Waiting on Test Results

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.
brittany
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Country: United States
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Pet name: Beau
My name: Brittany

Waiting on Test Results

Post by brittany » 24 Oct 2021, 13:10

I have a 3 year old German Shepherd who has been having chronic diarrhea for three/four weeks and has lost 10 lbs in that time. We did the blood draw for the GI panel which will test for EPI, but are waiting for the results. Our vet said we could try adding enzymes to see if it helps while we wait for the results to come back. Last night I bought Pancreatin (from the Vitamin Shoppe) and crushed some of the tablets (according to what I read on EnzymeDiane.com) and added it to his food last night and this morning.

He sleeps in the laundry room at night and this morning was the first morning in weeks that opening the door didn't immediately overwhelm me with the smell of dog farts. This seems to be a good sign, right? Or maybe just coincidence? His poop was still very loose, but less yellow and more of a brownish color.

From what I've read, you have to get the balance of enzymes right for the particular dog in question, so I'm wondering how long it takes to know if the enzymes are helping?

Tuckaboo Pam
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Re: Waiting on Test Results

Post by Tuckaboo Pam » 24 Oct 2021, 14:40

Hi Brittany, and welcome! First off, here is a link that will give you a little more info on the emergency enzymes you have.
https://enzymediane.com/emergency-enzymes/

You may want to go ahead & order a sample pack of 6X enzymes from enzyme diane (they are good quality, and a fraction of the cost of the enzymes you may get from your vet...a lot of us use them). This will put you ahead of the game, if the EPI test is positive.

Glad to hear the doggy toots subsided last night! And since that's the case, I'll go ahead & write a quick tutorial for you.

Treatment of EPI is based on four cornerstones. If you are feeling overwhelmed at the prospect of a lifetime of enzymes, etc, know that we have all been there. We are here to walk you through the process, though, and we will also help you save some money.

1) DIET-- food should have 4% or less fiber, and hopefully be grain-free without legumes or white potatoes. While getting your guy's weight back to normal, you should feed 150% of the amount you would feed at his normal weight. Daily feeding should be split into 2 or 3 enzymed meals.

2) ENZYMES---Most enzymes are in the powder form, and the ratio is 1 teaspoon enzymes to 1 cup kibble. Diane's page says 7 to 9 crushed pancreatin pills= 1 teaspoon of her enzymes. Enzymes & kibble should be doused with water or broth, and marinated for 20-30 minutes before feeding.

3) SID is a condition that all EPI dogs have, and it can be treated with slippery elm, probiotics, and/or Tylan. Many vets prescribe metronidazole, but current research says Tylan is the one to use.

4) B12---most EPI dogs need B12 supplements. Normal range is not enough for them. Some vets give injections, some of us use Wonderlabs Pet Factor B12, with intrinsic factor. Easy to find online.

All dogs are different, and since you seem to have caught this early, it might not take too long for you to start seeing some weight gain. For me, it was a few months, and Tucker gained 20 pounds. Actually, he got a little too fat for awhile. This happens.

I hope this helps. When your vet calls with the results, please ask her to email them so you can post them here on this thread.

Take Care!---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.

brittany
Member
Posts: 4
Country: United States
State: Washington
Pet name: Beau
My name: Brittany

Re: Waiting on Test Results

Post by brittany » 24 Oct 2021, 17:29

Thanks for your reply! I will definitely be ordering those enzymes - it has to be easier than crushing these pills.

When do you feed the probiotics? His vet prescribed Fortiflora (before we discussed enzymes) which is sprinkled on his food - will the enzymes kill the probiotics if they're given at the same time? Sorry if that's a dumb question, I'm probably going to be full of those.

Beau has never been fat - always a little too thin which has made his weight loss kind of dramatic. Getting a little chubby for once might be a good problem to have. :)

brittany
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Posts: 4
Country: United States
State: Washington
Pet name: Beau
My name: Brittany

Re: Waiting on Test Results

Post by brittany » 30 Oct 2021, 00:29

Got the results back for Beau and it's just led to more confusion. It says he doesn't have EPI, but when I stopped the enzymes the diarrhea started again about 36 hours later. The vet said we can continue giving enzymes at least until we speak to the specialist to give him some relief. I read the Non-EPI EPI article which (if I'm reading it right) suggests that maybe in dogs like Beau there is a specific enzyme which is not being produced, but other enzymes are still being produced appropriately which could lead to a negative EPI test?

Here are the results:
Spec cPL - 30
TLI - 18.0
Cobalamin <150
Folate > 24.0

Tuckaboo Pam
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Posts: 1345
Country: United States
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Pet name: Tucker
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Re: Waiting on Test Results

Post by Tuckaboo Pam » 30 Oct 2021, 19:36

Brittany, off the top, it seems Beau's B12 is low, but someone on staff can clarify that. Many of us use Wonderlabs. I do, and Tucker's B12 isn't even technically low. As far as the TLI score goes, we will also have to wait on staff, because I don't want to give you any wrong information. I would do what your vet says.

Initially, you mentioned dog farts, which makes me think SID. You could try adding slippery elm & see if that helps, too, but please don't give him metrodinazole, which many vets prescribe for diarrhea.It wreaks havoc on a dog's insides. My maltipoo took it, and she is a mess now. If you give an antibiotic, ask if you can get Tylan prescribed, instead.

I know this is a lot, and I'm glad you have an appointment with a specialist. Hang in there. I am going to try and reach someone on staff & see if they can help.


Hang in there---Pam
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.

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Olesia711
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Re: Waiting on Test Results

Post by Olesia711 » 30 Oct 2021, 20:35

Hi Brittany,
Glad the enzymes helped... and i will explain a few scenarios with you why the enzymes might be helping which we encourage you to share with your vet. BUt first to answer your question... yes you can give Forti Flora (or any probiotic) with food that has enzymes in it... it won't hurt a thing!

Scenario #1
So.... yes it is possible that there are other digestive enzymes that are truly lacking but not the lipase (fat digesting enzyme)...... so... what you can try to see if this might suggest that this is the case (although this possibility is rare) is try a plant enzyme product that has a lot of Amylase and Trypsin and Protease in it.. Usually plant enzymes are loaded with Amylase (carb digesting)and Trypsin & Protease (protein digesting) ... but plant product enzymes are light in animal Lipase (best fat digesting enzyme vs. non-animal lipase).

Scenario #2
However, what you are describing could very well be SID (small intestinal dysbiosis) that is being triggered by some food sensitivity....
Can you tell me what the Folate score was on the Cobalamin test that your vet did????? For SID.... the recommendation is first try a prebiotic, (we often use SLippery ELm powder), if that doesn't work, then try a symbiotic combo lor a pre & probiotic, CUrrently we are recommending Proviable or Visbiome . IF this doesn't work THEN we strongly suggest giving a 45 day/twice a day course of TYlan (DO NOT Give Metronidazole!!) . Once you are halfway thru the course of Tylan then introduce either Visbiome or Proviable or another per+probiotic that your vet recommended to the regimen.... you can give a probioti with TYlan as the Tylan is a macrolide and will not kill the probiotic.... whereas, you cannot do this with metronidazole as it will kill all the probiotic and bacteria in the gut flora.

In the Cobalamin B12 testing......If the Folate score portion was 7.7 or less... then your dog most likely has small proximal intestinal disease....and this would explain everything. Small Proximal Intestinal Disease covers a range of gastro issues, but the most common in laymen's is in short, is some sort of food sensitivity and (please share this with your vet) we have had multiple dogs who did NOT have EPI, had scores just like this (in the teens/low 20's) but the Folate score was 7.7 or less and when they were given enzymes they did well, when the enzymes were removed, the loose stools returned. Quite honestly i have no idea why this happens but for whatever reason, it was recommended in every case to continue with the enzymes.

The key is to not just give enzymes because they help without a diagnosis.... but if you figured out the cause of the issue like, small intestinal proximal disease and if the enzymes help, then give them. Just don't "assume" that this is what is going on. Always test.

Scenario #3
It is possible that your dog has neither the rare EPI without EPI condition and also does not have Small Proximal Intestinal Disease... but rather.... EPI in the making. We have also had a small handful of dogs who had ALL the symptoms of EPI, but yet when tested, same thing, test results were in the teens and definitely not clinical EPI, not even close. Owners/Vets ran all kinds of tests.... nothing else popped up.... however symptoms persisted, enzymes helped.
So they retested... TLI score came back lower but still not EPI. Was recommended to test again... i think it took a year.... but then the dog when re-tested again was in full blown EPI. This happened with a few dogs, not very common but not impossible either. SOOOOOOOoo... please share this with your vet also.... if you cannot find anything else wrong with your dog.... re-test for EPI in another 3 to six months.... and if the TLI score dropped some more... THEN, stay on top of it cause your dog might be segueing into EPI in this very uncommon way.

I know i didn't give you any direct answers, but these are some very possible scenarios that i hope you will share with your vet ... just in case.

In the meantime, i'll contact Madelon, her dog experienced #3...... and she can give you a better understanding of how this happens..............
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.........

Tuckaboo Pam
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Posts: 1345
Country: United States
State: Florida
Pet name: Tucker
My name: Pam H.

Re: Waiting on Test Results

Post by Tuckaboo Pam » 30 Oct 2021, 21:31

Olesia---her results say cobalamin <150, folate >24.
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.

Tuckaboo Pam
Member
Posts: 1345
Country: United States
State: Florida
Pet name: Tucker
My name: Pam H.

Re: Waiting on Test Results

Post by Tuckaboo Pam » 31 Oct 2021, 13:11

Brittany---

Scenario #3 is likely where Tucker would have fallen, if he'd been tested earlier. Ribs & hip bones showing no matter how much I fed him, eating poop & toilet paper for years, before the yellow diarrhea set in. Keep on it...he's lucky he's yours!
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.

brittany
Member
Posts: 4
Country: United States
State: Washington
Pet name: Beau
My name: Brittany

Re: Waiting on Test Results

Post by brittany » 31 Oct 2021, 13:13

Thanks everyone for the replies, I really appreciate it!

The vet did say his B12 was low, so we were given some B12 injections which we started last week.

He certainly has food sensitivities - he has been on a hydrolyzed protein diet since he was a puppy and any attempts to put him on a different food caused diarrhea. I have noticed over the past several months that he's been becoming more sensitive to treats that used to be okay - I only use beef treats with nothing else in it, like steak or beef lung - and even small amounts seemed to trigger diarrhea.

He was treated with metronidazole for 1 week when the diarrhea started, but I spoke with my vet regarding SID and tylosin and he prescribed 1/4 teaspoon once a day for 1 week. I haven't picked it up yet because I wanted to restart the enzymes and be certain they were helping before starting the tylosin.

One thing that makes me think it is not EPI is that he does not appear to be super hungry anymore. At first, he ate the food with enzymes enthusiastically, but now (after 3 or 4 meals with enzymes) he seems reluctant to eat it. I read loss of appetite can be attributed to low B12 and/or SID, so maybe it's related to one of those issues?

I also noticed a few pieces of totally undigested kibble in his diarrhea this morning, so wouldn't that point back to EPI? Thanks again for the help!

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Olesia711
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Posts: 3857
Location: North Carolina
Country: United States
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My name: olesia

Re: Waiting on Test Results

Post by Olesia711 » 31 Oct 2021, 13:41

Yes!!! Low B12 and with some dogs SID can both trigger diminishing or lack of appetite!

Regarding the Tylan dosing... Since Beau is a GSD... i am guessing he is in the 70lb/+ weight range... your vet is correct he needs 1/4 tsp BUT.... he needs to take the Tylan TWICE a day, with breakfast and dinner..... once a day will not do it. (these dosing instructions are per Texas A&M Gastrointestinal Lab in treating SID.

AHHHHhhh... so he DOES have food sensitivities....and is on hydrolyzed food.... glad you know this, are aware of it and properly treating it!
I wonder if this is just a flare up..... my understanding is once they start having food sensitivities/allergies.... very often they can either get more severe with that food item and/or they can develop even more sensitivities..... so bearing this in mind.... maybe this is what is going on.........
Ultimately if nothing helps, there is always prednisone, but that is a call that needs to be made by your vet. How much, how often. Prednisone is a double edge sword. It can be a life saver but can also do a lot of future damage (been there done that).............

Also... VERY glad that you have him on B12 too.... usually B12 supplementation takes anywhere from immediate up to 3 weeks to see any impact.....

Since you found whole kibbles in the poo...it doesn't necessarily mean Beau is heading into EPI..... BUT.... if you and your vet cannot come up with a diagnosis and do not think that this is a flare up of the food sensitivities..... then i would definitely do another TLI Blood test in 6 months... to give you and your vet an indication of this could possible be EPI in the making...............even though technically, at this point in time, he is not clinically EPI nor sub clinically EPI.

One last tidbit. the lack of appetite.... in case this continues even with the B12 supplementation... have your vet check him over for any possible kidney issues. SOmetimes lack of appetite is the first indication that there is an issue. BUt quite honestly, from what you are describing, to me it just sounds more like food sensitivities that have triggered a nasty case of SID....... SO...... hopefully the tylan (TWICE a day!!!) will improve things.
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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