New EPI diagnosis

[Tuckaboo Pam]

I'm going to send you an email. It took awhile for the slippery elm to kick in for Tucker, and then when I started adding proviable it really helped. Your baby is so small, though, I'd want you to have more input from staff before giving her the probiotics. Additionally, poo eating is grossly disgustingly atrocious & horrible, but I'm not sure it's really too unhealthy for them. It is a sign that she feels undernourished, though, and I know it makes you feel bad for her. Look for my email.---Pam

[Olesia711]

Sounds like your baby NEEDS Tylan.... have you shared the research on Tylan to treat SID?
An OMG NO!!!!!!!!!!!!!!!!!!!!!!! All breeds get EPI and consequently SID... not just GSDs .... have you considered getting a second opinion or possibly changing vets.? A comment like this kind of suggests that your vet has not taken the time to look into what the current and proper protocol is for an EPI dog....

[Madelon]

I'm so sorry your vet is unwilling to be open to learning new things. It might be time to find a new vet. I'm not sure where you're located but we have a list of vets that other EPI owners have had good luck with on the website in case you want to see if there's one near you - or you might just try calling around and asking a few questions to see if the vet has experience with EPI or if they are open to learning.

[Tuckaboo Pam]

I once took my mom to a rheumatologist, and he had prominently displayed a mug that read, "Your Google Search Does not Equal my Medical Degree". While I agree wholeheartedly, I think some professionals just don't like for us to be informed, and trying to communicate can be tricky. I am perfectly willing to listen to the reasons why they disagree, but they are in my (dog's) presence for 15 minutes, while I am there 24/7. When I come up against someone who absolutely shuts me out, I ask for my records and move on down the road.

Since you are in the military & may be moving sometimes, I would hope to see you establish a good set of records for your Cali, and to have learned about resources that can keep you self-sufficient. I was in a position last year, where I had been promised I could come back anytime & just get Tucker's testing done, but when I tried to do that, the vet who made that promise was gone, and a new one was going to make me start from scratch. That is SO expensive, which is why it's a good idea to get some independence, with the help of the forum.

Also, my maltipoo was given Metro for IBD or SID, they weren't sure, and she is a mess, going through phases where she is arching her back & pooping little squirts all over the place. I have figured out how to help her, but she still has problems. My advice is, don't do it. It's a quick fix with many ramifications.

Thinking of you---Pam

[CaliGirl]

Thank you all for you reply’s. Yes I have been actively looking for a new vet, but unfortunately am running into them not taking new clients or on a long wait list. I do have an appointment for her in late March as a back up but seems so far. I am in Northern California between Sacramento and San Francisco (I know someone had asked where I was located) I am going to attach the email I received back from the hospital where Cali was treated for parvo and where the original EPI diagnosis came from. I feel completely defeated. I don’t know how to help my baby right now.

[Tuckaboo Pam]

Oh, no, Nicole.

Did you find my email? When I get one from another member, it always carries all these warnings, but I did send you one, so if it's there it's likely mine.---Pam

[CaliGirl]

Did you send it to my personal email? I didn’t get anything?

[Tuckaboo Pam]

I clicked on your name, then clicked on send email. So I guess it would have gone to the email account you have listed with your membership.---Pam

[CaliGirl]

Pam- I got your message about keeping the records and becoming self taught but that’s all I can find. If you sent something else, maybe try re-sending one more time. The regular vet called me today saying now they want to change calis food, probiotic and put her on Prilosec for the reflux???? They want to do Purina E/N food, a probiotic called via biome and then the Prilosec. And ABSOLUTELY no tylan. They claim the tylan will create bigger problems for her. Like I said at this point, I have no idea what to do, I have never felt so lost. I know I have a baby who is uncomfortable has terrible gas and terrible reflux that seems to be getting worse!

[Madelon]

Hi Nicole - uggghhh - I can totally understand your frustration with your vet. What we recommend when first diagnosed with EPI is to give about two weeks of the right dose of enzymes, B12 and the right food - if that does not give good poops THEN we recommend trying Slippery Elm Bark Powder (I can't remember if you have tried that or not) if that does not produce good poops after 3-5 days THEN we recommend trying Proviable probiotics (prescription needed from the vet) for a week or two and if that does not give good poops THEN YES WE RECOMMEND Tylan. Your vet may not be familiar with Tylan - it is not like other antibiotics where it kills all of the bacteria - in fact Tylan does not kill any of the bacteria it just prevents the bad bacteria from reproducing/multiplying. And yes one of the symptoms of SID is regurgitation/acid reflux for which we recommend Omeprazole (over the counter) give 1 pill 30 minutes before each meal (make sure that dosing is correct for the weight of your dog). My German Shepherd gets Omeprazole every day with each meal and he is on a maintenance dose of Tylan of 1/8tsp once a day or once every other day.

Sometimes emailing might be best as they are forced to look at the information - maybe you could copy and paste the following - maybe this will show them all of the research you've done and this is not just some fly by night suggestion:

SID/SIBO in Brief https://epi4dogs.com/sidsibo-in-brief/

SID (small intestinal dysbiosis) formerly referred to as SIBO (small intestinal bacterial overgrowth) is usually present in all dogs when they are first diagnosed with EPI just because of the very nature of EPI.
This page discusses various options to manage SID: (1) Prebiotics (FOS) (2) Antibiotics (Tylan preferred) (3) Symbiotics (4) certain Probiotics (5) Fecal Transplant (promising).
The preferred antibiotic of choice is now Tylosin (Tylan) twice a day (breakfast and dinner) with food approx 12 hours apart, 30-45 days depending on the patient (see research below).After enzymes are implemented wait a week or two to see “if” the enzymes are enough to allow the gut imbalance to correct itself. Another drug commonly used is Metronidazole (Flagyl) not always successful..Some dogs relapse after antibiotics are completed. If so, do a repeat course of antibiotics.
Some dogs require an minimum management dose of antibiotic for life. However some can come off antibiotic use once the right diet is found.
In a recent study dogs with SID were divided into two treatment groups. 1/2 received FOS (prebiotic), 1/2 received Tylan (antibiotic). Both groups improved. However some in the antibiotic group relapsed, those in the FOS group continued to do well.
SID may encourage low B12. Be sure to keep B12 levels at upper-mid range levels.
Different types of stools and possible causes listed near bottom of page
Acid reflux possible causes and treatments discussed at the bottom of the page

https://epi4dogs.com/sid-sibo-microbiome-research/

August 2020: we now understand (until more in-depth research comes along) that SID (small intestinal dysbiosis) in EPI dogs and cats is not something that can be easily fixed, but rather just well managed with proper treatment that may vary from one pet to another. Although with EPI, the SID can be so out-of-control that we want and often need to do something to relieve the excessive loose stools, etc. from SID. But before automatically treating with an antibiotic, (which would be Tylosin Tartrate as it is now recommended to avoid Metronidazole if possible)… it is prudent to first try Prebiotics or Prebiotics with Probiotics.

If one has to use Tylosin Tartrate antibiotics to treat SID, approximately halfway thru the Tylosin Tartrate regimen, introduce a Pre & Probiotic product to the regimen also.

January 2020: Tylosin (Tylosin Tartrate/Tylan) is now listed in WSAVA (THE WORLD SMALL ANIMAL VETERINARY ASSOCIATION) “List of Essential Medicines for Dogs and Cats”

https://onlinelibrary.wiley.com/doi/10.1111/jsap.13135

8.Erythromycin or tylosin

These macrolides are recommended for treatment of severe Campylobacter infections and chronic enteric infections responsive to antimicrobial therapy.

Tylan Antibiotic (Tylosin Tartrate)

Currently the antibiotic of choice to treat SID in EPI patients is Tylan (Tylosin Tartrate 100 grams- -given according to weight / 30-45 day course given every 12 hours (breakfast & dinner). In some cases the dose may be split into 3 daily doses vs. 2 daily doses if optimal results are not being achieved. If Tylan does nothing within a week, THEN try a different antibiotic. Some of the other options are Metronidazole, Amoxycillan, Oxytetracycline (Oxytet), etc. Scroll to the bottom of this page for the revised 2016 UK Oxytetracycline dosing recommendation. Tylan (Tylosin Tartrate) Dosage Guide

13kg/30 lb – 1/8 tsp
27kg/60 lb – 1/4 tsp
41kg/90 lb – 3/8 tsp
54kg/120 lb – 1/2 tsp
twice per day
https://epi4dogs.com/antibiotics/