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Cats get EPI too!

There is not as much information on cats with EPI as there is with dogs dealing with EPI, however, more and more cats are being diagnosed with EPI.

Below is some of the more current research on cats with EPI, however, if you are a pet owner with a cat struggling with EPI, please know that we have established a separate yahoo support group, “EPI in Cats”  https://epiincats.webs.com/
“EPI in Cats” is managed by Soleil’s mom, Carol.


You can also contact Carol directly for help, or assistance with the Yahoo Group.   Her email is:    cmp25391@comcast.net

Please feel free to print this handout as a Quickie Overview of EPI in Cats:

Exocrine Pancreatic Insufficiency “EPI” in CATS  

Untreated or misdiagnosed, these cats suffer. And yet when recognized and properly treated, EPI can be successfully managed!

The Condition

Exocrine pancreatic insufficiency (EPI) is the inability of the pancreas to secrete necessary digestive enzymes, Amylase to digest starches, Lipase to digest fats, and Trypsin and Protease to digest protein. When these enzymes are not available to help digest nutrients, nutrients from food cannot be used by the body. The body in essence starts to starve.

EPI traditionally was thought to be rare in cats, however with introduction of the fTLI serum measurement, EPI in cats is now reported much more frequently. The most common cause of EPI in cats is chronic pancreatitis. Lesser causes are pancreatic acinar atrophy, aplasia or hypoplasia. However there are other conditions, not true EPI, that have the same clinical signs and require the same treatment as EPI such as a pancreatic duct obstruction, a pancreatic fluke infestation, abdominal surgery, and lack of intestinal enteropeptidase (needed to activate enzymes).

Cats are not considered clinical EPI until 85-90% of the acinar cells in the exocrine pancreas is either atrophied or damaged.

Possible Signs

  • Gradual wasting away
  • Semi-loose yellow/gray/tan stinky feces
  • Watery diarrhea
  • Poor hair-coat
  • Decreased appetite
  • Increased appetite
  • Depression

With EPI, traits may vary in degrees of severity and signs may be exacerbated by physical, emotional and/or environmental stress.

EPI kitty poo may look like this:

Concurrent Conditions

Cats with EPI often have concurrent conditions such as IBD, Diabetes, Pancreatitis, or Hepatic Lipidosis.

Testing

A trypsin-like immunoreactivity (fTLI) blood test shows the cat’s ability to produce the needed digestive enzymes. Values equal to or below 8.0 are diagnostic for EPI. Values between 8.1 and 11.9 may or may not be pre-EPI (referred to as “sEPI” subclinical EPI). Retest in a month/+. A cat must be food-fasted at least 12 hours prior to the blood test. It is cost efficient to run the B12 blood test at the same time as the fTLI test. Veterinarians may call the TAMU GI lab: 1-979-862-2861 for an EPI consultation.

Treatment

Treatment of EPI may be regulated after some trial and error in finding the right balance of Enzymes, Diet, B12, and Antibiotics (if needed for SID).

Enzymes: Powdered porcine enzymes (most reliable), or raw pancreas should be used with every meal. Enzymes are usually for life measured per volume of food and the individual cat’s needs. Food with enzymes must be served at room temperature. Heat temperatures 130/+ degrees Fahrenheit will destroy the enzymes. Cold inhibits enzyme activity. With the powdered enzymes (add enough liquid to moisten) incubation for 20 minutes is not required, but it helps avoid possible mouth sores and some EPI patients fare better with incubation. Some cats won’t eat food with enzymes, contact Carol Pilger  cmp25391@comcast.net for support or help with camouflaging the taste. Some enzyme products are: Pancrezyme, Viokase, or for a cost savings there are generic USA Pancreatin 6x or 8x at Enzyme Diane http://www.enzymediane.com/ .

B12: Almost all cats with EPI have decreased vitamin B12 levels. High dose oral B12 may be administered. Previously, only subcutaneous injection of 250µg cyanocobalamin (B12) serum per injection depending on weight, given weekly for 6 weeks. Retest 30 days after last injectable dose was given. Current research now suggests oral B12 daily works as well. Re-test after 6 weeks and 7 days after last oral dose. When B12 arises to normal range, oral or injected B12 should still be continued for life at a maintenance dose.

Vitamins: Malabsorption of fat-soluble vitamins (A,D,E,& K) may occur.  Fat soluble vitamin dosing should be determined by a vet to avoid over-dosing. Coagulopathy should be treated by a vet with vitamin K. Because of its antioxidant function monitored vitamin E supplementation may be helpful with cats as supportive management or with EPI cats that are dealing with other concurrent conditions.    

SID: It was previously thought that cats did not get SID (small intestinal dysbiosis) but because of the high occurrence of low B12 and high folate levels, that theory is rapidly changing. SID is now considered and treated in cats. Currently Tylan is the preferred drug of choice for SID. Standard dosage is typically 2.5 to 5mg per pound but should be determined by the vet depending on individual cases. Tylan is given twice daily.

Diet: Dietary changes are usually beneficial, high digestibility is essential. Fat restriction is not advisable (unless required by a concurrent health condition) as cats need relatively high doses of fat. Fats also promotes better digestibility with the enzymes and aides poor body conditions. Carbohydrates should be kept to a minimum. Some will fare better on low fiber foods, others may benefit from limited amounts of fermentable fiber.

The best diet and percentage of fats and carbs used will depend on the individual cat. Commercial kibble, canned, raw, home-prepared or hydrolyzed/prescription diets may be used. If there are concurrent health conditions, consideration should be given to the other health concern first.

To ascertain what works best for your EPI cat, start keeping an EPI Log. Record everything given, brand name, amount, dosing technique, etc. After initial implementation of the EPI protocol, if things are not progressing accordingly, make changes 1 at a time, assess the situation for 3-5 days to determine if the change is positive or not before implementing the next trial change.

For EPI Cat Support and/or references:

Testing

fTLI (Trypsin-Like Immunoreactivity (TLI)-Feline) blood test to confirm EPI is available at the following testing labs
Food-Fast 12 hours prior to having blood drawn.

TAMU (Texas A&M Gastro Lab) www.cvm.tamu.edu/gilab/assays/TLI.shtml
IDEXX  https://www.idexx.com/en/ 
ANTECH Labs https://www.antechdiagnostics.com/antech-reference-lab

Administration of oral pancreatic extracts does not affect serum TLI concentrations in either normal dogs or cats with EPI, so withdrawal of enzyme supplementation prior to testing of dogs and cats that are already receiving supplementation is unnecessary.

EPI Cat Support & Websites: https://epiincats.webs.com/ or contact Carol Pilger directly at: cmp25391@comcast.net 
EPI Vet Consultations: TAMU GI lab: 1-979-862-2861
Epi4Dogs (this website) and forum https://www.epi4dogs.com/forum/

Enzymes. Use only pig/porcine enzymes, not plant based enzymes. Pancrezyme, Viokase, Biocase, etc., EnzymeDiane (generic) https://enzymediane.com/
Give ½ tsp of powdered enzymes per ½ cup of food (adjust amounts accordingly). If dry food, add room temp liquid to moisten the food with the enzymes. Let sit for 20 minutes to avoid possible mouth sores.

For more complete enzyme resources, go to https://epi4dogs.com/enzyme-list/

B12 for Cats:

   250 µg subcutaneous B12 (simple serum Cyanocobalamin) weekly for 6 weeks, stop for 30 days, retest.
   250 µg oral B12 (Methylcobalamin/Folate/Intrinsic Factor) Wonderlabs Pet Factor B12
https://www.wonderlabs.com/itemleft.php?itemnum=K9688
(split oral capsule contents into 4 parts, sprinkle 1 part in a daily meal for 6 weeks, stop for 1 week, retest.

B12 should be continued for life on a “maintenance dose” even after B12 levels are brought up to normal range.

SID (small intestinal dysbiosis) YES!!!! they now realize this does happen in cats!

  1. Try changing the diet to a more reduced carbohydrate content (generally associated with increased protein content) or different amounts or types of fermentable fiber.
  2. If there is another health concern, give the other health concern dietary preference. Sometimes hydrolyzed/prescription food is needed.
  3. Or… try adding a prebiotic (Slippery Elm powder is a good mucilage with prebiotic properties) or a prebiotic with a probiotic to the diet.
  4. Or…. give an antibiotic. Tylan (Tylosin preferred).
    Tylosin is a macrolide, bacteriostatic antibiotic meaning that it does not actually kill the bacteria, but prevents it from growing and reproducing, allowing your pet to cope with the infection more easily using it’s own defenses. The initial dose recommendation for Tylosin in cats is 15 to 25mg/kg orally, twice a day, mixed with food (has a bitter taste) or given in a gelatin capsule for 30-45 days.

visit “EPI in Cats” and join the forum
http://epiincats.webs.com/  and/or contact:

Carol Pilger, EPI in Cats Manager at
cmp25391@comcast.net

 

Journal of Veterinary Medicine
2016 Feline EPI  – In Retrospect 150 cases

2016 Cat EPI-150 cases

 

Topics for Companion Animal Medicine
2012 EPI in Cats

TCAM-EPI in Cats

A Tiger with EPI….

It all began in May 2013…..  with the initial “Press Release” from Carolina Tiger in Pittsboro, North Carolina (a town i am proud to say i lived in back in the 1980’s!!) .

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As so many of us EPI owners sadly know… we are often looked upon as mis-treating our animals when people first see our EPI pets…. thin, emancipated… and just do not realize that we are feeding them and trying to make them healthy but nothing seems to be working. Thankfully, there is the TLI test and these animals can be properly diagnosed and treated!   

Luckily, in May 2013, the tiger, Aria, was reported to the Carolina Tiger Rescue …. and after their shocked observation at how emancipated this poor tiger (see initial press release below) was weighing in at only 250lbs, she was thankfully tested and discovered to have EPI…..by September 2013, Aria weighed in at approximately 400lbs!!!

Aria spends her days lounging around in her enclosure… She receives some sort of “enrichment” (something novel to play with) each day. She enjoys spending time with the volunteers and enjoys visitors too! So please… if you are ever near Raleigh or Durham North Carolina, consider stopping by and saying “hi” !

 Aria is fed once a day, mostly with whole chickens, but other meats too, such as venison, are included.. She is fed 8 ounces of raw pancreas once a day with her meals. The estimated cost of the enzymes at the current dose is $3,000 annually. Currently The Carolina Tiger Rescue is SOOOoooo very thankful that they have a donor  (Tom from Green Cuisine4Pets http://www.greencuisine4pets.com/ ) that purchases Aria’s raw pancreas and medications for her.

She gets medications twice a day….

Aria receives Cyanocobalamin twice a day, 50mg of Metoclopramide twice a day, 160mg  Prednisone twcie a day and 100mg of Famotidine twice a day….. and sometimes, they include Gas-X if needed.  Gee… doesn’t this sound familiar to many of us?!!!

And if you are wondering if she too had “SID” Small Intestinal Dysbiosis formerly called “SIBO”… like so many of our dogs ….YES!!!!!  Aria was given 2,000mg of Metronidazole twice a day vs. the usual 250mg to 500mg that we give our dogs for the same thing… pretty amazing,eh?!!

The center has done an amazing job bringing Aria back to health… from 250lbs to 400lbs in just 4 months. 

Aria was not mis-treated by her family, who really cared for her…. but tigers are not big kitties, they ARE wild animals and should not ever be a pet. Aria’s family knew something was wrong and they tried so very hard to get help for her, they contacted vet after vet, but could not locate a veterinarian that was willing to come out and examine her…. but we must also realize…. most vets are small animal practitioners or large (farm) animal practitioners. Most vets are not trained as wild animal vets unless they specialize as such and because of this are simply not able to handle working on tigers…. just one more reason why it is not a good idea to make pets out of exotic wild animals.

Thankfully Aria’s story has a happy ending  

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The initial “Press Release – Carolina Tiger Rescue Pittsboro, NC

PRESS RELEASE Date: 5/23/13

Contact: Pam Fulk, Executive Director E-mail: pamfulk@carolinatigerrescue.org

Telephone: (919) 542-4684x31 office; 919-619-0011 cell

Carolina Tiger Rescue Trying to Save Confiscated Tiger

PITTSBORO, N.C. – Carolina Tiger Rescue Executive Director Pam Fulk announced this morning that during the night a team of Carolina Tiger staff retrieved a critically ill tiger from Orangeburg County, South Carolina. A call was received from Orangeburg County, South Carolina Animal Control Monday about an emaciated tiger kept as a pet by a private owner. On Tuesday, a local veterinarian conducted an exam and determined that the female tiger was emaciated and dehydrated. Blood test results Wednesday morning indicated no obvious problems and that there could be hope for the tiger in knowledgeable hands. The Carolina Tiger Rescue Team left yesterday around 1:30 to retrieve the tiger when Orangeburg County served a seizure order late Wednesday afternoon.

 According to Kathryn Bertok, Curator of Animals, “In my fourteen years here this is by far the worst condition in which I’ve ever seen a rescued animal arrive.” Dr. Angela Lassiter and Ms. Bertok met early this morning to determine next steps in the effort to save the tiger. She will be quarantined for at least thirty days during which time she’ll receive the medical care and rest needed. It appears that the condition of the cat was not a result of a lack of food or water but of an as yet unidentified underlying medical condition interfering with the cat’s ability to maintain a proper weight. The owner reported that he had been unable to get a veterinarian to come to the home to tend to her.

 Carolina Tiger Rescue staff renamed the tiger Aria. (Carolina Tiger already has another animal with the tiger’s prior name.) Regular updates on Aria’s condition will be posted on Carolina Tiger’s Facebook page. While the sanctuary had some funds remaining from prior rescues, it is expected that Aria’s medical care will exceed the balance. If Aria survives, all funds raised in excess of her medical care will cover the cost of outfitting her new habitat with a water tub, tiger toys, and enriching items. Any funds raised above the cost of this rescue will be put toward future rescues.

 To donate to Carolina Tiger Rescue for this rescue, visit  www.CarolinaTigerRescue.org  and click on Donations, or mail a check payable to Carolina Tiger Rescue to 1940 Hanks Chapel Road, Pittsboro, N.C. 27312. Designate your gift to “Bring Them Home” for this rescue, or leave the gift un-designated for the care of all of the animals at Carolina Tiger Rescue.

 Carolina Tiger Rescue is a nonprofit organization located in Pittsboro, N.C. The 55-acre sanctuary is home to 70 animals,including tigers, ocelots, binturongs, and more. Carolina Tiger Rescue provides a home for mainly wild cats, as well as conservation education for the public through tours, community presentations and exhibits. For more information, call 919-542-4684 or visit the website: http://carolinatigerrescue.org/

The amazing YouTube video on “Aria’s” Exocrine Pancreatic Insufficiency:

The news cast by WRAL News on “Aria”
http://www.wral.com/news/local/video/12847937/#/vid12847937 

 And the homepage of Carolina Tigers where “Aria” is featured in a video.
http://www.carolinatigerrescue.org/default.asp

Updates on “Aria” on the Caroline Tigers Facebook page: https://www.facebook.com/CarolinaTigerRescue