Epi4Dogs was started May 25, 2008 to help bring better awareness and more accurate and current EPI information to others. At the time I founded Epi4Dogs, there was only 1 support group, EPI veterinarian research was at a stand still… and no one could give me any answers to why EPI happens. Luckily over time, multiple researchers came forward to assist with my quest to find answers to EPI. We are now pursuing EPI research on a large scale. I will forever be indebted to veterinarian researchers at Texas A&M, University of Illinois, Clemson University, University of Tennessee, Tufts University, University of Hannover/Germany, University of Sydney/Australia, Royal Veterinary College/London, University of Cambridge/UK, and others … but most of all I owe the most to Dr. David A. Williams, the esteemed veterinarian researcher who developed the TLI test, the gold standard to test for EPI, who not only worked with Epi4Dogs on EPI research, but who has taught me so much and took the time to work with me on many, many EPI projects throughout the years! Thank YOU!
My EPI journey began in the summer of 2005 when I picked up my Spanish Water Dog (SWD) puppy, Izzy, at the Charlotte Airport in North Carolina. I imported her from the top breeder of SWDs in Spain because I was going to start a working dog line of Spanish Water Dogs. Her father, Gordo, was a famous SWD working dog champion. Izzy and her sibling, Carlos, were delightful little pups. My friend Shelley took Carlos, who was a little bit more well-mannered, whereas Izzy was quite the little spit-fire!
When Izzy was around a year old we thought she looked a little thin, but just attributed it to her having a growing spurt. Shortly thereafter, while giving her a bath, it became obvious this was not a growth spurt. For three months the vet ran all kinds of tests and found nothing wrong. But something was wrong– Izzy lost almost half her weight, started eliminating 5 to 10 times a day and had many accidents in the house. I increased her food intake from two to nine cups a day and she was still losing weight. Then she started eating her own feces– she was almost feral about it, her feces were large, pale and tan colored and looked like cow plops. When my vet heard me describe the feces, he said, “if it looks like a duck and quacks like a duck it just might be a duck… let’s test her for EPI!” When I asked him “what’s EPI?”, he responded “a condition that German Shepherd Dogs get”. Thank goodness for this wonderful vet, Dr. Roy MacDonald, Our Team | Veterinarians Hillsborough, North Carolina | Hillsborough Veterinary Clinic (hillsboroughvetclinic.com) that thought “outside the box” and the fact that he even considered testing her for EPI because at one year and three months old, my Izzy was confirmed with EPI. She was the first of her breed world-wide to ever be recorded with EPI. A few years later I traveled to Spain to address the SWD club about EPI, and since then more cases have been properly diagnosed.
What is EPI?
EPI is Exocrine Pancreatic Insufficiency, a primary or secondary health condition in dogs and cats where they no longer produce the necessary digestive enzymes from the acinar cells located in the exocrine part of the pancreas. These digestive enzymes are needed to digest nutrients from food.
These three main types of digestive enzymes are: amylase for digestion of carbohydrates (sugars & starches in grains, fruits & vegetables), protease and trypsin for digestion of protein, and lipase for the digestion of fats. Normally the lipase enzyme breaks down undigested triglycerides into fatty acids and monoglycerides, which are then solubilized by bile salts. Impaired fat digestion is not apparent until the lipase enzyme output is less than approximately 10% of the normal level. This is why we do not see any physical signs that something might be wrong until approximately 85-95% of the exocrine part of the pancreas has atrophied.
When these critical digestive enzymes are not sufficiently available to help digest nutrients from food, the body goes into starvation mode. Left untreated, the dog will eventually die from either organ failure or starvation, whichever happens first.
Possible signs exhibited after 85-95% of the pancreas is atrophied are:
- Gradual wasting away with a voracious appetite
- Eliminating feces more frequently with large yellow/tan/gray feces resembling cow-plops
- Intermittent or watery diarrhea
- Eating feces (coprophagia) or other inappropriate items
- Vomiting, burping or acid reflux
- Tummy noises/grumbling
- Excessive flatulence
- Personality changes
Can EPI be managed? YES! Once the EPI is under control, EPI dogs can live just as long as any other dog and can do anything any other dog can do.
If you suspect your dog has EPI, contact your vet and request a TLI (trypsin-like immunoreactivity) blood test. You will need to food-fast your dog for 12 hours prior to the blood being draw. It is advisable to also ask for a Cobalamin blood test to be done at the same time, as over 80% of EPI dogs also have insufficient B12 levels and will not optimally respond to treatment until their B12 levels are in the upper-mid range. Follow Texas A&M lab (TAMU) recommendations for the B12 protocol http://vetmed.tamu.edu/gilab/service/assays/b12folate
If your dog tests positive for EPI you will need to start with the recommended protocol of managing the four aspects of treating EPI:
- Porcine Enzymes with every meal. For enzyme resources: epi4dogs.com/enzyme.htm
- Diet with low fiber content of 4% or less. For details: epi4dogs.com/diet.htm
- B12 (if needed for low B12) For details & research: epi4dogs.com/b12.htm
- Antibiotics (if needed for SID) For details, dosing and research: epi4dogs.com/sidsibo.htm
- Keep a journal to observe the 4 aspects and to make sure all is working well.
Enzymes are usually needed for life and should be included in all meals. There are multiple types of enzymes that can be used, such as freeze dried powdered enzymes (prescription or generic), enteric-coated enzymes in capsules, enzyme tablets, or raw pancreas. In the USA, freeze dried powdered enzymes are preferred as they are most consistent in potency and easiest to ascertain proper dosage and administration.
Diet is a key component of effectively managing EPI, but this can vary from dog to dog. We suggest starting with a very low fiber food that does not have any grain in it. This usually works best for most, simply because fiber may, to some degree, inhibit the effectiveness of the enzymes. However, some EPI dogs will require slightly different diets, such as a hydrolyzed diet, or some will do better with a very limited amount of grain (rice) added. Many EPI dogs have difficulty with too many carbs in the formula or if there are too many peas in the diet composition. Because finding the right diet can be so tricky, we advise pet owners to start keeping an EPI Journal and record everything given and record the output results and any other reactions. Keeping a journal will greatly help the pet owner identify what does and doesn’t work for their EPI dog.
B12 insufficiency is a secondary condition of EPI that occurs in 4 out of 5 EPI dogs. The recommended protocol is six weeks of weekly simple serum B12 shots and then re-assess to determine how often B12 supplementation is needed to maintain upper mid-range B12 levels. Often pet owners will opt for B12 pills, however, OTC B12 pills usually do not work unless they also include the intrinsic factor. There is recent research that suggests that very high doses of oral B12 can correct low B12. However, it has also been observed that B12 pills without the intrinsic factor included in the pill do not always work on EPI dogs. In the small intestine, the B12 becomes bound to intrinsic factor which eventually allows the B12 to be absorbed into the portal blood. With EPI, we have no way of identifying which dog may have viable intrinsic factor or if it has been damaged. Because of this we will continue to recommend only oral B12 that has the intrinsic factor included in the pill.
SID is small intestinal dysbiosis. SID means there is an imbalance of the microbiota in the small intestine. This too is a secondary condition of EPI and almost always present when EPI is first diagnosed just because of the very nature of EPI. The current protocol is to give the enzymes, and change the diet first and give this a week to two to determine if this is all that is needed for the gut flora to correct its’s own microbiota imbalance. If after a few weeks, you see any of the SID signs repeatedly, such as: yellowish/light colored stools, continued loose/soft stools, intermittent sloppy stools, gelatinous stool coating, flatulence, lack of appetite, grumbling stomach noise, acid reflux, regurgitation, then before you resort to starting your EPI dog on antibiotics to treat SID…the more current protocol (based on EPI gut flora research at TAMU) is to try adding a prebiotic to the dogs diet. Epi4Dogs suggests trying Slippery Elm powder (see SID/SIBO tab on Slippery Elm). If this helps, just not enough, then try a probiotic with prebiotics in it. Give these natural treatments a few weeks to work. If SID still persists, then talk to your vet about doing a course of antibiotics. The current antibiotic of choice is Tylan (Tylosin tartrate 100 grams) given according to weight twice daily/every 12 hours for 30-45 days. This is the SID protocol suggested by Texas A&M Gastrointestinal Lab, Dr. Joerg Steiner. Finding the right diet for your EPI dog is probably the most effective way to limit future SID flare-ups.
Many times even when the recommended protocol is followed, these EPI dogs still do not optimally respond. This usually means that something needs to be adjusted. Once you find the right balance of treatment for your pup, the recovery is amazing. The success rate has been estimated at 95-97%.
Over the years, there have been a variety of assessments and theories about this condition, many that have since been debunked due to new research with improved technology.
Currently Epi4dogs is collaborating with Dr. David A. Williams and Dr. Patrick Barko of the College of Veterinary Medicine, University of Illinois at Urbana-Champaign. Together we are embarking upon a new research, the Maya Metabolomic Study http://vetmed.illinois.edu/cmmi/ in their Clinical Metabolomics and Microbiome Initiative to further investigate possible environmental factors that may be involved in EPI. Metabolomics is an emerging field in which a very large number of small chemicals can be analyzed from samples of body fluids and tissues. This new technology has the potential to identify previously undetectable abnormalities associated with the development of various diseases including EPI. We hope this new information will provide clues as to why this disease develops and what we can do to prevent it. Findings are now scheduled to be published 2021.
Epi4Dogs also recently collaborated with Dr. Jan Suchodolski http://vetmed.tamu.edu/gilab/staff/dr-jan-suchodolski at the Texas A&M Gastrointestinal Lab on a Microbiota Study of EPI dogs and have found some very unusual anomalies which was also be published 2017 and presented at the 2017 ACVIM conference.
Epi4Dogs is not only dedicated to supporting non-invasive EPI research, but we also have the only EPI database in existence and are the largest EPI resource center with multiple current EPI research in our files. We work with both the veterinarian community and the pet owner. There is also an open EPI Forum 24/7 support group always available to help those struggling with EPI, along with social media, Twitter and Instagram.
If you would like to learn more about EPI please visit: http://www.epi4dogs.com/
Olesia C. Kennedy, Founder
Epi4Dogs Foundation, Inc.
February 13, 2020…..The End of an EPI Journey
It is with deep sadness to share with you that the inspiration for Epi4Dogs, Izzy, passed away on
February 13, 2020, from kidney failure at the age of 15. Our hearts are broken and our home is so silent and empty.
Izzy was a funny, sweet, joyful and very affectionate plain brown little Spanish water dog, who had a huge personality and was so full of life!
Every day for 15 years, Izzy would wake me up and we would start our routine. I swear she woke up smiling, with a twinkle in her eye and started planning her mischievous little antics for that day. She sure could make us laugh. Izzy was such a little smarty pants that I could just talk to her and she’d do whatever I asked. And she loved to tease the other dogs in the house. Everything that was hers was hers, and what was theirs was hers too. We dubbed her “greedy girl”. But on the flip side, she was a great little helper. No matter what I asked her to do for me, she did. Whether is was to bring something to me like my shoes, (and she always brought the correct matching set of footwear too), glasses, clothing, jewelry, etc. Or get something from my pocketbook like keys, wallet or comb, or if she had a job to do like put away the toys or carry dirty laundry to the laundry room, or bring me something I needed that I was working on. It was uncanny how she knew what I needed when I asked for something. When we went places, folks had fun with her because we would take an object from their person, hide it and Izzy would find it and return the item back to the right person within seconds. She loved going to the nursing home and always knew which patients needed a little extra time or doggie kisses.
Over time, she developed multiple health conditions in addition to EPI, but had such a positive spirit that she not only survived she flourished through it all. Until last week, when the light went out of her eyes and I knew it was time to let her go. We had a vet come to the house Feb 13th and Izzy passed quietly in my arms in our home. But even before she left this earth, she still managed to help one more dog, by giving her remaining enzymes to the vet that helped her cross over, to help another client that was struggling. Ironically, on the same day that Izzy passed away, a research grad student was approved to do EPI research on a new EPI Genetics Study at Clemson University.
She was my best friend, my all-time companion, once in a life-time heart dog, who taught me so much. She literally changed the course of my life. So many have said that I took such good care of her and gave her so much of my time… but they all had it backwards, I was the lucky one to have had Izzy in my life! God Speed Sweet Girl.
Izzy, who developed EPI (Exocrine Pancreatic Insufficiency), was the inspiration for Epi4Dogs, that was started 12 years ago and later became a non-profit charitable organization. At the time of her diagnosis she was only 1+1/2 years old. I had no idea what this condition was. When I researched it, it said only German Shepherds and Rough Coated Collies developed EPI. What? Izzy was a Spanish Water Dog! And then when I found out how expensive the enzymes were. I was in shock. I remember my husband saying, you know we can’t afford these enzymes for the life of the dog. But how could we put her down, she was such a sweet little being. So, I started researching the internet. Luckily, I eventually connected with Enzyme Diane. Thank Goodness… because of Enzyme Diane we were able to afford the enzymes for Izzy and I will forever be grateful to her!
In the meantime, I was troubled that there wasn’t more current EPI information out there, EPI research was not really being pursued, and that it was a misnomer that only GSDs and Rough Coated Collies got EPI. So, Epi4Dogs was born.
The objective of Epi4Dogs was and continues to be to bring better awareness to the condition and to help those struggling with EPI. And to further EPI research in hopes of finding answers as to why EPI happens. Epi4Dogs now has over 4,000 members and has assisted almost 3,000,000 people world-wide since it’s existence. And finally, EPI is now recognized in all breeds.
Over the years, Epi4Dogs has connected with some of the best veterinarian researchers and veterinarian universities worldwide. Some have collaborated with us on research, some have advised and guided us, others have sought us out for advice and information. We have been published multiple times and have presented at many seminars and conferences through the years. Some of the EPI research that Epi4Dogs has collaborated on has been on Genetics, Bile Acids, Dysbiosis, Vitamin Supplementation, Metabolomics, Microbiome, Slippery Elm, Enteric Coated Enzymes, etc.
In honor of Izzy’s legacy and all the advances that have been made because of her inspiration. I would like to acknowledge and thank those that have helped us accomplish so much. I am forever thankful to:
* Dr. David A Williams (Univ of Illinois), the premier vet researcher & developer of the gold-standard TLI test who has become my mentor in all things EPI and who guided and advised me along the way. Dr. Williams is also the lead investigator in multiple EPI research projects along with:
* Dr. Patrick Barko (Univ of Illinois), an innovative and rising star in research, currently one of the lead researchers in the Metabolomic & Microbiome study.
* Dr. Leigh Anne Clark (Clemson Univ) who has done multiple EPI genetics studies and is continuing her work on EPI genetics.
* Dr. Jan Suchodolski (Texas A&M Gastrointestinal Lab /TAMU) who has also done multiple studies on EPI gut flora/microbiome.
* Dr. Kate Tsai (Clemson)
* Dr. Jorg Steiner (TAMU),
* Dr. Cyrus (TAMU)
* Dr. Anne Mossler (Germany),
* Dr. Penny Watson (UK)
All who have all contributed to Epi4Dogs and EPI Research.
And last but not least, a very special and heartfelt thanks to Craig Taylor who created our fantastic website, and to the wonderful, staff at Epi4Dogs (Andrea, Ann, Barb, Craig, Dar, Devika, Diane, Elisabeth, Fiona, Jean, Jill, Judy, Julie, Madelon, Paula, Shirl, Staci, Susan, Terry and Tracey). All who volunteer their time and knowledge 24/7 to help others.
Thank you to all who have helped make Epi4dogs be what it is today and may Izzy’s EPI legacy continue to help others for as long as needed…………..