Case 2

After discussion with the owner you decide to try the NSAID and SAMe, and Spot will return in four weeks for a repeat liver panel.

Five weeks later, Spot comes in for a recheck. The owner has seen some improvement in mobility, and Spot still seems to be acting fine.

These are the notable findings from your liver panel.

Patient values

Reference range

ALT (IU/L)

220

12-118

ALP (IU/L)

520

5-131

Bilirubin (mg/dl)

0.1

0.1-0.3

QUESTION 3

What is your next step?

a) Continue the NSAID therapy, and recheck Spot in six months.

b) Discontinue the NSAIDs because of concern that we may be causing some hepatocellular injury with our therapy. Recommend an abdominal ultrasonographic examination next.

c) Continue the NSAIDs and SAMe, and add silymarin to the regimen to aid in liver support.

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