Tiny Lily arrived at The Cecchine Hotel for Dogs early in December 2018 from a hoarding/cruelty case. She managed to escape and evade the animal control officer and run stray until she was caught in a cage trap, lured by food. She was a skinny little thing, and the first thing we did was to start removing ticks from her. She was afraid of us, which was to be expected given her situation, but we just knew that with love, patience, and lots of good food, Lily would get her healthy, happily ever after.
On our very first vet visit, Lily weighed just 12lbs. They told us that she needed to be around 18lbs in order to be at a healthy weight and be spayed. No problem. We have had underweight strays before. I had a plan. Lily would get multiple meals per day which would include a high quality kibble, we use Earthborn Holistic Primitive (grain free, high in protein) and Miracle Vet High Calorie Weight Gainer for Dogs (150 calories per ounce, mainly from fish oil).
I made a healthier version of the popular “Satin Balls” weight gain recipe which mixes 1 lb of cooked ground meat, a dozen scrambled eggs, 1C ground flaxseed, 1C cooked oatmeal, 1 8oz package of cream cheese, 1 C of peanut butter, and 1T molasses. Combine everything and make small balls (the size depends on the size of dog you are working with). Freeze the balls on a cookie sheet and store in airtight containers. They can be thawed as needed, and fed to your dog no more than 3 times daily.
We used this same plan with our previous foster Mya, who was a very picky eater and also arrived underweight at 12lbs. In no time Mya achieved a healthy weight and was adopted. Read part of Mya’s story here.
Lily, it turned out, has different needs then Mya. We treated them the same, but, unlike Mya, Lily gained and then quickly LOST most of her weight gain. She seemed healthy and active. She had been treated for intestinal parasites and aside from a few occasions of vomiting in her crate overnight, she appeared healthy, but thin. We kept up feeding her, and feeding her, with little result. Lily was always hungry, ate everything we gave her, and wanted more. We had been feeding her more than our 50lbs Labrador Retriever each day for over a month, and she wasn’t gaining and holding onto enough weight. We knew that something was wrong. We just didn’t know what. Our veterinarian did basic blood tests, they were fine. They did a sonogram; it was fine. They did a Barium Study; it was fine. We even tested Lily for cancer, and she’s fine. The problem is, Lily is not digesting her food and absorbing nutrients properly. She’s not fine. She didn’t present with chronic diarrhea and vomiting, so it was hard to diagnose Exocrine Pancreatic Insufficiency (EPI).
So, what is EPI?
Exocrine Pancreatic Insufficiency (EPI) is a malabsorption/maldigestion condition. With EPI, the pancreas is unable to produce and secrete the necessary digestive enzymes to break down fats, carbohydrates and proteins in food. Although EPI was once thought to be a German Shepherd condition, it is found in all breeds. EPI is also sometimes called Pancreatic Hypoplasia or Pancreatic Acinar Atrophy (PAA). EPI can be a secondary condition of chronic illness, such as pancreatitis.
Common Symptoms of EPI
+Unexplained weight loss +Gradual wasting away despite voracious appetite
+Stools that are greasy, yellowish or grayish and soft
+coprophagia (eating their own stools) or eating other inappropriate substances
A dog with EPI, although eating large amounts of food, is constantly hungry and yet becoming malnourished. Lily is a champion eater, yet we felt like Lily was wasting away in front of us. She would eat a big meal and then run to the counter where it was prepared and jump up looking for more. We knew she was eating enough, but she remained thin. EPI can be a devastating disease. Without proper treatment, organs, the immune system, and the nervous system may become compromised. An untreated EPI dog can suffer and perish from malnourishment, starvation and organ failure.
What I’ve found in my research, is that EPI is also a frustrating disease that is often misdiagnosed. I can tell you that we considered everything under the sun, including giardia, coccidiosis, and tick-borne diseases, before we got to EPI. Some dogs will not show any symptoms, while some have intermittent watery diarrhea and/or vomiting. The only symptoms that we saw were weight loss, a huge appetite and copious, yellowish stools.
EPI symptoms may not appear at all until triggered by a stressful situation. Poor Lily was in a stressful hoarding environment and then running stray, and then caught and taken to a stressful shelter before joining us as a foster. That’s a lot to deal with.
Successfully managing EPI is all about finding the right balance of healthy diet and supplemental pancreatic enzymes. We are feeding Lily a mixture of fresh food and kibble. We feed her 3 meals a day and we are feeding her about 150% what she normally would require, until she gets to her target 18lbs. I am happy to report that she is at 17.6 lbs for the last 48hrs and doing really well. She is now having more normal looking, chocolate brown, well-formed stools.
Pancreatic Enzyme supplementation is the most important step in managing EPI. Lily will need pancreatic enzymes on every piece of food ingested for the remainder of her life. Enzymes must be incubated, meaning that you add them to moistened food prior to feeding, letting them sit on the food at room temperature for at least 20 minutes, or for up to an hour or more. **Lily is using prescription PancrePlus Powder for Dogs. Bio Case V is a non-prescription generic equivalent.
Some EPI dogs have a secondary condition called SID (small intestinal dysbiosis), which is an imbalance in the gut flora, requiring prebiotics & probiotics, and/ or antibiotics. Lily was on antibiotics and is now getting small amounts of Slippery Elm, a natural powder with beneficial prebiotic properties. She also loves a dollop of plain yogurt in her bowl.
Many EPI dogs cannot replenish B12 levels on their own(Cobalamin Deficiency). We are giving Lily powdered B12 with her breakfast. Some dogs receive B12 injections.
All of this is definitely not as easy as just scooping kibble into a bowl, but it really doesn’t take much effort, and the outcome has been amazing. Lily is looking so much healthier and she is more active and playful than ever. She is going to get her happily ever after!
For more info on EPI: