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Discussion Starter #1
Looks like I will be asking my vet to run a test for EPI. Unfortnately, it is strictly no frills here in Germany, so I don't get the nice 'fasting' test done... the name of the test is cTLI. Anybody know what a cTLI is?

Grimm was proudly parading about with his <span style="color: #3366FF">bright blue</span> vetrap bandage on his leg after getting his blood drawn. Worse, we were in the city center in big crowds of people, so he tried to hog the limelight with EVERYONE, fishing for sympathy and hugs.


I got the EPI test run because even though Grimm has now got perfect 5-star stallar poops, he sometimes had chronic, mysterious diarrhea, and especially seems sensitive to fats in the diet. The BIG reason is: I am trying to find a reason for his brittle, dry, sparse coat.. so we are getting thyroid (T4 is the ONLY test available.. no frills, remember?) and an EPI cTLI test done. We need answers for his crispy-crunchy coat!
 

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http://www.swdclub.org/SWDLiverPancreas.htm found something there

http://www.helium.com/items/903830-people-think-genetic-disorders

I think that will show the folate and cobalamin on it for SIBO too????? Who knows this stuff?

I googled: cTLI dog SIBO and got these and there other links too if you want to google that...

http://www.vin.com/VINDBPub/SearchPB/Proceedings/Pr05000/pr00127.htm

http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2003&PID=6589&O=Generic

Then this:
http://www.gsrne.org/Health/EPI%20Brochure%20for%20GSRNE.pdf

And this on cobalimin and folate:
http://www.vetmed.wsu.edu/courses_vm546/...d_cobalamin.htm

That I got from googling: cobalamin folate dog

I wish I could just tell you something instead of just googling!

Oh-I know! Grimm could come here and we will do the bloodwork for you! YES...yes, that would work well...please send goofy happy dog to me.
 

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More info re diagnostics:

Serum Folate & Cobalamin Concentrations
Laboratory tests available for evaluation of
small intestinal function are limited. Tests such as
fat balance studies, xylose absorption, and breath
hydrogen testing are impractical and often insensitive.
Serum concentrations of folate and cobalamin
are simple tests of small intestinal function that
can be helpful in the diagnosis and treatment of
patients with GI disease. Folate and cobalamin are
absorbed in different parts of the small intestine so
that an abnormal concentration of either one may
help to determine the precise location of intestinal
disease. Serum folate and cobalamin concentrations
must be measured after an 8 to 12-hour fast
to reduce dietary influence. As it is important to
have excluded EPI to correctly interpret folate and
cobalamin test results, TLI should be measured
simultaneously. In general, folate and cobalamin
concentrations are reported to have good specificity
but low sensitivity in detecting small intestinal
disease.
Disease of the proximal small intestine may
cause a decreased folate concentration, whereas
disease of the ileum may cause cobalamin to be
decreased. With diffuse small intestinal mucosal
disease, both cobalamin and folate concentrations
may be decreased. Small intestinal bacterial overgrowth
(SIBO) in dogs may cause increased serum
folate concentrations with or without decreased
serum cobalamin concentrations. Note that sample
hemolysis will cause folate concentrations to be falsely
increased because red blood cells contain high concentrations
of folate. EPI can influence serum folate and
cobalamin concentrations by causing cobalamin
malabsorption and SIBO. http://www.antechdiagnostics.com/clients/antechnews/1999/pdf/5-99.pdf


Increased folate (19/29), decreased cobalamin (16/ 29), or a combination (9/29) were common, but increased TUBA (Serum total unconjugated bile acid) concentrations were documented in only 5 of 30 clinical dogs.
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1939-1676.2003.tb01321.x?journalCode=jvim.


This is a human medicine reference on SIBO and testing. (But why don't I subscribe to a journal named "Gut"???
) http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1773090
 

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Discussion Starter #4
Thanks Jean and Lori... I appreciate the info! I can only get very, very simple tests here, unfortunately. Just the very skimmed-down basics only.

The cTLI test was just supposed to test for EPI. It wasn't the fasting one-- they don't do that here. Will the cTLI reveal if he has EPI, or not?
 

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From an online brochure of EPI for All Breeds:

Testing
A trypsin-like immunoreativity (cTLI) blood test
(Texas A & M University labs are most widely used)
will show the dog's ability to produce digestive
enzymes (lipase, protease, amylase). The normal
range is between 5.0 – 35.0. The dog must fast 12
hours prior to blood test. cTLI tests range
approximately $100.
 

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Discussion Starter #7
Thank you LJsMom!!
Good info!

Lori, nope.. no fasting. They do not suggest fasting. Why not, I wonder? They ARE very 'no-frills' here.. but they are not really very behind-the-times in general with vet tests. They knew I wanted to test for pancreatic insufficiency-- why didn't they need me to fast him? Color me baffled!
 

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If you don't fast him, you won't get an accurate level. Don't tell them!!
 

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I have heard of others in the States who were not informed about the 12-hour fast before the TLI blood draw. In fact, my own vet forgot to mention it until after the blood draw when she popped her head in and said 'When was the last time Risa ate other than the treats we just gave her?' Fortunately, she hadn't eaten since the night before.
 

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Discussion Starter #10
Should I tell them to only run thyroid then and not cTLI for EPI? Just means on another day, I will have to somehow bring him in and pay for another office visit and blood draw.
 

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That's what I would do, if they haven't sent the blood to the lab yet.

Wait -- I'm thinking over here -- shouldn't a T4 be a fasting test too? (Scanning brain for that file...erg! I can't locate it.)

Good thing you're filthy rich, eh?
 

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That's what I would do as well.
The TLI results really aren't worth the paper they're written on if the dog isn't fasted for at least 12 hours first.

I'm so sorry you're going through all of this with your lovely dog. Though I haven't responded, I've been reading all the posts
 

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Both need a 12 hour fast to be accurate. I personally would have them redraw the blood after fasting him for 12 hours.
 

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After extensive research and asking several vets' opinions on fasting a dog before a TLI I have found that eating does not signifanctly raise the enzymes, therefore if a non-fasted dog has a TLI value of say 10 + there is no way that food would have brought a dog with EPI up to that point.

Now if the dog eats and still has a TLI of 1 then obviously that dog is going to have EPI.

It's when the value is between 3.5 to 5.7 the results are iffy and not fasting could have altered the results.

So I would say that it is fine to not fast, but if the test falls in the iffy range then I would definately do the fast and retest. Fasting the dog for 12 hours definately helps with first time accurate results and not having to test over again.

I have run 6 TLI tests between both of my GSD's that had symptoms very similar to EPI, so I have done a lot of reading and talking to different vets about the results.

Hope that made sense and helps some.
 

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The cobalamin and folate must be fasted to have accurate results.
 

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Discussion Starter #16
Wait-- The Thyroid T4 test must be fasted, too??
 

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I didn't fast either of mine for the T4.
 

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Discussion Starter #19
Whewwww!! Thank you both! At least the thyroid can be run then. Yippieeee!


Grimm is not throwing up, and his poop is perfect-- should I get the EPI test run next week anyway? The 'symptoms' are:
1. that he seems to sometimes get diarrhea for weeks. No SIBO testing here, they do not believe SIBO exists.
2: If he gets an accidental extra cup of food for example, he gets the runs for a few days cos of the extra fat content, and
3. I give him a 1/2 cup food at bedtime so he won't urp a little yellow fluid first thing in the morning.
4. His coat is HORRIBLE-- sparse, barely there, brittle, dry, and crunchy
5. My personal feeling is that he is not absorbing what he should. He should have a thicker coat (he's Czech lines, Dad was a plushcoat), be putting on some width to his build at this age (17 months).

Is he thin? Kinda. Not drastic. I could feed more calories, if there were less fat involved.

Perfect poops right now, and have been for a month. Would you run the EPI test? (all that is available is the cTLI test.. nothing more. No frills here.
)
 
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