Finding out your senior dog’s blood work showed a high ALP can be confusing and concerning. Thankfully, integrative veterinarian Dr. Julie Buzby is here to help you make sense of high ALP in dogs. She explains what it is, why it can sometimes be elevated, and what the next steps might be.
Sampson, a 12-year-old Jack Russell Terrier mix with a zest for chewing sticks and chasing squirrels, was in to visit me recently. During a particularly vigorous stick chewing session he had cracked a tooth. As a result, he needed a dental procedure under anesthesia to remove the damaged tooth and clean the rest of his teeth.
I always recommend some basic bloodwork prior to any of my older doggy patients going under general anesthesia. Pre-anesthetic lab work helps ensure a dog isn’t at an increased risk for complications with anesthesia or the specific procedure. It also has the added benefit of occasionally picking up on medical issues before they become a bigger problem. That was how we found that Sampson’s ALP, while normal on his last yearly bloodwork, was now moderately high.
Sampson’s dog mom, Sarah, was the proactive type and had many questions about ALP. I answered her questions in detail before we formulated a plan.
What is ALP in dogs?
The abbreviation “ALP” stands for alkaline phosphatase, which is an enzyme many routine blood panels may measure. Primarily, the liver produces ALP, though there are other sources too. We will come back to this later in the article because it is important.
Within the liver, ALP is found along the outer layer of the liver cells. Even more specifically, it is associated with the liver cells that line the bile ducts. Alkaline Phosphatase’s normal job in the body is complicated, and actually isn’t critical to understand here. But what is important to understand about ALP is that it is a sensitive indicator of liver or gallbladder dysfunction.
A brief physiology lesson
The liver is an amazing organ that has, by many estimates, over 500 critical jobs in the body. To name a few, the liver is responsible for:
- Removing toxins from the bloodstream
- Regulating blood sugar (along with the pancreas)
- Taking old red blood cells out of circulation
- Releasing clotting factors
The liver is also responsible for making bile, which flows through ducts in the liver to the gallbladder. Bile is then released from the gallbladder into the GI tract where it helps with digestion.
With all these important functions, it would only make sense that keeping tabs on your dog’s liver is an important part of keeping him or her healthy. This is where ALP liver enzymes (among other liver enzymes) comes in.
How would the vet detect high ALP levels in dogs?
When your veterinarian performs general wellness blood work on your dog, either as part of a yearly exam or as part of a pre-anesthetic check-up, chances are the blood work will include a chemistry panel. This test measures protein and electrolyte levels. It also includes values that can offer clues about the function of the liver, kidneys, and pancreas.
For a chemistry panel, the vet or vet nurse will draw a small amount of blood from your dog and place in a test tube. Then, your veterinarian may sometimes perform the blood tests with an in-house laboratory machine. Alternatively, he or she can send your dog’s blood to an outside veterinary diagnostic lab. If your veterinarian runs these tests in-house, your results may be ready the same day. But if your vet sends the blood out, it can take several days for the final results to be available.
Liver values
The markers related to the liver on a chemistry panel include ALP, ALT, GGT, and total bilirubin. The liver also makes glucose, cholesterol, albumin, and BUN. These levels can give clues to how well the liver is functioning.
ALT, or alanine transferase, is what is known as a “hepatocellular” liver enzyme. When the cells of the liver are damaged, this enzyme leaks out into the blood. Elevated ALT is often more worrisome than high ALP to veterinarians since it indicates ongoing damage to the liver cells.
ALP and GGT are what are known as “cholestatic” enzymes. This means that elevations predominantly occur if there are issues with the flow of bile, either within the liver, or as it leaves the gallbladder.
Forms of ALP
Earlier we touched on the fact that the liver makes alkaline phosphatase (ALP), but other places in the body make it too. The three most important forms are ALP from the liver (L-ALP), ALP made in the bone (B-ALP), and ALP that is released in response to excess levels of corticosteroids (C-ALP). A chemistry panel measures all three of these forms together as ALP. Therefore, based on the chemistry panel alone, it is not possible to determine which form is contributing most to an elevated ALP.
Liver ALP
As the name implies, L-ALP elevations are often related to issues with the liver. This is the focus of much of the rest of the article.
Bone ALP
Increased ALP activity is common in young dogs who are growing rapidly because normal bone growth releases B-ALP. Generally, these dogs are less than a year old. In a young dog, a mild elevation in ALP is not a worrisome finding if the remainder of the liver values are normal and the dog is otherwise feeling well. However, conditions that cause ongoing damage to the bones, such as bone cancer (i.e. osteosarcoma) or infections within the bone (i.e. osteomyelitis), can also cause elevations in B-ALP levels.
Corticosteroid ALP
The liver produces corticosteroid-induced ALP in response to elevated blood steroid levels. These high C-ALP levels can either be due to the body producing increased amounts of steroids, as with Cushing’s Disease in dogs, or they can be from oral or topical steroid-containing medications.
What causes high ALP in dogs?
Many times, a vet will find high ALP in senior dogs. In fact, it is one of the most common lab work abnormalities in older dogs. An elevated ALP is very sensitive in its ability to assess for hepatobiliary disease (i.e. diseases affecting the liver, gallbladder, or bile ducts) in dogs and cats.
This means that most dogs with significant liver disease will have an elevated ALP. That sounds like great news, right? If that’s the case, an ALP blood test should be the perfect way to help decide if your dog has liver disease.
Unfortunately, it is not quite that simple. While a high alkaline phosphatase level is very sensitive, it is not also a non-specific finding. This means that lots of other conditions aside from liver disease can cause an elevation in ALP. The list of conditions that can cause an elevated ALP includes:
Liver or gallbladder conditions
Any disease that causes a back-up of the flow of bile (i.e. cholestasis) will cause increased serum ALP levels in dogs. Cholestasis can be due to primary liver disease in dogs. Structural problems that block the flow of bile out of the liver, into the gallbladder, or from the gallbladder into the intestinal tract, can also cause a high ALP in dogs. Finally, secondary liver diseases (i.e. other conditions that cause ongoing damage to the liver) also will cause an elevated ALP level.
Primary liver diseases include:
- Infectious hepatitis due to ascending bacterial infections, Leptospirosis (lepto in dogs), etc.
- Chronic active hepatitis
- Copper storage disease
- Benign nodular hyperplasia
- Vacuolar hepatopathy in dogs
- Hepatocellular carcinoma (i.e. a type of liver cancer)
Gallbladder diseases include:
- Cholelithiasis (i.e. gallstones)
- Cholecystitis (i.e. gallbladder infection)
- Gallbladder mucocele in dogs
- Bile duct carcinoma (i.e. cancer of bile ducts)
Other medical conditions
Many medical conditions that are unrelated to the liver itself can also cause a high ALP. They range from non-worrisome to very concerning. Some of these include:
Endocrine diseases:
- Diabetes mellitus
- Hypothyroidism in dogs
- Cushing’s disease
- Hyperparathyroidism
Non-liver cancers:
- Lymphoma in dogs
- Pancreatic carcinoma
- Osteosarcoma (i.e. bone cancer)
Other diseases:
- Pancreatitis in dogs
- Gastroenteritis (I.e. inflammation of the stomach and intestines from various causes)
- Osteomyelitis (i.e. bone infection)
Toxins
Any toxins that cause substantial liver damage can also cause a high ALP in dogs. However, these elevations will not normally be as significant as the increases in ALT levels. Some toxins that cause liver damage are:
- Xylitol toxicity in dogs
- Cycad palms (i.e. sago palms)
- Zinc
- Aflatoxin
- Amanita mushrooms
- Blue Green algae toxicity in dogs
Breed-related elevations
Certain dog breeds can have increased ALP levels without it being a problem. The most common breed-related cause of increased ALP is Benign Familial Hyperphosphatasemia in Siberian Huskies. Scottish Terriers can also have a similar condition.
Medications
Some medications also are connected with elevated ALP in dogs. Two of the most common are:
Phenobarbital
This is a common medication vets use to treat dog seizures that can benignly increase L-ALP levels. However, phenobarbital can also occasionally cause damage to the liver. This means that if a dog taking phenobarbital has a high ALP, it can be hard to determine if the ALP elevation is no big deal, or if it might indicate a bad reaction to this medication.
If you find your dear dog in this situation, your veterinarian will likely start by evaluating how your dog is feeling. He or she will also look at the levels of the other liver values on the chemistry panel. In cases where the ALP elevation is severe, your dog is feeling poorly, or your dog has other liver enzyme elevations, then your veterinarian may recommend additional liver function testing.
In some cases, dogs will need to stop phenobarbital due to concerns about liver damage. The good news is that in most dogs, the liver values quickly go back to normal when the vet weans them off phenobarbital and onto one of the other medications available to help control seizures.
Steroids
Oral steroids, like prednisone for dogs, commonly cause moderate to severe elevations in ALP. Higher doses of steroids, such as those used for immunosuppression in cases of IMHA in dogs or other immune-mediated conditions, tend to cause higher ALP elevations.
Luckily, the increase in ALP from steroids does not generally correlate with long-term liver damage or liver dysfunction. However, it is important to know that once the dog stops taking steroids, it can take much longer—up to several months—for the ALP levels to normalize.
If your dog has an elevated ALP level, ensure you tell your veterinarian about all the medications your dog is taking or has recently taken. Some eye and ear medications and skin sprays or ointments contain steroids. Even these topical steroids can lead to ALP elevations during or after treatment.
Is a higher ALP automatically worse for dogs?
You may be wondering if you can use the degree of ALP elevation to tell you how bad the underlying problem might be. It would be easy to think that if a dog has a very severely elevated ALP, her or she might have a worse prognosis. Happily, this is not always the case.
Some benign and completely reversible issues, like taking high doses of steroids, can cause very severe elevations in ALP. However, if there is not an obvious reason for the high ALP (like taking a course of steroids), then your veterinarian may use the degree of elevation to help decide how aggressive to be with additional diagnostic testing.
What are the next steps for a dog with a high ALP?
If your dog has a high ALP, your veterinarian will start with a detailed medical history and thorough physical examination. In many cases, clues from the exam and history can help point your veterinarian to the next best diagnostic test to perform.
Every case is different, but the most common and least invasive next step is often to perform full lab work. This typically includes a CBC (i.e. complete blood count), full chemistry panel (if the ALP elevation was found on a “short” panel), T4 level, and urinalysis. If the remainder of your dog’s lab work is normal, he or she is otherwise feeling well, and the physical exam reveals no major concerning changes, then your veterinarian may elect for the “watchful waiting” approach.
With this approach, your veterinarian would hold off on performing any additional diagnostic testing right now. He or she will repeat lab work periodically to monitor trends in the ALP and other liver values. If the ALP improves or remains mildly elevated, then together you may elect for continued “watchful waiting.” If the ALP elevation gets worse, repeat bloodwork shows other abnormalities, or your dog develops any new medical symptoms, then your veterinarian will likely recommend additional diagnostic testing.
Liver function testing
One additional non-invasive lab test that your veterinarian might recommend is a liver function test which measures bile acid levels. Bile acids are made in the liver, stored in the gallbladder, and released into the intestines to help digest fat after you, or your dog, eats a meal. If the liver is working well, these bile acids are pulled back out of the bloodstream to be recycled and used again. However, if the liver is not functioning well, it is unable to remove the bile acids from the bloodstream and the bile acid levels will be high.
Your veterinarian can measure bile acid levels by taking two blood samples and sending them to an outside veterinary diagnostic lab. Your dog must have fasted for 12 hours prior to the first blood draw. Then your veterinarian will feed your dog a small snack, which should cause the gallbladder to release bile acids. Next, the vet will take another blood sample two hours later to see if the liver was able to remove the released bile acids from the bloodstream.
Elevated bile acid levels tell your veterinarian that your dog has a significant problem with his or her liver. But it does not provide any information about the underlying cause of the liver problem. If your dog has elevated bile acid levels, your veterinarian will likely recommend additional testing or referral to an internal medicine specialist.
Imaging
Your veterinarian may also recommend some liver imaging. In general, X-rays and ultrasound are the two most common types of imaging offered in veterinary medicine. While X-rays are a useful tool for many issues, they have limited ability to evaluate the liver.
An abdominal ultrasound is much more useful in this regard. An ultrasound can evaluate for masses or nodules in the liver and can also assess the gallbladder for signs of infection, gallstones, or a mucocele. Plus, ultrasound can help determine if there might be other medical conditions like pancreatitis or Cushing’s disease that are causing a high ALP.
Liver sampling
One limitation to ultrasound is that while it can determine if the liver looks abnormal, it cannot definitively pinpoint the underlying cause of masses, nodules, or other abnormalities. Some nodules are benign changes, while others represent cancer. There may be clues on ultrasound that a mass or nodule is benign or malignant. But to know for sure the vet must take a sample of the liver. The two ways to sample the liver are fine needle aspiration or biopsy.
Fine needle aspirate
If your veterinarian finds nodules, masses, or other liver abnormalities, he or she may recommend a fine needle aspirate as the next diagnostic step. To perform an aspirate, your veterinarian will use an ultrasound probe to guide a small needle into the area of concern in the liver. Once the vet gathers the cells in the hub of the needle, he or she will squirt them onto a glass microscope slide. Then your vet will submit the slide to a veterinary pathologist for review.
In veterinary medicine we often start with fine needle aspirates over biopsies. This is because this testing is less expensive, less invasive, and the vet can do it while your dog is awake or with just mild sedation. The drawback of aspirates is that they do not always yield a diagnosis. If results are inconclusive, the vet may still recommend a liver biopsy.
Liver biopsy
A liver biopsy is the most definitive way to determine the underlying cause of liver enzyme elevations. However, it is more invasive than many of the other tests. To perform a liver biopsy, the vet will remove a small piece of the liver and submit it to a veterinary pathologist. Your vet may obtain the sample through an open abdominal surgery or laparoscopic surgery. Alternatively, your vet may use a large needle tool (i.e. the Tru-cut biopsy technique) which is significantly bigger than the needle for a fine needle aspirate.
Unlike a fine needle aspirate, which your vet can do on an awake dog, the vet will always perform the biopsy under general anesthesia. Although it may raise the question in some dog parents’ minds of “Is my dog too old for anesthesia,” a biopsy can be a very useful tool. It allows the vet to submit an actual chunk of liver tissue for evaluation. This can give a clearer idea of what is going on in the liver than a fine needle aspirate can.
Since biopsies are a more aggressive test, they may not be warranted in cases of mild or even moderate ALP elevations where the dog isn’t symptomatic and/or doesn’t have elevations in other liver enzymes. However, every dog and every case is unique. Your veterinarian will take your furry family member’s medical history, exam findings, and full lab work results into account when making his or her recommendations.
Back to my patient, Sampson
I am sure at this point you are wondering what happened to Sampson. We did perform full lab work, which aside from the ALP elevation, was beautifully normal. Apart from his sore tooth, Sampson was his normal squirrel-chasing self. He was energetic and had a great appetite.
We knew that his tooth was uncomfortable. Together his mom, Sarah, and I decided it was best to go ahead with his dental procedure. I am happy to report that the procedure went great. Sampson recovered uneventfully and is back to enjoying his crunchy dog biscuits and even the occasional stick (although sticks are not on my list of safe chew toys for dogs).
We rechecked lab work a month after his procedure and the ALP elevation was still there. Since Sarah is the proactive type, we decided to schedule an ultrasound for Sampson. The radiologist reported changes in the appearance of his liver that looked consistent with benign nodular hyperplasia, which was good news
I let Sarah know that benign nodular hyperplasia is very common condition in many senior dogs. It causes benign nodules to form in the liver and a mild to moderate ALP elevation without an elevation in the ALT. Changes on ultrasound can make the radiologist suspect this condition. But ultimately it would take a liver biopsy to rule out more nefarious causes of nodules.
After weighing the pros and cons, Sarah decided to continue monitoring for now. Sampson will come back in a month to monitor his ALP value. And then in a few more months he will have another ultrasound. I have a hunch that this is just going to be a blip on the radar for good old Sampson, and that the local squirrels won’t be able to rest anytime soon.
Talk to your vet
If like Sampson, your dog’s blood work showed a high ALP level, the best thing you can do is have an in-depth conversation with your veterinarian. Sometime being presented with all the different diagnostic options can feel a bit overwhelming. But at the end of the day, you and your trusted vet should be able to work together to create a plan for your dog—be it a “watchful waiting” approach or further diagnostics—that you feel confident about.
Hopefully, the elevated ALP will turn out to be nothing significant for your senior dog. But even if it does indicate a more serious problem, remember that your dog has a great ally in you and your veterinarian. Together, you can tackle whatever the future brings and keep making memories in the process.
Has the vet ever found a high ALP level in your senior dog’s blood work?
Please comment below to share your dog’s story.
Hi Dr. Buzby:
I love reading your blogs and just stumbled across them while looking at your toe grips! I am all about holistic medicine for the whole family including our big floof.
This comment is
1) to ask about Encore Mobility;
2) diet recommendations for our dog with HCC and arthritis;
2) my attempt to illustrate to hoomans why it’s important to advocate for your animals even when a vet chalks new symptoms up to old age.
Our dog Caesar is a 12yo male ChowChow. He was 8 when we rescued him. He was diagnosed with hepatic cellular carcinoma in July 2022 after an ultrasound (ordered to see his adrenal glands/rule out Cushing’s) revealed a 12cm mass on his liver. Adrenal glads were fine. CT w contrast confirmed heterogenous round shape/location, along with some multifocal hypoattenuating cysts within the renal cortices and chronic right-sided coxofemoral joint luxation with pseudoarthrosis formation.
A dexamethasone suppression test confirmed he did not have Cushings, so Caesar underwent an exploratory laparotomy on 8/23/22 where they removed the liver mass with good margins and has fully recovered from the surgery. BIG 13″ incision!
Rewind to when we first got Caesar in 6/2018. At our first check up the vet felt plenty of arthritis in his shoulder and hips and started him on dasuquin advanced and he is still on that. When an occasional limp would present, our vet would just do a 1-2 week course of rimadyl (wonder drug for Caesar) and limit his walks to “bathroom and back” so to rest the affected joint.
Fast forward to summer 2021 –he was snapping and very grouchy to almost everyone except me and my husband (even for a Chow). No limping or whimpering or even licking a foot. After hours of evaluation, his trainer and I concluded he was in chronic pain from his arthritis and the vet concurred. Vet started a course of adequan injections, but I didn’t see any difference after 7 months so we d/c. Vet performed a full body set of xrays in March 2022 and his arthritis had progressed. Vet started him on rimadyl as a maintenance dose and sure enough he was a new dog. (all of this vet work was driven by me driving them crazy).
In April 2022 his annual physical was performed. I reported symptoms of 90-100 breaths/minute 24/7, including at sleep. He was drinking LOADS of water and had a voracious appetite(always been very food motivated tho). The vet felt like his spleen was prominent upon physical examination and did a cardiac xray that was fine.
Full blood panel was performed and his ALK/ALPs were elevated. Vet stopped his rimadyl immediately and started Denamarin, with a plan to begin Galliprant after 10 days of Denamarin. Those 10 days were AWFUL. Trembling hind leg, mobility was worse than BEFORE he went on the rimadyl. He was only on rimadyl for 2 weeks before the bad liver results, and it was like the denamarin was making him worse – which is ridiculous of course (milk thistle can’t hurt anyone).
Finally the “detox” was over and we started the Galliprant (100mg, 1x/day) and he has regained decent mobility, but not as good as on rimadyl.. We repeated a blood test in June 2022 and those ALPs were still elevated. Vet wanted to wait and see – and I insisted on the ultrasound. You already read the rest.
I have worked in the human healthcare environment as a hospital and physician practice administrator for 25 years, so I’ve learned enough clinical info through osmosis to know when we press forward for answers on humans, and I didn’t want our dog to be treated much differently. But if I was a banker, he would still have a grapefuit sized mass in his diaphragm, and on a 60 lb dog, that’s like a beachball to my body.
Result: normal water intake, normalized appetite. Will have an ultrasound in 2 months to see if anything is growing back.
He still struggles with his hips – the CT showed the right one is BAD.
Do you think he would benefit from encore mobility in conjunction with Galliprant? He is also on Curcumin C3 and dasuquin advanced w MSM.
Diet: I blend rosemary, basil and turmeric with water packed sardines and use as a topper on Health Extension venison kibble, along with pureed pumpkin (bc I can’t have that anal gland smell in the house EVER AGAIN).
Any suggestions on ramping up the anti inflammatories through diet?
Longest comment ever – thanks Dr Buzby!
Hi Ashley,
Caesar is one lucky boy to have found you! I applaud you for taking such an active role in advocating for his health and wellbeing. I think his current diet and supplement regimen sound great. As for Encore Mobility, it could be an added bonus to all the amazing things you are already providing. I feel like the New Zealand deer antler velvet is such a game changer and isn’t found in any of the other supplements you currently use. You may also want to look into acupuncture or laser therapy to help with arthritis pain and decrease inflammation. Have you heard of PEMF therapy? I will attach links to other articles that may offer additional information. Best wishes to you both and keep up the good work!
1. PEMF Therapy for Dogs: 7 FAQs Answered by a PEMF Expert
2. Natural Pain Relief for Dogs: 13 Methods
3. Dog Arthritis Treatment: 8 Ways to Help a Senior Dog at Home
My 9 year old Boston Terrier was shedding a whole bunch more than I’d ever noticed. He left a halo of fur where he had been sleeping. I worried about Cushings. He had no other symptoms. He had a senior blood panel and everything was good but ASP was 818. Vet recommended x-ray/ultrasound investigation. However given his overall good health, In leaving towards Denamarin and retesting his liver enzymes. Should a month suffice?
Hi Jess,
There is really no way to know for sure how long it may take the liver to respond to the supplement or if it will respond. Since I haven’t personally examined your pup, it is hard to make specific recommendations. A month is a reasonable time period to recheck lab work. If you don’t see the improvements you are hoping for, I think the ultrasound investigation sounds like a very good next step. Best wishes!
Hi Dr Buzby, my 9 year old male Pomeranian Fazzie had an ALP of 934 and ALT of 250. He has had ultrasound which showed enlarged liver and a swollen right adrenal gland. He has been drinking a lot more water and is always hungry. He has had three seizures in the last 5 weeks unfortunately also . We are waiting on more blood work for Cushings and a cortisol check w last blood work which was three separate blood draws at 4 hours apart w fasting for Fazzie
Is there anything else this might
be? And there seemed to be no tumor on adrenals so can it be a pituitary tumor causing the problem I am wondering?
Btw… he had blood work three weeks back and levels were half of the latest results I shared w you
He’s currently taking Proteliv drops and Vit B in liquid form
Thank you David
Hi David,
I understand your concern for Fazzie and these worrisome abnormalities found on lab work and ultrasound. Cushing’s disease can be pituitary dependent or adrenal dependent. The extra bloodwork should help to distinguish the source if your pup is indeed diagnosed with Cushing’s. Luckily, Cushing’s is treatable, and symptoms usually resolve quickly once therapy is initiated. If the testing doesn’t provide the answers needed, you can always schedule a consult with a veterinary internal medicine specialist. I will attach links to other articles with additional information on Cushing’s. I hope you find the answers you need to give Fazzie the best life possible. Praying your vet is able to make a diagnosis and get things stabilized quickly. Wishing you both the best!
1. Cushing’s Disease in Dogs: Symptoms, Diagnosis, Medications
2. Trilostane for Dogs With Cushing’s Disease
7 year old Maltese/Yorkie has chronically elevated ALT (800) with cell damage, vet said AST very high too. Ultrasound scheduled next week. Our pup has had a few bouts of pancreatitis this past year and sometimes will go 2 days without eating, behavior is definitely changing lately with more naps and less interest of favorite things. Vet mentioned a look at his gallbladder during ultrasound. How many days of not eating should you worry?
Hi Tracey,
I understand your concern about these liver changes and decreased appetite in your little pup. I am glad you have an ultrasound scheduled with your vet and would be interested to know what they find. Since I haven’t personally examined your dog, it is hard to make specific conclusions about when to worry with the lack of eating. There are so many factors to consider such as blood sugar levels, hydration, etc. I hope the ultrasound findings will offer you some answers and guide you in the treatment process. Praying for a positive outcome.
My 11 year old yellow lab, Goldie, had blood work that indicates a high ALT level (296) and a high ALKP level (560). She is on Samilyn and milk thistle. Her ALT level has only increased slightly over the past year (from 219 a year ago to 296 now). Bur her ALKP level has increased from 346 a year ago to 560 now. What else should we do to help our dog?
Hi Cindy,
I understand your concern for your senior Lab and these increased liver enzymes on her bloodwork. If your pup has been on supplements for a year and the values continue to rise, it may be time for some additional testing. There are other liver specific blood tests that can be sent to the lab and an abdominal ultrasound may be warranted to see what the liver looks like. You can also request a consult with an internal medicine specialist. This is the perfect time to talk to your vet and discuss your concerns. Let them know you are ready for the next steps in the diagnostic testing process.
Hi Dr. Buzby. I have a 9.5yo (approx) Corgi/German Shep mix (my service dog) who on a recent exam showed an ALP of 190. Her urinalysis showed that her urine was diluted. It has been incredibly hot and humid and she has been drinking considerable amounts of water; however that fluctuates depending on the heat and this in and of itself it not unusual for her. Her appetite has been high (also, in and of itself not unusual for her), though if you tell her ‘drop it’ or ‘leave it’ she will. That said, she has virtually zero prey drive and I would think if her appetite were insatiable – especially with a cat in the house as well – that would be an issue. Her vet suggested a steroid-challenge blood test, as he suspects Cushings. I asked if we could pull back a bit on her water overnight and retest her urine to see if her body is still diluting; he agreed so long as we don’t totally withhold. That will be done this weekend.
Given that she has always had a hearty appetite, always compensated for heat by elevated water consumption and that her urine came back dilute, is it possible that this is an anomolous finding? I will repeat her bloodwork in a month or two when the weather cools.
Thank you for your input.
I neglected to add one detail – she has ALWAYS had a penchant for eating poop from the cat’s litter box (nasty, I know). We use Breeze pellets for the cat. Do you believe this could be a factor? We started using the Breeze pellets about 3 or so years ago. Thank you again.
Hi Lee,
I would not be worried about the Breeze pellets. And although I don’t think it would contribute to the symptoms you described in your original post; it might be a good idea to make sure your pup is negative for intestinal parasites.
Hi Lee,
I understand your concern for your senior guy and these recent abnormalities found on his bloodwork. As I was reading your comment, I was already suspicious of Cushing’s even before I saw where you mentioned it. I am going to be honest with you…. I think you should go ahead with the recommended testing your vet has discussed and not worry with trying to withhold water. Cushing’s disease causes an elevated level of steroids in the body. One of the side effects of steroids is increased thirst. I think the odds of this being anomalous finding are very low. Here is a link to an article with more information about Cushing’s disease: Cushing’s Disease in Dogs: Symptoms, Diagnosis, Medications
I hope you can get some answers quickly and start the appropriate treatment plan to give your pup the best quality of life. Wishing you both the best of luck.
Hello. My doogy son teddy is somewhere between 11 and 13. He has glaucoma. He has recently had an increase in appetite, decrease in energy, and sometimes trembles. He had bloodwork done and his cardio lab work was all normal. All 4 thyroid markers came back significantly low and he is now on thyroid medication. The vet said everything else was normal, but upon looking at the results, I noticed that his ALP is 249. Could this be because of his low thyroid numbers. Is that why he trembles? Does he need to be on Denamarin? He seems to be in some pain as well. Any guidance is appreciated.
Hi Jeanette,
I understand your concern for Teddy and the health issues he is facing. Since I haven’t examined your pup myself, it is hard to make specific conclusions and recommendations. If liver enzymes are found to be slightly elevated on one set of lab work, that doesn’t always mean there are ongoing liver issues. Thyroid levels can cause changes in almost every system of the body. There can be a one-time spike in liver values that would be completely resolved and back to normal if bloodwork was repeated in a few weeks. Also, many medications can cause changes in values seen on bloodwork. My best recommendation is to discuss your concerns with your vet. They can let you know why this number did not cause worry in your dog’s specific case or if a supplement should be considered. Please be sure to tell them you are suspicious Teddy may be in some pain. Trembling can be a sign of discomfort. I hope you can get the answers you need to feel comfortable with Teddy’s treatment plan. Praying everything can be stabilized and let your sweet boy keep living his best life.
I have a 11 year old GSD mix whose senior wellness bloodwork came back with very high levels of ALP(1110), slightly elevated GGT(17) and very high cholesterol(823). She has also had the following symptoms for the past 6 months:
Thinning hair(Lost a lot of hair – used to have a full bushy tail and now spindly, can see skin. Similar hair loss in other areas)
Very thirsty and drinks about a gallon + of water every day
Has an increasing pot belly
is always hungry and eats anything she can find on the ground
She’s already on proin for her spay incontinence for past 2 years or so. We are suspecting Cushings and she’s going in for her test in a couple of weeks. Any thoughts ?
Hi Guru,
I was already thinking Cushing’s before I made it to the end of your comment. It sounds like your vet is on the right track and this is the first thing that needs to be ruled out. I hope the testing will give you a definitive answer so treatment can be started right away. If your senior guy does have Cushing’s, then you should notice positive changes relatively quickly once the medications are administered. Praying for a positive outcome. Feel free to leave an update if you have a chance.
My dog Phoenix (13.5 yo) has very elevated ALP (1723 UL) and ALT (254). My vet prescribed Denamarin for 30 days. However, after about 10 days, he would throw up, and then had severe diarrhea, so the vet said to discontinue use. What do I do now? He is currently on Hill Science Diet – IB -Low Fat Prescription kibble. as he has a history of pancreatitis. He also takes a probiotic daily, dasaquin, and Welactin Fish Oil, and takes Heartgard monthly. Is there something I’m missing? Thanks for any info.
Hi Joan,
I am sorry Phoenix is dealing with elevated liver enzymes and doesn’t seem to be able to tolerate the Denamarin. The only way to find the best treatment is to first get a diagnosis. If you want to pursue diagnostic testing, the next step would probably be additional labwork and abdominal ultrasound. It would be a good idea to talk to your vet about your concerns and see what they recommend. You can also look into scheduling a consult with a veterinary internal medicine specialist. I think you are doing the right things and Phoenix is lucky to have you advocating for his health and wellbeing. Best wishes to you both.
Hi! I’m curious, does the Denamarin help with the elevated ALP, ALT, or both? Thank you in advance.
Hi Kimberly,
The Denamarin helps with both liver enzymes (ALP & ALT) since it acts as a liver protectant and contributes to liver health and repair.
My almost 8 yr old female spayed Shih Tzu hasn’t been herself for about 6 months and in Feb of this year we had blood tests done and her bloodwork was good except for an elevated ALKP of 451 on 2/22.. Yesterday, Aug. 16, we had more bloodwork done and her ALKP had jumped to 1783 U/L and is quite significant. She is not feeling that good and she, vomited yellow bile two nights in a row last week. No vomiting since. She is a great eater and is still eating and drinking water but her tail is always down and she seems more nervous She whines a lot but that is typical of what she does.. My vet has an ultrasound scheduled for next Wed., 8/24. She weighs 8.2 lbs and is small for her breed. She is also constantly scratching her underside (by her back legs and front legs) for some time now and they cannot find out why. She has no redness or anything on her skin but it’s almost like OCD. I have been spraying those areas with DogMX medicated Hot Spot & Anti-Itch Spray and maybe it helps a little but I just read that it could affect her liver. Is that true? I am worried sick about her and would like your comments on what is going on. Thank you very much.
Hi Elaine,
I am sorry your Shih Tzu is having issues with her liver function. I am glad your vet has scheduled an ultrasound and would be very curious to find out the results. I researched the DogMX spray you mentioned and found that one of the active ingredients is a steroid. Steroids are known to affect the liver if used long term, but this is usually when they are taken orally. Topical steroids like this spray can cause internal changes, but not to the same degree as oral medications. I would be highly surprised if the spray was the culprit behind this issue or if it even contributed at all. Don’t worry yourself too much about it, but it might be a good idea to discontinue the spray for now just until you get a diagnosis. I hope the ultrasound can give you some answers. Praying for good news and that treatment can be started quickly. Feel free to leave an update if you have a chance.