New Member "Niki"

[supernukes]

I am new to the forum and just want some help in figuring out what is going on with Niki my 8 year old German Shepherd. She has every sign of Epi gradual weight loss from 90 to 64 lbs over about 4-5 years. Yellow cow patty diarrhea... eating tissues (pica)...her coat is dull.... has become more aggressive with her step sister another younger GSD......Total workup including ABD ultrasound....and complete blood panel which showed B12 less than 150 ......she currently is on B12 injection, Tylan, high level probiotics.....Steroids .....and just now started (against my vets advice but with her permission) Pancreatic supplement....the only problem is that her TLI fasting is 18........I know it is a very small fraction but there are false negatives for that test...any input or advice would appreciated....Thanks in advance.

[Jean]

good afternoon from the UK

firstly. can you confirm the cTLI result. if it is 18 then it is not EPI . not sure what you mean by Small fraction

that b12 result is very low

[supernukes]

Like all tests there are false negatives...and I have read that the TLI test has a very small percentage of tests that say the dog does not have EFI and they actually do......I am asking about what people think of her history, lab results, and condition......Having worked in Healthcare my whole life I DO NOT put full faith in one test no matter if it considered the Gold Standard or not...Thanks...

[Jean]

If you had a 12 hour food fasted cTLI Test the result will be foolproof, it was and is the Gold standard test developed in Liverpool UK mid 1980s's by Dr David Williams

AI am very concerned by what you have said, and if you have proof please say so , if it is feelings the please contact

TMAU... ...https://vetmed.tamu.edu/gilab/service/assays/tli/

and quote your concerns

Jean Smitn

Forum Director

[Olesia711]

Hi James,

It is your prerogative whether or not to accept test results or not..... But... we here at Epi4Dogs do abide by test results.
HOWEVER..............that being said.... even though 18 on the TLI test is NOT indicative of EPI..... i would like to suggest a couple of things.

1. Watch the dog closely and if you/your vet do not come up with a diagnosis..... re-test the dog with another cTLI test in a few months to see if the TLI number is dropping dramatically.... that has happened with other dogs. Although not clinically EPI, over time they segued in full blown EPI.... so this can happen.

2, Look at the B12 blood test that was run.... check out the Folate score. Is the score at 7.7 or less??? If yes, then your dog has Small proximal intestinal disease... Many times this displays exactly how you are describing and many people think it is EPI, but it is not. it is more along the line of possible food sensitivities, liken to severe IBD. Sometimes giving these dogs a small amount of pancreatic enzymes actually helps... other times it does nothing.

3. THe other thing i am going to suggest...is "maybe" an adrenal issue..... like A-Typical Cushings (not regular Cushings) This happened with one of my other dogs. Vet was positive he had EPI, had all the same symptoms, but his TLI test results was 7.8 and it never segued into EPI.... even after retesting a few months later. It took them 2 LONNNGGGGGG years to finally figure out he had A-Typical Cushings....my guess is because he did not ever have that pot belly look AND he did not lose any hair until just before they properly diagnosed him. THe poos looked exactly like what you described (and its the same look for an EPI dog) but he too started getting aggressive. Diagnosing A-Typical is tricky... you have to do the full ACTH panel AND the other part is guess work from the vet......

4. Another possibility is IBD..... of course "technically" you cannot be sure unless they do a scope, but who wants to put their dog thru that .. very invasive. But what you can try is a Hydrolyzed food to see if it helps any. My personal suggestion if you want to try a Hydrolyzed food is to try Ultamino by Royal Canine first before trying any of the other hydrolyzed brands. They are all prescription foods though and are expensive, but with trying if this might be a possibility.

[supernukes]

Thank you for your time and effort to answer my concerns......My vet has suggested Hydrolized dog food and that is probably next. And yes her folate was 5.5. I will keep you posted and rerun the cTLI...and I am not arguing the validity of the test....its just that in Human beings there is essentially NO GOLD statndard for any condition.....Hx...Physical exam and many tests are used for conforming any condition to be Dx with 100% validity......From what I can gather we are already treating her for almost anything including EPI low fat diet...Tylan...B12 shots......steroids..........I will keep you all popsted...Jim

[Olesia711]

Hi JIm,

Thanks for your response and i can certainly understand your position completely. I too was shocked when i found this out.. but i hope my explanation will help clarify things a bit.....

In short, physiologically, there are some minute differences between the dog's digestive system and human's system hence why the cTLI blood test is accurate on dogs and yet with humans they still resort to stool tests. I know. Personally. My dog developed EPI 15 years ago, and shortly thereafter i connected with multiple veterinarian researchers, got involved with EPI research and with their guidance, i started this website.. fast forward to a few years ago, my husband developed acute pancreatitis and then that segued in necrotizing acute pancreatitis. He was in the hospital for 4 months and almost died from organ failure (his kidneys started shutting down). As you can imagine, I had many conversations with his medical team as we were at the precipice of putting him on pancreatic enzymes for possible developing EPI...and i was appalled that they do not do the TLI (trypsin-like immunoreactivity) blood test on humans.... and then it was explained to me..... the test does not always give clear cut results in humans... where as with dogs it does.

ANYWAY back to your dog......... since Niki had a 5.5 Folate test result...... you are dealing with small proximal intestinal disease. This often displays with a lot of the EPI symptoms. Your vet is spot on to try Hydrolyzed food. There are 5 different brands out there right now (as far as i know) And i'd like to share something not everyone realizes...... Although the goal of each of these hydrolyzed foods is to break down the protein so that the body does not recognize it as an offending agent.... the way each Hydrolyzed product goes about doing this is a little different from one another. The reason why i am explaining this is just in case whatever Hydrolyzed food your vet recommended... if it doesn't work.... PLEASE do not give up on Hydrolyzed food.... try another brand of Hydrolyzed food! This is very important. We have had people go thru the entire list of Hydrolyzed foods before they found one that works with their dog....

SO....Although i am speaking from the perspective of the EPI community (so this may or may not apply to your dog Niki) but overall the most successful Hydrolyzed food with our EPI dogs (many of them have EPI + IBD) seems to be Royal Canine "Ultamino" food. It seems to "usually" (but not always) work better than the others. Supposedly the breakdown with the particles is smaller than the other brands.... however... i really don't know if this is actual fact or just a rumor/marketing ploy. In any case... i thought i would share this about the Hydrolyzed foods.

Oh.. and the other thing, and please share this with your vet. Over the years, we have had some members with dogs that did not have EPI but who also were diagnosed with small proximal intestinal disease. Some of these dogs did not do well unless they were given a little bit of the pancreatic enzymes (same enzymes given to EPI dogs) . I have no idea why this happens. But on the flip side, some others with small proximal intestinal disease had no benefit at all from trying enzymes. So enzymes may or may not help........

I hope this helps you and your vet help Niki feel better!!!!

[Madelon]

Hi Jim! Glad Olesia mentioned the small proximal intestinal disease as that is what I was going to say when I saw the Folate test. Just to give you another personal story - my boy had yellow stinky cow pie poops at 3 months old - they tested the TLI (TLI was 16), Folate and B12 - the Folate was high and based on that and the symptoms they diagnosed him with SID (small intestinal dysbiosis) - very common in German Shepherds. He was treated with antibiotics and from then until 10months old he was a perfect puppy - and a very large one at that LOL. At 10mos old he slowly began losing weight - finally at 13months old he was tested for EPI again and this time it was less than .4!! Definitive EPI. So, with that being said I am a big advocate of if the TLI is within normal range but the dog continues to display symptoms or symptoms reappear to have the test run again in a few months.

[Olesia711]

Excellent suggestion Madelon... THANKS!

[supernukes]

Thank you for the suggestion......I was already going to wait a bit longer before repeating the test and see if low fat diet...Tylan...probiotics and b12 shots might turn her around...but I feel she has epi or is in the process of developing it...thanks again