Exocrine Pancreatic Insufficiency Or EPI Symptoms
After $1,600 of vet fees, my dog has been diagnosed with Exocrine Pancreatic Insufficiency or EPI. It all started when I came back from my vacation in Asia last October. I started noticing that one of my Lhasa Apso dogs Chester has been producing soft stools. Then gradually they turned soft enough to lose their normal tubular shape and result in a more patty like state but not to the extent of liquid diarrhea. Then the stool colour turned to a much paler yellow rather than the usual dark brown.
These pale soft stools persisted for days which is very unusual because both Chester and Roxie have had much worse diarrhea before if they ate something they shouldn’t have but things always went back to normal after 24 hours. So I knew something was not right and the dog sitter who was looking after my dogs claimed that Chester did not eat anything out of the ordinary during my vacation. Even if he did eat something wrong, it should have passed by now and he did not vomit or have any blood in stools.
A few days later, I weighed Chester and was shocked to see him at about 17 to 18 pounds. He is normally a husky 20 to 21 pounds being a big boy for a Lhasa Apso. So these were symptoms that clearly indicated that something was very wrong.
I thought that his food was the issue as we did change brands from Inova to a Canadian one called Acana. But the weird thing is that both Chester and Roxie had already finished off an entire bag of Acana a month before I left for my vacation and they did just fine.
So I decided to put Chester on rice and chicken for a few days but that just made the diarrhea worse. This was enough for me to bring Chester into the vet.
The locum vet put him on metronidazole antibiotics and they did nothing. Chester’s weight continued to drop to 16 pounds and we could now see his ribs. But other than the soft stools and weight loss, he was fine with normal behaviour, no vomiting nor blood in the stools.
Stool samples and initial blood tests revealed no parasites or diabetes. A follow up visit to our regular vet resulted in a change to a stronger antibiotic as well as a switch to an easy to digest prescription food called Hill’s I/D Gastrointestinal but results were still not significantly improved.
It just seemed that anything Chester was eating went right through him without being absorbed. I tried to increase his food amount from 1/2 cup twice per day to a full cup twice per day and all that did was increase the frequency and size of his soft stools. He was now pooing about six times per day!
Although sometimes cute, he also began to experience a lot of flatulence. Vet fees added up to about $600 by now and we were getting nowhere. Obviously I was very concerned.
Referral To Vet Specialist
With continued weight loss and soft stools for over two months, it was time to get a referral to a vet specialist. Fortunately, we got an appointment to an internal medicine specialist pretty quickly and we were instructed to fast Chester overnight as the specialist would likely do an ultrasound on his stomach and other internal organs.
Sure enough, after the initial consultation with the specialist vet, we did leave Chester there to get an ultrasound as well as further blood tests. The specialist later told us that Chester was very well behaved during the entire time he was at the clinic – this of course was a result of the good consistent dog obedience training he and his sister Roxie went through and continue to drill each day.
The specialist also put Chester back on Tylosin which was the antibiotic our regular vet prescribed along with an additional one, enrofloxacin. After a few days, I noticed that Chester’s stool became more tubular in shape rather than the usual patty. He was also given a vitamin B12 injection since many dogs tend to have deficiencies during such cases.
The vet fees from the specialist for the initial consultation, ultrasound and other tests along with the new antibiotics amounted to about $1,000. A possible next stage of tests would involve a gastrointestinal endoscopy which would cost about $1,500! This would determine if Chester has Crohn’s or inflammatory bowel disease.
A few days later, the specialist called me and told me that the results of a blood test which measures pancreatic deficiency indicated that Chester indeed has low pancreatic enzyme levels. These enzymes are required in order for food absorption. Without proper levels, food will not be absorbed and will just go through his system like what has been happening over the last two months.
The specialist said this is known as Exocrine Pancreatic Insufficiency or EPI. It is not known what caused this in Chester as most cases of EPI are in German Sheppards and seems to be genetic. Chester’s lineage had not seen any EPI cases according to our breeder. Instead, something must have caused Chester to have some type of autoimmune attack which destroyed the pancreatic cells responsible for secreting these enzymes.
Pancreatic Enzyme Supplementation
Chester was started immediately on treatment since the diagnosis definitely involves EPI. We don’t know if this is the only disorder yet but it will depend on what results we get from treatment. The specialist put him on Pancrease V which is a powder form of the pancreatic enzymes to be mixed in with food. We are continuing the antibiotics since an overgrowth of bad bacteria known as small intestinal bacterial overgrowth (SIBO) is often observed with cases of EPI.
The specialist also told me to add a bit of Pepcid and canned pumpkin into Chester’s food as well. These would help him absorb and digest food better. Everything was mixed into his food with a bit of warm water to make his food softer to help Chester absorb everything easier.
We just have to be careful of possible soreness or bleeding in the mouth and gums as a result of the enzymes which is why it is important to thoroughly mix the powder well with food and water. All of this takes a bit of food preparation but was overall quite easy on my part. If Chester has to go on Pancrease V for life, it should not be a difficult thing for either myself nor his pet sitters in the future.
An adjustment to Chester’s food schedule in the meantime was also made. Instead of a full cup twice per day, we decreased the amount of each meal of the Hill’s ID back to 1/2 cup but three times per day. It was considered that a smaller amount each meal but more frequent meals will help Chester digest his food easier rather than larger amounts of food at a time.
Initial Results Of Pancreatic Enzymes
After about two days of starting the pancreatic enzymes, Chester’s stool became dark brown again and in much smaller quantities than before. This was a good sign as it suggests that the Pancrease V powder is helping him absorb the nutrients in his food rather than just pass through his system.
The follow up visit with the specialist will be just after the end of the current course of antibiotics and the specialist did mention that in addition to Pancrease V supplemented for life, Chester will probably also require further vitamin B12 shots. Although my initial supply of Pancrease V was from the specialist clinic, I’ve already gone ahead to research my online pet pharmacies and they do have Pancrease V available at about 40% less cost. So I will be asking my vets for written prescriptions on a regular basis so I could obtain the Pancrease V at the lowest prices possible.
Another cheaper option to powder pancreatic enzymes is raw pancreas from a local butcher. But I don’t think I’ll go for this route as this is too much hassle and raw pancreas can be contaminated. Cooked pancreas will destroy its enzymes.
I’ll have an update on Chester’s follow up visit after we go in to see the specialist again. Hopefully Chester will start to regain some much needed weight back from his current 14 pounds. I also hope that he won’t have to go through with the gastrointestinal endoscopy procedure and that the treatment results over the next few weeks will point to Exocrine Pancreatic Insufficiency or EPI as the definitive diagnosis.