Epi results came in. Very confused

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.
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Kzh
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Posts: 62
Country: Malta

Epi results came in. Very confused

Post by Kzh » 30 Oct 2018, 14:15

Hi
MY 9 month old GSD has been on oreon tablets for a month. He was having loose stools, anormous appetite and no weight gain. If you saw him you would think he was being starved.
3 weeks ago I took an epi test and I was very surprised about the result. It seems that he does not have Epi but his bit b 12 was low. Here are the results
Trypsin like Immunoreactivity
Value 8.9ug/1. Reference value >5
Vitamin B12. 225pg/ml
Folic acid. 5.36

My vet said I am the first dog he had with epi. So basically what this group advice me he will follow. He said he thinks that the result might not be accurate as my dog was on Creon for about a week before tli test was taken. He doesn't want to stop the epi and truthfuly neither do I. I do not want to go back to the nightmare I have been living for the past 5 months.
How do we Continue from here? I am going to the vet first thing tomorrow morning. So I ll appreciate any advice you can give me.
Thanks for listening

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Miss Maddie Moo
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Country: United Kingdom - England

Re: Epi results came in. Very confused

Post by Miss Maddie Moo » 30 Oct 2018, 15:52

Hello...confused :D
Okay the B12 is low but so is the folate the low folate can indicate a food allergy?which may be what you are seeing ..also the TLI is on the low side so it may be that you need to retest again in 6 months time to see wether this has increased or decreased...i would look at at course of tylan and look at the food you are using it may be that you do need some sort of hydrolysed diet, b12 and Tylan often we do see that enzymes do help but they should only be used short term in a non epi dog ....hope this helps.
Maddie DX April 2011 along with low B12 she was feed with a low fibre food below 3% , fat was not restricted ( she wasnt good on pea based foods ) She initially had a course of B12 shots weekly over a period of 6 months and then we used the B12 pills from Chemeyes in the UK . We used Panzym and slowly had to increase the dose as she aged when she was first DX she was 23kg but she gained weight quickly and got back to 33 kg .
Maddie gained her angel wings in Jan 2018 at the age of 10 to a condition unrelated to EPI.
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Kzh
Member
Posts: 62
Country: Malta

Re: Epi results came in. Very confused

Post by Kzh » 30 Oct 2018, 16:27

I may be reading the results wrong but did you say that the folate is low? And that the TLI is on the low side? Isn't value of greater than 5 means epi is most unlikely?
I had him tested for food allergy and he us allergic to all meats except chicken. Salmon, deer and rabbit. He is on a salmon and potato kibble so he should be OK regarding food allergy.
I do not understand why did the Creon capsules work if the test indicates he has no epi? And why is vit b 12 low if he has no epi? Is it possible I could get a false reading?
And regard to the low vit k. Do I give human injections or are there specificly for animals? Do I give injections or pills?
Sorry for the long post but I really wish I can understand all this. My vet is new to this too so any help will be appreciated.
Thanks

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Miss Maddie Moo
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Posts: 120
Country: United Kingdom - England

Re: Epi results came in. Very confused

Post by Miss Maddie Moo » 31 Oct 2018, 06:53

This link may help you .
https://epi4dogs.com/malabsorption/.

It could even be that your dog has IBD or some other malabsorption problem.
Maddie DX April 2011 along with low B12 she was feed with a low fibre food below 3% , fat was not restricted ( she wasnt good on pea based foods ) She initially had a course of B12 shots weekly over a period of 6 months and then we used the B12 pills from Chemeyes in the UK . We used Panzym and slowly had to increase the dose as she aged when she was first DX she was 23kg but she gained weight quickly and got back to 33 kg .
Maddie gained her angel wings in Jan 2018 at the age of 10 to a condition unrelated to EPI.
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jilbert57
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Country: United States
State: Washington

Re: Epi results came in. Very confused

Post by jilbert57 » 31 Oct 2018, 10:10

Welcome to the forum. Was your pup fasted for 12 hours prior to the Tli test being run?
My name is Jill and we live on the Hood Canal in Washington State. We currently have 2 Jack russells, TJ is 8 and Sadie is 2.

Mickey and his pancreatitis brought me to Epi4dogs.com site in 2012 to help manage it.
He lived from 6/99 - 8/2014

Mickey, Jack Russell. Chronic Pancreatitis. Dianes enzymes, 1/8t 3x/day with meals.

Kzh
Member
Posts: 62
Country: Malta

Re: Epi results came in. Very confused

Post by Kzh » 31 Oct 2018, 15:19

Jilbert57, yes he was fasted for more than 12 hours.
I had a vet visit today and he wants to continue the Creon enzymes as they have worked miracles on him.
I have given my vet all the information I am getting from this wonderful group as EPI is something not familiar here.
We also started on the vitamin B12 injections for the low B12. We are giving human B12 injections because here b12 for animals are not available.
MY vet does not want to give antibiotics at this point. He said that he is starting to do well on the enzymes. His diarrhea has stopped and he has finally started to gain some weight. He has gained 2 and a half kilo in a month. He said at this point giving antibiotics will be hard on the intestines and can kill all the good Bacteria and can do more harm than good.
MY vet thinks that the epi results could not be accurate. Is that possible?
MY vet has never encountered anything like this before so we are both relying on any help we can get from thus group. So please if any one has had a similar experience or can give me any info it would be appreciated. Thanks

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Olesia711
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Posts: 3858
Location: North Carolina
Country: United States
State: North Carolina
Pet name: Izzy
My name: olesia

Re: Epi results came in. Very confused

Post by Olesia711 » 31 Oct 2018, 17:42

Hi! And first, please tell your vet he is doing a great job with your pup!!!

I have been offline for a few days... so am just now catching up.... and must say, our members have given you great suggestions!

First... i agree with your vet, for now continue with the enzymes... From the test values, assuming they are correct... your dog does have some sort of small distal proximal disease (low folate score). Very often this is some sort of food sensitivity. The fact that your dog already has known food allergies supports this. If you are feeding foods that are well tolerated, then that is perfect! However... if a sensitivity develops to the current foods you are feeding,,, best to next move on to a hydrolyzed food.

Anyway... please share with your vet that we have been running this EPI organization for over 10 years, 24/7 ... and we have had other dogs test negative on the TLI test but had a low folate score, and they too improved when on the enzymes, and yet had problems all over again when the enzymes were stopped. We have no idea why the enzymes helped in these cases.
My suggestion is to continue on the enzymes for now and if/when your pup shows consistent signs of being stable, at that point try to slowly withdraw the enzymes and see if your dog can function without using them. If he can't, then i would continue to use the enzymes.

Regarding why the low B12. A dog does not have to have EPI to have low B12. Many dogs with other gastrointestinal conditions end up with low B12... some other health conditions are: IBD, IBS, PLE, Chronic Pancreatitis, etc.

Next.... it is also possible (and was mentioned above) that it is possible that your dog is showing signs of EPI but does not yet clinically have EPI. We have had dogs that test out in the teens on the TLI test... definitely not EPI.... but then... 6 month to a year later when re-tested, they had full-blown EPI. So this is another possibility of what might be going on. I strongly urge re-testing for EPI in another 6 months.

Regarding the antibiotics... your vet is 100% correct....most antibiotics kill all the bacteria (good & bad)....and most when dealing with a gastro issue like to prescribe Metronidazole (Flagyl)..... however....if after trying everything and your pup continues to have loose stools ... please have your vet check out our SID/SIBO page.... on that page there is a lot of info/research on Tylan (Tylosin Tartrate) which is a macrolide antibiotic and it does not kill all the bacteria but rather inhibit reproducing....This drug was initially designed for chickens, pigs and honeybees, but is now successfully used on dogs (and cats) in treating SID. the dosing info in on the SID page..... but.... again..... if you and your vet can get the loose stools under control without having to resort to antibitoics, even Tylan.... that would be best. What seems to work well on SID, although it take time for it to become effective is to use a PREbiotic along with and PRObiotics.... (prebiotics feed the bacteria in probiotics).


And...last but not least....although we are all focusing on possible EPI, and especially cause the enzymes appear to be helping... please work with your vet, keep a journal and record any other weird signs/symptoms your dog is displaying. Too many times we have had other situations like yours where it sure looked like EPI in the making.... and in the end it turned out to be something completely different like A-Typical Cushing, Tick disease... so keep an open mind and continue to examine other possibilities just in case this is something else that can be easily treated.

Sorry for the long-winded response... but i want to cover all the bases for you and your vet.
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.........

Kzh
Member
Posts: 62
Country: Malta

Re: Epi results came in. Very confused

Post by Kzh » 01 Nov 2018, 15:39

Olesia, thankyou you so very much for your long detailed explanation and advice. I have forwarded all the info to my vet. We are very grateful that we have found this group. We have been struggling with this for 6 months now, trying to find a solution.

We will continue to treat Zeus with the Creon and the B12. We have already gave him the first B12 injection. I have ordered the B12 tablets with intristic factor from wonder lab. Can I switch from injections to tablets? I don't want to stress him any further. He gets so stressed out going to the vet!
It's been a month now that our the stools have been normal. I finally have hope that I
will see my Zeus healthy and strong. He is for the first time ever acting like a puppy, playing and getting into things that puppies do. He is gaining some weight and muscles too. 😊

Thank you all for your support. So glad to have found this group

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Olesia711
Founder & Research Director
Posts: 3858
Location: North Carolina
Country: United States
State: North Carolina
Pet name: Izzy
My name: olesia

Re: Epi results came in. Very confused

Post by Olesia711 » 01 Nov 2018, 19:51

You are very welcome and glad to hear that Zeus is finally feeling better.... now to find out the real underlying problem... which can be a challenge sometimes.

Regarding the B12..... yes you can switch from the shots to the B12 pills... the change should not stress your pup. Just, once again... pay close attention to your pup's response as you want to make sure it "appears" to be helping even before you "re-test".

1. If you continue with the shots....... after weekly shots for 6 weeks, then do one dose after 30 days, and then retest the B12 30 days after that last dose.

2. If you switch to the oral pills..... again.... give daily administration for total 12 weeks and then re-test the B12 one week after finishing supplementation.

You will want to re-test the B12 levels for you and your vet to get a bench mark of where the levels are after supplementation and that will tell you (1) how well the B12 method you are using is working[pills/shots] and (2) your vet will then know how much B12 and how frequently Zeus will need it going forward to maintain good B12 levels to handle whatever gastrointestinal situation he has going on.
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.........

Kzh
Member
Posts: 62
Country: Malta

Re: Epi results came in. Very confused

Post by Kzh » 02 Nov 2018, 02:14

Thanks. 😘

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