Cinda - GSD - EPI, SIBO, IBS or Tylan for Life?

[MrHT]

Hello. I am Pawel, from Poland. I have two long-haired German Shepherds, a male and a female. Currently, they are two years old. Since they were puppies, they have had food-related issues. They suffered from a Giardia infestation, which took quite a while to treat. Both dogs had cow pie-like stools - the male generally had slightly better stool quality. Eventually, we managed to treat it - the male tested negative and his stool returned to normal. However, our female kept testing positive. After Giardia treatment, we would have 2 weeks of calm followed by a relapse.

A year ago (October 2022), we conducted the first major blood test and a pancreatic diagnostic panel for Cindy.

Cindy:
Age: 2 years; Height: about 56-57cm; Weight: 24 to 27kg. Date: December 2023.

Since early 2022, it was a constant battle with Giardia. When medicated, she was okay. Anti-diarrheal supplements and probiotics only slightly improved the situation. We tried various diets: grain-free, single-protein, veterinary, gastric, and home-cooked meals. The problem persisted, and she continued to have cow pie-like stools. We changed veterinarians.

October 2022, Age: 11 months, Weight: 19kg.

Her blood morphology and biochemistry were relatively good for an underweight dog - nothing particularly alarming.
Ionogram - okay.
Thyroid hormones - okay.
Intestinal and pancreatic profile:
TLI - 10
cPLI - okay
Folic acid - borderline low
B12 - slightly below low normal

Based on this, EPI (Exocrine Pancreatic Insufficiency) was diagnosed. We introduced gastric food, pancreatic enzymes, and probiotics. Additionally, we continued treating Giardia. Several courses of metronidazole and 2 other drugs, but not longer than 14 days each. It was a continuous cycle: 2 weeks of treatment, then a week's break, and again because symptoms returned. The dog gained 7kg in 3 months, reaching a final weight of 26kg.

But something was still not right. Stopping the medication led to a return of diarrhea. Enzyme replacement therapy did not yield results. Giardia was still present in tests. At one point, the female dog was given tylosin for diarrhea. The symptoms disappeared, but Giardia was still present in the test. Since Tylosin doesn't work on Giardia, we eventually decided to ease up on treating it. If it wasn't the main symptom, why stress her with stronger drugs? We added B12 supplementation, but it wasn't reflected in the blood tests. It was still low.

Early 2023 - February/March: We added B12 with IF (not available in Poland, but I purchased it abroad). More courses with Tylosin (max 14 days at 25mg/kg body weight). With Tylosin - stools okay. Without Tylosin - bad stools. So we used it more frequently. In June, we redid the Giardia test, and to our surprise, the result was NEGATIVE. We repeated the test several times over a few weeks, and it was consistently okay. Giardia disappeared. I believe that as the dog aged and her intestinal function improved, the infection resolved itself.

We repeated the TLI and B12 tests:
TLI - 15.4
Folic acid - above normal (Cindy never received B9 supplementation)
B12 - above normal

We stopped B12 with IF and gave Tylosin for the first time for 4 weeks.

After 6 weeks:
TLI - 14.6
Folic acid - high normal
B12 - High normal

The results improved, but the cycle continues. With Tylosin, it's okay. Without it, everything collapses.

I bought 110g of Tylosin. We started a 45-day course. We tried to stop, but we couldn't. She needs a dose of 7-10mg/kg body weight because diarrhea returns.

We did food allergy tests (PAX). All clear. No allergies.

And I'm still thinking about what else can be done.

I had an idea. When Cindy was a few months old and taking medication for Giardia, there was an improvement in stool and the dog gained weight. But at that time, she wasn't taking digestive enzymes. I decided to question the EPI diagnosis. Since she has a relatively good TLI and there was an improvement in this result over a year.

From 10.12.2023:
We increased the Tylosin dose to 20mg/kg body weight to eliminate the unknown from the equation. We reduced the enzymes to 1/3 of the dose. Two days later - the stools are still okay.

I know my statement is long, but here are a few important questions for me:

Can unnecessary supplementation of digestive enzymes or excessive supplementation lead to digestive system disorders such as dysbiosis and overactive digestion causing irritation of the intestinal mucous membranes?
I want to perform a stool test for pancreatic elastase. Would a normal pancreatic elastase result in stool + TLI=15 rule out EPI?
Currently, I don't want to conduct very invasive tests - like taking biopsies. What direction should we go in? Everything seems okay with Tylosin, but maybe we can find the primary disease that leads to continuous diarrhea after stopping the medication.
I wrote this message using an AI translator. If anything is unclear, please ask.

Best regards, Pawel.

[Olesia711]

hi Pawal and thank you for writing in about CInda.... She looks like a very happy dog and i LOVE the picture of her chewing that big bone.... that is awesome!

Also... the A.I. translater you used was excellent.... everything written made perfect sense.

Thank you for ALL the details.... they were very helpful. I am cutting and pasting your questions here and my answers are in CAPITAL RED LETTERS

Can unnecessary supplementation of digestive enzymes or excessive supplementation lead to digestive system disorders such as dysbiosis and overactive digestion causing irritation of the intestinal mucous membranes? NO... OR AT LEAST NOT TO MY KNOWLEDGE.

I want to perform a stool test for pancreatic elastase. I WOULD NOT ADVISE THIS - -AS THIS IS THE OLD METHOD TO DETERMINE IF A DOG HAS EPI AND WAS NOT VERY ACCURATE. THE TLI BLOOD TEST THAT YOU HAD DONE IS THE GOLD STANDARD AND A MUCH BETTER TEST. EVEN THOUGH RECENTLY THE TLI BLOOD TEST ASSAY HAD TO REVISE THEIR TEST CONFIRMATION NUMBERS.... BUT THE FACT THAT CINDA WAS DIAGNOSED WITH MOST LIKELY EPI WHEN HER TLI TEST CAME BACK AT 10....WAS THE ABSOLUTELY RIGHT ASSESSMENT. HOWEVER... AS YOU SUSPECTED, THAT IS BARELY EPI.... AND THEN THE MORE RECENT TESTS SUGGESTED SHE DOES NOT HAVE EPI. MY SUSPECION IS THAT SHE "MIGHT" BE WHAT WE CALL "SEPI" WHICH IS SUBCLINICAL EPI. IN OTHER WORDS, SHE MAY BE FLIRTING WITH EPI BUT IS NOT THERE YET AND SHE MAY OR MAY NOT EVER BE FULLY EPI. THE RESEARCHERS JUST COMPLETED A 7 YEAR MICROBIOTA & METABOLOMICS STUDY WITH EPI AND WHEN THEY WERE COMPARING THE SEPI DOGS... APPROXIMATELY 50% WENT ON TO DEVELOP FULL BLOWN EPI, WHILE THE OTHERS DID NOT.... WITHIN THE TIME FRAME THAT WE FOLLOWED THEM......... SO.........BASED ON WHAT YOU WROTE..... I WOULD SAY THAT THIS MIGHT BE A POSSIBILITY OF WHAT IS GOING ON....

Would a normal pancreatic elastase result in stool + TLI=15 rule out EPI? IF SHE IS SEPI.... THEN SHE COULD GO ON TO EVENTUALLY DEVELOP EPI OR NOT. THE ONLY THING I KNOW OF TO DO IS IF IN A YEAR, YOU AND YOUR VET HAVE NOT FOUND ANOTHER HEALTH CONDITION THAT COULD BE TRIGGERING ALL THIS AND IF ALL HER SYMPTOMS CONITINUE, AND ONLY THE TYLAN APPEARS TO CONTROL THE LOOSE STOOLS... THEN I WOULD DO ANOTHER TLI TEST IN ANOTHER YEAR/+ TO SEE IF HER TEST SCORE IMPROVED AND GOT WORSE.... IN WHICH CASE, I WOULD THEN START TREATING HER FOR EPI.

Currently, I don't want to conduct very invasive tests - like taking biopsies. What direction should we go in? Everything seems okay with Tylosin, but maybe we can find the primary disease that leads to continuous diarrhea after stopping the medication.. FOR NOW, I WOULD CONTINUE THE TYLAN. SOME DOGS SIMPLY HAVE TO STAY ON TYLAN FOR LIFE. HOWEVER....TALK TO YOUR VET ABOUT 1/2 WAY THRU THE 45 DAY TYLAN REGIMEN, START GIVING A PROBIOTIC. ASK YOUR VET IF THEY CAN GET VISBIOME OR PROVIABLE.... START WITH LESS THAN 1/2 THE RECOMMENDED DOSE AND THEN WORK UP TO A FULL DOSE AFTER A WEEK. THEN.....AFTER YOU DO THE 45 DAYS/ TWICE A DAY TREATMENT WITH TYLAN.... THEN, TALK TO YOUR VET AND TRY THE FOLLOWING: AFTER THE 45TH DAY ON TYLAN...FOR THE NEXT WEEK, GIVE 1/2 THE TYLAN DOSE FOR BREAKFAST AND DINNER... THEN THE WEEK AFTER THIS, GIVE 1/2 DOSE OF TYLAN ONCE A DAY FOR ANOTHER WEEK... THEN AFTER THIS, GIVE 1/2 DOSE TYLAN EVERY OTHER DAY FOR THE FINAL WEEK. SOMETIMES THIS SLOW WITHDRAWAL HELPS SOME DOGS GET OFF THE TYLAN... IF THIS DOES NOT WORK THEN PUT CINDA BACK ON THE TYLAN AND ONCE HER POOS STRAIGHTEN OUT.... WORK WITH YOUR VET TO SEE WHAT THE LOWEST DOSE OF TYLAN WORKS BEST TO KEEP CINDA STABLE WITH THE LOOSE STOOLS.

ALSO... JUST WANTED TO SAY, THAT YES TYPICALLY METRONIDAZOLE IS USED FOR GIARDIA.... BUT.... WHAT WE HAVE OBSERVED HERE ON THE EPI FORUM IS THAT TYLAN WILL GET RID OF GIARDIA EVENTUALLY... THE TYLAN JUST DOES NOT WORK AS QUICK AS THE METRONIDAZOLE.............SO I AM GUESSING SINCE CINDA WAS ON TYLAN FOR A WHILE, THIS MIGHT BE WHAT HAPPENED.

ANOTHER POINT... I UNDERSTAND THAT HER B12 CAME UP SUBSTANTIALLY... WHICH IS WONDERFUL... BUT.... WHENEVER THERE IS A "CHRONIC" GASTROINTESTINAL CONDITION.... IT IS BEST NOT TO STOP THE B12 SUPPLEMENTATION COMPLETELY BUT RATHER ONCE THE DESIRED LEVEL IS REACHED, THEN CUT WAY BACK ON THE B12 DOSE BUT DO CONTINUE TO GIVE IT. THE REASON IS BECAUSE THE DYSBIOSIS WILL CONTINUE TO EAT AWAY AT THE B12 STORES, SO WITHOUT ADDITIONAL B12 SUPPLEMENTATION... HER B12 WILL START TO DRAOP ONCE AGAIN.

i HOPE SOME OF THIS INFORMATION HELPS.... PLEASE BE SURE TO SHARE EVERYTHING WE SUGGEST TO YOU WITH YOUR VET.

[MrHT]

Hello. Thank you for your answer.

In Poland, Visbiome is not available, but this seems to be a similar product.

Vivomixx 112 - a dietary supplement containing in its composition lyophilized live cultures of probiotic bacteria. The preparation is intended for infants, children, and adults.

Ingredients:
Lyophilized live bacterial cultures (produced with the participation of milk derivatives): Streptococcus thermophilus DSM24731® / NCIMB 30438, Bifidobacterium breve DSM24732® / NCIMB 30441, Bifidobacterium longum DSM24736® / NCIMB 30435*, Bifidobacterium infantis DSM24737® / NCIMB 30436*, Lactobacillus acidophilus DSM24735® / NCIMB 30442, Lactobacillus plantarum DSM24730® / NCIMB 30437, Lactobacillus paracasei DSM24733® / NCIMB 30439, Lactobacillus delbrueckii subsp. bulgaricus DSM24734® / NCIMB 30440**; plant-based glazing agent (capsule): hydroxypropyl methylcellulose; filler - microcrystalline cellulose; anti-caking agents: fatty acids, magnesium salts of fatty acids.

*reclassified as B. lactis;
**reclassified as L. helveticus;

Ingredients 1 capsule
Lyophilized live bacterial cultures 112 x 10^9 CFU*

4 capsules
448 x 10^9 CFU*

We will discuss further possibilities with our veterinarian.

[Olesia711]

hi Pawal, yes, the bacterium in this probiotic are all excellent strains for dogs.... i am glad to see it includes "bulgaricus" that seems to really help dogs with SID/SIBO (dysbiosis) along with the varied strains of Lactobacillus.... but do know that every dog's gut flora is unique so some respond well , while others do not in which case, you might want to try a different probiotic, and if that fails, then resort to Tylan antibiotic.

Because this is a human probiotic... i was not 100% sure the additives at the end of the ingredients were safe for dogs, so i check each one:
"hydroxypropyl methylcellulose; filler - microcrystalline cellulose; anti-caking agents: fatty acids, magnesium salts of fatty acids." ... and they are all safe for dogs.

So my thought is YES, this would be a good probiotic or your dog, however... do check with your vet first before administering. AND... for the first week or two when giving this probiotic, start with less than half of what your dog should take and work your way up to the full dose for her, over a week or two.

thanks for asking!