5 Month Old Puppy with low TLI - questions!

[patty_on]

Hello all,

My five month old female labrador retriever puppy has been having diarrhea on and off for the past two months. We finally had bloodwork done this week and discovered:

TLI 3.5
B12 551
Folate 31

I've already learned so much from this site—many thanks to all who contribute. I'm hoping for any advice/opinions on the following:

- Has anyone heard of puppies this young "growing out" of a possible EPI diagnosis/low TLI? My vet seems to think this is possible but I don't want to get my hopes up if not.
- We are in Canada and are awaiting shipment of EnzymeDiane; in the meantime have started with powdered bovine pancreas from Thrive. Has anyone had success with this product? It's expensive but pup seems to love the taste! We're doing about 1/2 tsp per meal to start (3 cups of kibble a day, 3 meals a day). She is still on Tylosin so poops are decent right now. It's hard to see if the Thrive product is having any effect.
- We are trying to eliminate treats and extra kibbles as much as possible but she still needs some occasionally due to her very young age and being in training (e.g., for puppy class, and to drop sticks etc. while on walks). Is this going to set us back massively or is a little bit of food without enzyme on it okay?
- Puppy will be spayed in March and the vet wants to use the opportunity to make a larger incision and take a look at her pancreas. Has anyone had any experience with exploratory surgery for EPI diagnosis?

Thanks very much!

[Eddiespaghetti]

Younger puppies "can" grow out of EPI. When they reach maturity that is more of when it is set it stone. Any can dog can actually recover from low cTLI numbers depending on what caused them in the first place. You can have the TLI retested at the year mark. It's a little uncommon. Always hope for the best though. Edit; puppies have a higher chance to recover from EPI than older dogs. Is what I am trying to say.
Pork enzymes are usually recommended, unless the puppo has an intolerance. From what I could gather, the strength is low. You might need to give more if you are finding bits of food in the poop.
Without enzymes the treats and food won't break down. Which means they will not absorb any of the nutrients. Well at least not very much. The undigested food can cause bacteria growth in the intestines leading to SIDs, or other GI issues. Will one treat without enzymes cause a healthy pup a lot of issues? No, but if you plan on feeding them more I definitely recommend adding enzymes to their meals. There is a recipe on the website for royal icing with enzymes, which you can put on top of the treats though.
I have never heard of any exploratory surgery for EPI, but I can see if there is a tumor causing the issues that it could help. If they are already in there it could potentially do good. I definitely wouldn't recommend it without other symptoms being presented.

[jilbert57]

I would increase the amount of nutrithrive to 1 teaspoon. Like Jeremy said he needs beef or pork based enzymes but sinse the Tli is not clinically Epi this might help. Please measure the enzyme on the kibble, add maybe 1/8 cup room temp water, stir and let incubate for 15 minutes. Then stir and serve.

What food are you feeding?
Are you hearing tummy rumblings, gas, bile vomiting, or burps?

Thanks

Jill

[patty_on]

Thanks so much for your thorough replies.

She's eating Royal Canin Large Breed Puppy, and we are mixing it with the powdered pancreas and water and letting it sit for 20 minutes. No tummy rumblings, gas, or burps. She did throw up once this week but that was a first, and possibly due to something she ate in the backyard as there was some plant matter present. No bile otherwise.

It's good to hear it's something she may grow out of. But I will certainly follow all your recommendations in the meantime! She had a very soft poop today so I'll increase the amount of the powdered pancreas and see if it improves over a couple of days.

Curious to know if giving chopped beef pancreas for treats and training is recommended? Or is that too much of a good thing? This product is available in Canada: https://shop.chewsraw.ca/k9-choice-cold ... creas.html

Thanks again for all the help.

[Eddiespaghetti]

In theory those should work as treats. The only issue I see with them is; there are considered a frozen treat. Freezing can cause a loss in effectiveness of the enzymes. Of course, most pancreas, comes to the consumer frozen, or it's frozen for longevity. If you let them thaw a little it should be okay. The only reason I am saying should is because I haven't tested them and I do not know their efficacy. Experimenting, as long as you do it slowly, is a great way to find what does and doesn't work for you and your puppo.

[patty_on]

Thanks so much—that makes sense. I was planning on mixing some kibbles with enzymes and water to fill and freeze Kongs—would you not recommend that based on the efficacy of frozen enzymes?

[Eddiespaghetti]

I have frozen stuff and thawed it out and had zero problems. It's not recommended to have the enzymes too cold as they get "stunned", if you will. I have made Eddie little frozen whip cream treats with enzymes and he did just fine with them. Now, it could be that it was whipped cream or it could be that Eddie doesn't have problems with it. Each dog with EPI is different and you will not know what does or doesn't work until you try. It is recommended to wait until they are stable to experiment. You want a good baseline of poops to have an idea what does and doesn't work for your doggo. They say stable is a month or two of good, solid poops. I personally think stable is when you're not pulling your hair out trying to treat them. You are around your dog the most and it's whenever you feel most comfortable. It's easy for me to say stuff like this because I am some rando on the Internet. However, I will never recommend anything that I haven't done with Eddie.

[Olesia711]

Hi.... i'd like to chime in here...........with a slightly different explanation on your situation, but with basically the same possible outcome.

If your dog was closer to 1 year old and with a 3.5 TLI test result.... i'd say your dog definitely has EPI.
IN the past clinical EPI was 2.5 or lower, but falltime of 2023 they found that the assays were off and now anything under 10 with the TLI test may be "suspicious" for EPI.

2.5 or lower is EPI and treat accordingly
2.6 to 7.5 could very likely be EPI and treat accordingly and observe. Retest later
7.5 to 10 may or may not be EPI, optional to treat or not, observe . Retest later.

Currently they are re-evaluating the assays.

SOOOOOOOOOoooooooo.... the issue is with younger dogs/under 6 months old....often times they test positive for EPI, but there are so many other things that go on with puppies that sometimes this is just a false read and it is highly recommended to retest in 1 month and assess the TLI value... if it goes higher (most likely not EPI) or if it stays the same or goes lower (assume this is EPI)

[Olesia711]

The THRIVE that you are feeding is extremely low in Lipase:
Lipase 700 USP/g
Protease 250,000 USP/g
Amylase 250,000 USP/g
So if your pup does have EPI, this product is on the low side, so you will need to give a lot more..... HOWEVER..... that being said, i'd give a full dose for now with her food, but watch the poos closely after the Tylan is completed. If the poos are fine, then continue as is. If the poos are not fine, then increase, or hopefully Enzyme Diane's enzymes will have arrived.

If not, the next best bet is CREON enzymes.

In the meantime, at least you have some enzymes on hand as a back up and these, although not potent enough, if this is EPI, is better than nothing.

Ahh... treats for training......... what you can do, if you really need to give treats for training.... is make a batch of mushy food with enzymes prior to training class... and put this "mush" in a squeeze bottle.... then give her a "squeezed" blob of treat whenever needed while at training.

As Jeremy mentioned.... you can also make you own treats with a little enzyme frosting. Here is out treat page for other ideas:
https://epi4dogs.com/treats/

And although "exploratory surgery for EPI diagnosis" is not the typical way of diagnosing EPI, yes it has been done.... although definitely not the first way to diagnose EPI since it is very invasive. BUT.... since your dog will already be under anesthesia for a spay, it should be fine for your vet to make a larger incision to confirm EPI, which he will be able to tell by looking to see of the pancreas has atrophied. However, the bigger question is will this put your dog at risk by being under surgery longer? SOmething i would ask the vet......

[Eddiespaghetti]

Ohhhh fine. Olesia will come in be succinct in compared to my rambling butt. All joking aside, the staff here are incredibly knowledgeable you really can't ask for a better group. I just try to help out when I can.