Help!! Not seeing improvement

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.
Shiloh18
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Country: United States
State: New Jersey
Pet name: Shiloh
My name: Erin

Help!! Not seeing improvement

Post by Shiloh18 » 30 Jul 2022, 16:05

Hello, my dog Shiloh had very loose stools, was very lethargic, ravenous, and was losing weight depsite feeding her more. She is a 50lb dog and went down to 44lbs. After bringing her to the vet twice, and a hospital stay, she was diagnosed with EPI on 7/20/22. She started PancrePlus enzymes (1tsp per cup of food) and Nutramax Cobalequin supplement on 7/22/22. At that time, her vet put her on Purina pro plan veterinary diet EN gastoenteric wet canned food. I began feeding her 4x per day 1 cup at each feeding. During the days following her lethargy worsened and her poops did not improve and she was down to 40lbs. On 7/25/22 I brought her to see a specialist, an internist. He suspected because of her degree of lethargy something else may be going on. On 7/27/22 he said her cortisol was low and she was in the early stages of Addison's Disease. She began taking prednisone (1 5mg prednisolone tablet per day) on 7/27/22 and we were instructed to begin to transition her back to her normal food. We feed her Ollie fresh human grade food, (beef lamb and turkey recipes), and Natural Balance Limited Ingredient Lamb & Brown Rice Recipe Dry Dog Food. On 7/28 and 7/29 her overall demeanor improved and she was less lethargic. Today, 7/30 her energy levels and demeanor have declined again and she still has yet to have a normal poop. They continue to either be straight liquid (like squirting ketchup out of a bottle) or a pile of mush. Her specialist is telling us to not make any changes and to continue with what we are giving her. Could the issue be her food? Any recommendations for a good food to start with? Looking for any advice on what to do next and how to help our girl!

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jilbert57
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Country: United States
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Re: Help!! Not seeing improvement

Post by jilbert57 » 30 Jul 2022, 16:51

The issue could be the food or possibly fiber amount. The grains in the food can interfere with the enzymes so we usually recommend a grain free diet(with no peas, lentils or legumes or very little) with 4% or less fiber.
Two popular ones are Sport Dog herding elite and Taste of the Wild Pacific stream.

https://epi4dogs.com/dog-food-options/

The B12 we usually recommend has the Intrinsic Factor added. I am not familiar with the Nutramax. Maybe someone else will weigh in.
https://www.wonderlabs.com/itemleft.php?itemnum=6881


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

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.

Tuckaboo Pam
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Posts: 1345
Country: United States
State: Florida
Pet name: Tucker
My name: Pam H.

Re: Help!! Not seeing improvement

Post by Tuckaboo Pam » 30 Jul 2022, 20:08

Erin, welcome to the forum to you and Shiloh.

This part of the process can be so disheartening, but you have come to a place where you will get lots of research-backed advice. We have all been where you are right now.

Will you please post the results of Shiloh's blood test? Your vet should be able to email them to you, and it's helpful if they are posted.

There are four cornerstones to EPI treatment---

ENZYMES...In the beginning we all get them from our vet, and then many of us switch to these http://www.enzymediane.com/, which are typically less expensive & great. 1 teaspoon per 1 cup of food, add liquid & let sit for 20-30 minutes.

B12...most EPI dogs need to be supplemented, and if they get too much they just pee it out. Many of us use
https://www.wonderlabs.com/itemleft.php ... aQQAvD_BwE Don't know why that link is so long.

DIET...Should be 4% fiber, at most, and good quality grain free. Jill has given you the top two suggestions. Sometimes EPI dogs don't do well with poultry, and I noticed your food has turkey in it. I was feeding Tucker baked chicken when I first started. He's better since I stopped that. You should feed Shiloh 150% of the amount of food she would get at her IDEAL weight.

And lastly, SID. All EPI dogs have it, and sometimes it flares up. It can be treated with slippery elm, easily available at health food stores & from Wonderlabs, the company that makes the B12. After a few days, if things are still runny, then you ask your vet for Tylan antibiotic.

I am sorry Shiloh is feeling so bad. My gut tells me that she will feel better if you can get the SID under control. Get the grain out of her diet, as soon as you can, and double check with the vet that you are doing the enzymes right. I think someone who is familiar with PancrePlus will have more to say about them. You are doing fine, being only 10 days into this. Good job with the four feedings per day.

Take Care & keep us posted. --- Pam
Tucker was a shepherd/lab mix--- TLI 1.3, Folate 9.7, Cobalamin 666, Lipase 38. Took Diane's Enzymes 4 teaspoons/day, Wonderlabs B12 one capsule per day, and Tylan 1/16 teaspoon/ morning (to hold SID at bay). Taste of the Wild High Prairie, 1 1/2 cups/day, with a total of 4 cups of Fresh Pet. Stopped eating everything in sight, and went from 60 to 85 pounds! Tucker was my boyfriend, and my husband was OK with that. Tucker succumbed to hemangiosarcoma, but we cherished every day we had with that wonderful, beautiful boy. I will always, always miss my sweet big boy.

Shiloh18
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Posts: 5
Country: United States
State: New Jersey
Pet name: Shiloh
My name: Erin

Re: Help!! Not seeing improvement

Post by Shiloh18 » 30 Jul 2022, 21:08

This process has been very overwhelming, thank you both for responding so quickly and being SO helpful already! I ordered a trial bag of the sport dog herding elite and ordered the wonderlabs B12.

I attached her lab that resulted in the EPI diagnosis, which was done by her primary vet. On the attachment it notes her B12 is HIGH. When I brought her to the specialist he was curious about the high B12. Upon contacting Shiloh's primary vet, they stated they gave her a a vitamin b complex injection the day before the bloodwork and day of the bloodwork (they were unable to tell us the exact time or order of either injection or the bloodwork). The specialist feels her b12 registered as HIGH as a result of one or both of those injections.

Prior to her first appointment with her specialist, I found this wonderful website. I read several times that Tylan was best for SID, not metro. I expressed that concern to her specialist, as her primary vet had her on metro from 7/15/22-7/26/22, and the specialist said it made no difference and that was not of concern for him :( I plan to implement the new B12, change to sport dog food, and add in slippery elm. I will definitely bring up the Tylan again if she isn't showing improvement.

For the wonderlabs B12 should I follow the label instructions and give one with breakfast and one with dinner?
And for the slippery elm should I give the dosing with both breakfast and dinner, every meal, or just once per day?
Attachments
Shiloh Seitz Lab.pdf
(10.16 KiB) Downloaded 41 times

Shiloh18
Member
Posts: 5
Country: United States
State: New Jersey
Pet name: Shiloh
My name: Erin

Re: Help!! Not seeing improvement

Post by Shiloh18 » 30 Jul 2022, 21:17

I forgot to add, she was also put on a probiotic starting 7/15. Proviable Forte sprinkle capsules (1 per day, sprinkled on breakfast after incubating, right before serving).

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jilbert57
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Re: Help!! Not seeing improvement

Post by jilbert57 » 30 Jul 2022, 21:34

Yes the low folate indicates SID. Please have your vet go with Tylan. It is a 2x/day for 45 day course.
I would probably go with 1 B12 cap per day or sometimes 1 every other day is used. I have not supplemented with B12 as Mickeys was also >1000 but he had pancreatitis, not Epi. Someone else who knows about it will come on. That being said, excess B12 is peed out so no chance of toxicity as long as the kidneys are fine.

As to why the Intrinsic Factor should be included
In the B12 pill from Olesia and the Epi website:
"82% of all EPI dogs have insufficient B12 levels that if not corrected will inhibit the dog from optimally healing. Lack of weight gain, lethargy, lack of appetite, continued loose stools, etc., all suggest possible insufficient B12. Recent preferred B12 regimen was with generic B12 injections not multivitamin or complex B12 injections. B12 dosing protocol is set forth by Texas A&M Gastro Lab http://vetmed.tamu.edu/gilab/service/assays/b12folate  In general, average-dose over-the-counter B12 pills tend not to work well. However, high-dose B12 pills that have the intrinsic factor included tend to work very well at increasing the B12 levels in most EPI dogs.  Although the intrinsic factor is needed to transport “digested” B12 into the blood stream, technically the intrinsic factor delivery system should not typically be damaged by EPI, and supposedly (according to old research) intrinsic factor should be species specific- -HOWEVER- -it has been observed in many EPI dogs (via individual B12 blood tests) that when a B12 pill includes the intrinsic factor, even if not species specific (i.e. porcine intrinsic factor), the success rate is extremely high.  Recent research suggests that B12 pills at very high doses without intrinsic factor may work, however we have also observed failures with oral B12 without intrinsic factor. Since we cannot identify which dogs do much better with the intrinsic factor (even if not species specific) and which don’t, Epi4Dogs position when giving oral B12, is that we suggest giving high-dose B12 pills with intrinsic factor included, until further research gives us a better understanding of the B12 and intrinsic process in the EPI dog."

Jill

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

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.

Jane&Clyde
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Posts: 157
Country: United States
Pet name: Clyde
My name: Jane

Re: Help!! Not seeing improvement

Post by Jane&Clyde » 30 Jul 2022, 23:07

One capsule of the Wonderlabs Pet Factor B12 should be plenty. It can be given all at once, meaning it doesn't need to be divided into 1/2 with each breakfast and dinner. Stop giving the Cobalequin when you start the Wonderlabs. You don't need both.

Thanks SO much for posting Shiloh's test results! They have cleared up a lot of questions that I had. It looks like Shiloh has 3 things going on with the digestive system:

1. EPI: Enzymes will always be needed. You seem to have a good handle on how to begin treatment.

2. Proximal small intestinal disease/IBD: This is what the low folate score indicates. It is noted in your test results. This is a very important diagnosis that needs addressed. It can certainly cause diarrhea and weight loss and is very possibly why the enzymes haven't done much good. Proximal small intestinal disease is usually associated with food sensitivities. Sport Dog Elite Herding Dog is usually the food I suggest for EPI alone. However, with the dual diagnosis, I doubt it will work. Proximal small intestine disease is usually treated with a diet made from hydrolyzed protein. These diets are by prescription only. When a hydrolyzed protein diet is used, it is very important not to give any other food or treats with it. The one that seems to get the most love around here is Royal Canin Ultamino. I am surprised that your vet told you to go back to your regular food. Please consider discussing this diagnosis and how to treat it with your vet.

3. SID: All dogs with EPI have SID to some degree. However, it is impossible to know how much SID is affecting Shiloh if, as I suspect, the proximal small intestine disease is causing lots of problems. I'm not saying that Shiloh won't need Tylan, but the Tylan won't do much good if the IBD isn't under control.

Tuckaboo Pam
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Posts: 1345
Country: United States
State: Florida
Pet name: Tucker
My name: Pam H.

Re: Help!! Not seeing improvement

Post by Tuckaboo Pam » 31 Jul 2022, 09:50

Hi Erin----The B12 score was definitely affected by the injection the day before her blood draw, no doubt at all. When we give oral B12 w/intrinsic factor, we stop it 10 days-2 weeks beforehand, so you can be sure of this.

As for the metro, and again I am not on staff, but I personally would not give it. There are too many negative outcomes. Instead, I would try slippery elm, from a health food store. https://epi4dogs.com/slippery-elm/ LESS is more, and if you don't see improvement in a few days, please share this group & the page on SID with your vet. It explains why Metro is not a good choice.

I hope they will prescribe Tylan if the slippery elm & probiotic don't help.

ALSO, and this is IMPORTANT----When probiotocs are started, you HAVE to start slowly. Half a capsule at most, daily, and work up to the whole capsule over at least a week. I recently decided to share Tucker's Proviable with the rest of the pack, and even though I started out slowly with them, I immediately noticed a big softening of their poop.

What SHOULD Shiloh weigh?

Take Care---Pam
Tucker was a shepherd/lab mix--- TLI 1.3, Folate 9.7, Cobalamin 666, Lipase 38. Took Diane's Enzymes 4 teaspoons/day, Wonderlabs B12 one capsule per day, and Tylan 1/16 teaspoon/ morning (to hold SID at bay). Taste of the Wild High Prairie, 1 1/2 cups/day, with a total of 4 cups of Fresh Pet. Stopped eating everything in sight, and went from 60 to 85 pounds! Tucker was my boyfriend, and my husband was OK with that. Tucker succumbed to hemangiosarcoma, but we cherished every day we had with that wonderful, beautiful boy. I will always, always miss my sweet big boy.

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Olesia711
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Location: North Carolina
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My name: olesia

Re: Help!! Not seeing improvement

Post by Olesia711 » 31 Jul 2022, 10:42

Hi Erin,

1. I just looked at your labs and your dog's low folate score IS indictive of small proximal intestinal disease..... translated into english, this is kind of a catch all phrase for a variety of things... but most commonly, it is often associated with a food intolerance or even food allergy.

2. one of the things that liquid stools indicate is often food sensitivities.........

So that is TWO indications that what you are dealing with is some sort of food sensitivity. possible IBD or just a specific ingredient in addition to EPI.

That high B12 score, was rendered so high because of the shot jsut prior to the B12 blood test.... to give you perspective.... a B12 shot is not supposed to be given A MONTH PRIOR to blood being drawn for a B12 blood test. (sigh!!!) if on B12 pills, you are supposed to stop the pills A WEEK prior to the B12 blood test.

THe "Purina pro plan veterinary diet EN gastoenteric wet canned food." doesn't always agree with our dogs...

THE" Ollie fresh human grade food, (beef lamb and turkey recipes), and Natural Balance Limited Ingredient Lamb & Brown Rice Recipe Dry Dog Food. On 7/28 and 7/29 her overall demeanor improved and she was less lethargic. " sounds like she started responding better to it...... but if you can continue with the Ollie fresh and just do one protein (either the beef, lamb or turkey ) for a week straight and record which one seem to give better poos and which one seems to give worse poos.

THe lamb and Rice dry food may or may not be okay... because you have no idea if how much / if any the rice in this food interferes or agrees with her system now that she is on pancreatic enzymes.

Glad you ONLY ordered a sample of the SPort food (because even though a LOT of EPI dogs do great on this food because of the lack of peas (they do horribly with too many peas in the diet) if this is IBD, you don't want to try too many different proteins without knowing if this is what you are really dealing with.

SO.... if you can just do the individual OLLie FOODS 1st- record the results... and one of the food trial weeks try the sample of the SPORT food and see how well that is or is not tolerated.

IF nothing is well tolerated then talk to your vet about trying a hydrolyzed prescription food and we suggest starting with Ultamino by Royal Canine.

NEXT........... the lethargy could be SID. Especially if your dog is struggling with both EPI and Small proximal intestinal disease. with EPI SID is always present to one degree or another. WITH Proximal disease/food sensitivities... same thing... there is inflammation :(
The WEIRD thing about SID is that some dogs can have a bad case and go about their routine as if there is no problem, no pain... just loose stools.
BUT........some other dogs can have the same degree of SID and act sick and lethargic..... SOOOOOOOOO based on this i would insist that the vet put your dog on a curse of TYlan.... https://epi4dogs.com/antibiotics/ ...

There is TONS of information and research on this and Metronidazole is definitely a no-no.
Metro kills ALL the gut bacteria, where as Tylan is a Macrolide and only inhibits the bacteria from reproducing... of course if you leave a dog on Tylan forever, that too will eventually result in all the bacteria being gone too... but with Tylan it takes a very LONG time...

Of course all this to say, that even though the lethargy "may" be related to SID... it is best that your vet 1st rule out other possibilities,... just in case... cause not everything is related to EPI with an EPI dog.

i hope this helps a little.............
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.........

Shiloh18
Member
Posts: 5
Country: United States
State: New Jersey
Pet name: Shiloh
My name: Erin

Re: Help!! Not seeing improvement

Post by Shiloh18 » 31 Jul 2022, 11:03

Thank you all, this has been so informative! That is good to know about why her b12 was so high and to start easy with the probiotics.

Pam- Shiloh should weigh about 50lbs, she is about 40lbs right now.

Right now I will stick to just one Ollie protein at a time and continue to monitor her poops to see how she responds to each one.

Since her specialist said no to the Tylan rx, I am waiting on a call back from her primary vet to ask her instead.

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