New to EPI questions from the UK!

[Olesia711]

Hi Susie.... it sounds like your vet feels and understands the situation..... but may not be willing to push it with the government.
Best thing you can do is have a full disclosure-type conversation with your vet.

If the folate was very high..... that does indicate raging SID..... the problem with the folate test is that years ago vets would look at the folate test and if the results were in the teens, the vet would say no SID/SIBO/Dysbiosis.....and things would unfortunately get worse. We now know that ALL dogs with EPI have SID to one degree or another..... hence why we don't go by the folate test any more.

I understand your position exactly.... you simply want Oscar to be comfortable.... maybe push this with your vet and maybe he'll be more accommodating to your requests.

Looking forward to seeing Oscar's test results.... although i will be offline Friday for personal reasons... so i won't be able to chime in until Saturday or Sunday.

[scoozle]

Hello forum, it's been a busy couple of weeks and I've been meaning to post Oscar's test results from the 11th March!

so here we go

2025.03.13 Oscar blood test page 2.jpg (183.89 KiB) Viewed 12147 times

2025.03.13 Oscar blood test page 1.jpg (156.14 KiB) Viewed 12147 times

compared to end of January, so pretty much 6 weeks on the dot:

- White blood cells and platelets are the same, ie low
- ALP and ALT have gone off the scale, very high - vet was worried
- bile acids are way down - good
- GLDH, Gamma GT, Cholestrol all very high - vet was worried
- B12 550 vs 111 in January - yay!
- Folate is 29.9 when the upper normal range stops at 30 - so vet said normal!!!! eye roll!!!
- TLI has gone down but vet said that it's normal for enzymes not to affect TLI levels

I've also since joined the UK EPi dogs facebook group, and lots of them suggested i get a second opinion on the Tylan situation.
Someone also suggested stopping the probiotics and slippery elm as it could all be causing more problems than its helping, so we have pretty much stopped both for the last week or so and the stomach noises have gone down! I always thought you couldn't overdo it with probiotics, obviously still learning!

But anyway, vet is very concerned about Oscar's liver, so he is having an abdominal ultrasound scan on Thursday.

I'm in that horrible position where I don't want it to be anything awful, but I also don't want them to come back and say everything's normal because then what do these test results mean?!

He perked up again a couple of days after his blood test but then went back to slow and weak last week and had to be encouraged to eat a couple of times, and is now back to mostly normal self again, so something's not right. But poops have been fine the whole time.

Interested to hear thoughts on the test results...!

[Chance]

I'm not sure about platelets? It's not great if it really is low. But sometimes it can just happen from the blood draw and testing timing. But if it's something they've been monitoring, then it's worth talking to the vet. If low, it's something that needs careful monitoring. That can cause lethargy and lack of appetite.

With high ALT and cholesterol, that to me has me wondering about thyroid function. Dogs, unlike humans don't really do high cholesterol on their own. Most often, it's related to something else; often thyroid. I don't see a full thyroid panel in the tests you included here. Was this checked at all.

As you said folate is technically normal. But very high end of normal. But if poops are okay, then I wouldn't be overly concerned about it.

Since the TLI was already checked, and confirmed to be low, there's no need to be checking that anymore. It's an expensive test, and it's not something that's going to improve without Devine intervention. It's probably going to go down, but since you're on enzyme replacement, it really doesn't matter.

It looks like B12 is pretty well maintained right now, so that's good.

[scoozle]

Thanks Chance

Yes, the platelets are quite low and were the same the first time around but vet hasn't commented on them at all. I think I'll ask about them. Olesia mentioned bone marrow previously as well.

Thank you for mentioning possible thyroid issues. No, we haven't had a thyroid panel done. But a quick google (always a bit dangerous) suggests high cholesterol could be related to all sorts, including cushings, or diabetes mellitus which I've seen on here can be a concurrent condition with EPI. He doesn't have a lot of the tell tale symptoms for hypothyroidism, cushings or diabetes though, and his glucose is at the high end but not out of range, so it feels like a bit of a minefield!

Oscar has gradually developed quite a lot of "fatty lumps" over the last couple of years, mostly on his neck and chest - I know it's normal to an extent for older dogs to get lumpy, and they've never bothered him, but I am curious to see what the scan shows. Obviously I'd be devastated if it turns out he's riddled with tumours, but I'm also dreading them doing the scan and then just saying "everything's normal"! because it's obviously not!

I'm not worried about TLI, I think the TLI level is just part of this package of tests, it seems like the blood tests are packaged up ie we don't pick and choose each line to test if that makes sense, and this ended up being the best value one to check what the vet wanted to check (and was the same as the one we did previously so handy to see the comparison).

Thanks again, will keep you posted

[Olesia711]

Hi Susie and Doug,

My heart is breaking for you... when you know something is wrong but you don't know what.

I tried to review Oscar's blood values to the best of my ability..... and i keep going back to a possible immune -mediated condition that in turn created a liver issue or a liver issue contributed to an immune -mediated condition.... but.... i am not getting a definite read on things. .... This almost sounds like Thrombocytopenia & liver issues... but not quite... or this can be cancer....or something else.....i really can't tell and i am so sorry, as i would have liked to give you some insight.. The only positive is that your vet recognizes something is seriously going on and i trust is going to run more tests on Oscar....... I do hope that he can figure it out quickly.

Sending you tons of doggie prayers................

WHen you can, please keep us posted.

[Chance]

Although it's technically not diagnostic, I would expect glucose levels to be a little higher is cortisol levels were high (ie: Cushing's). Cortisol and glucose typically follow each other to some extent. Often Addison's (low cortisol) dogs will get have glucose on the lower side, while Cushing's dogs would have it in the higher side. If he was digesting a meal, you'd expect glucose to be near the higher range of normal. If it goes outside of range first thing in the morning, before eating - then further testing is necessary. (I owned a dog with Addison's for almost 16 years)

With platelets, it doesn't hurt to ask the vet. I have had blood work done and the vet commented that it wasn't a concern. He said why, but I don't recall the reasoning; but said it's a false low.

Sadly, lumps and bumps are quite common in senior dogs! Many are fatty tissue lumps. Vets can give an educated guess by feeling. Or stick a needle in and determine what comes out. Fat cells they'll see on the microscope, and can pretty much say if it looks like fatty tissue lumps.

Good luck with getting everything figured out!

[scoozle]

Thanks s much Olesia and Chance, really interesting reading your thoughts and info on what some of the counts mean, really appreciate your insight!

Oscar had his scan on Thursday and it was not bad news but not conclusive either, so a bit neutral.

He had some thickening of the gut lining which could indicate IBD
Liver was on the big side but not alarmingly so
Gall bladder was full but they said that was to be expected because he was starved before the scan
Kidneys, lymph nodes, everything else looked normal
Lumps look fatty rather than anything to worry about

So we have come home with a months course of Urso acid (Ursodeoxycholic acid), a liver medication that they hope will calm his liver down. They said after that it may be a case of short courses of steroids if he has flare ups.

They have referred his results and history to a specialist for a second opinion but we won't hear back from them for 4 weeks.

IBD would seem to make sense with Oscars symptoms coming and going. He's doing better now, loads of energy, but weight is still hanging around 14kgs or just under. So I think we'll just have to see how he goes on these meds for a bit. We can of course play around with his diet/supplements more but I REALLY don't want to do that.

For now we are on:
Skinners wet dog food 3x day (150% of recommended amount) 10% protein, 5-8% fat, 1.5-3% fibre
Chemeyes enzyme - 1 capsule per meal
Chemeyes B12 - 1 capsule in the morning
Urso acid - 1 tablet in the evening
Not using probiotic or slippery elm at the moment, but might use ad hoc if he gets noisy stomach etc.

Fingers crossed for the next few weeks! Thanks again

[scoozle]

hello forum, I need to get some thoughts down from the last few weeks.

Oscars been on Urso acid for the last 3 weeks following a blood test and an abdominal scan that suggested his liver needed to calm down.

Since starting Urso acid, his energy and strength dipped again but has stayed at a constant level until two days ago and how he's dropped right down again to being very lethargic, not putting weight on his hind legs, trembling when standing, zero muscle mass on his hind legs, lying in odd positions and now whining/groaning almost all the time. He's obviously in pain.

His poop has been great this whole time - solid and good colour. His farts are awful, but stomach noises have reduced a bit. We changed to measuring out enzyme powder instead of capsules this week but it's the same product from Chemeyes.

Is this SID/SIBO? IBD? I have no idea what to try.

He's been fine on his food since we started it back in Feb.
He has been scavenging on walks which we try to stop as best we can but he has eaten the odd gross thing! he eats after every walk with his enzymes so I was hoping that whatever he does scavenge his enzymes will at least be in his system within 20mins.

We stopped giving him probiotics and Slippery Elm because they seemed to be making it worse, but should we try introducing SE again to soothe his gut??

I gave him half a paracetamol this morning but it doesn't seem like it's done anything for his comfort.

I'm talking myself in and out of calling the vet because I don't even know what to ask for. I feel like it might be worth trying steroids?

Thanks for reading if you get this far! losing my mind a bit here...

[Olesia711]

hi Susie and Doug,

I am so sorry that Oscar is struggling again.... thanks for sharing these observations:

"very lethargic, not putting weight on ... in pain."

I would call the vet..... the "very lethargic" along with the back leg issue and moaning.... something is going on and i would have the vet see him.

I am so sorry this is happening.... but the back leg issue rules this out as being connected to EPI.
T

[scoozle]

Thanks Olesia, I agree it didn't seem like EPI related. I just wondered if raging SID/SIBO can become so painful that it turns into whatever this is.

Shortly after posting I found a tick on Oscars backside and he hasn't had his usual tick treatment for about 4 months because it causes a bit of stomach upset and the vet told us to wait until he was stable. So I then got paranoid that he had Lyme disease symptoms!!! Which are lethargy, weakness in joints closest to tick bite etc.

We went to the vet but couldn't see our usual one, so I had to try and catch her up with the story so far. She said Lyme disease is rare and takes months to show up, but she was also at a loss for what to do. Really frustrating.also our usual vet is leaving soon so it feels like I'm back at square one

We ended up going home with some non-steroid anti inflammatory meds which helped for two days and now we're back to constant whining and groaning.

Can't remember if I said before but he's still doing awful farts and his poop is solid but smells awful too. His ears are quite waxy at the moment as well. All of that suggests bacterial stuff to me.

My gut is telling me that going this whole time without treating him for SID/SIBO because the vet won't give us antibiotics has caused whatever is happening now. Maybe I'm just projecting my frustration!