Epi4Dogs

Well test results came back and Ruby's TLI was 21.7. Her B12 and Folate were also well within normal ranges. I am stumped. She was not fasted and on enzymes, but the number was not even close. We are being referred on to an internist at a local vet school. I will likely ask for the test to be redone there. He thought she was a bit young for IBS and wanted an internal medicine doctor to make the decision to put her on steroids or not. She does respond well to slippery elm, so I would rather proceed that way until it doesn't work if it is IBS.

I am SOOOOOOOooooooooooooo glad you had her tested for EPI....... and you are correct, 21 is not even close to EPI.

Understand completely about your vet suspecting IBS, wanting an internal vet to check her out and prescribe steroids, but PLEASE before you go this route, ask your vet to let you try, just try .....a prescription high fiber diet and see if that helps before anyone prescribes steroids, even if in the end nothing else helps and that is what is needed.

I agree with your wanting to just use SLippery ELm powder for now, i agree with you..... but more may be needed in short order... or not..... but i really think it is worth trying a high fiber prescription food... even if mixed half and half with the current food that she seems to do best on.

Please, please PLEASE keep us posted..

Do you think it is safe to assume it is not EPI even though she wasn’t fasted for the test? I assumed so because her number was so high.

yes. It is safe to assume this is not EPI.

Not fasting will skew the test results but not by almost 20 points. (Confirmed EPi is below 2.5)

However.... after 6 or 9 months or even a year from now...........if you, your vet and internal vet do other tests and cannot find anything wrong... and you have tried other things....., if the same symptoms persist no matter what then retest for EPI at a later date............

FYI I have not seen a dog who's TLI came back in the 20's go on to test for EPI later on..... HOWEVER..... i have seen dogs TLI test results in the teens....eventually segue into EPI a year later.

Thank you for all your responses. As with human illness, it is so easy to feel like we’re on an island. You have helped me so much! I will be talking with my vet about the high fiber diet.

Please do keep us posted.

BTW... there are two prescription high fiber foods..... one by Purina and one by Royal Canin... they are both equally good, but ask your vet if he write a script for the Royal Canin one :
https://www.royalcanin.com/us/dogs/products/vet-products/gastrointestinal-high-fiber-dry-dog-food
......Because you can buy a smaller bag of this one and not spend so much money.... just in case it doesn't work out.

Well we’re back on the EPI train this week. We went ahead and asked our vet to call and get us set up with an appointment at a vet school near by for a second opinion/other tests that our local vet doesn’t do. When he called the vet school the vet he talked to there said that there seems to be no way this isn’t EPI based on symptoms/labs. He said to have her do another TLI (fasted this time for 12 hours) and then if that doesn’t show EPI we will go to the vet school to investigate further. We did the blood draw today after a 15 hour fast. (Poor baby thought I was starving her! We just can’t get her satiated.) Fingers crossed that it shows EPI this time. It would nice to be able to have a diagnosis.

We have held off giving her the Enzyme Diane enzymes because the non-fasted TLI was 21. So I figured she didn’t need more intense enzymes it was probably something else like her food. Unfortunately after a week of beautiful poops 2 weeks ago, she started to have soft stools. It was immediate. I didn’t realize until the meal after the soft stool started that I hadn’t gotten all the enzymes out of the pill crusher on her previous meal. So she had only a partially enzymed meal and it was not good.

Does the effect of eating without enzymes last several days? Of course she ate her poop that day too after a good few weeks of not eating it (because of course it wasn’t fully digested). She can only tolerate a little extra probiotics outside of what’s in her food. So I treated her with Pro-Pectalin paste (it has probiotics)on the second day of super soft stools. We’re a week out from the mess up and finally this morning we had a beautiful poop.

glad the poos are back to normal.... and if she is an EPI dog... yes, any "blip" can result in sloppy stools for a day or multiple days.

Please be VERY careful assuming this is EPI at a TLI value of 21. Are you sure that labs said "21" ????? and not 2.1????? cause 21 is not EPI, where as 2.1 most definitely is.

If the lab results said 21......Just because the enzymes are working at this point in time is no guarantee that this is EPI ... but i agree with your vet to eventually re-do the TLI to see if this is EPI in the making........... (if the TLI numbers go down).

Of course there always is the remote possibility that the test results somehow are wrong because of inappropriate sample storage or wrong test results.
another possibility is another condition that displays like EPI and even giving enzymes helps..... temporarily.... but unintended consequences can happen.

We have seen dogs with small proximal intestinal disease respond favorably to the enzymes and not have EPI, and yet when the enzymes were stopped the loose stools started up again.... and, as i mentioned (i think earlier) we have had dogs with tick disease that also responded to enzymes until they didn't.

The fact that you noticed improvement after the Pro=Pectalin paste, still (to me) suggests SID.... but from your post, i can't discern if this was from just giving Pro-Pectin or from a combo of ProPectin and Enzymes..........

Please do keep us posted!!!!!!!!!!! And i hear you... it is way better to have a diagnosis, even if EPI, then no diagnosis..... that is the worst cause you don't know what you are dealing with and am not sure how to treat......................