chappie

James Wellbeloved foods

BurnsPork & Potato

BurnsChicken and Rice

Many in the UK do home cooked/prepared meals

Some soak food in warm water to soften it

HI Robert,

I see Olesia has given you some good info!  Yeah, Green cow tripe worked on her for about a day and then she wanted nothing to do with it...I would definately have a chat with your vet about B12 shots as they really are the one thing that made a huge difference in my Tara's eating habits, Also, you might want to try some different enticers.  One of Tara's all time favorties was BBQ sauce...We think she has a sweet tooth. 

Hi Robert.  Sorry you are going through all this.  Besides the low B12, SIBO can take some time to clear up and may need more than 1 anti.  Sometimes a certain one doesn't work as well, depends on the bacteria.  So then you have to try another one,  sometimes a couple together.  Some dogs may need long term anti's also.  Hopefully you will get to the bottom of this soon.

Hi Robert

Sorry to hear you are having problems.  I am from the UK and quite new to this as my dog Wallace was diagnosed just one month ago with EPI.  He is just eight months old.  He was started on Lypex capsules two per day with food but we found he wasnt tolerating this very well.  With good advice from EPI4dogs, I adjusted his Lypex and food to three smaller meals a day with about two-thirds of a capsule on each meal.  He is also on Metronidazole for SIBO.  We are feeding with Royal Canin Gastrointestinal dry food mixed with Wainrights who do a great range of wet food in trays which is easy on the digestion (lamb, duck or turkey & rice).  We are having no problems getting Wallace to eat this mix and although he has the occasional loose stool, on the whole he seems to be thriving and putting on weight (although we are back to the vets on Saturday for weight check etc - so will keep everyone posted on his progress). 

We are finding the Lypex really easy to use and although just one month into treatment and diet plan - so far so good (fingers and paws crossed this continues). 

I also looked up foods which are easy to digest which are low in fat, and three times a week as a treat Wallace gets two very ripe mashed bananas with a very small sprinkle of Lypex.   The day after he has this he one seems to do one very well formed poop, and he really loves his banana treat. 

As I am so new to this myself, I am sure you have tried many regimes for Tara, but hope my experience helps and please let me know if you want any further info on our regime.  Hope you find a balance and Tara gains some weight soon.  Please let me know how you get on. 

Fiona & Wallace

hi

a big thank you to you all for all the posts so far lots to read , research and try

we are back at the vets thursday will question all that we can

please keep posting

thanks again

bob.

Good idea Fiona!!  Tara also loves her banannas and I had forgotten about that!  She gets one or two a week mixed in her food.  See, I told you she had a sweet tooth! 

Hello Bob,

I don't have any other ideas beyond the great ones already given above by others but did want to say I know how frustrating it can be when they will not eat, so you have my sympathy!   Hopefully you will find a combination of what works for Tara.  For our GSD Boss, who never had food drive, we have found a capsule form of enzymes and Hills Z/D kibble with various enticers added, along with weekly B12 shots and Tylan antibiotic to be a winning combination, but every dog is different.  Please let us all know how the vet appointment goes Thursday.