Question Details
Elevated Liver Enzymes In A Dog
by WandaV - January 22, 2018    View Case Report
Maddie is a 6 year old FS Bichon Frise. She was originally brought to me in January 2013 with intermittent gastroenteritis for 3 months. We switched her to a raw diet, and her GI issues resolved.
She developed liquid diarrhea with mild pancreatitis in August 2013 after getting a large marrow bone. Also discovered to have a mild urinary tract infection at that time. Tongue was dusky pink with lavender centre, slight whitish coating, active BL 18 and 20.Given antibiotics by the emergency vet, but I added Wei Ling Tang when I saw her a few days later.
After that, no further issues until "routine" blood was taken in April 2016, and we discovered an elevated SGPT (at 1314, ref range 18-121); other enzymes in normal range. Started on Hepatosupport (VetriScience), Ursodiol, Hepatosyl (SAM-e and antioxidants), and Vitamin A and D. SGPT dropped somewhat by September 2016 but came up again by November. Still no clinical signs. Unfortunately I don't have details on tongue and pulse for this time, but during the next few months we cycled through Wei Ling Tang, Xiao Yao San, Ge Xia Zhu Yu Tang and Xiao Chai Hu Tang with no lasting improvements in the SGPT (although in June 2017 it was down as far as 697). Finally in October 2017, her SGPT jumped back up to 1193. After this, Maddie had an abdominal ultrasound. Her liver looked relatively normal, but there were some signs of inflammation in the lining of her small intestine. We dropped the Ursodiol, Vitamin A and D and the Hepatosyl in case any of these were irritating her GI.
A repeat of her liver enzymes in late December showed her ALT was 1098, slightly lower than in October. At that time, her tongue was dusky pink to slightly reddish, her pulses were toned, wirey and superficial, and Bl 18 and 22 were active. She has no clinical symptoms. She is a little shy in the clinic, and always defecates in the kennel on the way in to the clinic, but at home is apparently fairly outgoing.
I would appreciate an opinion on herbs or other supplements for Maddie.
by naturevet
January 23, 2018
Hi Wanda,

I've struggled with some cases like this myself. The worsening over the winter solstice suggests a Liver Blood deficiency and Qi stagnation problem, the lack of response notwithstanding. I have found some of these dogs will improve on Chai Hu Shu Gan San. That formula would not seem different enough from what you have tried to expect it to make a difference, but it has in my patients, and so is the first thing I'd try before exploring other therapies. In our own cases, it has notched the ALT down considerably, but not normalized it. Still, to finally have the ALT in control, is often enough of an achievement to satisfy the owner. Meanwhile, the herbs you have used (as with CHSGS) are inhibitors of fibrosis and cirrhosis, allowing livers to remain morphologically normal despite persistent liver enzyme elevations.

Hope that helps you out!

by WandaV
January 23, 2018
Thanks Steve! I will give it a try.
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