A quick google showed me this:
https://www.vetfolio.com/learn/arti...t-2-exocrine-pancreatic-insufficiency-in-cats
"Chronic pancreatitis is the most common cause of EPI in cats.""
CLINICAL SIGNS
Clinical signs associated with EPI in cats include the classic “big 3” of chronic diarrhea, weight loss, and increased appetite. These signs are nonspecific, however, and can occur with other conditions besides EPI, including inflammatory bowel disease (IBD), hyperthyroidism, and even occasionally with chronic low grade lymphocytic lymphoma of the small intestine. Polyphagia can also occur in cats with diabetes mellitus and with corticosteroid therapy. EPI and diabetes mellitus may also occur concurrently. There are many causes of weight loss in cats, including chronic kidney disease, dental and periodontal disease, heart failure, neoplasia, IBD, and liver disease. Also note that not every cat with EPI has diarrhea and EPI should be considered in cats with unexplained weight loss with or without diarrhea.
Diarrhea in cats with EPI is often loose or semi-formed, voluminous, and malodorous. The feces may be lighter in color than normal, e.g., tan or “clay” colored. There is increased frequency. There is a high fat content in the feces and this can occasionally cause a greasy appearance on the haircoat of the perineum and tail head. I have also observed cats with severe IBD without concurrent EPI to have this same appearance."
Then: (
AND NOTE THE VERY LAST SENTENCE WAAAY DOWN BELOW*)
"
fTLI
A variety of tests have been used in the past for diagnosis of EPI in cats but most have been unreliable. The fTLI assay is by far the test of choice today. There are only two assays for fTLI available worldwide. One is available through the Texas A&M Gastrointestinal Laboratory and the other is available in Europe. The current reference range for the Texas A&M serum fTLI assay is 12 to 82 µg/L, with values of 8 µg/L or lower being diagnostic for EPI. The fTLI assay quantifies the amount of trypsin
and related compounds in the bloodstream. This includes trypsinogen, which is the inactive zymogen of trypsin. In healthy cats significant amounts of trypsin do not circulate in the bloodstream, whereas trypsinogen is expected to be found in significant amounts.
This test involves obtaining a serum sample after fasting the animal for 12 to 18 hours. Serum TLI has been validated for use in both dogs and cats (cTLI and fTLI). Most cats develop EPI as a result of chronic pancreatitis. The fTLI may actually be high initially (in association with pancreatitis), and then over time it will gradually decrease until it reaches a diagnostic range for EPI. It should be noted that occasionally a cat with signs very consistent with EPI will not have a fTLI result in the diagnostic range. Usually the fTLI will be in the low end of the reference range for normal in these patients. Eventually these cats will reach a point where the fTLI is in the diagnostic range. The main point is that, if there are signs consistent with EPI and treatment for any other conditions that have been diagnosed (e.g., IBD, hypocobalaminemia) are not resolving the clinical signs, treatment for EPI with digestive enzymes should also be instituted. A positive response to therapy will help confirm the presence of EPI. The serum fTLI may also be noted to be in the diagnostic range when it is rechecked one to several months after the initial “gray zone” result.
TREATMENT OF CATS WITH EPI
Therapy for EPI involves dietary supplementation of pancreatic enzymes. Any concurrent disorders that have been identified must also be addressed. Supplementation with cobalamin is added if levels are low, as is the case with many EPI cats. Specific dietary therapy is not required (e.g., fat restriction to any degree).
Most cats are treated with a commercial preparation of dried pancreatic extract of bovine or porcine origin (e.g., Viokase, Pancrezyme, Epizyme). A powdered preparation is more effective than tablets or capsules and is the only form recommended. Enteric products should be avoided. The starting dose is ½ to 1 teaspoon mixed with each meal. Cats do not like the taste and do not accept enzyme replacement powder in their food as well as dogs and so it is best to thoroughly mix the powder in canned food in order to more effectively mask its presence. If this does not work, try mixing the powder in some fish oil and stirring it into the food. The enzymes can also be packed into gelatin capsules. If these steps fail, raw pancreas can be used. Raw beef, pork, or game pancreas can be obtained from butcher shops. Raw pancreas obtained in bulk is chopped and portioned into individual meal dose sizes and kept frozen until ready to use. Fresh-frozen raw pancreas can be kept frozen for several months without losing efficacy. The dose is 30 to 60 grams of raw chopped pancreas per meal. There is no need to pre-incubate enzymes in the food for any period of time before feeding, or to add gastric acid reducing drugs.
Most cats respond rapidly to enzyme replacement therapy and stools should be normal by 3 to 4 days after the start of therapy, if EPI is the only disorder. If there is a limited response to therapy, other problems may be present and must be treated (e.g., as previously discussed other disorders could include diabetes mellitus, IBD, villous atrophy, hyperthyroidism, hypocobalaminemia). Pure cobalamin is administered subcutaneously at a starting dose of 150 to 250 µg per cat based on body size. Injections are given once weekly for 6 weeks, followed by an injection every other week for 6 weeks, and then one more dose a month later. The serum cobalamin level should be rechecked one month after the last does. Some cats with EPI may require lifelong therapy.
Once clinical signs have been well under control, the amount of enzyme supplementation that is provided with each meal can be gradually reduced to the lowest effective dose, which may vary from patient to patient and also between different batches of the pancreatic supplement.
There are no studies detailing the effect of various types of diets on feline patients with EPI. In general, most cats do well on a commercial maintenance type diet. Low fat diets should be avoided because of their lower caloric density. High fiber diets should also not be fed because some types of dietary fiber interfere with pancreatic enzyme activity.
PROGNOSIS
EPI is associated with irreversible loss of pancreatic acinar tissue in most cases. Recovery is not expected and lifelong therapy should be anticipated.
However, with careful monitoring and prompt management of any other problems, a normal lifespan can usually be enjoyed."
A *NORMAL LIFE*. Not a 'death sentence'. It is manageable.
It looks to me like it will require some research, for sure, and some balancing of diet because cats with EPI must have some fat in their diet and not a high-fibre diet.
But the powdered pancreatic enzyme - the WENZYME already prescribed (or maybe better and easier to get would be raw pancreas from pork/beef/game at 30-60 grams raw & chopped per meal might be less cost-prohibitive?)) at least is obtainable. Local butcher shops or grocery chains could provide this, and it can be frozen in meal-sized portions.
Google can be very helpful to find explanations and definitions that are clearer to understand than doctors and vets sometimes make things.
Glad you have asked about this here, I had not heard of EPI before now.
. For instance, most of them recommend prescription dry for diabetes.
