Signalment

• Age: 9 years
• Sex: female spayed
• Breed: Dachshund
• Species: dog

Disease Notes

• Certainty: confirmed
• Final Status: slightly better as of day 90

Treatment and Outcome

• Cushings Therapy Questions: I've been treating a classic Cushing's dog, 9YO SF Dachshund, for 3 months now using higher dose Si Miao San per Dr Marsden's protocol. She is clinically doing well, no worsening of her various symptoms / signs and even some very small improvements. Recheck of blood tests last week show that ALP (382, 5-131) and PSL (195, 24-140) are down by 50%, great! But now, AST (141, 15-66) and ALT (591, 12-118) are elevated, they were nice and quiet in March. I'm assuming this is from the SMS? Clearly, I need to address this, but can't find the info in the Endocrine lectures. From one of Marsden's lectures on pancreatitis, he mentions that when using a SY formula, e.g., XCHT, as ALP goes down, if AST goes up, to introduce XYS or YGJ as a tonic. Since SMS is being used as a Damp Heat formula v Cushing's, I'm not sure if this strategy applies. I wonder instead if I should roll in XCHT to help with the inflammation and congestion and to accelerate lipid / Chol clearance in general, also b/c she's probably a SYD dog. I could use some guidance please! Her tongue is dusky pink w/ redder tip, a little peeled or coated w/ cracks. Her pulse is deep, thin, soft, pretty toneless.
  
  My TCM diagnosis back in March was: Dampness accumulation and Damp Heat creating pathological Yang 2' to insulin resistance and Spleen Qi deficiency. I'm unsure how to characterize this (subacute?) hepatitis. I don't think Damp Heat in the Liver, no icterus. Liver Qi stagnation? The thin toneless pulse does not fit Stasis, but Liver Blood stagnation is possible and fits the exercise intolerance and abdominal distention, although these are not new signs, the T&P fit.
  
  I didn't order an AUS to check for possible liver abscess, but WBC are high d/t increased pmns and monocytes, this was not the case in March, checking her urine this week and the culture was negative. Her oral health is terrible... I did start her on a liver detox at same time as SMS, I just felt she needed it w/ her toxic history (food, vaccines, preventatives, meds), it's a blend of: *Milk Thistle, *Bladderwrack , *Cilantro Leaf, *Burdock Root, *Broccoli Sprouts, *Amalaki, *Rhodiola Root, *Schissandra, *Dandelion Leaf, †Calcium Bentonite, *Red Root, *Spirulina, †Oregon Grape Root. I don't see how that can be the culprit? Is it possible the SMS has incited underlying Liver Dampness while pulling circulation into the parenchyma? Options to deal with this while not interfering with managing the Cushing's?
  

• Four Marvels Combination