New Diagnosis

[nellydog]

Hello everyone,
The EPI topic is fairly new to me as my dog was just diagnosed 4 days ago. She is a 17.5 y/o yorkie named Nelly. She started vomiting and having diarrhea bowel movements about 4 weeks ago. Her initial diagnosis was a GI infection and was put on a course of oral antibiotic tablets and acid reflux meds. She was also given shots in office to halt the vomiting and diarrhea. This worked for a couple of days but then her stools eventually became completely loose again. This past week her blood counts showed that it was definitely her pancreas which was confirmed with further specific tests. She also was diagnosed with a severe B12 deficiency.
She was given a B12 shot a few days ago (and is due to have a weekly injection over the next 6 weeks) and we have started her on Pancreved and Omega 3s To be honest the vet wasn't very clear as to when we should start seeing improvement and we were initially told to use the Pancreved enzyme once daily. No instructions as to how to properly prepare the food were given other than to wait 20 minutes.
So my questions are this
1. When I prepare the food it should be at room temperature correct? Is it best to mix the enzyme w/ a little warm water and then add separately to the food after the 20 minute incubation period? How many times daily should I be giving this enzyme? I've read conflicting information on line...
2. We have currently eliminated all kibble and are just feeding Nelly roasted chicken and eggs (alternating meals). Any other suggestions as she's quite a picky girl?
3. At what point should I start to see an improvement in her stools?
4. She seems to be more lethargic over the past couple of days after having all of the blood drawn and starting treatment. Should I be alarmed by this or is this normal?
5. How likely is it that I need to be worried about SIBO? I am suspecting that this is a problem and am going to request another course of antibiotics but was wondering about others' experiences with this aspect of the condition.
Thank you, thank you

[Olesia711]

Oh wow... congrats on having a 17.5 year old yorkie pup!!!!! WOW! Any pup that reaches 17.5 yrs old is doing great!!!!

First.... that enzyme powder needs to be given with every meal. Do not give snacks/treats inbetween... at least not until your pup becomes stable... then you can try to see how much she can cheat (have any food without enzymes)

The suggested dose is 1 level tsp of enzymes per 1 cup of food with enough room temp liquid (water is fine) to moisten the powder on the food.Mix & Let sit for 20 minutes and then serve.

Figure out how much she "normally" would eat and then feed her 1+1/2 times the amount... HOWEVER... try to give all this food in smaller portions... so what we suggest is to feed more meals, just smaller amounts at each meal. Many of us (if working) will feed breakfast before we leave the house, then lunch when we get home and then dinner just before bed time....

You can feed kibble but usually the more agreeable kibble is very low in fiber content... Start with something without grain and that the fiber content in less than 4%. Sometimes food with 3.5 or only 3% fiber content works better. But what you are doing sounds good to me... maybe add some baked and skinned mashed sweet potato (20 to 25% ) and the rest chicken & the egg. If you decide to do this longer than just a few weeks, you need to add some calcium (bone meal works) and also include a quality doggie vitamin.

My guess is that the lethargy could be from the low B12. So glad you are getting shots....... but..... (and please share this with your vet) i don't know why this happens but over the years, we have observed that for some reason "some" small" dogs do not respond as they should to the B12 cynacobalamin injections.. but when they are given oral methycobalamin B12 then their B12 levels shoot up....anyway, please share this with your vet and let him know that if this is the case, you might want to start your pup on Wonderlabs Pet Factor B12 (1000mcg methycobalamin with 800mcg of folate and 40 mg of intrinsic factor)... my guess is (if this is the problem) you will only need to give 1/4 capsule maybe 3 times a week in-between the shots. Please talk to your vet about this just in case your pup is one of those that is not fully absorbing the injectible B12...as this will help ..

You mention another course of antibiotics..... per chance did your vet put your pup on Metronidazole???? If so, call him as the lethargy can also be an adverse effect from Metro... if your pup is on Metronidazole (Flagyl) please call your vet and tell him what you are observing and ask that he switch her to Tylan (Tylosin Tartrate 100 gram) by Elanco...Tylan will not give any adverse effects like Metro can. Again, i do not know if this is the cause, but just in case it is you will want to stop the metro right away. And you will know if the metro caused this if after you stop the metro the lethargy goes away.

I hope this sort of answered some of your questions.... please keep us posted!!!!!

[jilbert57]

Welcome to the forum. Olesia has covered it well but if you have additional questions ask away!

[Riley's Mom]

I'd like to add my welcome as well.
Sounds like Olesia gave you lots to think about and questions for your vet.
Glad you came here and asked about how and when to give the enzymes. Most don't get good instructions about this, even some of the prescription bottles have the wrong dosage on the label
Please keep us posted and ask questions as they arise.

[nellydog]

Thanks for the warm welcome and insightful information!
I took Nelly for a follow up visit today because of the increased lethargy and poor stools.
The vet gave a Tylan injection (apparently injection is the only form available in Bermuda) and gave her a new prescription for Metaprozole.
She was not very open to the idea of adding pumpkin or sweet potato to the diet. Nor was she open to the idea of coconut oil. I mentioned adding oral B12 and she thought that would be too much. She had never heard of slippery elm. Overall I wasn't super impressed.
I also reviewed the TLI results and found that the TLI was actually at the high end of normal when measured last week. It was really only her B12 that was below normal. I find this strange if she truly has EPI for her TLI levels to be so good. Any thoughts?

[Olesia711]

Oh dear.... your pup may not even be EPI.... what was the actual TLI value?

[nellydog]

This is what is worrying me most.
TLI levels were 33.2
B12 was 172 (not even on the chart)
Folate was normal at 10.8

[nellydog]

Small update - I used a little telemedicine to discuss w/ another vet as we are in Bermuda and there aren't many options and he agrees that it quite possibly is not EPI. I suppose that's good and bad...
I've finally managed to bug another local practice enough to take us in for another consult today w/ potential for stomach/small intestine ultrasound.
Fingers crossed that it's just bacterial.
Will post update...

[Olesia711]

thank you so much for posting the results AND so glad you consulted with another vet.
The TLI at 33.2 is not EPI.

if it is bacterial and mostly in the small intestine... again, ask the vet to order some Elanco "Tylan" powder (Tylosin tartrate 100 grams soluble powder- -although you do not wet the powder) ....this is actually a product originally designed for chickens, bees & pigs, but research has shown that it works great on dogs (and cats) battling SID- -often better than Metronidazole/Flagyl which can have adverse affects. Tylan is not knows for any adverse effects and is also often used because it will not affect the kidneys where as other anti's can....... SID usually happens not only with EPI but other gastrointestinal conditions..... the Tylan injection the other vet gave your pup is not for bacteria in the intestine but rather for respiratory conditions.... .

It really looks like your pup does not need any enzymes.

What might help (especially if this is IBD, IBS or some sort of bacterial infection that has upset the gut flora ) is SLippery Elm powder, but if you live in Bermuda... you might not have access to it...but before eliminating Slippery Elm powder... maybe talk to a pharmacist first and ask if they have any Slippery Elm powder (a powder made from the inner bark of the American elm tree)is a prebiotic, loaded with mucilage, nutrients and Short Chain Fatty Acids, specifically Butyrate which ironically helps get SID in control...(check out the SLippery Elm page here https://epi4dogs.com/slippery-elm/ /share with new vet) .. if your pharmacist doesn't have this.... ask what they have that might be comparable.... BUT............ do not give your pup any thing until you first talk to a vet at another practice...... although this is not harmful, you still want to be careful with such an elderly dog and one that does not have EPI, but has something going on.......... if you do get some Slippery Elm.... please connect with us first to find out how much to give.... The internet is loaded with suggestions..... but almost all dose recommendations on the internet is way too much to give a dog..........

[Barb]

Hello,
I am glad you are looking to get to the bottom of what is happening with Nelly. Getting the correct diagnosis is the most important thing......and sometimes it is not easy. Olesia has given you excellent information to help you figure out what is going on. Give us updates when you can.

Barb