Enzyme dose not working? What should I try next?

[lylzzf3841]

Eddie is on 1/64th of a teaspoon twice a day as a maintenance dose. It's about 7mg/kg. It's the smallest measuring spoon I can find. We want to be able to have a measured amount.
Did you try giving a night time snack? Otherwise, I would recommend not changing anything and just keep on keeping on. Every once in a while Eddie will have days like this. Where it seems like he is reverting, but it only lasts a day or two. We give him a half of an Imodium for two days. Then it goes away. The Imodium is to help with the diarrhea and not really a treatment. The half of Immodiam is because his size. It's like 1mg per 50 pounds of dog. Not to be giving long term (more than 5 days)

7mg/kg per day seems to be a good maintenance dose. This is what my vet keeps telling me - Leo is on an extremely high dose (36mg/kg per day) for maintenance. She still thinks the treatment period shouldn’t be longer than 2 weeks

I haven’t tried late night snack yet, but we had a later dinner and earlier breakfast today, he didn’t vomit this morning, but there is definitely increased stomach noises and gas… I’m all very puzzled at the moment. I hope it was a one time thing but based on his stomach noises this morning something is definitely off…

[Eddiespaghetti]

I am just trying to help troubleshoot here. When your dog eats, do they eat super fast? Is it possible they got into something they shouldn't have? Is it possible to give a third meal and give smaller feedings?
The stomach noises could be something relatively harmless like they are eating too fast and getting a lot of air in their stomach, or they are just hungry.
One piece of advice my vet gave me was "not everything is an issue". I do try to apply it whenever has issues. It's hard sometimes though. After months of watching Eddie go through hell, I want to fix anything that goes wrong. It might be acid reflux rearing it's head.
I am not saying there is nothing wrong. I am only saying it might clear up on it's own.
One option to try is to see is you can get them to drink a cup or teo warm water and like a tablespoon of honey. This is an old school treatment to help with acid reflux and/or if the dog has to fast. One of Eddie's vet is really old school.

[lylzzf3841]

When your dog eats, do they eat super fast? - Yeah Leo always has great appetite and tend to eat super fast - it's a lot longer to prepare his food than him finishing it. 2 1/2 cups of wet food takes him less than a minute

Is it possible they got into something they shouldn't have? Not likely. We've been having ice storm/freezing temperature for last 4 days or so, we couldn't even go outside for a short walk. And I keep a close watch when he's in the backyard. I was actually wondering if this could be due to the weather. We were out of power for almost 2 days and the temperature in the house was only around 49F..... maybe the cold air put some stress on his GI tract?

Is it possible to give a third meal and give smaller feedings? He's already having 3 meals per day, each with about 2 cups of wet food.

One piece of advice my vet gave me was "not everything is an issue". I agree. But yeah it's hard, especially when dealing with SID. I think it even started to impact my mental health Now even a slightest stomach noise from him makes me jump out of the couch. To be honest I wouldn't have even notice noise like that before knowing about the condition. We used to joke about the smell of him passing gas and gave him a belly rub. But now it became a sign for me that SID is out of control...

I'm going to try with the warm water today to see if it's easier on his stomach. Hopefully it'll clear up soon... Again, thank you Jeremy. It's great to have someone that knows about the condition to troubleshoot with.

[Eddiespaghetti]

If he eats super fast, there is a chance the noise you are hearing is air in his tummy. One of my dogs does this and we had to get a slow feeder. You could also try to give him a little at a time to see if it helps. I don't know if it will fix the problem, but sometimes experimenting can lead to positive results.
On a side note; another thing you can do if your dog has to fast is give a tablespoon of pancake batter.

[Olesia711]

this sure sounds like SID/SIBO/Dysbiosis out of control.... Unfortunately with SID, it never really goes away, so our best objective is to try and keep it under good control.

Usually the best control is finding a diet that best agrees with the dog... but this can be very, very difficult as there are so many factors that you have to sift thru.... and all the while, the dog is having loose stools...... so we try circumventing the issue by adding prebiotics, and if that fails, try pre+probiotics, and if that fails, then try Tylan, and if that fails, the try a fecal transplant (enema version) .

I went back and reviewed everything you wrote.... and it sounds like SID, it sounds like the Tylan has helped but that there is still an issue ... the 2 steps forward and 1 step back.... is an excellent description of dealing with SID.

This food that you are feeding "2 cups of Chicken breast, Salmon, rice, vegetables (wet food)" is this homemade or is it a commercial canned food? Where i am going with this question is that you "might" want to try a different food..... with either different proteins, or a different ratio of the ingredients as sometimes, it is not so much that the dog cannot have certain ingredients, but rather that they can only have so much of certain ingredients.

The other thought that came to mind, is maybe add Slippery ELm powder to the mix, start with only 1/8 tsp. The reason why i am suggesting this is because not only i slippery elm a good fiber with prebiotic properties, but it is also a mucilage that coats the intestine and with SID/SIBO/Dysbiosis... that's like a bunch of little holes that perforated the lining and now bad metabolites are getting thru hence triggering SID/SIBO/Dysbiosis.... so they "think" that this might be why Slippery Elm helps a lot of EPI dogs struggling with repeated loose stools. But... fair warning... it does not help every single dog with SID.

The other thing i noticed reading back thru your notes is that is appears that Metronidazole always helped Leo. Although we highly recommend NOT using Metro since it kills ALL the bacteria in the gut.... it does make me wonder if the bacteria that Leo is having the most issue with might not be more concentrated in the large intestine vs. the small intestine simply because even though both antibiotics will address bacteria in both places.... Tylan is more geared towards addressing bacteria in the small intestine and Metro is more geared towards addressing bacteria in the large intestine..... so this makes me wonder why the metro appeared to help Leo much more quickly than Tylan... Mayb something to talk to your vet about..

However, above and beyond all of the above regarding Metro.... in the end, you will want to give as little antibiotics as possible if possible........... so even though i know it is very frustrating when Leo has a set-back, Like Jeremy alluded to.... you are really REALLY doing a great job with Leo so try not to get too upset too readily when his poor tummy makes those awful noises, he stinks up a room with farting, and or he has semi good poos..... IMHO it means, something is still off, but you are getting there....... by doing all the right things to figure out what seems to be LEo's triggers............ besides... if you tense up, unfortunately Leo is going to pick up on that too.

[lylzzf3841]

Thank you Olesia for the detailed response! here are some more info regarding your questions -

is this homemade or is it a commercial canned food? Homemade. Leo stopped eating kibbles when he was 11 months, and we've on homemade/canned food combination ever since. We've done couple of rounds of elimination diet trials and protein rotation. Things he is great with used to be beef, lamb, chicken, white fish, salmon and rabbit. Ever since he started to show GI issues (last September), he's no longer able to eat beef or lamb, I think it's due to the fat content. Now he's on a very low fat diet with chicken breast, and rabbit. We've been trying to figure out the better combination, but so far he can't eat anything with more than 6% of fat, even when on Tylan.

The other thought that came to mind, is maybe add Slippery ELm powder to the mix, start with only 1/8 tsp. We've tried SE at the beginning of the Tylan cycle. I couldn't tell if it was helping or not. I'm okay with start this again. But he takes Tylan with breakfast and dinner, so only SE timeslot available is lunch, or late night snack. How is SE usually given? Is it okay to mix it with honey as a snack? Do I need to use enzyme if mixing with honey?

The other thing i noticed reading back thru your notes is that is appears that Metronidazole always helped Leo. He's only taken Metronidazole once during a severe watery diarrhea early last month. We hadn't started any EPI/SID treatment back then. It was the first time he was ever on meds for GI issue. I'm also wondering if the soft stool were more of a colon issue, as the stool is still formed, right color and shape, but just seems to have more water content.

you are really REALLY doing a great job with Leo so try not to get too upset too readily when his poor tummy makes those awful noises, he stinks up a room with farting, and or he has semi good poos. Thank you so much for the kind words. I wanted to believe that I'm doing good job and we're headed towards the correct direction, as Leo is now 86lbs, gained about 11lbs since early December. But he used to be so healthy... with almost perfect poop every single day and can enjoy all kinds of food... It just broke my heart seeing him struggling now... I tried my best to hide any negative emotions in front of him, but he knows...

Another update - Leo's stool is better now. The setback with formless stool somehow cleared up after about 2 days. I'm adding one spoonful of Hill's Biome canned food with each meal since it's supposed to have more prebiotics/fiber, and maybe beneficial if it's more of a large intestine problem. It's very hard to get the correct fiber content with homemade food, especially now he's not having any fresh fruit snack as he used to. I have also mixed in 2 tsp pumpkin puree each meal but I don't think it's enough for a dog his size.

[Olesia711]

thanks for your answers. really appreciate it!!!

Okay.. so the food is home made... IMHO... that is excellent and the best. Alleviates a lot of concerns and issues.

Regarding SE (SLippery Elm)... we can suggest to folks how much to give based on the dog's weight... however... how often to give and or how long.... it all depends on the dog's owner and what results they see. Some folks use it every day, some only use it when there is an issue they are trying to correct.

ALso.... i used to just give it with Tylan and a meal... even though yes it can inhibit some of an antibiotic's .... but it is so slight it didn't really make a difference. HOWEVER... on the flip side... whenever i gave my other dog his Lysodren for Cushings meds... it was crucial that THAT med was given the exact dose and that was one occasion when i never gave slippery elm at the same time. Just sharing this so that you can see it can be a personal decision depending..............

Because it appears that you probably are not comfortable giving the slippery elm with the Tylan dose, then if you want, just give the SLippery Elm once a day during the meal that you don't give the Tylan . Do this for a few days or so and see if this helps further improve the stools or not, even though it sounds like they are already improved .... this way you can determine if you want to continue if it appears it helps or don't bother if it doesn't appear to help.

thanks for the clarification on the Metro... that is one anti, if possible, that i like to advise not to use... but then again, sometimes one doesn't have a choice so we do what we have to if we have to....

SOOOoooo glad to hear that Leo's stool did improve after a couple of days, so either it worked itself out (this does happen) or the added fiber helped..... since you are not sure which... i would continue with the pumpkin and the tsps of canned biome....then at a later date... once Leo has been doing well for a good while...then tr removing one at a time and see if the stools remain good... or not and then you will have your answer if more fiber is needed on a steady basis, or if it was only needed because the gut flora was out of good control.

And yes, you really are doing a great job!!!! But i know first hand how hard it is not to get upset watching our beloved companions struggle or even just not be 100%. My Izzy stopped eating for 4 days after her spay surgery... i was frantic and she picked up on it. WHen i called the vet (who knew me very well!) laughed and said she stopped eating cause she was sensing my frustration and he advised me to sing while i tried getting her to eat her meal so that she wouldn't sense my frustration/anxiety. Sure enough she started eating as soon as i started singing (to cover up my frustration). i'll always remember this because it really drove home the point on how much they pick up on our emotions..............