Levi-9 month old golden retriever (home from ER/ICU 3 days)

[LisaDorn2024]

Levi spent 15 days in the ER/ICU and has not responded to the treatment protocol with the exception of his diarrhea status. Upon admission he was unable to control his liquid diarrhea (both free flowing and squirts when passing gas) and there was a lot of nausea. Since discharge, Levi's stool has consistently been 6 or 6/7, yellow, foul smelling, goes immediately after eating which is 3x/day and maybe 3-4 other times during the day and night. I am noticing a lot of stomach rumbling, frequent passing of foul smelling gas, occasional burning, and lethargy about an hour after he eats. Yesterday, I asked the ICU Internal Medicine veterinarian if these were symptoms of Levi's SID/SIBO/Dysbiosis, and if so, should his treatment protocol be tweaked or food changed. Levi was put on a prescription diet of Purina Pro HA Hydrolyzed Protein (canned chicken and soy-based kibble.). He has 1 can and 1 cup of kibble at breakfast, lunch, and dinner with meals spaced about 5 hours a part. He is allergic to all protein sources according to his Allercept testing (which may or may not be 100% valid) which is the reason the ICU vet put him on the hydrolyzed protein diet which has 4% fiber and contains pea starch (NOT MY CHOICE.) Since he is a puppy, and has experienced maldigestion/malabsorption since I adopted him at 8.5 weeks, the vet is adamant about Levi eating a food designed for "growth and development." His treatment protocol is as follows:
2 Creon at each meal
1/4 tsp of Tylan b.i.d.
Proviable Forte probiotic in the morning (vet wants to change this to Visbiome)
10 mg Prednisone b.i.d.
Omeprazole was just terminated - vet thinks this may be causing some of Levi's symptoms
Methylated B12 injection 1x/week
Wonderlabs B12+Folate+Intrinsic Factor has been ordered, but not received
Levi's diagnoses are:
EPI (PAA)
IBD
SID/SIBO/Dysbiosis
Protein Allergies
B12/Folate Deficiency
My reason for posting and asking for some suggestions is to help Levi respond to his treatment. His ICU vet told me Levi has too many diagnoses with complicated issues going on and he does not know which diagnosis is causing which symptoms and/or preventing Levi from responding to treatment. Since his ICU veterinarian does not have any suggestions on how to help Levi progress, I am hoping this EPI4Dogs community can offer some helpful ideas. I am looking for your thoughts on Levi's current treatment protocol and perhaps changes that can be made (e.g. adding slippery elm, how much Creon is too little/too much, etc.) that might have a positive impact on his stool, SID/SIBO/Dysbiosis, IBD, and energy level. And has anyone had a puppy with EPI in training (of course Levi is on a medical leave right now, but we still practice tiny skills) and not been able to use treats? Levi has spent months in training since the day he came home (he has earned 5 AKC titles/certificates including his CGC-he was supposed to be my ADA Service Dog) and is used to getting high value treats (real food treats like tiny pieces of chicken, salmon, beef, etc.) which had to be stopped due to his allergies and digestive issues. I am wondering how you train a puppy with a positive program without using lots of treats. Levi is not that motivated by toys or praise as he takes those things for granted. LOL I admit he has been more than a little spoiled.
Thank you to everyone who might have a suggestion or recommendation. I am at such a loss as to how I can best care for Levi. I have had 10 previous goldens who all passed away from hemangiosarcoma, but have never dealt with EPI or any puppy health issues.

[jilbert57]

Hi Lisa,
I am sorry Levi has so much going on. I suspect the Epi is responsible for the SID and low B12.
I suspect the IBD is the food allergy.
Can you tell me what each Creon capsule potency is?
How much does Levi weigh (wondering if the dose is correct)for his twice daily Tylan dose?
We like to see the Royal Canin Ultamino food used for food allergies as it seems to get better results. But will see others consensus.

Jill

[Greyden]

I am by no means an expert but I can tell you from our experience Visbiome is a great probiotic. If you get the Visbiome Vet, it will require a prescription from your vet. If you go to the Visbiome site you can order the Visbiome 112.5 billion in a 60 count bottle with out a prescription. It is the exact formulation as Visbiome Vet and costs a lot less. We just sprinkle the contents of the capsule on food. See Visbiome.com>news.

Is there any blood in Levi’s diarrhea? If so, is it bright red or dark and tarry?

I am curious about the CREON dosage as well? Knowing the strength of it would be helpful.

Do you have lab result numbers you can share for ctli, cobalumin, folate, etc?

Wonderlabs Slippery Elm is a great product. Wonderlabs standard delivery is thru USPS which in our experience is notoriously slow. If you want stuff shipped via UPS put that in the notes on your order. From what Wonderlabs told me, shipping $ remain the same. Their customer support is really nice and helpful.

[Greyden]

A couple other questions:
Has the vet done any imaging? X-rays, ultrasound, mri?

I am so sorry Levi and you are struggling.

If you can get help anywhere - it will be here.

[LisaDorn2024]

Thank you for your kind words. It truly has been a difficult journey. I never once got to hold Levi in my arms or in my lap. He did not like to snuggle and never wanted to sit next to me or sleep with me. I truly believed he did not like me since this was atypical behavior fir a golden. Now I know his gut microbiome was a mess and he did not feel well.
Yes, Levi has had x-rays, ultrasounds and endoscopies, but no MRI. That's how the IBD was diagnosed and cancer ruled out. Would an MRI give information that these other diagnostics cannot?
I feel so blessed to have found EPI4Dogs.

[LisaDorn2024]

How much slippery elm would you recommend for a 55 lb golden retriever puppy taking a probiotic? How many times a day? Would you add this his food with the probiotic? And does the brand make a difference in efficacy? Thank you.

[jilbert57]

From this site:

"Give Slippery Elm (SE) powder with breakfast and dinner meals. It can also be given separately with something like yogurt. Just be sure to always give with moisten food, and add a spoon or two of water as SE is a mucilage and will thicken. Incubating not necessary. SE can be give for just a few days, or a week or two…. or it may be given at a reduced amount continuously as a maintenance supplement. Remember…. sometimes even less (Slippery Elm) works better…..

1/8 tsp for dogs under 10lbs,
¼ tsp for dogs 10lbs to 30lbs,
½ tsp for dogs 30lbs to 80lbs,
3/4 tsp for dogs 80lbs to 100lbs,
1 tsp for dog 100/+lbs.

EPi4Dogs highly recommends the Wonderlabs Slippery Elm powder product… is is a very high quality source of SE at a reasonable price: https://www.wonderlabs.com/itemleft.php?itemnum=K97024"

Jill

[LisaDorn2024]

Hi Jill,
Levi get 1 can and 1 cup of food with the creon so I cannot moisten. The canned hydrolyzed protein is on the very dry side. I have to mix in the Tylan already. Levi cannot have yogurt or any dairy. He is allergic to all protein and dairy makes him especially sick.
I do not know how I would administer this to him. All he can eat right now is the dry kibble and the canned food that is super dry. I am not supposed to add any water.
I could possible mix a tablespoon of the canned food with water and make a meatball and put the slippery elm inside, I could do this while I am feeding him his meal so he would have the Creon on the rest of his food at the same time. Would this possibly work?

I have an organic slippery elm that I purchased from a veterinary supply store in Palm Beach, Florida. I used it a few times when Levi was about 6 months old, but it seemed to make things worse...by that I mean the diarrhea worsened. Pumpkin puree also seemed to have the same affect. Sometimes things do the opposite in Levi's body. I often wonder if that's because he is a puppy.

He is having a really bad day. He does not feel well at all. Afternoons seem to be the worst time of day for him,

Thanks so much!

[LisaDorn2024]

Hi Jill...one more question,
Do you think adding the slippery elm is the one variable I should change at this time (and not increase/decrease Creon or Tylan, or change the probiotic to Visbiome or decrease the prednisone?)

If I do end up changing Levi's food, how would I gradually do it? Perhaps start by transitioning the Purina HA kibble to Ultamino tiny bits at a time?
Then move to the canned food?

Thank you,
Lisa

[jilbert57]

I am so sorry just saw your two posts!

What strength Creon are your capsules?

I just put the slippery elm in a little warm water and let it start to gel a tad. Then feed. Or you can mix like you said.

Are you giving the correct amount of Tylan for weight?



Tylan (Tylosin Tartrate) Dosage Guide

13kg/30 lb – 1/8 tsp
27kg/60 lb – 1/4 tsp
41kg/90 lb – 3/8 tsp
54kg/120 lb – 1/2 tsp
twice per day

Jill