HI there..... glad to hear that Roxanne's recovery and adoption is a wonderful success story.... WAHOO!!!
Now..... about Altuve.
First, Madelon gave you very sound advice, as far as pancreas goes.... when possible use powdered porcine/pig enzymes. They are the best and most closely aligned with the dog's natural pancreas enzyme function. However, if using raw panacreas.... THAT is when you opt for cow pancreas to avoid any possible bacteria with pig pancreas - -however if you ever use beef powdered enzymes you need to use more that pig powdered enzymes!
My guess is that it is a multitude of factors as to why Altuve is not doing as well as expected.
My suggestion is as follows (and you know the drill, do one change at a time- -watch & observe for a few days to see if things improve or worsen and then move on to the next change)
FOOD
1. With current food, try increasing the amount of enzymes by an additional 1/8tsp to 1/4 tsp each meal....see if that improves the poop.... if it does, that means you need /should change the dog food that this dog food is NOT working.
2. I do think a food change is probably a big cause of the problem here... although i will still cover other possibilities - so.....my suggestion is, for a food change, try SPORT food, grain free/pea free & fish based
https://www.chewy.com/sport-dog-food-el ... /dp/172138
Remember... until weight is gained back..... feed 150% of what is required... feed smaller portions, just more meals throughout the day... 3 meals will suffice.
ENZYMES
i strongly recommend EnzymeDiane''s powdered pig enzymes or PancreaPowder Plus powered's pigs' enzymes like was previously used... just know that the "extra" vitamin ingredients in Pancreapowder are not much to get excited about- -due to processing,if you want the EPI dog to have extra vitamin you really need to add separate vitamins, etc. but other than that it is a good product as is EnzymeDiane.
B12
Has the dog been rechecked to see if the B12 shots are working...sometimes in difficult/hard to gain weight cases, the underlying problem is that the Cyanocobalamin B12 (used in shots) is not working as well as expected, so then we suggest trying Wonderlabs oral B12 made with Methylcobalamin B12... You just might want to add this to the list anyway to try These capsules are cheap
https://www.wonderlabs.com/itemleft.php?itemnum=K9688
ACID
Try slippery elm powder first to see if this alleviates the "acid" issue. (is there a noticeable acid issue- -or are acid meds given just because ??)
It can either be acid from SID which is not really acid reflux - -but rather not enough of the right kind of acid caused by gut flora imbalance......OR..... this is a bile acid issue that is not in good control in which case acid meds are helpful. The following is a list of acid meds (if really needed) to try.... there are different brands and some work better than others on dogs with acid issue- -but please have the vet decide which one and how much to use: Some options are: Pepcid AC (famotidine), Prilosec (omeprazole), ranitidine, cimetidine, sucralafate, etc….
If the Slippery Elm helps.... then this is most likely due to SID not well managed.
ANTIBIOTICS
Is Tylan being administered? If the pre+probiotics don't work, and if the food change doesn't help might want to look at giving Tylan.... the right amount for his weight for 45 days/twice daily... if his SID is really bad and uncontrollable (which at this point does not sound like it is a major problem).... what can be done is take the daily dose and divide into 3 parts (and give with breakfast, lunch and dinner) rather than 2 parts (given with breakfast & dinner).
WEIGHT GAIN
Also.... once you get the dog straightened out with the right balance of things to manage the EPI... THEN what you can try is having the client add a little bit (start with 1/2 tsp) of extra virgin / cold-pressed / organic coconut oil. This will REALLY pack on the pounds and it is a healthy fat for EPI dogs. However...it is very rich and most can tolerate it very well, but start slow... and then over the course of a week bring it up to 1 tsp per meal "if" well tolerated.
The other thing that helps is adding healthy protein sources to the meal- -as long as the pup can tolerate these things (no allergies/sensitivities/ and tolerates it well with the EPI)... what can be tried one at a time and just a little at a time to see how well it is tolerated are:
- cottage cheese
Ricotta cheese
raw egg
extra meat (fat trimmed) like chicken, pork loin, beef, etc.
kippers (fish)
sardines
Please let us know if the client try any of this, how it goes and how we can be of further help.
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.........
So I'm going to throw out there what I know about him and his current diet and see if anyone here has a suggestion. Poor guy is still skin and bones. 
