B-12 Supplementation - 3 questions please

[Mackie's Mom]

Mackie Mac is doing really well. She is back to her pre-EPI weight. She gets 1 tsp enzymes per cup kibble, 1 Proviable, 1 Omeprazole. She is eating 5 cups kibble (78 lb girl), divided into 2 meals. She has two darker than ever before, well formed stools a day!

My concern: She got 6 weeks of weekly B-12 injections. Her last weekly was on 11-21-23. Three weeks after her lasts B-12 injection, the Vet did labs and her B12 was 332 and her Folate was 11. Vet said she would not need additional B-12 injections since her B-12 was normal. Even though she said this, one month following her last weekly, I did give her one more injection (since my Vet gave me 7 to begin with) because I've read that an EPI dog needs a high B-12 result, not lower normal.

Three questions please: When should I start her on oral (Wonderlabs) B-12 - now? If she has low B-12 how would it evidence itself? And, how often should I take Mackie Mac in for B-12 testing?

Thank you!

[Patsy]

Your vet is judging the B12 as for non -epi dog. Ours need it at about 600. Higher makes no difference because it gets wee’d out.
Another injection at least, would be desirable, then a daily tablet.
When my dog had low B12, she was lethargic, depressed, and mentally confused (brain fog), unable to understand night was for sleeping.
I don’t know what the recommended testing interval is. I never took mine for testing because I kept her tablets going and she was fine, and didn’t want to pay for the obvious.. I’ve experienced low B12 myself.
It would be useful if your vet would accept information from the Epi website, which should be in their recent text books!

[Mackie's Mom]

My Vet won't give me another injection. Given this, how should I proceed with giving Mackie Mac the Wonderlabs Pet Factor B-12? Starting with x number capsules per day (each has 1000 mcg B-12 and 400 mcg Folate) and then a maintenance dose of x number capsules per day, starting when?

Mackie Mac's affect is good - energy, behavior, etc.

[Eddiespaghetti]

Given the weight of your upper, I would start with two tablets everyday. After a couple weeks, there really isn't a set amount of time, you can go to one tablet a day. If everything continues to go well and you feel comfortable you might be able to do half a pill a day or one tablet every two days. You will have to experiment and see what works best for you and then.
The problem with low B12 is the symptoms are the same as a lot of issues. The things to watch out for are; diarrhea and not eating. The other symptoms are the same as malnutrition. Brittle coat, lethargic and/or being grumpy. Luckily, if you give the tablets consistently it shouldn't get too low.

[Olesia711]

Hi Laura and thanks for the details about Mackie. Sounds like she has done really well...... except my going forward concern would be for the B12 situation.

If she was receiving B12 shots for the past 6 weeks and her B12 level only came up to 332... not only is her B12 levels not where they need to be for an EPI dog, but based on this retest value, she is not responding as well as expected on the Cyanocobalamin version of B12 either.... So it is a very good thing that you purchased Pet Factor B12 pills as they are made with Methylcobalamin version of B12 and when being don't respond as well as expected to the Cyanocobalmin version of B12 then the Methylcobalamin (or Hydroxycobalamin) usually comes to the rescue . Also.... based on her weight, give 2 capsules daily.

Next, it is very frustrating when a vet is under an incorrect assumption about B12 dosing ..... not only has Epi4Dogs stressed continued B12 supplementation with any chronic gastro condition.......... but the Texas A&M gastro lab also reiterates it....

https://vetmed.tamu.edu/gilab/research/ ... formation/
"For either oral or parenteral supplementation, if the underlying disease process has resolved and cobalamin body stores have been replenished, serum cobalamin concentration should be supranormal at the time of reevaluation. However, if serum cobalamin concentration is within the normal range, treatment should be continued at least monthly (for parenteral supplementation) and the owner should be forewarned that clinical signs may recur sometime in the future. Finally, if the serum cobalamin concentration at the time of reevaluation is subnormal, further work-up is required to definitively diagnose the underlying disease process and cobalamin supplementation should be continued weekly or bi-weekly (for parenteral supplementation) or daily (for oral supplementation)".

the key point here is "If the underlying disease/condition has been resolved" .... EPI does not get resolved, it is a chronic condition and NEEDS B12 supplementation to continue for life. The take-away is that once the B12 level is at an upper midrange value, in an EPI or any chronic gastro disease/condition .... then you and your vet should reassess the amount of B12 or the frequency of the B12 supplementation that should be given going forward.

Too often, if stopped completely when there is a chronic condition, is that things will eventually go downhill and everyone then stands around scratching their heads wondering ..." gee....what went wrong?".....thinking the B12 was okay.... and they often don't give the B12 possibility a second thought.....

With an EPI dog, you have to treat the WHOLE dog. ... for example.... all EPI dogs have SID/SIBO (dysbiosis) and little by little, SID munchies away at B12..... so this is another behind the scenes as to why B12 supplementation should be continued....

Our observation has been that no matter what condition a dog may be battling, if their B12 is insufficient, no matter how much the care-taker adheres to a treatment protocol, the dog will not flourish as it should.... to sum it up simply, their recovery will languish sooner or later....

TAMU states it this way: "As clinical signs of cobalamin deficiency include chronic wasting or failure to thrive, malaise, and gastrointestinal signs such as diarrhea, serum cobalamin concentration should be measured in any dog ......"

hope this helps

Please continue to keep us posted on how Macki Mac does.