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Chronic Hepatitis

by henry - February 23, 2017

Serra is a 12 year old spayed female Doberman who has been diagnosed via biopsy with chronic active hepatitis. She was diagnosed about two years ago when elevations in ALT and ALP were discovered at another practice on routine lab work. Other lab work was normal and she has no other symptoms, with the exception of recent rear leg weakness which may be due to weight gain and other side effects of the prednisone she is receiving. She was adopted at six years through a rescue and was treated for heart worm when first adopted. She has no other health issues in her history. She eats a homemade diet.

After a thorough workup at a specialty practice, she was started on prednisone, Ursodiol, antioxidants, and milk thistle. Her liver values have stayed in a range of 773-1734 (ALP) and 87-235 (ALT) despite medication. She is currently at her highest values ever and there does not seem to be a seasonal aspect to past highs and lows for values.

Her tongue is consistently lavender and her pulse thin and weak. She has a somewhat mixed pattern. Weight gain, polyphagia and pica with pred. Large flakes of dandruff. But thin pulse and good pulse response when Yin tonifying points are used. Yi Guan Jian seemed to stabilize her liver values for several months but does not seem to be helping currently. DGSYS and XYS have not improved values.

I am wondering about XCHT next, although it is not a typical Shao Yang disharmony pulse and treating Shao Yang points has also not improved the pulse.

These basically normal dogs (except for pred side effects) with creeping liver values drive me nuts. They feel like a ticking bomb (and usually are) but can be frustrating to treat.

Any suggestions welcome. Hope all is well. Deirdre Farr

by naturevet

February 24, 2017

Hi Dierdre,

I have one case myself, that coincidentally I just saw yesterday. What finally stabilized her ALT was Wu Mei Wan. There is new research showing Mu Mei (which is in WMW) as improving hepatitis and lowering liver enzymes.

Any chance the pred is confounding the ALP elevation (via inducing steroid hepatopathy)? If so, consider SMS. Conversely, if the pred has accomplished something, then still consider SMS. I know it does not fit the pulse and tongue per se, but in a webinar last night, we discussed a behaviour case where SMS ended up working, and the dog had the same pulse and tongue as your patient. Perhaps with Dang Gui added, SMS might be a good fit for that pulse and tongue.

Note that SMS helped the liver dog I discussed above, so WMW + SMS is yet another possibility if WMW ends up stabilizing things. Certainly with a failure to respond to Blood tonics like YGJ and XYS, we can assume the dog is still in the sub-acute stages of inflammation, calling for something like SMS.

As to the XCHT, if the GB points failed to improve the pulse, then I don't know that I would try it before the other formulas we discussed above. It is a sub-acute inflammation formula, though, so I guess I would say it's option #3.

My last comment is to make sure the homemade diet isn't loaded with starches and oils, given the Damp tendencies evident in the side effects to pred.

Hope that helps

Steve

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