Epi4Dogs

Hello! I am a newbie to the forum and not so good with technology. I have an 8-mo old Aussie diagnosed with SID/SIBO. We just finished a six-week course of Tylosin which worked like a charm in normalizing poops after many many onths of issues. Within four days of ending the course, diarrhea returned. We are going to the vet today and I will take the info on the step-down recommendation. It was a cold turkey stop.
As far as food, he has been on Eukanuba puppy lamb and rice, and I am trying to slowly transition him to Purina EN prescription diet, per the vet's recommendation. We've been at it for almost a month and not quite to the half and half mark.
Most of this post is questions about slippery elm. I have a zillion questions, but focusing on this for now.
Two days ago, I started slippery elm to see if it helps but have questions. Hoping for some help from this great group!
Our pup weighs a little more than 36 pounds but I started with low dose of 1/8 tsp to be sure he could tolerate. How quickly should I go ahead and increase to recommended dose of 1/2 tsp for his size?
How long to continue the SE? I've seen that you can do short-term or long-term maintenance? Can folks share their experiences please?
How soon might there be positive results? Also does SE ever make things worse? In last two days, we have progressed to full-blown diarrhea & I'm not sure if the slippery elm is a factor in that or not
Can SE be taken at the exact same time as a probiotic? He's been on a daily dose of FortiFlora for month. Right now, I've been splitting his meal -- feeding small portion with SE and then an hour later rest of meal with the probiotic.
Can SE be taken while the pup is on a course of Tylosin? Or better to wait until the course is finished?
Is SE ok to use with flea/tick and heartworm preventatives?
Apologies for the long list of questions ... hope it's not too many. I've been reading and learning a lot from this site/forum and am trying to learn as fast as I can. I want to help my boy and it's really hard to know all the right things to do! So glad to have found this site, and appreciate any & all help. Thank you, thank you!!!

Hi, Mary! Welcome to our forum. This is Pam, and my dog Tucker has EPI. He is on tylan, a small amount, probably for life. We did try slippery elm, but had poor results, so went back to Tylan. I do know that on here the consensus is, tylan has to be tapered off...you can add slippery elm while you are doing this, but I'm not an expert so I'll stop there. You've just posted, and you will be getting some very specific advice, probably from Madelon. She's great, and her dog takes slippery elm. Take care!

Hi Pam, thanks so much for your response. It is appreciated. I'm not sure if I posted correctly as I haven't had any other responses as yet. Looking forward to any help from the forum team and other members.

welcome from the UK

We never had any luck with Slippery Elm, Kara couldnt cope with it, so i am a bit in the dark as far as experience goes, however, as far as Tylan is concerned Kara was a lifer, we could never stop, and she was on a maintenance dose of probably 1/32nd of a teaspoon twice daily for probably, 8 years

i will ask the others who have used SE

Hi Mary. I have a aussie and a jack russell, both do not have EPI but I use slippery elm with them.
If diarrhea or vomiting comes on it fixes both. After they eat I put the dose in a little warm water in their food bowl, stir till thick and feed.

Maybe the rice in the food is causing the SID?is your pup losing weight also?

Jill

Hi Mary and welcome to the group. Sorry for the delay in responding - I just got home from traveling and things have been crazy. I've been using Slippery Elm for a few years so I'll try to answer all of your questions. However, I do have a question - was your dog tested for EPI with the fasted blood test? If so, can you post the results (TLI, B12 and Folate) - I'm guessing that is how your vet diagnosed SID. My boy was tested at 3mos old and was negative for EPI (TLI was 16) but diagnosed with SID - cleared it up and he was fine for the next 7months when he slowly started to lose weight - at 13mos old he was tested again and he was definitively EPI (TLI less than .4). So just keep it in mind that if your pup was tested and it was negative and the symptoms come back after a few months you might need to test again.

First, my guess for the relapse of diarrhea is because the SID was not completely under control when you stopped the Tylan cold turkey. So yes, I would get another course of Tylan and slowly taper off. SE could make things worse if your dog can't tolerate it, but because you started it and stopped Tylan at the same time it's hard to say if the SE is the cause. We recommend only one change at a time so you know what works and what doesn't but that's not always easy and I'm a member of the impatient club and have broken this rule many times - LOL.

Yes you can give SE with a probiotic - SE is a prebiotic and the probiotics feed off of prebiotics.

Be sure you're mixing SE with a little water and using it on the am and pm feedings.

Yes you can give SE with Tylan - it's my boy's current protocol.

Yes it's safe to give with flea/tick and heartworm meds - however on a personal note I suggest giving heartworm meds and flea/tick meds a few weeks apart from each other so a not to overload the system with too much chemicals at one time. I give heartworm on the 1st of the month and flea/tick on the 15th of the month.

I would increase the SE to 1/4tsp for a few days and see if things improve, if so you can try the full dose at that time. My 95lb GSD is on 1/2tsp maintenance dose.

If you're still having diarrhea despite the FortiFlora I would stop the FortiFlora - it's expensive and does not always work for every dog. It's best to keep things simple as you try to rule things out.

Why did the vet suggest the Purina EN? What symptoms other than diarrhea does your pup have? Are you hearing tummy grumbling? Voracious appetite? Weight loss? Vomiting? Burping?

Hang in there - I'm very curious about the test results.

Thanks so much for the responses. All helpful and super appreciated. I am in the process of getting all the test results from our vet. As soon as I have those, I'll follow up with another post. In the meantime, we have started another cycle of the Tylosin and things (ie poop) almost immediately returned to normal!

Glad to hear that the reintroduction of Tylan is helping.... a lot!
As Madelon mentioned, SLippery Elm is also a prebiotic (and a mucilage).....many EPI dog respond very well to Slippery ELm... but not all do. If the SLippery Elm does not agree with a dog, it will have loose stools. SUpposedly, the only adverse reaction to slippery elm is if a dog has an allergy to the American Elm tree... however, that being said.... because it is a prebiotic, if you give too much that too can trigger loose stools.

What i would do, especially now since the Tylan has been reintroduced and things improved immediately, is after a week or so on the Tylan... i would take a low dose of Slippery Elm powder, add it to one meal with a little water added... and then watch for the next elimination (poop).... and if it appears a wee bit looser, then you will know that Slippery ELm is not going to work well for your dog.

With a 36 lb dog, although technically you can give 1/4 tsp.... or you can give a little less.. Just to proof if SE will or will not agree with your pup.

Thank you! I appreciate this suggestion and will give it a try. We have a vet appointment next week so I will write a fuller post with the tests that have been done to date and where we stand. Upon meeting our pup for the first time, the vets at our practice all start by commenting on how many pages he has medical record already. Not a distinction we really want to have, but we are learning as we go. Our vets are somewhat familiar with EPI and SID/SIBO so that's helpful too. Thanks again!

Hello again! I'm really sorry for the delay in following up on the initial responses. We had a death in the family and then, like everyone, have been dealing with the ups and downs on the COVID crisis. Our vet has only been taking emergencies during the two-month lockdown, so not much to report from there. Anyway, I greatly and truly appreciate the help!!

Here are Smokey's IDEXX test results from December 2019 at six months of age. Unfortunately, this was not done as a fasting test. I didn't know about that until after the fact.
TLI was 17.9
Cobalamin was 549
Folate was 11.1
The vet indicated these findings were considered normal and not consistent with EPI. Thus, the diagnosis of SID.

During the extended period that the diarrhea was full throttle, Smokey also had an extensive fecal test (done November 2019). The only thing that showed positive was the presence of clostridium perfringens DNA, but the sample was negative for the presence of C. perfringens enterotoxin. All other results were negative.

He was treated for a UTI early in the course of his illness. Bloodwork was also done, and the results were normal.

Since I last posted, he has been on a maintenance dose of Tylosin (Tylan) 2 capsules (150 mg) twice a day every other day. This has kept the diarrhea under good control. Poops are fairly regular, 2x day, and pretty normal overall.

He is still eating the Eukanuba lamb & rice, divided over three meals, with one packet of FortiFlora per day. I use hand-fed kibble, boiled chicken, low-fat string cheese and an occasional chicken liver treat for training. Very small pieces (1/2 fingernail). We use frozen pumpin, plain greek yogurt and/or canned food for occasional "kong"-style treats.

He's now 11 months old. While he has gained weight and "seems" to be doing well, I am concerned about whether he is getting full proper nutrition. He seems constantly hungry & has never refused food of any kind, no matter how much he gets. I can't tell if there is sufficient muscle mass over his bones, particularly in the shoulder and shoulder blade area. He constantly nibbles on grass, mud pies, and small stones(if I'd let him). Particularly in the evenings and/or when he is due for pooping, he gets very hyper & "snippy," jumping up, biting at the leash, and nipping at my arms. This is very out of character for him otherwise.

Vets in our area are accepting some appointments now. I have a nutrition consult appointment with a holistic vet in about two weeks. They will take him in for an office visit, although I have to stay out & talk by phone.

I will take all his records, of course, but want to prep, ask good questions, and get the most out of this visit. Reaching out to ask for opinions from those who have been down this road. How will I know when/if it makes sense to have him re-tested for EPI? Is there anything else I should be doing? I want to make wise choices and I need to be economical as best I can. As many will know, it's been quite an expense so far. It's so hard when you don't really know how best to help. Will greatly appreciate insights/experiences ... thank you again, so, so much!!!