Razzie 14 year old

[diggininit]

Thank you for accepting me into the forum. It was suggested that I join this forum by a member of an EPI Facebook group. He suggested I post my story to your group as maybe you can help, so I will get my notes together and try to condense my story with my girl so as not to make a novel for you all to read. Just wanted to say Hi and thank you for now. - Cheryl

[Jean]

Hell Cheryl and welcome from me in UK

Tell us as much as you can and we will do what we can to help

Jean

[Shirl D.]

Hi Cheryl, and welcome to the forum. I think Jean meant hello, too, not hell! LOL! Unless the hell was a commentary on all it sounds like you've been through. Make sure when you give us the story that you tell us the specific enzyme you're using, how much and how you use it, what food and how much food you are feeding. The more details, the easier it is to figure things out.

[jilbert57]

Hi Cheryl and welcome to you and Razzie. Thanks for getting your pups information together. We look forward to helping you.

[Jean]

it was definitely HELLO many apologies

j

[Madelon]

Hi Cheryl - welcome to our EPI family!! We are here for you and it doesn't matter how long your story is - the more details the better.

[Olesia711]

Hi Cheryl and WELCOME!

Please cut and paste from FB Razzie's story... we'd love to hear all about her and no story is too long!
Besides, many of the folks on the forum are not the same as the folks on the FB page, so please don't be concerned about repeating anything

[diggininit]

No guys, that's fine. I have just read your welcome and didn't think a thing about the "hell" statement. lol. Just having a lot of problems with her lately. We had her tested for EPI, her EPI was fine, her B12 was fine, her folate was on the high side. I tried to tell my vet that high folate could mean SIBO. She totally discounted that. The EPI - the report said could either be Pancreatitis, Kidney/Renal or Starvation. Well, that didn't really tell me much at all. She stays dehydrated all the time, drinks tons of water, is very wobbly, I have to give her fluids at least twice a week, she flinches if you just touch her. Last night while giving fluids she kept taking one of her back legs and was pulling it up by her stomach. Did that several times. First bet says she has liver disease, then vet says she has IBD, then says she probably has cancer, then wants to put her on prednisone. Her liver ALT was up 1100 back in November. I took her off, or cut way down the Carprofen. She has Spondylosis, hip dysplasia, so I guess with the TLI/cpli - her cpli was fine, her TLI was elevated, so I guess she doesn't have EPI. I still think she has SIBO. Her vet just said continue on with the Tramadol, Carprofen and star on the prednisone. I have another appt with a different vet in hopes that he can come up with something concrete from all the tests we've run. So, thank you, but unless she really doesn't has EPI, I feel like I would be wasting your time on this forum. She may have liver disease, she has not had a biopsy, nor an endoscopy. She had an ultrasound about a year ago and it showed nothing, except one of her adrenal glands were smaller than the other. She has tons of muscle waste and is about 30 lbs less than she could be. Vet wants to keep her on the Purina EN, she hates it, and I don't think she is even assimilating it as I still find grinds of corn in her poop. She has frequent diarrhea, however, since I took her off of the Purina and put her back on TOTW (Taste of the Wild), this week she hasn't had any diarrhea. I'm at a loss and I am beginning not to trust this vet, thus I am taking her to a different one Thursday.

[Olesia711]

Oh wow..... you sure are dealing with a lot.. and the worst part is not knowing and the vets not knowing *sigh*

Glad that the TOTW foods seems to be agreeing better with her.... and a dog can get SIBO (now called SID) with any gastrointestinal condition.... does not have to have EPI.... and those Folate scores are USELESS!!! TOTALLY! I get discouraged with vets that are not current and still use the folate score as a guide to test for SID.. "The best way to assess SID/SIBO is by (1) symptoms and (2) accompanying medical ailment, in this case EPI, and treat early on for best results. Folate test results such as Culturing, Counting bacterial numbers, and Duodenal juice collection all have majors flaws in their technique rendering them inaccurate indications of SID/SIBO. Recent studies have determined that it is not the number of bacteria but rather “the type of flora and/or how the host and flora interact that are more important than numbers.” Also.... just a FYI.... when a dog has SID in play, their ALT is elevated... just like what you are seeing.. and it is because of infection from SID. However, if the AST (the other liver enzymes is elevated) then you have something to be concerned about.

I think you are on the right path regarding seeking another vet opinion.....

Also.... even though your dog is not EPI, please know that you are still welcome here!

[diggininit]

TLI (1) 46.1 5.0 - 35.0 ug/L HIGH
COBALAMIN (B-12) 710 284 - 836 ng/L
FOLATE >24.0 4.8 - 19.0 ug/L HIGH
GI PANEL W/ SPEC cPL K9 : SPEC cPL
Test Result Reference Range
SPEC cPL 110 0 - 200 ug/L
So her TLI was 46.1 - high
B-12 was 710 - normal
Folate was >24 - High
cpl - GI Panel 110 - normal

Liver enzyme test as of 12/28/2018
ALT 392 18 - 121 U/L HIGH
AST 53 16 - 55 U/L
ALP 175 5 - 160 U/L HIGH
GGT (2) 39 0 - 13 U/L HIGH

Liver Enzyme Test as of 11/25/2018:
ALT 1122 18 - 121 U/L HIGH
AST 86 16 - 55 U/L HIGH
ALP 142 5 - 160 U/L
GGT (2) 20 0 - 13 U/L HIGH

After the 11/25/2018 test with ALT at 1122, I took her off the Carprofen, well, lowered the dose to less than half of what she was taking. Lowered the Tramadol to 1/4 of what she was taking and the vet said the "liver pills" with Milk Thistle seems to be working. I e-mailed my vet after the EPI test was done and asked her what the high TLI & folate meant. She never responded, probably because I told her I had hoped she would send the test off to Texas A&M, but it appears that IDEXX did it. I told her I am tired of guessing what might be wrong, send her a long email and asked her to try to connect the dots between the tests of November & December and come up with something. Asked her if we did another ultrasound will it definitely show inflammation in her intestines/stomach/liver, gall bladder, etc, will it show her thyroid glands or any tumors in her stomach, liver - all organs and she never answered me back. Guess I asked too many questions.

So, I bought some enzymes - porcine based, just to try on her for a few days to see if they made any difference, but I don't know how much to give. It was the Now brand that was listed as "emergency enzymes" and I didn't pay attention when I bought them and I think they are 10X so I don't know how much to give. I am already giving probiotics (Forti Flora) of course from the vet, probably the most expensive, and I was reading last night that dogs who ate other dogs poop do it because other dogs poop has enzymes. Have you ever heard of that? She is a poop eater. I have almost an acre of backyard and try to get out often and pick up - at least 3 times a day as I have 2 other dogs and of course no one goes out at the same time, so it is a constant poop detail job for me. Of course I always seem to miss a pile here and there and she should have been a bloodhound as I think she can smell poop miles away. She never eats her own. I wouldn't either as it is like soft serve ice cream, she prefers the more firm kind. Maybe I should try the enzymes and prednisone?

I had to cancel the other vet today as something serious came up with my Mom, so I told them I couldn't help it, but I will reschedule it for next week. Of course much more blood work was done besides the liver tests and EPI. which I didn't include. I just asked my vet to try to connect the dots and come up with something.

Someone had asked that I copy and paste the original post from Facebook, so here it is:

Hello and thank you for adding me. Long post, but I am at a loss. I have read and read about symptoms of IBD vs EPI. Seems most of the symptoms are the same. My vet insists it is IBD. She is 14 years old, a Rhodesian Ridgeback. My vet also insists she has Liver disease. My vet also along with two other vets said just treat the Liver disease as she is too old to undergo liver biopsy. She is too old go undergo Endoscopy to test for IBD. I am tired of guessing and trying different things without a definitive diagnosis, but what is my choice. So I am asking here if some of you will tell me what symptoms yours experienced with EPI. I asked my vet to do the EPI B12/folate test and she just came back with she has liver disease and since her levels have come down, we are doing the right things. If she is still miserable, then we are not doing the right things, IMO. History - 14 years old, spondylosis, liver enzymes ALT was at 1122. December down to 392. GGT was 20 November, now 39. I thought dehydration was part of EPI, but now I guess I've read too much and got dehydration confused with something else. December 2017, rapidly started losing weight and is down from about 85 to 62 lbs. Has a voracious appetite, will eat anything you put in front of her, can never get full, drinks water all the time. Currently with the unconfirmed medical diagnosis of IBD, she is on Purina EN, which she absolutely hates. For her arthritis/spondylosis, she is on Carprofen and Tramadol, for her "unconfirmed" liver issues she is on a milk thistle supplement. She stays dehydrated and gets fluids at least once a week if not twice. I fear we are treating her for things that have not been medically confirmed as I see a lot of similarities between IBD and EPI, this is where it is getting confusing. I am going to have my "hospice" vet do the EPI and B12 test just to rule that in or out. The problem is, she's too old to be under for any invasive tests, so the problem is I will never know if she has true liver disease or IBD. She did have a ultrasound May 2018 which showed nothing - no enlarged liver, no masses, only that one of her adrenal glands were slightly enlarged. I may be wrong, but I feel like either the Carprofen or Tramadol were causing her high liver levels, so I took her down from 2 Carprofen per day to one and reduced the Tramadol from 150 mg per day to .75 per day. One month later her liver levels fell from 1122 ro 392. What am I looking for as far as EPI symptoms? Someone from the IBD group suggested this group as treatment for IBD vs EPI is different, and that's what scares me that I am treating her for the wrong thing. The vet just says, let's just keep her comfortable as she is not going to get better. I feel like she is on life support is all, but is still miserable. Doesn't make sense. Sorry for the long post, which is my first and thank you in advance for any replies I may receive.