Exocrine Pancreatic Insufficiency in Dogs: Weight Loss, Brittle Fur, Starving All The Time … Beaner’s Story

The pancreas is an essential organ that is involved both in food digestion and metabolism.

The two crucial functions it fulfills is the production of digestive enzymes and the production of insulin. Without digestive enzymes present, your dog cannot break down their food and can literally starve to death regardless of the amount of food they consume.

Thank you, Angie Falcsik, for sharing Beaner’s story.

Beaner’s story

These are just some of the symptoms I was noticing with Beaner, my 10-year-old German Shepherd/Greyhound.

It started out with weight loss. But because Beaner was a little on the pudgy side, and was reducing her food a bit. So I didn’t think much of it.

However, then other symptoms started to appear.

Coat changes

When I was brushing her I noticed that she was losing more fur than normal. As well as her skin was very dry and flaky.

Yes, I know, GSD’s don’t have a shedding season (she is predominately GSD) – they shed all year long; but this was in the fall and not the time of year she should be shedding this much. I also noticed that her fur was not as soft. But I concluded she needed a bath. And since it was getting colder outside, maybe her skin was just getting dry.

Or perhaps the food the dogs eat had changed the formula. However, after doing some research, I learned that was not the case.

All the dogs are on fish oil daily so I knew she was getting enough Omega 3. I decided to give her just a little bit of EVOO in her food and give her a bath. I use Main & Tail shampoo and conditioner which has always worked very well for the dogs.

However, even after her bath, her fur still didn’t feel right. She was also depressed and irritable.

Behavior changes

She didn’t want to engage in play or even snuggling at times. She was less tolerant of her canine brothers and would snap and growl at them over the littlest things. Her eyes were sunken and she literally looked sad.

Coprophagia

I also would catch her eating not only her poo, but her brothers’ as well.

Not even waiting for it to hit the ground at times! I know – disgusting. Beaner was ravenous and despite increasing her food from 1 ¼ cups twice a day slowly all the way to 2 cups twice a day, she continued to act as if she was starving and was still losing weight.

Stomach upsets

I also heard loud rumblings from her tummy all the time. She also had really bad gas.

I thought she just had a tummy ache. So I started to add pumpkin to her food to help settle her tummy. The rumbling and gas continued. I thought could I have been wrong about her food? Was this not the right brand for her? The boys were not losing weight. Then, I thought, worms? Parasite? But the boys weren’t losing weight. Their fur was still soft and had normal shedding. They were not acting as if they were starving.

I figured if one had a parasite, it was likely the others would as well. At this point, I decided to call the vet.

Although he agreed with my analysis, he still said it was possible and he wanted a stool sample; a fresh one – not frozen or refrigerated overnight. Yeah, right! I work 3 jobs; 85+ hours a week. How was I going to get a “fresh” sample during a time that the vet was open? I decided to wait for the weekend and try to get one in the morning before I went to go teach obedience class.

Beaner gets really ill

During the week (called the vet on Monday), she deteriorated.

I watched her come inside one evening after playing ball, her muscles were quivering. She stood there for a bit and then basically collapsed to the floor. Her muscles had begun to atrophy already and she was not strong enough after 10-15 mts of playing to hold herself up.

I was very scared at this point!

I examined her and could see that she had lost some muscle tone and knew at this point we were not dealing with a parasite, or at least not only a parasite.

Cancer concern

I immediately looked at her fatty tumor on her chest that has now gotten to the size of a golf ball and thought, the vet has been wrong all this time – it was not a fatty tumor – it is cancer and I’m going to lose my girl!

I kept trying to remind myself of the times the vet had pulled fluid from this fatty tumor and over the years assured me that is all it was. He had given me the option of having her undergo surgery to remove it but I could not justify putting her under to remove something that was not bothering/hurting her; it bothered me. Selfish. She did not need to risk the possible risks of surgery because I didn’t like how it looked.

Still, I thought, can a fatty tumor become cancerous? Research told me no.

Back to the drawing board. That whole week I watched her like a hawk. I decided not to overexert her and other than her ravenous eating, poo eating, and brittle fur, she was walking/standing/jumping on/off the bed okay.

Slimy poop

Saturday finally came.

I knew that the dogs’ poo schedule was right around 10 am so right after breakfast I locked them in the house for a couple of hours. I finally let them out and followed Beaner with a large baggie – 2 in fact. (Beaner’s poo is extra large!). I wasn’t sure what type of tests they were going to do or how much they needed so I was planning accordingly.

She did not want to go with mom watching and knowing I wanted her to go. She tried to get me to play with her, she ran across the ¼ acre backyard to try and poo in private. No luck –I waited around the bush and as she was squatting ran up to her. It was gray! It was slimy and runny too!

I expected soft, or even runny, but not gray and slime! Now I was very concerned.

Veterinary visit

With Beaner and poo bag in tow, we were off to the vet for her appointment. I handed the poo bag to the vet assistant and she assured me I had more than enough. I think she was being sarcastic.

The vet examined Beaner and weighed her. She was 56 pounds!

Her normal weight was about 80 pounds! I could not believe her weight was that low! The vet drew some blood and asked me to get a urine sample. Sure, now he tells me – could have done that at home. Good thing Beaner pees on command, even if she just went. He handed me a Styrofoam cup and I took her outside and told her to go potty.

Of course, the good girl that she is, she started to pee but I got a little snow in the cup as I tried to get it under her and the vet said he needs a completely clean sample. Again –now he tells me. The vet assistant came in with another cup and suggested we cut the cup lengthwise so it was more like a scoop – good idea. This time I took her to the parking lot close to the snow but not in it. Hoping she still had something in her asked her to go potty again.

She looked at me as if to say, “I just went!” But again, the good girl she is, she peed again and this time we got a clean sample. Very carefully so as not to spill, I poured it into another cup and brought it back inside.

Waiting for diagnosis

Now it was a waiting game.

Blood work would take a couple of days, urine would take a day as would the stool, unless more extensive tests were needed and then it would be a couple of days.

The vet had a couple of things he was thinking; protein loss, digestion issue, and of course, the “C” word – cancer.

We got home and after a bit of snuggling, I decided not to let her see me so upset. Beaner and her brothers and I went to do some nosework to get our minds off things.

Surprisingly, a couple of hours after leaving the vet, I got a phone call. The vet said, although the other tests still needed to be done, it was very clear from the initial stool test that

Beaner was not absorbing ANY nutrients from her food …

Exocrine pancreatic insufficiency (EPI)

I said, “exocrine, what?” The vet explained that there are certain cells (acinar cells) found in the pancreas that are needed to produce and secrete enzymes needed to digest food. They are:

Amylase for digestion of carbohydrates (sugars & starches in grains, fruits & vegetables);
Lipases for digestion of fats and oils; and,
Trypsin and Proteases for digestion of proteins.

Beaner can no longer produce what is necessary to digest her food and allow her body to absorb and utilize the nutrients – basically, she was literally starving and without treatment, would not live!

EPI is not curable, only treatable with specific enzymes. I made another appointment to go in as soon as the other tests were completed.

After hanging up with the vet, I sat down and cried!

Learning about EPI

How could I not have known it was this serious? What kind of mom am I? Why didn’t I take her in sooner? I decided to do some research. I read more about the enzymes that were needed to digest food, about how this disease can affect other parts of a dog’s body; organs, immune, nervous system, and mental status. Dogs suffering from exocrine pancreatic insufficiency can become depressed, aggressive and/or fearful.

I also found out that this disease is very hard to diagnose and that many times the obvious symptoms do not reveal themselves until 80-90% of the exocrine pancreas acinar cells are destroyed.

While that did not change anything, it at least eased my mind a little in that I was not beating myself up – as much. I pride myself on being very aware of my dog’s health and daily routines and now this is the second dog that something serious has happened and I didn’t realize it immediately. First Indy with his dysplasia and now Beaner with EPI.

Otherwise healthy

A few days later we were back at the vet.Beaner’s urine test was perfect and her blood work was as well. No protein loss and no cancer.

The vet discussed a more specific test where blood would be drawn again and sent down to Texas, the only lab in the US that conducts this particular test and runs approximately $200.00. This test, called a cTLI test, is the only test that can confirm EPI. One is looking for a range between 5.0-35.0.Now I had to decide what to do.

Her blood work was normal, her urine was normal, her stool was grey, slimy, running, she was losing weight, bony frame, losing hair, fur turning brittle, mental status changes, tummy gurgling/gas – classic EPI symptoms. The enzymes she would be started on is $150.00 a bottle which lasts approximately 6-8 weeks.I made the decision to start Beaner on the pancreatic enzymes without having the cTLI test as I completely trust my vet and he has seen this many times before and has patients suffering from this disease.

Of course, we could perform the cTLI at any time if I chose to do so but for now, I chose to get her started on the enzymes right away.

Beaner’s treatment

There are a few ways of treating this, but the recommended treatment is powdered porcine pancreatic enzyme, which, by the way, does not smell very good.

The vet warned me it smells like vomit and I asked if Beaner will even eat it if it smells that bad. His response, “she eats poo doesn’t she?”.

Touché. As it turns out, it is not as bad as they made it out, but you definitely do not want to get your nose too close! I picked up a few cans of pumpkin and canned dog food on our way home with enzymes in tote.

The directions state that the enzymes must “incubate” for a minimum of 10-15 mts so I measured 1 tsp with a good size spoonful of canned food, mixed it really well and let it sit for the appropriate time. Meanwhile, the dogs are going crazy because they know it’s dinner time, they see me preparing the food and then they have to wait! Not happy campers I tell you!

I continued this regimen for a few days.

I got Beaner’s food ready in the morning after my work out and while I was getting ready for work which worked out well, but it was the dinner time regimen that was a nightmare for everyone.

Fine-tuning the regimen

I remembered a Yahoo Group that I found and joined for owners of EPI dogs and posted my dilemma.

I received a number of really great responses! Many people had the same situation I did. They worked late, multiple jobs and didn’t want their dogs to have to wait to eat after a long day.

It was also recommended that depending on the level of the disease, feeding small amounts multiple times a day was the best thing to do until it was under control.

The idea that worked best for me was to place her dry kibble in containers along with the enzymes and shake really well so all the kibble is coated. I have about 5-6 containers in the fridge at all times. When I feed the dogs at night, I add just enough water to barely coat the kibble and let it sit overnight for her morning feeding. In the morning, I do the same thing for her evening feed.

This is a great idea if one is going on vacation and either has a pet sitter coming in or wants to make sure the boarding facility has appropriately mixed food/meds. It was even suggested to mix food, meds, and meds, let it incubate a few hours and then freeze it!

With my schedule, working 3 jobs, and crazy hours, this formula works great for Beaner. If I’m going to be running late, I can have a neighbor come over and feed the dogs and know she is getting exactly what she needs.

Beaner improves

Okay, so back to our story.The first week was difficult as I was not seeing any changes in her behavior, appetite, poo eating regimen, attitude, weight – nothing!

I called the vet and he said we needed to give it a bit more time. If I was still not seeing any changes in another 4-5 days, we would move forward with cTLI test.

A few days later I was looking out the window and saw Indy outside doing his duty and Beaner right next to him waiting for him to finish. I was just about to tell her to leave it so I could pick it up when much to my surprise, she sniffed it and walked away! I knew that this meant progress was occurring and she was feeling better! The enzymes were working!

Positive results

Each day I noticed more and more signs that she was doing better.

Beaner was not as ravenous at the food bowl. Her fur started to feel less brittle and after about a week, she actually started feeling soft again! Beaner began to get that spark back in her eyes and spunk in her attitude! She even began to smile and wink at me again! And she was able to play and walk longer without getting so tired she could barely stand up and her mental status became more stable.

Beaner became tolerant of the little things again and her depression was going away. I knew she was really feeling better when her nosework started going from hunting for the food box because she was starving to hunting because she loved the game! My girl was back!

It has now been about almost a month and she has gained 5 pounds!

Her fur is really soft again, she plays, throws her toys at me, runs and has that sparkle in her eyes again! We still have a ways to go to put another 12-15 pounds but we are well on our way to better health. Although her normal weight when she was younger and healthier (developing some hip/joint issues), the vet and I decided not to bring her weight back to her 76-80 pound weight but to keep her at about 70-72 so as not to put too much pressure on her joints.

In closing

Beaner will need to have her enzymes for the rest of her life, but now that we have finally gotten the right diagnosis, she is getting healthier day by day!

I do, of course, continue to read and converse with my Yahoo EPI group as there is always something that comes up in someone’s life that we can learn from to help Beaner in her recovery. They have been a wonderful support group and a wealth of information.

Further reading:
Lack Of Digestive Enzymes in Dogs