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ALT Elevation In A Dog

by doctorlaura50 - October 25, 2018 View Case Report

Rosey is an 8 year old FS Golden Retriever who I first saw on 8/23/18 for chronically elevated ALT since 2016. She was a rescue who was adopted 2 years ago & was intact at the time of adoption (now spayed). Just prior to seeing me, she was diagnosed with Golden Retriever Pigmentary uveitis, glaucoma OD, blind OD.

Her diet had been changed several weeks before seeing me due to the concern of grain free diets being associated with DCM. She is eating Honest Kitchen & Primal. She tried adding fish oil, but Rosey began to burp, so she stopped. She has been gaining weight for several months & is now 89 pounds (BCS 7/9). A thyroid panel was performed by Hemolife on 8/9/18: thyroid normal. Platelet count is normal. Abdominal ultrasound unremarkable.

Tongue is pale pink, thin, with normal moisture. Pads have gotten drier since the first visit and have developed hyperkeratosis recently. Pulse is deep and slow. BL 18 has been intermittently active. Her eyes were red when I first began seeing her, but are not now (she is being treated by an ophthalmologist).

Her relevant chemistry values (non-fasting):

10/18/16: ALT 360 (8-75), col 219 (100-400)
12/6/16: ALT 211 (10-125), chol 187 (110-320)
2/7/18: ALT 193 (10-125)
8/9/18: ALT 564 (12-118), 383 (92-234)
9/21/18: ALT 152 (18-121), chol 411 (131-345) – after one month of XYS at ½ tsp
10/18/18: ALT 253 (18-121), chol 424 (131-345) – after 2 months of XYS at ½ tsp, milk thistle
No other liver enzymes have been elevated.

The XYS and milk thistle are from A Time to Heal. She gets burpy if we try to increase the XYS. She can only take ¾ ml of milk thistle without having a “gurgling” stomach.

I feel she has Liver Blood Deficiency, with Qi Stagnation, & Spleen Deficiency or Liver Overacting on Spleen. Because of the chronicity and the Spleen issues, I chose XYS. I was very encouraged when the ALT decreased to 152, but wasn’t sure if I should continue the XYS or add in something else because the ALT increased to 253. Not sure where I should go from here, or should I wait a few more months?

Thanks for you help.

Laura

by naturevet

October 25, 2018

Hi Laura,

The GI unrest on fish oils and a Liver Blood tonic suggest Dampness and Phlegm are playing a role

The improvement on XYS is encouraging, but also surprising, since the improvement in winter and worsening in August suggest an acute to subacute inflammatory condition that is better when portal circulation is lower (winter) and worse when it is higher (summer). By that logic, XYS should have been aggravating, but is perhaps anti-inflammatory enough to address subacute inflammation.

Did anything else happen that could have affected Dampness? For example, was the diet changed at the same time? If so, perhaps it was the diet change that precipitated the initial improvement, with the effect of XYS lagging.

If you hadn't already started something, and the pulse was deep and strong, then I would recommend starting with Xiao Chai Hu Tang, since it also addresses stomach unrest due to Dampness and Phlegm accumulation, as well as excess liver blood flow. Note that Blood deficiency can occur in tandem with the Shao Yang disharmonies that call for the use of XCHT, but it's a good idea when treating liver disease to let that Blood deficiency more overtly manifest itself than to try to treat it simultaneously. In a way, though, XYS does just that, making it a good formula for subacute inflammation, and not just chronic inflammation

Since you have already started, I would suggest continuing for one more month. If the ALT increases again, then I think we can conclude it was something else that improved the liver, paving the way for a switch to XCHT.

If the ALT does drop, then you should continue as you have been

Hope that helps!

Steve

Xiao Chai Hu Tang

by doctorlaura50

October 26, 2018

Thank you! I wasn't getting a strong pulse, so I shied away from XCHT. Also, since this has been going on for a couple of years, I read that XYS was the better choice. I will keep her on it one more month and change if the ALT continues to increase. She did have a diet change just prior to starting the herbs, so that may have caused the decrease.

Thanks for your time.

Laura

by doctorlaura50

November 18, 2018

ALT repeated on 11/17/18 and has decreased to 212 (N: 18-121). ALT on 10/18 was 253. Will continue with XYS since the ALT has decreased. The owner has discontinued the milk thistle since she feels Rosey is not tolerating it well. Rosey began gagging when she started taking it and the gagging has decreased since discontinuing.

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