Exocrine Pancreatic Insufficiency (EPI)

[Steve]

Re: Exocrine Pancreatic Insufficiency (EPI)

Yes, I exercise Rusty everyday. Some days he is not as energetic as others.

[Lolo]

Re: Exocrine Pancreatic Insufficiency (EPI)

Following up on jessegirl’s comment, I’ve had to be strategic about when I exercise my Lucy. A 15-20 minute walk can drop her 100+ points some days. I know testing is hard for Rusty but I only learned this by testing immediately before a walk and then when we return. Sometimes it’s only a 50 point drop but if we happen to see a cat and insanity ensues she’s dropped as much as 150! This is not normal but you never know what’s normal for your dog. It could throw off curves if you exercise at diff times on days you test.
I’ve learned I can only exercise Lucy in the 4+ hrs before her next insulin dose when she’s always higher.

[jesse girl]

Re: Exocrine Pancreatic Insufficiency (EPI)

The exercise could be the problem with the substantial drop you are seeing . As lolo sugested you may need to test right before the walk and after . If you are seeing a large drop that is a problem that will need to be solved to regulate your dog . there are ways to do that

[Raysaint]

Re: Exocrine Pancreatic Insufficiency (EPI)

Vets shouldn't get upset, they should understand what you are trying to do. And what you were doing seemed not bad. The dog had better numbers on the higher dose, symptoms diminished. Cutting back the dose raised the numbers and had him drinking/peeing again.

And not testing for a couple weeks?? When you are making all these changes? That's when you test more, in my opinion. Especially knowing he had lows of 72, but that doesn't mean it happens every day. You might want to test a few days around nadir time and get an average.

[amydunn19]

Re: Exocrine Pancreatic Insufficiency (EPI)

I would worry about those big swings and in all honesty, the vet does have a legitimate concern with your dog going from 500s to 72 and back to 500’s. Low numbers are dangerous and that up and down points more to an imbalance with insulin and food and processing food. What exactly are you feeding and in what quantity? What times are you feeding and injecting? Anything in between?

I think the vet was thinking rebound but going down to 4 was probably too low of a dose. What you need to do is try to figure out by breaking down what you are feeding and possibly changing the % of protein and carbs or which protein or carbs you use. Regulation is about balancing the food they take in and how it is metabolized and matches up with insulin. It could be timing or adding a different carb source or lowering protein or feeding more fiber to try to balance with insulin. There are options but you have to do the testing in the beginning while trying to figure it out. The problem is with many vets, they don’t really have answers when a dog is outside what the “book” suggests. And dogs react differently to foods. I used to try things that worked for others and it was a no-go for Maggie. I kind of had to just keep trying things.

If you can post your entire routine and food, we can see if anything jumps out and give some ideas to tweak it. You can actually figure this out without the vet. Many don’t get how to tweak food - they don’t really get in depth on nutrition.

[Eddie]

Re: Exocrine Pancreatic Insufficiency (EPI)

Our dog had EPI long before he got diabetes and the symptoms are very different. With EPI they are voraciously hungry, lose weight very very fast despite eating all they can, and their poops are sloppy, light-coloured and stinky (apologies for TMI but it’s a very diagnostic thing for EPI)!
Adding enzymes to their food magically transforms all those symptoms and we did not find it hard to cope with once we realised what it was. I did think it made the diabetes a bit harder to manage because I thought that the artificial enzymes made Eddie digest his food rather too fast but that’s just my theory.
If you are seeing those symptoms you can always try some enzymes and see if they help. We did it that way as Eddie tested inconclusive for the specific EPI test so we thought we’d just try them anyway and they were a complete solution.
Antonia

[Steve]

Re: Exocrine Pancreatic Insufficiency (EPI)

Not sure if I should start a new post or not, but if I get no response, I will enter a new one. I spoke to the vet today at length about my concerns.One thing we agreed upon is the possibility of EPI. He said rather than spend the money on the test I could just contact an online pharmacy and order Pancreazyne. He said he would sign off on it if they would send him a fax request. He said there would be no down side in my trying the enzyme.

Do any of you have a recommendation of an online pharmacy I could use to get the enzyme?

[amydunn19]

Re: Exocrine Pancreatic Insufficiency (EPI)

I ordered Maggies from Foster and Smith. Some of the others did not stock her dementia meds on a regular basis. They always had hers in stock. I can’t remember but I think they were as cheap as anybody else. And they take care of getting the prescription requedts to the vet so it was easy.

It is always best to post anything concerning your dog in your original thread. All new posts will push it to the top. It keeps all of your info together. Weekend nights and days are slower response wise so people don’t check in as much. I can also rename your thread with your dog’s name and what you want it to say. Just let me know what you would like the title to be.

[Raysaint]

Re: Exocrine Pancreatic Insufficiency (EPI)

I kinda think there is a downside, in that, others have said that extra enzymes can speed up metabolism of food and thus change the sugar curve, and the matchup of food to insulin.

[Eddie]

Re: Exocrine Pancreatic Insufficiency (EPI)

Sorry I can’t help with sourcing enzymes as we are in the uk and they are readily available online.
I did suspect that they speeded up the digestion of food but there was no way our dog could have survived without them so they were in no way optional and we just had to do our best in balancing food and blood sugar.
Antonia

[Steve]

Re: Exocrine Pancreatic Insufficiency (EPI)

Thank you all for your response. Amydunn19 I spoke with Foster and Smith. They have a pill form and a powder form. The pill is alot cheaper than the powder. Which did you utilize? It would not only be cheaper but, easier to give Rusty a pill as he can recognize anytime I add a powder (like wormer) to his food and I have to hold off on feeding him until he eats the doctored food. A pill I can hide in a clump of food.

I know the old saying you get what you pay for. Also I am not sure how much of the powder you would use per dose. One hundred pills are $30.00 versus an eight ounce container of powder for $140.00.

I hate to experiment with the way the enzyme is processed by Rusty as this is kinda an experiment already. The pill would be much easier to administer. I also hate to spend the extra money if the pill is just as good. The Foster's representative could not tell me if the powder was more readily absorbed or what but, she did say the powder say's most vets recommend in some literature she was reading.

I ordered the pills so the fax could be sent to the doctor, but he is not back in the office until Monday, so I could change the order if you think I should.

[Steve]

Re: Exocrine Pancreatic Insufficiency (EPI)

Finally after having a chance to digest all the responses to my questions, I find a few questions I failed to respond to. I am new to this venue and hope my lengthy explanations are not out of place. I feel a little background might not only help me, but help others who might have similar pet.

Rusty became ill the last day in January, this year. After changing and modifying insulin levels and types, as of a week ago we are back to a level we were using in March. I returned to nine units of NPH insulin twice a day. Rusty has already returned to his energetic afternoon activity. His first dose is at 6AM and I test his glucose level at 1000 and it has been a little over 200, which is far better than the 400 and 500 readings I was getting with the low dose of NPH. This morning at four hours after NPH, the level was 140. I will soon explain why I think there is still a fluctuating reading at (my determined low point ) at four hours. I am feeling the real low readings I got in March may have been an error or due to his lack of eating any food in the AM. At that time, I was just learning how to perform the tests, and get a good sample sometimes utilizing two or three (expensive) test strips before I got a reading and not err. Also,Rusty's behavior was not reflective of a really low blood glucose level.

I found Rusty in 2012. A month after his arrival on my property I decided to adopt him. According to the vet he was two years old at that time. He had a broken hip I diagnosed as a sprain. He was occasionally limping, but upon my feeling his leg he did not respond in pain. The break healed on its own due my lack of intelligence. The break was revealed later through an ex ray at the vets for another issue. Early this year he is going on eight, things have been difficult.

Rusty's diet is a very difficult thing to deal with. For years he has been eating 12 to 18 ounces of Alpo canned food once a day in the evening with a few ounces of dried kibbles and bit small bites later in the evening. He loves the variety and will lick the Alpo can clean before eating the food.

When he first started exhibiting lethargic behavior (prior to his diagnosis of Pancreatitis) he had gained some weight, approaching 34 pounds. I tired to get him to eat some (alleged) healthier food. Upon my attempted change to Orijen Six Fish dried food. In the evening (in protest) he caught a (maybe one-pound) ground squirrel and ate the whole thing. He would not touch the new food. I tried to soften it with water and he still shunned the mixture. I tried Science Diet Vegetable and Chicken Stew in a can and it was tolerated for a couple of nights and then he resorted to catching rodents (Mice, moles, squirrels and rabbits) or digging up rodents he had buried in the back yard. Rusty is an American Hunt Terrier and is extremely good at hunting down his own meal if I do not produce satisfactory results.

Once the Pancreatitis hit and insulin was being administered I began (per Vets request) to feed him in the morning (AM) when I injected the insulin. At first he would not eat in the AM, as he never had. I was very concerned, as he had lost more than ten pounds in just a few days prior to his being diagnosed with Pancreatitis. I found Prescription Diet Digestive Care i/d with turkey he enjoyed and seemed like as a treat. For a long time I had given him a couple of slices of smoked turkey breast as an evening treat. The i/d variety was a good substitute. I could get him to eat a quarter of a can (3 ounces or so) when I administered the NPH. He is still eating the Alpo varieties, some evenings a can and a half, and is starting to gain a little weight (today 24.0 pounds). I am keeping the i/d as a treat so he will eat in the AM and is also a good medium for me to hide medication (antibiotics, ect.).

Rusty sleeps most nights, but has open access to the backyard where he roams and forages some evenings. I cannot and will not try to change his hunting instinct. He is very proud when he catches something, whether a bird or rabbit (sorry rodent lovers, survival of the fittest).

Rusty's daily routine includes sleep most all morning, whether I am working or at home. In the afternoon we head for a local park where there is a major walkway as well as acres of open undeveloped space. I consider this time to be his walk and have told people he is taking me for a walk, not the other way around. Except for occasional redirection, I let him go where he wants to go.

We begin on the developed walkway ultimately ending up in the open space. The open space is infested with rodents and Rusty loves the place especially in the spring when he can take advantage of the inexperienced pests. I do not discourage his chasing or digging. Our exercise routine lasts from two to three hours (shorter in the winter months). It is good daily exercise for both of us.

When the Pancreatitis hit, Rusty did not want to go to the park or play with anything, even rodents. He is finally getting back an interest in life and recently started gaining a little weight (today 24.0 pounds). I recently started him on an antibiotic (from the vet) as I think he might have bladder or some kind of infection. His urination smells strange.

I do not know if the diet we have settled on is good for a diabetic animal, but he enjoys it and seems to be doing better regardless. His diet addition of fresh rodents my be causing a fluctuation in his glucose readings and I will have to monitor and maybe modify the treatments. Currently I plan to stick with the menu and insulin dosage and see what enzyme treatment produces. If you made it to the end of this lengthy post, I will keep you posted. If you have any comments, I welcome the input.

[jesse girl]

Re: Exocrine Pancreatic Insufficiency (EPI)

Just keep in mind that exercise has the potential to drop blood sugar dangerously low . Always carry liquid sugar like honey or karo and some snacks like milk bones . Make sure you understand the symptoms of low blood sugar

Now diabetics can live normal lives and do the same things what they did before becoming diabetic but they may have some limitations as my jesse does .

[amydunn19]

Re: Exocrine Pancreatic Insufficiency (EPI)

Maggie was a JRT so I completely understand the rodent thing. When she was young, she would dig up voles(little moles?), shake them, and then drop them in the pool, wagging her tail while watching them drown. She would not eat her prey but she loved to kill rodents and snakes. In fact, taking on a copperhead got us started on the road that led to diabetes.

We had really just gotten to enzymes during her last 6-8 months. The powder we started with was one she really liked, which surprised me because she always refused any type of powder. She could immediately recognize anything even Fish oil on her food and turn her nose up. I think they made it taste meaty. You could start with pills and just see, though. It would make sense that the powder would be most effective but if he won’t eat it, it certainly won’t work.

I understand that you want to maintain his passion for eating his prizes but it will likely create some havoc. The enemy of pancreatitis is fat and a diabetic dog with pancreatitis is a sad, pitiful soul. The pain is rough. Maggie settled down after a few near death experiences. I don’t know if you can find a low fat food that will satisfy him and he will eat or how low in fat his current food is. But he has to eat. Maggie refused all prescription foods and a variety of top commercial diets as well. After a huge search, we finally found a couple she would eat and there are some really good canned ones as well. Again, you just have to look at labels. Keep in mind with wet food, you have to take the moisture factor out to figure fat so what is on the label is not really the fat percentage. I can find that link to the formula if you need it - it is called dry matter analysis. If he likes the prescription I.d. Food, can you just feed that? Maggie hated it - my vet said he had never had a dog who spit food out in disgust like she did. But, the prescription food would ease the pancreatitis. He really needs to eat as low fat as possible- it will keep the pancreatitis at bay and give him a chance to live a normal life. If all else fails, you can keep your current course, but just be aware of the symptoms of pancreatitis and low blood sugar.

In the end, dogs have to be dogs and they will do those instinctual things. Maybe he won’t eat things if you can keep him eating dog food.

[Raysaint]

Re: Exocrine Pancreatic Insufficiency (EPI)

I looked at a few of the Alpo products and some of them have a fat content (dry matter basis) in the low 20's. A bit high for my liking. Others were in the 15-16 range.
But if your dog has pancreatitis or epi, ingredients also matter in that you want highly/easily digestible food. Fat is the hardest thing to digest.

This link has a calculator for calculating dry matter content. Just input the moisture content and the fat or protein and it'll show dry matter equivalents.

http://fnae.org/dmb.html?inputboxm=8...64&button.y=21