Would galliprant be better with liver issues?

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My 11 year old labrador, Tess, has osteoarthritis and a wonky gait following being hit by a car as a youngster (20 months). She first went on Metacam at the end of 2016 despite having an ALT of 198. She remained on it for six months over the winter. She went back on Metacam in late 2017 and in April 2018 her ALT was 202. The vet encouraged me to keep her on Metacam but on as low a dose as possible so she was having about a 50% dosage. In July 2018 her ALT was 273 and she was taken off Metacam to see if this would reduce. ALT was the only enzyme elevated. She had also had a leptospirosis vaccine in April (L2). Taking her off Metacam didn’t help (297 after a month off) and in September she had liver biopsies at the Cambridge vet school.   The findings were that there was little or no active hepatitis and that the fibrosis was likely to be the result of a previous ‘insult’ which had now passed. They said Metacam might have been the cause but not necessarily. The vet school strongly recommended Denamarin on an ongoing basis and said she could return to taking Metacam with close monitoring. I decided to see how she would go without the Metacam but with regular (weekly) hydrotherapy and monthly physio with laser and underwater treadmill. She was given Denamarin and ALT levels were 344 (Nov ’18), 337 (Jan ’19) and now 283 (Apr ’19).
For the past couple of months she has been quite sore on her left front leg after resting. The soreness gets worse every time she gets up from a rest during the day but is much better first thing in the morning. She is also more anxious. I feel that I would like her to be on anti-inflammatories for at least a few weeks to see if this helps her. However, my vet is now adamant that she shouldn’t have any drugs because of her liver despite the liver specialist (Penny Watson) saying it should be okay as long as bloods are taken in the first week or two and Denamarin is continued. I also asked my vet about whether galliprant might be a safer option for her liver but she hadn’t heard of it. So my question is should I push my vet to look into galliprant i.e. is it a safer option for the liver? Or should I just push her into allowing me to put Tess back on Metacam, reminding her of the specialist’s advice.
She is a good weight, all slippery surfaces are covered and she uses a ramp for the car. Sorry to be so long-winded and thank you in advance for any advice.
Amanda

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Thank you, Gwen, that’s really helpful. It’s useful to have some perspective from the vet’s point of view as well as it’s so easy to adopt an antagonistic stance when you are trying to do the best for a much-loved pet. I appreciate that vets have to make difficult decisions and that their viewpoint will be affected by their own experiences. I imagine it’s also pretty frustrating when a vet spends years qualifying and then a client, armed with all the information they’ve gleaned from the internet, questions their decisions. I think consulting a pain specialist may well be the best way forward. Thanks again, Amanda

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