Hi Sandy,
thank you thank you THANK YOU for taking this poor pup in. And for contacting us.
I will try to answer your questions as best i can AND, like Jill mentioned, we also contacted our UK rep to chime in as soon as she can.
First, your plan to increase hie meal is an excellent next step:
"
I intend to up his meals to 200g 4 x day" ... this should be sufficient for now, and while giving him 200g of food, start with 1/2 capsule sprinkled on top of the food and served immediately with each of these meals... so you will be going thru 2 capsules a day.
My hope is that 1/2 capsule with this amount of food should be enough...
Regarding the bile acid test.....good plan. i am very interested in the test results as dogs with EPI all have disrupted bile acid functionality. Please see the research about this on this page:
https://epi4dogs.com/epi-research/
Long ago, when a dog was diagnosed with EPI, they automatically gave them Cholestyramine which worked like a charm for the bile acid malfunction... but then they stopped doing this, i have no idea why. Since then they started recommending various acid reflux meds, and the current recommendation is Omeprazole. However, we often start with Slippery ELm powder and if that doesn't work, then go to Omeprazole. However.. very recently they are starting to use Cholestryamine again.
Regarding the high ALT, if it is just the ALT that is that elevated, my guess is that this is nothing more than out of control SID S(small intestinal dysbiosis) which greatly raises the ALT. At this time, no one know how to get rid of SID, BUT they do know how to treat it. First they start with prebiotics, if that fails, then a combo of probiotics & prebiotics, if that fails, (and it often does), then they recommend Tylan (Tylosin Tartrate antibiotic)... DO NOT let the vet prescribe Metronidazole (Flagyl).... as this will kill ALL the gut flora bacteria which is the last thing you want to do with an EPI dog. If the Tylan fails (even after a couple of repeat trials).. then they are now recommending a Fecal transplant... which sounds disgusting, but is simple, cheap and kind of give the gut flora a new lease on life
IN the end, what we have observed, is when SID is out of control, do the above that is recommended.... BUT.... in the end, what usually is the final piece of the puzzle is to change the food to something that really agrees with the individual dog's gut flora. UNfortunately every dog's gut flora is unique so sometimes (many times) it is a real pain to try and figure out what composition of food ingredients best agree with each dog.
Over time, because we see more EPI cases than any other entity in the world, we noticed that most (but not all) EPi dogs do better on food without grain, keep the carb content low, avoid foods packed with peas, lentils, but rather start with foods that have sweet potato or white potato. ONce the dog is doing better on a certain food THEN, if you are willing, "try" adding a little rice to the meals to see if it is or is not well tolerated. and then feed accordingly. This way you can ascertain if the dog can or cannot handle grain
and which grain. For those that can handle grain, we noticed that rice seems to be the most well tolerated.
regarding the B12.... considering the condition of this dog, even though the Proenzorb has B12 in i, i would still give a B12 supplement for now... and then once dog is stable, back off on the extra B12. For now, any excess B12 in the body will be eliminated via urine.
I hope some of this information helps and PLEASE if you have any more questions, please ask
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.........
) and a scan of his liver because his ALT was reading 720, up from Septembers reading of 416! 
