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View Full Version : Anyone have experience with canine pancreatic insufficiency? UPDATE & Jingles for Mak



sisu27
Dec. 29, 2008, 06:39 PM
My 8yo Dobe has had chronic active pancreatitis for years and has reached the point where he is eating lots but dropping weight so it would appear his pancreas is no longer able to do its job. He does have loads of energy and normal stool still so he isn't too bad. He has dropped from about 110lbs to probably 90lbs and I have been denying him hacks as I don't want him running until he can use his food better. He objects strongy to having to stay at the house and not being at the barn...I'm feeling guilty.

The powdered enzyme is really expensive and I have heard that it is very hard to adjust the dosage as each case is different and that it can cause ulceration in the mouth. People seem to have good luck with feeding raw bovine/porcine pancreas though. I would like to try this route first and may switch him to a more of a BARF type diet and feed less of the Prescription Diet W/D. Anyone out there have any experience with this? How much can you feed? If cooking kills the enzyme in the pancreas does that mean you can't freeze it either? Any help would be great, thanks.

Thanks for all the great responses. Mak has had a CBC and TLI and everything has come back normal. He is down to 79lbs. My vet is going to call me today and discuss what to do next. I'm worried and not at all ready to lose him, 8 is not old enough. Cancer, diabetes, heart??? The other horrible thing that has crossed my mind is that my neighbor is poisening him somehow as he HATES Mak and Mak hates him. I would hope he isn't that much of a retched human being but who knows.

Brydelle Farm
Dec. 29, 2008, 08:45 PM
Was the EPI diagnosed based on the results of a TLI? Generally, dogs that have lost 20% of their body weight would have the very common odorous yellow/mustard colored stools that are so common with EPI. Any history of vomiting? And stools are completely normal?

Has had an Abdominal US?

Viokase/Pancreazyme is the best way to go. There are issues with using beef/pork pancrease such as Aujeszky's disease and BSE, respectively, as well as Echinococcus from raw game pancreas. Cooking it will kill the infectious disease but will also inactive the pancreatic enzyme. It can be frozen though w/o affecting the pancreatic enzyme. You may substitute 1 tsp of viokase/pancreazume for 1-3 oz (30-90 g) of raw chopped pancreas.

Often times, you need to also supplement with B12 (cobalamine). This level can be tested for at your vets, be sure to fast them first!!

Here is a client handout...

THE PET HEALTH LIBRARY
By Wendy C. Brooks, DVM, DipABVP
Educational Director, VeterinaryPartner.com

Exocrine Pancreatic Insufficiency

What the Pancreas Normally Does

The pancreas is a small light pink glandular organ nestled under the stomach and along side the duodenum (upper small intestine). The endocrine pancreas is the part of the pancreas that secretes hormones involved in blood sugar regulation, such as insulin and glucagon. The exocrine pancreas produces enzymes we use to digest our food. These two parts of the pancreas are not in separate areas but instead these two different types of pancreatic tissues are all mixed together throughout the entire pancreas.

Digestive enzymes include amylase to digest starches, lipases to digest fats, and trypsin and proteases to digest protein. They are stored in inactive forms inside special granules in the exocrine pancreatic tissue (the acinar cells) and are secreted into the duodenum (the first part of the small intestine after the stomach) when ground up food begins its passage out of the stomach. Once nutrients are broken down into smaller molecules (i.e. they are digested), they can be absorbed down the entire length of the GI tract. Without adequate productive of these enzymes, we cannot break down/digest our food. If we cannot digest the food, we cannot absorb the food. We get skinny, have especially nasty rather greasy diarrhea, or both. Often, a dog will develop a dry, dandruffy coat from inability to absorb dietary fats.

Exocrine Pancreatic Insufficiency (also called Maldigestion)

The most common cause of digestive enzyme deficiency in dogs is pancreatic acinar atrophy, where the pancreas simply becomes shriveled and useless. This condition seems to have a genetic basis but is not congenital and may develop at any age (though usually shows up before age 4 years). The German Shepherd Dog and Rough-Coated Collie are particularly at risk and the mode of inheritance appears to be autosomal recessive (meaning genetic carriers will appear normal). About 70% of dogs with exocrine pancreatic insufficiency are German Shepherd dogs and 20% are Rough Collies. Dogs can also develop exocrine pancreatic insufficiency after chronic pancreatitis has destroyed over 90% of the functioning acinar glands. Cancer of the pancreas can also lead to pancreatic exocrine insufficiency though this is a rare cause as is congenital pancreatic atrophy.

In cats, chronic pancreatitis is the usual cause of exocrine pancreatic insufficiency. There does not appear to be a genetic concern.

Diagnosis Requires Specific Tests

The biggest breakthrough in the diagnosis of exocrine pancreatic insufficiency was the development of the serum trypsin-like immunoreactivity test, a blood test. Prior to this, an assortment of inaccurate fecal tests were used. The TLI test looks for a normal level of trypsin-like enzymes in the bloodstream. In the normal animals, trypsin, an enzyme of protein digestion, is stored in the pancreas in an inactive form so as to avoid digestion of your own body. Still, trace amounts of active enzyme make it into the bloodstream. This is harmless, normal, and detectable. A dog or cat with EPI will have almost no serum trypsin-like immunoreactivity in the bloodstream. The patient must be fasted for the test to be accurate but only a single blood sample is needed to make the diagnosis. The feline version of this test often requires that the sample be sent to a university laboratory and generally a week or so is needed to get results but the canine test can be run in just a few days.

Another popular test is the fecal protease test, where a stool sample is tested for protein digesting enzymes. Fasting is not necessary and any fecal sample will do; however, three consecutive samples are needed to get a consistent result as there is tremendous variability in fecal enzyme activity over the day. Sometimes soybeans are given to dogs to help stimulate release of pancreatic protein digestion enzymes and get a more accurate test.

The fecal elastase test (elastase being another digestive enzyme) is the newest test and it is only available for dogs. a single fecal sample is needed but the problem is that some times normal dogs will test negative for elastase. This means that EPI can be ruled out when the elastase test is positive but not confirmed when the elastase test is negative.

Treatment

Dietary supplementation with digestive enzymes is an effective therapy for EPI even though most of the supplement given is digested in the stomach along with other dietary proteins. The little bit that survives the acid bath of the stomach and the patient’s own protein-digesting chemicals turns out to be enough to stop the diarrhea and enable the patient to actually gain some weight. Powdered enzymes (Viokase-V, Pancrezyme) seem to work the best; tablets are available but do not seem to break down consistently. If the pet finds the taste of the enzymes objectionable, a compounding pharmacy can fill gel capsules with the powder. Again, enteric-coated tablets simply do not seem to work well.

In the past, it was suggested that incubating the enzymes in the patient’s food would help initiate the digestion process in the food bowl but this has not been found to be true; the enzymes can be fed immediately mixed with the patient’s regular pet food. Some patients respond best when an H2 blocker-type antacid (such as famotidine) is given concurrently with the enzymes.

It is important to thoroughly mix the enzyme powder into the food, because if it is sprinkled on top, it can be abrasive and actually lead to ulceration in the pet’s mouth. If ulceration has already occurred in this situation, incubating the food with the enzymes can help resolve the problem.

Raw beef or lamb pancreas can also be used as a possibly inexpensive form of enzyme replacement but the problems with raw foods include parasite and bacterial contamination. Cooking the pancreas relieves these concerns but inactivates the desired digestive enzymes. Raw pancreas can be stored frozen without losing digestive enzyme activity.

Generally a high digestibility diet is the best choice for an EPI patient. These foods are low in fiber and fat and may be especially helpful for patients with trouble gaining weight. Many animals simply use enzymes mixed with their regular food.

EPI patients commonly have an overgrowth of bacteria in their intestines, which means that the unabsorbed nutrients in the tract have fed the bacteria living there (instead of the patient) and an over-population of bacteria has occurred. This results in a vitamin B-12 (also called cobalamin) deficiency as the bacteria consume the vitamin instead of the patient getting his or her share. A course of antibiotics is helpful to correct this problem, especially early in the course of treatment. Periodic injections of vitamin B-12 and blood test monitoring have been recommended for patients with EPI. The B-12/Cobalamin deficiency is a particularly big problem for cats with EPI, who typically require injections every couple of weeks for life. Folate deficiency is also common in the cat and supplements are required for the first month of therapy. Regular cobalamin and folate blood levels important for cats with EPI. Supplementation with fat soluble vitamins (especially vitamin K and vitamin E) is not usually needed.

Treatment is for life and without enzyme supplementation, all the unpleasant symptoms will recur. The good news is that a response to therapy is generally seen within a week of beginning therapy. Response can be excellent but approximately one dog in five will simply not respond well. Many do not ever regain a normal amount of weight.

I hope this helps!! Jingles for both of you!!

Sing Mia Song
Dec. 30, 2008, 05:05 PM
Listen to Brydelle. She is a phenomenal internal medicine tech who really should have gone to vet school! :yes: She absolutely knows of what she speaks and I would follow her advice without question.

Brydelle Farm
Dec. 31, 2008, 10:28 AM
Listen to Brydelle. She is a phenomenal internal medicine tech who really should have gone to vet school! :yes: She absolutely knows of what she speaks and I would follow her advice without question.

WOW, thanks!! I am blushing!! :) Happy Holidays!!

beaulilly
Dec. 31, 2008, 11:39 PM
Hi, my GSD mix was diagnosed at about 3yrs old and she is now almost 12 and going strong. She has been maintained on the powders with one good sized teaspoon per meal, I tried the tabs once and found them ineffective for some reason. I've got her on PanaKare Plus and it's been the best so far, the best price I've found is through Absolutely Pets I get the 12 oz for $95.00 and it lasts me a few months.

http://absolutelypets.stores.yahoo.net/papl.html

strawberry roan
Jan. 2, 2009, 11:04 AM
I am going through this right now with one of our dogs. I noticed in the fall that she was getting a bit thin. Then a bit more. And more. She should weigh about 70+ lbs and is at 48. We are trying the Prozyme route at the moment and she is maintaining her weight. She is very bony but happy in herself and runs and plays as normal. We are feeding her a high protein diet. I stopped by the vet's to have her weight checked and another vet wanted to switch her to Vet One Pancre Plus. But until my usual vet tells me to, we are sticking with the Prozyme. I was told the Pancre Plus would be 2 or 3 pills before each meal. I prefer the Prozyme powder. I just hope she puts on a bit more weight. We have had her for 6 years(rescue dog) and is such a sweetie. Making her meals takes more time but she is worth it. :):)

bdj
Jan. 2, 2009, 11:35 AM
Long ago, we had an Irish Setter who had "pancreatitis" - this was probably 25 years ago, and I was quite a bit younger, so I'm guessing it was really exocrine pancreatic insufficiency - but my folks and I were just told "pancreatitis". Oversimplification, I suppose, but whatever.
Red lived for many more years on his Viokase (funny that I still remember the name) - it definitely saved his life and was totally worth it.

chism
Jan. 2, 2009, 05:18 PM
I have a three year old German Shepherd with EPI. I believe he was around 9 months old when he was diagnosed. We knew he was thin, and had increased his feed, but since young shepherds tend to be lanky we weren't overly concerned. I took him to the vet when it became apparent that no matter how much he ate, he was still not gaining weight, he also had loose yellowish stools. I didn't really realize how sick he must have been until after he'd been on the PanaKare for about a month, he started to fill out and his coat changed, he started to bloom and became just a gorgeous GSD specimen. My horse vet is also my small animal vet & she always comments on how great he looks for a dog with EPI. He's still on the thin side, especially compared to my 120lb Ridgeback, but he's got a nice padding over his ribs and he's the picture of health.
I get my PanaKare from my vet for about $120 . I'll have to check out that website. Do you need a script?

beaulilly
Jan. 2, 2009, 10:18 PM
Yes, you do need a script for the PanaKare.

oldbutnotdead
Jan. 3, 2009, 12:05 AM
My female German Shepherd Dog has this. She was just diagnosed last month, after she, a very skinny dog anyway, started dropping weight. A full panel of blood work showed her okay in April, but things change. Anyway, we are using the tablets and they are working for us. She is also on the high calorie dog food. My male German Shepherd Dog and I are eating low calorie food . . . .

chism
Jan. 3, 2009, 10:34 AM
You know what really stinks about this, besides the obvious...everywhere I went with my dog, either people would say "OMG, he's so thin" or I'd feel I had to explain as soon as they saw him that he had a metabolic condition. I was always worried that people thought I was starving my dog. It was better when I had both dogs with me, because the other one is fat as a tick.

bdj
Jan. 5, 2009, 03:20 PM
Hey chism, you do what you can - way back when, our poor Irish Setter got dewormed for months and months to no avail, because our old vet didn't look for "pancreatitis". It took a getting a "new in town" vet to even figure out what was going on - I guess it just wasn't on the old vet's radar at the time.
You're taking care of your boy - and YOU know how much better he probably looks now than he did before! If random strangers feel the need to comment on your dog's weight, you could always tell them "If you think he looks skinny now, you should have seen him before!" and remind them (as my vet always reminds me) that bigger dogs shouldn't carry extra weight - it's not good for their joints!

HydroPHILE
Jan. 5, 2009, 03:41 PM
Not only have I had dogs that had EPI, but I am part of a German Shepherd EPI support group.

My first EPI dog was a Craigslist dog that the owners abandoned at 4 months old at a vet's office. At 10 months, the vet's office put him up for adoption (the owner called when the dog was 7 months old and said, "do whatever.") The vet's office wasn't too familiar with EPI nor how to properly feed an EPI dog and its enzyme additives so little weight was gained.

Sure, giving your dog the adequate amount of enzymes varies, but once you get the right dosage, you'll see a HUGE difference. Tobey went from 43 lbs to 89 lbs.

Something else we noticed the more we got involved in the EPI community is that the powdered enzymes you get from the vet...you can buy OTC from health food stores. What I did was I found a veterinarian familiar with EPI, brought in Pancrezyme capsules from a health food store, and he sent it off for testing. Same things.

Some dogs work fine off of the plant-based enzymes. Some dogs don't.
Some dogs work fine off the powdered porcine-based enzymes. Some don't.
You would have to also change his diet to reflect the EPI diagnosis (one not high in fats, etc.)

It's a matter of getting EPI properly diagnosed. There are, indeed, tell-tale signs of EPI, but sometimes they are diagnosed as merely pancreatitis.

For more information on EPI and such, feel free to visit an [online] friend's website devoted to EPI and her EPI dog:

Ekko Canyon (http://home.comcast.net/~tula4gsds/index_files/Page517.htm)

bdj
Jan. 8, 2009, 02:06 PM
Hey sisu -
A friend just gave me the new copy of Whole Dog Journal - and there's an article about homemade low-fat diets for dogs that need them (like those with chronic pancreatitis or EPI). Might be worth looking for if you're interested.

chism
Jan. 8, 2009, 07:47 PM
Hey chism, you do what you can - way back when, our poor Irish Setter got dewormed for months and months to no avail, because our old vet didn't look for "pancreatitis". It took a getting a "new in town" vet to even figure out what was going on - I guess it just wasn't on the old vet's radar at the time.
You're taking care of your boy - and YOU know how much better he probably looks now than he did before! If random strangers feel the need to comment on your dog's weight, you could always tell them "If you think he looks skinny now, you should have seen him before!" and remind them (as my vet always reminds me) that bigger dogs shouldn't carry extra weight - it's not good for their joints!


Thanks..I think it's just my over-developed sense of quilt & responsibility. lol

Yeah..I forgot to mention that we thought worms were the culprit at first too, I think we de--wormed him a couple times before we realized it wasn't worms we were dealing with.

sisu27
Jan. 22, 2009, 10:32 AM
Thanks for all the great responses. Mak has had a CBC and TLI and everything has come back normal. He is down to 79lbs. My vet is going to call me today and discuss what to do next. I'm worried and not at all ready to lose him, 8 is not old enough. Cancer, diabetes, heart??? The other horrible thing that has crossed my mind is that my neighbor is poisening him somehow as he HATES Mak and Mak hates him. I would hope he isn't that much of a retched human being but who knows.

This is Mak:

http://good-times.webshots.com/photo/2830736240103114374DYeGBu

equusvilla
Jan. 22, 2009, 11:52 AM
Jingles for Mac. I love Dobe's

oldbutnotdead
Jan. 22, 2009, 02:00 PM
Jingles for Mak.

Curses for your neighbor.

firesongix
Jul. 16, 2009, 11:02 PM
Gosh, it's been awhile since anyone posted on here, but this forum made me feel very welcome upon reading the responses.

I rescued a little chihuahua mix ("Edie" now) off of the side of the highway 2.5 years ago. After falling in love and thousands of dollars and her failing health in the few months to come, I found out she had diabetes mellitus( juvenile onset). She was skin and bones and did crazy things like eat as much food as my 50 lb dog, ate her own feces, etc. She was never, ever full. We finally found out, after much more money was spent, she also had chronic pancreatic insufficiency.

Fast forward 2 years: She's given insulin daily and the viokase at each of her 2 daily meals. She's still skin and bones. Like other posters, people still stare and make mean comments to me about Edie. I bring her to coffeeshops with a t-shirt on to cover up her ribs and hold her in my lap and yet people still assume I mistreat her.

She weighs about 6 lbs now, but at her very best she was 7.5. Her health is failing her quickly. I know diabetes + pancreatic insufficiency is hard to treat, and I've been trying my best for a few years now. I love her very much, but I'm afraid it's becoming inhumane to keep her alive at this point. Although she loves licking my face and napping with me, she's lethargic and always starving to death, no matter how much viokase I put on her plate. She is thinner than I've ever seen her.

Does anyone out there have any experience or advice on this? I'm trying my hardest to make the right decision for her, and it breaks my heart. Any advice would be appreciated.

oldbutnotdead
Jul. 17, 2009, 12:18 AM
Jingles for all the thin dogs out there!

My female GSD was on the pancreatic insufficiency tablets, but since they seem to be discontinued, she is now on the powder. The power is working well. I also switched to feeding her puppy food! She has gained several pounds, and looks good!

I hope that you all find ways to help your dogs, and hugs and jingles to all.