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They include: Chronic diarrhea Weight loss despite normal or increased appetite Lethargy, weakness, or low energy Muscle wasting (atrophy) Poor appetite Neurologic signs in advanced cases (e.g., confusion, tremors) “If your dog—especially breeds predisposed to EPI or IBD [inflammatory bowel disease] like German Shepherds, Border Collies, Beagles—has ongoing GI issues, then a serum cobalamin test may be recommended,” Dr