EPI * Exocrine Pancreatic Insufficiency

Ruby has a B12 level in mid range folate was high. B12 not lasting. loose stool starts up again Vet suggested to use some probiotics.  How do I administer probiotics...

with enzyems when feeding? 

sounds like a couple of things going on - high folate = SIBO - you probably should treat with Tylan.   B12 not lasting - did you order the Trinifac - I think there was a thread on that one...

I give these guys one probiotic in the am - after I let their food incubate - right before I am going to serve I break up the probiotic - throw it in and mix.   THAT is assuming you are not using any anti's.   If you are - give the probiotic 2 or 3 hrs before or after meal...

Hope Ruby is feeling better...

Marilyn,

As Michele suggested, I would try the Tylan before the probiotics.  I think you will see much better and faster results, as it sounds like Ruby has SIBO.  You can get Tylan without a prescription...I ordered from KV vet, you might also be able to find on Amazon.  You sound like you have the enzymes, food, and the B12 parts of the equation in place, now take care of the last part being the SIBO.

Lisa

Lisa and Michele, Thanks for your help.   We are not using any antibiotics as yet, my vet wants to try the probiotics and see how that goes????? Hope it goes well.  I am also wondering if Ruby should be getting B12 tablets instead of shots.  I have read that someone here is using the tablets and is working great. My vet really does not want to keep giving B12 shots. 

Ruby doo bee has a ton of energy and is a happy camper right now. But, has had very loose stool for a few days. She even gained 2 1/2 lbs.  I was surprised. 

Thanks again ladies. 

Marilyn, you really should print the info under SIBO and show it to your vet - SIBO is extremely common with EPI dogs and if you have never treated with anti's yet - well, chance are you need to - especially with high folate numbers.   Like Lisa said - if your vet will not give it to you you might want to think about purchasing on amazon.   The longer you let it go the harder it can be to get your hands around.   

Have you done the protocol for the B12 shots - weekly, bi-weekly, monthly - that is what is recommended in the protocol.   I think I did the monthly for a while then just went with daily pills on the Metagenics.   Now I do the Trinfac 3 or 4 times a week - they are much stronger than the Metagenics.   Here is the link to the Trinfac http://www.wonderlabs.com/itemleft.php?itemnum=6881#factbox- you may want to start supplementing the shots with them or you may want to just try the pills for a month and have Ruby tested to see how she is doing on them...

I am a big fan of probiotics.  I give my 100 lb. GSD, Jed, one with each meal (3 meals per day).   I let his food incubate for an hour and right before serving I put the feed the probiotic capsule in a small amount of canned food and he eats it that way.  Then he eats his meal.  I believe they calm the gut and he began to gain weight when I started them (or at least my vet and I believe that it contributed toward his weight gain but can't prove it scientifically, of course).  I buy my probiotic capsules from the refrigerated section in the health food store.  He and I take the same one.  I confess I have not had to deal with low B12 or SIBO, but only one time since this started four years ago so I cannot add anything to that, but if giving antibiotics then the probiotics have to be given about 3 hours apart from the antibiotics. 

Leslee (and Jed)

Michele at October 18, 2011 at 7:02 PM

Marilyn, you really should print the info under SIBO and show it to your vet - SIBO is extremely common with EPI dogs and if you have never treated with anti's yet - well, chance are you need to - especially with high folate numbers.   Like Lisa said - if your vet will not give it to you you might want to think about purchasing on amazon.   The longer you let it go the harder it can be to get your hands around.   

Have you done the protocol for the B12 shots - weekly, bi-weekly, monthly - that is what is recommended in the protocol.   I think I did the monthly for a while then just went with daily pills on the Metagenics.   Now I do the Trinfac 3 or 4 times a week - they are much stronger than the Metagenics.   Here is the link to the Trinfac http://www.wonderlabs.com/itemleft.php?itemnum=6881#factbox- you may want to start supplementing the shots with them or you may want to just try the pills for a month and have Ruby tested to see how she is doing on them...

Hi Michele,

I have printed the info on SIBO out and showed it to my vet. Ruby was on antibiotics before she was diagnosed with EPI.

We did the B12 shots ...only we did 6 weeks of shots and waited 2 weeks and then another shot and took test.  The test came out wonderful.  However, it seems that Ruby is holding her own with the B12 shot for a while... Thanks for the woderlabs link...I already have all the information on it and called about the cost.  I like your idea of trying the pills for a month and have Ruby tested.

Soooo many decisions...I need to go just one step at a time...

Leslee Hoober at October 18, 2011 at 7:59 PM

I am a big fan of probiotics.  I give my 100 lb. GSD, Jed, one with each meal (3 meals per day).   I let his food incubate for an hour and right before serving I put the feed the probiotic capsule in a small amount of canned food and he eats it that way.  Then he eats his meal.  I believe they calm the gut and he began to gain weight when I started them (or at least my vet and I believe that it contributed toward his weight gain but can't prove it scientifically, of course).  I buy my probiotic capsules from the refrigerated section in the health food store.  He and I take the same one.  I confess I have not had to deal with low B12 or SIBO, but only one time since this started four years ago so I cannot add anything to that, but if giving antibiotics then the probiotics have to be given about 3 hours apart from the antibiotics. 

Leslee (and Jed)

Hi Leslee,

What kind of probiotic capsule  do you purchase at the health food store.  There is one where I live I can go check it out price wise.

The probiotic you are using may be better than the one the vet suggests.  I would think that refrigerated probiotics may be a healthier form??

Marilyn~

Hi! My thought is to get Ruby on antibiotics first to clear the SIBO up and then start her on a probiotic regimen.

Regarding probiotics... find out what others ar using and try it on Ruby.... if one doesn't work...try another...the following is a good summation on prebiotics and/or probiotics:

✔ An inclusion of prebiotics such as fructo-oligosaccharides are logical although not yet proven. Basically, prebiotics are non-digestible food components (dietary fiber) that are being fermented by intestinal bacteria. This can lead to normalization of the intestinal microbiota. In a recent study the use of fructooligosaccharides (FOS) in the diet showed a lasting advantageous effect. While this has not been evaluated as of yet, other prebiotics, such as inulin or beet-pulp may also prove to be beneficial. This syndrome is also a potential target for probiotic therapy but one must be careful when administering probiotics. Per Dr. Jorg Steiner of Texas A&M University “...unrealistic expectations have been replaced with well-defined requirements for probiotics and controlled studies of their beneficial effects. Three key requirements for a probiotic for use in dogs are:

          1) the probiotic must be safe;

          2) the probiotic must be stable; and

          3) the probiotic must be efficacious.

In a recent study, 8 veterinary and 5 human probiotics were evaluated and only 2 of the 13 products contained the strains and concentrations of those strains indicated on the label. Several of the products contained bacterial species that could potentially act as pathogens. Thus, in order to ensure safety, the probiotic product should adhere to strict production and storage requirements. The probiotic also must be stable throughout transport and storage until the product is being administered by the pet-owner. In order to ensure that a certain number of colonies are administered to the patient, the colonies in the product should neither

proliferate nor die. (use a 3rd party lab to verify product “claims” such as http://www.consumerlab.com/).

Finally, a probiotic must be efficacious. In order to be efficacious, the bacteria must reach the intestinal lumen. This requires that the bacterial species being used in the formulation are both acid- and bile-acid resistant. Also, the bacterial species of the probiotic preparation should adhere to the intestinal mucosa to prolong the time of interaction. Finally, the presence of the probiotic species must have beneficial effects in the host. Several controlled studies have been conducted in dogs that also show that certain probiotics carry health benefits in dogs with gastrointestinal disorders.”

And the thing about gut flora is that " Recent studies have determined that it is not the number of bacteria but rather “the type of flora and/or how the host and flora interact that are more important than numbers.”:

Not trying to bash your vet here, but just keep in mind that many vets don't have much experience with EPI.  So even if your vet is not wanting to do antibiotics/Tylan right now, you may have to agree to disagree.    My vet did not give Tylan either (tried a couple weeks of Metro/Flagyl), but I purchased on my own and gave at my own discretion.I am not telling you to go against your vet's advice, you have to do what you personally are comfortable with.....however,  being a member of another EPI group at the time, I figured that the hundreds of members that were supporting the use of Tylan couldn't all be wrong!

  SIBO can come and go, sometimes needs to be treated several times.  Star had not had to deal with SIBO for quite a while (ie years), but when we got the puppy it threw her system off from the stress and the SIBO came back.  Could not get the stool back on track  with enzymes, probiotics, food.....only when we went back on Tylan did things settle down again.  She is back to perfect poops again, I am still giving the Tylan as we just changed to Diane's enzymes and I didn't want tweaking the enzyme amounts to set off the SIBO again. 

As far as the probiotics, I do not give them to Star because she is doing well without them.  When Maya was on several rounds of antibiotics for UTI, I did give them to her because she was getting loose stool from the meds.  I tried adding some yogurt to her food, that didn't help in our case.  So I gave probiotics from the refridgerated section of the health food store, spaced between the doses of antibiotics.  I gave those until we discontinued the antiobiotics and no longer use them currently. 

Just my 2 cents,

Lisa

Marilyn - i definitely agree that the high folate points to SIBO. SIBO creates a situation where the body cannot absorb B12. Once you have the SIBO under control you may see much improved retention of B!2. Really recommend a course of Tylan, which is mild as far as antibiotics go.

It seems as if her body does take B12 but only for a certain amount of time and does very well.

Let's see my vet didn't follow protocol when it came to B12 shots gave her 6 then waited almost 2 weeks gave her another shot and took a B12 test.   I didn't know till now that she only took the B12 test for Ruby and not the folate. The B12 came out above normal range. Don't know about the folate.  She said if the B12 is that good than the folate is alright. She didn't want to charge more money to test the folate. 

She wants to see how long the B12 shot from yesterday will last if it doesn't she wants me to use probiotics (vet ones). Though I went to the Health Food Supermarket today and found Probiotics for Dogs (has many many many ingredients in it also, all the enyzems that we give our EPI dogs no to much of a high dose).  So then I think which is better the one from the Health food supermarket or the vets.  I would think the health food store.

My vet doesn't want to give Ruby too many B12 shots she just wants to see the B12 to stay.  If not try the probiotics.

I just ordered Trinic-B-12 Intrinsic Factor Pills..Just incase I need some B12 for Ruby ... or maybe like someone else wrote on the forum she just uses the pills and they  are working find NO SHOTS.

I know I sound confused I am.  Also, I know I will also keep in mind the tylan deal.   One thing at a time 1 st I have to deal with the only vet I know here that will try to work with this EPI thing. I need to  make some decision with my husband of what makes some sense and go with it with all your help of course.

Thanks for listening and being there....      

Ruby's B12 is  now 419 which is above normal based on the lab used.  She also gained 3 lbs.

Hello Marilyn,

I am so glad to hear that Ruby has been gaining some weight and has lots of energy but sorry to hear that she is having loose stools recently.  

Regarding your probiotic questions.... some brands recommend administering with food and some without, so it all depends on which brand you find that suits Ruby best.  This seems to be another trial and error process for each individual dog.... what brand works for one can cause diarrhea for another.  Several that I have used with Boss that worked for him are Primal Defense and Kyo-Dophilus (both purchased at health food stores) and Proviable-DC (purchased on Amazon).  Also, when starting any probiotic it is recommended to start with a low dose and work up slowly to the full dose.  

Sorry, but I am gonna jump on the SIBO bandwagon with the others here.  SIBO happens when bacteria accumulates due to undigested food fermenting.   After being diagnosed with EPI it can often take awhile to find the food that suits each dog best and then get the enzymes tweaked just right for that individual dog and food.... and in the meanwhile food isn't really digesting properly setting up the environment for SIBO.   So even when a dog is given antibiotics prior to being diagnosed with EPI they can still need antibiotics for SIBO as it is not until all the pieces of the puzzle are in place and they are digesting properly that the antibiotics have a chance to hopefully win the battle against the SIBO.  And I say "hopefully" because SIBO can be really hard for EPI dogs with their challenged digestive processes to get rid of.  They sometimes require multiple rounds of antibiotics and sometimes can never totally quit them.  As SIBO can be a challenge, many that have battled and conquered it still keep antibiotics on hand to knock it down quickly whenever it shows signs of rearing it ugly head again.... which it can whenever things get slightly out of balance with EPI dogs.   

Your doing a great job learning all the aspects of what is involved with EPI and from the sounds of it, also educating your vet along the way.  If it sounds like we are all nagging about the SIBO it is only because no one wants to see you or Ruby running around in circles any longer than needed and that is what can often happen if one of the common other components (SIBO/B12) of EPI is not addressed.  

Wishing both you and Ruby the best

Sounds like Ruby is in the normal range for B12, however she is not ABOVE the range.  She actually is on the lower end of normal.

Normal range for Cobalamin (B12): 252 - 908 ng/L

Sorry, the rest of my post disappeared into   space somewhere.........

I was gonna say.....the B12 should still be monitored and you may need to continue with shots and /or the B12 pills to keep her levels up.

Also was agreeing with Becky about not wanting to sound naggy about the SIBO, however I think you are putting the cart before the horse with wanting to supplement with vitamins and probiotics at this point.  Those are all secondary things that can be tweaked IF needed once Ruby is stable.  If she still is having loose stool, she is not stable yet.  I would nix the probiotics, spend the $$ instead on the Tylan (with or without the vet's blessing) and deal with the SIBO first and foremost.  You are doing great with the enzymes, B12, and the food.....the SIBO is the last hurdle.  I am glad to hear that Ruby did gain some weight, so yes you are headed in the right direction.  End of soapbox. 

Lisa

I agree with Lisa and Becky.   Nothing against your vet but many do not handle many cases of EPI.   Everything that is being suggested here is from tons of experience dealing with EPI.    Basic on EPI is finding the correct balance of food, enzymes, B12 (if low) and SIBO (if present).   Before you move onto the probiotics def treat the SIBO with Tylan.   

I think what is confusing you is that your vet is not treating the EPI the way most do.   At some point we need to say - this is what I want - you may be at that point...

Hi Michele:  You are getting so much good information and guidance from others with much more knowledge than me.  I agree that you need to deal with the SIBO first or it can be a vicious cycle.  Thankfully, my dog only had one bout of SIBO so I freely admit that I lack knowledge on that part of your situation.  I really hope I did not cause you false hope.  I will just tell you, since you asked, that the probiotics I buy are called PrimeDophilus and run between $30-$40 per bottle. 

Olesia, you are always a wonderful fountain of information!  I read the pre and probiotic information you posted and will try to find out where PrimeDophilus stands.  Thankfully Jed is doing well (aside from the other autoimmune issues we have had to deal with).  He's back to his old self and looks great.  Knock on wood! 

Good luck to you Michele. 

Leslee (and Jed)

Opps, sorry I meant Marilyn, but good luck to you, too, Michele.  I think I need to sign off now!