EPI * Exocrine Pancreatic Insufficiency

I have a 4 year old staffy called Stella who comes to work with me every day.  She is a much-loved dog with a beautiful personality and it was devastating whren she was diagnosed with EPI several weeks ago after losing nearly 4 kilos in as many months. The weightloss seems to have stabilised a bit now that she is on an enzyme supplement, anti-biotics and enough food to feed a Great Dane, but she hasn't started to put on weight and she still has all the other EPI symptoms like yellow faeces, hunger and rumbling tummy. I would have thought that after 3 weeks of treatment we should be seeing some improvement. The vet has recommended that we wait another week before reviewing the treatment and when I weighed her tonight she had gained 200gms since Sunday but I don't think we can be very accurate about that. I'm very worried about her.

When can I expect to see results?

Hi Maryann - I know one of the more knowledable memebers will chime in soon with some ideas.  I am a newbie here, but have learned so much from the wonderful people here.  I am so sorry to hear about Stella. My 4 year old GSD Apollo was diagnosed with EPI last week.  From what I understand a lot of these dogs devolop SIBO, and will not improve until that is addressed.  I would ask your vet about the possibility of Stella having this condition, which is treated with long term (4-6 weeks of an antibiotic).  Also, she may have B12 deficiency, which a lot of EPI doggies get, and that would needed to be addressed also.  Do you have her testing scores?  A low B12 score and a high Folate score is indicitive of SIBO (small intestinal bacterial overgrowth).  I would ask your vet about this to start out with.

Again, I know you will be hearing from others soon - sorry you have to be at this forum, but you will learn so much and be able to do your best to help Stella.  Welcome.

Hi Maryann,

A very warm welcome to you & Stella to our EPI forum.   I am also from Melbourne.   My EPI girl is my English Setter Megg & she has had EPI for 3.5 years now & thankfully is doing well. 

I gather Stella is taking Creon capsules; what strength are you using.?   We use the 10000 strength & we get them from Chemist Warehouse which are cheaper than other pharmacies.   Was she tested for SIBO & B12 deficiency at the time of her diagnosis.?   Sorry for all the questions but it is important that we know as much as possible. 

I can tell you are very worried about Stella. She looks a sweet girl in your profile pic.  We have all been where you are now & it is very scarey, but we will all help you as much as we can.    Hang in there.

Again welcome.

Hi Maryann and welcome to the forum.  My Jackie did not stabilize until I began weekly B12 shots (which I did myself) - very important to test her B12 as mentioned above.   Also - what are you feeding her - it is recommended completely grain free in the beginning - no treats either.     How wonderful that you get to take her to work every day - love it.   Looking forward to hearing how Stella is making out.

Good Morning & Welcome Maryann & Stella - 

As stated above Gradually change Stellas food to a low fat, low fiber and grain free food.  No treats, table scraps, etc.  

You have already gotten great advise from the others on this site so I won't repeat what they have said.  One more thing like I was told, Stella is your girl and you need to make the decisions for her.  Be strong with your vet because it's your money as well.

My Ika just went in yesterday to get tested and I have gotten so much helpful info. on this forum and have also had MANY questions answered so don't be afraid to keep asking!

Again, welcome and keep us posted.

Stella is on a course of anti-biotics, presumably to address SIBO.  She is being fed Hills Prescription I/D and is definitely not having any treats.  I have also barricaded the cat's bowl which she used to raid.  I'm using Enzyplex powder as the enzyme supplement and I'm wondering if maybe there is a better one for her. I'll get her B12 levels checked.  Thanks everyone for the advice and support, it's great to have people to talk to who have been through the same thing, The emotional ups and downs have been pretty draining.

HI MaryAnn and Stella and welcome to you.

Aha!!! I think i see the problem from your last post.... Enzyplex. 

ENZYMES

This is widely used in Australia.... but unfiortunately is not strong enough to treat EPI.....   You need to get her on CREON capsules ASAP.  PLease speak with your vet about this.... and Craig and Lynn,  Samantha and others (they are all memebers here  from Australia) can help you with because CREON users start with CREON 10 (like Lynn described above) but some EPI dogs need more lie CRE|ON 25 while others do  great on CREON 10.

ANTIBIOTIC (for SIBO)......secondary condition that accompanies EPI about 70% of the time

Ask your vet to check into getting Tylan....for 30 days..... Your vet will have trouble finding it... but Lynn and Craig can give you the information on how to obtain it in Australia

B12 for B12 Deficiency... andother secondary condition that happens about 50% of the time with an EPI dog

Please check out the B12 page and share with your vet http://www.epi4dogs.com/b12.htm

DIET

EPI dogs tend to do musch better with low grain or no grain food.

Many of the prescription foods are hydrolyzed... which, in many cases are okay to give an EPI dog, because the food is "Hydrolyzed"  which means the proteins are broken down in a certain way so that the dog can absorb them.

BUT not all dogs do well with this and you might have to change.... but don't worry about this today.....

 .............. for now.. since you have started on this journey... in order to find out what works best... you have to make one change at a time.. wait & record results for 3-5 days and then make the next change. (with items like food)

From what you you are describing... get her on CFREON 10 right away.  let us know what the results are... we will help you tweak things until you find the right balance.

Also... let us know what the name of the antibiotics are... and for how long they are to be given..... only certain anti's work

Discuss with your vet B12

Regarding the weight gain..... some gain weight right away... some can  take up to 2 years before they put on all their weight... each dog is different....

After you take care of the above.... we can help you with feeding and diet.... but in short...if possible, at the beginning try feeding smaller portions but more often to where you are giving her 150% of what her body requires daily. Once3 the weight comes back on this can be changed / reduced.

Hi Maryann,

Enzyplex powder is a supplement enzyme, not a replacement.  Stella will need to be on Creon capsules.  This will probably be why you haven't seen much improvement as yet. 

Some of the Aussies here, at first,  have been prescribed just Enzyplex & it definately does not work on it's own.  I'm sure they will pop in here & tell you their experiences.  It can & probably does help,  but you will need to use Creon.  For a little girl like Stella, she would probably need one 10000 strength capsule with every meal.  They really do work well.

I've just seen above, that Olesia is writing to you at the same time.  She has given you excellent advice. 

Good luck.

Hi there Mary Ann & Stella,

Indeed, it is daunting and quite draining when confronted with this disorder not least for the fact that there is so little support readily available from the veterinary fraternity but fear not, it gets easier and better once a foothold is established against the scourge of EPI. It really is manageable but there's some work ahead so batten down the hatches.

Olesia has given you a fantastic and comprehensive overview to get you started and Lynn some great advice on enzymes in Australia which at this point in time is limited to a choice of one - CREON. Enzyplex as both you and she have noted is a supplement, but just a supplement. As a plant-based enzyme it cannot (and does not) provide enough firepower to replace the role of the pancreas (which has atrophied with EPI) in producing enough enzymes to digest food. In Oz , Creon is the only replacement available. 

At first our vet prescribed Enzyplex too and while it made a slight difference for our Lulu it only slowed the weight-loss, it didn't stop or reverse it. Through this forum we were made aware of Creon, we took the literature to our vet who was open but unsure as like most vets in Oz (despite diagnosing it correctly) she didn't have a great deal of experience in managing EPI. We waited to see if the Enzyplex was effective, possibly too long and then went with Creon. We saw an improvement within the next digestive cycle of 12-18 hours.

Creon is a porcine-based enzymes extract that comes in 3 different strengths - 5000, 10000 and 25000 (also called Forte). A data sheet for Creon 10000 is available here. You don't need a prescription for the first two, you do for the last.

I would strongly recommend you getting some Creon 10000 over the counter from Chemist Warehouse or similar and start Stella on one capsule per meal to begin with as Lynn has suggested. Continue the Enzyplex if you wish, it won't do any harm, it just isn't that effective on its own.

On the diet I would suggest to begin to think about a grain free intake, many (but not all) EPI pups cannot tolerate grains and the Hills I/d has cereal fillers in it (ie Brewers Rice). There are now some alternative grain free kibbles in Australia (yippee!) which you can see in this thread here. 

As for when to expect improvement, as others have said evey dog is different. For our part there is a little graph in Lulu's thread whereby you can see how our journey panned out over several months here. Stick with it, have patience and she'll come around.

Good luck, keep us posted on the tests and the many good folk here will share their experiences with you and your vet to get Stella back to her bouncy ol' self.

best & welcome

Craig

Welcome to the Forum Mary Ann and Stella...  everyone above has touched on all the details but when you have time you might want to sit and read all the way through Miss Lulupants thread.  It is a long read but their journey started out similar to yours and maybe the information in it will offer you a few shortcuts on your EPI journey.   Good luck!

www.epi4dogs.com/apps/forums/topics/show/2465142-introducing-lulu-newly-diagnosed-and-keen-to-get-better-?page=1

We have recently switched over to products that we obtain at www.swansonvitamins.com and have been exceptionally happy with them.  We used to spend $115 every three weeks on the pancreatic supplement that we obtained through our vet.  Now we spend $12 (plus shipping) per month.  The product we buy is called Triple-Strength Pancreatin Enteric Coated Dietary Supplement.  It comes in a jar of 300 tablets and is the equivalent of 1,500 mg. per tablet.  We purchased an inexpensive coffee bean grinder that does a great job of turning the tablets into powder.  Our GSD is doing great on it, as we have been giving this to him for going on 3 months now.  It is saving us a whole lot of money and he is healthy and very active. 

Hi Maryann.....yes, EPI is a horrible diagnosis.  But, you are in the right place!

It's 5am here and I just had to get up and let Stella out for a poo so thought I'd check the forum.  Thanks everyone, the help, support and advice is amazing. Stella's antibiotic is Metrogyl and she has been on it for 2 weeks, 1.25 tablets 2x per day.  She has 1 day left.  I will check out the Creon later today when I wake up properly!  I note that it's a porcine derivative - I have a pet pig (Isabel), what a shame I can't just run a line directly from her pancreas to Stella! 

Thanks again for all the help, it's put me in a much more positive frame of mind.

Welcome Mary Ann & Stella. This is the best place for advice and reassurance. The advice you have been given is really comprehensive, there's nothing I can add as I am fairly new too. So welcome and keep us all posted on Stella's progress.

Just want to mention Thank you to Craig, another Aussie ;), for helping Mary out and providing some links for Mary.

Hi Mary Anne and Stella and welcome! 

I see you are in great hands with Lynn and Craig, so I will not add anything, but wanted to welcome you! 

Hi Mary Ann and  Stella,

Welcome.  You have been given wonderful suggestions and good advice.  EPI is overwhelming at the beginning, but hang in there.  It will get  better.  Once you have the enzymes and antibiotics and food and B12 in balance, things will start to improve.

Let us know how Stella does.  She is quite lovely.

Barb

...in which case Ill post one tiny link more as Mary Ann you've mentioned my second favourite topic - antibiotics. As Olesia has said one of the standard protocol tests done for EPI dogs is for SIBO. Left under-treated SIBO can wreck much of the progress made with diet, enzymes etc so it's vital that if present it be tackled at the same time.

Metrogyl (or Metronidazole/Flagyll) doesn't always work and should really be run for 30 days regardless although I can appreciate that a vet would not want to run any antibiotic for longer than necessary. With EPI & SIBO I've yet to read of a successful case treated for less than 30 days. Lynn and others on the forum were great advocates of Tylan (Tylosin) Soluble 100 as a milder and more effective alternative. Her vet prescribed it, ours couldn't get it and we had to track it down. For our Lulu it started to show its effectiveness within a week and has slowly worked its magic since (it's our 11th week of a 12 week regime).

Some details for your vet if they need it (their rep should be able to get it easily. It is prescription only in Australia I think)

Tylan Soluble 100

Elanco Animal Health.

A division of Eli Lilly Australia Pty. Ltd.

112 Wharf Road, West Ryde, N.S.W. 2114

Telephone Toll Free 1800 226 324

If you do use it there's info on the forums about how to administer it etc or we can help you out.

Post the test results when you get them, we're suckers for a set of numbers,

best

Craig

Hi Maryanne and Stella,

welcome to the forum. You have been given a lot of great advice from those with far more experience than I could offer you :-)

I just wanted to say, as a fellow Aussie, my Fergus is on Creon 25 capsules bought from Chemists Warehouse. He is fed Canidae grain free food bought online.

This is a great site, where you will get a lot of support and invaluable advice.

Cheers,
Jacky & Fergus

I was in the same shoes as you . My Brava got down to fortytwo plounds and that drove me nuts. The Vets said to put her down. I said I would not KILL my dog.It did take some time for her to gain her weight back on. Now she looks as good as new. Any one who would looks at her now would have no idewhat we have been through.I do tell everyone we meet about EPI to get the word out. Don't give up and good luck. We are here for you.