Cheetah's Canine EPI Exocrine Pancreatic Insufficiency FAQs

What are the effects of EPI?
EPI is potentially life-threatening, without treatment your dog may die. Since dogs with EPI are unable to digest their food without treatment they will starve to death but don't worry it is treatable providing you act quickly.

What are the symptoms of EPI?
Chronic yellowish diarrhoea and vomiting. Flatulence. Rapid weight loss. Dog eating large amounts of food yet remaining ravenously hungry. Dog quiet and depressed due to being in pain. Coat loses its lustre.

How can I tell if my dog has EPI?
If your dog is exhibiting the symptoms described above and you believe the cause may be EPI ask your vet to give your dog a TLI test.

What is a TLI test?
The serum Trypsin-Like Immunoreactivity (TLI) test is performed by a laboratory on a blood sample taken by your vet. A TLI level of 2.6 (micrograms per litre) or lower is indicative of TLI. Cheetah’s TLI level is 0.5 (very very low). The TLI level range for a healthy dog is 5.0 - 100 micrograms per litre.

Is the TLI test reliable?
Yes, it's not infallible but it's the best test there is.

How can canine EPI be treated?
Since a dog with EPI is unable to produce sufficient digestive enzymes by itself it is necessary to introduce additional digestive enzymes into its food.

Are there commercially available products containing digestive enzymes which can be put into my dog's food?
Yes, there are veterinary products on the market like Viokase and Pancrease which contain enzyme replacements in tablet or powder form and which can be obtained from your vet. Powders are more effective than tablets because they are easier to mix into the food but both powders and tablets can be prohibitively expensive, especially for large dogs. Treating Cheetah with enzyme powders would have cost us about £10 ($16) per day.

Is it possible to treat canine EPI with human pancreatic enzyme replacements?
Yes. Several people have written to us saying that they are using human pancreatic enzyme replacements such as Lipram and Panzytrat on their dogs and that this treatment is effective and about half the price of the veterinary brands. We understand that human pancreatic enzyme replacements may also be tax deductible in the US.

Are the manufactured enzymes the only treatment for canine EPI?
No. Pig pancreas added to your dog's diet works very well.

Does pig pancreas really control canine EPI?
Yes. It completely controls Cheetah's EPI and we have received many emails from dog owners saying that they have also found it to be an effective solution for their dog's EPI.

Why didn't my vet mention pancreas as being a possible treatment for EPI?
Vets are human and can't know everything. Using pancreas to treat EPI is not as well-known as it should be.

Where can I obtain pig pancreas?
We receive more emails asking this question than any other and this is particularly true of Cheetah's American friends for whom obtaining pancreas seems to be especially difficult perhaps due to US federal laws. If you are American and if you know where to obtain pancreas in your country would you please email us with that information - we will then include it in future updates of this website. As a first goal we would like to be able to name at least one reliable supplier of pancreas for every state in the US.

In England, where we live, pancreas is obtained primarily from government licensed slaughterhouses a list of which is obtainable from the Veterinary Public Health Operations Division of the Food Standards Agency but of course this list only applies to the United Kingdom. I do not know where to obtain equivalent lists for the United States (you could try the United States Department of Agriculture), Canada, Australia, New Zealand, South Africa or other territories. You may also be able to obtain pancreas through your butcher. One dog owner obtains it from a Chinese grocery store!

Does it have to be pig pancreas?
No. Some of my friends say that beef pancreas works just as well but that beef pancreas is harder to liquidise than pig pancreas (see the question on preparing the pancreas below.) We have no direct experience of treating EPI with beef pancreas and we like to hear from those who have.

How much does pig pancreas cost?
We pay about £1.25 (roughly $2) per kilo. This works out at about £10 ($16) per month.

How long can pancreas be kept when frozen?
We have used pancreas which has been frozen for over 18 months and it has been completely effective.

Can the pancreas be cooked and still remain effective?
No, we understand that cooking destroys the enzymes.

Can pancreas be defrosted in a microwave?
We don't know as we've not tried. When we need to thaw some pancreas quickly we seal it in a plastic bag and immerse the bag in warm water. This thaws the pancreas quickly and it remains effective.

What does pig pancreas look like?
When frozen it is pale pink and is odourless, when thawed it resembles pale raw liver and has a peculiar pungent odour.

When I buy pancreas it’s frozen into a large solid block. How can I break it up?
Drop the block onto a concrete floor a number of times. This cracks the block so that large chunks can be pulled off. Then put one or two of the large chunks into a couple of bin liners and pound them with a lump hammer to shatter them into smaller pieces.

How should the pancreas be prepared?
Every evening weigh out the appropriate amount of frozen pancreas for the following day and leave it to thaw overnight. In the morning thoroughly liquidise the thawed pancreas in an old blender to about the consistency of a milk shake.

How should I give the pancreas to my dog?
Thoroughly mix the liquidised pancreas into each of your dog's meals.

Is it really that important to ensure that the pancreas is thoroughly liquidised and thoroughly mixed into every meal?
Yes, it is absolutely essential. The idea is to get the enzymes in the pancreas into the closest possible contact with the food.

I think I may have been sold something other than pancreas. Is there any way I can test it to see if it's pancreas?
Yes. Normally when you liquidise the pancreas and thoroughly mix it into your dog's food you will immediately feed it to your dog but to see whether the pancreas is doing its job thoroughly mix it into your dog's food, leave it in a bowl for a few hours and you should see a chemical reaction taking place. If the digestive enzymes from the pancreas are working you will see your dog's food become darker and runnier as the enzymes break it down. This is a clear indication that the pancreas is working.

How much pancreas should I give my dog?
Each dog has different requirements depending on its bodyweight and the severity of its EPI.

How much pancreas does Cheetah need per day?
Cheetah has about 250 grams of pancreas per day. When liquidised this is about 7 fluid ounces or roughly equivalent to one cupful. Cheetah eats about 1100 grams of food per day so the ratio of pancreas to food she has is 250 to 1100 or roughly 1 to 4.5.

Can I feed my dog his normal food providing I mix pancreas into it?
Not necessarily - it depends on what food you normally feed your dog and the severity of your dog's EPI. It is essential that you eliminate all unnecessary fat from your dog's diet.

What sort of meal should I add the pancreas to?
The most important thing is that it must be low fat. Ideally it should be canned food - dried foods are not as good as the enzymes in the pancreas do not easily penetrate into the centre of the pellets. It is very difficult to digest fat so it is essential to eliminate fat from your dog's diet as far as possible.

What dogfood does Cheetah eat?
Before EPI was diagnosed Cheetah was fed on Waltham Canine Selected Protein which is an expensive prescription-only canned food so after she was diagnosed we continued feeding her Canine Selected Protein while we got the condition completely under control. Then, over a period of several months, we gradually replaced the Canine Selected Protein in her diet with Chappie Original which is a low fat, vitamin enriched canned dogfood made with fish, chicken and cereal. Cheetah is now fed solely on Chappie Original which is widely available here in the United Kingdom, she has two meals per day and has two thirds of an 825 gram can of Chappie per meal. Chappie is specially formulated to be highly digestible and it's competitively priced.

What are the constituents of Chappie?
Chappie, which is marketed by Waltham consists of protein 5.5%, oil 2.0%, ash 1.5%, fibre 0.4%, moisture 77.0%, copper 2mg/kg as copper sulphate, vitamin A 500 iu/kg, vitamin D 150 iu/kg, vitamin E 10mg/kg.

What are the constituents of Waltham Canine Veterinary Diet Sensitivity Control?
Canine Veterinary Diet Sensitivity Control (formerly known as Canine Selected Protein Chicken and Rice) which is marketed by Waltham consists of: protein 9.20%, oil 8.00%, ash 2.4%, fibre 0.9% and moisture 71.2%.

Can I feed my dog occasional little treats?
You will have to determine this by experiment. First get the EPI under control then, when you are certain that it is completely under control you can experiment by giving your dog a small biscuit noting whether there is an adverse reaction the next day.

Do you give Cheetah little treats?
Occasionally yes, but we are careful not to overdo it.

What sort of treats does Cheetah have?
Every evening Cheetah has one or two very small 'rocks' of frozen pancreas. She also gets an occasional biscuit.

How do you feed Cheetah when you are going away?
A few days before we leave we thaw an appropriate amount of pancreas, liquidise it, then thoroughly mix it into the appropriate amount of food. We then bag this up in freezer bags, one meal per bag, which we refreeze.

My dog smells of pancreas - how can I prevent this?
Cheetah suffered from this problem initially but when her condition stabilised we gradually reduced the amount of pancreas and the smell disappeared. So when you've got the symptoms under control try gradually reducing the amount of pancreas in your dog’s diet.

My dog doesn't like pancreas and he won't eat his food when it has pancreas in it. What do I do?
We don’t know. We welcome suggestions from dog owners who have met and overcome this problem.

Now that Cheetah is on her pancreas-supplemented diet does she ever have 'accidents'?
No, never. The pancreas supplement has completely eliminated the problem.

I'm supplementing my dog's diet with pancreas or commercially produced enzymes but my dog is still upset. What should I do?
Consult your vet. Cheetah suffered from this problem due to bacterial overgrowth in the gut. If your dog also has this problem, a course of broad spectrum antibiotics should solve it, as it did for Cheetah.

Apart from enzyme replacement is any other treatment required?
Sometimes it is necessary for your dog to have a B12 vitamin supplement, you will need to consult your vet about this. Cheetah has never needed this however.

I have heard that canine EPI can be treated herbally - is this correct?
We don't know but we're sceptical. We would like to hear the experiences, whether positive or negative, of dog owners who have treated, or tried to treat, their dog's EPI, herbally. If herbal treatment can be effective then it should be publicised but if not then this too should be publicised.

Can there can be spontaneous remission in canine EPI?
We don't know. We understand there is some anecdotal evidence to this effect and some clinicians believe that introducing replacement enzymes into a dog's diet can in rare and presumably less severe, cases 'remind' the dog's pancreas to start producing enzymes again but the evidence for this seems to be sketchy.

Are you a vet?
No. We are dog owners who have practical experience of successfully treating canine EPI with pig pancreas.

Is this web page intended to replace professional veterinary advice?
No, absolutely not. If you think your dog has EPI you should take your dog to your vet and request a TLI test at once. The purpose of this page is to broadcast how canine EPI can be treated very effectively and very inexpensively. We have received many emails from owners who have tried the treatment and found that it works. We have also received a small number of emails from owners saying that they were on the verge of having their dogs put to sleep because they were no longer able to afford the medication costs which can be very considerable. Had we not found this solution Cheetah's medication would have cost us £300 ($480) per month.

Is there a notice board on the Internet where I can talk to other owners whose dogs have this disorder?
Yes, we have set one up here.

I think that I (not my dog) may have human pancreatitis - what should I do?
Consult your doctor immediately.

Now that you've put this FAQ here do you still welcome email requests for more information?
Yes, but we receive many emails so please read this FAQ and the material above very carefully to ensure that your question has not been answered before you email us.

I know something which should be included on this web page - would you like me to email you with it?
Yes please. Our aim is to make this page as accurate and helpful as possible.

The pancreas treatment has worked for my dog - would you like to hear about it?
Yes, we always like to hear how our friends are getting on - especially when accompanied by a photo. Please note that it is not always possible for us to give a substantial reply however. We intend to put photos of some of Cheetah's friends on this website in the future so if you send a photo please let us know whether you'd like us to put it here.

I have followed all the directions here but my dog is still having problems - may I email you?
Yes, of course. We always help if we can. If you do email us please be sure to include your dog's name, breed, age, history, TLI level, diet and method of food preparation.

You can email us at cheetah@ellsbury.com

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