EPI * Exocrine Pancreatic Insufficiency

Hi everyone.  My 9 year old English Mastiff was just diagnosed with EPI, so I am trying to learn everything I can about this diagnosis and what it means for us.  My vet prescribed Pancrezyme tablets, but my big boy weighs 150 pounds,so I'm concerned about how much Pancrezyme I will have to give him.  Because I worry about bloat and because he's always had a "sensitive stomach", he eats 4 small meals a day.  I was just wondering if there were any other EPI parents out there who feed 4 times a day, and it you use tablets or powder, and if anyone knows of a co-op I can join that carries the tablets. I read somewhere about enzymediane, but it looks like they only carry the powder.  Any and all suggestions and words of wisdom would be much appreciated.  Thanks everyone!

Hello and welcome to you and your big guy.  Are you able to post his actual test results?  Also helpful would be his current and ideal weights, the type and amount of food you're currently feeding, what his poops are like and if he has any other symptoms such as gurgling stomach, gas, vomiting, eating strange things.  With a dog that big, the powdered enzyme is going to for sure be most economical for you and Enzyme Diane is I think the most economical of the powders.  We use it.  You don't need a prescription and can order it online or even give her a call.  You'll find the info at the top of the page under "Enzymes".  With the tablets, most folks here crush them into powder and mix that with the food with a bit of warmish water and incubate (let that all sit together) for a minimum of 20 minutes.  They aren't very effective if you just give them whole.  What dose did your vet recommend?  It should be a tablet : food amount ratio.  Feeding 4 meals/ day is recommended although most of us can't manage that.  And depending on how much weight your guy has lost, it's recommended to feed 150% of recommended until the lost weight is regained.

EPI is manageable but you have to find a balance of a few elements and that takes a bit of time and tweaking.  We found it very helpful to keep a log of everything and there's a log template available under "Downloads".  Has your vet started your pup on antibiotics for SIBO or on B12 injections?  Generally these are required, especially at the beginning.  Our Cedar requires ongoing B12 injections weekly and we do these at home.  If an antibiotic is required, most of our pups do well on Tylan/tylosin and the dosing for both B12 and Tylan is found up top under the "B12" and "SIBO" tabs.  If you can post a bit more info, we'll be able to respond more specifically and feel free to post any questions you have and of course pictures!

Hello and welcome to the forum.   I am sorry your guy was just diagnosed - but know, it is very managable.   Actually, it's good that you feed 4 small meals a day.   I cannot help you on the tablets, as I used enzyme Diane.   Some have done good on the tablets and some not - I'll let others who use them chime in on the tablets.

Did your vet also test cobalamin (b12) and Folate (usually an indicator of SIBO - small intestine bacterial overgrowth).   Both low B12 and SIBO are very common when EPI dogs are first diagnosed.   Also - what kind of food do you have him on?   Most EPI dogs do best on 100% grain free food and in the beginning it is recommended to feed 150% of the normal amt of food (small meals like you are doing) to bulk them back up.

What is your dog's name?   Please tell us a little more about him so we can point you in the right direction.  

If you scroll down on this link there is a section "Detailed Effective EPI Management" - it gives you a great overview  http://www.epi4dogs.com/

This is a fabulous, generous group of individuals willing to pay it forward and I am confident you will receive the info you need to help your boy out.   Again...welcome to this beautiful EPI family - although I am very sorry you need to be here...

hello and welcome from the UK

Barb has given as usual brilliant advice

we have different enzymes here but wish we had enzyme diane the results are phenomenal

dont get hung up on tablets just coz the vet says so

there is a wealth of experience here and vets are not always right it takes tweaking and tears and glasses of wine and everything else to square the circle of epi

grain free food is the big one

we have just had a real few days when my girl stole a tub of cheese biscuits full of grains of all sorts and it was not nice

read my thread" kara and cheese biscuits"

barb has told you about antibiotics and b12 and i would echo all of that

as far as feeding four times a day we had kara on 5 or 6 at one time you may find in time that can be reduced or at least changed

they do better on several small meals at the start

their gut is badly compromised as is their immune system so little and often is better

there is a lot to learn but if i were you seriously consider enzyme diane and definitely go for antibiotics and b12 these are essential at the start and at intervals for life

keep in touch

jean 

Thank you so much for the responses. I will have to ask my vet about Kobi's exact results so I can post them.  Kobi actually hasn't lost much weight. I think my vet caught this at just the right time. Kobi had meningitis a few months ago and is still on a very low dose of steroids. The steroids make him very hungry, so I attributed his appetite to that (although now I wonder if it could also be the EPI).  Anyway, he lost about 12 pounds with the meningitis, but gained about 14 back once he started to get better. Since then he has only lost about 2 pounds. So, he weighs about 147 now, which is very close to his "normal" weight of 150 pounds.  He recently started having episodes of loose stool.  That is really the only symptom he had.  My vet said the powder would be more expensive because of his weight, but maybe buying the powder through the co-op is the way to go.  My vet did say that his B12 was a little low, but only said to give him a B12 vitamin pill every day for about a month.  I will definitely ask him about all of these things everyone is mentioning here. I really appreciate everyone's input. I read that you can mix the powder with yogurt instead of water. Does anyone use that trick? If so, can you mix it with the yogurt and let that stand for 20 minutes and then add that to the food or does the powder actually have to sit ON the food itself. Oh yeah, Kobi also has a lot of allergies, so his food options are pretty limited. Right now he's on California Natural low fat lamb and rice.

Thanks again everyone!

Sandy and Kobi

blimee menigitis

not sure we have had this

how did this present itsseff and what did you do??? all very intersting

ok

what are the allergies??????

we have major allergies in our family and for most we have an answer between us 

so please more info please

jxx

Hi Sandy,

Poor Kobi has had a time of it!   I'm glad he hasn't lost much weight but I'm wondering about such a quick diagnosis with only diarrhea as the symptom particularly when he's been so ill with the meningitis and that he gained his lost weight back so well...that seems strange for an EPI dog.  Did your vet do a cTLI test on Kobi and tell you to fast him for 12 hrs before the blood draw?  It will be good to see the results.  If Kobi's B12 is low and he does have EPI, he should have a course of B12 injections to stabilize him.  Then you might be able to switch him to a pill, but only if it has intrinsic factor in it.  Regular B12 won't work because intrinsic factor is needed to absorb it and EPI dogs are intrinsic factor deficient as well. 

Grain free food is recommended for EPI dogs and rice seems to be especially problematic for lots.  Is Kobi ok with sweet potato?  There are some limited ingredient lamb and sweet potato kibbles out there I think.  Once the food is being appropriately treated with enzyme it's actually not recommended to use low fat food, unless of course Kobi needs that for another reason.  I think our current kibble is 18 % fat and Cedar is fine with this.  Fiber is the thing to watch and generally 4% or less is better tolerated.

As far as mixing the enzyme into yogurt, we haven't done that but the purpose of the enzyme is to predigest the food, so I think it is generally more effective to incubate the food and enzyme together.  Of course if Kobi won't eat it that way, then the next best thing might be what you suggest.  Assuming of course he can tolerate yogurt.  Cedar can't at all...makes her poop really soft.

How did your vet tell you to use the tablets and how many did he say to use?

Hi Sandi, and welcome to you and Kobi!  He's a handsome big boy!  My Pixie is just a tad smaller (she's chunky at about 19 lbs!).  I'm glad you seem to have caught this pretty early and he doesn't have a lot of weight to gain back - you're ahead of the game!  I don't use the tablets, so I can't really comment on them.  We use Pancreatin from Enzyme Diane (www.enzymediane.com).  Your vet may very well be right about the powders being more expensive than the tablets if he was comparing the cost you would pay to buy it from him.  The first bottle of powder we got was from the vet and cost us $150.  Then I found Enzyme Diane, and ordered from her.  We got slightly more enzymes for around $50 - literally 1/3 the cost.  It's definitely worth looking into.  There is a thread at the top of the forum page titled "Sticky: Calculating enzyme cost from Enzyme Diane (6x vs 8X)".   Check it out for some specific numbers.  Diane is very helpful, too.  Before I ordered, I called her and asked her all kinds of questions.   Hopefully someone who uses tablets will pop on soon to help you out, too.

As for grain-free food and allergies, Nature's Variety Instinct (grain-free) now has a limited ingredient kibble Lamb recipe.  You might want to check that out.  We're using that with good results with one of our non-EPI dogs who we suspect has irritable bowel. 

Good luck!

Oh yeah- I forgot to make sure you know that he needs to have the enzymes with everything he eats, not just a couple times a day. 

Hi Sandy and welcome to you and Kobi and congrats for jumping onlie to find out all you can to be part of the road to wellness for Kobi. So glad your vet caught it so early, hold onto that professional for sure. Everyone else seems to have got you covered but I'll just echo two things prior to you being able to post his results; write everything down in a log to help you (and your vet) see what worked and what didn't as you progress and make sure that the B12 tablets you're giving have the intrinsic factor in them or he won't absorb the vitamin. There are two products we know of that are appropriate Metagenics Intrinsi B12/Folate and TRINFAC-B Intrinsic Factor

Again welcome!

Hi Sandy and a very warm welcome to you and Kobi! 

Managing EPI is all about finding the right balance of 4 things (Enzymes, Diet, and B12 and Antibiotics if needed).

If Kobi was positively confirmed with EPI via a TLI test and if your vet says his B12 is low, then he most likely also will need antibiotics for SIBO, unless the enzymes straighten out the bacterial imbalance in the gut... so even though you are giving him enyzmes.... keep a very close on him for SIBO (if he has stinky gas, lots of tummy grumblings, his stools remain loose and stink or have yellow coloring to them)... because if the enzymes are not straightening it out, you will want to put him on antibiotics sooner rather than later (Tylan).

Regarding the B12.. Craig gave you the links for the only two viable B12 pills that work with an EPI dog because they both have the intrinsic factor included... any regular B12 pill from the drug store will not work with an EPI dog because it will not be processed in the digestive system because the the intrinsic factor is damaged and cannot carry the B12 to be absorbed in the bloodstream.... check out the visuals that explain this on http://www.epi4dogs.com/theroleofnutrition.htm.

Also..... since Kobi is a new EPI patient with low B12, we strongly advise being treated with generic B12 injections first... then later, if you want to manage the maintenance program, you might want to try the pills.... but talk to your vet about the injections first (feel free to print the B12 page and bring it to your vet).... they usually do either 6weeks of shots, then bi-weekly then monthly... etc... or they opt to do a 6 week regimen and then jump to monthly and re-test the dog to see if they can hold their levels with only monthly shots.  FYI.... this is also something you can ask your vet to teach you to do at home if you want so you can save tons of money.Your vet can sell you the B12 serum and needles or we have a source (on the products page) where you can purchase it...

Regarding the enzymes. I personally use EnzymeDiane 's Pancreatin 6x.... and have been using this product for 5 years now  ...my Izzy's EPI and my wallet are very VERY happy customers of EnzymeDiane!!!!!  My vet also placed my dog on Pancrezyme... i about fainted when i paid $160 for 12 ounces... and realized that i had to use 1 teaspoon per 1 cup of food....it worked out (for us) that it was going to cost me $1,200 a year jsut for enzymes. I switched to EnzymeDiane and the cost dropped to $400 a year.  THen i was able to further reduce this cost to $200 a year beacuse once my Izzy became stable, i was able to reduce the amount of enzymes she needed to only 1/2 teaspoon per meal (which was 1 cup of food) and i was able to stay at this rate for 4 years!!!!! EnzymeDiane lso has an EPi dog ...

The food you are feeding has rice in it... as others said, you might want to look for a grain free brand of food....look for one that has a fiber content of 4% or less.

ANyway... as mentioned... check out the EPI Log... record EVERYTHING you give Kobi... how much, how it is prepared, brand name, etc... and then.....record the results (poop!) volume, texture, frequency, color. Evfen take poo pictures and post here-no joke...(okay so we are a little crazy! but it helps owners understand if things are working) THis will help you determine if what you are doing for Kobi is helping or not... and if not, what specifically needs to be adjusted.  Once all things are implemented at the initial diagnosis and treatment... thereafter, if the poo does not become normal, it means something needs to be "tweaked" and this is where the EPI Log comes in handy... and we recommend "tweaking" only one thing at a time... watch the poo for 3-5 days... before you make the next change.

There is lots more to tell,but do not want to overwhelm you. Again, welcome to our family!

Oh... and did i read that right... Kobi is 150 lbs?????????????????????? WHOA... that is one BIG dog! He is a cutie though, i would love to see some pics of him, if/when you have time!

Wow. Thanks again for all of the responses. I really appreciate it. Yes, the meningitis gave us quite a scare, but thankfully he's doing much better now. I told my vet that Kobi was having normal stool one minute and loose the next (and stinky gas) and I was concerned it was a side effect of the steroids. He did not think it was and told me he would think about it. A week later he suggested we test Kobi for EPI. He confirmed the results with an internal medicine specialist once the test results were back. Kobi is allergic to eggs, chicken, turkey, potatoes, oats, corn etc. Hopefully I can find something to meet his EPI and allergy needs! So, what does everyone do about treats? Does he need the enzyme with EVERYTHING he eats, and is there a max amount of enzyme per day?  I can't thank everyone enough for the help. I really appreciate it! I will be happy to post pictures of my boy!

How do you post pictures on here?

hi

absolutely everything except watter has to have enzymes in it and there is no limit to enzymes

the issue here is that the part of the pancreas that produces the enzymes to digest food has stopped prodcing so we have to replace it

every time we eat the pancreas goes into production and so we digest

treats are for now a thing of the past and its hard

you may be able to introduce them again at some time

thiose allergies are a pain but again we have folk here in the same boat so we need to look for a food without these

http://www.epi4dogs.com/downloads.htm

this will show you how to download pictures

jean

http://www.justwheatfreedogtreats.com/great-life-dog-food

this one might work

me again

this is interesting for you

but we need to be realistic here fortunately most of us dont have issues with potatoes

http/www.justwheatfreedogtreats.com/page/407989836

jx

jean

Hi Sandy and welcome to you and Kobi,

One of our members, Terry, successfully uses the tablets and I'm sure she will pop on and tell you how she does it. I think she does 2 crushed plus 1 tablet per cup of food and incubates. As long as you have the tablets you might as well use them up, you have already paid for them. As Jean said, yes, he needs the enzymes with everything he eats. I will echo what Craig said about using the log, it's an wonderful tool to help you manage this.

Oh yeah, Kobi also has a lot of allergies, so his food options are pretty limited. Right now he's on California Natural low fat lamb and rice.

You need to post your TLI results because part of your post suggets you may have IBD issues here if this is the case a food that works well with both is Hills Z/D .

Belated welcome from the UK.

Ann

Welcome to Sandy and Kobi,

Glad that you have found this site....but sorry you have to be here. This is an awesome forum and  as to the treats..I use Yummy Chummies ( www.yummychummies.com  ).. we had another class and I fed Kodi right before we left, so we were good to go with the grain free  treats right after a meal, but Kodi is stable and remember that each dog is different. It is recommended that they are stable for 3 months of good poo before you start with treats.