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.
Hello. My 7 1/2 year old Schnoodle has had “mildly elevated” liver enzyme lab results since first measured at 2 years of age. Last week they were ALT 158, ALK Phosphatase 255, which is higher than before, especially the ALK. All other chemistry/CBC work-up was normal. My vet is uncertain what the next step will be, other than measuring water intake for 72 hours. Your thoughts please– greatly appreciated!
Hi Donald,
I understand your concern for your pup and think it is good you are searching for answers. Here is a link to another article that discusses the recommending testing and possible treatment options: High Liver Enzymes in Dogs: A Vet Explains What It Means
Hoping the information will help guide you along this difficult path. Wishing you and your sweet boy the best and praying for a positive outcome.
I have a English / French bulldog mix named Angel that has an ALP of 353. I’ve done some reading on the joint supplement glucosamine and that it can be bad for a dog with underlying liver issues. Is this true? and could this have caused the elevated ALP? I just got these boys results last week. I haven’t given the joint supplement to Angel in about a month now. I’ve ordered a special liver health prescription dog food for her. I don’t know what to do.
I’m particularly frightened as I just lost my dog Daisy, an olde English bulldog, to liver failure a month ago.
Hi Amy,
I understand your concern for Angel and am so sorry for your recent loss of Daisy. From the articles I searched, it seems as though glucosamine could cause a mild progression of liver dysfunction. This is because glucosamine is metabolized by the liver so it will cause the liver to have to work a bit harder. But the liver dysfunction must already be present. I could not find definitive evidence of glucosamine being the primary cause of liver issues. So, I do not think the glucosamine caused your dog’s elevated ALP, but now that you know about these abnormal blood work results it might be a good idea to discontinue the supplement out of an abundance of caution. Hoping you can find the cause of Angel’s liver problems and start the appropriate treatment. Praying for a positive outcome!
hi I have a 5 year old short hair terrier/cocker spaniel she just had her annual blood work done a little early for next year since we were getting annual heart worm/tick testing done. my vet called me with the results and said that Oreo’s ALP levels are high and now we go on Wednesday for an ultrasound of her liver… I’m worried for her , my sister just had her beagle Jinger put to sleep because of her declining cushings disease she was only 5 years old we both got our dogs within weeks of ech other. I hoping that Oreo doesn’t have cushings… she has no other symptoms of this but she does get ear infections/yeast over growth in both ears other then that she eats normal she plays like crazy runs ,just I’m just hoping this turns out to be something else that can be treated with medication for a longer life with me and her sister Mooey . What are your thoughts? thx April N.
Hi April,
I understand your concern for Oreo with these new changes to her bloodwork. I think ultrasound is a good idea and I am glad your vet is being so proactive with testing. Hoping you get some definitive answers and there is a clear path forward. Wishing you both the best and praying for a positive outcome. Feel free to leave an update as you continue your journey.
Hello!
I have 14-year-old Pomeranian shih-tzu mix. She has been on two rounds of antibiotics for a UTI that she just can’t shake. Her last labs showed an elevated ALP of 628. Could antibiotics be responsible in causing a spike in ALP levels?
Hi Alex,
I am sorry your senior girl is having so many health issues. While there are some antibiotics that can have negative effects on the liver, I would not normally expect this after treating a UTI. It sounds like this may require some more investigation. Hoping you can partner with your vet to get some answers and ensure your sweet girl is headed in the right direction.
I have a 13 year old Chiweenie that was just diagnosed with Cushings disease. Her ALP result came at 3049 Reference value should be 5-160 U/L. This being so way off the chat, Is there still hope? We just started a regime with Demamarin for 2 months.
Thank you for any input.
Sheila
Hi Sheila,
I am sorry your pup is dealing with liver dysfunction. I am assuming it is probably a side effect of the Cushing’s disease. Did your vet start your girl on a treatment for the Cushing’s? In my experience, the liver function usually improves as the Cushing’s disease becomes more regulated and the symptoms decrease. Hoping this is the case for your dog as well. Wishing you the best of luck.
Hi thank you for all the information my 12 year old terrier mix we went to the vet to have some warts removed from her head they had to do bloodwork and her results came back high ALP 967 and high PLT 605 and low LYM 0.79 so after that was tested for Cushing not that and also passes her bile acid test what could be the causes and she doesn’t seem bothered at all by any of it
Hi Heidi,
I am sorry your senior pup has these abnormalities on her lab work. I am glad her Cushing’s test was negative and so far, everything else seems to be ok. Without playing a personal role in your dog’s medical care I am afraid I can’t make specific conclusions. It sounds like you will have to do more in-depth testing if you want to find the cause. Maybe you can talk to your vet about what the best next step would be. They may recommend abdominal ultrasound or even scheduling a consultation with a specialist. Hoping you can get some answers soon. Best wishes to you and your sweet girl.
I have 2 6month old Aussaliers brother and sister Flash, and Molly from the same litter. They just had their little boy and little little girl surgeries this week and we have their first bloodwork done so that we had a baseline in their chart and everything came back normal except their ALKP or both high Molly was 239 and Flash was 262 They have been fasting 12 hours prior to bloodwork being done with this of caused the ALKP to be high? Should I be concerned? The vet says that the mild elevation in their bloodwork is normal because they are growing. I just wanted to get a second opinion. We do not feed them anything except their dog food which is science diet and they are exercised well. Any feedback would be great and appreciated. Thank you.
Hi Melissa,
I know it it can be concerning anytime your dog has bloodwork abnormalities. Hopefully it will ease your mind to know that yes, like your vet mentioned, ALKP elevations do sometimes occur in young growing dogs. In this case, the elevation typically comes from the “bone version” of ALKP rather than the “liver version” so it isn’t usually a cause for concern. Especially since it was the case for both of them, rather than just one of them, bone growth seems to be the most likely explanation. However, there is certainly nothing wrong with asking your vet for some follow-up bloodwork after your puppies are fully grown (or sooner if you are noticing anything is off with them). Hope that helps!
Was happy to come across your article on high ALP levels. My daughter’s 11-year old YorkiePoo had a recent level of 1207, it was 1003 in May, 290 in 2/2020. The vet prescribed Denamarin and the levels did not go down after 30 days. Now is recommending more testing and pushing a $600 ultrasound, or an in-house test for $100 that could tell them if he has a liver disease or damage, or another one for $170 where they can figure out which ‘protien its coming from’. My daughter, of course, loves her dog and wants what is best, but doesn’t want to go in debt because of tests and then what may come after. Remy has the energy of a puppy, eats and drinks well, normal fecal movements and shows no sign of anything wrong. Can I ask you advice? Your article was so easy to understand, I’m hoping you can provide a second opinion and guidance. Thank you!
Hi Vicki,
I understand your concern for your daughter and her pup and think it is great you are reaching out for advice. I know testing can get expensive and everyone has a financial limit. Unfortunately, finances can also limit our options and make owners face some difficult decisions. It is very possible that even though her dog is feeling well now, Remy may start to show symptoms if things continue down this path. Your vet is trying to get ahead of things and get answers before Remy becomes sick or painful. In a situation like this, I too would be recommending abdominal ultrasound and some additional lab work. With that being said, it doesn’t mean it all has to be done right away. I think it would be best for your daughter to talk to her vet and make sure they are aware of her concerns and wishes. Her vet should be able to prioritize the testing and work with her to meet in the middle. I am hopeful that working together as a team you can find the best way to proceed. Wishing you all the best and praying for a positive outcome.
We have a pure bread Beagle named Daisy who is 4 years old.. last November we had ALP bloods checked and they were 353, Had them checked today (one year later) and they are at 903… All else is normal with her, all other bloods were normal range (ALT etc). Had her tested for cushings a year ago and it was negative, also had ultrasound of abdomen a year ago and was negative. Urine test was negative for proteins a year ago.. What are your thoughts?
Hi Emma,
I am sorry Daisy is showing a steady increase in her liver values over the last year. It may be that when the tests were originally performed, the disease process was not far enough along to show any other abnormalities. If you repeated the testing now, you may in fact find something to help point you in the right direction. Also, it might be a good idea to schedule a consultation with an internal medicine specialist. Cases like this are hard when you do everything right but still are left with more questions than answers. I would also recommend talking to your vet about trying a liver supplement such as Denamarin if Daisy is not already taking one. Feel free to leave an update as things progress. Wishing you both nothing but the best.
Our dog is old and his old bones aren’t what they were. However, up to now he had still enjoyed going for a walk and had a big appetite. In the last couple of weeks he’s eaten less and less, and now is not even interested in his treats. He’s a big dog and was 38 kg a few weeks ago but is now down to 34.4 kg. He still likes a walk each day (though it’s usually less than 30 mins, instead of what used to be an hour or more) and drinks normally. Blood tests today revealed a very high ALP level; the vet said it was “in the thousands” (I spoke to him over the phone and it wasn’t a great line) with elevated ALT (I think) levels too. The vet wants to have him in to do an ultrasound and a liver biopsy but he’s over 14 years old and I wouldn’t like to put him through that, especially as he probably doesn’t have much longer anyway. It’s possible he may have had a seizure or TSA recently. He spends most of his time sleeping these days. Is it time to say goodbye?
Hi Mike,
So sorry to hear about your dog’s recent decline. The amount of weight he has lost plus the elevations in ALP (and maybe ALT) are definitely concerning, especially coupled with him not wanting to eat much of anything. I agree with your vet that an ultrasound and biopsy would be the next steps if you wanted to look for answers, but it is also perfectly fine for you to decide that those aren’t things you want to pursue at his age. You know your dog well, and you know what is best for him.
In terms of thinking through when it may be time to say goodbye to him, there is usually a window of time in which euthanasia may be the best choice. Based on what you have said, he may be approaching or already in that window, but I can’t tell you that for sure. Sometimes filling out a quality of life scale or having a conversation with your vet (or an end-of-life-care vet) can help bring some clarity. I’m including links to a few articles that you may find helpful too.
Thinking about you as you wrestle with this difficult decision. ❤️
Here are those links:
1) When to Euthanize A Dog With Liver Failure: A Vet’s Advice
2) Using a Quality of Life Scale for Dogs
3) Preparing for Your Dog’s Euthanasia: 10 Thoughts for Peace
4) How Will You Know When It’s Time to Euthanize Your Dog? 5 Caring, Heartfelt Messages
Hello,
My Siberian Husky Chloe just turned 9y on November 2. I took her to the vet in October since she was having weekly diarrhea with only one case of vomiting each episode. I had a full panel blood test done in October which resulted in ALP just over 1500. she was prescribed a low fat diet which would not settle well with her tummy so I opted for another brand of food that she did do well with to ease the diarrhea symptoms. i followed up with the vet 3 weeks later to do a single panel test and the ALP levels dropped to just over 1000. However her globulin levels were 5.2 over 4.8. She also started to become severely flatulent. However after adding a probiotic supplement to each meal, her flatulence has subsided to just some rare occurrence. she has no symptoms as of today other than mild flatulence and random gulping noises. I assume the gulping is from acid reflux. Also her stools are no longer diarrhea but in the middle of firm and diarrhea. it looks normal but when picked up, the texture feels like loose playdough or cake mix. The vet wants to do a bite test and an ultrasound but I feel as though a wait and see is more appropriate considering her symptoms are very mild. what are your thoughts?
Thank you and regards,
Jeff
Hi Jeff,
Sorry to hear about Chloe’s recent tummy troubles and elevated ALP. It is great that her ALP is going down and her stools are improving, but it sounds like she isn’t quite back to normal yet. Whether you decide to give it more time or pursue further diagnostics at this point is ultimately up to you. I agree with your vet that a bile acids test and ultrasound would be the next logical steps should you want to dig deeper into her significantly elevated ALP. But I also understand where you are coming from with wanting to give it more time since the ALP is trending downward and her symptoms are improving. What you decide to do depends in part on how aggressive you want to be and how the results of the bile acid testing and liver ultrasound could change her treatment and monitoring plan and/or her prognosis. Since I haven’t been involved in her case, I can’t give you more specifics about the pros and cons of waiting vs. doing the testing, but I think it is worth discussing with your vet as he or she would likely have some insights.
I hope you feel peace about whatever decision you make and that Chloe keeps improving!
My 14 and 1/2 year old jack russell has been on Rimadyl for the last 2 -3 years for his arthritis. As part of his heath check he had his bloods tested and his ALP has come back at 566. His other liver and kidney tests are all normal.
Is 566 on the high side and something to be concerned about and could this be caused by the Rimadyl? What should our next steps be?
Hello Newts,
I’m sorry to hear that your pup had an elevated ALP at the last health check, but thankful that the other liver and kidney values are still normal. ALP elevations are a fairly common finding in older dogs and can have a variety of causes, which can make it challenging to decide how worried to be. Rimadyl has been known to contribute to an elevated ALP in dogs, so it could potentially be the cause. But so could benign nodular hyperplasia (a common condition in older dogs) and many other things. Without being able to examine your dog, I can’t give you any concrete recommendations about the next best steps. However, I do think it is worth talking to your vet about what he or she thinks would be best. Sometimes monitoring the values for now is all that is needed. Other times that might be changing to a different pain medication, adding in a liver support supplement like Denamarin, pursuing further diagnostics, etc.
I hope that you are able to have a good conversation with the vet and leave feeling confident in whatever the plan ends up being.