Recent diagnosis, struggling with making progress

[Ingathedog]

Hi everyone,
Inga is a 10 month old Shepherd/Husky mix. Starting in the fall she became obsessed with the kitchen, and food, and chewing, we thought she was just a challenging puppy. Then in December she started having diarrhea, losing weight and eating her poop. After a visit to the vet and a round of antibiotics and then a probiotic and she didn't get better, was hungry ALL the time and lost a significant amount of weight over 2 weeks in January.
We got her EPI diagnosis, confirmed by blood test just over a month ago. Initially she was on Metronodiazole for a couple of weeks, a probiotic and Pancreatin enzymes. Her poops seemed to get better, but she would still have diarrhea about once a day, and she wasn't gaining weight.
She started on Tylan and we increased her Enzymes. We decided to order from Enzyme Diane at this point because of the cost of the Pancreatin and have started on that. About a week after starting the Tylan her stomach got noisy and she got gassy again. After 24 hours of liquid diarrhea this weekend and our vet being closed I doubled her dose of they Tylan for 24 hours and the liquid diarrhea stopped - and her poops are brown but between a soft formed to a pasty texture.

I've been trying to do 150% of her daily intake - but I'm struggling with how much to feed her because I don't really know how much she should weigh or eat.
We've been using a meat based can food with little no additives and virtually no fibre that is made here in Canada. Our vet said to use 1.5 tsp enzymes per meal. But I've been doing more small meals during the day and have been following more the 3/4 tsp enzymes per cup. But increased it a bit to see if that helped with her poops.

We need help - our vet is lovely but has only ever had 1 other dog with EPI -
I think my questions for you all are - Do we need a different antibiotic? How do I know if I am using too little or too much enzyme? When will things get better?

Jennie

[Olesia711]

Hi Jennie and a very warm welcome to you and Inga,

I suspect there might be a few factors that are contributing to the not so perfect poos and gas.

FIrst...... the runny poos could be from multiple things:
1. not utilizing the right amount of enzymes or preparing the enzymes properly.
2. sometimes watery/runny poos could be from the food and the fact that the dog may have developed a food sensitivity to some ingredient in the food you are feeding.
3. or runny poos can be from SID (small intestinal dysbiosis) in which case, YES, give Tylan and if you have to give more, then that is perfectly fine with Tylan (DO NOT give Metronidazole - -recent research suggests not to do this with chronic gastrointestinal conditions like SID cuz Metro can permanently destroy some bacterial strains that can never be replenished even with probiotics .
4. sometimes you are doing everything right and nothing is coming together as expected because there is a B12 deficiency (this happens in over 82% of all dogs with EPI) and you need to start supplementing with the right kind and amount of B12.

SOOOOOOOOoo..... in your case..... this is what i would look at:
ENZYMES
1. WHen administering enzymes, start with 1 level tsp per 1 cup of food (if dry) and moisten the food enough for the enzymes to stick to. If feeding canned food, measure 1/2 tsp to 3/4 of a tsp of enzymes per 1 cup of wet food.... you may or may not need to add water for a little more moisture for the enzymes.
2. whether wet or dry food.... after mixing in the enzymes, allow the enzymes to incubate in the food for about 20 minutes.
3. Sometimes some dogs need a pinch more enzymes, but don't overload on the enzymes because too much can sometimes trigger loose stools.
4. Serve food at room temp. Too cold will inhibit the activity of the enzymes and heating the food up with enzymes will destroy the efficacy of the enzymes.

SID
if your dog has any repeated signs of SID ....... "SID is not under good control if the dog displays any repeated signs such as yellowish or pale colored stools, loose stools, gelatinous stool coating, flatulence, lack of appetite, stomach noises, vomiting, acid reflux, low or low normal B12 then treat for existing secondary SID/SIBO." then we first recommend trying prebiotics/ prebiotic+probiotics.... but it sounds like you've already been there done that... so now, you move on to Tylan. TYlan is very forgiving.... you can give more ... Here are the recommended dosing instructions: https://epi4dogs.com/antibiotics/ ..But..... you also need to give Tylan twice a day with breakfast & dinner and for 45 days. ONce a day or too little will not cut it..................

B12
Was your dog blood drawn and tested for B12 levels? It is called a Cobalamin B12 test. They usually do this when they take blood to run the TLI test. If this was not done, and if you can have it tested, that would be great so that you and your vet have a bench mark and can proceed properly. ... but if you cannot afford it, B12 is water soluble so no harm will be done if you just go ahead and start giving B12. YOur vet can either show you how to give simply B12 serum shots at home or you can order these special Methylcobalamin B12 pills made with Intrinsic Factor that many of us use from https://www.wonderlabs.com/itemleft.php?itemnum=K9688 . THe following is the amount of B12 that needs to be given. 1000mcg pills and B12 shots are the same dosage:

B12 Dosing.jpg (36.64 KiB) Viewed 2728 times

FOOD
How much does your do's breed weigh (look up the average on the internet).... you can then look at the food you are currently feeding and serve 150% of wht is recommended. HOWEVER..... try to feed smaller portions but feeding the 150% via more meals throughout the day. For those of us that work, sometimes feed breakfast before you go to work , feed lunch when you come home from work, and feed dinner about 1 hr before you go to bed. If you are home and can find 4 meals a day instead of 3, that's even better. Of course this doesn't have to be done forever.... just until the majority of the weight has been regained.

Next... if you do ALL of the above... and you are still experiencing watery/very loose stools.... THEN that could be an indication that there is a food sensitivity also going on (this happens a lot too) and the short cut to working thru this is talking to your vet to try a true Hydrolyzed food. Unfortunately they are all prescription foods tht your vet has to orer, but worth trying if you get to this point. The 1st one to try that we recommend is "Ultamino" by Royal Canin (in Canada, i think this now goes by the name " Canine Anallergenic").... this particular hydrolyzed food often (but not always) appears to work better on our EPI dogs then some of the other brands..........

Hopefully this is enough to get you started.... looking forward to hearing more from you....

And please share everything we suggest to you with our vet

[Barb]

Hi Jennie,

I wrote you a long post, but it disappeared into thin air somewhere when I sent it, so I will just welcome you and Inga to our EPI family. You have already done a good job of adjusting some of the treatment for Inga. This is the hardest stage when our pups are first diagnosed. You are trying to get everything balanced while worrying about your pup. We have all been where you are. It will get easier and better.

Olesia gave you excellent suggestions. Supplementing Inga's B12 level is really important and sometimes gets overlooked. As Olesia said, you may have a number level from her cTLI test, but if not, you can supplement anyway. We gave Kolby injections for many years, but eventually switched over to Wonderlabs Pet Factor for the B12 and it worked great.

I also heartily endorse keeping a log/journal. Record everything you give Inga and the amounts each day. Then watch the resulting poos. You can use a log form from our website or just use a notebook. This will help you to see what is working and what needs to be adjusted. It also helps you to see information you might have missed if you hadn't written it down. It saved our sanity!

Hang in there and let us know how she is doing.

Barb

[Ingathedog]

Thank you so much everyone, I will post an update after we try some things.
Here is the cutie we're talking about (it's hard to appreciate how thin she is, but when you touch her she is just skin, fur and bones)

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IMG_20210226_174302_resized_20210301_011333306.jpg (132.45 KiB) Viewed 2710 times

[Olesia711]

Oh my... she looks so sweet... but you can see sadness in her eyes.. and we often see this with those that just aren't yet stable with their EPI treatment..... Hopefully we can help you get there!!!!!!!!!!!!

[Ingathedog]

Hi, thank you so much for all of the advice. We have made a little progress with some small weight gains - yay!!!
We have been trying to be meticulous in measuring her food and enzyme quantities and although she still could eat anytime, she somehow seems more settled and is a calmer dog (for an 11 month old puppy)

We have a couple questions:
1) Can vitamin B12 injections cause liquidy diarrhea - 2 days post IM injection? - this is something that has happened after her 2 B12 injections
2) What poop is acceptable -what I really would like is photos of your dogs poops!!! We are going back and forth between a formed soft to a pasty unformed poop
3) Could it be a too little probiotic/prebiotic issue or a too much/too little enzyme issue that could cause pasty texture to poop? (it is not the greasy poops we were having before the diagnosis)

Thank you in advance for the continued assistance!!
Jennie

[jilbert57]

Hi Jennie and welcome, your pup is so cute!
The link below is for the poop chart.

https://epi4dogs.com/poop-chart/

Jill

[Olesia711]

Hi Jennie,

I have not heard of B12 giving runny stool in an EPI dog that needs B12... HOWEVER, that being said, i know it has happened in two people that i know of.... SO..... what you might want to do is mention this to your vet and when the next injections is due, ask your vet if trying a lesser dose would be okay.... and then see if that improves the poo situation.

And yes... too much pre/probiotic can indeed cause looser stools... as can not enough enzymes or in some cases way too much enzymes.

If you ae going to try these possibilities, be sure to try just one thing at a time. give it a few days (3 to 5 days) and take pics of the poo so that you can compare and see if the change you tried helped or hindered.

[Ingathedog]

Hi,

Our poops have gone downhill this week and we are worse that the photos now.

She is going for a b12 shot on Saturday - is it better to do a supplement with food?
Wonderland b12 doesn't seem easy to get here in Canada with longer shipping times and unknown duty costs. I did find it on Amazon but the shipping window is vague and may be over a month. If the border reopens at some point we will have more options to order to pick up at a point there.

I've been trying to find slippery elm with difficulty also for the brand's recommended. It's it ok to use another brand from a health store?
I've been keeping a log but haven't noticed and patterns or changes that would have led us to the current situation. Her food is split into 4+ meals a day. Her poops look bad and have increased slightly from 2-3 to 4-5.

Part of the reason we are struggling is because I am still recovering from a prepandemic head injury. And now my partner fell on the ice in the backyard last week and ended up with a back injury and concussion. Lists and keeping track of things we can do but problem solving is not our strong point right now.

Does this poop look like a SID issue? We have been on the Tylan antibiotics for over a month now.

[Ingathedog]

Hi,

Our poops have gone downhill this week and we are worse that the photos now.

She is going for a b12 shot on Saturday - is it better to do a supplement with food?
Wonderland b12 doesn't seem easy to get here in Canada with longer shipping times and unknown duty costs. I did find it on Amazon but the shipping window is vague and may be over a month. If the border reopens at some point we will have more options to order to pick up at a point there.

I've been trying to find slippery elm with difficulty also for the brand's recommended. It's it ok to use another brand from a health store?
I've been keeping a log but haven't noticed and patterns or changes that would have led us to the current situation. Her food is split into 4+ meals a day. Her poops look bad and have increased slightly from 2-3 to 4-5.

Part of the reason we are struggling is because I am still recovering from a prepandemic head injury. And now my partner fell on the ice in the backyard last week and ended up with a back injury and concussion. Lists and keeping track of things we can do but problem solving is not our strong point right now.

Does this poop look like a SID issue? We have been on the Tylan antibiotics for over a month now.