Treatment plan check, not quite EPI

[ACDLouMa]

Our dog Louie, a 10-year-old Australian cattle dog has had bouts of diarrhea for about 10 months, after 2-3 days it would go away, then back to his normal soft to regular poops. Due to CCL surgery in May 2020, we have been keeping his weight on the low side, but we recently noticed he was looking too skinny, especially for a dog who had not been very active in the past month.

Mor recently, in late February he became cyclic with diarrhea, soft stools, normal poop. We had in the past done a homemade chicken, rice, and pumpkin food that cleared him up in a few days and he was back to normal, but that stopped working for him. The vet suggested we switch him to a hydrolyzed diet, thinking he has stress colitis, but the hydrolyzed food did not make a change, and since then he has had watery diarrhea only, and multiple times (6-8+ /day)
EPI was the secondary thought, and the day they did the blood draw the vet started Louie on EPI treatment. IT has been 8 days with no improvement. Yesterday we got his results, and the diagnosis isn't fully consistent with EPI, but very consistent with SIBO, but the vet would like to treat for both.

Cobalamin <150
Folate 22.7
TLI 6.3

His treatment has been:
4/15
PancrePlus Enzymes Tablets (2 tablets 3x a day)
Metronidazole 500mg (2x an day)
Prednisone (1o mg 1x a day for 7 days, then every other day)
Continuing on the hydrolyzed diet while looking for replacement food

There were no changes in 7 days

4/22
started 1/2tsp of slippery elm 2x a day

on 4/23 we got the results
switch from metro to Tylosin (1/4tsp 2x a day)
added B-12 oral
we were given a B12 injection to take home and administer (he took it like a champ)


We have ordered Natural Balance LID Grain Free Food, B-12 with Intrinsic Factor, powder form of enzymes, probiotics.

Are we missing anything? Any idea on how soon we should see improvements? Will just the tylosin make a difference or will we need to wait for the food, powdered enzyme, and probiotic that also start?

Thank you for everything and this website, my husband and I have been spending all of our free time in the past few weeks reading every corner of the site and it has helped tremendously with helping us work with the vet and learn how to advocate for our guy.

[jilbert57]

Hi Jackie, welcome to the forum. Was your pup 8 hour food fasted before the test for Epi?
I am sorry you are having such a time.

Are you crushing the tablets, sprinkling them on the food, mixing them with a little room temp water and then letting them incubate before feeding?(stir again before serving)Also you might need to add another tablet for the bowl as we say.

Thanks

Jill

[ACDLouMa]

We had crushed the tablets but hadn't incubated them, we will try that with his next feeding, thank you!

[Olesia711]

Whoa,.... poor thing...i am so sorry you AND your pup is going throu all of this.

I am working with someone else who situation sound extremely similar to your.... their dog's TLI came back at 5.8, B12 was low too at 154 and the folate was high at 24. Their vet also started the dog on Metro, tried hydrolyzed food, prednisone.... nothing worked...........

I started working with him and he started using pancreatic powder (not the pills) , and Tylan, and had him order the wonderlabs Pet Factor B12 .....things finally started improving and now the dog has consistently good poo and gained weight too.... and this is just in a few weeks.

Glad you started the Tylan! With Tylan you usually see some positive improvement within a few days... but the fact that the B12 is so low... this may not happen as quickly as you'd like..... and the enzyme tabs... sometimes just don't work as well as the powder.

What is the brand name of the enzyme tablets you are using?
Are you giving tablet with every meal? Tablets are not the best IMHO to work with. You often have to give extra pill, you have to crush them and incubate them just like you do with powder. Some dogs do well on tablets once prepared properly and enough are given, but some dogs just dont do well on tablets no matter what..... so.... please let me know what brand you are using and we can suggest how many pills to crush and incubate with EVERY meal.

ALso... don't give ANY food inbetween

At this point, you "might" be giving too much SLippery Elm.... it is a mucilage and a fiber and has prebiotic properties...SO it soothes the gut,/inflammation and actually helps get SID under control and firms up the poo........ BUT too much of it and you will encourage loose stools ...with SLippery Elm "sometimes (but not always) less is better....... SO.... based on your dog's weight, louis is on the edge of 1/4 tsp to 1/2tsp....so......my suggestion is to back down on the slippery elm for now and just give 1/4 tsp per meal....

Some hydrolyzed foods just don't work, even for dogs that have IBD.... some help and some actually give the dog loose stools.....which hydrolyzed food are you using?

What you might want to "try" is buy the smallest bag possible of "Taste of the Wild- Pacific Stream" version this is a middle of the road food that works well with many EPI dogs, not all, but it is a good place to start.

How much pred are you giving?

HAve you started giving the Pet Factor B12 yet? Give 1 capsule daily.

For probiotics.... hold off until you have been giving the Tylan/twice a day for 23 days..... right about this mark, THEN start giving probiotics. There are lots of good probiotic out there but just because they are well touted by your vet is no guarantee that it will be the best product for your dog. All these dogs have unique individual gut flora composition..... and all the probiotics to date are off the shelf one-size fits all..... and that is not going to work for all....but the best you can do is try them and hope that it is a product that will serve your dog's situation well.

THe probiotics that we are currently recommending are:
Visbiome
Proviable
VetriScience Mega Probiotics

Next... you would like to know when you should see improvement.... in your case... you started the Tylan and one often sees improvement fairly quick if everything else is in line.
But the fact that you are giving pancreatic pills not powder may or may not be a problem ....
And the fact that the B12 is SOOOooooo low.... that in itself, even if you are doing EVERYTHING right, can continue to produce loose stools until the B12 level comes up a bit. Once on proper B12 supplementation, this should help....and this could take anywhere from a few days to 3 weeks.

SO.....you are on the right path.... my suggestion is just go ahead and change the food, slightly reduce the SLippery Elm, give the Tylan as you are, give the enzyme pills (but let us know how many pill you are giving per how much food) crush and incubate, give the Pet Factor B12 pills daily, and you should see some sort of improvement within a week or so (if the B12 wasn't so low, i could more comfortably say you'd see improvement sooner)

REcord everything you are doing, take poo pictures so you have something to compare to daily... to see if things are or are not improving..........
feel free to share to poo pics here on the forum. Pictures help us a lot!

[jilbert57]

You want to incubate the food, water and enzymes 15 to 20 minutes before serving. Besides the brand name of the tablets please let is know how many cups of food you feed at each meal. Thanks

Jill

[ACDLouMa]

We had read that with the slippery elm “less is more” thank you for clarifying what that means. We Will cut back on the next feeding.

We have ordered the Wonder Labs B-12, and the PancrePlus Enzymes in powder form, and Proviable probiotics.
This evening we did start crushing the tablets, 2 a meal which will be 3 times a day (PancrePlus 425mg), and incubating, we will continue this until the powder arrives.
We have withheld any treats or food in-between meals.

This is our first day transitioning from the Purina ProPlan HA to Natural Balance LID Grain Free, it is tempting to want to switch him quickly as his system is so off-balance already, in his situation would a rapid switch make him even worse, or is it better to get him on the grain-free faster?

The Prednisone was 10mg 1x/day for 7 days, now every other day until it is gone, 7 more doses.

We gave him a B12 shot this morning, and he’s taking Cobalaquin until the Wonder Labs B-12 arrives.

We have a log going for all the changes in his diet and med schedule, will include poo in that as well.

Thank you for taking the time to review and provide advice and support.

[Olesia711]

how much food are you feeding per meal?

[ACDLouMa]

Right now 2 cups, 3x a day, heavy end but he's not maintaining or gaining weight yet.

Once he is fully transitioned it will be 1.5 cups 3x a day (at 150% of what the food chart calls for until he starts to gain)

[jilbert57]

Jackie,
I just checked with our staff and the recommendation on the tablets is 1 tablet per 1 cup kibble plus "1 tablet for the bowl". So for 2 cups kibble please use 3 tablets.(1 for each cup plus 1 for the bowl)

Did I forget to tell you about Enzyme Diane? They are enzymes at a great cost saving. www.enzymediane.com you would use 6x strength. Maybe you can check on her site? Diane had an Epi dog Sarge and wanted to help other folks be able to better afford them.

Not sure on cold switch on food.

Jill

[ACDLouMa]

with the "1 for the bowl" do I crush it with the other 2 or toss it in?

Hopefully, the powder will be here soon.

Thank you!