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EPI
EPI
What you need to know with Dr. Barry

When your pet has Exocrine Pancreatic Insufficienty or EPI they receive very little nutritional value from their food. In this series of brief articles, I will share with you that by replacing your pet's pancreatic enzymes you can restore your pet to a happy and healthy lifestyle.  I will also discuss a recommended supplement called Digestive Vitality, please read the article called, " It Doesn't Have To Be A Death Sentence." for more information.       To Your Pet's Good Health!,        Barry Miller DVM

 

What You Need To Know
What You Need To Know

Most pet parents, that have a pet with EPI, begin the diagnosing office visit by first reassuring me that although their dog looks like it is starving to death they feed their pet regularly and that their pet could eat them out of house and home.

After determining what their pet has, I usually hear….

My pet has what? Say that again….

Exocrine Pancreatic Insufficiency also known as EPI.

Second response usually is…

A disease, I thought he had worms!

What is EPI?

Exocrine Pancreatic insufficiency basically means that your dog's pancreas is not producing sufficient pancreatic enzymes. Pancreatic enzymes help digest food. Essentially your dog is not digesting the food they eat. Or more exactly the proteins, starches, and fats in their food cannot be digested or broken down into small enough pieces to be absorbed by the body. The nutritional value of their food, is not absorbed and is passed out in their poop. Their poop typically becomes a golden color and has a fatty appearance. Your pet will also experience more gas than usual and have extreme weight loss.

By the time most pets show symptoms close to 90% of the pancreas has been destroyed. Early detection can be a life saver. We will discuss in more detail the signs and symptoms of EPI in the section called How do you Know.

How serious is EPI?

Understanding that your pet receives very little nutritional value from their food will explain why they are constantly hungry. An affected dog, without treatment, literally starves to death even though it may be constantly eating.

How did my dog get EPI?

Did something cause this or is it Genetic?

The answer is….both are correct.

One of the causes of EPI is Chronic Pancreatitis or inflammation of the pancreas.

Pancreatitis can be caused by the ingestion of large amounts of highly fatty foods, toxins or caused by infection. Pancreatitis results in the pancreas becoming inflamed causing digestive enzymes that are normally inactive until they reach the small intestine to become activated in the pancreas. These activated digestive enzymes in the pancreas result in pain and swelling as the pancreas actually begins to digest itself. Dogs with chronic pancreatitis essentially have multiple attacks of acute pancreatitis.

A second cause of EPI is the fact that in some young animals (usually less than two years of age), the cells of the pancreas just start decreasing in number and functioning. The cause for this is unknown, but it may be an inherited condition. Many different dog breeds can be affected, however, it is more common in large breeds, especially German Shepherds. But it can also occur in these dog breeds that are prone to Pancreatitis:

Miniature schnauzers, miniature poodles, and cocker spaniels.

Additionally, EPI can result from chronic pancreatitis in pets that are older and pets that are overweight.

How Do You Know?
How Do You Know?

Unlike many disorders with vague or common symptoms to other illnesses, EPI has very specific and obvious symptoms. EPI can appear gradually over a long period of time or very rapidly like a week or two.

Your pet will be ravenously hungry but show rapid weight loss.  A very skinny appearance will begin to show as they lose body fat and have muscle atrophy. Your pet’s hunger may cause them to suddenly eat things they never have eaten before or that they know better not to eat such as dirt, plants and containers that have housed food.

Their coat or hair will change from healthy to a poor lack luster coat. 

They will experience diarrhea that will be golden or a light yellow color with a consistency of mashed potatoes.  It is not uncommon for there to be undigested food particles in their feces.

 

What to expect at the Vet’s office:

Your Vet will more than likely suspect EPI by just by looking at your pet and asking  you a few questions but they will do the following to diagnosis EPI for sure.

 These include:

•  A blood test for levels of digestive enzymes
•  Measuring the level of chymotrypsin activity
•  A stool test to determine the level of digestive enzymes in the stool (
•  Examining the stool under the microscope (least reliable)

 

It Doesn't Have To Be A Death Sentence
It Doesn't Have To Be A Death Sentence

Is there a treatment?

Yes!

The good news, is that with medications you can replace your dog’s pancreatic enzymes with pancreatic enzymes from other sources like the pig.

The bad news, this can be expensive and in most cases is a lifelong commitment of treatment.

Your Vet will prescribe medications such as:

PancreaPowder Plus, Panakare Plus, PancreVed Powder or PancrePlus Powder. These are formulated either as tablets or powders.

These powders and tablets contain large quantities of the same naturally occurring digestive enzymes that your pet does not produce enough of on their own. They begin working once they are in contact with your pet’s food.

The tablets are given prior to a meal or may be crushed and mixed with food.

The powder is usually mixed with food and allowed to set for about 30 minutes before feeding.

There are over the counter drugs that are a helpful addition to the enzyme replacement. Cimetidine or Tagamet is given before a meal, which decreases stomach acid, by decreasing the stomach acid more of the pancreatic enzymes found in their medicine will be intact as it passes through stomach and the treatment will be more effective.

I have found that by using both Cimetidine and a good supplement a smaller dose of pancreatic medication is possible. Since the pancreatic enzymes are the most expensive part of treatment, being able to reduce the dose will decrease the cost of treating EPI in your pet.

How well does treatment work?

It is hard to believe but the response to treatment can be immediate and you will see your pet return to normal health quickly.

What More Can I Do?
What More Can I Do?

If your dog does not respond well to the addition of the digestive enzymes, their diet may sometimes need to be altered. A highly digestible diet is an option. Such as adding a diet of triglycerides, is a fat source which does not require pancreatic enzymes to break them down.    

I highly recommend a product called Digestive Vitality

Digestive Vitality is a capsule formula designed to support gut, bowel and urinary tract function and health.

A combination of N-acetyl glucosamine, beneficial bacteria lactobacillus acidophilus, digestive enzymes, and alfafa, This product contains Proteolytic enzymes like pepsin, papain and bromelain that support digestion, nutrient absorption and utilization. N-acetyl glucosamine is naturally found in the glycoprotein layer of the mucous membrane. Through support of glycoprotein production, N-acetyl glucosamine supports the structural integrity and healthy function, meaning it supports the body’s natural protective barriers against invading microorganisms.

In addition to the prescribed pancreatic enzymes, Digestive Vitality is highly recommended for EPI patients because it will provide a healthier gut so that your dog will better be able to absorb the nutrients from the food it is consuming.

Multi vitamin supplements may be given. I recommend a multi vitamin containing Vitamin B12 and the fat soluble vitamins A, D, E, and K to prevent vitamin deficiencies. A great multi vitamin is DVM Daily Soft Chews. DVM Daily Soft Chews® are formulated with an array of vitamins and nutrients to accompany a dog’s daily diet. Each soft chew is a palatable blend of 22 vitamins, minerals and dried fermentation extracts. Plus, antioxidants to help support a healthy lifestyle for dogs suffering from EPI.

 

In rare cases EPI is temporary:

I have seen pets suffer from pancreatic insufficiency that was only temporary and resolves in less than a year. Treatment was still necessary during these months, or death will occur. In these cases it is possible that the pancreatic insufficiency was caused by temporary inflammation of the pancreas and permanent damage was not caused.  Thus allowing the pancreas to produce the digestive enzymes once the inflammation is gone.

 

Recommended by Dr. Barry!