Back again with maybe EPI

[Crista & Ming]

Hello! It’s been a while since my last visit back to FDMB. I was here regularly on the Lantus board with my kitty, Ming. He’s still diabetic and was doing very well. Life got in the way and my ability to update his SS and visit our dear friends here slipped away.

But now I’m back hoping for some guidance once again.

Ming lost over 2 kg in a year and after a b12/folate/TLI test, his b12 levels were low. While his TLI results didn’t out right prove that he has EPI, I’m suspecting he does (he has BMs 3-5 times a day!! They’re always pale and large. Eats like a truck too). It makes sense though: his pancreas is super toast from his chronic pancreatitis and diabetes.

I’d love some guidance on how to manage giving him enzymes, especially in Canada where the options seem very limited.

We thinking of starting him on Viokase but the dose is 1 HUGE tab to 3.5 tabs for every meal. And well… I don’t know how I’m going to manage that if he’s eating multiple times a day.

He’s a pill pocket hater. And while I am able to pill him on my own, sometimes his other caretakers cannot.

I’m considering the powder but I’m 99.9999% sure he’s not going to eat anything with that mixed in.

I’ve done some googling but since it’s a pretty “rare” disease for cats, I’m not having much luck.

I would appreciate anyone’s experiences or knowledge about EPI and administering enzymes. And specifically about products available in Canada. I’m also open to feeding raw pancreas but not sure how to go about that.

 

[Sienne and Gabby (GA)]

This is a vet clinic that has an excellent "Library" and the information is not overly technical. Their post on EPI is good and I suspect will offer some insight into what's available and how to treat Ming.

 

[Renee2602]

Hi there, I thought I'd share our experience with Oscar and his potential (likely) EPI which may help. He was diagnosed several years ago when there was much less availability of products as there are now regarding foods to try.

Firstly, I suggest joining the facebook group 'IBD Kitties' where you can post asking for advice and they have people who have cats with IBD, EPI, pancreatitis.

Oscar had triaditis in 2018 and since then had ongoing issues with constant diarrhoea. He lost weight and we had tried prednisolone but it seemed to make things worse. We ran all the tests and the only thing that came back was a slightly elevated number of healthy natural gut bacteria... so nothing really. We got the EPI test done and he fell within normal limits but was close to being out of range - so I think on the lower side. At this point there were much less options of foods to try, medications, and guidance - we were down to trying raw food and kangaroo etc next. Triaditis and ongoing pancreatitis which Oscar has were quite the rarity back then. Plus, we are in Australia. So with not many options left the vet said to try creon capsules - 1 capsule a day with each main meal (Oscar would usually have two main meals a day and then kibble in between) - so 1 capsule twice daily. And it was amazing, his diarrhoea eventually stopped. He did instead tend to have some hard poos, or poos that got stuck coming out of his bottom, but it was a good trade off and these can be managed with catlax and psyllium husk or others to keep the cat not constipated. So even though he was technically not in the range of EPI on testing, the vets concluded he had EPI from his symptoms plus the fact the creon worked. Other symptoms of EPI included ravenous hunger, diarrhoea mainly and not much vomiting, he also has low b12. However it should be noted that we still kept feeding him a bland diet and never found a wet food that didn't make him unwell. So for the last 6 years he has been fed 1/2 cup plain cooked chicken morning and night, with hills z/d biscuits throughout the day. So while creon stopped the diarrhoea, we also weren't able to transition from this diet. As he is in palliative care now for a brain tumour, we are not looking to experiment further with diet, but it sounds like you may need to consider it.

You will likely need to consider diet change, probiotics, prednisolone or budesonide, nausea medications etc as well if your cat has IBD, pancreatitis, and/or EPI. The diabetes makes things incredibly hard as steroids will likely make the diabetes worse though budesonide may be ok. And of course changing the diet is really tricky with diabetes and pancreatitis. I would highly suggest seeing an internal medicine specialist vet if you have the option in Canada.

As for getting the medication in.... we were so nervous to have to administer medication twice daily for the rest of Oscar's life as he hates being pilled, but thankfully creon is honestly the easiest medication we have ever had to give. It comes as a creon capsule and contains small little granules, these are pancreatic enzymes. We just open the capsule and sprinkle it right on his chicken and doesn't notice a thing at all, never had any problems for 6 years, meanwhile every other pill or powder we try he has an issue with unless its compounded or completely tasteless. Creon comes in capsules of little granules and we call it his 'sprinkles', we don't use a powder. With dosage, when we first started it was so unheard of that there was no dosage information for cats but it has seemed to work ok. And just to be clear, while we get the creon from our vet, I believe it is exactly the same as the ones humans use and get at the pharmacy and here is the link but it is in Australia https://www.chemistwarehouse.com.au...GBm3FFG_iUH4Dsb7mZhoCwJgQAvD_BwE&gclsrc=aw.ds

If you are still really having trouble, you could try putting the powder or whatever form into a flavoured gel capsule that masks the taste - apparently these can be found in chicken flavour on amazon for pets but I couldn't get that available in Australia. And then try to hide the capsule in the food. Just make sure you are still having your kitty monitored regularly by the vet and they know if you start this medication as it shouldn't be used in cats that don't have EPI, apparently there's been reports of bad reflux and burning of the esophagus - Oscar did have increased indigestion but he seemed fine. So just be cautious, but then again Oscar wasn't EPI by test, but was EPI by clinical signs and treatment response.

I really hope this works out for you and feel free to ask me any questions you have. Just keep in mind its a difficult situation going on my end with Oscar in palliative care so if I don't respond for some reason please don't take it to heart.