About 3 months ago he had a really bad diarrhea (mostly large bowel because of the urgency and frequency) out of nowhere and were put on bland diet immediately. The diarrhea resolved after a day, but came back even worse (with fresh blood streaks) when we tried to switch him back to his normal diet. We ran a fecal tests for parasites and it was all negative. He was sent home with Hills i/d and probiotics which worked well. His poop returned to normal when he's on bland diet + hill's i/d.
This is where all things began. Ever since the initial diarrhea episode he could no longer eat his normal diet, no matter how slowly we tried to switch him back. The soft stool will always return at certain point. It seems he couldn't handle even a little bit of fat content. The only thing was working for him was lean chicken breast/fish, boiled rice and Hill's i/d. He's lost about 5lbs in the past 3 month.
About a week ago, he had another really bad diarrhea which was completely liquid and bloody and won't resolve with bland diet. We rushed him to emergency where they ran all sorts of tests, xrays, ultrasound and also IDEXX GI and pancreas tests. We were sent home with Metronidazole and Panacur. The antibiotics worked really well for him. The diarrhea immediately stopped even when he has higher content fat intake. But after we finished a 5 days of antibiotics and Panacur course, the soft stool came back.
His IDEXX result were in 2 days ago, it turned out his TLI was 6.7, and he's also got a really low B12 number. He received a B12 shot immediately and doctor prescribed Tylan powder because I was so worried about long term side effect with Metronidazole. The doctor doesn't seem to think he's got EPI because according to IDEXX, his number was in the normal range. But I read about the updated interval from TAMU and know that this is considered subnormal and EPI is highly possible.
I've been reading through the EPI4dogs website and am really overwhelmed by all the info. So I got some questions that I'd really appreciate if someone can help me out here -
- Based on his TLI number, should I start enzyme treatment immediately? If he doesn't have EPI, would enzyme do any harm to him? e.g. make the enzyme produced by pancreas reduce further?
- The doctor seems to believe that it's more like SIBO or IBD because his diarrhea was very responsive to antibiotics. But as I understand SID/SIBO don't normally show up as a primary condition. So what should I try first, Tylan or enzyme? The dosage doctor prescribed was 1/8 tsp per 24 hours, which also doesn't seem to align with what I read about treating SID/SIBO
- Currently he has not been on any medication for about 5 days. His stool is usually very solid and normal in the morning, but very soft/formless in the evening. Is this a typical sign of EPI?
- He's now scheduled for weekly B12 shot for 6 week. Should I also do oral supplements at the same time, will that help?