Signalment
- Age: 12 years
- Sex: male neutered
- Breed: Cairn Terrier
- Species: dog
Disease Notes
- Certainty: tentative
- Comments: Diagnosis is tentative as there was no biopsy of the liver. Laboratory findings, chronic liver enzyme elevation, presenting signs, and a small liver on ultrasound are all consistent with the diagnosis, however.
Originally the condition manifested with vomiting, inappetance and jaundice. ALP levels were at 3000. Treatment with Zentonyl (Milk Thistle plus SAMe) lowered ALP to 2000 in 6 weeks and cleared the jaundice, but other symptoms remained unabated. The owner then sought holistic care.
Has also been on a mixture of dandelion, wormwood, Oregon grape, ginger, fennel, black walnut and chaparral
Onset of the problem was 7 weeks after a dental with 11 extractions followed by treatment with amoxicillin. - Final Status: much better as of day 90 of treatment
Treatment and Outcome
Problem Notes
- ALP Elevation: 2000 U/L at time of initial presentation
- ALT Elevation: 900 at time of initial presentation
- Bile Acid Elevation: > 250 umol/L
- Inappetance: Dog was prescribed 2.5 mg prednisone daily as appetite stimulant
- Low Energy: Very lethargic after eating. Able to go on a 45 minute walk per day
- Vomiting: After drinking
Treatments
Notes:
Doesn't seem to feel as well in the heat of summer. ALP at 1600, ALT at 360, GGT at 9, TBIL at 24, albumin at 20
Liver circulation varies with overall peripheral circulation - at the height of summer it is maximal. Hence decongesting treatments for the liver were chosen
Diet is largely canned or kibble
Acupuncture points were stimulated
Notes:
GGT, cholesterol and ALT slightly elevated relative to the last visit.
Still using prednisone to bolster appetite every other day
On off days, prefers carrots and crackers. I suspect that the dog is having trouble metabolizing protein, making it feel unwell unless on a higher carbohydrate diet
Now going on walks lasting over an hour.
Acupuncture points were stimulated
Notes:
Flushes of heat showing in ears and tongue each day at 3 p.m.; empty Heat?
ALP is elevated relative to last appointment at 858 U/L, but Ursodiol was stopped
Generalized improvements since last visit otherwise indicate that the current strategy of enhancing liver blood flow is the correct one. In fact, the next formula (Yi Guan Jian) will do so even more aggressively, since it contains only Blood and Yin tonics. Huang Lian (Coptis) is added to reduce biliary inflammation and for its cholagogue effects.
Acupuncture points were stimulated