Late in the summer of 2005 I picked up my Spanish Water Dog (SWD) puppy, Izzy, at Charlotte Airport in North Carolina. I imported her from the top breeder of SWDs in Spain because I was going to start a working dog line of Spanish Water Dogs. Her father, Gordo, was a famous SWD working dog champion. Izzy and her sibling, Carlos, were delightful little pups. My friend Shelley took Carlos, who was a little bit more well-mannered, whereas Izzy was quite energetic!
Izzy (left) and Carlos (right)
When Izzy was around a year old we thought she looked a little thin, but just attributed it to her having a growing spurt. Shortly thereafter, while giving her a bath, it became obvious this was not a growth spurt. For three months the vet ran all kinds of tests and found nothing wrong. But something was wrong– Izzy lost almost half her weight, started eliminating 5 to 10 times a day and had many accidents in the house. I increased her food intake from two to nine cups a day and she was still losing weight. Then she started eating her own feces– she was almost feral about it, her feces were large, pale and tan colored and looked like cow plops. When my vet heard me describe the feces, he said, “if it looks like a duck and quacks like a duck it just might be a duck… let’s test her for EPI!” When I asked him “what’s EPI?”, he responded “a condition that German Shepherd Dogs get”. At one year and three months old, my Izzy was diagnosed with EPI. She was the first of her breed to ever be recorded diagnosed with EPI. A few years later I traveled to Spain to address the SWD club about EPI, and since then more cases have been properly diagnosed.
What is EPI?
EPI is Exocrine Pancreatic Insufficiency, a primary or secondary health condition in dogs and cats where they no longer produce the necessary digestive enzymes from the acinar cells located in the exocrine part of the pancreas. These digestive enzymes are needed to digest nutrients from food.
These three main types of digestive enzymes are: amylase for digestion of carbohydrates (sugars & starches in grains, fruits & vegetables), protease and trypsin for digestion of protein, and lipase for the digestion of fats. Normally the lipase enzyme breaks down undigested triglycerides into fatty acids and monoglycerides, which are then solubilized by bile salts. Impaired fat digestion is not apparent until the lipase enzyme output is less than approximately 10% of the normal level. This is why we do not see any physical signs that something might be wrong until approximately 85-95% of the exocrine part of the pancreas has atrophied.
When these critical digestive enzymes are not sufficiently available to help digest nutrients from food, the body goes into starvation mode. Left untreated, the dog will eventually die from either organ failure or starvation, whichever happens first.
Possible signs exhibited after 85-95% of the pancreas is atrophied are:
- Gradual wasting away with a voracious appetite
- Eliminating feces more frequently with large yellow/tan/gray feces resembling cow-plops
- Intermittent or watery diarrhea
- Eating feces (coprophagia) or other inappropriate items
- Vomiting, burping or acid reflux
- Tummy noises/grumbling
- Excessive flatulence
- Personality changes
Can EPI be managed? YES! Once the EPI is under control EPI dogs can live just as long as any other dog and can do anything any other dog can do.
Fiona’s Dexter before and after EPI treatment
Dexter pictures re- printed with permission from owner, Fiona & www.Epi4Dogs.com
If you suspect your dog has EPI, contact your vet and request a TLI (trypsin-like immunoreactivity) blood test. You will need to food-fast your dog for 12 hours prior to the blood being draw. It is advisable to also ask for a Cobalamin blood test to be done at the same time, as over 80% of EPI dogs also have insufficient B12 levels and will not optimally respond to treatment until their B12 levels are in the upper-mid range. Follow Texas A&M lab (TAMU) recommendations for the B12 protocol http://vetmed.tamu.edu/gilab/service/assays/b12folate
If your dog tests positive for EPI you will need to start with the recommended protocol of managing the four aspects of treating EPI:
- Porcine Enzymes with every meal. For enzyme resources: epi4dogs.com/enzyme.htm
- Diet with low fiber content of 4% or less. For details: epi4dogs.com/diet.htm
- B12 (if needed for low B12) For details & research: epi4dogs.com/b12.htm
- Antibiotics (if needed for SID) For details, dosing and research: epi4dogs.com/sidsibo.htm
Enzymes are usually needed for life and should be included in all meals. There are multiple types of enzymes that can be used, such as freeze dried powdered enzymes (prescription or generic), enteric-coated enzymes in capsules, enzyme tablets, or raw pancreas. In the USA, freeze dried powdered enzymes are preferred as they are most consistent in potency and easiest to ascertain proper dosage and administration.
Diet is a key component of effectively managing EPI, but this can vary from dog to dog. We suggest starting with a very low fiber food that does not have any grain in it. This usually works best for most, simply because fiber may, to some degree, inhibit the effectiveness of the enzymes. However, some EPI dogs will require slightly different diets, such as a hydrolyzed diet, or some will do better with a very limited amount of grain (rice) added. Many EPI dogs have difficulty with too many carbs in the formula or if there are too many peas in the diet composition. Because finding the right diet can be so tricky, we advise pet owners to start keeping an EPI Journal and record everything given and record the output results and any other reactions. Keeping a journal will greatly help the pet owner identify what does and doesn’t work for their EPI dog.
B12 insufficiency is a secondary condition of EPI that occurs in 4 out of 5 EPI dogs. The recommended protocol is six weeks of weekly simple serum B12 shots and then re-assess to determine how often B12 supplementation is needed to maintain upper mid-range B12 levels. Often pet owners will opt for B12 pills, however, OTC B12 pills usually do not work unless they also include the intrinsic factor. There is recent research that suggests that very high doses of oral B12 can correct low B12. However, it has also been observed that B12 pills without the intrinsic factor included in the pill do not always work on EPI dogs. In the small intestine, the B12 becomes bound to intrinsic factor which eventually allows the B12 to be absorbed into the portal blood. With EPI, we have no way of identifying which dog may have viable intrinsic factor or if it has been damaged. Because of this we will continue to recommend only oral B12 that has the intrinsic factor included in the pill.
SID is small intestinal dysbiosis. SID means there is an imbalance of the microbiota in the small intestine. This too is a secondary condition of EPI and almost always present when EPI is first diagnosed just because of the very nature of EPI. The current protocol is to give the enzymes, and change the diet first and give this a week to two to determine if this is all that is needed for the gut flora to correct its’s own microbiota imbalance. If after a few weeks, you see any of the SID signs repeatedly, such as: yellowish/light colored stools, continued loose/soft stools, intermittent sloppy stools, gelatinous stool coating, flatulence, lack of appetite, grumbling stomach noise, acid reflux, regurgitation, then it is time to have a discussion with your vet about starting your EPI dog on antibiotics to treat SID. The current drug of choice is Tylan (Tylosin tartrate 100 grams) given according to weight twice daily/every 12 hours for 30-45 days. This is the SID protocol suggested by Texas A&M Gastrointestinal Lab, Dr. Jorg Steiner. Finding the right diet for your EPI dog is probably the most effective way to limit future SID flare-ups.
Many times even when the recommended protocol is followed, these EPI dogs still do not optimally respond. This usually means that something needs to be adjusted. Once you find the right balance of treatment for your pup, the recovery is amazing. The success rate has been estimated at 95-97%.
My Izzy is now 12 years old, has managed EPI for 10+1/2 years and is as lively as ever.
Over the years, there have been a variety of assessments and theories about this condition, many that have since been debunked due to new research with improved technology.
Currently Epi4dogs is collaborating with Dr. David A. Williams and Dr. Patrick Barko of the College of Veterinary Medicine, University of Illinois at Urbana-Champaign. Together we are embarking upon a new research, the Maya Metabolomic Study http://vetmed.illinois.edu/cmmi/ in their Clinical Metabolomics and Microbiome Initiative to further investigate possible environmental factors that may be involved in EPI. Metabolomics is an emerging field in which a very large number of small chemicals can be analyzed from samples of body fluids and tissues. This new technology has the potential to identify previously undetectable abnormalities associated with the development of various diseases including EPI. We hope this new information will provide clues as to why this disease develops and what we can do to prevent it. We expect the findings to be published towards the end of 2017.
Epi4Dogs also recently collaborated with Dr. Jan Suchodolski http://vetmed.tamu.edu/gilab/staff/dr-jan-suchodolski at the Texas A&M Gastrointestinal Lab on a Microbiota Study of EPI dogs and have found some very unusual anomalies which will also be published later 2017 and presented at the 2017 ACVIM conference.
Epi4Dogs is not only dedicated to supporting non-invasive EPI research, but we also have the only EPI database in existence and are the largest EPI resource center with multiple current EPI research in our files. We work with both the veterinarian community and the pet owner. There is also an open EPI Forum 24/7 support group always available to help those struggling with EPI, along with social media, Twitter and Instagram.
If you would like to learn more about EPI please visit: http://www.epi4dogs.com/
Olesia C. Kennedy, President
Epi4Dogs Foundation, Inc.