C09980439 / invoice 10000

Recent laproscopic liver biopsy --> Copper associated hepatopathy diagnosed

Has been in for s/o at specialist centre 
- O then noticed remaining suture ?
--> 1 x skin suture remaining - removed easily

Diet- recommended from VSOS -->
Home cooked
- have tried various berries incl rasperries, strawberries, blueberries
- apples
- pear 
- banana
- pineapple
- papaya
--> cooked seperately and mixed together - tried in different combination
BUT- strongly resents most fruits

pumpkin, broccoli, cauliflower, green beans, carrots, zuccini also offered- will eat some

Meats
- various
- low fat pork, beef , chicken
- tuna in spring water
- added fish oils
- 3 tspoons canola oil

Havent tried commercial liver diets yet

On D-Penicillamine ( compounded 60mg capsules ) and Ciclosporin ( having difficulty medicating ) - esp the D Pen. capsuules- need to give on empty tomach- gagging ang frothing and will often spit the capsule back

O interested in trying P Penicillamine TABLETS ( can source 125mg tablets ) and pharmacist has advised O that thay can be safely split

Discussed diet
- important to avoid high level copper containing foods eg organ meats, shellfish, legumes
- improtant to follow dietary guidelines as rec. by specialist BUT, theres no point if she wont eat it and has lost weight
- from list of rec foods, feed ones that she prefers, then add in various vegies/ fruits one at a time and find out what she likes then go from there
- can also feed RC Hepatic as treats - O thinks she will like this

- r/c one month to monitor liver enzymes and reassess diet

 O also enquiring re medications for grooming. Gets very anxious and snappy with the groomer
Previously tried Alprazolam- O said made no improvement