Question Details
Hepatic Encephalopathy ???
by todd - December 2, 2009
Hi Steve,
Am seeing 10 yr. old Maltese that 2 mo. ago became aggressive toward the husband.When husband approaches dog the dog launches into a viscious full-on attack--I saw it. Other hstory is seizure disorder medicated w/ Phenob.' for 7 yrs. with no seizures seen since the initial one; that seizure was a full convulsion. Recent bloodwork showed mild inc. AP=165 (10-150);Mod. in. ALT=461 (5-107);greater inc. AST=371 (5-55). Double Bile acids both > 125! Phenobarb. dose was reduced and was put on Lactulose by RDVM and the aggression is 50 % better--but still very strong attack. (The dog calmed and let me and the wife spouse treat it and examine it).Dog has chronic gingivitis, yet has never had a dental. Has Reverse Sneeze. Thirst typically greater than appetite.Tongue is slightly too pink-red, but not Damp--normal.Pulse is thin, weak, collapses easily, normal rate. Feet, ears-cool. Coat-normal with some thinning.Temperament is normal except relentlessly seeks attention from guests. Radiant points include B19 which makes Pulse pound. I didn't needle any other points as I was afraid the dog might go postal on the holistic vet.But he melted in my arms and went to the male after I did osteopathy of head , neck, thoracics. Anyways... PHYSICALLY the dog looks more Blood Def. to me, than D.Ht.I would be prone to YGJ. But the Rev. Sneeze and thirst greater than app' suggest D.Ht .Gingivitis is questionable to me given long period on Phenobarb. I see the computer notes LDXGT for Hep' enceph"---but I'm concerned with the Pulse tongue, ear and feet temp. not showing much D.H. Please throw me a bone.
Thanks-your work has made my practice more fun and fascinating!
Todd
Replies
by naturevet
December 3, 2009
Hi Todd,

I agree with your notion of trying a Liver Blood tonic first. I agree that there is a subtle suggestion of Damp in there, but there is pretty strong evidence of Liver Blood deficiency: elevated bile acids (signifying poor liver blood supply and bile acid clearance); coat complaints; aggression coupled with need for reassurance, timidity or support; pulse; and mild to moderate liver enzyme elevations.

Of our options, Yi Guan Jian might be best, since it is relatively non-Dampening. Watch for that, though. It's also a potent antioxidant, which will help the liver recover from the phenobarbital damage. Finally, it has that slight cooling effect that seems called for (tongue, thirt). Perhaps here the appetite has not followed the thirst (as would be typical with Yin or Blood deficiency) because the dog is feeling a little toxic.

Hope this proves useful advice,

Steve

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