At time of mucocele sx she was histologically dx'd with IBD. She has separation anxiety which flares her vomiting. No liver wedge biopsies were performed at the time.
She had been using the Hills L/D diet for low protein, copper, anti-ox support + SAMe + silymarin + lactobacillus based synbiosis therapy from vet + glutamine/slippery elm from animal naturopath + empirical MTZ for IBD flareups.
On initial exam in Sep she was in optimal body condition, comfortable on abdo palpation, thor ausc NAD, had a shrivelled lavender tongue with a slippery superficial pulse. She was active at GB27 bilat, and BL24. She had pain on coxofem and stifle pROM and elbow abduction. Trigger Point -ve. "John Wayne Cowboy Hindlimb Gait".
My Assessment was uncharacterized ALT elev + musculoskeletal comorbidity, plus chronic IBD but likely IBS-type component w sufficient and neccessary criteria for dx of separation anxiety/panic disorder.
TCVM assessment; Spleen Qi Deficient leading to Liver Deficient/Shen Disturbance. I suspect element of dampness before I met her w/ hx of colitis/vomiting, but suspect a high GI diet was involved.
I initially moved her to a home prepared low copper liver cleansing/ gut cleansing diet per Jean Dodds Nutrigenomics + spirulina + enterococcus based probiotics for gentle chelation. Client was initially wanting to use naturopath for supplement side wanting my counselling only for base diet, so I suggested we proceed to Nutrascan testing and for O to consider adding Xiao Yao San to current hepatosupport + Adaptil collar with recheck of bloods in one month, ideally after GI signs settle to ascertain if elev ALT was primary hepatocellular vs an element of IBS/IBD.
There was some offenders on nutrascan which we eliminated. After a month the ALT had remained elevated at 900, so we ultrasounded, finding no morphological changes and normal sized liver, no pancreatitis/steatis.
I then advised to add Xiao Yao San for another 6 weeks before repeating the testing and continue gut/liver cleansing diet.
She presented yesterday for reassessment, her weight is stable, her anxiety has improved, her vomiting fully resolved for weeks. She has been fasted for bile acids.
Her results after 6 weeks of XYS were ALT moved from mid 900 to high 800s, AST moved from 600 to 900, GGT remained high at 24, fasting bile acids (no gb re: stimulation) moved from 150 to 100.
I had advised if XYS not effective in reducing enzymes we could consider moving to Ge Xia Zhu Yu Tang for a congestive lesion. I advised my differentials are chronic hepatitis +/- idiopathic fibrotic disease, copper storage dz or some diffuse hepatic neoplasia.
Her TCVM energetics are showing pinker tongue but pulse the same.
We have discussed wedge biopsy but O unsure she wants to put her through another surgery. I have cautioned that if we delay procedure we may end up with a sick end stage dog. The internists would think about gemfibrozil and medical chelation but I was wondering about whether we just leave her be for a few months with no vomiting on SAMe, silymarin and XYS and re-test in a few months, or can you "hedge bets" and use a combo of XYS and GXZYT or is this too polarising. Her energetics don't seem to match with GXZYT (red tongue, toned pulse) but thought id ask.
Thanks in advance,
Matt
Dr Matthew J Muir
All Natural Vet Care