I heard back from the IMS office today/yesterday. He said to continue with 10mg vetoryl, add 3mg melatonin twice per day. HMR lignans not indicated since estrogen not elevated. At some point, may need to switch to lysodren but at this time that's also not indicated. Recheck cortisol (and ALKP?) in 4-6 weeks.

A few questions about melatonin..will it also lower cortisol? Is there more chance of levels getting too low? I'm still going to give both, but just want to know if I need to keep more of an eye on that. Also, any certain type? The K9 brand of melatonin flavored chewables, are those ok? Do I give at same time with vetoryl?

An ALKP of 3288 doesn't seem too high? Normal range is 23-212 u/L. His ALT was also elevated in January - 135, normal 10-125 u/L. He's been taking adenosyl/Denamarin for 4 years now - 8 hours after eating, 1-2 hours before he eats, I do have to give him a teeny bit of chicken with it, though. IMS has mentioned liver biopsy if ALKP doesn't go down...really don't want to have to do that.

Thank you all so much for your advice so far.