Sept 2022: New B12 protocol

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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Olesia711
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Sept 2022: New B12 protocol

Post by Olesia711 » 28 Sep 2022, 20:12

Hi everyone,

Just want to share with everyone that the B12 protocol by TAMU has been updated:
September 2022 COBALAMIN DOSING update and revision (TAMU recommendations):
https://vetmed.tamu.edu/gilab/research/ ... formation/

Cobalamin should be supplemented whenever serum cobalamin concentration is in the low normal range (i.e., less than approximately 400 ng/L) in both dogs and cats. Most commonly, cyanocobalamin is chosen for supplementation, as it is both widely available and inexpensive. Very little evidence-based information about the route and dose of cobalamin supplementation in dogs and cats is available. Recent studies in humans, dogs, and cats suggest that oral supplementation is as equally effective as parenteral supplementation.

We currently recommend either oral or parenteral cobalamin supplementation and the recommended protocol and dose for each route is as below.


ORAL
Protocol: daily administration for a total of 12 weeks and re-check serum cobalamin concentration one week after finishing supplementation.

Dose: 250 µg in cats and 250 – 2000 µg in dogs, depending on the size of the patient:

Dogs weight (lb)
Below 22 lbs (give 250 µg)
22 to 100 lbs (give 1000 µg)
Above 100 lbs (give 2000 µg)


INJECTABLE

Protocol: weekly injections for 6 weeks, then one dose a month later, and retesting one month after the last dose.

For either oral or parenteral supplementation, if the underlying disease process has resolved and cobalamin body stores have been replenished, serum cobalamin concentration should be supranormal at the time of reevaluation. However, if serum cobalamin concentration is within the normal range, treatment should be continued at least monthly (for parenteral supplementation) and the owner should be forewarned that clinical signs may recur sometime in the future. Finally, if the serum cobalamin concentration at the time of reevaluation is subnormal, further work-up is required to definitively diagnose the underlying disease process and cobalamin supplementation should be continued weekly or bi-weekly (for parenteral supplementation) or daily (for oral supplementation).

Dose: SC injection of 250 µg per injection in cats and, 250-1500 µg per injection in dogs, depending on the size of the patient:

Canine B-12 Table for injectable (See pic below)
Image

Cobalamin

It should be pointed out that in rare cases cobalamin supplementation fails to increase serum cobalamin concentration for reasons that are not currently understood. In these patients, another formulation of cobalamin, such as hydroxocobalamin (only available as an injectable formulation), might be effective.
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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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jilbert57
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Re: Sept 2022: New B12 protocol

Post by jilbert57 » 28 Sep 2022, 20:40

Thank you Olesia.

Jill
My name is Jill and we live on the Hood Canal in Washington State. We currently have 2 Jack russells, TJ is 6 and Sadie is 8months.

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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Location: North Carolina
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Re: Sept 2022: New B12 protocol

Post by Olesia711 » 28 Sep 2022, 21:23

well.... as time goes on, more research is done.... we "evolve"...with our protocols............ so... we need to share with everyone when updates/changes are made to the protocols. ;)
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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jilbert57
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Re: Sept 2022: New B12 protocol

Post by jilbert57 » 28 Sep 2022, 21:30

Yes I agree!

Jill
My name is Jill and we live on the Hood Canal in Washington State. We currently have 2 Jack russells, TJ is 6 and Sadie is 8months.

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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Jean
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Re: Sept 2022: New B12 protocol

Post by Jean » 29 Sep 2022, 05:42

its good that the people in the know do update their findings

We have come a long way since mid 80's and the development of c/f TLI here in Liverpool UK by David Williams, and the research into B12 being so important

When my cat Cleo was diagnosed in 1983 it was by xray film

This is a bit descriptive, but explaines it

https://www.vetlexicon.com/treat/canis/ ... ty-trypsin

in those days it was a bit hit and miss, but she survived to tell the tale to 20 years old, or should I say Tail !

and it proves that we are moving forward in the roller coaster world of EPI

JXX
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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Olesia711
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Location: North Carolina
Country: United States
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My name: olesia

Re: Sept 2022: New B12 protocol

Post by Olesia711 » 29 Sep 2022, 09:59

thanks Jean... and YES we are moving forward.....
I know it may be confusing to some when the protocol is changed or updated, but thank goodness we have that information and can share with the EPI community.
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.........

Tuckaboo Pam
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Re: Sept 2022: New B12 protocol

Post by Tuckaboo Pam » 01 Oct 2022, 14:35

Hi Olesia--

My eyes are rolling back into my head, as I am not good at digesting research. So, I will just give my scenario & hope it helps someone else, too.

First off, I am not going to get Tucker's B12 tested again. When I got all the original testing done, his score was 666, after two weeks fasting him from Pet Factor. A staff member told me that if it were her dog, she'd supplement anyway, since it was just above the 600 cut-off. I have been comfortable in doing this, since I know he will just pee it out if he gets too much.

So if the number is now down to 400(???), what if I just give him B12 every 3 days & see what happens? Does this make sense? And if it's the wrong thing to do, how will I know that? What should I look for?

Thank you so much.

---Pam
Tucker is a shepherd/lab mix; he has tested positive on the ScheBo test for EPI, as well as the fasting TLI. Results--- TLI 1.3, Folate 9.7, Cobalamin 666, Lipase 38. Currently taking Diane's Enzymes 4 teaspoons/day, Wonderlabs B12 one capsule per day, two capsules slippery elm/evening, 1 Proviable capsule/day, and Tylan 1/32 teaspoon/ morning (to hold SID at bay). Taste of the Wild High Prairie, 4 cups/day, with a couple tablespoons of Fresh Pet mixed in, because everybody else gets some. No more poop eating, has gone from 60 to 95!!! pounds, and he is a happy member of the family, though a bit of a stinker, if you ask the other dogs. Tucker is my boyfriend, and my husband is OK with that.

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Olesia711
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Posts: 2867
Location: North Carolina
Country: United States
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My name: olesia

Re: Sept 2022: New B12 protocol

Post by Olesia711 » 01 Oct 2022, 15:37

Pam.... doesn't Tucker weigh about 90 lbs?....

and when you say "number down to 400?"... do you mean his B12 blood test values? If so... . give him 1 wonderlab Pet Factor daily (the conversion is 1000 mcg the same as 1000 µg) if his last B12 test said he was at 400. ...

However if he is getting B12 shots...at 90lbs he should be getting 1200 µg of B12 serum (a wee bit more than pills)

If it helps any... translating µg to mcg is the same. :) when dealing with B12 pills vs. injections
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.........

Tuckaboo Pam
Member
Posts: 1195
Country: United States
State: Florida
Pet name: Tucker
My name: Pam H.

Re: Sept 2022: New B12 protocol

Post by Tuckaboo Pam » 01 Oct 2022, 17:35

Sorry, this is what I'm talking about, being a science dummy!!! The last time Tucker was tested, at 80 pounds, his B12 was at 666. Since that time, he has taken one B12 every day, even though his score of 600 was high "enough". He now weighs 95, still taking ONE because I have no reason to think he needs more (or even one!).

The research looks to me like it is saying that instead of at least 600, EPI dogs should have at least 400. Sounds like I am misreading this.

So, technically, he didn't really need to be supplemented at 666, right? He has always taken one Wonderlabs B12 daily, since the start of EPI treatment (he weighed 60 then, and wasn't tested for about 18 months...vet followed protocol without blood draw). When he got the blood draw for the EPI bundle of tests, I fasted him from B12 for two whole weeks, so his score was accurate. After getting test results, I felt that continuing B12 wouldn't hurt, even though he didn't necessarily need it.

I just thought the new standard was a minimum 400 cobalamin (not sure why I thought that), which would put him way in the clear based on the original test, and I wondered if cutting back was a good idea. Also wondered what signs would tell me to go back to original dose.
Tucker is a shepherd/lab mix; he has tested positive on the ScheBo test for EPI, as well as the fasting TLI. Results--- TLI 1.3, Folate 9.7, Cobalamin 666, Lipase 38. Currently taking Diane's Enzymes 4 teaspoons/day, Wonderlabs B12 one capsule per day, two capsules slippery elm/evening, 1 Proviable capsule/day, and Tylan 1/32 teaspoon/ morning (to hold SID at bay). Taste of the Wild High Prairie, 4 cups/day, with a couple tablespoons of Fresh Pet mixed in, because everybody else gets some. No more poop eating, has gone from 60 to 95!!! pounds, and he is a happy member of the family, though a bit of a stinker, if you ask the other dogs. Tucker is my boyfriend, and my husband is OK with that.

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Olesia711
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Posts: 2867
Location: North Carolina
Country: United States
State: North Carolina
Pet name: Izzy
My name: olesia

Re: Sept 2022: New B12 protocol

Post by Olesia711 » 01 Oct 2022, 19:46

Ahhh..... thanks for the clarification of what you meant....yes the new TAMU protocol is for an EPI dog to be at least 400..... if not it will need B12 supplementation.

we at Epi4Dogs have repeatedly seen that this doesn't seem to be good enough for many EPI dogs.... so we still stand by the B12 level should be at least in the upper 500's to 600's ... if less... give B12.

If Tucker's was 666 a while back.... i would either continue what you are doing or at least give him a B12 pill 3 times a week. The reason i am suggesting this is because even if their B12 is fine when diagnosed..... as they age they will need B12 supplementation... so might as well give it to him so that he doesn't start having B12 deficiency to one degree or another simply because he is now getting older............

hope this helps!
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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