EPI in Cats

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Carol's Soleil

"Soleil" the love of my life ..... was only five years old when she was diagnosed. 

Soleil started developing symptoms a little over a year ago with occasional vomiting and gagging.  They were treating her for hairballs.  They gave her a medication to increase her intestinal motility and it nearly killed her.  Following that, she received her yearly immunizations and she became very ill with fevers, lethargy, etc.  This had never happened before.  As an aside, I have decided not to give her immunizations anymore.  She is an inside cat and the last time was too scary.

Shortly after that, she started eating me out of house and home but  continued to lose weight.  She got down to 6 lbs. 2 oz. (her six month kitten weight).  She was so skinny . . .  fur and bones.    It made me cry just to look at her.  She would keep me up all night crying.  I would get up and pet her and try to console her, but I did not know what to do.  It was horrible!  Her bowel movements were very large and yellow in color.  Finally, my local vet sent me to a specialist.  They did an ultrasound which revealed thickened bowel and they told me they were pretty sure she had lymphoma.  I was devasted!   They did an endoscopy and biopsy of the affected area.  I was happy five days later to get a call telling me she did not have lymphoma but she had inflammatory bowel disease.  A few days later they called to tell me her lab results from blood tests were back and she had exocrine pancreatic insufficiency.  Wow!    They told me it was extremely rare in cats and they put her on 2.5 mg. of Prednisone every day for the inflammatory bowel disease and told me to mix Viokase with her food and she started a regimen of B12 injections.  That all seemed fine except Soleil would NOT eat any food with the enzymes in it.  For two months I syringe fed her with chicken baby food after adding Viokase and waiting 20 minutes.  It was horrible but it was the only way I could get the enzymes in her.  She started to gain some weight back which was good but she and I both hated the syringe feeding.  She would run and hide from me when I got home and although I got pretty good at it she would still freak out because they occasionally get choked by that method of feeding no matter how hard you tried not too.  She would fight me like crazy and I would stop and cry.  It was terrible!   

My next attempt at getting her the enzymes was to talk to a slaughter house in Lake Geneva, WI.  They would sell me raw bovine pancreas.  I cut it up and put it in a food processor and froze it in ice cube trays.   My vet said I could mix this in her food and if she ate it, this would give her the enzymes she needed.  My kitchen looked like a slaughter house by the time I was done with this process.  Raw pancreas is good for three months if you freeze it.   I tried feeding it to Soleil one evening and she threw up so bad I thought she was going to die.  I think she just over ate because she was so hungry, but after several attempts at feeding her raw pancreas I found that she did not like that either and I went back to the dreaded syringe feeding.

Shortly after that my local vet told me about Flavorx.  It is a company that sells materials to compound the Viokase to taste like chicken pot pie (or any flavor you want).  My vet would compound the enzymes which I would syringe drizzle over her food mix it up and she ate it!   I was so happy!   No more syringe feeding!    I asked my vet if I could do this myself at home.  I wanted to have control over all of it.  My vet wrote  a letter to the company "Flavorx" giving me the ability to order all the compounding products directly from them and he then showed me how to compound the enzymes and I am able to do this at home now.  

During all this, Soleil was receiving weekly, then bi-weekly B12 shots.  These were SO important for her.  Even after a long B12 therapy she was still low when tested.   A few months ago she was tested again and her levels are normal but they recommend monthly B12 shots and then she gets rechecked in February.  I will always continue to monitor this for her even though I hate when she gets the blood test because she has to fast for 12 hours prior.  Nothing worse than withholding food from an EPI animal.   I don't get much sleep.  LOL!   It is worth it though. 

At some point during all this craziness I talked to a holistic vet (a friend of someone else I met on line with a dog with EPI).   He suggested FortaFlora probiotics sprinkled on her food.  This was to help with the inflammatory bowel disease and digestion.   This seemed to help Soleil a lot and they smell like beef boullion and she seems to like the taste so I use about half packet of that on each of her two feedings daily.   I mix it with the food after I mix the compounded enzymes with the food. 

I did receive another tip for feeding cats enzymes from her specialist.  It did not work for Soleil but it might work for someone else.  You buy fish oil tablets and mix the liquid from the tablet with the Viokase (making a paste).  Some cats like this and will lap it up getting them their enzymes, but miss finicky did not care for it at all, but a good suggestion if it works, I guess.   It is a cheap way to compound the enzymes yourself if it works. 

Also during my research I found a product called "Cat Man Do" sprinkles.  These are dried bonitos fish flakes.  You sprinkle them over the food.  I sent some of these to my friend Melissa, mentioned above, and she said her cat loves them.  I bought some but never tried them with Soleil because I finally got the compounding flavored enzymes working well.  I would think these may help disguise the taste of the enzymes if the cat likes them.   You can order them on line.

Soleil is now on Prednisone, 2.5 mg. five days a week.  She needs this for her inflammatory bowel disease and it seems to keep her under great control.  I hate having to give her this, but when I cut back further she starts gagging again. 

I also purchased a pediatric scale for Soleil because it is hard to tell when a cat is gaining or losing weight and waiting between vet appointments to have her weighed was too stressful.  The scale cost about $70.00 and it was worth every penny.  I ordered it on line.   I can see immediately if there is any problem going on if she starts losing weight.  It weighs in ounces and pounds.

One other great item for those working cat mommies (such as myself) is the timed feeder from Petsmart.  My friend Melissa told me about this and it works great if you are going to be away from home for more than ten hours or so.  It has a slot under the trays that you can place an ice pack keeping the food and enzymes fresh.  As you know, you can't leave the enzymes out all day.   You set the timer and the door opens at the specified time.   Voila!  Dinner is served!   I rarely use this, but it has come in handy on a few occasions. 

I have the additional complication of having two cats.   Soleil's BIG sister weighs 13 1/2 lbs. They were not really litter mates, but I call them sisters anyway.   I have the challenge of getting Luna to lose weight and Soleil to gain weight.  The only good thing about Luna's additional weight is that she can no longer jump up on the counter tops.  This is where I have to feed Soleil so that Luna cannot get to her food.   Luna has to eat before I leave now because I cannot leave un-enzymed food down during the day or Soleil will eat that first.   

Soleil weighed in last night at 7 lbs. 6 oz.   This is a really good weight for her.  When she was two years old she weighed 7 lbs. 8 oz.  She has always been a small cat and was the runt of the litter when I adopted her.  She is a polydactyl kitty.  She has seven claws on her front paws and six claws on each back paw.  She has big mitten feet but they are so cute!  

Currently I am feeding Soleil Fancy Feast Chicken with some spinach in a broth (green can).  This is the food I mix the enzymes and probiotics in.  Then I top it off with Blue Buffalo dry food (Gluten free/grain free) chicken Freedom.  She loves that and seems to digest it very well.   I give her the Blue Buffalo for treats occasionally too, just not a lot without being in the enzymes.

If anyone goes the compounding route with the vet syrups and flavorings, they must NOT use the conventional syrup to compound the enzymes if their cat has diabetes.  Diabetes is somewhat common in cats with EPI.  I don't know about dogs.  However, there is another solution.  I believe it is called Versa Free (it contains no sugar).  This is what I believe you would use for a diabetic cat. Basically, if someone has a diabetic EPI cat they should definitely consult with their vet first.  I'm sure they would anyway, but just wanted to add this bit of info. 

Timothy's EPI story

Timothy's EPI story began in the fall of 2011, when he abruptly began acting very sick.  My five year old Siamese mix, who had always been very playful and a great eater, suddenly refused his food and became extremely lethargic.  He had severe diarrhea and some vomiting, and waddled around the house as if it was very painful to move.  After a couple of vet visits and an ultrasound, he was diagnosed with acute pancreatitis and I took him home with subcutaneous fluids and injectable medications to support him as he recovered.  I had worked at a veterinary hospital for seven years back before I left to start a business of my own, so I was able to do all the necessary treatments without hospitalizing him, which was great as it was less stressful for him and less expensive for me.  Thankfully he pulled through the severe episode of pancreatitis, and a couple of less severe recurrences thereafter.
Even though he had survived the pancreatitis, Tim didn't really return to normal.
His stools remained soft, were a clay-like grey color rather than brown, and smelled truly horrible.  The stench was so intense that if he passed a stool at night, the smell would wake me up even though the litter box was located on another floor at the opposite end of the house from my bedroom!
Around February, I noticed that Timothy was behaving oddly.  He had always been extremely interested in food, but that interest began to morph into an absolute obsession with anything even remotely edible.  Nothing was safe in our house.  He would open the pantry and eat uncooked pasta and whole wheat bread.  He raided our fruit bowl for peaches and avocados. He also began to lose weight rapidly.  His pre-pancreatitis weight had been about eight pounds.  Between February and April, he went from seven pounds to just barely over five pounds.  As Tim's sixth birthday rolled around, I began seriously doubting that he would survive to see seven.
At some point, as I stood in the vet's office at yet another visit talking about awful things that it could be, one of us said, "Do cats get EPI?"  I can't remember which of us brought up the subject.  I had seen cases of EPI over the years in dogs, and so had the vet.  Neither of us had seen it in a cat, but the symptoms that Tim was exhibiting were uncannily familiar.  She left the room, and came back a few minutes later practically beaming as she declared that we would start him on enzymes right away.  I was so relieved to finally have something concrete to pursue, even if it was a condition that would require lifelong management.  I knew that EPI could be frustrating and expensive, but I also knew that it was treatable!
Tim's EPI is currently being managed with one teaspoon of EPI-Pro 6x enzyme powder mixed into each of his meals.  I had him on a probiotic for a while as well, but it didn’t seem to make much of a difference and he wasn’t especially pleased with his food when the probiotic was present, so we eventually discontinued it.
Finding a food that works for Tim has been a bit of a struggle.  He isn’t a fussy eater by any means, but it seemed as though I just could not get his diarrhea under control as long as he was on a normal canned diet, even if the canned diet was a very respectable brand like Innova EVO, Weruva, or Wellness.  For the last few months, I have been feeding The Honest Kitchen’s dehydrated “Prowl” diet, and that seems to be working very well.  He gets ¼ cup of the dehydrated food mixed with ½  cup of water and his enzymes twice per day.  The food looks kind of like a soup when made with that much water.  After mixing things up, I let everything sit for five minutes before feeding Tim.  So far, his stools have been pretty consistently firm on this diet plan.  It may be that the enzymes end up better mixed in his food now than they were previously, or that one of the ingredients in canned diets was not working well for Tim.  Whatever the cause of the improvement may be, I am glad for it.

I give him weekly subcutaneous injections of 250mcg of vitamin B12.  I noticed dramatic improvements in his energy level after beginning the B12 injections, and his stools seem to be approaching closer to normal as well.  The hope is that we may be able to reduce the frequency of the injections in the future, but we aren't to that point yet; every few months, I will try to space the injections out a little bit further, but doing so has so far resulted in a return to loose stools.  Tim is generally pretty good about his injections and allows me to give them without putting up much of a fight, though I do occasionally have to fall back on the "kitty burrito" method of wrapping the cat in a towel while giving the injection.  He loves his food, so if I give him the injection while he is eating, he often does not notice that I have done anything!

Since beginning treatment for EPI, Tim's weight has increased from five pounds to over eleven pounds. I have twice the cat I had before!  He is no longer constantly foraging for food around our house; he naps and plays like a normal cat.  His stools have returned to a normal color and no longer smell as foul, and are only rarely soft at all.
Timothy's doing great.  After coming so close to losing him over the last year, I almost feel like the EPI diagnosis was a blessing.  He's living with it-- living WELL with it!-- and I have my cat back

I'm happy to talk to anyone who may need support or advice about working with their EPI cat. 
My email is [email protected].

The following EPI in Cats information is taken in it's entirety from the Mercola Pets website written by Dr. Karen Becker:

Exocrine Pancreatic Insufficiency: Can Cause Your Kitty to Starve to Death - Even While Eating PlentyMay 15, 2013 

By Dr. Becker    

Story at-a-glance

  • Exocrine pancreatic insufficiency (EPI) is thought to be rare in cats. But new research indicates that vets might need to take a closer look for evidence of the disorder in kitties with recurrent diarrhea and chronic weight loss.
  • The pancreas is involved not only with insulin production, but also with the production of digestive enzymes. Many people who understand the connection between the pancreas and diabetes are unaware this important organ can also play a role in digestive disease.
  • Exocrine pancreatic insufficiency means there is a decrease or lack of digestive enzymes being produced by the pancreas. As a result, proteins, starches and fats from the diet can’t get into the bloodstream to supply nourishment to the body’s tissues.
  • In the largest research study to date on feline EPI, it was revealed the disease may be more prevalent in cats than previously thought. Symptoms in cats vary significantly from those seen in dogs with the disease. For example, diarrhea isn’t consistently present in cats, nor is it as severe as it is in dogs. Also, about half the cats in the survey had a decrease rather than an increase in appetite.
  • In kitties with unexplained chronic weight loss with or without diarrhea, including diabetic cats, it may make sense to run fTLI, cobalamin and folate tests before considering more invasive, costly diagnostic procedures.

Exocrine pancreatic insufficiency (EPI), also called pancreatic insufficiency and maldigestion syndrome, is thought to be rare in cats. However, according to dvm360, new research suggests veterinarians should look more closely at EPI as a potential cause of diarrhea and chronic weight loss in kitties.

Exocrine Pancreatic Insufficiency

The pancreas has many functions. It produces not only insulin, but also various enzymes that provide for the digestion of food. Many people are aware the pancreas plays a role in insulin production and diabetes; relatively few people realize the role the pancreas can play in digestive diseases.

Pancreatic enzymes include amylase, which breaks down starches; lipase, which breaks down fats; and trypsin and chymotrypsin, which break down proteins.

The actions of these enzymes are crucial to the digestive process. They allow nutrients from the diet to be absorbed by the cells of the intestine, where they pass into the bloodstream and are transported throughout the body for use by tissues. When a cat eats, the pancreas gets a signal to release digestive enzymes, which travel into the small intestine via the pancreatic duct (“exocrine” glands secrete their products into ducts, whereas “endocrine” glands secrete their products directly into the bloodstream).

Once they reach the center of the intestine, the enzymes go to work breaking down food particles.

Exocrine pancreatic insufficiency means there is a decrease or lack of digestive enzymes being produced by the pancreas. In kitties with the disorder, proteins, starches and fats from the diet aren’t broken down sufficiently to be absorbed through the intestinal wall. This means nutrients can’t get into the bloodstream to supply nourishment to the body’s tissues. Much of the food that is eaten remains undigested in the GI tract and ultimately leaves the body in feces. If left untreated, a cat with EPI can literally starve to death despite how much food is consumed.

Causes, Symptoms and Diagnosis of EPI 

Pancreatic insufficiency can have several potential causes, but the most common source in cats is chronic inflammation of the pancreas. Other causes are parasitic infestations, as well as cancer.

Signs a kitty may be dealing with EPI include weight loss; constant hunger; lots of watery, loose or semi-loose stools that may have a foul odor and contain large quantities of undigested fat; and poor coat condition. Cats with this disorder look and behave as though they are starving to death … because they are.

Occasionally, cats with EPI are also diabetic.

A test called the feline trypsin-like immunoreactivity (fTLI) assay is considered diagnostic for EPI. Prior to the availability of the fTLI, diagnosis was trickier and involved taking a symptom history and running repeated fecal digestion tests.

Results of Largest Feline EPI Study to Date 

In 2010, the GI Laboratory at Texas A&M University received 775 samples from veterinarians of fTLI assay results that were consistent with a diagnosis of feline EPI.

Then in 2011, researchers from the GI Laboratory and Department of Clinical Sciences at Texas A&M conducted an EPI survey of veterinarians who submitted samples. One hundred-fifty surveys were returned. The average age of affected cats with the condition was eight years. Males represented 59 percent of the samples; females, 41 percent.

Average body condition of the kitties was poor. Of the cats for which cobalamin (vitamin B12) levels were measured, 77 percent were deficient and many had no detectable levels of B12 at all. For those that had folate concentrations tested, 47 percent showed an increase.

As for symptoms, in 91 percent of the cats, weight loss was the primary symptom. Weight loss varied from 1.4 ounces to 15 pounds, with an average of 3 pounds. Loose stools were seen in 62 percent of affected cats; poor haircoat in 50 percent; loss of appetite in 45 percent and increased appetite in 42 percent; and depression was present in 40 percent of the kitties. Almost 60 percent of the cats had coexisting diseases including inflammatory bowel disease (IBD), diabetes,pancreatitis and hepatic lipidosis.

Of the kitties with EPI, 68 percent were given pancreatic enzyme supplementation. Of those, 66 percent showed a good response, 24 percent had a partial response, and 10 percent had a poor response to the treatment.

What These Results Mean for Cat Owners and Vets  

According to dvm360, the results of the survey are evidence that exocrine pancreatic insufficiency is not as uncommon in cats as previously thought. However, symptoms in cats vary noticeably from canine symptoms. In cases of feline EPI, diarrhea isn’t a consistent finding and isn’t as severe as it is in dogs dealing with the disease. Also in cats, excessive hunger is not consistently present, and in fact about half the cats in the survey showed a decrease in appetite.

Treatment with pancreatic enzyme supplementation appears to be successful in a large percentage of kitties with EPI. If there are also low cobalamin levels, subcutaneous (under the skin) supplementation for several weeks is often required to help resolve gastrointestinal symptoms.

Also, EPI can be associated with small intestinal dysbiosis (also called small intestinal bacterial overgrowth, or SIBO), especially when low B12 and high folate levels are present.

Cat owners and especially veterinarians should consider fTLI, cobalamin and folate tests for kitties with unexplained weight loss or chronic diarrhea, regardless of the pet’s age. These tests could conceivably eliminate the need for more expensive and invasive diagnostic procedures.

EPI should also be viewed as a possible concurrent condition in diabetic cats whose blood sugar levels are well controlled but who have weight loss and/or diarrhea.

In accordance with Mercola's copywrite permission, the following must be included when copying the article:   
This article was brought to you by Dr. Mercola.For more helpful articles, please visit Mercola.com http://www.mercola.com/Today!

The following is an excellent in-depth article recently written by Dr. Jorg Steiner of Texas A&M Gastrointestinal Lab. Because of copywrite laws, we are not able to re-print the article on this website... however... it is available for purchase: 
" Steiner JM: Exocrine pancreatic insufficiency in the cat. Top Companion Anim Med; 2012 Aug;27(3):113-6 "
  • The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • Exocrine pancreatic insufficiency in the cat.
  • Exocrine pancreatic insufficiency (EPI) is a syndrome caused by an insufficient amount of pancreatic digestive enzymes in the small intestine.
  • Clinical signs most commonly reported in cats with EPI are weight loss, loose and voluminous stools, steatorrhea, polyphagia, and in some cases a greasy soiling of the hair coat in the perianal region.
  • Serum feline trypsin-like immunoreactivity concentration is the diagnostic test of choice for the diagnosis of affected cats.
  • Treatment of cats with EPI consists of enzyme supplementation with either a powdered pancreatic extract or raw pancreas.
  • Most cats with EPI also have severely decreased serum cobalamin concentrations and may require lifelong parenteral cobalamin supplementation.
  • Most cats respond well to therapy and can have a normal life expectancy and quality of life.
  • -------------------------------------------------
    To test for EPI  have your vet contact Texas A&M Gastrointestinal Laboratory: http://vetmed.tamu.edu/gilab/service/assays/tli
    To test for Pancreatitis have your vet contact Texas A&M Gastrointestinal Laboratory: http://vetmed.tamu.edu/gilab/service/assays/pli



    Some interesting reading material

    1. Seizures in the Cat ...a study done by  Sarah A Moore at the Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH,  file:///C:/Users/Olesia/Desktop/seizures-and-epilepsy-in-cats_7-30-14.pdf 

    Article taken fin it's entirety from DovePress: http://www.dovepress.com/articles.php?article_id=17776#)  


    When I will find interesting medical research cat articles i will post here.