Is this is new diagnosis or has she been sick for awhile?
Lactulose could be tried. Yes, it is safe to give milk thistle, lactulose, and SAMe together (Denosyl is SAMe). As long as your vet is giving you the okay, then I would have absolutely no concerns about using these there supplements together. It's done all the time.
Did the vet say to add the egg and oats in?
The circling could very well be caused by a liver issue, but as pups age, there is a possibility that those symptoms relating to her not recognizing things could be a type of senility. Lactulose should help if it's just toxins building up from a liver issue.
Some also give omega 3 with vitamin e. It can help the liver a bit potentially.
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