EPI * Exocrine Pancreatic Insufficiency

am new to the and hope I can get some ideas to help Orion a 1 yr old GSD. He was diagnosed with EPI around October of 2011. We have not had any testing done yet, but he has all the classic signs and symptoms. He weight 56lbs and is not gaining weight. The Vet prescribed Pancreved tabs 3 at each meal. He couldn't tolerate this dose at first. A lot of diarrhea. He is now up to 3 tabs with each meal and I am including rice. I have been giving him Bromelain of each meal but I'm not sure how much really to give. I want to start giving him B-12 as wll. His stool is firm now as has a good ordor. He seems happy and has more energy but not a lot of stamina or muscle. Any advice is welcomed.

Patty M.

HI

A quick welcome from me .

Read all the tabs on the top of the forum,

Main Points

Enzymes

Grain Free Food

B12 ( really important probably why your dog isnt gaining weight)

Antibotics if requires for SIBO

I will post about Bromelain tomorrow i use it as well.

Somebody will be by in a while to give you more detsils and make sure you have the right enzyme to food ratio.

Ann

x

Hi,

Just curious, was Orion actually diagnosed with a confirmed case of  EPI, or are you just treating as if it is EPI?   You had mentioned that no testing had been done.

Epi dogs tend to do better on grain free food, so if you are still giving rice, you may want to stop that as many dogs cannot tolerate grain.  The amount of enzymes is dependent on the amount of food you are giving.  I do not use the capsules so I am no help there.  Many of use use the powdered enzymes through Enzyme Diane, as you can cut down on costs.  Tylan or Metro is often used for SIBO (see tabs at the top for more info).  B12 deficiencies are also common and should be addressed if this is a problem for your particular dog. Many give their own B12 shots at home.

The link for Enzyme Diane is http://www.enzymediane.com/

Feel free to ask questions, also there is lots of info to be gleened from the main pages and also may help to clarify things.

Thank you for your replies! I hope I'm replying in the correct box.

The Vet told me his signs and symptoms are consistant with EPI. I declined testing because of the cost. He had just been diagnosed with Panosteitis (growing pains) and that was a big chunk of change. He developed the Pano and EPI symptoms at the same time.

The Vet started him on enzymes and his is eating Royal Canine Gastro high energy food. He eats 3 times a day. 2 cups w/ 3 tabs am & pm. 1 cup 3 tabs for lunch. What are some good grain free foods? Also could I give him B-12 tabs for now and is it better to give supplements with meals. I will be stopping the rice.  I will check out the enzyme website.

Thanks Patty

maddie ann at February 1, 2012 at 3:37 PM

HI

A quick welcome from me .

Read all the tabs on the top of the forum,

Main Points

Enzymes

Grain Free Food

B12 ( really important probably why your dog isnt gaining weight)

Antibotics if requires for SIBO

I will post about Bromelain tomorrow i use it as well.

Somebody will be by in a while to give you more detsils and make sure you have the right enzyme to food ratio.

Ann

x

Can't wait to hear about the Bromelain

Hi Patty & welcome to you & Orion. Sorry your boy seems to have EP I from the description of his symptoms. Once you get his food, enzymes, B-12 & SIBO addressed, it is very manageable.

I am going to address the B-12 issue. Yes, you may be able to give tablets eventually, but in the beginning, the injections are best. B-12 is very inexpensive ($12 bottle) & almost all of us here, give the shots to our dogs ourselves. It's very easy to do & your vet can show you how. There is even a video on our site to demonstrate giving a B-12 shot.

After reading the B-12 tab above, you can see how important B-12 is to these pups. It gives them energy & stimulates appetite. Some members, after stabilizing their dog, will try the B-12 tablets, BUT you must use the ones that have intrinsic factor in them for the B-12 to be absorbed.

I will let others chime in on the food, etc. My girl Addie does best on Canidae Pure Elements, but every dog is different.

Good Luck- look forward to hearing about progress!

Kelli

Star's Mom at February 1, 2012 at 3:48 PM

Hi,

Just curious, was Orion actually diagnosed with a confirmed case of  EPI, or are you just treating as if it is EPI?   You had mentioned that no testing had been done.

 

Epi dogs tend to do better on grain free food, so if you are still giving rice, you may want to stop that as many dogs cannot tolerate grain.  The amount of enzymes is dependent on the amount of food you are giving.  I do not use the capsules so I am no help there.  Many of use use the powdered enzymes through Enzyme Diane, as you can cut down on costs.  Tylan or Metro is often used for SIBO (see tabs at the top for more info).  B12 deficiencies are also common and should be addressed if this is a problem for your particular dog. Many give their own B12 shots at home.

The link for Enzyme Diane is http://www.enzymediane.com/

Feel free to ask questions, also there is lots of info to be gleened from the main pages and also may help to clarify things.

 

Thanks for the info. I hope I'm posting correctly.

Addiemoose at February 1, 2012 at 4:42 PM

Hi Patty & welcome to you & Orion. Sorry your boy seems to have EP I from the description of his symptoms. Once you get his food, enzymes, B-12 & SIBO addressed, it is very manageable.

I am going to address the B-12 issue. Yes, you may be able to give tablets eventually, but in the beginning, the injections are best. B-12 is very inexpensive ($12 bottle) & almost all of us here, give the shots to our dogs ourselves. It's very easy to do & your vet can show you how. There is even a video on our site to demonstrate giving a B-12 shot.

After reading the B-12 tab above, you can see how important B-12 is to these pups. It gives them energy & stimulates appetite. Some members, after stabilizing their dog, will try the B-12 tablets, BUT you must use the ones that have intrinsic factor in them for the B-12 to be absorbed.

I will let others chime in on the food, etc. My girl Addie does best on Canidae Pure Elements, but every dog is different.

Good Luck- look forward to hearing about progress!

Kelli

Wow,

I'm excited about all of the responses so far. Do I get the injectable B-12 from my Vet or can it be purchased elsewhere?

If you don't start to see improvements based on what some of the forum members recommend - you might want to consider testing.  I have a GSD who had all of the classic signs of EPI - but when tested she did not have it.  She has IBD and the two are very different and treated very differently.  Just don't stick with the course if you aren't seeing improvement.

we got our B-12 from the vet, but I believe others have ordered it online

Karla at February 1, 2012 at 4:55 PM

If you don't start to see improvements based on what some of the forum members recommend - you might want to consider testing.  I have a GSD who had all of the classic signs of EPI - but when tested she did not have it.  She has IBD and the two are very different and treated very differently.  Just don't stick with the course if you aren't seeing improvement.

Karla,

Interesting about the IBD. I have read info on that and will research further. Has your dog recovered fully or is this a life long condition you monitor?

It is life long - essentially they have developed almost a total allergy to any protien they have been fed before.  Mine has a severe case - so is on medications (life long) and a special food that has hydolyzed protiens in it.  Some milder cases can be treated with diet (once initial symptoms are under control.)

The one things that always stood out as different about Marley's symptoms than what I was reading on EPI - was that she wasn't ravenous and I could barely get her to eat as she got worse.  I think her intestines were so inflammed that she just felt crappy.  That took steroids to get the inflamation down.

But watery poops, stinky (SIBO), extreme weightloss - they two (EPI and IBD) can look alot alike.

I'm not a vet so clearly can't diagnose - but you will have to go with your gut.  If yours has a big appetite but still isn't gaining... then it would "seem" more like EPI.  But if some of the things you are trying don't work... you might need to ask your vet about IBD also. 

Welcome to you both.  We all understand about the cost of diagnosis for our furbaby's condition....it can get costly.  Eventually you may want/need to test, but if you wish to treat as if epi and see if improvement, that can work too.  So a few thoughts.  Most people on this forum use powdered enzymes, which most find more economical and very successful in treatment.  We are one of the few that use tablets (PancreaPlus)...now, every pup is different but we find 1 tablet per 1 cup food PLUS 1 is a good starting point.  Very important:  crush the tablet, then add them with some warmish water to the food and let sit for about 20 minutes, stir again and serve.  We didn't have as much success with full tablets, works better with the crushing.  Grain-free food is very important.  We use Costco's brand, Nature's Domain.  B12 makes a huge different for most pups and you can give at home.  We get the bottle (will last a year or more) for about $16 from our vet and I think the syringes are $.50 or so each and buy enough for a few months at a time.  Would like to write more, but have to run.  Again, welcome!

Hi, and Welcome! I'd suggest you start with your vet on the B-12 injections - it's best to have your vet fully on board.  They will hopefully give you a vial of the cyanocobalamin (make sure it's not B complex) and the sharps. Mine will (I'm not doing it myself yet, but will start soon - I've been too chicken) take back the used sharps (and told me how to dipose of them until I can take them to the office). Many on the forum use Taste of the Wild food. It's high quality, mid-price. The best luck seems to be with the fish or high-prairie formulas (for some reason, some EPI dogs don't do well on fowl).

Some dogs present with EPI symptoms, but then, after some help from the enzymes for whatever is ailing their pancreas, they are able to cut way, way back. You will only know for sure if you have the cTLi test. Otherwise, EPI, unfortunately, is for life. But very manageable and a very high-quality life. Most of us on here have dogs that, to look at them, you wouldn't know they were sick. Tney just can't eat untreated food.

You haven't talked about SIBO, but virtually 100% of EPI dogs have small intestine bacterial overgrowth at diagnosis. So, treating with at least a 30 day course of antibiotics is highly recommended. Tylan is the anti of choice for most dogs, it's mild and specific. 

There are 4 legs to the EPI management table: diet (grain free), SIBO (it's wise to start with the tylan - SIBO cannot be definitively diagnosed without endoscopy), B12 - with the SIBO comes an inability of the body to absorb B-12, and, of course, enzymes. Without all four of these legs, you'll have a wobbly table - and not very successful results (kind of a waste of money). I know some of this is redundant, sorry.

This is long enough, but we can give you specific info on tylan (dose, administration, etc)

Hi Patty and a very warm welcome to you and Orion... everyone gave you really great suggestions... and good advice just in case it is not EPI.... one thing that you might want to try is to start keeping an EPI Log (journal) start writing down EVERYTHING you give Orion, how it is prepared, how much, brand name, amount, etc.  Then ... i know this is going to sound ridiculous....... but it really helps you determine if what you are doing is helping or not....if you record what the poos look like: frequency, volume, texture, color. Even take pictures and start comparing a sequence of them....see if things appear to be getting better or not. You can download an EPI Log from the download page

Also..... there is a trick to deternine the transit time (time for food to be processed thru the dog's system and then the remainder waste eliminated{poo}) that we use here.  WIth one meal... chop up a raw carrot.... add a handful of these chopped up raw carrot pieces to his meal...... watch every elimination.... when  you finally see some of these bits of carrots in the poo... then that will be Orion's approx "transit" time (at least for now). YOu use this transit time for example....if you feed him a new dog food.... by knowing which pile of poo is the result of the new food you are trying out....the condition of the poo will indicate if it is agreeing (normal looking) or not agreeing (sloppy looking) with his digestive system

This journal keeping tool is excellent to help you figure out what is going on whether it is EPI or IBD or a food sensntivity.... after you implement the "4" items to treat EPI.... and watch him closely... if you need to make a change or adjustment afterwards... you make one change at a time. Watch the poo for 3-5 days before making the next change... again watch the poo.... This technique can also be used for many other gastrointestinal conditions in helping you figure out (1) what is going on (2) what seems to help or hurt

Unlike pancreatic enzymes, bromelain has a relatively broad pH range in which it can remain ef¬fective (4.5-9.8),33 providing proteolytic activity in the stomach as well as the small intestine. Consequently, bromelain can be used as a supplement in cases of pep¬sin and/or trypsin deficiencies, for example. Bromelain has been used in combination with pancreatic enzymes to facilitate digestion in cases of exocrine pancreatic insufficiency.34 A formula consisting of ox bile, pancre¬atin, and bromelain lowered stool fat excretion in some patients with pancreatic steatorrhoea, and resulted in weight gain, as well as relief from pain, excess flatulence, and diarrhea.35

Dosage Recommendations

Bromelain

As with any enzyme preparation, potency is a key factor in determining proper dosage. It is recom¬mended to use bromelain with an enzymatic activity of at least 2,000 m.c.u/g (or 1,200 g.d.u./g) activity. Typical daily dosages range from 200-2,000 mg/day and most re¬search has utilized four divided doses.45 When used other than as a digestive aid, it has been suggested to ingest bro¬melain between meals, although research is unavailable to confirm enhanced efficacy of this approach

Maddie had a course on antibotics for SIBO but I have used 300 mg since September per day which I give in addition to her normal enzymes she hasn’t had any re-occurrence of SIBo since.

http://www.epi4dogs.com/apps/forums/topics/show/6288345

Now I am going to beat the B12 drum Maddie original weight gain was halted because her B12 level was low she had the correct food and enzyme but my original vet had ignored the B12 reading (it was at 144 and the minimum is 250) once she started receiving weekly injections everything changed her weight went back on this is really important and will always be one week for some reason I missed her vets appointment and this may not sound allot but she lost 100 grams and I knew exactly why ……2 weeks without her jab. It has taken me 9 months and 4 B12 tests and we are know at 644 only now after a five week trial is my vet confident to let her go on the tablets. You need to be aware of the side affects that lack of this can have and your dog I presume is still quite young so he need the right building blocks and this is one of them.

I realize now why Maddie is so small in statue she was 3 ½ when dx but she had spates of bad stomachs over the years and obviously wasn’t absorbing the proper amount of protein etc.

Ann

xxxx

Welcome Patty and Orion. Everyone has given you excellent  advice, we know it can be overwhelming in the beginning... but hang  in there , someone is usually on this site to ease your nerves and answer you questions, or at least 'listen' to you , as we have members from all over the world. Our first GSD EPI girl lived to be 14 with this condition. Remember it is one day at a time!!

Ann.... please do beat the B12 durm ;)... this cannot be stressed enough and too often overlooked in EPI patients!

epi4dogs at February 2, 2012 at 10:32 AM

Ann.... please do beat the B12 durm ;)... this cannot be stressed enough and too often overlooked in EPI patients!

I am very excited to hear from all of you! :o) You are all wonderful, thank you for your time.   I have a lot of things to think about and implement. I will get started on all of my homework right away. This is very overwhelming and there's so many options and treatments I had no idea about. I will be touching base with Diane for Enzyme options

I asked my Vet to sell me B-12 and he declined, so I will be researching others avenues. I plan on getting him tested soon to see what his B-12 level really is.  The vet felt a B supplement would be good enough, so I have purchased a good quality B-12 and crushing to add to his food for now.

I have been giving him Bromelain after his meals (I can't remember the dosage, sorry). Bare with me. I will start journaling and will keep pushing forward.

I have limited internet and will read and respond as much as I can.

Thanks Patty and Orion

Hello Patty - If Orion does have EPI and you want to try supplementing his B12 levels using pills... there are a couple brands used by folks here on the Forum...

Metagenics Intrinsi B12/Folate pills

Wonder Laboratories TRINFAC-B Intrinsic Factor

The Intrinsic factor found in both these is needed for EPI dogs to be able to absorb the B12.

And a belated Welcome to the Forum