Signalment

• Age: 2 years
• Sex: male
• Breed: Shih Tsu
• Species: dog

Disease Notes

• Certainty: confirmed
• Comments: Patient presented for routine wellness exam and labs. He has been eating a raw diet since puppyhood. No clinical signs at home. Patient’s ALT was 203 U/L. Previous year was 194 U/L. Pre and Post bile acids elevated (18, 42 respectively). Radiographs illustrated smaller liver silouhette otherwise WNL. U/S report results: no primary large liver shunt but cannot R/O MVD, otherwise WNL.
  
  Discussed suspected MVD with the owner and we talked about Happy Wanderer and rectal insufflation of ozone. She had read it was okay to give Cessorex and Happy Wanderer together, so I wanted to confirm if this is okay to use both together? Or just one is best?
  
• Final Status:

Treatment and Outcome