Signs of Instability

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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Brin625
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Country: Canada

Signs of Instability

Post by Brin625 » 13 Feb 2019, 13:01

Hi there! Anja and I are previous members of the old forum, which we used several times shortly after she was diagnosed with EPI. Thanks to all the wonderful info I was able to gain from this site, Anja was stabilized and gained back most of her weight loss. However, now she appears to be in relapse. She has been on her original dry kibble (4% fiber) all along and since I buy 1 kilo of Pancreatin at a time, her enzyme values have not changed over the last 6 months. She began to have sporadic bouts of cow-patty type stool, seemed hungry all the time, and began to eat her own stool. This started occurring late November. About 2 months ago, I switched her over to a totally raw food diet. Her stool has never looked so normal as it does now! It was really great to see that change! But she continues to eat her stool, she's constantly hungry, she's quite gassy at times, she's a little more aggressive than normal, and although I have not weighed her recently, her backbone and ribs seem to be a little more prominent. The recommended amount of raw to feed for her body weight is 1.7 lbs. daily. However, because she is looking thin, I feed 2 lbs per day.

Her B12 issues are totally perplexing. As noted below, I was quite shocked at the huge spike in Anja's B12 levels. This occurred the end of July. So I did stop the injections as recommended by my vet and then 3 months later (end of October), Anja had a total collapse. She became very weak, almost overnight, and then by morning she refused to eat. She was extremely lethargic and could barely manage to go up or down the stairs. She couldn't manage jumping up into the car when I took her to the vet. I felt that her B12 levels had crashed. I had my vet draw the blood for her Cobalamin test first, and then asked her to give Anja an injection of B12. Within 2 days, Anja was completely back to normal, and 2 days after that, I received the results of her B12 test. Her levels were >738. So I am totally not understanding why she crashed when her levels were way above normal. I have not given her any B12 injections since and it has now been 3 1/2 months since that episode. I am definitely not sure of where to go from here. Any advice or insight will be greatly appreciated!

Hali
My girl is Anja, born Feb. 9, 2014. Diagnosed with EPI Sept. 2017. TLI 1.6, Cobalamin <111, Folate 13. Was 93lbs but had dropped to 74lbs. Is on Enzyme Diane's Pancreatin 6X 1/2 tsp per cup of food and is on a raw food diet. Current weight is 85 lbs. Followed B12 protocol at 1 injection per week for 6 weeks, then 1 injection after 30 days, then a retest 30 days after that. Results still poor at 164, Folate at 17. Continued with monthly B12 injections, then retested 5 months later. Results came in at a whopping >3689! Veterinarian told me to stop injections and retest in 6 months.

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jilbert57
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Re: Signs of Instability

Post by jilbert57 » 13 Feb 2019, 15:13

Hi Hali! I remember you and Anja. Glad you signed on to the new forum.
As our EPI dogs age sometimes they need the amount of enzymes tweaked. I would try increasing the amount of enzymes you are giving each meal. I might try adding 1/8 teaspoon in to what you are already giving. Maybe 1/4 teaspoon but maybe someone will come on and advise, I would start at 1/8 teaspoon.

As far as B12 it is vital in bodily functions and maybe at that particular collapse she was at a bottom low. It can affect everything. Excess B12 is excreted innbn the urine so don't worry about overloading.
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.

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Olesia711
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Re: Signs of Instability

Post by Olesia711 » 13 Feb 2019, 20:14

So sorry to hear that Anja sounds like she crashed... with EPI , once they are diagnosed and have insufficient B12, they need to be given B12 supplementation, as you and your vet did. HOWEVER.... once they reach an upper mid-range (or above B12 level) you are not supposed to completely stop the B12, but rather continue to give B12 on a maintenance level. With the shots, some dogs need to continue to receive the shots weekly, others only need it bi-weekly and then still others only need it monthly.... one is not supposed to stop the B12 completely.

Regarding the recent hunger, and gas - -first i would try giving her a little more enzymes with her food... as Jill suggested, try increasing by 1/8 tsp to begin with... give it a few days and see if that helps any... if it helps but not completely... then try upping it to 1/4 tsp more enzymes ... it sounds a little like SID getting out of good control (especially with the gas).

With the little bit of aggressiveness, it could be that for her, she simply needs more B12... or it could be SID-based cause some dogs, when SID starts acting up they get a little cranky.... where as some other dogs act like nothing is wrong...

If the increased enzymes don't appear to do anything.... then i would take the next step and (1) try a little SLippery Elm powder to see if that would help (check out the Slippery ELm powder page for dosing instructions) (2) and if that doesn't help and Anja is still gassy.... THEN i would ask the vet for a course of Tylan antibiotic powder

The best thing is to try these things but keep good notes of each change and the results.... so that you can figure out what the cause is and what helps or hinders the situation.
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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Madelon
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Re: Signs of Instability

Post by Madelon » 16 Feb 2019, 12:30

Hi Hali. Olesia covered it all :) . I hope you are able to get your sweet pup back on track quickly. Please keep us posted.
Madelon, owned by DOC. DOC dx EPI 5/2015 = TLI < .4, B12 406; Folate >24. DOC taught me so much and together we battled and overcame EPI, food sensitivies, environmental allergies but we lost the cancer battle. DOC was dx with hemangiosarcoma 5/2022 and crossed the rainbow bridge July 24, 2022. He is and always will be the love of my life, my soulmate, my heart dog.

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Brin625
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Re: Signs of Instability

Post by Brin625 » 19 Mar 2019, 21:19

Hello Everyone. It has been just over a month since I last posted regarding Anja's relapse. Much to my worry and frustration, I cannot seem to turn this thing around. Anya continues on a downward spiral, and I am at a loss as to what to do next. I am using a new batch of enzymes now, which are somewhat weaker in potency than her previous batch. Diane had suggested increasing by 1/4 tsp.per cup of food. Since Anya had always only required 1/2 tsp per cup of food, I am now giving 3/4 tsp per cup. Her stool continues to be normal, which she will still eat if I don't get it cleaned up in time (she only seems to get gassy if she has gotten into it). I am still feeding her 2 lbs. of raw food a day, and I was advised that that amount is normally what you would feed a 100 lb. dog. Anya now only weighs 79 lbs. I have been trying to incorporate a grain-free kibble as an extra meal for her, but have not had much success. I had started her on a small amount and gradually increased to 1 cup but it gave her major diarrhea--not sure if the fiber content is too high at 4.5%? I have never had her on a grain-free kibble anyway. Gave her pumpkin and continue with the raw for now. Her stool is back to normal.

I am back on track with monthly injections of B12. She has lost 7 lbs since December and is now looking very thin and bony. Wondering if I should stop feeding the raw and get her back on her original diet of dry kibble which was not grain-free and was 4% fiber. She had been doing well on that since she was diagnosed and had actually gained all of her weight back and then some. But back in November she had started bouts of cow-pattie stools, was starting to look thin then, and that is why I switched her over to a raw diet. I have not taken her to my veterinarian yet, but cannot help but wonder if there is something else going on? Any ideas or suggestions anyone?
My girl is Anja, born Feb. 9, 2014. Diagnosed with EPI Sept. 2017. TLI 1.6, Cobalamin <111, Folate 13. Was 93lbs but had dropped to 74lbs. Is on Enzyme Diane's Pancreatin 6X 1/2 tsp per cup of food and is on a raw food diet. Current weight is 85 lbs. Followed B12 protocol at 1 injection per week for 6 weeks, then 1 injection after 30 days, then a retest 30 days after that. Results still poor at 164, Folate at 17. Continued with monthly B12 injections, then retested 5 months later. Results came in at a whopping >3689! Veterinarian told me to stop injections and retest in 6 months.

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Madelon
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Re: Signs of Instability

Post by Madelon » 19 Mar 2019, 21:35

I'm so sorry to hear you and Anja are still having issues. Did you try the Slippery Elm Bark Powder as Olesia suggested or Tylan? In my opinion, and I am not a vet, when they start eating their stool and it's a new behavior, I tend to think it's because something is missing in their diet. When you feed raw, were you also adding bone or bone meal, vitamins, etc. to ensure it's properly balanced? When she first started having cow pies it may have been that the enzymes needed to be tweaked - a lot of EPI dogs need a bit more enzymes as they age - or it may have been SID brewing needing a course of Tylan or Slippery Elm Bark powder.

If it were me, I would try to get her back on kibble or at least a good mix (I know a lot of GSD owners swear by raw but I tend to worry about bacteria) and start the enzyme dosing at the typical recommended dose of 1tsp per cup of kibble, slightly less if feeding raw/can food. 4.5% fiber is a bit higher than what we recommend but some EPI dogs can hand a tad more and others need the lowest possible fiber.

I would try the Slippery Elm as Olesia suggested - it's a prebiotic mucilage and tends to work wonders for a lot of EPI dogs. Here's a link to our page on Slippery Elm https://epi4dogs.com/slippery-elm/
Madelon, owned by DOC. DOC dx EPI 5/2015 = TLI < .4, B12 406; Folate >24. DOC taught me so much and together we battled and overcame EPI, food sensitivies, environmental allergies but we lost the cancer battle. DOC was dx with hemangiosarcoma 5/2022 and crossed the rainbow bridge July 24, 2022. He is and always will be the love of my life, my soulmate, my heart dog.

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Jean
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Pet name: Kara, lost 10th May 2019
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Re: Signs of Instability

Post by Jean » 20 Mar 2019, 03:58

hi there

the cobalamin levels are possibly still low, unless I am reading incorrectly, this could well be the reason Anja is losing weight

so, the b2 injections, are they the generic type, dark pink in colour

if this is the case, I would supplement daily Wonderlabs b12

https://www.wonderlabs.com/itemleft.php?itemnum=K9688

Kara's b12 levels plummet on a regular basis, so even after 9 years, she has daily b12 capsules

no real ideas what else could be going on, maybe the vets need a visit

keep a diary on everything

Jean
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

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Riley's Mom
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Re: Signs of Instability

Post by Riley's Mom » 20 Mar 2019, 08:32

I'm sorry you're still struggling. You have been given good advise. Did you try the slippery elm? And Madelon had a good question about the bone meal and vitamins when feeding raw. All dogs need the bone meal, but it's my understanding EPI dogs can't tolerate the full amount.
I just wanted to throw out there...has the vet checked for anything else that could be the cause of your new troubles? As EPI pet owners, we tend to blame any issues we have on EPI. Sometimes it's just something else entirely. Just a thought.
Keep us posted.
Elisabeth

Riley is a 10 year old Labradoodle. She was diagnosed with EPI in 2014.
She currently eats Taste of the Wild, I cup in the morning, 2 cups in the evening, each meal with 1 Wonderlabs B12 sprinkled over her dinner. Enzymes are EnzymeDiane, 1 tsp per cup of food, mixed in home made bone broth. No other supplements or meds at this time.
Riley currently weighs about 44 pounds, which is pretty heavy for her.

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Brin625
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Re: Signs of Instability

Post by Brin625 » 20 Mar 2019, 13:34

Thank you all for your valuable advice.

Anja is on MegaDog Raw which consists of muscle meat, triple-ground bone, organs, kelp, and a mixture of veggies. I do think I will start to slowly reintroduce the original dry kibble she was on. Her Vitamin B12 is Cyanocobalamin Injection USP 10,000 mcg/10 mL. I have ordered the PetFactor B12 w/Intrinsic Factor and the Slippery Elm from Wonderlabs. I am wondering if Anja should get the full recommended dose of the oral B12 since she is getting monthly injections?
My girl is Anja, born Feb. 9, 2014. Diagnosed with EPI Sept. 2017. TLI 1.6, Cobalamin <111, Folate 13. Was 93lbs but had dropped to 74lbs. Is on Enzyme Diane's Pancreatin 6X 1/2 tsp per cup of food and is on a raw food diet. Current weight is 85 lbs. Followed B12 protocol at 1 injection per week for 6 weeks, then 1 injection after 30 days, then a retest 30 days after that. Results still poor at 164, Folate at 17. Continued with monthly B12 injections, then retested 5 months later. Results came in at a whopping >3689! Veterinarian told me to stop injections and retest in 6 months.

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Patsy
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Re: Signs of Instability

Post by Patsy » 20 Mar 2019, 16:11

Time for antibiotics ?
Springer spaniel Marti had Epi, PLE , MMM just to confuse me. She lived till 12yrs, chubby and happy despite eight years of epi.
Capsule enzymes suited her best. B12 supplements made her into a new dog!
After a cocker with PLN kidney disease, I now have two healthy rescues, a lively, suicidal , small ginger terrier, adopted with pneumonia, and gum disease needing nearly all his teeth out, and a fluffy grey toy poodle/terrier from Greece.

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