History - 1/2020 back pain/hind limb weakness/knuckling, cp deficits - resolved with prednisone, weight 19 lbs
2/2021 evaluated for Chinese herbs - tongue lavender/hangs over teeth, pulse toned, deep L >R, good appetite, increased thirst/urination frequency, coughs when picked up, 3-4/6 murmur
started on Du Huo Ji Sheng Tang Nat Path 1/4 tsp BID
echo cxr 8/20 - no cardiac meds indicated
1/21/21 - CHF started on furosemide, pimobendan, elevated liver enzymes noted
AST 84, ALT 257, ALP 163, HCT 60%
2/2021 abdominal ultrasound - echogenic material in gb, portion immobile - rule out early mucocele, heterogenous hepatic mass right liver - fna/cytology - hepatocellular proliferation with mild atypia
started ursodiol, standard process milk thistle forte
6/2021 - weight 16.6 lbs, louder coughing, doesn't keep her up at night, can only go on short walks, progressive elevation in liver enzymes AST 103, ALT 314, ALP 230, globulin elevated at 4.0, cxr - no evidence of CHF
Started Nat Path Ge Xia Zhu Yu Tang 1/4 tsp BID
8/19/21 - wt stable, presented for lethargy, decreased appetite, diarrhea
progressive elevation in liver enzymes AST 237, ALT 695, ALP 405, globulin 3.9
9/10/2021 - d/c GXZYT, started Xiao Yao San
episode of vomiting/diarrhea 9/23/21 - owner d/c'd xiao yao san and Du Huo Ji Sheng Tang
exam 10/8/21 wt 15 lbs - v/d resolved, eating well, increased thirst at same level as before, hind end weakness - collapses when walking, hard time crouching to defecate/urinate, leaks urine in bed, developed head tilt
PE - mm pink, crt wnl, moderate to heavy calculus, small cataract OS, right head tilt, no resting nystagmus or other cranial nerve deficits, 3/6 murmur, ambulatory x 4, hind limbs splay our on table, no cp deficits, tense lumbar spine
tongue lavender/small - not wet, pulse weak/toned, not slow or fast, ears/feet cool, body neutral to warm
significant progressive increase in liver enzymes
AST 566, ALT 2554, ALP 745, globulin 4.3
plt 558, HCT53%
bactiuria - treated with Clavamox
10/28/21 wt 14.3 lbs - dramatic decrease in 2 weeks, abdominal ultrasound - slowly growing heterogenous mass in right liver, solitary hypoechoic splenic nodules, gb sludge, increased prominence of jejunal lymph nodes
Assessment - Liver blood stagnation - liver mass/severely elevated liver enzymes, spleen qi deficiency - cool extremities, weight loss
liver yin deficiency - increased thirst, weight loss despite good appetite
head tilt - internal wind?
Overall she seem on exam like an deficient cold case, but her liver mass/liver enzymes seem like an excess so I am at a loss as to what formula would help her. Maybe Minor Bupleurum - but her pulses don't fit?