Sushi's Saga

[Tuckaboo Pam]

Hi, Beatrice. I think the tummy rumblings could mean SID is flaring. Check it out under managing EPI. It doesn't look like you're giving your cute girl any slippery elm or tylan, so you may want to check it out. ---Pam

[Eddiespaghetti]

Tell Sushi happy birthday for me.
My Eddie would have infrequent tummy rumblings as well. Through experimentation we discovered it was from not enough enzyme to fully breakdown the food. We increased his amount by 1/8th a teaspoon and they have gone away, except when he finds something on the ground, or when someone gives him a treat without us knowing. The belching might be from eating too quickly.

[Beatrice]

Hi, Beatrice. I think the tummy rumblings could mean SID is flaring. Check it out under managing EPI. It doesn't look like you're giving your cute girl any slippery elm or tylan, so you may want to check it out. ---Pam

Thanks Pam. I will look into slippery elm. I was thinking of discontuing the pre/probobiotic also.

[Beatrice]

Tell Sushi happy birthday for me.
My Eddie would have infrequent tummy rumblings as well. Through experimentation we discovered it was from not enough enzyme to fully breakdown the food. We increased his amount by 1/8th a teaspoon and they have gone away, except when he finds something on the ground, or when someone gives him a treat without us knowing. The belching might be from eating too quickly.

Thanks Eddie's mom. Sushi does eat very fast. I am looking to get her trained to become more confident. My husband is notorious for giving small snacks without enzymes so that doesn't help.

[Olesia711]

Hi Beatrice,'

Wishing Sushi a wonder 4th birthday....
She looks so much better now than in 2022!! And she is such a cutie too.

I always let my EPI dog, Izzy, put on a few extra ponds... just in case she had a SID "set-back".

Sushi is certainly doing so much better under your very good care AND attention to details... which is very time consuming but o so important... so HUGE "Kudos" to you.

those poos look darn good. With regards to the occasional burps/vurps etc. just wondering... have you tried Pepcid a.c... maybe at a very low dose?
I do agree with trying (one thing at a time) like slippery elm or very slightly increasing the enzymes... or even trying a course of Tylan ..... but another thought is an acid reflux med might help as these dogs have messed up secondary bile function due to EPI... in some dogs we notice a problem with others we don't. Talk to your vet about trying a low dose of pepcid A.C. to see if this helps.

The other thing i noticed with my non-EPI dog who looks a lot like Sushi and was having crappy poos like Sushi... (we finally got him straightened out).... but even when straightened out... his poos will get a little softer when i feed him just a little too much in a meal... i noticed smaller portions are MUCH more agreeable with his gut.

Oh... and the other thing... i looked back at your record and Sushi's TLI was at 3.1.... which earlier this year this value was not "clinically" EPI but advised to treat as EPI as we were told with this value the dog was SEPI and most likely segueing into EPI..... WELL... fast forward to Sept 2023 and they realized the TLI test assay's were inaccurate. in short , Sushi has EPI and has had it for a while!!!!!

Here are the revised explanations for the TLI test value results
https://vetmed.tamu.edu/gilab/service/assays/tli/

Canine trypsin-like immunoreactivity assay

IMPROTANT: new reference interval and decision thresholds

The cTLI assay we use is a commercial assay made by Siemens that is widely used by veterinary laboratories world-wide. We recently became aware that there are dogs with a cTLI that is higher than the current cut-off value of ≤2.5 µg/L that appear to have exocrine pancreatic insufficiency (EPI). We gathered serum samples from more than 100 healthy dogs to determine whether maybe there has been an assay shift, which there does appear to be. Thus, we have adjusted our reference interval to 10.1 to >50.0 µg/L. Of course the more important question is what the cut-off value for diagnosing EPI in dogs should be. We have started a prospective observational study to determine the best cut-off value for the shifted assay. Until this study is completed, we have instituted provisional diagnostic thresholds and recommendations (see below). Values ≤2.5 µg/L are still considered to be diagnostic for EPI. Our recommendation for dogs with equivocal cTLI concentrations in the lower range (2.6 to 7.5 µg/L) is to initiate a trial with pancreatic enzyme replacement therapy and to closely monitor their response. Based on epidemiological data from more than 500,000 dogs we feel confident that these dogs likely have EPI. For dogs with equivocal cTLI concentrations in the higher range (7.6 to 10.0 µg/L), incorporate how well the dog’s clinical signs fit with EPI, whether other causes of these signs have been eliminated, and possibly the patient’s response to pancreatic enzyme replacement therapy.

Additionally, some healthy dogs have cTLI concentrations >50 µg/L but cTLI concentrations may also be increased in dogs with pancreatitis or renal insufficiency. Therefore, the clinical significance of a cTLI concentration >50.0 µg/L is uncertain. If you are concerned about pancreatitis consider running a cPLI test as this is more reliable for diagnosing this condition. In dogs without clinical signs of pancreatitis or with normal cPLI concentrations, a cTLI >50 µg/L is unlikely to be clinically important.

We will update you as soon as we have gathered enough prospective data to make more definitive recommendations. As always, we are available to consult on complex cases.

New cTLI interpretations:

0 to 2.5 µg/L Diagnostic for EPI
2.6 to 7.5 µg/L Subnormal cTLI concentration, highly suggestive of EPI. Assess response to pancreatic enzyme replacement therapy to confirm diagnosis.
7.6 to 10.0 µg/L Subnormal cTLI concentration, EPI cannot be excluded. If signs are consistent with EPI, consider assessing response to pancreatic enzyme replacement therapy to confirm diagnosis.
10.1 to 50.0 µg/L Result is within the reference interval.
>50.0 µg/L The clinical significance of a cTLI concentration >50.0 µg/L is uncertain. If you have also run a cPLI and this is within the reference interval pancreatitis is unlikely.

I hope some of this information helps and PLEASE continue to keep us posted on this very cute birthday girl, Sushi!!!!

[Olesia711]

REgarding Sushi's not so nice attitude with other dogs.... i am assuming "boot camp" means you are working with a trainer now?

[Beatrice]

REgarding Sushi's not so nice attitude with other dogs.... i am assuming "boot camp" means you are working with a trainer now?

Not yet. I sent a query but no response. I was going to phone them to book a "free" consultation appt but we both got sick this week. Although I tested negative for covid, I didn't want to spread germs to anybody.

But very soon I hope to get her into training. Hopefully she has better welcome gestures when the kids come trick or treating.

[Beatrice]

Re TLI:

Earlier this year, I read from DVM360 website that dogs with TLI above 2.5 don't need treatment and may even revert to normal.

I haven't come back to see if they've changed their content but have you seen any dog reverting back to normal again?

I haven't tried pepcid ac yet. I am gonna go with slippery elm first then move forward.

[Olesia711]

Unfortunately, DVM360 reporting that dogs with TLI test results above 2.5 don't need treatment (was and still is inaccurate!!!)

If you remember who the speaker was, PLEASE let me know so that i can contact them..... this is very bad information..........

[Olesia711]

i am always very disappointed when vets or anyone give blanket statements like that..... without giving the details to back it up or explain.
'In the past, when the TLI assays were still accurately reporting the test results..... what we found (via the most current research... please see page: https://epi4dogs.com/epi-research/
and read the "Untargeted Analysis of Serum Metabolomes in Dogs with Exocrine Pancreatic Insufficiency" Epi4Dogs collaborated with this research and i even personally helped with some of the stats ..... what we find is that some of the dogs who's test results came back as SEPI (subclinical EPI/Subnormal) never did evolve into full blown EPI.... however, many of these dogs had to continue with the EPI treatment or they did not do well at all....HOWEVER.... this was when the TLI test results were accurate..... as these dogs TLI's were done 7 yrs ago.

Now if a dog's test results come back at:

2.6 to 7.5 µg/L : Subnormal cTLI concentration, highly suggestive of EPI. Assess response to pancreatic enzyme replacement therapy to confirm diagnosis.

7.6 to 10.0 µg/L : Subnormal cTLI concentration, EPI cannot be excluded. If signs are consistent with EPI, consider assessing response to pancreatic enzyme replacement therapy to confirm diagnosis.

THis is a HUGE change in interpretation of the test results and should be followed.

ANother point i'd like to make.... i think i read earlier that your other vet/ or some vet stated that if the dog didn't have pancreatitis/chronic pancreatitis, that this most likely wasn't EPI. Yes, what i call secondary EPI very often does evolve from a dog that struggled with chronic pancreatitis ... HOWEVER... just as many dogs develop EPI and never had an issue with chronic pancreatitis, some just always had some sort of gastro issue that no one could find a cause for... based on old research.... i think many of these dogs were just segueing into EPI and it took a longer time than others to develop (this is just my personal opinion)..... and some dogs develop EPI after a blockage, surgery, etc.

There are also dogs that we have repeatedly seen, that have small intestinal distal proximal disease.... not EPI... and yet.... they cannot be taken off the pancreatic enzymes or else they start going downhill.

EPI is a very convoluted and tricky condition... and not only should the typical EPI protocol be implemented.... but very often, "tweaks" or adjustments need to be made to the typical EPI protocol so that optimal results can be achieved for that individual EPI dog.