Dog not responding after 5 months

Epi4Dogs Foundation Inc.’s mission is the advancement of science and education relating to EPI (Exocrine Pancreatic Insufficiency), yielding useful insights and positive outcomes in better managing EPI in dogs and cats. Our goals are to support and/or collaborate with veterinary EPI research and researchers, and to promote EPI awareness by educating the general public, pet owners, pet organizations, rescue and shelter organizations, veterinary schools and veterinarians.
barbhamon@gmail.com
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Pet name: Sarge
My name: Barb

Dog not responding after 5 months

Post by barbhamon@gmail.com » 01 Oct 2021, 12:04

Hello, I'm new to this group, however I have been reading posts for some time now. I have a 4 yr. old GSD that was diagnosed with EPI about 5 months ago. Let me explain a little of his background. I received this dog at 10 weeks old so I could puppy raise him for a veteran to be used as his PTSD service dog. I noticed by the time he was 5 months old that he was not going to be a good candidate for a service dog (too much drive). I sent him to the training center for a couple of weeks and they agreed with my assessment (I have a PhD from Texas A&M in behavior science and agriculture). At this time we decided to re-home him. I kept him with me until we found a family to adopt him when he was 1 yr. That family kept him until about 5 months ago when they had to move and couldn't take him with them. They called me and I agreed to take him back. When I picked him up I was stunned to see his condition. They told me he had recently been diagnosed with EPI. Their vet had him on enzyme pills (3 before each meal) and 2 omeprazole per day. After a couple of days at my home I didn't notice any change in his stool so I decided to take him to my vet. My vet ran a complete blood test panel on him to rule out any other underlying issues and decided to change him to a powdered enzyme and antibiotic (metronidazole). He went 14 days on this course, and his stools became more formed, better color, but still soft and mushy with large volumes and continued weight loss. Since then we have added B12 shots (he is on his 4th shot of 6) and slippery elm. After about 3 weeks I was pleased to see 2 well formed stools, good color and not so voluminous. But after those 2, it's right back to mushy and large amounts. Two weeks ago he was rushed in for emergency surgery for bloat. Of course he had to be on pain and sedation medication. Of course I continued his enzymes. His staples were removed last week and the surgeon said he was fine to continue normal activity. He is still losing weight and at this point I am at a loss as to what to do. The vet is also stumped as to what to try next. I have switched his food (Taste of the Wild Pacific Stream), given slippery elm, B12 shots along with B12 capsules(Wonderlabs). He is still losing weight. He still has a lot of energy and loves to play catch, but I worry he may break a bone since he has no muscle. The people who had him never told me if their vet did a TLI test and I haven't been able to contact them for that information. I ordered the Schebo test and it showed positive, however when he has completed his current round of B12 shots he will then be tested with the TLI test as well as for his B12 levels. I hope someone here might have suggestions for things I have not tried. If I can't get this under control soon I feel I may have to euthanize him as I can't watch him stave to death. Thanks in advance for any help, and please, if I've left any questions unanswered, let me know. Barb Hamon

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Olesia711
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Re: Dog not responding after 5 months

Post by Olesia711 » 01 Oct 2021, 15:10

Hi Barb,

Thank you for contacting us.... i am so so sorry you are not finding success with managing this dog's possible EPI.
First of all, since we do not know for sure if this is clinical EPI, but since you will be having him properly tested soon, lets "assume" for the sake of this post, that you are dealing with EPI. Thankfully if it is not, treating for EPI temporarily will not hurt him, but you don't want to keep him on an EPI protocol if this is not EPI.

1. That being said.....continue with the B12 (shots and wonderlab Pet Factor pill) as a GSD, he should be getting 1 capsule a day, but since he is also getting the B12 shots for now, try only giving the capsule maybe just 3 or 4 days a week.
2. Next, usually the TOTW food works well with a good majority of all our dogs, but not all... but i need more details in order to assess the situation.
a. which version of TOTW are you feeding"
b. how much are you feeding per meal.
c. how many meals are you giving a day (are you feeding approx 150% of what your dog would
normally require at his current weight?)
d. how much powdered enzymes are you giving with each meal?
e. what is the brand name of the powdered enzymes you are currently giving?
f. Metronidazole.... No! PLEASE ask tell your vet that you do not want to use Metronidazole but prefer
Tylan (Tylosin Tartrate 100 grams soluble powder) Metro kills ALL the gut bacteria, you don't want this,
but if you HAVE to use an antibiotic, go with Tylan as Tylan is a macrolide antibiotic and will not kill
all the bacteria but rather will inhibit the bacteria reproduction. So although still not ideal, MUCH better
than Metro. Besides, Metro should not be used for any chronic gastro intestinal issue, like EPI (which
is chronic) now only be used for certain situations they (see 202 research out
of Texas A&M Gastro Lab https://epi4dogs.com/sid-sibo-microbiome-research/
.. this is the first research listed at the top of the page.

Once you can answer my questions above, i should be able to help. A LOT of times, something of the recommended protocol needs to be tweaked in order to start seeing results. this is why i am asking these questions. Looking forward to hearing back from you and hopefully being able to help you ou.t
Olesia, was owned by Izzy, a 35lb Spanish Water Dog (SWD), Diagnosed at 1.5 years old - TLI results 1.. Izzy passed away on February 13, 2020 at 15 years old. She lived with EPI for 13+1/2 years. It was because of Izzy that Epi4Dogs was started... she was the inspiration. May her legacy of helping others with EPI continue for as long as needed.........

barbhamon@gmail.com
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Pet name: Sarge
My name: Barb

Re: Dog not responding after 5 months

Post by barbhamon@gmail.com » 01 Oct 2021, 16:26

(1)He is getting 2 B12 capsules per day as recommended on the bottle (2)He is on TOTW grain free Pacific Stream , 150% of his normal meals 4 times per day with 1 tsp of enzymes, enzyme Diane 6x(3) He is through with the metronidazole and I have already discussed with the vet that should he have to go back on antibiotics I want Tylan. I have been reading most of TAMU's research and saw where they recommend Tylan (thank you). In reading EPI4Dogs posted information I have also started giving him slippery elm. I have also just reordered enzymes, but have switch to the 8x thinking perhaps he just needs stronger enzymes. I was also concerned the medicine he had to take for post surgery might have had an effect on him, but he is also through with that now. As per you recommendation I will cut out at least one of his B12 capsules. Do you think I could be over doing things? I've been around dogs with EPI and understand the disease but never actually owned one and that makes a big difference. I sometimes think since I have been in the animal industry for years I tend to overthink things. Thanks for your response and I look forward to any other help.

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Olesia711
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Re: Dog not responding after 5 months

Post by Olesia711 » 01 Oct 2021, 16:56

with EPI, we WELCOME "over-thinkers" :D

The deal with EPI (if this IS solely EPI) is that you kind of have to scrutinize and test things one-at-a-time to figure out what needs adjusting and what may or may not work, no matter what is recommended. This is why we suggest keeping an EPI log.

1. Okay, yes, i DO think you are giving way too much B12. Especially since he is already getting shots too which may or may not be working. i don't go by WOnderlabs B12 dosing protocol, but rather prefer to use TAMU. Their B12 injectable dosing is the same for oral 1000mcg B12. However that being said, there are a few GSD EPI dogs that actually do need 2 Wonderlab capsules daily, however, i prefer to start conservative and increase if/when there ar symptoms or a B12 re-test show that the B12 levels are off the charts.
Since your dog is getting weekly B12 shots, to cover things, just in case the cyanocobalamin B12 is not being absorbed as expected, i would also give the B12 capsules but lets give 1 capsule 4 days a week....until the shots are completed. See if this make ANY change.

2. that is great that you are feeding 4times a day... and 150% of what your dog needs... this is GREAT... but, specifically how much are you feeding at each meal (1 cup or more) and how many tsps of enzymes are you including with each meal??

3. Next, and supposedly this shouldn't matter, but we found with some dogs, it actually does make a difference.... are you adding a wee bit of liquid to the food (just enough to moisten it slightly) and then adding the enzyme powder and letting it "incubate" for about 20 minutes??

Looking forward to your response.

BOTH issues above can cause what you are describing.... BUT..... i would like to hear exactly how much food you are feeding at each meal with how many tsps of enzymes with each of those meals...........

And i also have another consideration, but would like to hear from you first.........
Olesia, was owned by Izzy, a 35lb Spanish Water Dog (SWD), Diagnosed at 1.5 years old - TLI results 1.. Izzy passed away on February 13, 2020 at 15 years old. She lived with EPI for 13+1/2 years. It was because of Izzy that Epi4Dogs was started... she was the inspiration. May her legacy of helping others with EPI continue for as long as needed.........

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Olesia711
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Location: North Carolina
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Re: Dog not responding after 5 months

Post by Olesia711 » 01 Oct 2021, 17:02

sorry for all the questions.... but sometimes its a little detail that can be the problem......
ANother question for you... when you started the SLippery Elm.... is that when the poo started to improve before it went down hill again? What did you notice when you started the SLippery Elm... it's pretty immediate acting... so poo any observation shortly there after or within maximum 2 days can be tied to the Slippery Elm.

Also... how much SLippery Elm are you giving and are you giving it with every meal or what.
Slippery Elm most of the time is like a miracle supplement.... BUT.... with some dogs it doesn't work at all AND it is a fine line giving just enough and not too much cause it is a dietary fiber & mucilage and too much will actually trigger loose stools, even though dietary fiber is what helps get SID in check.....
Olesia, was owned by Izzy, a 35lb Spanish Water Dog (SWD), Diagnosed at 1.5 years old - TLI results 1.. Izzy passed away on February 13, 2020 at 15 years old. She lived with EPI for 13+1/2 years. It was because of Izzy that Epi4Dogs was started... she was the inspiration. May her legacy of helping others with EPI continue for as long as needed.........

barbhamon@gmail.com
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Posts: 13
Country: United States
State: Kentucky
Pet name: Sarge
My name: Barb

Re: Dog not responding after 5 months

Post by barbhamon@gmail.com » 01 Oct 2021, 19:02

Okay. His normal food was 4 cups/day, 2 in the AM and 2 in the PM. He is now getting 6 cups/day, 1.5 cups 4 times/day with 1.5 tsp. 6x enzymes with small amount (may 1/3 cup)warm water and marinated for 20-30 minutes. As for the slippery elm, I took him off that while he was on the metronidazole but I was giving him 1 tsp twice a day. He has had so much going on lately I can't honestly say if that helped or not. I have now started a dated journal as you suggested so I can keep track of his progress (or lack of it). The more questions the better. I feel walking this path with people who have already walked it is the best way to navigate out of the forest and get to the clearing. Thank you so much for your time. :)

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Olesia711
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Re: Dog not responding after 5 months

Post by Olesia711 » 01 Oct 2021, 23:30

Thank you so much for responding to my latest slew of questions.... i just wanted to make sure that you are giving the right amount of enzymes with the food... Sounds like you are doing everything possible to help this dog get better. And At this point, don't add the Slippery Elm back to the regimen just yet.

A tsp of SLippery ELm might have been too much, but no matter at this point... sometimes to figure out what is going on/what needs to be tweaked ... you need to step back and go back to basics.

SO... from what i am reading.... and glad you have started keeping a journal... this will help you identify patterns and that in turn will help you figure out what is helping/hurting) my thought is as follows;

1. The first thing to try is reducing the amount of B12 pills that you are giving... since you are still giving the shot. Give this a few days and see if this helps at all or not.
2. if you do not see ANY improvement at all from the above, then the next thing to try is give a pinch more enzymes (not forever, just for now) with each meal. Since you are feeding 1.5 cups of food.... try giving 1+3/4 tsp of enzymes.... watch poo for about 3 to 5 days, see if this improves the poo.
3. If still no improvement for either #1 or #2 ... ask your vet to have you try TYlan. GO here for the dosing instructions: https://epi4dogs.com/antibiotics/.
4. If/when you start the TYlan.... about 1/2 thru the 45 days... ask your vet to give you a pre+probiotic to add to the regimen. Ask for either Visbiome or Proviable. WHen starting a pre=probiotic... ALWAYS start with LESS than half the recommended dose and over the course of a week or two, work your way up to the full dose. WHen you reach the 45 day mark, do not stop the Tylan completely but rather, slowly withdraw from it over the course of the next few weeks week 1 after 45 days, give 1/2 dose of Tylan morning and night, week 2 after 45 days, give 1/2 dose of Tylan once a day, week 3 after 45 days, give 1/2 dose Tylan every other day.... and then stop... this "sometimes" helps the SID to not get out of control again.

If you can, post poop pics here.... you'd be amazed at how much we can tell from looking at actual pictures.
if none of the above works, (and i don't mean that you have to wait until you go thru the 45+ day course of Tylan,,, but after a week on Tylan if you still are not seeing ANY difference/improvement).... then it is possible that the TOTW is not an optimal food for your dog and you need to try something else ... OR..... it could be that your dog has EPI + IBD and may need to try a hydrolyzed food... however, just based on what you already told me, i don't think this is the case.. To me it sounds more like you just have not found the right balance of the recommended protocol.

Please keep us posted, post pics and try these things, one-at-a-time, keeping the journal will REALLY help both you and the vet, and chat with us and we will walk you thru as best we can.

Oops... forgot to ask you one more thing..... is your dog experiencing anything that appears like acid reflux?
Olesia, was owned by Izzy, a 35lb Spanish Water Dog (SWD), Diagnosed at 1.5 years old - TLI results 1.. Izzy passed away on February 13, 2020 at 15 years old. She lived with EPI for 13+1/2 years. It was because of Izzy that Epi4Dogs was started... she was the inspiration. May her legacy of helping others with EPI continue for as long as needed.........

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Jean
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Re: Dog not responding after 5 months

Post by Jean » 02 Oct 2021, 07:21

Hello Barb

so you cant get his results of the TLI test if I read correctly, that really is important

and dealing with bloat is horrible, and one of the reasons for bloat is said to be undiagnosed EPI , or badly managed and I dont think you fit into either

is he still permanently hungry ?

It took the best part of a year for my girl to start putting weight on properly, and its hard to watch them

we used to give a late evening meal of scrambled eggs and mashed potato enzymed as per volume this helped her get through the night

I dont really have anything else to add as Olesia has asked everything

the only thing here as she says is try a different food, my girl was intolerant of most proteins, she could tolerate lamb , but chicken in dog food was a no no as was poultry fat

the food you are using is a good one

https://www.tasteofthewildpetfood.com/t ... ed-salmon/

but again maybe its not enough for him calorie wise, what is his current weight, and how heavy should he be for his build
My name is Jean we live in Liverpool in Uk

I am the Forum Director which I am very proud of

My Kara born 21 July 2009 diagnosed with EPI by cTLI test August 2010 TLI = <1...folate 14 Cobalamin 408, shot down to 94, b12 injections every other day

Lowest weight 39 pounds

We used Panzym enzymes, Tylan and Chemeyes b12 capsules

Sadly, on 10th May 2019, we lost her to DM


Jeanx

Tuckaboo Pam
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Re: Dog not responding after 5 months

Post by Tuckaboo Pam » 02 Oct 2021, 07:59

Hi Barb, and welcome to you & to Sarge. You are in a good place, on this forum. So many of us have gotten help from this wonderful group of dog-loving people.

Ask all your questions, we all check occasionally to see if someone needs help.

I noticed at first that you may have been giving too little enzymes. The ratio of 6X is 1 teaspoon/ 1 cup of kibble. The ration of 8X is 3/4 teaspoon/ 1 cup of kibble, since you mentioned them. I think Olesia wants you to bump it up because you are struggling. So, you will be giving 1 3/4 teaspoons 6X to 1 1/2 cup of kibble, 4 times a day, right? I'm just trying to be clear because sometimes the smallest detail can make the difference. If you do order the 8X, let us know so we can help with the adjustment.

Tucker does OK when I feed him TOTW Pacific Stream, but he does better on Sport Dog Elite buffalo & sweet potato for herding dogs. Can be ordered from their website or sometimes from Amazon

For weight gain it is sometimes suggested to see if dogs can tolerate adding some coconut oil to their meals, too.

Take care, and please post your test results when you can. --- Pam & Tucker
Tucker was a shepherd/lab mix--- TLI 1.3, Folate 9.7, Cobalamin 666, Lipase 38. Took Diane's Enzymes 4 teaspoons/day, Wonderlabs B12 one capsule per day, and Tylan 1/16 teaspoon/ morning (to hold SID at bay). Taste of the Wild High Prairie, 1 1/2 cups/day, with a total of 4 cups of Fresh Pet. Stopped eating everything in sight, and went from 60 to 85 pounds! Tucker was my boyfriend, and my husband was OK with that. Tucker succumbed to hemangiosarcoma, but we cherished every day we had with that wonderful, beautiful boy. I will always, always miss my sweet big boy.

barbhamon@gmail.com
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Re: Dog not responding after 5 months

Post by barbhamon@gmail.com » 02 Oct 2021, 14:47

Hi everyone and thanks for your input and encouragement. I feel much better knowing there is a wealth of knowledge from experience to learn from. Just to recap, Sarge came back to me about 5months ago (I puppy raised him until he was 1). The people who had him couldn't keep him and called me to see what they should do with him. I picked him up and that is when I found out he had been diagnosed with EPI. I tried to reach out to them to see if their vet had him tested through TAMU, but have not been able to reach them. So, I took him to my vet and about a month ago decided to put him on the powdered enzymes and B12 shots. Since I can't seem to get the TLI results (if there were any) I am going to have my vet do the test when he does the B12 test after his current round of shots are completed. This will be in about a month since they have to do that test a month after the last shot. So I should be able to let you all know those results when I get them. Meanwhile I have started on the regimen Olesia has suggested. Since yesterday I have stopped the B12 capsules and will give him 1 3 times a week and have increased the enzyme amount. As of today, this morning's poo was quite a bit, formed but still mushy. This afternoon's poo was a nice surprise. It wasn't quite as much and had better form and more solid. The color was a good chocolate brown. It was the best it's looked since I've had him back. I know this may have been a fluke since I don't believe a change could happen this quickly, but I'm encouraged and I'll take it. I will continue to post updates and hope you all don't get tired of my questions and picking your brains for information. And one more answer for Olesia, he doesn't seem to have acid reflux. The previous owners' vet had him on PanacrePlus tablets and Omeprazole which they said he had been on for a month. Again, thank you all so very much.

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