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Cats get EPI too!

… In October 2023 the website “EPIinCats” https://www.epiincats.com/ has been transferred to this section and no longer will be a separate website.

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
If you would like to speak to someone regarding EPI in Cats…. please contact Soleil’s mom, Carol directly:


Carol Pilger’s email:    cmp25391@comcast.net
Carol Pilger’s text & cell:      847-997-0853

 

EPI in Cats … Exocrine Pancreatic Insufficiency

Exocrine pancreatic insufficiency (EPI) is the inability of the pancreas to secrete necessary digestive enzymes, Amylase to digest starches, Lipase to digest fats, and Protease & Trypsin 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 possible 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. Some examples are pancreatic duct obstruction, a pancreatic fluke infestation, damage via abdominal surgery, and lack of intestinal enteropeptidase (needed to activate enzymes).

“The functional reserve of the pancreas is considerable, however true EPI only develops when the exocrine secretory capacity is reduced to less than 10 – 15% of normal of it’s function. At this point residual pancreatic function together with extra-pancreatic mechanisms of digestion cannot support adequate nutrient digestion so weight loss, diarrhea, and other clinical signs ensue.”

https://vetmed.tamu.edu/gilab/service/assays/tli/

Possible EPI 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.

Concurrent Conditions

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

Testing

A trypsin-like immunoreativity (fTLI) blood test: https://vetmed.tamu.edu/gilab/service/assays/tli/

shows the cat’s ability to produce the needed digestive enzymes. Values equal to or below 8.0 are diagnostic for EPI in a cat. Values between 8.0 and 12.0 may or may not be EPI and it is then suggested to retest in a month/+. A cat must be food-fasted at least 12 hours prior to the blood test. The fTLI test costs approximately $125+. It is cost efficient to run the B12 (Cobalamin) blood test at the same time as the fTLI test.

Vets may call the TAMU GI lab: 1-979-862-2861 for an EPI consultation.

Tel: 979.862.2861 | Fax: 979.862.2864
Emailgilab@cvm.tamu.edu | Web: vetmed.tamu.edu/gilab

Hours: Mon.-Fri. 8:00 AM to 5:00 PM (CT)

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 previously known as SIBO). Powdered porcine enzymes (most reliable), or raw pancreas may be used with every meal. Some will do well on tablets if crushed into a powder. Enzymes are usually required for life measured per volume of food and the individual cat’s needs. Food with enzymes should be served at room temperature. Heat temperatures 130/+ degrees Fahrenheit will destroy the enzymes. Cold inhibits enzymes 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 enzyme products are: 

Pancrezyme, Viokase, even CREON can now be used with cats, etc (there are many pig pancreas enzymes) but for a cost savings there are generic USA Pancreatin 6x or 8x at Enzyme Diane
https://enzymediane.com/

Almost all cats with EPI have decreased vitamin B12 levels. TAMU suggest subcutaneous injection of 250µg cyanocobalamin (B12) serum per injection depending on weight, weekly for 6 weeks, 1 dose after 30 days, retest 30 days after last dose. When the B12 regimen is completed and the re-tested B12 levels are in normal range B12 injections should be continued on a maintenance basis, starting with monthly injections, increase frequency if needed.

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. If coagulopathy happens, it should be treated by a vet with vitamin K. Because of it’s antioxidant function monitored vitamin E supplementation may be helpful with cats that do not respond to enzymes and supportive management or with EPI cats that are dealing with other concurrent conditions.

It was previously thought that cats did not get SID (small intestinal dysbiosis) but that theory has changed. SID is now considered as a possibility and is being treated with success 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. 

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, wait 3-5 days to determine if results are positive or not before implementing the next trial change.

 
 
 
 
EPI CAT STORIES
 
 

Carol’s Soleil’ story

“Soleil” the love of my life… she was only five years old when she was diagnosed.

Soleil started developing symptoms a little over a year ago with occasional vomiting and gagging. They were treating her for hairballs. They gave her a medication to increase her intestinal motility and it nearly killed her. Following that, she received her yearly immunizations, and she became very ill with fevers, lethargy, etc. This had never happened before. As an aside, I have decided not to give her immunizations anymore. She is an inside cat and the last time was too scary.

Shortly after that, she started eating me out of house and home but continued to lose weight. She got down to 6 lbs. 2 oz. (her six month kitten weight). She was so skinny . . . fur and bones. It made me cry just to look at her. She would keep me up all night crying. I would get up and pet her and try to console her, but I did not know what to do. It was horrible! Her bowel movements were very large and yellow in color. Finally, my local vet sent me to a specialist. They did an 

ultrasound which revealed thickened bowel and they told me they were pretty sure she had lymphoma. I was devasted! They did an endoscopy and biopsy of the affected area. I was happy five days later to get a call telling me she did not have lymphoma, but she had inflammatory bowel disease. A few days later they called to tell me her lab results from blood tests were back and she had exocrine pancreatic insufficiency. Wow! They told me it was extremely rare in cats and they put her on 2.5 mg. of Prednisone every day for the inflammatory bowel disease and told me to mix Viokase with her food and she started a regimen of B12 injections. That all seemed fine except Soleil would NOT eat any food with the enzymes in it. For two months I syringe fed her with chicken baby food after adding Viokase and waiting 20 minutes. It was horrible but it was the only way I could get the enzymes in her. She started to gain some weight back which was good but she and I both hated the syringe feeding. She would run and hide from me when I got home and although I got pretty good at it she would still freak out because they occasionally get choked by that method of feeding no matter how hard you tried not to. She would fight me like crazy and I would stop and cry. It was terrible!

My next attempt at getting her the enzymes was to talk to a slaughter house in Lake Geneva, WI. They would sell me raw bovine pancreas. I cut it up and put it in a food processor and froze it in ice cube trays. My vet said I could mix this in her food and if she ate it, this would give her the enzymes she needed. My kitchen looked like a slaughter house by the time I was done with this process. Raw pancreas is good for three months if you freeze it. I tried feeding it to Soleil one evening and she threw up so bad I thought she was going to die. I think she just over ate because she was so hungry, but after several attempts at feeding her raw pancreas I found that she did not like that either and I went back to the dreaded syringe feeding.

Shortly after that my local vet told me about Flavorx. It is a company that sells materials to compound the Viokase to taste like chicken pot pie (or any flavor you want). My vet would compound the enzymes which I would syringe drizzle over her food mix it up and she ate it! I was so happy! No more syringe feeding! I asked my vet if I could do this myself at home. I wanted to have control over all of it. My vet wrote a letter to the company “Flavorx” giving me the ability to order all the compounding products directly from them and he then showed me how to compound the enzymes and I am able to do this at home now.  

During all this, Soleil was receiving weekly, then bi-weekly B12 shots. These were SO important for her. Even after a long B12 therapy she was still low when tested. A few months ago she was tested again and her levels are normal but they recommend monthly B12 shots and then she gets rechecked in February. I will always continue to monitor this for her even though I hate when she gets the blood test because she has to fast for 12 hours prior. Nothing worse than withholding food from an EPI animal. I don’t get much sleep. LOL! It is worth it though. 

At some point during all this craziness I talked to a holistic vet (a friend of someone else I met on line with a dog with EPI). He suggested FortaFlora probiotics sprinkled on her food. This was to help with the inflammatory bowel disease and digestion. This seemed to help Soleil a lot and they smell like beef boullion and she seems to like the taste so I use about half packet of that on each of her two feedings daily. I mix it with the food after I mix the compounded enzymes with the food. 

I did receive another tip for feeding cats enzymes from her specialist. It did not work for Soleil but it might work for someone else. You buy fish oil tablets and mix the liquid from the tablet with the Viokase (making a paste). Some cats like this and will lap it up getting them their enzymes, but miss finicky did not care for it at all, but a good suggestion if it works, I guess. It is a cheap way to compound the enzymes yourself if it works. 

Also during my research I found a product called “Cat Man Do” sprinkles. These are dried bonitos fish flakes. You sprinkle them over the food. I sent some of these to my friend Melissa, mentioned above, and she said her cat loves them. I bought some but never tried them with Soleil because I finally got the compounding flavored enzymes working well. I would think these may help disguise the taste of the enzymes if the cat likes them. You can order them on line.

Soleil is now on Prednisone, 2.5 mg. five days a week. She needs this for her inflammatory bowel disease and it seems to keep her under great control. I hate having to give her this, but when I cut back further she starts gagging again. 

I also purchased a pediatric scale for Soleil because it is hard to tell when a cat is gaining or losing weight and waiting between vet appointments to have her weighed was too stressful. The scale cost about $70.00 and it was worth every penny. I ordered it on line. I can see immediately if there is any problem going on if she starts losing weight. It weighs in ounces and pounds.

One other great item for those working cat mommies (such as myself) is the timed feeder from Petsmart. My friend Melissa told me about this and it works great if you are going to be away from home for more than ten hours or so. It has a slot under the trays that you can place an ice pack keeping the food and enzymes fresh. As you know, you can’t leave the enzymes out all day. You set the timer and the door opens at the specified time. Voila! Dinner is served! I rarely use this, but it has come in handy on a few occasions. 

I have the additional complication of having two cats. Soleil’s BIG sister weighs 13 1/2 lbs. They were not really litter mates, but I call them sisters anyway. I have the challenge of getting Luna to lose weight and Soleil to gain weight. The only good thing about Luna’s additional weight is that she can no longer jump up on the counter tops. This is where I have to feed Soleil so that Luna cannot get to her food. Luna has to eat before I leave now because I cannot leave un-enzymed food down during the day or Soleil will eat that first.   

Soleil weighed in last night at 7 lbs. 6 oz. This is a really good weight for her. When she was two years old she weighed 7 lbs. 8 oz. She has always been a small cat and was the runt of the litter when I adopted her. She is a polydactyl kitty. She has seven claws on her front paws and six claws on each back paw. She has big mitten feet but they are so cute!  

Currently I am feeding Soleil Fancy Feast Chicken with some spinach in a broth (green can). This is the food I mix the enzymes and probiotics in. Then I top it off with Blue Buffalo dry food (Gluten free/grain free) chicken Freedom. She loves that and seems to digest it very well. I give her the Blue Buffalo for treats occasionally too, just not a lot without being in the enzymes.

If anyone goes the compounding route with the vet syrups and flavorings, they must NOT use the conventional syrup to compound the enzymes if their cat has diabetes. Diabetes is somewhat common in cats with EPI. I don’t know about dogs. However, there is another solution. I believe it is called Versa Free (it contains no sugar). This is what I believe you would use for a diabetic cat. Basically, if someone has a diabetic EPI cat they should definitely consult with their vet first. I’m sure they would anyway, but just wanted to add this bit of info. 

 

Timothy’s EPI story

Timothy’s EPI story began in the fall of 2011, when he abruptly began acting very sick. My five year old Siamese mix, who had always been very playful and a great eater, suddenly refused his food and became extremely lethargic. He had severe diarrhea and some vomiting, and waddled around the house as if it was very painful to move. After a couple of vet visits and an ultrasound, he was diagnosed with acute pancreatitis and I took him home with subcutaneous fluids and injectable medications to support him as he recovered. I had worked at a veterinary hospital for seven years back before I left to start a business of my own, so I was able to do all the necessary treatments without hospitalizing him, which was great as it was less stressful for him and less expensive for me. Thankfully he pulled through the severe episode of pancreatitis, and a couple of less severe recurrences thereafter.

Even though he had survived the pancreatitis, Tim didn’t really return to normal.

His stools remained soft, were a clay-like grey color rather than brown, and smelled truly horrible. The stench was so intense that if he passed a stool at night, the smell would wake me up even though the litter box was located on another floor at the opposite end of the house from my bedroom!

Around February, I noticed that Timothy was behaving oddly. He had always been extremely interested in food, but that interest began to morph into an absolute obsession with anything even remotely edible. Nothing was safe in our house. He would open the pantry and eat uncooked pasta and whole wheat bread. He raided our fruit bowl for peaches and avocados. He also began to lose weight rapidly. His pre-pancreatitis weight had been about eight pounds. Between February and April, he went from seven pounds to just barely over five pounds. As Tim’s sixth birthday rolled around, I began seriously doubting that he would survive to see seven.

At some point, as I stood in the vet’s office at yet another visit talking about awful things that it could be, one of us said, “Do cats get EPI?” I can’t remember which of us brought up the subject. I had seen cases of EPI over the years in dogs, and so had the vet. Neither of us had seen it in a cat, but the symptoms that Tim was exhibiting were uncannily familiar. She left the room, and came back a few minutes later practically beaming as she declared that we would start him on enzymes right away. I was so relieved to finally have something concrete to pursue, even if it was a condition that would require lifelong management. I knew that EPI could be frustrating and expensive, but I also knew that it was treatable!

Tim’s EPI is currently being managed with one teaspoon of EPI-Pro 6x enzyme powder mixed into each of his meals. I had him on a probiotic for a while as well, but it didn’t seem to make much of a difference and he wasn’t especially pleased with his food when the probiotic was present, so we eventually discontinued it.

Finding a food that works for Tim has been a bit of a struggle. He isn’t a fussy eater by any means, but it seemed as though I just could not get his diarrhea under control as long as he was on a normal canned diet, even if the canned diet was a very respectable brand like Innova EVO, Weruva, or Wellness. For the last few months, I have been feeding The Honest Kitchen’s dehydrated “Prowl” diet, and that seems to be working very well. He gets ¼ cup of the dehydrated food mixed with ½ cup of water and his enzymes twice per day. The food looks kind of like a soup when made with that much water. After mixing things up, I let everything sit for five minutes before feeding Tim. So far, his stools have been pretty consistently firm on this diet plan. It may be that the enzymes end up better mixed in his food now than they were previously, or that one of the ingredients in canned diets was not working well for Tim. Whatever the cause of the improvement may be, I am glad for it.

I give him weekly subcutaneous injections of 250mcg of vitamin B12. I noticed dramatic improvements in his energy level after beginning the B12 injections, and his stools seem to be approaching closer to normal as well. The hope is that we may be able to reduce the frequency of the injections in the future, but we aren’t to that point yet; every few months, I will try to space the injections out a little bit further, but doing so has so far resulted in a return to loose stools. Tim is generally pretty good about his injections and allows me to give them without putting up much of a fight, though I do occasionally have to fall back on the “kitty burrito” method of wrapping the cat in a towel while giving the injection. He loves his food, so if I give him the injection while he is eating, he often does not notice that I have done anything!

Since beginning treatment for EPI, Tim’s weight has increased from five pounds to over eleven pounds. I have twice the cat I had before! He is no longer constantly foraging for food around our house; he naps and plays like a normal cat. His stools have returned to a normal color and no longer smell as foul, and are only rarely soft at all.

Timothy’s doing great. After coming so close to losing him over the last year, I almost feel like the EPI diagnosis was a blessing. He’s living with it– living WELL with it!– and I have my cat back

I’m happy to talk to anyone who may need support or advice about working with their EPI cat.

My email is houles@georgetown.edu.

 

The following EPI in Cats information is taken in it’s entirety from the 2013 Mercola Pets website written by Dr. Karen Becker… In accordance with Mercola’s copywrite permission, the following must be included when copying the article (The below article was brought to you by Dr. Mercola.For more helpful articles, please visit Mercola.com http://www.mercola.com/

Exocrine Pancreatic Insufficiency: Can Cause Your Kitty to Starve to Death – Even While Eating PlentyMay 15, 2013

By Dr. Becker

Story at-a-glance

  • Exocrine pancreatic insufficiency (EPI) is thought to be rare in cats. But new research indicates that vets might need to take a closer look for evidence of the disorder in kitties with recurrent diarrhea and chronic weight loss.
  • The pancreas is involved not only with insulin production, but also with the production of digestive enzymes. Many people who understand the connection between the pancreas and diabetes are unaware this important organ can also play a role in digestive disease.
  • Exocrine pancreatic insufficiency means there is a decrease or lack of digestive enzymes being produced by the pancreas. As a result, proteins, starches and fats from the diet can’t get into the bloodstream to supply nourishment to the body’s tissues.
  • In the largest research study to date on feline EPI, it was revealed the disease may be more prevalent in cats than previously thought. Symptoms in cats vary significantly from those seen in dogs with the disease. For example, diarrhea isn’t consistently present in cats, nor is it as severe as it is in dogs. Also, about half the cats in the survey had a decrease rather than an increase in appetite.
  • In kitties with unexplained chronic weight loss with or without diarrhea, including diabetic cats, it may make sense to run fTLI, cobalamin and folate tests before considering more invasive, costly diagnostic procedures.

Exocrine pancreatic insufficiency (EPI), also called pancreatic insufficiency and maldigestion syndrome, is thought to be rare in cats. However, according to dvm360, new research suggests veterinarians should look more closely at EPI as a potential cause of diarrhea and chronic weight loss in kitties.

Exocrine Pancreatic Insufficiency

The pancreas has many functions. It produces not only insulin, but also various enzymes that provide for the digestion of food. Many people are aware the pancreas plays a role in insulin production and diabetes; relatively few people realize the role the pancreas can play in digestive diseases.

Pancreatic enzymes include amylase, which breaks down starches; lipase, which breaks down fats; and trypsin and chymotrypsin, which break down proteins.

The actions of these enzymes are crucial to the digestive process. They allow nutrients from the diet to be absorbed by the cells of the intestine, where they pass into the bloodstream and are transported throughout the body for use by tissues. When a cat eats, the pancreas gets a signal to release digestive enzymes, which travel into the small intestine via the pancreatic duct (“exocrine” glands secrete their products into ducts, whereas “endocrine” glands secrete their products directly into the bloodstream).

Once they reach the center of the intestine, the enzymes go to work breaking down food particles.

Exocrine pancreatic insufficiency means there is a decrease or lack of digestive enzymes being produced by the pancreas. In kitties with the disorder, proteins, starches and fats from the diet aren’t broken down sufficiently to be absorbed through the intestinal wall. This means nutrients can’t get into the bloodstream to supply nourishment to the body’s tissues. Much of the food that is eaten remains undigested in the GI tract and ultimately leaves the body in feces. If left untreated, a cat with EPI can literally starve to death despite how much food is consumed.

Causes, Symptoms and Diagnosis of EPI

Pancreatic insufficiency can have several potential causes, but the most common source in cats is chronic inflammation of the pancreas. Other causes are parasitic infestations, as well as cancer.

Signs a kitty may be dealing with EPI include weight loss; constant hunger; lots of watery, loose or semi-loose stools that may have a foul odor and contain large quantities of undigested fat; and poor coat condition. Cats with this disorder look and behave as though they are starving to death … because they are.

Occasionally, cats with EPI are also diabetic.

A test called the feline trypsin-like immunoreactivity (fTLI) assay is considered diagnostic for EPI. Prior to the availability of the fTLI, diagnosis was trickier and involved taking a symptom history and running repeated fecal digestion tests.

2020 TAMU Results of Largest Feline EPI Study to Date

In 2010, the GI Laboratory at Texas A&M University received 775 samples from veterinarians of fTLI assay results that were consistent with a diagnosis of feline EPI.

Then in 2011, researchers from the GI Laboratory and Department of Clinical Sciences at Texas A&M conducted an EPI survey of veterinarians who submitted samples. One hundred-fifty surveys were returned. The average age of affected cats with the condition was eight years. Males represented 59 percent of the samples; females, 41 percent.

Average body condition of the kitties was poor. Of the cats for which cobalamin (vitamin B12) levels were measured, 77 percent were deficient and many had no detectable levels of B12 at all. For those that had folate concentrations tested, 47 percent showed an increase.

As for symptoms, in 91 percent of the cats, weight loss was the primary symptom. Weight loss varied from 1.4 ounces to 15 pounds, with an average of 3 pounds. Loose stools were seen in 62 percent of affected cats; poor haircoat in 50 percent; loss of appetite in 45 percent and increased appetite in 42 percent; and depression was present in 40 percent of the kitties. Almost 60 percent of the cats had coexisting diseases including inflammatory bowel disease (IBD), diabetes,pancreatitis and hepatic lipidosis.

Of the kitties with EPI, 68 percent were given pancreatic enzyme supplementation. Of those, 66 percent showed a good response, 24 percent had a partial response, and 10 percent had a poor response to the treatment.

What These Results Mean for Cat Owners and Vets  

According to dvm360, the results of the survey are evidence that exocrine pancreatic insufficiency is not as uncommon in cats as previously thought. However, symptoms in cats vary noticeably from canine symptoms. In cases of feline EPI, diarrhea isn’t a consistent finding and isn’t as severe as it is in dogs dealing with the disease. Also in cats, excessive hunger is not consistently present, and in fact about half the cats in the survey showed a decrease in appetite.

Treatment with pancreatic enzyme supplementation appears to be successful in a large percentage of kitties with EPI. If there are also low cobalamin levels, subcutaneous (under the skin) supplementation for several weeks is often required to help resolve gastrointestinal symptoms.

Also, EPI can be associated with small intestinal dysbiosis (also called small intestinal bacterial overgrowth, or SIBO), especially when low B12 and high folate levels are present.

Cat owners and especially veterinarians should consider fTLI, cobalamin and folate tests for kitties with unexplained weight loss or chronic diarrhea, regardless of the pet’s age. These tests could conceivably eliminate the need for more expensive and invasive diagnostic procedures.

EPI should also be viewed as a possible concurrent condition in diabetic cats whose blood sugar levels are well controlled but who have weight loss and/or diarrhea.

The following is an excellent in-depth article recently written by Dr. Jorg Steiner of Texas A&M Gastrointestinal Lab. 
 

” Steiner JM: Exocrine pancreatic insufficiency in the cat. Top Companion Anim Med; 2012 Aug;27(3):113-6 

  • The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • Exocrine pancreatic insufficiency in the cat.
  • Exocrine pancreatic insufficiency (EPI) is a syndrome caused by an insufficient amount of pancreatic digestive enzymes in the small intestine.
  • Clinical signs most commonly reported in cats with EPI are weight loss, loose and voluminous stools, steatorrhea, polyphagia, and in some cases a greasy soiling of the hair coat in the perianal region.
  • Serum feline trypsin-like immunoreactivity concentration is the diagnostic test of choice for the diagnosis of affected cats.
  • Treatment of cats with EPI consists of enzyme supplementation with either a powdered pancreatic extract or raw pancreas.
  • Most cats with EPI also have severely decreased serum cobalamin concentrations and may require lifelong parenteral cobalamin supplementation.
  • Most cats respond well to therapy and can have a normal life expectancy and quality of life.
 

To test for EPI have your vet contact Texas A&M Gastrointestinal Laboratory: https://vetmed.tamu.edu/gilab/service/assays/tli/

To test for Pancreatitis have your vet contact Texas A&M Gastrointestinal Laboratory: https://vetmed.tamu.edu/gilab/service/assays/pli/

 

Feeding the EPI cat

 

Gussie’s Cat Coco’s Feeding Regime

Coco is my 9 year old Torti.

She refused to eat food with the enzymes on it, I even tried the flavorings for the powder and she still refused to eat it. My vet suggested the pills so gave that a try and that is what I have been giving her for over a year. She gets ½ pill with food, usually 3 or 4 times per day. She was always a frequent eater and still is.

The pill is Pancrezyme, 425 mg tablets which I get with a prescription from my vet. My vet had pills on hand and I got them from him until I wanted to have them on hand and not have to worry about refilling a small supply each month. I buy a bottle of 500 now and it lasts me a little over a year.

My biggest challenge now is giving her what she likes to eat so she doesn’t get tired of Her weight has gone back up to just under 10 lbs. She also is getting a B 12 shot twice a month. Gussie

Carol’s Cat Soleil’s Feeding Regimen

EPI/IBD

Soleil will not eat her enzymes unless they are compounded. Most places will tell you that they cannot or are unable to compound pancreatic enzymes. This is not true. I have done it for three years as have others. Below is my feeding regimen for Soleil and I will attach another document with the recipe for Soleil’s compounding and also include other options for getting the enzymes compounded. Always check first with your vet on the ingredients of the compounding to be certain this is something safe for your kitty. If your kitty is diabetic the compounding ingredients would be different than the ones I am currently using.

Soleil’s compounded enzymes are in a thick liquid form. Once they are compounded, they are kept in the fridge in an 8 oz. bottle. I must shake the bottle well before syringe drizzling over her food. I compound her enzymes myself at home and I make a new bottle every week.

Soleil receives three meals a day. She does not always finish all her food. Her meals consist of:

One 3 oz. can of Fancy Feast Elegrant Medley shredded chicken with garden greens in a light broth. I place the can of food on a small plate. I then syringe drizzle 2.5 mls. of the chicken pot pie flavored compounded liquid over the food. (The 2.5 mls. of liquid contain 1/3 tsp. of enzymes). I mix the liquid compound well with the food. I then sprinkle 1/3 packet of Forti Florz over her food and mix again. I top this off with 10-20 pieces of dry Blue Buffalo Chicken Freedom and push the dry food down into the wet.

If I am home and able to see when Soleil eats, I will immediately give her another 10-12 pieces of Blue Buffalo Freedom Chicken dry food as I know that she just took in her enzymes. I do this because Soleil does like to eat some dry food and this is like a treat for her. It also seems to help her not to gag or lick so much after eating the wet enzymed food. I also believe this helped her gain a little weight.

If you are interested in compounding enzymes, please see the separate attachment.

Carol

Lily’s Feeding Regimen

Linda Deckard

Lily will be 8 in August this year. She is a tortie and was the runt of the litter. She was diagnosed in July 2013 with EPI. They sent me home with a small amount of Pancrezyme powder. I was thrilled to have a diagnosis until she would not eat her food with the enzymes. I was really desperate until I saw Carol’s story on the EPI dog website and emailed her. Carol gave me her compounding recipe and a link to compounding pharmacies. Carol was a lifesaver!

After calling several pharmacies and having them tell me they could not compound the enzyme with a flavor because it would not be stable, I found a compounder with a cat who listened to me. She said she could not compound it, but she could make a flavor for me that I could mix with Lily’s food to mask the enzymes. I gave her Carol’s recipe. She mixed a chicken flavor for me and Lily ate eat her food with it. I was thrilled! Her chicken flavor is oil based with stevia natural sweetener.

At first I mixed a heaping ¼ tsp. Pancrezme powder with 1.5 ml. of flavor in a dish. Then I mix about ½ can 5.5 oz. Wellness chicken canned food with it. I would then let it set for 20 min. and feed her. I did this morning, noon, and night for a while. Then I started using the Pancrezyme tablets for some of her feedings. I would use ½ tablet crushed with a spoon and 1.5 ml. of flavor mixed in a dish. Then I add the canned food and mix it together. I use both Wellness chicken and Merrick Chicken Pate canned food. I heat up food stored in the refrigerator in the microwave for 10 – 12 seconds on 7 power in a separate dish until it is at room temperature and then mix it in the dish with the enzymes (tablet or powder) and flavoring.

After Lily went from 5 lbs. to 8.6 lbs., she wasn’t as hungry and became picky. I started having to sprinkle dry food on top of the wet food mixture to get her to eat more. I also mainly use the tablets now because she seemed to eat more of her food with them than the enzyme powder. I use Merrick Before Grain Chicken dry food and sometimes Canidae Chicken dry food. I also use Stella & Chewy’s Chick, Chick, Chicken Freeze Dried Raw sparingly because it is more expensive. Like Gussie, my challenge is keeping her interested and eating now that she isn’t starving. I feed three meals a day unless I am gone all day, which is rare.

Compounding Viokase (pancreatin enzymes)

The following recipe is not yet approved by the company Flavorx. They are in the process of getting it approved at present. My vet created this recipe for my cat Soleil. It has worked for us for over a year now. Have your vet look over the following information and if he/she approves it, you may use the following information to try compounding your pancreatic enzymes for your EPI kitty. I hope it helps. If you have any questions, you can reach me at cmp25391@comcast.net.

The company that sells the products for compounding this recipe is Flavorx.

My contact at the company is Tina Coleman. Give her my name, Carol Pilger or my cat’s name, Soleil Pilger. She will know what you are looking for. You must let her know whether your cat is diabetic or not. This recipe, etc. must be approved by your own personal vet before trying it with your kitty.

Tina Coleman’s phone number is (800) 884-5771 Ext. 239. Her e-mail address is tcoleman@flavorx.com. Her fax number is (240) 223-1099.

For a non-diabetic cat the following are the things you can order from Flavorx once your vet has written a letter to the company authorizing you to order. The company usually only sells to vets so they need a letter of approval from your vet prior to you being able to order. The letter can be faxed to the above fax number above to the attention of Tina Coleman. You can contact Tina first and she can let you know exactly how this letter should read and the information she requires.

Below are the items to order for a non-diabetic cat w/confirmed EPI:

  • Vet Syrup – One 16 oz. Bottle (Ingredients – Sucrose 85% w/v, Purified. Water, citric acid and 0.1% Methylparaben as a preservative). Not to be used for a diabetic cat.
  • Chicken Pot Pie – 60 ml. Bottle (Ingredients – Contains Water, Natural Flavors, Caramel Color, Glycerine, MSG, Salt, Potassium Sorbate).

For a Diabetic Cat you should check with your vet to see if you can substitute the Versa Free Sugarless Syrup Vehicle for the Vet Syrup (listed above). The VersaFree is a versatile, sugar free, paraben free, saccharin free, aspartame free, dye free, unflavored syrup like vehicle formulated for use in compounding oral extemporaneous delivery systems. The VersaFree Sugarless vehicle comes in a 16 oz. Bottle and is sold by Flavorx. (Ingredients: Purified water, Glycerin, Sorbital, Xanthan Gum, Neotame, and buffered with Sodium Citrate and Citric acid. Preserved with potassium sorbate and sodium benzoate).

I have not used the VersaFree Sugarless Syrup Vehicle because my cat is not diabetic.

For compounding the enzymes you will also need to order from Flavorx a mortar and pestle, a graduated cylinder, the eye droppers for the sweetening enhancer and for the chicken pot pie bottles, a small spatula, perfect plug tops for your finished product bottles, and syringes for dosing (I order the 3 ml. Syringes as Soleil’s dose is 2.5 mls. Per 3 oz. of food, which I give her twice a day). You will need 6 or 8 oz. bottles to put the finished product in. Flavorx does not sell bottles of this size. I buy them from my vet’s office. Ask your vet if you can purchase your 6 or 8 oz. medicine bottles from them. You can also possibly purchase your perfect plugs and syringes from your vet.

The recipe I use to compound the Viokase for my cat Soleil, who is 7 lbs. 4 oz., is as follows:

Soleil’s Dosing and Recipe: (Your cat’s dosing should be determined by your vet)

  • 3 Tablespoons (which is the equivalent of 9 teaspoons) Viokase.
  • 40 ml. Vet Syrup (For No Diabetic Cats Only)
  • 40 ml. Feline Solution
  • 40 drops Sweetening Enhancer
  • 40 drops Chicken Pot Pie

To compound these items, I first place the 3 tablespoons of Viokase in the mortar. I slowly add the 40 ml. of Vet Syrup and mix. I next add the 40 ml. of feline solution and mix again. I then add 40 drops of sweetening enhancer and then 40 drops of chicken pot pie and mix well again. I then pour the finished product into the 6 to 8 oz. bottle. I then place the perfect plug into the top of the bottle. I then place the top on the bottle and shake very well. This finished product of compounded enzymes must be kept in the refrigerator and it only lasts for 7-9 days. I make a new batch once a week. You must shake it well before each feeding.

This link is a You-Tube video by the company Flavorx demonstrating some of the compounding techniques. It will help give you an idea. It is not the same recipe of course. http://www.youtube.com/watch?v=K44jL8wvpK0

I feed Soleil 3 oz. of Fancy Feast Elegant Medleys shredded white meat chicken fare with garden greens in a savory broth. I syringe drizzle 2.5 mls. of the compounded enzyme solution over the food and mix it up. I then sprinkle ½ packet of Fortiflora (probiotic) over the food and mix again. I then put 15 or so pieces of Blue Buffalo Freedom dry chicken food on top and push into the food. This gives Soleil a little crunch that she likes. Blue Buffalo Freedom is a grain free gluten free food, which Soleil seems to tolerate very well. I feed this to Soleil twice a day (sometimes three times a day). I would not leave this food out for more than 9 hours or so. I do work full time so I put it out in the morning and come straight home from work and make her second batch for her evening food. If your home does not have air conditioning during the summer, this food should probably not be left out this long.

You certainly don’t have to use these foods but I am listing it as it works for Soleil. You can mix this into any of your cats favorite wet/dry tolerated food. Flavorx also makes several other flavors such as grilled tuna and beef, etc. I don’t know if the recipe would be the same for these different flavors but you can check with your vet.

I hope this helps your EPI kitty eat his/her enzymes. I know my finicky little Soleil would not eat them any other way. Best of Luck and again, don’t hesitate to contact me if you have any questions. cmp25391@comcast.net

Carol Pilger

PCCA Compounding

Flavorx Compounding

Other Suggestions

For Compounding Pancreatic Enzymes

Any method of compounding enzymes should be run by and approved by your vet before using. The following are suggestions to help with your kitty eating the enzymes. Any suggestion should be approved by your vet before trying. Your kitty may have other medical issues that may preclude attempting any of these suggestions.

This link is for finding a PCCA Compounding Pharmacist in your area. Simply put your zip code in the search box and several options near you should come up.

This is the link: http://www.pccarx.com/

Linda Deckard and Kaveh are using PCCA compounding pharmacists. Margaret is also using PCCA.

If you call a PCCA pharmacist in your area and they tell you that they cannot compound the enzymes, please have them contact one of the compounding pharmacists that someone in our group is using, ie Kaveh, Linda, or Margaret. These pharmacists have talked to each other and will share the information because they are a nationwide network.

If you choose to use the Flavorx method, you must order all of those supplies through your vet. Flavorx will not sell to individuals. They will sell only to vets. You would need to give your vet my compounding Viokase instructions and ingredients and your vet would have to order and possibly compound for you. (Instructions and Ingredients are attached on this site under a separate attachment).

This is the link to Flavorx: http://flavorx.com/about/

Other Options

The PCCA compounding pharmacist that helps Margaret, gave her a recipe for catnip tea to use on the food. This has helped her kitty Runt eat the enzymes. I will try to get the recipe from Margaret for this.

Other suggestions that may help your kitty eat the enzymes are Cat-Man-Do Fish flakes. Sprinkle these over the food after the enzymes are added. You can order Cat-Man-Do Fish Flakes from http://www.hare-today.com/

Also – you could try purchasing fish oil tablets (the stinky kind), poke a hole in the tablet to release half of the liquid fish oil from the tablet and mix this with the correct amount of powdered enzymes per meal for your kitty to form a paste. You could then mix this paste in the food or see if kitty will eat the paste.

Raw Pancreas – If you want to try raw pancreas you may be able to purchase this from a slaughter house in your area. Another option to order this on line is http://www.hare-today.com/ Raw pancreas can be frozen for up to three months. One suggestion I received was to freeze the raw pancreas in ice cube trays so you can just thaw out one serving at a time. The raw pancreas must never be heated to thaw. It must always be thawed at room temperature. Do not leave raw pancreas out all day. Kitty should eat this fresh mixed with his/her food and then pick the plate up.

Lynda Doty is using freeze dried raw tripe. She says it is pretty stinky but it is working for her kitty.

Carol Pilger

Scale Options and Auto Feeder Option

This link gives options for scales. I use the Salter Pediatric scale.

http://www.amazon.com/s/?ie=UTF8&keywords=pediatric+scale&tag=googhydr-20&index=aps&hvadid=30682714841&hvpos=1s2&hvexid=&hvnetw=g&hvrand=3745187827854098813&hvpone=&hvptwo=&hvqmt=b&hvdev=c&ref=pd_sl_2qkvyhpesu_b

This link is for an automatic pet feeder

I see that this option comes with an ice pack

http://www.wag.com/cat/p/cat-mate-c20-2-bowl-48-hour-automatic-feeder-with-ice-pack-113386?site=CA&utm_source=Google&utm_medium=cpc_W&utm_term=ZXY-004&utm_campaign=GooglePLA&CAWELAID=1323888449&utm_content=pla&ca_sku=ZXY-004&ca_gpa=pla&ca_kw={keyword}

You can also purchase auto pet feeders at Petsmart and Petco. I have never seen the one that comes with the ice pack . . . . . interesting.

Syringe Feeding

When all else fails or before you figure things out

Syringe feeding is another way to get the enzymes into your kitty if your kitty will not eat the enzymes. Hopefully, this would be something used only for the short term. Syringe feeding can be extremely stressful for both you and your kitty, but it is certainly an option. I am attaching a link to a You-Tube video that demonstrates syringe feeding. I highly recommend that you bring kitty to your vet once or twice for instruction before attempting this yourself. Things don’t always go as smoothly as they do in this video, but I hope you find it helpful if needed.

Video or How to Syringe Feed a Cat: http://www.youtube.com/watch?v=B9ygsA93vQc

When I syringe fed Soleil, I would use Gerber chicken baby food, the small jar. I used the food that was just pureed chicken, no vegies, etc. I would place the baby food jar in warm (not hot) water for a few minutes. I would then mix the appropriate amount of enzyme in 1 to 1 ½ oz. of the baby food. I would stir well and let sit for 20 minutes. I would stir it again in 20 minutes, and then put the food in a large syringe and feed Soleil while holding her on my lap. You need to go slow and see that kitty is swallowing okay. It is easy to choke them a bit if you go too fast. I also do recommend a few instructions with your cat at the vet’s office before trying this. It is a fairly messy procedure. Once you are finished syringe feeding, have a warm damp towel or paper towel handy to wipe kitty’s face or any area where the food and enzymes may get on the kitty. The enzymes can burn a bit so be sure to keep kitties face clean after feeding.

Carol

Websites that show you

HOW TO ANALYZE THE NUTRIENTS IN CAT FOOD

Thank you Stephanie for sharing these links with us!

  1. http://www.felinecrf.org/food_data_tables.htm
  2. http://www.felinecrf.org/food_data_tables.htm
  3. http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf

Need to Camouflage the taste of Enzymes???? Try Cat Nip Tea !

This recipe was submitted (and used with success) by Margaret “Peg” Kuhn… thank you very much Peg !!!!!

Cat Nip Tea Recipe-simple and easy to make::

Place 1 teaspoon cat nip into a tea ball (you can purchase the tea ball at the store for $2.00 or so). Place the tea ball into 4 oz of boiling water and let it steep 5-10 minutes as you would making tea for yourself. Let it cool, then cover it and place in the refridgerator. I add about 12-15 drops of this tea to Runt’s food, along with the compound; I also then then add a couple pinches of ground catnip and.stir it all together. I make a new batch of tea every 3 days per the pharmacist’s recommendation in order for it to stay fresh and tasty!

B12 IN CATS

 

Gastrointestinal Laboratory | Dr. Jörg M. Steiner

 Department of Small Animal Clinical Sciences

Texas A&M University | 4474 TAMU | College Station, TX 77843-4474

Phone 979 862 2861 | Fax 979 862 2864 | gilab@cvm.tamu.edu | Web Content: Dr. Jan Suchodolski

(taken in it’s entirety from TAMU gastro lab website- -the premier lab for EPI testing)

http://vetmed.tamu.edu/gilab/research/cobalamin-information

(B12) Cobalamin: Diagnostic use and therapeutic considerations

Introduction

Cobalamin (Vitamin B12) is a water-soluble, cobalt-containing vitamin with an important role in biochemical processes referred to as single carbon transfers. During these reactions, functional units such as methyl groups (-CH3) are transferred onto or between biologically important compounds. Cobalamin is a co-factor for at least three enzymes that carry out these types of reactions, acting as a transitional carrier of the single carbon group. A typical reaction catalyzed by a cobalamin dependant enzyme, methionine synthase, is illustrated in figure 1. Single carbon biochemistry is an area of great interest in the human population, as deficiencies in the activity of these enzymes may be associated with hyperhomocysteinemia. Hyperhomocysteinemia is a recognized risk factor for cardiovascular disease. Deficiency in cobalamin may also be associated with demyelinating neuropathies, dementia and megaloblastic anemia (Pernicious Anemia) in human patients.

In companion animal medicine, most attention to cobalamin has been directed towards its use as a diagnostic marker for gastrointestinal disease. Recent evidence from studies at the Gastrointestinal Laboratory have also shown that supplementation of cobalamin is important to get the best response to therapy for gastrointestinal disease.

Figure 1 (on TAMU website: http://vetmed.tamu.edu/gilab/research/cobalamin-information ) A typical cobalamin dependent reaction, where a methyl group (-CH3) is added to homocysteine to make methionine

Cobalamin Deficiency in Gastrointestinal Disease

In animals with reduced cobalamin absorption, regardless of the cause, it is reasonable to expect that eventual depletion of bodily cobalamin stores will occur and cobalamin deficiency will ensue. As all cells in the body require cobalamin for single carbon metabolism, it has been hypothesized that cobalamin deficiency may actually contribute to the clinical signs and manifestations of gastrointestinal disease in some patients. Studies of radiolabelled cobalamin in cats have demonstrated that the half-life of this compound is significantly reduced with gastrointestinal disease.

While the serum concentration of cobalamin is used diagnostically, the reactions catalyzed by cobalamin dependent enzymes occur in the mitochondria, making it difficult to assess the state of cobalamin availability in the patient. Tissue-level deficiency of cobalamin is associated with an increase in the urinary and serum concentrations of an organic acid called methylmalonic acid, which is an alternative product of a cobalamin dependent pathway within the mitochondria. Using this compound as a marker of cobalamin deficiency, we have been able to demonstrate that cats and dogs with very low serum cobalamin do indeed have a significant tissue-level cobalamin deficiency (Figure 2.). Interestingly, in cats, there was no change in serum concentration of homocysteine (see figure 1. Elevation in homocysteine is expected with cobalamin deficiency due to reduced methionine synthase activity) even in the face of extreme cobalamin deficiency. In dogs, preliminary evidence suggests that there is an increase in serum homocysteine concentration with reduced serum cobalamin concentration.

Figure 2: (on TAMU website: http://vetmed.tamu.edu/gilab/research/cobalamin-information ) Serum concentrations of methylmalonic acid are extremely high in cats with cobalamin deficiency, when compared to clinically healthy cats with normal serum cobalamin.

Cobalamin Therapy

As described above, there is compelling evidence that significant tissue-level cobalamin deficiency is present in some companion animal patients with gastrointestinal disease. The significance of this finding for the clinical management of these patients is also becoming clearer. A recent study has examined the effect of cobalamin supplementation on the outcomes of treatment for feline patients with severe cobalamin deficiency and histories suggesting chronic gastrointestinal disease.5 In this study, serum concentrations of methylmalonic acid normalized following parenteral cobalamin supplementation, indicating that cobalamin deficiency was the cause of the high methylmalonic acid in serum. There was an overall weight gain in these patients, and a decrease in the frequency of clinical signs such as vomiting and diarrhea. During the course of the study, there was no change to the therapeutic regime other than the introduction of parenteral cobalamin supplementation.

Dogs with exocrine pancreatic insufficiency will commonly present with subnormal serum cobalamin concentrations. Therapy with bovine pancreatic enzyme extracts is not sufficient to restore cobalamin absorption in dogs with EPI, as intrinsic factor appears to be species specific. Failure to absorb cobalamin in dogs with EPI may be due to all three potential causes of low serum cobalamin. Pancreatic secretion of intrinsic factor is reduced or absent, secondary bacterial overgrowth of the intestine is common, and the mucosa may be compromised by the presence of excessive bacterial numbers and toxic metabolites. Dogs with exocrine pancreatic insufficiency should be considered at high risk for the development of cobalamin deficiency. As clinical signs of cobalamin deficiency include chronic wasting or failure to thrive, malaise, and gastrointestinal signs such as diarrhea, serum cobalamin concentration should be measured in any dog with poor response to enzyme replacement therapy for EPI.

Therapeutic Dosing and Route

Cobalamin should be supplemented whenever serum cobalamin concentration is in the low normal range (approximately less than 300 ng/L) in both dogs and cats. Most commonly, cyanocobalamin is chosen for supplementation, as it is both widely available and inexpensive. Very little evidence-based information about cobalamin supplementation in dogs and cats is available. However, as in people, cobalamin deficiency leads to cobalamin malabsorption so that cobalamin should always be supplemented parenterally. Since cobalamin is a water-soluble vitamin, excess cobalamin is excreted through the kidneys and clinical disease due to over-supplementation has not been described.

We currently recommend SC injection of 250 µg per injection in cats and, depending on the size of the patient, 250-1500 µg per injection in dogs. We have recently changed our suggested dosing schedule for cobalamin supplementation: q 7 days for 6 weeks, then one dose after 30 days, and retesting 30 days after the last dose. If the underlying disease process has resolved and cobalamin body stores have been replenished, serum cobalamin concentration should be supranormal at the time of reevaluation. However, if serum cobalamin concentration is within the normal range, treatment should be continued at least monthly and the owner should be forewarned that clinical signs may recur sometime in the future. Finally, if the serum cobalamin concentration at the time of reevaluation is subnormal, further work-up is required to definitively diagnose the underlying disease process and cobalamin supplementation should be continued weekly or bi-weekly.

It should be pointed out that in rare cases cobalamin supplementation fails to increase serum cobalamin concentration for reasons that are not currently understood. In these cases another formulation of cobalamin, such as hydroxocobalamin, might be effective.

Cobalamin may also have a pharmacologic effect as an appetite stimulant. Anorectic feline patients with cobalamin deficiency often start to eat again once they are being supplemented and appetite wanes once again when cobalamin is no longer administered weekly, despite a normal serum cobalamin concentration. In these patients cobalamin supplementation should be continued on a weekly or biweekly dosing schedule.

Recommendations

We currently recommend that all dogs and cats with chronic histories of gastrointestinal disease should have serum cobalamin concentrations measured. This is particularly important in any case with sub-optimal response to previously instituted therapy. As cobalamin is inexpensive, water soluble and any excess is readily disposed, cobalamin supplementation should certainly be considered for any animal with a serum cobalamin concentration lower than the laboratory reference range.

Further Reading

  • Simpson KW, Fyfe J, Cornetta A, Sachs A, Strauss-Ayali D, Lamb SV, Reimers TJ (2001), Subnormal concentrations of serum cobalamin (Vitamin B12) in cats with gastrointestinal disease, Journal of Veterinary Internal Medicine 15: 26-32
  • Vaden SL, Wood PA, Ledley FD, Cornwell PE, Miller RT, Page R (1992), Cobalamin deficiency associated with methylmalonic acidemia in a cat, Journal of the American Veterinary Medical Association 200 No.8: 1101-1103
  • Ruaux CG, Steiner JM, Williams DA. (2001), Metabolism of amino acids in cats with severe cobalamin deficiency. American Journal of Veterinary Research 62: 1852-1858
  • Ruaux CG, Steiner JM, Williams DA. (2005), Early Biochemical and Clinical Responses to Cobalamin Supplementation in Cats with Signs of Gastrointestinal Disease and Severe Hypocobalaminemia. Journal of Veterinary Internal Medicine 19: 155-160
  • Simpson KW, Morton DB, Batt RM (1989), Effect of exocrine pancreatic insufficiency on cobalamin absorption in dogs, American Journal of Veterinary Research 50: 1233-1236

 

EPI IN CATS RESEARCH

ARTICLES/RESEARCH

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0257856

October 2021

RESEARCH ARTICLE

Untargeted analysis of the serum metabolome in cats with exocrine pancreatic insufficiency

Patrick C. Barko *, David A. Williams

Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois,

United States of America

pcbarko@illinois.edu

ABSTRACT

Exocrine pancreatic insufficiency (EPI) causes chronic digestive dysfunction in cats, but its pathogenesis and pathophysiology are poorly understood. Untargeted metabolomics is a promising analytic methodology that can reveal novel metabolic features and biomarkers of clinical disease syndromes. The purpose of this preliminary study was to use untargeted analysis of the serum metabolome to discover novel aspects of the pathobiology of EPI in cats. Serum samples were collected from 5 cats with EPI and 8 healthy controls. The diagnosis of EPI was confirmed by measurement of subnormal serum feline trypsin-like immunoreactivity (fTLI). Untargeted quantification of serum metabolite utilized ultra-high performance liquid chromatography-tandem mass spectroscopy. Cats with EPI had significantly increased serum quantities of long-chain fatty acids, polyunsaturated fatty acids, mevalonate pathway intermediates, and endocannabinoids compared with healthy controls. Diacylglycerols, phosphatidylethanolamines, amino acid derivatives, and microbial metabolites were significantly decreased in cats with EPI compared to healthy controls. Diacyclglycerols and amino acid metabolites were positively correlated, and sphingolipids and longchain fatty acids were negatively correlated with serum fTLI, respectively. These results suggest that EPI in cats is associated with increased lipolysis of peripheral adipose stores, dysfunction of the mevalonate pathway, and altered amino acid metabolism. Differences in microbial metabolites indicate that feline EPI is also associated with enteric microbial dysbiosis. Targeted studies of the metabolome of cats with EPI are warranted to further elucidate the mechanisms of these metabolic derangements and their influence on the pathogenesis and pathophysiology of EPI in cats Untargeted analysis of the serum metabolome in cats with exocrine pancreatic insufficiency

Patrick C. Barko ,David A. Williams

Published: September 30, 2021

THIS RESEARCH IN IT’S ENTIRETY:

EPI-in-cat-research-2021

https://doi.org/10.1371/journal.pone.0257856

——————————————————————————————————————-

 

https://onlinelibrary.wiley.com/doi/full/10.1111/jvim.16267

Abdominal ultrasound and clinicopathologic findings in 22 cats with exocrine pancreatic insufficiency

Mylène Auger,Constance Fazio,Joerg M. Steiner,Dominique G. Penninck,Gwendolyn J. Levine,John F. Griffin IV,Cary M. Springer

First published: 01 October 2021 https://doi.org/10.1111/jvim.16267

RESULTS

The most common clinical sign was weight loss (15/22 cats). Chronic enteropathy was the most common concurrent disease (13/22 cats). In 39% of cats, the pancreas had minimal or no sonographic alterations. Pancreatic duct dilatation (>2.5 mm), pancreatic duct tortuosity with variable diameter, or both were seen in 6/13 cats. The pancreatic parenchyma was subjectively thin in 6 cats. A significant relationship was found between subjectively thin pancreatic parenchyma and increased pancreatic duct size : pancreatic thickness ratio (P = .004). Diffuse gastrointestinal dilatation with echogenic content was observed in 8/22 cats.

 

CONCLUSION

Exocrine pancreatic insufficiency often causes minimal to no sonographic pancreatic changes. Nonetheless, the findings of thin pancreatic parenchyma, pancreatic duct dilatation, or diffuse small intestinal dilatation with echogenic contents in cats with unexplained weight loss or unformed feces should raise clinical suspicion for EPI.I’m a paragraph. Click once to begin entering your own content. You can change my font, size, line height, color and more by highlighting part of me and selecting the options from the toolbar.

Skinny old cats: Why some senior cats lose weight. What’s going on? 

(Sponsored by Purina Veterinary Diets)

Nov 12, 2014

By David Williams, MA, VetMB, PhD, DACVIM, DECVIM-CA

http://veterinarycalendar.dvm360.com/skinny-old-cats-why-some-senior-cats-lose-weight-what-s-going-sponsored-purina-veterinary-diets?pageID=3

 

CUSTOM VETERINARY MEDIA

Decline in body weight is common in cats that are older than 11 years.1 Sometimes this loss is readily attributable to apparent disease, but in many cases, there are no obvious signs of illness and routine diagnostic approaches fail to reveal evidence of an underlying problem.2,3 Energy requirements of older cats apparently do not decline as markedly as they do in dogs and people, perhaps because physical activity does not decrease as much with age in cats. Indeed, the maintenance energy requirement of older cats may increase rather than decrease.3,4 Although cats might be expected to regulate their energy intake to compensate for these changes to maintain body weight, that clearly is not always the case.4,5

It has been recognized for many years that both protein and fat digestibility decrease in many apparently normal cats after 10 years of age. While the cause of the decreases remains unclear, the changes are quite marked in some individuals and in particular can be dramatic with regard to fat digestibility.4,5 Often these changes are not readily apparent from casual observation of feces and may only be verified if fecal fat content is quantified by appropriate analytic testing. Methods for such testing are rarely available for evaluation of veterinary patients, even at referral centers.

Whatever the explanation for weight loss and decline in nutrient digestibility in older cats, progressive decline in body weight has been reported in the two years before death from a variety of seemingly unrelated diseases. As cats live increasingly longer lives and receive attentive health care, this weight loss is more frequently recognized. In this article, I will review what is known about common age-related changes and what may be done to halt or reverse the decline in body weight that is apparently a predictable prelude to death.3,4,6

Attributable weight loss

Well-recognized causes of weight loss in old cats include chronic renal disease, diabetes mellitus, hyperthyroidism, inflammatory bowel disease (IBD), exocrine pancreatic insufficiency, and dental problems. Most are readily suspected and confirmed based on physical examination and routine laboratory testing. At times, selected additional testing of parameters such as serum thyroxine, serum trypsin-like immunoreactivity, cobalamin and folate, dental radiography (Figures 1A & 1B), or gastrointestinal (GI) endoscopy and biopsy may be necessary. Despite thorough investigation, however, the underlying cause of even severe weight loss can be remarkably difficult to establish conclusively.

1/1

Figure 1A. Dental disease can contribute to weight loss in senior cats. Tooth resorption of the left maxillary canine (a) and 3rd premolar in a cat (b). Small focal areas of inflammation are apparent on the left maxillary 3rd premolar (b) and the left mandibular 4th premolar (c). The left mandibular 3rd premolar is missing, leaving focal residual inflammation (d).

Figure 1B. In the same cat, an intraoral bisecting angle dental radiograph of the left maxilla shows an unsuspected extensive tooth resorption at the cementoenamel junction of the distal left maxillary canine tooth (a). Tooth resorption affecting the root and crown of the 3rd premolar is also apparent (b). (Courtesy of the Veterinary Dental Service Library, University of Illinois)

Unattributed weight loss

Subtle weight loss may not even be noted unless careful records of body weight and body condition scores are kept over repeated veterinary examinations. Similarly, moderate increases or decreases in food or water intake will probably go unnoticed by most owners. Even when the most attentive owners provide the best veterinary care for their cats, a substantial proportion of senior cats will experience weight loss, despite being in otherwise good health and exhibiting no detectable change in food intake.

Figure 2. Fat digestibility (by percentage) in cats ranging in age from 8 to 18 years (n = 208)

Click here to edit text Evidence indicates that, in these older cats with no apparent classic diseases to explain the weight loss, there is an age-related decline in food digestibility.3 There is a significant (p < 0.0001) negative correlation (r = −0.76) between age and fat digestibility (Figure 2). The incidence of low fat digestibility increases with age, affecting 10% to 15% of mature cats (8 to 12 years old) and 30% of geriatric cats (> 12 years old). In some geriatric cats, fat digestibility was found to be as low as 30%, and the only clinical signs were large stools (not frank diarrhea) and low body weight.

Figure 3. Protein digestibility (by percentage) in cats ages ranging in age from 8 to 18 years (n = 208).

There is also a significant (p < 0.0001) negative (r = −0.66) correlation between age and protein digestibility (Figure 3). Low protein digestibility also seems to affect mature and geriatric cats. Although the incidence of low protein digestibility is lower than that of fat digestibility, about 20% of cats older than 14 years show protein digestibility lower than 77%. The incidence of low fat and protein digestibility tends to occur in the same cats. A marked decline apparently becomes particularly prevalent after around age 10 (Figures 4 & 5).

Figure 4. Percentage of cats with low fat digestibility by age (pooled data from four colonies).

Figure 5. Percentage of cats with low protein digestibility by age (pooled data from four colonies).

It is perhaps not surprising that these changes were correlated with several other measures of health or well-being, including serum vitamin E (tocopherol), vitamin B12 (cobalamin), skin thickness, body fat, and body condition score. Overall, while obesity tends to be the predominant body-mass concern in cats between 7 and 12 years of age, in those older than 12 years, obesity is rare and being underweight is a far greater life-threatening risk factor (Table 1 and Figure 6).3

Figure 6. After 12 years of age, there is marked decline in body weight among cats, which supplants obesity as a common life-threatening condition.

Table 1. Incidence of Feline Obesity and Underweight by Age*

http://veterinarycalendar.dvm360.com/skinny-old-cats-why-some-senior-cats-lose-weight-what-s-going-sponsored-purina-veterinary-diets?pageID=3

Nutrient digestibility

The cause or causes of this decline in nutrient digestibility remain unknown but presumably reflect enteropathy of some type. In some cases, this intestinal dysfunction may overlap with what is loosely classified as (idiopathic) IBD. Some cats compensate for the loss in digestive function by eating more and, therefore, exhibit no weight loss. It is important to recognize that many cats show only subtle changes in stool characteristics (slightly larger volumes of stool with a more clay-like consistency) but not frank diarrhea, even when steatorrhea is marked.

Regardless of the precise cause or causes, weight loss in otherwise healthy older cats and changes in fecal characteristics should be investigated, as should malabsorption. Thorough physical examination, routine complete blood count, serum chemistry profile, urinalysis, and fecal examination are all indicated, as are radiographic and ultrasonographic evaluations as appropriate. If nothing specific is found to explain the weight loss, the next step is to measure serum thyroxine, feline pancreatic lipase, feline trypsin-like immunoreactivity, and cobalamin/folate levels. I recommend that these be determined concurrently because studies have indicated that about 50% of hyperthyroid cats have evidence of concurrent intestinal and/or pancreatic abnormalities, including sometimes severe hypocobalaminemia, when the endocrinopathy is initially diagnosed.7,8

Furthermore, all abnormalities detected should be treated concurrently to optimize clinical response to treatment. Many hyperthyroid cats are appropriately diagnosed and treated, but GI signs, especially weight loss, persist despite return to the euthyroid state. Subsequent evaluation of GI function as outlined above then reveals evidence of enteric disease and cobalamin deficiency. Only when these are also appropriately treated do the cats return to optimal health.

The diagnostic process

Determination of fecal fat (by percentage) would be desirable and may be the only way to confirm an intestinal problem in some patients. Fecal fat greater than 20% would indicate fat malabsorption. Unfortunately, such a test is not commercially available for pet cats. It has been reported that 100% of cats older than 7 years of age with serum tocopherol (vitamin E) less than 5 mg/L also have low fat digestibility, and that more than 90% of cats with serum cobalamin less than 100 g/L have low fat digestibility.3 So finding such low serum concentrations of either cobalamin or tocopherol can be the basis for inferring that a cat has low fat (and probably protein) digestibility.3

A new test that often reveals abnormalities in intestinal function in affected cats is an assay of fecal α1-proteinase inhibitor by species-specific immunoassay.9 This test is presently available only from the Gastrointestinal Laboratory at Texas A&M University. Abnormal results indicate the presence of an enteropathy-associated increase in enteric loss of protein; this test can detect protein-losing enteropathy that is not sufficiently severe to lower serum albumin (the liver can compensate for enteric protein loss). Chronic enteric protein loss can contribute to gradual depletion of lean body mass. In a recent study more than 70% of affected cats had abnormal [α1-PI] test results (Figure 7), but interestingly, serum albumin was slightly subnormal in only two of the 11 cats with protein-losing enteropathy.10

Figure 7. Fecal alpha1-proteinase inhibitor concentration was increased in 11 of 15 geriatric cats with idiopathic chronic enteropathy, indicating active protein-losing enteropathy in addition to the previously recognized nutrient malabsorption. The tan line indicates normal α1-PI concentration.

Finally, it should be noted that it is very common to see increased serum concentrations of trypsinlike immunoreactivity (fTLI) and/or pancreatic lipase (fPL) in these cats with idiopathic chronic enteropathy (Figure 8). The significance of these pancreatic abnormalities is not clear. Many affected cats show few if any signs that may be considered suggestive of pancreatitis (e.g.anorexia or vomiting), but the increases can be striking in some individuals.

Figure 8. Pancreatic pathology is also present in a high proportion of geriatric cats with idiopathic chronic enteropathy, as reflected in increased serum concentrations of trypsin-like immmunoreactivity (fTLI) and pancreatic lipase (fPL). The shaded areas represent normal reference ranges.

In the future, assay of enteric inflammatory markers such as fecal calprotectin may prove useful in confirming the presence of enteric disease, but the relationship of inflammation to this enteropathy is currently uncertain. Even histologic examination of intestinal biopsy specimens may not provide evidence of a conclusive diagnosis; lesions may be patchy and interpretation of biopsy findings is inherently subjective. It is also likely that in cats, as in dogs, functional problems in the intestine may not be associated with either inflammation or villous atrophy but rather with intraluminal microbial changes and biochemical derangements in the enterocytes lining the small intestine that are not revealed by classic histologic evaluation.

Treatment

In some cats, despite a thorough investigation, it is not possible to confirm enteropathy. A presumptive diagnosis of idiopathic enteropathy is the best that can be achieved. The approach to management in these instances is essentially the same as for patients with histologically confirmed IBD — that is, a dietary change (low-carbohydrate alternative fiber source, novel antigen, or hydrolyzed diet), prebiotic or probiotic supplementation, correction of low serum cobalamin/folate concentrations, supplementation with vitamin E and perhaps other antioxidants, antibiotic treatment with metronidazole or tylosin, and perhaps glucocorticoid therapy or immunomodulation with chlorambucil or cyclosporine.11 However, in the absence of specific laboratory abnormalities or any overt clinical signs to monitor, other than perhaps very slowly progressive weight loss, it is probably premature to recommend particularly aggressive treatment for these patients. A cautious, conservative approach is warranted.

As many of the observations about digestive disturbances in elderly cats are relatively new, appropriate clinical studies evaluating treatment interventions have not been performed. Dietary changes and supplements would certainly be the safest and most easily administered interventions. When specific abnormalities such as hypocobalaminemia are identified, they should be rectified.

The effect of dietary changes has to be evaluated on an individual trial-and-error basis, which can be difficult if gradual weight loss is the only clinical sign to evaluate. Observing improvements in the newer GI disease markers, such as fecal α1-proteinase inhibitor and serum fPL, may provide objective evidence of a positive response, but the value of this approach remains to be evaluated.

Careful observation of stool characteristics may provide some evidence of improved digestibility, especially if grossly apparent abnormalities were present at the outset. If there is no apparent response to dietary change after two to four weeks, an alternative diet should be tried. I prefer to select diet changes based on reduced carbohydrate content (generally associated with increased protein content) or different amounts or types of fermentable fiber. Adjusting the fat content of the diet does not appear to be particularly useful in treating feline enteropathies. Unfortunately, definitive studies in geriatric cats with malabsorption have not been done. Treatment needs to be individualized and evaluated on a trial-and-error basis.

With regard to older cats in general, there is some evidence that diet can play a role in maintaining body weight and fat mass — and prolonging life. A control diet (nutritionally complete and balanced adult cat food) supplemented with antioxidants (vitamin E and ss-carotene), a blend of n-3 and n-6 fatty acids, and a prebiotic (dried chicory root) was associated with reduced decline in body weight and increased longevity (by more than 1 year) compared with feeding either the control diet alone or the control diet supplemented with antioxidants alone.6 These striking observations illustrate the potential benefit to be gained from dietary and other interventions to address the gastrointestinal changes that appear to be so common in aging cats.

References

  1. Pittari J, Rodan I, Beekman G, et al. American Association of Feline Practitioners. Senior care guidelines. J Feline Med Surg 2009;11(9):763-778.
  2. Caney S. Weight loss in the elderly cat. Appetite is fine, and everything looks normal…. J Feline Med Surg 2009;11(9):738-746.
  3. Patil AR, Cupp CJ. Addressing age-related changes in feline digestion. Proc Nestle-Purina Compan Anim Nutr Summit, Focus Gastroenterol 2010:55-61.
  4. Taylor EJ, Adams C, Neville R. Some nutritional aspects of aging cats and dogs.Proc Nutr Soc 1995;54:645-656.
  5. Fahey GC, Barry KA, Swanson KS. Age-related changes in nutrient utilization by companion animals. Annu Rev Nutr 2008;28:425-445.
  6. Cupp CJ, Kerr WW Effect of diet and body composition on life span in aging cats.Proc Nestle-Purina Compan Anim Nutr Summit Focus Gastroenterol 2010;36-42.
  7. Steiner JM, Peterson MA, Ruaux CG, et al. Serum cobalamin and folate concentrations in cats with hyperthyroidism. J Vet Intern Med 2005;19:474-475.
  8. Cook AK, Suchodolski JS, Steiner JM, et al. The prevalence of hypocobalaminaemia in cats with spontaneous hyperthyroidism. J Small Anim Pract 2011;52(2):101-106.
  9. Burke KF, Broussard JD, Craig G, et al. Evaluation of fecal alpha1-proteinase inhibitor concentrations in cats with idiopathic inflammatory bowel disease and cats with gastrointestinal neoplasia. Vet J 2013;196(2)189-196.
  10. Williams DA, Czarnecki-Maulden G. Protein-losing enteropathy commonly co-exists with high fecal fat output in geriatric cats with idiopathic malabsorption and persists following correction of subnormal serum cobalamin concentration. In Proc 23rd Congress Europ Coll Vet Inter Med – Comp Anim, Liverpool, England, Sept. 2013.
  11. Webb CB. Feline inflammatory bowel disease. NAVC Clinician’s Brief2012;10:11-14.

We are pleased to announce that an article, written by one of our very own members, Stephanie Bouchard, on EPI, was published in the August 2014 edition of the ” Cat Fancy ” magazine. It is an excellent article that brings much needed awareness to the general public about EPI. Check out Stephanie’s blog:

http://www.stephaniebouchard.net/portfolio/cats/

Thank YOU Stephanie !!!!

 

ce of hypocobalaminaemia in cats with spontaneous hyperthyroidism. J Small Anim Pract 2011;52(2):101-106.

  1. Burke KF, Broussard JD, Craig G, et al. Evaluation of fecal alpha1-proteinase inhibitor concentrations in cats with idiopathic inflammatory bowel disease and cats with gastrointestinal neoplasia. Vet J 2013;196(2)189-196.
  2. Williams DA, Czarnecki-Maulden G. Protein-losing enteropathy commonly co-exists with high fecal fat output in geriatric cats with idiopathic malabsorption and persists following correction of subnormal serum cobalamin concentration. In Proc 23rd Congress Europ Coll Vet Inter Med – Comp Anim, Liverpool, England, Sept. 2013.
  3. Webb CB. Feline inflammatory bowel disease. NAVC Clinician’s Brief2012;10:11-14.

We are pleased to announce that an article, written by one of our very own members, Stephanie Bouchard, on EPI, was published in the August 2014 edition of the ” Cat Fancy ” magazine. It is an excellent article that brings much needed awareness to the general public about EPI. Check out Stephanie’s blog:

http://www.stephaniebouchard.net/portfolio/cats/

Thank YOU Stephanie !!!!

 

Please feel free to print the following as a 

handout… or 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 https://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 has changed. 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 – TLI test) https://vetmed.tamu.edu/gilab/service/assays/tli/ 
TAMU (Texas A&M Gastro Lab – B12 test) https://vetmed.tamu.edu/gilab/service/assays/b12folate/
IDEXX https://www.idexx.com/en/
ANTECH Labs https://www.antechdiagnostics.com/

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 : contact Carol Pilger directly via text: 847-997-0853 or email: 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.

2023 – YES!  Cats can take CREON.  Start with CREON 5000 or CREON 6000.  Open capsule, start with using 1/2 the capsule per meal. Sprinkle on top of wet food. Do not mix in the food. not incubate. Serve immediately. Watch poos for 2 to 3 days…. if poos remain loose, slightly increase the dose, watch the poo for another few days.

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.

contact:

Carol Pilger, EPI in Cats Manager via
text or cell call: 847-997-0853 or
email:
cmp25391@comcast.net

 

2022 Cat Dysbiosis Index  (scroll to 2nd page for article)

Cat Dysbiosis index

 

2021 Analysis of serum metabolome in EPI cats

EPI in cat research 2021

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) 542-4684×31 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