New Diagnosis....maybe?

Epi4Dogs Foundation Inc.’s mission is the advancement of science and education relating to EPI (Exocrine Pancreatic Insufficiency), yielding useful insights and positive outcomes in better managing EPI in dogs and cats. Our goals are to support and/or collaborate with veterinary EPI research and researchers, and to promote EPI awareness by educating the general public, pet owners, pet organizations, rescue and shelter organizations, veterinary schools and veterinarians.
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jaegerNmom
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Country: United States
State: Colorado
Pet name: Jaeger
My name: Anna

New Diagnosis....maybe?

Post by jaegerNmom » 22 Jun 2020, 13:49

Hello World -
We are Jaeger and his mom Anna. Jaeger is a ~6 year old rescue GSD that has been with Anna for about 18 months. After lots of tests, and getting nowhere, Anna stumbled upon this site and suggested an EPI test to our vet. Lo and behold, last week the test came back, and the vet called to say that Jaeger has EPI. Anna asked our vet if he was borderline, or truly EPI, and the vet said "solidly EPI." Great. Or so we thought.

I've ordered the B12 capsules you all suggested, and enzymes from Diane, and have started some emergency enzymes until they get here. But today I called the vet to get a copy of the test results from A&M, and to me, it looks like he may actually be subclinical? His TLI is 3.2. Clearly that's below optimal, but do I need to keep digging for other answers? Test results should be attached to this message.

What do I do here?
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Shirl D.
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Re: New Diagnosis....maybe?

Post by Shirl D. » 22 Jun 2020, 16:11

Hello Anna and Jaeger! Welcome to the forum. It sounds like you've done your homework. Have you read this page?: TLI test - not quite EPI https://epi4dogs.com/tli-test-not-quite-epi/
With a TLI of 3.2, Jaeger does fall into the subclinical range, but these dogs typically respond well to treating the dog as if it is EPI, meaning enzymes, the right food, B12 and SID treatment if necessary. So you are doing the right thing. Once a dog is clearly diagnosed with EPI, meaning the TLI score is 2.5 or less, there is no need to ever retest the TLI. With these subclinical values, the recommendation is to retest in one month (treating in the meantime) to see if there has been a change. Make sure to fast him for at least 8-12 hours (the recommendation has changed recently from the 12 to 15 hours it says below to 8-12. Water is fine, but no food for 8-12 hours.). Did you fast him before the original test?

This is from TAMU (Texas A&M University):
In dogs, values below 2.5 µg/L are diagnostic for EPI. Values between 3.5 and 5.7 µg/L are rarely if ever associated with signs of EPI but may reflect subclinical pancreatic disease such as subtotal pancreatic acinar cell destruction secondary to on-going immune-mediated lymphocytic pancreatitis. Progression of the disease in such patients may ultimately lead to EPI. Values between 2.5 and 3.5 µg/L are sometimes (but rarely) associated with clinical signs due to EPI. In these cases the TLI assay should be repeated after one month paying particular attention to ensuring that food is withheld for 12 to 15 hours before the blood sample is collected.

Jaeger's B12 is low, so it's great that you are getting the B12 with intrinsic factor. That should start helping him soon, too.

As for continuing to look for other possible causes, I would suggest holding off for now. We know for sure that he's got something going on with his digestion and pancreas. See how he responds to treating it like full blown EPI. If he responds well to treatment, wait the month and retest. If he starts getting worse or doesn't improve with treatment, it would probably be worth continuing your search.

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jilbert57
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Re: New Diagnosis....maybe?

Post by jilbert57 » 22 Jun 2020, 17:01

Welcome to the forum! There is a lot of good information on the site. Shirl covered the B12 and the area that your dogs Tli test results came back. Was Jaeger fasted 6+ hours before the test?
Please ask any questions, we are here to help☺

Jill
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 13, TJ is a 4 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

Rapids77
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Pet name: Blu
My name: Andrea

Re: New Diagnosis....maybe?

Post by Rapids77 » 22 Jun 2020, 17:11

Hi Anna and Jaeger!

I am very new to the EPI diagnosis for my boy as well and have nothing to add to help you EXCEPT to reiterate you have come to the right place! The people here on this forum are INCREDIBLE and so extremely helpful. Welcome, and I hope you can stabilize your pup - which I know you will be able to with the help of all the great people here!

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jaegerNmom
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Country: United States
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Pet name: Jaeger
My name: Anna

Re: New Diagnosis....maybe?

Post by jaegerNmom » 22 Jun 2020, 18:18

Thanks to all for the quick responses. Jaeger fasted for ~18 hours before the blood draw for the TLI test per instructions from my vet, so that shouldn't be the problem with the test. I guess this is where medicine becomes more of an art than a science, and I just have to trust that we're on the right path. Jaeger and I will keep doing what we're doing - enzymes with food, B12 w/ intrinsic, probiotics, and a few more days to finish a course of tylosin. I'm sure I will have more questions moving forward, but for now, fingers crossed for beautiful poops!

I cannot say enough how much the website has meant to me. My vet mentioned that she has never seen an EPI dog before, so it can feel like you're drifting alone, and the website has been an invaluable lifeline. You all are angels.

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Shirl D.
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Re: New Diagnosis....maybe?

Post by Shirl D. » 22 Jun 2020, 20:16

Anna,
Thanks for letting us know that Jaeger was fasted prior to the test, so as you said, that didn't skew the results. If you are not seeing improvement within a few days of starting the enzymes, let us know. I see that you are using probiotics. We generally recommend waiting to implement probiotics because different probiotics work well with different EPI dogs. It's another variable in the mix when trying to get things stable. You don't necessarily need to stop them if you've already started, that's up to you. I just want you to be aware if things aren't going in the right direction, that could be a possible reason. I also wanted to make you aware that sometimes things get worse when the Tylosin ends, so keep a close eye on things. We recommend keeping a log to help you track what you have done and what the results were. Here's a link to one on our website if you want to use it. https://epi4dogs.com/epi-log/

Good luck and come back with any questions you have!

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Olesia711
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Re: New Diagnosis....maybe?

Post by Olesia711 » 22 Jun 2020, 20:26

Hi Anna,

I can see that our staff has already covered all the major points with you. The only thing i can add is that even though "technically" with a subclincal EPI they suggest re-testing in one month, quite honestly, if Jaeger appears to be responding well overall to the full EPI treatment, you might want to wait 2 or even 3 months before running another TLI test to see if he is now a confirmed EPI dog. I only say this cause sometimes it takes a little longer than a month for them to segue into EPI.
BTW, you are doing a great job!
Olesia, was owned by Izzy, a 35lb Spanish Water Dog (SWD), Diagnosed at 1.5 years old - TLI results 1.. Izzy passed away on February 13, 2020 at 15 years old. She lived with EPI for 13+1/2 years. It was because of Izzy that Epi4Dogs was started... she was the inspiration. May her legacy of helping others with EPI continue for as long as needed.........

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Jean
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Pet name: Kara, lost 10th May 2019
My name: Jean

Re: New Diagnosis....maybe?

Post by Jean » 23 Jun 2020, 05:03

Good morning from the UK

You have a start to steer you by on your voyage

Its hard to start with as there are many balls to keep in the air but it becomes normal, I would agree that you need to get retested in the future, and you dont need to stop the enzymes for that test

remember to ask questions, its important and keep a diary

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 used Panzym enzymes, Tylan and Chemeyes b12 capsules

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


Jeanx

Barb
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Re: New Diagnosis....maybe?

Post by Barb » 23 Jun 2020, 13:28

You have had excellent advice.....may I add that keeping a daily log/journal helped us enormously when Kolby was diagnosed. Record everything you give Jaeger and the amounts, then the resulting poos. You can download a blank log form from our website or just use a notebook. This will help you to see what is working and what needs to be adjusted. It also helps you to see patterns you might not have noticed if you hadn't written them down.

Whoops! I see that Shirl has already suggested the log.....It's a great tool.

Keep us posted.

Barb

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Jean
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Location: South Liverpool
Country: United Kingdom - England
Pet name: Kara, lost 10th May 2019
My name: Jean

Re: New Diagnosis....maybe?

Post by Jean » 23 Jun 2020, 13:32

i think we need to start selling diaries/ journals !
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 used Panzym enzymes, Tylan and Chemeyes b12 capsules

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


Jeanx

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