Another Newby with Questions

[Poppiesmom]

It's been a while and I thought we had made decent progress overall but we did the TLI/Colbalamin retest this week and I am so disheartened.
We just finished the 12 week oral wonderlabs B12/folate/intrinsic factor with a week of waiting before testing and they called with the results yesterday.
These were her results
The cobalamin was previously <150, it has since come into the normal range between 251-908, at 799.
Although, that is the only value that has returned to the normal range.
The folate has decreased to 5.17, which was previously 6.19 back in December.
The TLI has also decreased to 1.8, which was previously 2.2 in December as well.

At least the B12 looks better.
I have been diligent in giving her slippery elm prior to eating, using the suggested amount of Diane's enzymes on room temp food with a 20 minute wait before eating along with the proviable dc with each meal. And up until last week, the B supplement.
They also noted she has lost more weight although we haven't noted it ourselves- at best it was about a pound. I did catch her trying to eat poop again the other day as well though. She still overall acts okay - she loves eating and walks and gets the zoomies.
Her poops have overall been decent - there is a bit of an ebb and flow but I have also been trying to carefully add more variety to her proteins,...she doesn't tolerate as many as she used to. I need to get back to the graph you suggested to track but honestly the rest of our lives has been super stressful the last 6 months as well and I am limited in my capacity right now to mentally handle much more. I know our "safe" foods and just keep an eye out when I add something new/ different.
The regular vet has suggested going to the specialist at this point.
I am also guessing it may be time to try the antibiotic?? Help! I am at a loss and so overwhelmed. Also super grateful that I can come here for help and insight,
Thank you!
Sad Erin and Poppie

:

[Olesia711]

Ahh Erin, don't be sad..... this is not a bad test result.

First ... YES!!!! the B12 has increased to an upper mid range level.

Regarding the TLI test value.... it doesn't matter whether it is 2.2 or 1.8... all you need to know is if it is in the positive EPI range of 2.5 or below...this DOES NOT mean that his EPI has worsened....as a matter of fact, Dr. Williams (who developed the TLI test) explains the variance here:

https://epi4dogs.com/tli-universal-testing/

EXPLANATION FOR POSSIBLE TLI VARIANCE: Dr. David A. Williams, developer of the TLI test, said was that there are no absolutes. There is inherent variability in the TLI assay (as with any assay) and this variability is not the same across all values ? indeed the variation in the numerical value is greatest for low (especially within the ?EPI range?) and high values. So do not over-interpret the absolute values in the ?EPI range?. Anything that is reported as less than 2.0 should just be regarded as essentially undetectable. A dog with a reported value of 0.6 is no sicker than one with a value of 1.6, and by the same token, there is no reason to believe that it will need more enzymes or do less well.

Regarding the variability in reported values, the way Dr. Williams explained it to me was that if you took one vial of blood and tested it (for example) on Tuesday at 1:00 and got one numeric value of 1.5? you can take more blood from that same vial and test it on the same equipment on the same Tuesday at 2:00 and get a different numeric value of maybe 1.0. Indeed, if you tested the same sample twice at the same time you still might get the same difference of 0.5 between the two sets of results! The more you did this; took an average of all the values you got from that one vial of blood tested on the same day on the same equipment would yield a more accurate value, but it still would not be all absolute. This is why, he explained, there is variability that does not reflect any significant difference, and both values are diagnostically low and indicative of EPI. Differences between test results of approximately 2.0 and approximately 3.0 are generally reproducible however, and of diagnostic and functional significance. While both are abnormally low values, the former is almost always associated with clinical signs while the latter almost never is. Fortunately, the vast majority of test results are usually clearly diagnostically low (less than 2.5) or clearly normal (greater than 5.0) so these niceties regarding the assay are of no practical consequence. I hope this helps clarify why TLI values may somewhat fluctuate within the EPI range.

Regarding the Folate value..... from 6.19 to 5.17 ..... this means that there is PROXIMAL SMALL INTESTINAL DISEASE.... which most likely means that there is a food sensitivity (IBD) going on.

This is the ONLY current test result that i would have any concern about.... and before i'd see a specialist, i would first try a hydrolyzed food, my suggestion would be "Royal Canin ULTAMINO".. although no guarantee, out of the few real hydrolyzed prescription food, this particular brand seems to work better than some of the others. Of course this ultimately depends on the individual dog, but worth trying before seeing a specialist.

Here is a snapshot of what Proximal Small Intestinal Disease in dogs could be:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7125622/

Causes of Chronic Small Intestinal Disease

Extragastrointestinal (Metabolic) Causes


Gastrointestinal Causes

•
Intestinal parasites (Giardia infection, Tritrichomonas infection) (cats)
•
Chronic partial obstruction of the small intestine
•
Lymphangiectasia
•
Neoplasia: lymphosarcoma
•
Food intolerance/food allergy
•
Chronic enteropathies/IBD
○
Eosinophilic enteritis
○
Lymphoplasmacytic enteritis

Just an anecdotal observation, but with our EPI dogs, it "almost" always is IBD/food sensitivity....

[Poppiesmom]

Thank you for reminding me that the B12 values look so much better!! And thank you for the reassurance that the TLI number changing isn't indicative of the EPI getting worse. I have been using the oral b12 - how often should I continue to administer to maintain higher values? I was thinking a few days a week?
As far as the folate, I raw feed.
I know for sure ( at least when we started this process in Nov) that parasites have been ruled out.
I would feel swollen gland if lymphoma ( I've had 2 dogs with this unfortunately)
I have also noticed that she doesn't tolerate some proteins as well as she used to. I had to stop most turkey ( although she seems to do fine with turkey hearts)- when you mention food sensitivity - I am wondering how to best figure that out. Chicken is a staple food and I am guessing I may need to start with eliminating that but any suggestions on affordable bone meal replacement or other ideas? I have to limit pork as well due to fat content and rabbit is not affordable nor easy to get .
Also, we have not tried the antibiotic route yet. We have been treating with slippery elm (before) and proviable DC with every meal - is the antibiotic route worth exploring?
As always, I am very grateful for your insight and experience.
Erin & Poppie

[Olesia711]

Hi Erin, the easiest way is to try various true prescription hydrolyzed foods.... the problem is (I think there are 5 brands now) that even though the end goal is the same with each of these, not all will agree with these dogs, you have to try them and see which one you have success with. Overall, Royal Canin "Ultamino" appears to be better tolerated than some of the others with our EPI dogs,... but that is no guarantee that it will be the best for Poppie.

The other solution is to home feed (this way you have ultimate control over ALL the ingredients as sometimes the sensitivity is not a specific protein but rather some minor ingredient in some commercial dog foods. And start with a stripped down meal... for example.... try:
1. a simple meal of mashed baked sweet potato (or white potato) and 1 protein....maybe start with cheap chick roast, trim fat, and grind cooked meat. Serve for maybe 5 days... if explosive, loose or runny stools don't happen, then this protein is tolerable. take pictures of the poos.
2. then move on to sweet potato (or white potato.... keep it consistent).... and try with cooked & ground chicken white meat only.

etc, etc. this of course is totally unbalanced BUT will not harm if done for a short period only.

3. Also...if you find 1 or 2 proteins that appear okay with Poppie... then before moving on to a next protein to try.... you can use the 1 or 2 protiens and add 1 quality vitamin... for a few days... see if THAT is tolerated well... if yes... the moving forward always include the vitamin.
4. Then again. if you find 1 or 2 proteins that appear okay and the vitamin works too, THEN add bone matter. I personally used UPCO porcine bone meal for the bone matter. again watch the poo for a few days to make sure all is okay with the bone meal
5. If the bone meal is okay then add an Essential Fatty Acid or Fish oil.... pick one and watch closely to see how well this is tolerated. If well tolerated... then also include all the time.

Remember some proteins that you can also try is not always meat, but can be cottage cheese, eggs, fish...
To learn about ratios when doing home feeding.... please use this page for some guidelines but do get your vet's blessing before proceeding:
https://epi4dogs.com/diet-raw-home-prepared-recipes/

Also.... go to FAT SEECRET if you want a nutrition breakdown of the individual foods you are feeding :
https://www.fatsecret.com/
no need to join, just type in the food type you are interested in in the upper left corner after clicking on "FOODS"

[Chance]

Have you started folate supplementation yet? If not, it would be a good idea to do that. It did make a difference for my dog.

Although low folate is often a sign of intestinal disease (IBD); it's not always the case. My dog's folate levels were very low. But we know from various tests, including ultrasounds that he does not have IBD. (Although apparently, a large number of EPI dogs do have IBD as well) :/

My dog seems okay with most proteins (I feed raw also). But it's a balancing act getting the right ratios, when. Everything obviously has to be well ground up. Anything that's not well enough ground up, I see come out in the poop. Some meals though I do find I need a slight enzyme increase for. One is beef, if there's a lot of fat in it, I'll give extra enzymes that meal (avoids problems later). Another one is green tripe. For some reason (which makes no sense), he needs a little extra enzymes for also.

Something I still haven't played enough with finding solutions for is meals with extra bone. Although the bone is well ground up in the meat, we still have problems after. I have not tried increasing dose for those meals yet. I will, but I kinda wonder if too much bone is just never going to digest well . I'm kinda avoiding the meals with high bone content for now, doing one thing at a time, so if something happens, or doesn't, I'll know why....hopefully!

Organ meats are important; but it has to be the right ratios in balance. Organ meats tend to make stools softer. (Bone is constipating. Organ is the opposite).

[Olesia711]

Andrea, good suggestion regarding Folate...... in some cases giving a folate supplement (with a vet's guidance) is the answer just in case it is not some sort of food intolerance.