Digestive Enzymes required?

[ConfusedPuppy]

Hi everyone,

I am so new to this topic EPI/SID etc. I have a golden retriever and he is approximately 4 years old. He has had intermittent diarrhea and vomiting since last year. Last May he was diagnosed with clostridium perfringens and was on a long course of Metronidazole for that. His stools then were just pure blood. When he came off of it, within 10 days he relapsed and we switched him to RC hydrolyzed protein. We also did an ultrasound last May that showed no abnormalities. He did well on that until last summer (mid-August) when for unknown reasons he again relapsed. We did a 5 day metro course and some proviable paste and he was alright but relapsed. He vomitted and had yellow, mucusy stools. We did use tylan with panacur for 6 days and then switched to metro for 10 days. He recovered and here we are again this year with a relapse. This time (February 2024) we had left him with a pet sitter and when we returned he had the most awful breath and seemed bloated. He then went on to have yellow, mucusy diarrhea with a bit of blood and vomiting. This went on for a while and he was treated with metro which helps but then he relapses after the metronidazole course. The vomiting has ceased but we would like to ensure that he doesn't have the diarrhea....

We then did the Texas GI panel and these were his results from last week...

TLI: 20.2 ug/L
Cobalamin: 368 ng/L
Folate: 17.6ug/L

It was indicated that he should be supplemented for his B12 (cobalamin levels) as they are low-normal and indicate possible SID/SIBO. We are starting his B12 shots today and tylan.

However, I wonder if he requires digestive enzymes with his food?

Thanks to all of you for your help! We really appreciate it!

[jilbert57]

Hi. Sorry your pup is not always doing well. According to TAMU testing protocol for Epi this is the read out:

cTli interpretations(updated 3/14/2024)

0 to 5.5 µg/L Diagnostic for EPI
5.6 to 10.8 µg/L Subnormal cTLI concentration, EPI cannot be excluded. If signs are consistent with EPI, consider assessing response to pancreatic enzyme replacement therapy and/or remeasuring cTLI in 1 to 2 months using a fasted sample (enzyme therapy will not interfere with testing).
10.9 to 50.0 µg/L Result is within the reference interval.
>50.0 µg/L In dogs without clinical signs of pancreatitis or with normal cPLI concentrations, a cTLI >50 µg/L is unlikely to be clinically important.

So according to the chart it would indicate no Epi and in my view enzymes are not indicated. Do supplement B12 and the Tylan should be dosed twice a day.

Maybe Prozyme or Total zymes both plant based might help?

Jill

[ConfusedPuppy]

Hi Jill,

Thank you for your quick response. I was thinking he didn't need enzymes as well but just wanted to be sure as I would like to relieve him of his symptoms. His other bloodwork came back otherwise unremarkable except for his cortisol - which we will test today to see if he has atypical Addison's disease. The vet thinks he is most likely experiencing SID/SIBO but we have not yet discussed all of the treatment plan..

If you feel that enzymes aren't needed, is it alright to see if symptoms resolve just by supplementing B12 and trying Tylan? If you think plant enzymes might help which ones should I look for? Also, do you have any idea how quickly B12 supplementation will help with firming up stools?

I am sorry for all these questions but I really appreciate your help!

Thanks again..

[Eddiespaghetti]

The B12 is low, but not low enough to be causing huge issues. It doesn't hurt to supplement it though.
The Tylan powder is really what is going to help with the SIDs. Tylan is also a different type of antibiotic as it's a macro... I am not even going to try to spell it. It basically stops new bacteria from growing. I say this because the results can be delayed. Some experience almost instantaneous results while some won't see a difference for a couple days. If you don't see any improvement in 5-7 days something else is going on.
They make digestive supplements you could also try.
https://a.co/d/0D73OD0
They a lot weaker than the typical EPI enzymes but your pup doesn't need full strength ones.

[Patsy]

It doesn’t sound like epi but that doesn’t mean we can’t help. Has your vet given suggestions for caring for the relapses? Blood in the poop means a bit of inflammation and ulceration. Does the blood appear to be fresh, as from the lower gut?
With humans and dogs , it can help to use a mucilage like Slippery Elm which makes the intestine make a soothing slimy coating which protects it from irritants.and allows the inflammation to heal. This also means the guts aren’t in spasm causing diarrhoea. It’s cheap and gentle .
I hope that the vet sorts it, it’s a wide subject with parasites, infection , colitis, IBD etc .

[ConfusedPuppy]

Sorry for my late response. The vet doesn't think he has EPI but possibly SIBO. I just wondered if digestive enzymes were also needed. I realise there's a dedicated section for SIBO now in your webpage and I am sorry I hadn't gone through that prior to my questions. My pup also had a low cortisol value in his bloodwork (his other bloodwork came back otherwise unremarkable) and it could be atypical Addison's disease which would require steriods (prednisone) to treat. We went today to do the ACTH stim test and will be awaiting results.....

It would be odd if Addison's were to be the case as metronidazole always stops his diarrhea episodes. He occasionally has fresh blood streaks in his stools - slightly inflamed colon. But mostly they are yellow, mucusy and smell bad. This last episode that he had - he had really bad breath and was bloated. And again with the metronidazole, the bad breath always clears up. We tried Tylan in the episode last summer and it also worked to firm up his stools - in fact he didn't poop for 2 days when we started. I am unsure if this is fairly typical in this sort of SIBO situations?

Thank you Patsy for the tip regarding Slippery elm - we will have to try that!

@eddiespaghetti - when you mention improvement in 5-7 days do you mean that stools should already firm up?

Thanks again guys for your help. We really appreciate everything!

[silkstairs]

The best digestive enzymes are the ones our bodies make naturally, and they work best when you eat a whole food diet.

[Eddiespaghetti]

5-7 days is the far side of what i have heard when it comes to Tylan. A lot of people saw improvement a lot quicker. It all depends on how much of an overgrowth they have, I think. And then, sometimes, it seems to clear it up pretty quickly. Then a week or so later in comes back for a day or two.
With tylan though, as it is a different type, it should be given over a long period. For EPI and SIDs, a 45 day course is recommended. Though, some dogs do require it for life.

[ConfusedPuppy]

Thank you again @eddiespaghetti for your response. The last time and only time we tried tylan was last year and he didn't poop for about 2 days and came out with a formed poop(little softer that firmed up). He was then switched to metro and then he came off it just fine.

Until this recent episode we had not done too much extensive testing. The SIBO analysis seems pretty accurate but just to rule out atypical Addison's disease (since his cortisol came back low). He did his ACTH stim test yesterday to rule in or out if he has atypical Addison's disease. Just in the event that Addison's is causing all of his issues but we aren't sure.

He got his first B12 shot yesterday and we have them scheduled out already. We will know end of this week and we are hoping for conclusive results.. I will update this thread when we get them.

Thanks again to everyone!

[Olesia711]

looking forward to hearing what the test results are... so please do keep us posted!