EPI * Exocrine Pancreatic Insufficiency

A place to purchase B12 injectibles on-line: http://www.b12-shot.com/

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The following is from one of our members, Barnum's mom:

I thought I would post this here because I found this interesting. I've got hypothyroidism and with that a recent Vitamin B12 deficiency. My endocrinologist told me to stay on Vit B12 supplements, at least 500 mcg. Since I felt better I stopped using it. Maybe that and other factors contributed to another thyroiditis attack. Who knows. 

One thing I do know is after reading about the symptoms and signs of Vit B12 deficiency I knew I had one. I didn't need to get tested to know it. They could confirm it though. Maybe on my next round of tests I'll request it.

Here are the symptoms of a Vitamin B12 deficiency (Ones I had/have are in bold.):

Fatigue

Shortness of breath (mostly during exercise)

Heart palpitations

Very pale skin

Dizziness/Lightheadedness

Sore, red, smooth beefy tongue

Nausea

Crashing fatigue where a nap is absolutely necessary, usually this occurs around 3 PM

Diarrhea

Muscle weakness

Numbness/Tingling in hands and feet

Cold hands and feet

Unsteady gait

Vision problems

Eyelid twitching

Memory loss

Disorientation

Difficulty concentrating (I haven't been able to read a book in months.)

Loss of appetite

Nerve shock to the sides of the body

Sores at the corner of the mouth which come and go

Mood disturbances, especially irritability

White spots on the skin

Constipation

Weight loss

Bleeding gums

Depression

Incontinence

Hypotension

Spasticity

Dementia

Migraine headaches

Psychoses

Ataxia

The Vitamin B12 level test performed during the time you're taking the vitamin should be in normal to above normal range. I had a doctor who told me to stop taking B12 because mine was 1500 and the top range was 1000. She was wrong. The result meant the supplement was the correct amount. The amount was 2000 mcg. That was 2007. Right now I'm taking 2500 mcg.

If Vit B12 is given without Folic Acid there will be a deficiency in Folic Acid and vice versa.

Of particular interest to those here would be the red, smooth beefy tongue. I looked at Barnum's the other day and it is rather smooth. Before diagnosis, it was red, smooth and beefy. After treatment, it is less red and beefy but still smooth.

I wonder if their gums would be pale like our skin being pale?

Before treatment, Barnum would crash around three in the afternoon every day. He no longer does that.

He did have an odd gait for about three months which returned to normal shortly after treatment began.

He does not nor did he ever get Vitamin B12 injections. I've given him Vitamin B12 sublingual.

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RK, Barnum's Mom

Barnum, a Leonberger, was diagnosed at 6.5 months by stool sample and elevated ALT. I believe he was born w/EPI. He presented symptoms at 8.5 weeks, predominately a voracious appetite. One month later, Barnum started to regurgitate his food due to pica (not eating stools). Barnum's diet was changed to Raw Meaty Bones on 6/1/2010. He now receives 4 BioCase V capsules twice a day and 1000 mg Salmon Oil once a day.  42 days without owl pellet. 123.8 lbs.

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From Olesia:

B12 Deficiency: The standard protocol for an EPI dog with B12 Deficiency or low side of normal B12 levels is that the only scientifically proven thing that works is to administer B12 injections.

However,  on this FORUM we have noted (and this has been tested with a few dogs) exceptions.. Many EPI dogs that were having difficulty are finally being stabilized with a combination of the B12 injections and a B12 pill called Metagenics B12/Intrinsi/Folate pills.

     500 mcg B12800 mcg Folate20 mg Intrinsic Factor 

Another exception that we have "observed" is :

Some dogs are finding stabilization with just the Metagenics pill alone. Again, touted that it works because it has the Intrinsic Factor in it.  But again, we have observed more exceptions:

We are now beginning to hear of some examples from some of our own members having positive results from other B12 pills that are working for “some” EPI dogs. 

For example, one pill, the Metagen B12/Folate has a high concentration of B12 coupled with just Folate, and has been used successfully.

     1000 mcg B12500 mcg Folate 

Another over-the-counter B12 pill that has worked for another member did not have any Folate in it but rather an extremely high concentration of B12.

     3000 mcg B12 

Our findings above have not been scientifically proven in a clinical study,but  rather, has been tried and met with success with some EPI FORUM members. That is what we do here. Share what works for us in hopes that something we are doing might help someone else having a problem.

If anyone chooses to try any of the above, please share with your vet what is posted above, what our observations have been and please work with their guidance in the matter.

I think the other thing to note is that it is important to watch for signs of low B12 and test periodically.  I don't have the numbers right in front of me, but Pharaoh was low in B12 when first dx in December 2009 and received six weeks of weekly shots.  In July we had him re-tested (he finished his course of B12 in late Jan/early Feb) and he was below normal (which explains the recent decreased appetite and weight loss and his behavior on walks).  So he is back on weekly B12 which will then go to every 2 weeks and then probably to monthly.  I plan to retest in about 4 months, sooner if I see symptoms.  Taiko had six weeks of weekly B12 and when we tested her in July (2 weeks after her last injection) she was in the normal range but very low so she is now on B12 injections every two weeks.  I don't know why I didn't think to retest Pharaoh sooner.  I guess I thought once he had his injections he was fine; and he was for awhile.  But not every dog can keep the B12 up and need more maintenace.  Our vet thought once he was stable on enzymes he could keep his B12 up on his own and she's learned that he can't. 

Very interesting B12 post and info. Onza is still getting one B12 injection per week and one daily B12 tablet of 3000 mcg except than on the day she gets the injection. Her B12 level is maintained at greater than 1000. Thanks for putting it up for us Olesia.   Donna W.