EPI * Exocrine Pancreatic Insufficiency

I was disappointed when Wallace hadn't gained any weight in the last month. He's been eating like a wee trooper and poos are good. Then it clicked! I've been using Lypex for the last month and not pancreas, he always does better on pancreas. Been cheating because I've not been feeling too well.

Anyway..... I don't think (and neither does Jean!) that Lypex is as good as the US enzymes, wish we could try Diane's enzymes. To the point, I have nearly a full bottle of Creon 10 in my fridge that I haven't used yet, and I need to use it before the date expires. So maybe a change of enzyme is what I need? Worth a try.

I was reading up on the amount of Creon others are using and it seems so little in comparison to Wallace is getting in Lypex. Wallace is getting 5 Lypex per meal with Creon it seems to be between 1 and 3.

Can anyone suggest what I should give him in the way of Creon to get started? The units are below for comparison.

Lypex

PancreatinBP to provide enzymatic activity per capsule not less than:

Free protease

1200 BP units

Lipase

30000 BP units

Amylase

18750 BP units

Creon10

PancreatinBP to provide enzymatic activity per capsule not less than:

Free protease

600 BP units also equal 37,500 USP units

Lipase

10000 BP units also equals 10,000 USP units

Amylase

8000 BP units also equals 33,400 USP units

Lypex is costing between £35 and £40 every 6 days. So I need to get back on to the pancreas now really, but I was looking at the cost of Creon and it would only cost around £30 per month if he was getting 6 per day, 3 per meal. Even at 10 a day it would still work out WAY cheaper than the Lypex. Down side is I need a prescription. Anyone in the UK have any experience of obtaining Creon? If I have to do it through the vet it will probably be 5 times the price!!

Anyway I have to say a HUGE thank you to Jean for her very kind gift of Lypex to Wallace for his Christmas. It was her wonderful generosity that allowed me to take a month off processing pancreas. I can't tell you how much that means to me! Lol! Love you Jean!!

All suggestions gratefully appreciated!

Gillian x

I wish I could help you, I really do. It is sad that these things are not available all over.

Creon can be a funny dosing but many do well on it, many have no choice but its finding that right dose that can be tricky. I am sure someone will jump in and give you a starting dose per cup of food. Also on the Enzyme page under Creon Frank has a database of prices and where available. That may be a good cost starting point.

Hello Gillian -

I have no idea if Creon works any better or worse than Lypex but if you have the Creon already you might as well try to use it up in some fashion.  I am not sure what kibble Wallace is on currently, it's calorie count and how much he eats at each meal but here is the scoop on what we have been doing with Boss... maybe it will help you figure a starting point to try with Wallace.  For about a year Boss was using one Creon 25 for 2 cups of Z/D kibble (254 kcal/cup) with about 1/2 cup diced meat added.... three times a day.  The Z/D is not very nutrient dense compared to some kibbles, a factor which I think plays into the Creon to kibble ratio.   Since August he has been on a mixture of Instinct Lamb kibble (433 kcal/cup) and Instinct Lamb canned (621 kcal/13oz. can).   Now he gets 1 1/2 cup kibble plus 1 can twice a day.... but we found the need to increase the Creon to two 25's with each of these two meals... as the total calorie count per meal had increased compared to with the Z/D.  Good luck and let us know what your Creon to Lypex experiment yields.... hopefully at least good poops

Howdy Gillian,

Those numbers seem a little odd to me as Lypex reads to be about 2.5x stronger than Creon 10 

Based on that he'd need about 12-13 capsules of Creon 10 to equal 5 Lypex no? That can't be right, i must be missing something, the products can't vary that much...?

We use Creon 25 too, one capsule of which is cloer to the one capsule of Lypex on paper:

Each CREON 25,000 capsule contains Pancreatic Extract 300mg equivalent to not less than

protease 1,000 Ph. Eur. units.

lipase 25,000 BP units,

 amylase 18,000 BP units

I'd guesstimate that Wallace would need 2-3 Creon 10 per meal as a starting point but if he's closer to Boss then you'll need one or two more. If the equivalent in Lypex is needed you're going to need alot more.

Hadn't really dwelt on calorie count until Becky mentioned it, as being the last kibble option for us at the time it had to work! Lulu gets 1.5 cups per meal twice per day. At 498 kcal/cup (2085 kJ) that means she gets an intake of 747 calories to one 25k capsule (or 2.5 x 10k capsules). Buuut then she's only 20kg (a very active 20kg) so how the size of the dog and energy expended factors in I dunno. Helpful no?  

The scoop will be in the poop!

Craig

Hi Craig - I don't really know for sure about the calorie count to Creon ratio theory... I just know that Boss was getting 1 Creon 25 with about 600 kcal per meal which equaled 3 Creon 25s for about 1,800 kcal per day with his 3 feedings.  Nowadays with this higher calorie kibble we have been able to drop him to 2 feedings per day which equal about 1270 kcal per meal with 2 Creon 25s or about 2540 kcal per day with 4 Creon 25s.  Initially we left it at 1 Creon 25 per meal as the volume of intake per meal did not seem that different... the poop change was not dramatic but became a smidge softer, smidge larger, increased from 2 to 3 times a day and baby girl Scout and the magpies started munching on it... they are my early warning system    So we increased the Creon 25 to 2 per meal and the poop became perfect 5 star twice a day again with no free range grazing going on    So the calorie count to Creon ratio that we dialed in on as working best for Boss for both the old and new kibbles works out to be about the same.  It looks to be not that far off from what you currently have going with Miss Lulu also... especially since I think we have both also noted that with Creon the dosing does not have to be as exact as it seems to be with the powdered enzymes most folk use?

...yes but an interesting theory in part or whole. Interesting too how 'Lu and Boss are running a similar caloric intake with our girl slightly higher. Every metabolism is different of course but it's also relative to being a dog. I'm particularly interested again as Lulu hasn't had a great December SIBO-wise but we've managed to get a hold of it finally. I'm thinking of upping her Creon maybe by 10 next month to see what, if any, difference it may make. I tried this before way back but QOP decreased and we went settled on 25. With the last SIBO outbreak we had a brief return to poop snacking with larger, softer examples. Only this week have we consistently got 5 star. She'll be on Tylan until the end of Jan just to make sure so will play it by ear as much as one can play poop by ear which is a fairly disgusting note to end on.

Craig

Oh and Jean, you rock!  My address is only an email away 

Wallace is getting 5 Lypex per meal?

That sounds an awful lot... but it is different with each food / kibble.

With Razzy it worked out 1 Lypex (or 2 caps of Tryplase) to 8 ozs of well soaked Bakers Complete.

Or one Lypex to 12 ozs of raw diet.

I have no idea what that would have been in Creon.

You are sprinkling and feeding Lypex straight off? Otherwise the pre-digestion would break the enteric coating and the stomach acid would kill the enzymes.

But then you may be spot on because Wallace is a hard one to manage... while Razzy was comparatively easy.

Val

hello all

Gee you are very welcome and you know it

we have become friends over the last year and i am grateful of your support in Karas behaviour issues and everything else we talk about lets face it we have highs and lows and get through them

this will make people laugh

last year she told me she couldnt get pancreas so off we go to south of the border with 12 kilos of frozen pig pancreas in the car can you imagine being stopped by the police and explaning that!!!!!!!!!!! apart from all Karas drugs to say nothing of mine, funny......................

George's face when he saw it in a large container was a picture, and worth getting up at 6.30 am to go to the slaughter house which made me very sick

anyway about the enzymes

we decided to change to pancrex granules last summer and i like it

my vet (the senior one) who has been dealing with epi as he puts it for ever prefers pancrex powder which is known as pancrex vet powder

http://www.chemistdirect.co.uk/pancreatic-enzyme-for-cats-and-dogs_1_20400.html

pancrex granules

http://www.medicines.org.uk/emc/medicine/23372/PIL/pancrex%20granules/

have a look at the pdf

the granules are human grade and we were told that one tspoon per 200 grams of food so we give three in the morning and two at night

the reason i like this is that it covers the food and you can see it no smell of sour milk

the stories of the weight gain in usa is depressing as we dont seem to get the same results and the cost over here is disgraceful

anyway we work with what we have

jean

As far as i am aware creon and Lypex are the same product but one is much more expensive as it has a picture of a GSD on .

I am with  Val on this one i use 1 lypex per 100 grams of food and was told by my vet not to go higher than 3 too many enzymes is a bad as to little.

Are you sure he is holding his B12 .

The other thing is perhaps look for a food with higher amounts of fat in it or do as Val did and go Raw i think she said this put more weight on her.

Why dont you try the granules that Jean is using.

Are you still using the Butchers tripe is this unbalancing what the Kibble should be doing .

Ann

HAAAAAAAAAAAAAAA!

Jean.... I wish I'd known you were travelling with a load of frozen pancreas... OMG!... I would have phoned the 'Old Bill' and told them you had dismbowelled a cow and were running off over the border.

Gillian.

So far as I can make out Creon is good because you can give the capsule whole..

But Lypex has a hard plastic type capsule and all the research I've found insists you have to open and sprinkle.... The human site I looked at said it should be sprinkled in a small glass of warm milk and drunk before eating a meal..... so Lypex and Creon are a bit different.

Val

Thanks everyone for your replies.

Diane - I wish we could try your enzymes too!

Becky - that's a good idea to look at the k/cal per cup but there is nothing on the food bag to tell me the kcal.

Craig - my thoughts completely, I would need way more Creon than what others seem to be using.

Val - Wallace can't cope with any less than the 5 Lypex per meal (or equivalent pancreas). He was eating 3 meals a day with 4 Lypex in each meal but he will only eat 3 meals a day for 3-4 weeks then he starts refusing food completely. So he's back on 2 slightly larger meals a day which he eats well. I feel it's better for him to enjoy his food instead of walking away from it. All food is soaked and Lypex sprinkled on just before serving.

Anne - yes his B12 is holding an on the high side which is great. I did start with 2 Lypex per meal but had to increase gradually until I found Wallace's level. Unfortunately for us his level is 5 per meal, anything less produces large soft poos. This is why we went down the pancreas route. We stabilised Wallace on Lypex first, then had to change to pancreas because of the cost.

Wallace gets B12 every month. He's eating the only grain-free food I can get him to eat! He gets a little tinned tripe over the food as a tempter. He was getting 150% but started refusing food, so had to reduce to 110%, which is probably contributing to why he's not gaining weight but I can't make him eat.

He's very stable, no SIBO and poos are good. Hubby says I'm worrying over nothing because he's happy and full of energy! But I would just love to see a little more weight on him. We always seem to plateau at 27kg and just can't get passed it. It's always at the 27kg point he stops eating the 3 meals a day.

His poos are just a little more volumous than they should be, not much just a little, but frequency is the same as Cal and Roxy. I suspect reducing the volume might require more enzymes (£££££!!!!) or maybe different ones? This is why I was thinking that maybe the Lypex isn't the best one for Wallace.

To get the same enzymes as Jean I would have to buy from the vet because they are human enzymes (I would need a human presciption to buy online) but the vet prices are way higher so they would probably cost a fortune. Thankfully Jean has insurance. E.g. vets charge £80 per box of Lypex, I buy it from around £35 online.

Anyway thanks for listening to my "thinking out loud"!

I will use the Creon up, no way it's going to waste. I'll just tweak it possibly with the Lypex too.

Gillian x

Awww, hon... you have a really difficult problem and I wish I could come up with something to help.... I would gladly give Wallace a bit of Cassie's weight if I could.... she's just 7 months and weights 5 kilo MORE than Razzy at that age... Cassie weights out at 36kilos and that is a headache when she jumps up at everyone.... AND the little devil is putting on 2 kilo every 3 weeks even on a regulated raw diet..... I hope she slows down or she will be like a pit-pony.

That is the thing with dogs ... you are either trying to put weight on or keep it down.

Have you thought about a raw diet?

Its a bit pricey and hard work but it may cut down on the enzymes which are frightening when there is no insurance.

Val

Wowser, our bonny boy does nees a lot of enzyme-lovin' doesn't he. If Lulu needed the same we'd be giving her not 1 Creon 25 but 5 or so per meal! My next thought was are all the enzymes reaching the small intestine but Lypex are enteric coated and they manufactuer does say you can sprinkle or give whole so either method shouldn't matter. Out of interest, would he not take them whole? When you try the Creon maybe try giving them whole as an experiement, if he'll come at that that is.

Re prescriptions, Creon is a human product too but our vet writes it for 'Lulu Dog' and we have our discount pharmacy fill it. It always seems to amuse them for some reason  Hopefully you can do this in the UK, vets are doctors too (sounds like a car bumper sticker campaign).

Good thing is he's happy and healthy and frankly if he won't eat past a point then that's his point I reckon. Some GSDs are just light-on naturally.  At least he's in no risk of being sent 'down pit' like Cassie 

Craig

Gillian.....considering Wallace's history, you might want to start with two CREON 10 and see how the poos look... if too soft or large.... then increase the dose a little to bring it up to 25. It seems that these dogs do well on either Creon 10 or Creon 25.....

I never thought of a possible relationship of Creon to calorie intake.... hmmm.... Becky might be on to something here!

Regarding Wallace's weight.. or lack there of..... you might want to "try" something... although this might backfire with lousy poops... but.... according to research... fat actually helps the enzymes work better (where as fiber inhibits the enzymatic activity).... so .....i am wondering .... maybe if you increased Wallace's fat intake....with each meal... the enzymes might  work better and Wallace might even put on some more weight..... especially since once they are receiving enzymes, digesting fat is not an issue.  Of course,,,,, this might sound great in theory... and a complete failure in real life.... but it might be something to try.... maybe add  a teaspoon ofsomething like butter to the meals for a couple of days.... see if there is any improvement in the poo......or not..... Just a thought....

Jean.... i had no idea you did that for Gillian..... you are such an angel! 

hello everyone

thanks Olesia we do what we can

anyway

http://www.petmeds.co.uk/p-3530-lypex-capsules-60.aspx

the description on this site says to give lypex either whole or sprinkled

on the box in large letters it says "do not administer whole"

i intend to ring them on monday to ask questions as to the relevance and will report back

sadly we dont have text book dogs

kara has three lypex per meal and i was to increase them to 4 on vetinary advice before i changed to pancrex but i still have them in reserve as previously said she has three teaspoons of that per meal

as uncle Ian the vet says you work with the animal you have some need 1 lypex some need 6 and that is the way it is and god knows why(i said that) ,

i did an experiment with lypex with 1 per meal and it did not work for us at all and  created a real problem with sibo and everything else poor baby was sick and i mean sick it seems as if we are both at the struggling end of things as you know Kara has to have antibiotics for life and what makes me amused is that the vets have a large tub of oxytet with her name on it

Gillian and i talked about this at length and she was right in saying dont, but it felt right to me to try, i won't again, she is too important

the fat and calorie content is interesting but Wallace has other issues with oils so difficult .............................

my thoughts are to go back to pig pancreas but again this may not be possible at the moment

none of this is easy and now our dog food outlet is not answering the phone............................

jeanxxxxxxxxx

None of this is easy?????

Too damn right... there are so many different problems with so many different dogs its certainly one of the worse conditions I have ever come across in all my long life.

Most things are just teated by dogs weight... a pill here and there... this one you are thinking on your feet running all the time.

Val

Jean.... is Wallace sensitive to all fats and oils or just (so far)  with a specific one like the (hope i get it right this time :D) SunFlower oil??? 

i think its so far just sunflower oil and this was deduced bt eleimination no scientific evidence

but i know that my little love cannot tolerate any oily fish such as pilchards and mackrell

any butters give her the burbs so sibo and out come the antis big bats that is the oxytet 3 immediately and then 2 3 times a day for a few days and then back on the regime

wht the hell is this so hard???????

still jealous of us enzymes

jeanxxxxxx

HI Jean... ahhhhhhh..... i get it.... Gillian would probably be nervous to try this (butter) with Wallace, just in case he does have a reaction....