EPI Experts please - Page 2

Thanks for all of the links and information.  I've been reading through it all.  I can say he has many similar symptoms to what I'm reading, so at least after the retest I will know what to do if it turns out to be this.  We'll see what happens ... 

My old man had what they termed "symptomatic EPI". His last  cTLI test was 5.1 fasting. His cTLI without fasting was 7.2. They initially thought it couldn't be EPI because his value was too low. However, with more studies, biopsies of pancreas', treatment, etc the researchers found that EPI does still exist in dogs with low normal values.
What you are describing sounds like a mix of possible EPI with definite SIBO. I would start the dog first on Tylan for a minimum of 6 weeks. See how he does after the first week and if you notice a change, it is most likely a bad case of SIBO. Then go from there.

My vet never called me when the TLI test came back at 4.9 as she figured this was not in the EPI range of under 2.5. Weeks later when I asked for the test result to be faxed to me she asked me how my dog was doing.  I said still the same nothing is working, that is when she clued in to maybe we should try the enzymes. Two days after the enzymes my girl was back to normal.  Months and months of a starving dying dog and two days on enzymes and she was a whole heck of a lot better.

For 6 months I lived through hell, trying different foods, giving her pepto bismal, cooking chicken and rice, running back and forth to the vet,  no sleeping through the night and crying myself to sleep worrying that I would have to put her down. And all it took was two days on enzymes to cure her.  Now she is fine, on her B-12 and vitamins and probiotics and it is as simple as anything.  It takes a bit of time to adjust but it is not big deal.  I have Creon 5 pills on hand so that I can give her some food sometimes without the enzymes.  Today she had scrambled eggs and minced chicken with a creon pill. Her treats are freeze dried liver and carrot pieces. Life can't get any better then when your really sick dog doesn't have to be put down, she just needs something simple like help with digesting her foods. 

Thank you everyone for your stories and ideas.  I had my dog retested this week for both the TLI and the other one too.  This time he was fasted for a little over 17 hours.  Just got the results back, and somehow, with fasting, his values went up instead of down! TLi 12.5 (Range 5 -35), Cobalamine 349 (Range 175-550), Folate 8 (Range 5-35)
So at this point, it doesn't look like he has EPI....his stools have firmed up better the last few days.  Perhaps the probiotics have greatly helped him.  He hasn't put any weight back on, though.  There is something going on; I just don't know what it is. 

Folate seems on the low side.  Perhaps since vitamin B-12 is so vital for proper digestion, you could check with your vet and try some weekly B-12 injections. Your dog certainly does not have clinical EPI, however, 12.5 is on the low side for pancreatic enzymes. Therefore, a B-12 injection may not be a bad idea. It can't hurt. If it turns out your dog responds positively to the B-12 shot, you can pick up the B-12 from the drug store for about a years worth for $7.00 and do it yourself. Also, it may not hurt to feed a grain free good qualtiy kibble and remember to soak it first. There are a lot of good quality grain free canned as well, or you can cook your own stew.

According to Texas A&M, the cobalamine scale is 251-908 and the folate scale is 7.7-24.4. Your dog's folate is relatively low. Low ranges of folate point to a disease in the small intestine. I am thinkng maybe IBD?

Glad you're seeing some improvement with the probiotics...could be a simple case of garbage gut, though the low folate suggests to me that this may have been going on for a while.  Unless you're feeding a really incomplete diet, its hard to have a low folate result without some disease process being involved.  It bears keeping an eye on.

Malabsorption of folate can be due to various diseases and parasites that can contribute to inflammation of the proximal small intestine.  Any chance this dog has been exposed to giardia or coccidia?

Here's a link to Malabsorption Syndromes that you might find helpful. 
http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/23313.htm

I will have to ask my vet about possible b-12 and see what she thinks on that end of it.  I will also check out the link on malabsorption because there has to be something going on.  He's eating above normal but still no weight added on.  He also has a low albumin value, so he's been losing protein for some reason at the same time as everything else.  I do have an older small terrier that dealt with a serious bout of gastric enteritis (bloody diarrhea and bloody vomit) several weeks back, but my vet feels these aren't related at all since they presented differently.  He doesn't have any parasites.  All fecals have been negative, and he's had panacur and metronidazole too.  Thank again everyone! These ideas are helping me a lot.  

You can buy enzymes from enzymediane.com without a prescription. She sells small 'sample' packs that give about 2 weeks worth of enzymes. Soak the kibble in warm water with about a half teaspoon of enzymes for about 30 minutes, then feed.  In just a few days you'll know if this is helping, because your dog will stop acting like he's ravenous. What would it hurt? I can tell you as a nurse, lots of times things don't follow the diagnostic rule book, & trying a treatment to see if it works is time honored & medically accepted; it's called treating the presumptive condition 'empirically'. And why worry about your vet? Worry about your dog! I like my vet, too; but she gets that the dog is my priority, & that I listen to MY gut. Good luck. jackie harris

I agree with Jackie. The enzymes won't hurt they simply predigest the food in the bowl for the dog as he is not producing enough pancreatic enzymes on his own. He may not need a teaspoon per cup of food, like Jackie said, 1/2 teaspoon of enzymes per cup you could start with. Presoak the grain free kibble first in warm water and let it soak for 1/2 hour. Then mix in the enzymes add a bit more warm water and mix well.  ( goes kind of soupy the way it would in the tummy but it is predigesting in the bowl) wait another 1/2 hour then feed.  Do this every time you feed the dog and I'll bet the hunger will cease and the weight will start to come on. Alot of german shepherds and shiloh shepherds have malabsorption issues and a little enzymes on their food red ally helps if that is the case. When it comes to nutrition issues and digestive disorders in dogs vets sometimes can be very perplexed. Again, a shot of B-12 would be good and keep up with the probiotics.

So many dog owners are so afraid to try the enzymes because I think they don't want to believe their dog needs this help. Yet, their dog is starving and never gaining any weight. They keep trying different foods and still the same issues are presenting. Enzymes are not drugs, so you won't be drugging your dog. You are simply helping him garner all the nutrition from the food he is eating rather than it just passing through him partly digested.  The undigested food simply sits in the small intestine fermenting and causing a host of other issues that gets treated with the metro and tylan, but the underlying cause is not treated. The bacteria is killed with the tylan, dog is fine for a few weeks then it flairs up again. It becomes a neverending cycle if you don't get that food digested before it gets into him. 

Now, I am not saying your dog has full blown EPI with a number like 7 on the TLI scale, However, normal dogs usually have numbers in the high twenties and thirties. Which means they are producing enough pancreatic enzymes to digest just about anything, ( except grains of course ).  So, therefore from what I have learned about digestion in dogs I would simply try the enzymes to see if they help. If they don't then you have something else to deal with.

But I agree with nurse jackie.  rule out malabsorption issues on your own, before you spend hundreds of dollars at the vets.  Just my humble opinion. 

Again,  go to enzymediane.com and try the sample or simply call her and she can help.  Her enzyme cost is at least 1/3 of the vets and makes this condition affordable to treat. 
The reason both nurse jackie and I are telling you about enzyme diane is because she has the correct enzymes.  The enzymes for a dog cannot be plant based they have to be pork based. Health food stores usually only sell plant based enzymes, and are not strong enough to help a dog with this problem.  Sometimes you can find Pancreatin 4x ( these are pork based )at a health food store and you could maybe start with that.

Again, remember to always pre soak the food, then add the enzymes then wait 20 minutes before feeding.  Important rule!!

It may turn out in the end, that your dog may simply just need a bit of enzyme help to digest his food. Wouldn't that be great!!  No EPI, but just a bit of help is needed.  Oh, how I wish that could be my dog.