Canine Exocrine Pancreatic Insufficiency: A Challenging Condition

Introduction

Exocrine pancreatic insufficiency (EPI) is a particularly concerning digestive condition that leads to nutrient deficiencies, weight loss, and death if left untreated (Foster and Smith, 2012). EPI4dogs Foundation defines EPI as “the inability of the pancreas to secrete digestive enzymes: amylase to digest starches, lipases to digest fats, and proteases to digest protein. Without a steady supply of these enzymes to help break down and absorb nutrients, the body starves. When EPI is undiagnosed and left untreated, the entire body is deprived of the nutrients needed for growth, renewal, and maintenance. In time, the body becomes so compromised that the dog either starves to death or dies of organ failure. The Merck Veterinary Manual defines EPI as “a syndrome caused by insufficient synthesis and secretion of digestive enzymes by the exocrine portion of the pancreas”. “Lack of pancreatic digestive enzymes leads to maldigestion and malabsorption” (2011). This condition is certainly nothing to overlook. Many pet owners and veterinarians are unfamiliar with the detrimental condition and the purpose of this case study is to enhance the veterinarian’s and pet owner’s knowledge and awareness of EPI.

Like other canine medical conditions, EPI requires proper diagnosis and management. However, the condition is unique because it also requires a responsible and financially stable dog owner with patience and willingness to learn as much as he or she can about EPI and nutrition. Clinical signs can be misleading, as they are comparable to those of many other conditions. While diagnosis can be simplified when differentials get ruled out, medical bills can add up to an outrageously high expense. Overall management of EPI is best described as nutritionally variable, effective, expensive, and lifelong. The following case report outlines signs, diagnosis, dietary management, and financial aspects of a canine EPI patient. Its purpose is to emphasize requirements of the veterinarian and client in nutritional support for the condition, as well as to highlight the significance of financial requirements. As such, this case can be of interest to a broad readership of veterinary professionals, veterinary science students, and pet owners.

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When the Time Comes

Sally Moseley - St. Matthew's

Creative Corner

A Cripple, a Burst, and a Newborn Love

Sally Moseley, St. Matthew's Veterinary School

Experiences, Winner

     Many of us can probably say that our love of animals began the first time we saw a dog, the first time we held a kitten, the first time we rode a horse.  Some fond, early memory—or group of memories—often represents our journeys to becoming veterinarians.  Also interesting with perhaps an even greater variety are the stories of our love of medicine.

Every time we prepare for interviews, someone knowingly informs us that we cannot just say we want to become veterinarians because we want to help animals.  A medical student cannot say he wants to become a doctor because he wants to help people.  Many vocations are conducive to help people, animals, or even both.  Something about medicine is particularly alluring for all of us to rack up debt while spending years in school.

Benjamin Bunny was the first vehicle that drove my love for medicine.  Prior to first grade, this was the equivalent of showing me a shiny trinket that I could have easily discarded without a thought.  Many such shiny things turned up around this time and in the next couple of years.  And many times I found my shiny thing was merely a paper clip, and it, though useful, was not the exciting thing I once thought it was.  However, in this particular case, instead of discovering a paper clip I discovered a diamond.

Benjamin Bunny died the summer before I entered first grade.

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The Invisible Hook

Sally Moseley, St. Matthew's University

Life as A Vet Student, Honorable Mention

Throughout any given day, between classes, on an isle in the grocery store, walking down to the end of an apartment complex, there are multiple occasions to indulge in apparently meaningless conversations.  Many of us take great advantage of these opportunities to have meaningless conversations for the greater part of our free-time.  This is a wonderful way to discover that meaningless conversations are really only ever seemingly meaningless. 

Sometimes it is the people, sometimes it is the words, and sometimes it is the effect those words have on us even years after they are spoken.  Whatever the reason, when we engage in others, we learn a little bit more about ourselves as human beings. 

Being a vet student, as many of us might have noticed, involves large amounts of time dedicated to academics.  Many times, the aforementioned “free-time” becomes time to get more experience at a clinic, with the ultrasound machine, or with suture materials.  Yet we are willing to do it all and exhaust our major resources: time and energy.  We have dreams, and we love what we do.

Every once in a while, though, we need to have a really good meaningless conversation.

This spring semester, I can recall a single moment captured in a meaningless conversation that will probably stick with me for quite some time.  A friend of mine, who managed to lose technological means of morning arousal, asked if I could wake him up before classes.  Except he did not just want to wake up before classes; he wanted to wake up at the time I got up around 5:00 am, hours before class began.  This coming from someone who had nearly accomplished the conversion into becoming completely nocturnal.

So I laughed.  I made fun of him.  He made fun of himself.  It was a joke, and there was no real point in anything we were saying.

It happened right after he said it was just something he “needed” to do.  I did not really think he “needed” to do anything.  That was until he said, yes, he did, “by the same desire that drives anyone to need to do anything, otherwise we wouldn’t have to do shit”. 

With a mixture of the person speaking, the words he spoke, and the effect those words are sure to have on me in the years to come, I realized what all of us were doing.  We can probably all say that, when it comes right down to it, we do not “need” to cut down on an hour of sleep each night to fit in that little bit of anatomy review before doing clinical rotations.  Maybe we do not “need” to spend lunch with a pile of notecards.

But, sometimes you might be nocturnal with a desire to change yourself.  And sometimes we want to become something that means we must sacrifice those things that do not arouse the same desire.  And sometimes we need a meaningless conversation to remind us that, for whatever reason, we are doing what we are driven to do because it is what we love the most.

The Parent and the Mishap

Entry, Life As A Vet Student
Sally Moseley, St. Matthew's University

I have always thought of myself as a good pet owner.

That being said, how many discredited parents have told a similar tale?

How I think most pet owners (and many parents, as well) get into trouble is not by lack of caring but lack of knowing.  I have been a huge advocate for client education before I even knew what client education was; I spoke to youth groups about the importance of realizing the responsibility of taking care of a pet before they got a pet, and I also spoke to them about common dangers  pets may face.

I honestly did not inform them of very much, just some basic ideas.  I mostly wanted to encourage those kids to follow the adage “look before you leap” so that they might get the most out of having a pet. 

Somewhere along the line, I must have forgotten my own advice.  I certainly cared, I just did not know.  And I did not learn until the incident, which may be considered the point at which it was “too late”.

Left: Fintsy (with a chubby, regrown tail) Middle: Chris the tennis ball (with bowtie) Right: Coraco (with some degree of crummy eyes)For ten years, I had two beautiful female leopard geckos: Fintsy and Coraco.  When I first set up their tank, overjoyed with the thrill of the exotic experience, I had a stack of books about leopard geckos.  I would have told you that I read every single word.  I would have told you, and I would have believed it myself.

Ten years after first pouring sand into that tank, on a cold morning before the sun cared to join us, I woke up to a gargled shriek.  It was a moment where I had no idea what was happening, but I did know that one of my geckos was in pain.  (Later, my vet would try to comfort me by saying reptiles did not feel pain, but I changed his mind that day.)  I jumped out of bed and lifted up my geckos’ favorite cave to find a strange site.

Fintsy was not only missing a foot, but she was biting her own leg.  Maybe sometime in my veterinary career I will make up some plausible explanation for her biting her own leg.  I wish I could give an explanation now, but all I can come up with at the moment is that it was in response to Coraco biting off her foot.

I am not sure how many people know about leopard geckos.  Maybe to some people this incident does not look like my fault.

But I have not exactly given the full story yet.  A couple of years before the incident, Coraco bit off Fintsy’s tail.  Why didn’t I separate them after that?  Two reasons: I had my suspicions that Coraco was partially blind, and leopard gecko tails grow back.

It was not until years later that the incident occurred, and in a panic of Googling I discovered that you are not supposed to let two female leopard geckos live in the same tank.  They fight.  I thought ten years was a long time to go with one “fight” that might have been a blind gecko’s attempt at catching a cricket.  But then I read that everyone said they had geckos for three years or five years or even ten years before they fought.

If this had happened to everyone, how did I not discover this before?

Needless to say, I felt extremely foolish.  Poor Fintsy lost a foot because of my little negligence.  I took her to the vet that day, and the infection was already spreading to her abdomen.  She survived another half a year.

I still have one beautiful leopard gecko, and I now believe she is enjoying the tank to herself.  I can understand when a client misses something about raising a pet.  And I understand the feeling when he realizes he did something wrong.  Maybe it would be easier to know everything about everything so that we would never make these mistakes.  Maybe it would, but I am inclined to think that we should continue to learn.  When I spoke to youth groups, I wanted the kids to learn before anything happened.  But when something does happen, we can learn from that as well.

And, more importantly, we can teach what we have learned.