Exocrine Pancreatic Insufficiency

[AndyB]

Does anyone have any experience of EPI.  Jazz was diagnosed with diabetes almost 12 months ago.  Over the last 3-4 months his poo output has increased considerably, he has lost weight and muscle tone.  Jazz has always had a very muscular neck, in fact my husband and I used to say he had a neck like Mike Tyson.  His body felt really hard when you touched his sides and he seemed super fit.  When I stroke him he now feels quite boney, even his head feels boney. His appetite is good and I have been adding various treats to encourage him to eat more, i.e. fish.  I also add bio yoghurt to his food to try and improve the consistency of his poo.  He has to visit the vet regularly to have his blood sugar checked and I have mentioned at least three times that I am very concerned about the increased poo output.  On my last two visits my appointment has been with one of the partners at my veterinary practice, both of whom are over 60 and very well regarded.  In fact the practice is listed as one of the top three veterinary practices in the city where I live.   

Why is it then that after some research on the internet this weekend I feel almost certain that Jazz has EPI.   Problems with the pancreas and pancreatitis are well known in Cocker Spaniels,  Jazz has diabetes which is again related to the pancreas.  Astonishingly the time before last when I visited the practice and had a consultation with one of the two senior partners he commented "I just cannot understand why Jazz is losing so much weight". 

I feel angry and astounded that I, a mere mortal, can potentially diagnose the problem when a vet with many years of experience has failed to pick this up.  Jazz has all the classic symptoms of EPI and had it been diagnosed earlier he would now be receiving the treatment he badly needs and would not have lost the amount of weight that he has.  Fortunately, I already have an appointment arranged on Wednesday morning to have his blood sugar checked again so I will be raising this matter.

AND to top it all, I am paying hundreds of pounds for their experience and expert advice.  Sorry for the rant. 

[phoenix]

YES
I understand completely. Marti, my springer lived with it for eight years  till she was twelve and a half. Yes.... Vets worldwide are not experienced with it.  Please read Epi4dogs website, and especially the forum, which you canreadwithout signing up. I am still an active member(Patsy). It has saved countless dogs' lives, and owners' sanity.
If you suspect Epi, the cTLI test is absolute. Under 2.5 is positive , the pancreas completely necrotised. This means you also need a B12test, because the pancreas produces Intrinsic Factor to digest it. So Epi dogs don't have it, and need top ups of B12. They need higher maintenance levels of 600 despite what vets tell you. We have all the scientific papers on the Epi website, plus Quick guides and info for vets.    You must fast Jazz for 12 hours prior to the Epi test, and results can take 5 days.
It is entirely controllable with patience, enzymes with everything they eat,  antibiotics for SIBO / small intestinal disease,  and a low fibre,cereal free diet. Many dogs on the forum also have diabetes.

If the vet wants you to buy enzymes from them.....don't.  They will cost twice as much as from the online vet pharmacy sites like Vetuk and Chemeyes.     Also we can choose between capsules and powder which tastes foul.
Arm yourself with handouts printed fromEpi4dogs website downloads.  Please pm me for anything.

Now , of  course it may be something else, but tbh, Epi is a 'better' option.

[AndyB]

Thank you so much Phoenix.  Jazz was diagnosed with diabetes in February last year.  He will be 13 next month, so not a young dog.  The vet who diagnosed him and treated him with utmost kindness left the practice in June last year.  John always had a feeling there was something else going on with Jazz because it proved extremely difficult to get the diabetes under control.  He was drinking masses of water and there were obviously consequences with this during the night, even though I often got up and let him out during the night.  That has passed thankfully and he can now go through the night without any accidents.  John always felt there may be something else going on with Jazz (I think he suspected cancer), and said if there is anything it will manifest itself soon and he will display other symptoms.   Thankfully that has not happened.  John did suggest an MRI scan at a cost of £2,000 but I disdn't want to go down that route at that stage.  Jazz did lose a bit of weight when he was initially diagnosed with diabetes but he is quite a big cocker, not fat but very muscular and quite tall, so I wasn't unduly concerned.   However,  but over the past 3-4 months he has lost weight every time I visit the vet and weigh him.   His insurance policy will no longer cover any costs related to his diabetes after 20th February so I am anxious to get this resolved before then so that the cost of any tests will be covered.  Quite apart from wanting a diagnosis for Jazz's benefit. 

I really feel astounded that the vets have not picked up on this, it surely cannot be that rare a condition.   I am so grateful to you for replying and now feel armed with some factual information when I attend Jazz's appointment on Wednesday.  I will obviously look at the forum  to prepare myself fully.  The two senior partners at the vets I use are very highly regarded in my area and I know other members of the COL forum use this practice. 

I will keep you posted. 

[phoenix]

The blood test may be £100,  plus £60 for B12.   certainly not have any scans or invasive procedures  till this result is known .  I guess you've had a general blood test to check liver and kidneys?  Jazz may be senior,  but I would agree that these symptoms after pancreatitis are highly likely for Epi, so enzymes would return some normality.   Some people try the enzymes anyway without seeing the vet. They must be porcine, not the cheap vegetable based ones.  Send me a message if you need to know the best ones.
I think Jazz is the same age that Bobby would have been,  tail docked in October before the ban!

[AndyB]

Yes Jazz had a blood test just before Christmas and Nigel, the other partner, phoned me on the Friday night and went into tremendous detail about the results.   He was very pleased with the way Jazz was now responding to the insulin and his Fructosomine levels had come down considerably from the previous reading.  He also told me that Jazz's kidney function was excellent for a dog his age, which we all know is often a problem with senior dogs.

PS  Not sure if I have mentioned this but Jazz's father died of pancreatitis when he was around 7 years of age.  There is a school of thought that pancreatitis could be hereditary. 

[AndyB]

UPDATE

I took Jazz to his appointment yesterday and told the vet of my suspicions that he had Exorcrine Pancreatic Insufficiency.  Not the greatest prospect to advise your vet what is wrong with your dog.  This was confirmed by my vet who is 99% sure of this diagnosis.  Jazz had bloods taken which have gone to the lab for analysis and is now on enzymes and the blood results should be back by next Tuesday. In a matter of months Jazz has gone from 17 kg to 11.7 kg yesterday morning.  He was literally starving to death.   This condition is common in dogs with diabetes so please be aware if your dog starts to produce a lot of poo and is losing weight insist your vet does blood tests to check for Epi.  I understand that in the UK many vets are not aware of this condition.  Also, it is particularly prevalent in German Shepherds.

I would like to thank Phoenix from the bottom of my heart.  She has provided me with lots of invaluable information and guidance on this dreadful condition and if she hadn't read my post last weekend Jazz may still not have been diagnosed. 
Thank heavens for COL.

[bizzylizzy]

So glad you‘re finally getting somewhere and how lucky that Pheonix has been able able to help, - that really is a feather in COL‘s cap!!
All the best for Jazz, hope he starts to feel better soon!

[AndyB]

It certainly is bizzylizzy.  This has been going on for almost 9 months now.  One of the vets had said to me a while after Jazz was diagnosed with diabetes that he thought there must be something else going on as well because we could not seem to get the diabetes under control.  I believe he suspected that Jazz had cancer because he said whatever it is it will manifest itself over the coming weeks and he will display other symptoms.   In December I had an appointment with one of the partners at the practice and after taking bloods to check his fructosamine levels he commented "I just cannot understand why he keeps losing weight". 

Another pointer was dreadful poisonous wind, which I posted about on here a few months ago, but it was thought that could be related to the Caninsulin he has for diabetes, which can cause this problem.  It has certainly been a bit of a "Sherlock Holmes" case.

It just seems very odd to me that they don't make the connection that there may be an issue with the pancreas, as diabetes is obviously related to the pancreas.  I have been asked many times if Jazz was vomiting but because he hasn't been and did not appear to be in any discomfort they obviously didn't pursue the pancreatitis route.  I asked the vet yesterday whether Jazz would have been in pain and he said no definitely not, which was a huge relief to me considering how long this has been going on. 

Everything crossed he will start to gain weight and thrive now that we have a diagnosis.

[phoenix]

The 'Sticky' at the top of the Health section on pancreatitis  by Dr Penny Watson  says this
Quote....."The pancreas is a small organ just behind the stomach which has two very important functions:
• Firstly, it produces enzymes which go down a duct in to the gut and are critical in the digestion of food.
These enzymes are especially important for fat digestion. If they are deficient, the animal develops what is know as ‘exocrine pancreatic insufficiency’ (EPI) where they cannot digest fat properly so typically loose weight in spite of a ravenous appetite and have smelly, fatty faeces. This is treated relatively easily by feeding a low fat diet and adding enzymes to the food.
• Secondly, the pancreas produces a hormone called insulin which passes in the blood stream to all the organs in the body and is centrally important in the regulation of blood glucose levels and energy supply to the cells of the body. A deficiency of this hormone results in the development of DIABETES MELLITUS where the blood sugar level is very high and the animal drinks and urinates excessively. This is also relatively easily treated by giving the dog regular insulin injections and keeping daily food and exercise as stable as possible."

I think she needs to update this to mention , as is known, that pancreatitis can segue into both Epi and diabetes, because the pancreas literally rots away.

It took months for the vet to diagnose my springer, who lost 7kg, she'd been about to be pts.  Vets who've heard of it, sayit's rare, but as AndyB said, it is missed and thought to be a terminal cancer, whereas its controlled by adding pork enzymes and B12 injections, grain free food and antibiotics when the room emptying farting creeps in. My dog
I end a happy chubby life till she was 12. Sadly followed by Bob cocker who was only 8, from a much nastier condition, protein losing nephropathy  of the kidneys. I couldn't bear to even see a spaniel after that, hence now having healthy terrier rescues.
Anyway , I hope to hear that Jazz does some proper poops soon to show he's digesting some food and won't feel hungry all the time.
I second the comments about the power of COL, I was so grateful to read the Behaviour section for years, after Bobby turned out to be a puppy from h-ll!

[ejp]

Delighted you finally have a diagnosis and you can gets the mess Jazz needs. Well done for hanging in there and getting your boy sorted. Xx

[AndyB]

  to you all.  Thank you so much for your support and suggestions.  I have some white fish in the freezer which I will cook for Jazz and I will get some turkey mince from Sainsbury's.  Jazz was sick again last night but only a little bit.  I am just grateful that he has managed to get to 12 yrs and 11 months before this condition was diagnosed as Jazz's dad is Norbert on the Facebook fundraising page for Pancreatitis.  Norbert was the most wonderful Cocker and tragically died far too young.   Unfortunately I am not a member of Facebook so I cannot access this.  Onwards and upwards as they say.  Its a matter of trial and error.  He is quite perky and still has his cheeky personality so I don't think he is feeling too poorly.  The vet has assured me that Jazz is not in pain.