Enzyme dose not working? What should I try next?

[lylzzf3841]

Yeah last week I was giving wonderlabs b12 capsules everyday between the shots because I wasn’t sure how long before the b12 shots wear off… but I guess that’s a bit excessive.

It’s just so hard to be “patient” when you don’t know what you do is helping or harming your dog everything just changed so drastically for him ever since I got his TLI lab. He’s so confused sometimes and don’t understand why I no longer share an apple with him, or why there is not more treats when I praise him. I just feel so terrible sometimes…

[lylzzf3841]

Even when his is having a better day (meaning better poop of course), I’m still so profoundly scared that something I do would “break” that balance, and we’re back to ground zero…

[Eddiespaghetti]

Once everything is dialed in, when you know what does and doesn't work. One bad thing happening won't start you from square 1, luckily. It will be more of "oh that wasn't enough enzymes better increase it for next meal". Even one meal with zero enzymes won't set anything back too far, I know this first hand.
I agree that look they give us when we won't share is devastating. The betrayal they feel will go away, when they are use to less treats. Hopefully, you will still be able to small treats here and there. I can give Eddie a bite of things throughout the day with very little negatives. I hope you will be able to as well.

[lylzzf3841]

So it's been a while since my last post, so here's a quick update -

Leo's has been doing great since we started the correct Tylosin course (1/4 tsp twice per day), with the combination of a bit more fiber and Visbiome. He now has 2 BM per day that are pretty much score 2. Sometimes there might be once piece with some extra moisture but still very well formed, so I'm not too worried about that.

Now my question is - tomorrow will be the 30th day since we started Tylosin, and 22nd day with the correct dose. Is it about the time we start to taper it down? If so, how does the process look like? I'm planning to do so by 1/8tsp each time. So is it okay to do 1/4 tsp in the morning and 1/8 tsp in the evening, or does it need to be evenly distributed throughout the day? (3/16 in the morning and 3/16 in the evening).

[Eddiespaghetti]

The typical regimen is for 45 days. It's best to do the full 45 days before weening off. Usually, about the 30 day mark is when we recommend introducing probiotics if you are already giving them, then continue.
The weening process is don't reduce more than half the amount for about 1-2 weeks. You want to give it enough time to make sure it isn't getting worse. If you want you can do it slower. The reduction by no more than half applies to everything you might have to ween. Pred, Tylosin anything. The amount you give each meal, how long to wait before dropping again, is completely up to you and how they are doing.

[lylzzf3841]

The typical regimen is for 45 days. It's best to do the full 45 days before weening off. Usually, about the 30 day mark is when we recommend introducing probiotics if you are already giving them, then continue.
The weening process is don't reduce more than half the amount for about 1-2 weeks. You want to give it enough time to make sure it isn't getting worse. If you want you can do it slower. The reduction by no more than half applies to everything you might have to ween. Pred, Tylosin anything. The amount you give each meal, how long to wait before dropping again, is completely up to you and how they are doing.

Thanks Jeremy for the info! I'm a bit curious if there's a study or clinic trial regarding the 45-day course?

The reason I'm asking is that I talked to 2 vets about it and neither of them know where '45 day' come from. They both told me 45 day is considered as long term use and 20mg/kg BID is extremely high dose for long term use, which will have severe impacts on liver, and non-reversible impact on gut bacteria, causing some good bacteria to be completely missing and can only be restored via FMT. And my primary vet actually got quite upset with me...So now I'm really scared...

[Eddiespaghetti]

https://www.vin.com/apputil/content/def ... jTypeID=17

TL:DR version. I underlined the important parts
Antibiotics

Oxytetracycline used to be the therapy of choice for small intestinal dysbiosis, but oxytetracycline for oral use has become largely unavailable. Tylosin (25 mg/kg q12h for 6 weeks) is the new antibiotic agent of choice. Tylosin is extremely safe and is not used in humans for the most part - thus, creating resistant bacterial strains is not a big concern. In one study, a group of dogs was treated with 400 mg/kg daily for a period of 2 years and none of them developed any side-effects. The superb efficacy of tylosin has been well-demonstrated in studies from Finland. Some of those newer studies would suggest that smaller dosages may also be beneficial, but these findings will need to be verified. Other antibiotics, such as metronidazole, can also be used. Some patients respond to therapy rapidly and do not have a recurrence. However, other patients do not respond to antibiotic therapy alone. If there is no marked improvement after 2 weeks of appropriate antibiotic therapy, further work-up is necessary. Some patients may respond to therapy with a complete resolution of clinical signs but may have a recurrence of clinical signs as soon as antibiotic therapy is discontinued. These patients require further diagnostic work-up. In some of these patients, a specific underlying cause of the dysbiosis can be identified and treated accordingly. However, in some patients no specific cause can be identified; and prolonged, maybe even life-long, antimicrobial therapy is required.

There is the recommended regimen and what you are your vet feel comfortable with. There are some newer studies saying that the longer cycle isn't anymore effective than shorter ones as the article says. Personally, knowing there is no side-effects from going 45 days, I much rather make sure everything is fixed and not have to start over. Of course, you make the decisions on what is best for your dog. I am only giving advice based off what worked for me and what studies say.

[lylzzf3841]

Thanks a lot Jeremy for the details and links!!! It's actually a speech by Dr. Jörg M. Steiner from TAMU's GI lab! I actually was thinking about reaching out to them regarding Leo's case and the new intervals to see if they have any recommendations. I guess I can also check to see if they have a updated protocol for Tylosin courses based on more recent studies. And wow.. 400mg/kg for 2 years?? In Leo's case that's going to be 14g per day!!! I am so interested in the statement of 'and none of them developed any side-effects' cuz it seems very absolute and contradicts to what my vet told me...

.Personally, knowing there is no side-effects from going 45 days, I much rather make sure everything is fixed and not have to start over. Of course, you make the decisions on what is best for your dog. I am only giving advice based off what worked for me and what studies say.

So based on your experience, if you don't mind sharing - How often does Eddie need to go through this 45 day course? Is there always going to be relapse? My vet also recommended a gut microbiome test. Have you run any of these similar tests post antibiotics treatments for Eddie to see if there's significant impact?

[Olesia711]

the 45 day regimen / 2 times a day came directly from Dr. Joerg Steiner at the TAMU (Texas A&M Gastro lab) for EPI dogs.

We have been following that for years now.

The slow withdrawal after the 45 days comes from Epi4Dogs that we noticed works with some of the more difficult cases. It often alleviates SID coming back shortly after the 45 days are over. I personally discussed with Dr. Jan Suchodolski also at TAMU and he said the withdrawl actually makes a lot of sense.

in Layman's terms... Tylan is a macrolide antibiotic and hence only inhibit the reproduction of more bacteria... it does NOT kill all the bacteria in the gut like Metronidazole does. Staying on it for 45 days will not eliminate all the bacteria.... the dog would have to be on Tylan long term in order to eventually deplete all the bacteria and 45 days is not long term.

I hope this explanation puts things in perspective.

P.S. If you want to share the "Tylan for 45 days" recommendation with your vet ... the actual recommendation by Dr. Joerg Steiner is located here on this page:
https://epi4dogs.com/sid-sibo-microbiome-research/
scroll down until you see:

NAVC – How I Treat Small Intestinal Dysbiosis
World Small Animal Veterinary Association World Congress Proceedings, 2014
Jörg M. Steiner, DrMedVet, PhD, DACVIM, DECVIM-CA, AGAF
Texas A&M University, College Station, TX, USA

http://www.vin.com/apputil/content/defa ... &pid=12886

scroll to the "Antibiotics" section... and it is stated here:

Oxytetracycline used to be the therapy of choice for small intestinal dysbiosis, but oxytetracycline for oral use has become largely unavailable. Tylosin (25 mg/kg q12h for 6 weeks) is the new antibiotic agent of choice. Tylosin is extremely safe and is not used in humans for the most part – thus, creating resistant bacterial strains is not a big concern. In one study, a group of dogs was treated with 400 mg/kg daily for a period of 2 years and none of them developed any side-effects. The superb efficacy of tylosin has been well-demonstrated in studies from Finland.

[lylzzf3841]

Thank you Olesia for the context! Yes I think it helps a lot knowing where the recommendation come from and I'll send the links to my primary vet.

I'm still surprised how different vets follow completely different, even opposite protocols for the same condition. And even now I haven't met a single vet who's aware of the new TLI intervals and recognize it. It's so hard to imagine if same thing would happen in human medicine...

But anyway, I'm drafting an email to TAMU's GI lab with some of my questions, and hopefully it doesn't directly go into their spam folder...