ahhh.... now i understand.... unfortunately in addition to adding enzymes, watching the diet, adding B12 in most cases, and keeping SID under good control.... EPI parents also need a HUGE dose of patience ..... and that can be very tough at times!
Yeah, don't give the B12 pills just yet while on the shots and before the retest of the B12.... but do save them for later.... you can always use them for your dog with that kind of low B12 (she is going to need to be supplemented for life... but once you raise her B12 levels, afterwards you only have to give her periodic B12 to maintain the upper B12 levels of 600 or more...........)
Also... these are the same B12 pills that they mfg for people.... so you can take them too
Her B12 is very low indeed, but the fact that she is on enzymes, on B12, is happy, has a good appetite, but i my understanding is that her stools are not the best yet.....and she hasn't really gained much weight (yet) ... if so.....
regarding the weight gain... that can start to happen within weeks... or it can take more than a year.
regarding the not optimal stools are most likely due to SID which is not yet under good control. The way to get the stools under good control is to
1. make sure you are giving proper enzymes (pig enzymes) powdered works best. (71,000/+ LIpase USP units, etc....
2. make sure you are giving the right amount of enzymes, rule of thumb to start with 1 level tsp per 1 cup of food, add just liquid to moisten the enzymes in the food (water works) and let sit for approx 20 minutes to avoid any possible mouth sores and this actually does appear to help some dogs digest their food better.
3. Most dogs do better with a low fiber food (4% fiber content or less) since fiber can destroy the efficacy of the enzymes from anywhere between 0% to 50%... and we just don't know which dog will be affected by what %.. so when starting out, best to go with a food with 4% or less fiber content in it, avoid foods with multiple pea ingredients and avoid food (in the beginning) with grains in it.
d. be sure to supplement with B12 if needed (which you are doing)
Once you are doing all of 1 thru 4 and if the stools are STILL not optimal.... this means SID is having a big ol party in the gut and you need to get it under better control.
First you treat and then sometimes you just need to change the food.
SOOoooooooo.... the protocol for SID is:
1. give prebiotics (many of us try SLippery ELm powder
https://epi4dogs.com/slippery-elm/ ) first as a prebiotic
2. if a prebiotic helps but not enough.... then talk to your vet about tryin a pre+probioitc,. Currently we are recommending Proviable or Visbiome... many vets prescribe Forti Flora... but we kind of like the other two a little better . WHen giving a probiotic, ALWAYS start with less than half the dose and work your way up to a full dose over the course of a week or two. This helps avoid even more diarrhea with some dogs........
3. If the above does'nt help or doesn't help enough....(over the course of a few weeks).... THEN.... talk to your vet about prescribing Tylan (Tylosin Tartrate soluble powder antibiotic
https://epi4dogs.com/antibiotics/ . DO NOT let your vet prescribe Metronidazole
https://epi4dogs.com/sid-sibo-microbiome-research/ .... Metro kills ALL the bacteria in the gut flora and some of it will never ever come back in an EPI dog no matter how much probiotics you feed it. EPI dogs not only do not have enough bacteria but they also do not have enough variety.... so this is why you do not want to use Metro... but rather Tylan which is a macrolide antibiotic which means it inhibits bacterial reproduction- - so the EPI dog's gut flora has a much better changed of being repopulated......... Tylan needs to be taken twice a day for 45 days.
This is the SID protocol for EPI dogs set forth by Texas A&M Gastro Lab/Dr. Joerg Steiner & Jan Suchodolski