Mei - doubtful EPI diagnosis (?)

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Anja_G
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Country: Spain
Pet name: Mei

Mei - doubtful EPI diagnosis (?)

Post by Anja_G » 04 Jun 2019, 11:50

Hi everyone! I’m so glad this forum exists, because I’m at the end of my wits, and I think my vet is, too. At this stage, I’m not even sure anymore if my dog, Mei, has EPI at all.

Let me tell you a little bit about Mei first. She’s just turned two, roundabout in April or May. When she was about 4 months old, her and her brother were thrown over the fence of the animal rescue from where we adopted her when she was about a year and half. She was and still is (although much less now) an incredibly fearful dog, and in the rescue she would hardly eat because of this. Everybody thought that this was why she was so skinny. However, from the first day with us, she had an insatiable appetite and she would wolf every meal down within seconds - she still does that despite all the methods we use trying to slow her down. In the beginning we got her high energy food, which we noticed didn’t help at all with her weight and she kept having diarrhoea. So we had her checked up at the vet. The vet did several tests and was able to eliminate many potential causes (e.g. parasites, illnesses like Leishmaniasis, Heartworm etc.). After a bloodtest, the vet told us the diagnosis EPI. Also, Mei’s vitamin B12 was way too low.

So this was 3 months ago. Mei has been on enzymes (PancreaPharma first, then Lypex), probiotics (Enterovital) and on weekly vitamin B12 injections. Her poo has been absolutely normal for at least 2 months, she’s full of energy and still has this huge appetite. She would sometimes pick up things on walks, like leaves, certain kinds of poop (especially rabbit poo) but she never ate her own poo or any inorganic things. Recently, the vet advised not to let her off the lead too much or at all, so her body has a chance to put on weight instead of burning it all off running. I personally believe she gets way too much food to be burned off by a bit of running. But of course we’re trying everything. However, in all this time she has not put on any weight at all and her vitamin B12 level is still super low. Last week here faeces was sent to the lab to see if she eliminates fats, proteins etc. instead of absorbing it into the body. There was nothing! Everything very normal and as it should be (she also was again tested for parasites, this was negative too).

I do think that to a certain extent her scrawniness could be attributed to her breed and nature - although we don’t know her breed exactly, she might have some Podenco in her. But even so, she is painfully thin. And then there is the issue with the vitamin B12, which worries me. Her body just doesn’t seem able to absorb it, even after weeks and weeks of weekly injections. She has no other symptoms, no flatulence, no rumbling sounds and no diarrhoea in months. We even changed from one enzyme to another (now on 3 Lypex/day), because we thought the enzyme wasn’t working.

The full blood test in January revealed slightly elevated MCV (73.3 fl)and MCH (24.7 pg) and also Bilirubin (0.6 mg/dl).

Early March Mei’s TLI was 9.6 ng/ml and vitamin B12 level 206 pg/ml.

The repeat test about 10 weeks later was taken after fasting her for 7 hours, it revealed TLI 6.6 ng/ml and vitamin B12 level 202 pg/ml - after 10 weeks of weekly injections!

Does this sound familiar at all to anybody here? Does this sound like EPI at all? I’m really starting to doubt this and I’m losing confidence in my vet as well. I wonder are we giving her meds (specifically enzymes) that aren’t really necessary, but I don’t dare discontinuing them. Before I change vet and start from scratch with another one, I’d rather get the opinion from other experienced dog/cat-parents.

Sorry for writing a whole "book“ and thank you in advance for your suggestions, opinions and advice.
Anja and Mei

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Jean
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Re: Mei - doubtful EPI diagnosis (?)

Post by Jean » 04 Jun 2019, 12:29

Hello and welcome Anja and Mel

we are from the UK and have used Lypex in the past

I would love to see a picture of her, I have never seen a Podenco in real life, and as she is a mix, it would be even more interesting

now the resullts of the cTLI test taken at 7 hours fasting, it has to be at least 8 hours fasted, the 7 hours might have caused a wrong result

the B12 test, was this at least 8-12 hours fasted ? again, if not, the results will be faulty, I will check the current protocol just to make sure

b12 is the vet giving the generic b12 injections, this will be dark pink in colour, the ordinary b12 vitamin injections will not work to increase cobalamin levels

you might want to look at this

Chemeyes b12

https://www.chemeyes.co.uk/product/vita ... ic-factor/

they ship to Spain

Lypex how many are you giving to how much food, and how many times each day do you feed with Lypex

as the results of the cTLI are going downwards towards EPI it would seem she does have a possible EPI in the making , but not at the moment

did the vets say she was positive ?

as for being fearful, low b12 can cause that problem but not in its entirety

Lastly, are there any tummy rumbles

please keep a journal and let me have the answers to these questions


Jean
My name is Jean we live in Liverpool in Uk

My Kara born 21 July 2009 diagnosed with EPI by cTLI test August 2010 TLI = <1...folate 14 Cobalamin 408, shot down to 94, b12 injections every other day

Lowest weight 39 pounds

We use Panzym enzymes, Tylan and Chemeyes b12 capsules

Sadly, on 10th May 2019, we lost her to DM


Jeanx

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jilbert57
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Re: Mei - doubtful EPI diagnosis (?)

Post by jilbert57 » 04 Jun 2019, 14:03

Hi. Please make sure the vet is using the correct B12 serum. Also you can supplement with oral B12 with intrinsic factor. Please check out this link from our site links:

https://epi4dogs.com/b12-in-brief-2/
My name is Jill and I live on the Hood Canal in Washington State. I have two dogs: Kiya is an aussie/blue heeler and is 12 yrs young. TJ is a 3 year old Jack Russell. They keep me on my toes.
Mickey and his pancreatitis brought me to Epi4dogs.com site in 2012 to help manage it.

Mickey, Jack Russell. Chronic Pancreatitis. Dianes enzymes, 1/8t 3x/day with meals.
6/1999 - 8/2014

Anja_G
Member
Posts: 4
Country: Spain
Pet name: Mei

Re: Mei - doubtful EPI diagnosis (?)

Post by Anja_G » 04 Jun 2019, 15:32

Hello and thank you Jean and jilbert57!

The blood tests will need to be repeated then, because Mei definitely didn't fast long enough beforehand in the previous tests.
When she received the B12-injections for about 10 weeks, it was indeed a dark pink liquid. The vet now gave me a product called "Complex B" by JT Pharma, which actually contains several B-vitamins, of which 1mg B12.

Mei is getting fed 3x/daily, and she gets the content of Lypex poured over every of these 3 meals. In order to get the diarrhoea sorted, the vet initially recommendet Advance Veterinary Gastroenteric food, which worked fine. However, our other dog gets Hepadiet, which is also suitable for dogs with IBD etc. (https://luposan-iberica.com/en/products ... bd-hepatic), so I asked our vet if this would be okay to feed to Mei also. She okayed it, we very slowly adapted her to the new food and Mei's poo has been even better with this than with the Advance Vet. Gastro food. She gets roundabout 270 grams per day, but in addition to that I always have some of the same kibble with me on walks, because she is still in training. So all in all, she gets, I would guess, about 350 grams at least.

Tummy rumbles - I never heard any and the vet, whenever she listens to Mei's abdomen, always says it sounds fine.
Regarding the diagnosis, back in March after the blood tests, she said the symptoms and results were consistent with EPI.

I guess the next steps now will be another blood test with the appropriate fasting beforehand, and either buying the vitamin B12 intrinsic capsules as you advised, or going back to injections.

I'm adding a couple of pictures of Mei. We really don't know if she is or isn't a Podenco-mix, that's just my guess. I'm also suspecting that she might be part Staffie. But really, it's a guessing game :D

The pictures don't really show just how skinny she is. Especially the picture on the sofa - that was a few months before we took her home for good. I think, since she's with us, her body has grown, but her weight stayed the same. That's how it seems to me.

Again, thank you so much
Anja and Mei x
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Riley's Mom
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Re: Mei - doubtful EPI diagnosis (?)

Post by Riley's Mom » 04 Jun 2019, 19:29

Welcome to the forum, glad you found us.
She is super cute!
Her B12 is low, even after the injections. Are you still giving them? Some dogs just aren't able to hold the B12 levels, so going with a daily capsule might work better for you, or a combination of pills and injections. Some find the pills work better than the injections because it keeps a constant level rather than depleting while waiting for the next dose.
The TLI numbers are trending down, and while not technically EPI yet, doesn't mean she isn't heading that way. I would wait a couple of months and repeat the TLI, make sure to fast at least 8-12 and see what the numbers say.
Even if she doesn't turn out to have EPI, the low B12 can cause a host of problems. So it's a good thing to get a handle on.
Keep us posted and ask questions as you have them
Elisabeth

Riley is a 10 year old Labradoodle. She was diagnosed with EPI in 2014.
She currently eats Taste of the Wild, I cup in the morning, 2 cups in the evening, each meal with 1 Wonderlabs B12 sprinkled over her dinner. Enzymes are EnzymeDiane, 1 tsp per cup of food, mixed in home made bone broth. No other supplements or meds at this time.
Riley currently weighs about 44 pounds, which is pretty heavy for her.

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Madelon
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Re: Mei - doubtful EPI diagnosis (?)

Post by Madelon » 04 Jun 2019, 22:28

Hi and welcome to our EPI family. Mei is one gorgeous girl!!

With regard to fasting, the dog should be fasted for at least 12 hours before the TLI test is done. Since you've had more than one test and the values are going down as well as you've seen an improvement since starting the Lypex I would continue to treat as if EPI, save your money, and re-test in 2 or 3 months.

As for enzymes, I would contact Chemeyes as has been suggested. Suj, the owner, is an amazingly kind person and they might be able to ship the powder enzymes to you which I believe are less expensive and a little more accurate to use.

Do NOT use the Complex B - that is the wrong B vitamin to use and you would have to use such a large amount that it can be painful for the dog. B12 supplementing is for life and I highly recommend the Chemeyes B12 pills with Intrinsic Factor - the Intrinsic Factor helps with B12 absorption. Low B12 may prevent weight gain.

As for food, we recommend grain free with 4% fiber or less as grains can interfere with the efficacy of the enzymes. Also try to avoid or limit peas. We recommend feeding 150% of the food for the weight your dog SHOULD BE but in smaller, more frequent meals throughout the day until they reach their ideal weight.
MADELON and Doc. DX EPI and SIBO: 5/22/2015
Test Results: (1st) 7/2014 = TLI 16.5, B12 894, Folate > 24; (2nd) 5/2015 = TLI < .4, B12 406; Folate >24; (3rd) 10/2015 TLI < .4; B12 >1000; Folate 14.4. Prior to DX: May 2014 (2mos) - DX coccidia/bladder infection; July 2014 (3mos) 1st EPI test = TLI 16.5, B12 894, Folate >24 - Dx SIBO not EPI; Feb 2015 thru May 2015 - weight loss only; May 2015 vomitted several times, diarrhea and eating poop. Regimen: 4 cups Sport Dog Food Elite Herding - Diane 6x 1tsp per cup; 1 WonderLab PetFactor B12 2x day; 1/2tsp Slippery Elm 2xday; Multivitamin; 1 Zyrtec 10mg 2x day; Salmon Oil

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Olesia711
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Re: Mei - doubtful EPI diagnosis (?)

Post by Olesia711 » 04 Jun 2019, 23:09

Hi Anja and Mei,

Mei is such a striking, elegant looking dog, WOW! So sorry that she is not doing well.

With regards to the testing before any blood is drawn for the standard TLI test and for the B12 test (Cobalamin) test... the dog should be "food" fasted for 12 hours. Anything less may skew the test results to one degree or another.

With regards to Mei receiving B12 injections and her B12 is STILL in the 200's, she is obviously not responding to the B12 shots.... Sometimes this happens. My guess is that she was given Cyanocobalamin B12.... if yes (please check with your vet) then you need to give her Hydroxycobalamin B12 (serum) instead.... OR..... as mentioned above, start her on Methycobalamin B12 from Chemeyes, LLC... they have 1000mcg Methycobalamin, 800 mcg Folate and 40 mg Intrinsic Factor. If you decide to go with the pills, they need to be given daily (for now- -until her B12 comes up).
https://www.chemeyes.co.uk/product/vita ... ic-factor/
Just a FYI.. a dog does not have to have EPI to have low B12 :(
Many gastrointestinal conditions encourage low B12., and if a dog has SID, SID depletes the B12 stores in the body too ....

The complex B12 that your vet now prescribed is the WRONG stuff... it is not potent enough and it will also sting Mei... :(
The vitamins in the B12 product are useful but also not nearly enough to really make a difference with an EPI dog, and unfortunately the B12 is way under-dosed in this product, so this won't work either :(

The tummy rumbles that you are hearing is most likely small intestinal dysbiosis.... what you can first try is a prebiotic.... a prebiotic is food for the bacteria vs. bacteria.... see if that helps. Here in the USA we use SLippery ELm powder. HOWEVER.... what you can also try is Tylosin which is an antibiotic. What we use here in the USA is TYlan made by Elanco.... Since you live in Spain i am not sure if your vet can get it. Your vet will probably have to order it from another country. Previously they used to prescribe Metronidazole for SID (SIBO), unfortunately Metro doesn't always work on SID and there can be adverse side effects with some dogs (metronidazole toxicity) ...

If Mei has EPI... she has SID (small intestinal dysbiosis) whether or not you see signs of it or not. SID is a permanent part of EPI. WHat is currently recommended is to treat if it gets out of control.... (loose stools, burping, acid reflux, gas, tummy noises, vomiting etc). SOme dogs have all the symptoms, others have only one, or a few or none!
Olesia, owned by Izzy, a 35lb Spanish Water Dog (SWD), Diagnosed at 1.5 years old - TLI results 1.3, Doing great 12+ years later! Once stable at 3+ months, was able to reduce enzymes to only 1/2 tsp of Enzymes (use EnzymeDiane's 6x) with each cup of food, but as she aged- -had to go back 1 tsp enzymes per cup of food. Fed various grain-free kibble+real meat, 6x pancreatin enzymes from EnzymeDiane., gave 1 tsp of coconut oil / fish oil daily .... until she developed Diabetes and she now cannot tolerate higher fat foods. Currently feed an 80% home-made diet of sweet potato, a lean meat/fish, 1/3 of a raw egg, fat free cottage cheese, fish oil+vitamins and bone meal with 20% Annamaet Lean & Grain Free kibble. This combo has regulated her Diabetes (takes Vetsulin) and EPI and is very well managed. In Feb 2013, Izzy developed a very serious condition called IMHA which she (thankfully) beat and is now in remission. This is when we discovered that she also developed Diabetes & Low Thyroid. Izzy was able to receive excellent care because of the generosity of folks on Epi4dogs! Izzy continues to wake up every day full of joy. I am not a vet. All of my suggestions/recommendations are based on personal experiences, observations, information gleaned from EPI researchers & pet parents alike, and EPI research. Please share with your vet everything we suggest.

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Jean
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Pet name: Kara
My name: Jean

Re: Mei - doubtful EPI diagnosis (?)

Post by Jean » 05 Jun 2019, 03:50

well you have had some consistent replies

if this was me, I would contact Chemeyes and order some b12, as already said the b12 complex is not the right one for an EPI dog

save your money, and get her tested after a month or two on the b12 from them

the reason being

https://epi4dogs.com/b12-in-brief-2/

however, there still could be gut issues, and if SIBO small instinal bacterial overgrowth is present then it will deplete any B12 might be worth askingf about a course of antibiotics just in case, Tylan is the favourite, but possibly you will use Oxytetracycline over there, called Oxycare for dogs and MUST be given on an empty stomach, 1 hour before food or 2 after food

http://www.animalcare.co.uk/FileDeposit ... PIL_v5.pdf

please feel free to share any of this website with your vet, and if needs be, there is a language translator at the top of the forum page

Mel is gorgeous, all legs, she definitely has Staff in her somewhere, and those ears are fab

KEEP IN TOUCH

J
My name is Jean we live in Liverpool in Uk

My Kara born 21 July 2009 diagnosed with EPI by cTLI test August 2010 TLI = <1...folate 14 Cobalamin 408, shot down to 94, b12 injections every other day

Lowest weight 39 pounds

We use Panzym enzymes, Tylan and Chemeyes b12 capsules

Sadly, on 10th May 2019, we lost her to DM


Jeanx

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Olesia711
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Posts: 897
Location: North Carolina
Country: United States
State: North Carolina
Pet name: Izzy

Re: Mei - doubtful EPI diagnosis (?)

Post by Olesia711 » 05 Jun 2019, 08:49

Ahh... thanks Jean so much for mentioning Oxytetracycline.... or product name Oxycare or Oxytet......(it was late when i was finally able to get on the computer last night and my mind went blank on the UK med to effectively treat SID/SIBO) .. that is the "go-to" antibiotic when you cannot access Tylan (Tylosin)... and it is available in the UK..... and it works very, very well!!!
Olesia, owned by Izzy, a 35lb Spanish Water Dog (SWD), Diagnosed at 1.5 years old - TLI results 1.3, Doing great 12+ years later! Once stable at 3+ months, was able to reduce enzymes to only 1/2 tsp of Enzymes (use EnzymeDiane's 6x) with each cup of food, but as she aged- -had to go back 1 tsp enzymes per cup of food. Fed various grain-free kibble+real meat, 6x pancreatin enzymes from EnzymeDiane., gave 1 tsp of coconut oil / fish oil daily .... until she developed Diabetes and she now cannot tolerate higher fat foods. Currently feed an 80% home-made diet of sweet potato, a lean meat/fish, 1/3 of a raw egg, fat free cottage cheese, fish oil+vitamins and bone meal with 20% Annamaet Lean & Grain Free kibble. This combo has regulated her Diabetes (takes Vetsulin) and EPI and is very well managed. In Feb 2013, Izzy developed a very serious condition called IMHA which she (thankfully) beat and is now in remission. This is when we discovered that she also developed Diabetes & Low Thyroid. Izzy was able to receive excellent care because of the generosity of folks on Epi4dogs! Izzy continues to wake up every day full of joy. I am not a vet. All of my suggestions/recommendations are based on personal experiences, observations, information gleaned from EPI researchers & pet parents alike, and EPI research. Please share with your vet everything we suggest.

Anja_G
Member
Posts: 4
Country: Spain
Pet name: Mei

Re: Mei - doubtful EPI diagnosis (?)

Post by Anja_G » 05 Jun 2019, 09:17

Hi everyone!

Thanks again for all this helpful advice, it's much appreciated! I now know what steps to take next and I'll keep you posted on her progress, although it may take a while. It's such a complicated situation, but I am grateful that at least Mei is always happy and full of energy. It takes away a bit of the worry.

Muchas gracias! :)
Anja and Mei xx

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