So many questions for EPI GS dog

[cfreeman0405]

Let me start off mentioning I am so thankful I found this website. I'm overwhelmed with all the information, so forgive me if I have overlooked a previous post regarding some of my questions.

Here is how it all started. My GS puppy (Sin 12 months old/weight 59.8 pds) was struggling with gaining weight and constantly having diarrhea. After numerous tests for other possibilities causing the struggles, my vet ran a GI Panel with Spec cPL test on 8/17/22. Listed below are the results:

Spec cPL result: 30
TLI result: 6.5
Cobalamin result: 203
Folate result: 9.1

The vet informed me Sin has EPI and prescribed PancrePlus (2 tablets per meal) and Cobalamin Supplement Cobalequin B12 (1 tablet a day). Sin's dog food was Fromm but changed to Purina ProPlan Large Puppy Sensitive Skin and Stomach. His meal consists of 2 1/2 cup kibble in the morning, and 2 1/2 cup kibble at night. Since adding enzymes to meals, it has been a nightmare to get him to eat. Before enzyme's, he would get excited about meals, but not no more.

After a couple months, we didn't see any change in his weight, but his stool was no longer runny/soft. On 10/20/22 (Sin 14 months old/weight 60.5 pds.), the vet ran another GI Panel with Spec cPL test on Sin. Listed below are the results:

Spec cPL result: 30
TLI result: 24.0
Cobalamin result: 2,000
Folate result: 24.0

The vet recommended PancrePlus (3 tablets per meal) vs (2 tablets per meal). His poops have been off and on at a #2, #3 and #4 (description from the Fecal Scoring Chart).

Since 8/17/22 to today 2/15/23 (6 months later), Sin has only gained 1 pound. After reading so many posts, I learned not all products work on all dogs, so I ordered Pan-tenex digestive supplement for dogs and started giving to Sin on 2/13/23.

Now that I have provided the backstory on Sin, it brings me to the following questions:

It was suggested on a previous post, feeding 3-4x's a day. Supposed to get 150% food intake until reaching a healthy weight.

Sin's daily feeding routine:

1 1/2 cup kibble, sprinkle water and 3/4 tsp. Pan-tenex enzyme on food. Mix well and let sit for 20 minutes. Then I add 1 tsp. plain yogurt and serve.
Lunch time 1 cup kibble, sprinkle water and 3/4 tsp. Pan-tenex enzyme on food. Mix well and let sit for 20 minutes.
Mid-day 1 cup kibble, sprinkle water and 3/4 tsp. Pan-tenex enzyme on food. Mix well and let sit for 20 minutes.
Dinner time 1 cup kibble, sprinkle water and 3/4 tsp. Pan-tenex enzyme on food. Mix well and let sit for 20 minutes. Then I add 1 tsp. plain yogurt and serve.

Since starting new enzyme, his poops have been #3 and #4 (the description from the Fecal Scoring Chart). It was suggested to start the enzyme dose low at first. If so, for how long? Should I up his enzyme dosage to 1 tsp. per meal? If so, then how much food should be added as well?

How can I get Sin interested in food again? I'm at no means able to get 150% food into him. I have tried parmesan cheese sprinkled on kibble, numerous toppers, cracked or boiled egg and boiled chicken. The only thing he is interested in, is the yogurt and sometimes that is a 50/50 shot. Someone on a post mentioned cat food. What kind of cat food for EPI dog? What serving size per meal?

Why is he not gaining weight?

What am I missing?

Originally the vet said he would be happy to see 10-15 pounds on Sin, but his last comment was "well maybe we are going to have to accept him being at 60 pounds". That statement tells me, the vet is giving up on trying to get Sin at a healthy weight. Sin's backbone is predominated, and he is all sunk in at the hips.

Since on enzymes, I noticed Sin has patches of fur missing on ears/legs and extremely dry skin. I tried adding 1/2 tsp. coconut oil to his morning and evening meals, but the next day he had full blown cow pies with a bright green color. It took me a couple days to get his stool back to "basically" what has been normal for him. Any suggestions what I can do to help get his coat healthy and skin not dry?

Thank you in advance for any guidance and suggestions! It is greatly appreciated!

[jilbert57]

Hi and welcome to you and Sin.
Was he food fasted before both Tli tests? A Tli of 24 is normal.
Thanks

[cfreeman0405]

To be honest, I don't recall. When blood work was ordered, our vet didn't mention fasting beforehand. Since both tests were done in the morning, I don't believe he had eaten breakfast, but I could be wrong.

[Olesia711]

Dear SIn's mom,

Thank you so much for contacting us..... according to the TLI test results, your dog does not have EPI.

However, sometimes enzymes help temporarily even when not EPI... but without further examining the dog and figuring out what is really going on, it may be something easy to fix once properly diagnosed, but if not properly diagnosed, unintended consequences can happen.

To clinically be diagnosed with EPI, the TLI value needs to be 2.5 or less.
To maybe be sub-clinical EPI.... then the value can be anywhere between 2.6 and 5.7. Approx 50% of sub-clinical EPI dogs, called "SEPI" will go on to develop EPI and the other 50% don't.
Sometimes, when a dog displays EPI symptoms but when tested, the TLI test comes back in the teens... and if no other condition was diagnosed.... then re-test the TLI in a few months.... to see if the dog is segueing towards EPI.


From your post, the TLI test results initially at 6.5 was not EPI
The repeated TLI test (which was very good to do) was definitely not EPI.

HOWEVER, many other conditions mimic EPI signs.... and a lot of other conditions will also have SID (small intestinal dysbiosis) which although is present in every dog with EPI, can also be present with other conditions.

has your vet checked for tick disease (any limping going on)?
has your vet checked for IBD, IBS?
Food sensitivities (have you tried a hydrolyzed food?)
Possible PLE??? (Has blood work shown and low protein, like low albumin?)

Please have a conversation with your vet why he is saying your dog has EPI with these TLI values.
Please feel free to reference Gastro Lab parameters for EPI:
https://vetmed.tamu.edu/gilab/service/assays/tli/

[cfreeman0405]

Not that I recall. I have attached Lab work done on Sin 8/3/22. After reviewing the attachment, does this answer any of your questions?

[Olesia711]

thank you.

Since i couldn't read the full report in the first picture.... i went on the IDEXX website and looked at their TLI range to test for EPI.
It is basically the same that i typed above
I took a snapshot of their explanation / interpretation of their TLI test results and am posting it here for you and for you to show your vet that Sin doesn't have EPI.


Also.... you mentioned hair loss.... along with everything else.... is the hair loss on the flanks ? if so, another thing to mention to your vet to check for is Cushings.... or more accurately, A-Typical Cushings. I had 3 dogs, the middle one, Izzy was diagnosed with EPI. About a year later, my older dogs started show all the same symptoms. We ran the TLI test on him cause my vet was convinced he too had EPI. His TLI test results was 7.8... not EPI, but yet he had all the symptoms.

It took us two years before we finally figured out it was A-Typical Cushings.... which does NOT show all the typical Cushing symptoms and why the vet did not initially think to test for it. After we ran the ACTH test, put him on Lysodren (for Cushings) OMG... within a week he started improving. It was amazing. I am sharing this with you just in case it might be another possibility.

It sounds like your dog is really struggling...... please share everything we are suggesting to you with your vet and let us know how things are going.

I can see that you are trying to do everything right to help Sin... and i applaud you and even when not EPI, we will still help you if we can.

[cfreeman0405]

No, the hair loss isn't on the flanks. He chews on his legs, in my opinion, because his skin is so dry. I REALLY appreciate all the information you have provided. My gut is telling me to reach out to another vet for a 2nd opinion. You are the 2nd person commenting on the EPI results. I think Sin's health is too complicated for his current vet. I will be taking all his tests results, my spreadsheet on Sin's daily routine and your comments with me to our appointment next week. Fingers crossed the mystery diagnosis will be resolved in a timely manner. I will keep you up to date. Thank you again!

[Olesia711]

i do think a second opinion is definitely warranted
since he is chewing himself, along with the weight loss and loose stools..... this maybe some sort of allergy/sensitivity.

honestly it is usually not worth having a dog tested for allergies, cause a lot of times it will state anything over 100 and the dog has a reaction and has been proven repeatedly that these are not an accurate gage/range.... HOWEVER... if you do an allergy test (once you understand not to be concerned with the lower values) and certain items come back extraordinarily high.... then your dog has a true allergy to that item and this could be a game changer.

Regarding toppers, try something super stinky like kippers/sardines ... a tsp on top of the food.... get the kind in a can with "no salt"
Regarding cat food, anything stinky and again, just use a tsp spread on top of the food.

The other thing you can do that may or may not work is take the pantenex powder and pour it into empty gel caps ... let SIN eat about half the untreated meal... and then give him these enzyme stuffed capsules (since he like yogurt.. then he should be fine if you wrap the capsules with a little bit of real cream cheese... once he finished the capsules, then let him eat the rest of the meal..........)

It is very possible that his appetite is fading because his tummy hurts from dysbiosis....and if you are not seeing any improvement from the slippery elm, or the pre+probiotics....(and you might want to try a few different brands.... then it unfortunately might be time to do a course of Tylan.................

[debbybender]

I adopted a dog from Thailand once, and they also had difficulty eating and being healthy. Lots of from there have challenging lives, and it's unfortunate.

For Sin, try changing his food a bit, like using different kinds or textures. Sometimes, this can help a dog get interested in eating again. Also, watch how Sin acts with other foods. Slowly upping the enzyme dose might be good, but talking to your vet about what Sin needs is best.