EPI * Exocrine Pancreatic Insufficiency

Hi all, firstly my thanks to everyone - this is a really valuable site, and unfortunately I'm not here just for fun....my German Shepherd Ruby was recently diagnosed with EPI (after a lot of weight loss, soft stool and a TLI test with a low rating of 0.23 ? ). So yes - happy days....

The site and views held by its members seem pretty hard and fast that if its EPI, then its 'full on' EPI without much negotiation - which is cool, and most probably and unfortunately correct. But - I was wondering if it is possible to have mild, medium or severe EPI ?

In my girls case - if I was to skip a meal, her stool for the next 2 days would be fine...so I'm hoping perhaps the pancreas is just weak ?, and could she just have a mild form of it ? As it comes right (momentarily) when its had a rest... - now your thinking why on earth would this guy skips meals for this poor dog ! Well - for several months we thought she had a sensitive stomach as Sherpherds often do, and on advice of the Vet who FAILED to recognise EPI we skipped the odd meal as part of the dietry change to stop the soft stool - and it worked ( only she never actually had a sensitive stomach - just EPI....)

She was diagnosed and medicated with Panzytrat 25000 and a Hills Vet/ID diet about 10 days ago, and has had firm/good stool immediately since - which is great, and she's gaining weight. As the medication is really expensive I'll have to either change it for a more affordable option, or ( best case scenario ) reduce her from 3 capsules per day to a lower dose - if she is okay....

Your thoughts and comments would really be appreciated.

thanks, Mike

Hi Mike,

Welcome to the forum....it is unfortunate you have to be here as it means Ruby has epi but it's a great pace to get information and support.  If epi was confirmed with the TLI test then yes, she has epi.  What can happen is that once you get Ruby stable you may be able to cut back on the amount of enzyme you give.  For instance in the US the normal ratio of enzyme to food is 1 tsp. of the 6x powder to 1 cup food...but there are people here giving half of that for twice the amount of food...so it really varies, as some people need to give more.  I would say once you have good poops for a few months and have gained back weight you might want to consider seeing if you can cut back on the enzyme.  I am not familiar with the enzyme you are using.  It would be helpful if we knew a bit more about the medication you are giving.  Does it have on the bottle what the contents are (how much lipase, etc. are in each pill) as that is helpful to know...and how much you are feeding her and how often.  What is her current weight and what is the goal weight.  I knew New Zealand is not Australia and many things available in one country may not be available in the other, but one of our Australian members has written a great brochure for the Australian members that you might find helpful.  Some of the options available in Australia may be available in New Zealand.  It's in the Downloads section, about half way down the page.  There's a pdf you can download.

I am a little concerned about the food as it looks like the Hills ID food has grain in it and most pups do much better on a grain-free food.  I know some of the vet foods are hydrolized so that the pup's body doesn't recognize it as grain and some do well on prescription food.  But prescription food is often the most expensive.  You may want to see if you can find a grain free (no rice, no corn, no oatmeal, no barley, etc.) food that costs less than what you are buying now...and that can be one way to save a little money.

So we can help you as much as we can (if you have more questions and need some help tweaking her treatment), would you give us a little more info about her:  age, current weight, goal weight, amount of food (and whether kibble or canned or combo), info on the enzyme. 

Look forward to hearing more (and seeing photos...we LOVE photos here!).

Oh, one last thing.  While getting a pup stable we recommend no treats...which is usually harder on us than the pups!:D  If you are in the middle of any kind of training that can be a challenge, but lots of people here have dealt with that and will have suggestions.  There is also some options for treats down the road such as making your own that have enzymes in them...or giving treats (with no grain) near a meal.

Hi Mike, Welcome to our EPI forum. I am from Australia so we are neighbours. We have relatives who live in New Plymouth so have visited your beautiful country many times over the years. Always love it there. Terry has given you excellent advice. Can't really add much more but I was wondering if you can perhaps look into Creon capsules over there. They might be a little cheaper than what you're using now, but not sure. There is also a lot of great info. in our files on Creon which, like your Panzytrat is a 'human' capsule & available through our pharmacy. Looks as if your Panzytrat is a similar strength to our Creon 25 which is the strongest. Creon also has 10,000 & 5,000 strength. Perhaps worth looking into but again, the cost might not be much different. My girl only ever used the 10000 strength & a bottle of 100 capsules would cost around $35.00. I know the 25000 are quite a bit more expensive.

Good luck & again welcome.

Hi Mike.  Welcome.  Contact Diane at www.enzymediane.com  A lot of us get the generic enzymes from her and I know she ships to NZ.  She can tell you what you will need to do in order for her to ship to you.  If needed, she can put you in contact w/ another member who lives there.  This will save you a lot of money.

Hi Mike,

Welcome to you and your beautiful Ruby!   It sounds like you are on your way to helping Ruby to good health.   I just wanted to recommend something that was suggested to me and it helped so much.....the daily log.   There are forms here that you can download so that you can keep track of everything you are giving Ruby and how her poops look each day.   Then if something looks "OFF" youcan go back and read the log and often see what is causing the problem.   We just used a daily notebook, but it was very valuable in the beginning when we were trying to get Kolby stable.  It doesn't sound like you are having as many problems as we did, but keeping the log can still be a really helpful tool.....especially if setbacks occur. 

The other thing I wanted to mention is her B12 levels.   Many dogs with EPI have low or low normal B12 levels and they need to be in the high or high normal range. Did you have it tested when they did the EPI test?   You would have had to fast her for 12 hours.   If you didn't and you don't want to pay for another test, you can keep an eye on her stools and her eating habits and supplement her with generic B12  (not complex) injections as directed under the B12 tab.  Kolby does not hold his levels well, so we give him the injections here at home to save lots of $$$$.   The good part is you can't give her too much B12......she will just eliminate any excess.

Just something to keep in mind. 

It sounds like you and Ruby are doing a great job and we would love to see more pictures of her.

Barb

Hi Mike and welcome,

The Panzytrat is pancrelipase, same as Creon is pancrelipase. Panzytrat and Creon are the brand names, same product just different manufacturers. They do come in different strengths but I'm not sure how to compare USP to B.P units. I don't know what her ideal weight would be, think it depends on the dog.. bone structure, etc.

Hi Mike.  One thing I think that was not mentioned.  You mentioned skipping a meal and still having good stools.  The enzymes are given w/ ea meal and that is all it works on, that meal.  It is not a med like an antibiotic or Blood Pressure med where you only take a couple of times a day.  So if you do not feed a meal, she does not need the enzymes.  But all meals must be treated w/ the enzymes.  You do not give the enzymes if not feeding, does that make sense?  That is why w/ the skipped meal, the stools are still good.  Hope I explained it ok.

hello mike and welcome from across several ponds we are in Liverpool in uk

when we boarded this roller coaster in August 2010 we were lost, the vets were knowlegable but basically go away and sprinkle enzymes you will be fine

i think not!!!!!!!!!!!!!!!!!!!!!

so you turn too the experts none of whom are in any way medical but have experience and that is invaluable

and here we are one little girl saved thank god and Olesia and our vets who are awesome note which order that was in!!!!!!!!!!!!!!!!!!!!!

epi is for life sadly there is no cure and no going back so we replace the enzymes the pancreas excretes when it is healthy and functioning

every time we eat the pancreas does just this and so we digest food so every time we feed anything the enzymes have to be added so no food in nothing to digest

"food in enzyme in"

the enzyme you have is the same as creon used in aus and usa

in humans it is mainly used for cystic fybrosis which also attacks the pancreas and causes malabsorption which is the same as our dogs resulting in diarreah and weight loss 

my thoughts are for you to find a less expensive option if you can and maybe others can point you in the right direction

also i would be looking at the diet hills science diet is full of grains our dogs in the main do better on grain free as the grains tend to compound small intestinal bacterial overgrowth along with other issues

my big piece of advice is to keep a journal on everything you do no matter what it is invaluable in this illness and having met a human recently with epi my eyes have been openned wide

good luck

jean

Lynn at January 2, 2012 at 6:42 AM

Hi Mike, Welcome to our EPI forum. I am from Australia so we are neighbours. We have relatives who live in New Plymouth so have visited your beautiful country many times over the years. Always love it there. Terry has given you excellent advice. Can't really add much more but I was wondering if you can perhaps look into Creon capsules over there. They might be a little cheaper than what you're using now, but not sure. There is also a lot of great info. in our files on Creon which, like your Panzytrat is a 'human' capsule & available through our pharmacy. Looks as if your Panzytrat is a similar strength to our Creon 25 which is the strongest. Creon also has 10,000 & 5,000 strength. Perhaps worth looking into but again, the cost might not be much different. My girl only ever used the 10000 strength & a bottle of 100 capsules would cost around $35.00. I know the 25000 are quite a bit more expensive.

 

Good luck & again welcome.

Hi Lynn,

Thanks very very much for your information. Brace yourself......the Panzytrat is $270.00NZD for 100 capsules !!!!

Thats about 1 monts supply on the current doseage - so $35 for 100 caps of Creon sounds like heaven ! - I'll start investigating asap.

Thanks again, great to hear from you,

Mike

Hello again and thanks to everyone for your insight and information - I'm not very clued up on writing in forums, so cant figure how to reply to each individual reply - so please forgive this generic note to everyone. So thanks to everyone for your kind comments and information.

Muchly appreciated,

Mike

Just a Hello and welcome to you and Ruby from the states !!!  It is a life long issue, but once stable and adjusted ... it gets easier !!!   Out first EPI girl, lived to be 14  years old and the last 10 of those with EPI. Sounds like you are on top of it !! Good Luck !!

Hi Mike and a very warm welcome to you  and Ruby! Everyone already gave you some great tips, so i will try not repeat things..... but i must say ...$270.00NZD for 100 capsules ..... OMG !!!!SOunds like the CREON is much more cost effective! But also check into the Pancreatin Powder 6x or 8x from EnzymeDiane. SHe already ships to another individual in NZ... but i am not sure of  the cost of doing that but it might be worth looking into... you can write her privately...or just  check her out at  http://www.enzymediane.com/. I only pay $134 for 1 kilo which is equivalent to:

1 kilo = 35.274 ounces. There are 357 teaspoons in a kilo of 6x since a teaspoon is 2.8 grams of powder. 

When my dog first started on the enzymes it was costing me $1,200 a year.

Then i got my enzymes from EnzymeDiane and it was going to cost me $400 a year... until i figured out that once my Izzy became stable (stable for an EPI dog means delivering normal looking poop at a normal frequency (2-3 times a day) consistently for 2+ to 3 months...)  i was actually able to reduce the amount of enzymes i gave with each meal (i gave 1 cup of food at each meal)  by 1/8 of a teaspoon...watch the poo for a few days.. if still good... reduce the enzymes yet again by another 1/8 of a teaspoon. I kept doing this until the poops started getting "soft serve" looking... then i knew i reduced the amount too much and increased back to the amount where she stll had normal poo.

By doing this .. i was able to give my dog only 1/2 the amount of "suggested" enzymes and save yet another 50% on the enzymes... so.... i went from spending $1,200 a year on enzymes to $200 a year ;). Pretty good, eh?!

Not everyone can reduce the enzymes once their dog is stable... but many can ....so be sure to try this when you get to this juncture with Ruby.

Also... you had asked about varying degrees of EPI. ONce a dog tests positive for EPI via the TLI test, it simply has EPI and will never get better... BUT that being said... YES!!!! Some dogs have a harder time and need more enzymes while others don't. SOme, once "stable" can even cheat with a little bit of a treat without enzymes, while others can't.  Some only need a tiny bit of enzymes (once stable) while others need a bit more than normal....It all depends on the individual EPI dog...per the research:. "Depending on the underlying cause of damage to the exocrine pancreatic cells, there may be variable damage to the acinar,centroacinar and/or duct cells, as well as to the cells of the endocrine pancreas"  ....

Oh and don't ever feel you have to respond to all the posts.... feel free to just jump in and write one post and answer who you want to say something to... we are not formal here at all.  We just share the tried and true guidelines for EPI and then... we also share what little adjustments worked for us individually... because what you'll find out about these EPI dogs is that although they all have the same condition and need the same "basic" treatment... within those guidelines, sometimes there are many, many variables... and that is what we are here for to help you out with!

Wow, and I thought my first estimates for enzyme cost were bad! (It was looking like just over $2,000 annually)

I just wanted to offer my hello. I've only been here a couple of days myself, so I won't add any advice except to say that the folks here are wonderful and very knowledgeable about things, and have been a great help!

It's funny what you said about "varying degrees" of EPI, because I was actually wondering that myself. But I really won't go any further, I have too much to learn anyway.

Again, Welcome, and I hope your Ruby does great!  (And I know it's not fun, especially in the beginning!)

Hi Mike and another welcome fro across the trough in Australia.

Only have a moment but just on the enzymes, if you can get powder from enzyme Diane and it's cost effective to do so that I suggest would be the way to go. We can't in Oz because of the necessary quarrantine restrictions, obviously NZ is different.

On the Panzytrat Vs Creon, they're the same thing as Kathy mentioned and almost exactly the same strengths (slght variations don't make much difference)

Creon 25,000: Each CREON 25,000 capsule contains Pancreatic Extract 300mg equivalent to not less than lipase 25,000 BP units, amylase 18,000 BP units and protease 1,000 Ph. Eur. units.

If you can't get this brand in NZ then www.chemistwarehouse.com.au in Oz sell them and ship them to NZ airmail (see here) We pay AU$69 inc GST per 100 capsules. Bit of a difference no?

Creon now comes in three strengths - 10,000, 25,000 and 40,000 (the 5,000 was discontinued this year which the lovely Lynn wouldn't be aware of). The first one is sold over-the-counter, the other two need a prescription (Doctor/Vet). Not sure if they'll sell without a 'script if it's going to NZ but you could ask.

Let us know how you go...

Craig

Hi again Mike, it appears Creon 10,000 is available in NZ, not sure about the others but highly likely you'd think. Here's the manufacturer's details in Auckland...

Boehringer Ingelheim (N.Z.) Limited P O Box 76-216 Manukau City Auckland Telephone (09) 274 8664 Facsimile (09) 271 0629

The 10 000 is listed here on the NZ Medsafe website.

Craig

Welcome from us up in Ontario, Canada!  Just a note about the food.  Cedar was started on the Hills I/D when she was first diagnosed and did better on it than on the rather inexpensive store brand we were using.  But she didn't really do well and gain weight until we switched her to a grain free (non prescription, much cheaper!).  The Hills I/D is not a hydrolyzed food, although some of the prescription ones are and others have had great success with these.  I think it's worth a try of a grain free; ask for the smallest bag you can get.  And we found it really helpful to keep a log of the tweaking and changing we were doing...there's a template in the Downloads section.  Just remember to make one change at a time and wait 3-5 days, logging the effects before you make another change.

Nice one Barb, meant to mention food again...Mike, there's a few grain free options for you in NZ, a couple of home grown brands as well. Have a squizz at ZiwiPeak and K9Natural for starters. 

Craig

Miss Lulupants at January 2, 2012 at 8:33 PM

Nice one Barb, meant to mention food again...Mike, there's a few grain free options for you in NZ, a couple of home grown brands as well. Have a squizz at ZiwiPeak and K9Natural for starters. 

Craig

Hi Craig,

Hey - thanks very very much for all of your help and advice from across the ditch ! - very very useful. I'm going to the pharmacy tomorrow to investigate Creon 10. Theres also a food here ( Canada made ) called Orijen that seems to be about the similar price of other foods - so if it helps, then I'm happy with that.

Creon 25 ? would be maybe be good - but its 'script only' here - so I'm hoping the 10's will be okay...

Anyway - great to hear from you.

Mike