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.
I am the owner of a 13 year old Hungarian Vizsla and I am a little bit distressed about the high alkaline phosphatase levels. We have been experiencing abnormal lab values since he was 7 years old. At that time we went to the vet for polyuria and polydipsia and the blood work showed a significant variation in alkaline phosphatase. The alkaline phosphatase value is usually between 2000 and 3000. In addition to alkaline phosphatase, his pancreatic enzymes have been elevated at times , as well as cholesterol and triglycerides. She has had all possible tests but nothing concrete has been confirmed. Alkaline phosphatase is steroid induced but Cushing’s and all other hormonal problems have been ruled out. She also had a severe pancreatitis at 9 ( probably secondary to the above problem), which she thankfully recovered from without any problems. She is on a steady diet and eats a special veterinary food, but every time blood is taken her serum is cloudy and full of fat. Over the years, there have also been ultrasound abnormalities in the liver. Currently, the liver structure shows inhomogeneity and there is a large nodule. She also had a liver biopsy from this nodule with a Tru-cut biopsy technique , which showed that glycogen is stored in the liver. Finally, the doctors concluded that she probably has some kind of hereditary fat metabolism disorder and is currently taking fat reducers, but her serum is as opalescent as before. I am desperate because she has been under constant monitoring and we noticed the problem at the very beginning, but we have not had any meaningful answers as to what is behind the ugly lab values and the ultrasound has slowly started to show a deteriorating picture which makes me feel helpless. The overall condition of the doggy is otherwise very good and even now she is very active and lively. However, I am afraid that the disease is causing changes to his liver that may shorten her life.
Hi Viktoria,
I understand your concern for your girl and am so sorry you are in this difficult situation. The only thing I can think of to offer as advice is maybe it would be good to pursue genetic testing. There are several options available and I’m sure the internal medicine specialist would be able to recommend one. I hope you can find a way to maintain your pup’s health and quality of life for as long as possible. Praying for healing and a clear path forward.
Our 16yr old Chi-Chi mix just celebrated her 3rd year post SRT for right sinus cancer. Her bloodwork levels have always been a bit odd, primarily her neutrophils and occasionally platelet count.
At the time of her SRT her liver enzymes were elevated so she was started on Denamarin. In the past 2 years her bloodwork has continued to deteriorate and in the last year she has shown signs of slowing down. A few days ago she started to have difficulty using her back legs. It was as if they had frozen. This has occurred intermittently.
The vet has done bloodwork and X-rays without coming to a conclusion. Her ALP level is now 2198, up from 1544 a year ago, 530 two years ago and 298 three years ago. Her GGTP is 62 up from 35, 21, and 13. Her cholesterol is up to 943. Platelet count is 370, neutrophils are 1922 and monocytes are 217. Her T4 is now 1.6, down from 1.4, 2.5, and 5.4.
The signs appear to point to Cushings, but from what I have read, only a large pituitary tumor would cause the hind leg issues.
She is a survivor, but we don’t want to put her through a lot at her age. Do you have any suggestions as to the diagnosis or additional diagnostics? Thank you.
Hi Joe,
I am sorry your senior girl has been through so much over the last few years. Unfortunately, I don’t have any good ideas as to what could be causing the elevations in her liver enzymes. If you are wanting to pursue further testing, an abdominal ultrasound could be very helpful. Also, you can always ask for a referral to an internal medicine specialist. They may have recommendations on testing or therapies you could try that wouldn’t be too stressful for your girl. Hoping you can find a way to improve her health and wishing you all the best for many happy days ahead.
My 12 year old Bichpoo has had a high ALP for the last 4 years. They did an ultrasound 3 years ago but that did not show anything explicit. She was put on Denamarin. Two years ago they added Ursodiol to be taken daily. I just received an email from the vet that her ALP went from 2252 to 2722 over the last six months and her ALT is now 170. She also said her pancreatic enzyme is much better. She suggested I either repeat the blood test in a few weeks or schedule another ultrasound. My girl does not act sick. The only change I noticed is an increased appetite. My vet wants to see senior dogs every six months and do bloodwork. Every time I take her the results are that her ALT is too high.
Dear M.,
I am so sorry you are facing this difficult situation with your senior pup. It sounds like your vet is trying to stay on top of things and being proactive with the medical decisions that are being made. I understand how stressful it must be to still have more questions than answers. It may be worth considering a consultation with an internal medicine specialist. I am glad your girl is feeling good and is still able to enjoy life. Wishing you both all the best and praying for many happy years ahead.
Renuka de Silva
Sri Lanka
Dear Doctor,
My Cockerspaniel mix female dog Mishty is 7 years of age.Few months ago she got Tick fever and her Liver ALT has increased to 400.The vet has given her Liv.52 with other Medications.Doctor now today I have checked her Blood Liver Test.ALT normal but ALP 800.Doctor can you please give me some information about what to do.Our Country Sri Lanka is a Poor Country.We have few experience Veterinary Doctors.Please doctor please give me some advice.Thank you.
Hi Renuka,
I am so sorry Mishty is having issues with an elevated ALP on her lab work. It is good news that her ALT is now normal as this enzyme is much more liver specific and would indicate the liver was having problems functioning properly. Since the ALP can be elevated for any number of reasons, it is harder to narrow down the cause without in-depth testing. I was not familiar with the Liv 52 supplement you mentioned but took the time to look over the ingredients. I did not see Milk Thistle mentioned, which is a very good natural supplement that helps to promote liver healing and protection. If you can find a Milk Thistle supplement that might be a good addition to what you are already doing. Here in the U.S. I use a product called Denamarin with great success. Hoping you can find the best way to ensure Mishty remains happy and healthy for as long as possible. Wishing you all the best and keep up the good work!
My sweet pup is 14 this month, a little 10 pound Havanese. They suspect Cushings (ultrasound a year ago didn’t show any issues but liver numbers elevated). He doesn’t have a pot belly, has always had a good appetite, hair does seem somewhat thinner throughout but not terribly, and thankfully no incontinence or strange thirst. I feed him a fresh food turkey or chicken diet (brand is Raised Right) that is lower carb. I add fish oil daily and some organic pumpkin powder for fiber. The vet did give me Denamarin which I’ve just started him on. Will bring him back to vet every six months for blood work – should I have it done more frequently? Also, are there foods I should avoid giving him – I was adding a fresh canned sardine (no oil or salt added) once a week, but read somewhere those are bad for dogs with Cushings. Should I stop all flee/tick, and heart worm monthly treatments? He’s an inside dog and does not go to dog parks or kennels. Thank you – much appreciated!
Hi Candace,
I understand your concern for your little pup, and think he is very lucky to have you advocating for his health and well-being. I am not aware of any issues with dogs with Cushing’s and feeding sardines. I highly recommend you continue giving monthly parasite prevention. While your boy’s risk might be low, I would much rather err on the side of caution and prevent a tick-borne disease (Lyme, ehrlichia, anaplasma, etc.) and possible deadly heartworm infection, than try to treat them after the fact. Also, most heartworm preventatives deworm for intestinal parasites as well. This is very important because several species of these GI parasites are contagious to humans. I feel like the current recommendations from your vet to monitor lab work every 6 months seems pretty standard. I usually only push to run labs more frequently if things are changing fast or I am seeing drastic changes. If you would like to have lab work repeated sooner, I am sure your vet would be happy to oblige, and you would only need to ask. Hoping your sweet boy is doing well and wishing you all the best. Keep up the good work!
hello, my 8 year old Bichon Frise has gone through bladder stone removal, she had 7 big stones (1.6 cm ), ofc my vet did a full blood test before the surgery and everything was normal, we changed her food to Hills CD, since the stones were sent to a lab and from results she needs to be on that food for the rest of her life, one and half months past since then and one day she was throwing up and making choking noises and shaking, i toke her to the vet he did a scan and seen nothing but 1 stone in her kidney (1.6 cm), we did a full blood test and found her ALP 2000 and her ALT was 176, we did an ultrasound and found everything was ok, he did say there are some leftovers of the infection in her bladder, also he said she had a lot of poop, I wanted to ask if it can be that the kennel cough, the kidney stone and the leftovers of the inaction in her bladder can make her ALP jump so high in 1 month, right now we are testing her for Cushing syndrom via a urine test, we also tested her for parathyroid gland and was negative
Hi Song,
I understand your concern for your girl with the recent abnormalities on her lab work. Without playing a personal role in your dog’s medical care, it is hard for me to make specific conclusions. Generally, I would not expect to see problems with the liver due to bladder stones or kennel cough but that doesn’t mean it isn’t possible. I am hopeful that your vet will continue investigating until the cause can be determined. Praying for answers and a clear path forward for your sweet girl.
Just took my female 15 yr old bird dog mix to vet today because she has a large amount of gas every night and has had 2 focal seizures within the last month. So much gas that she paces and can’t settle down to sleep. Had been thinking it was sundowners but she is alert and not confused at all. My gut says it is the amount of gas making her act the way she does in the evenings. Had full blood panel and thyroid tested. Everything was normal except ALP was 1200.. Had ultrasound and everything looked great there too. Vet suggested using a hydrolyzed protein food and do an elimination diet. Starting that today but was wondering if you had any thoughts?
Hi Jeanne,
I understand your concern for your senior girl and think it is great you are searching for ways to help her. Any time I have a patient with GI issues I recommend trying a probiotic supplement. You would be amazed at what a simple supplement can do to help restore normal function in the stomach and intestines. Gut health is a big deal! Hoping the new diet will be beneficial and make sure you keep your vet updated on any new developments. Best wishes to you and your sweet girl.
Hi Doctor. Mickey is 14 years old rat terrier (possibly older, he’s a rescue) . Not active, sleeps a lot but still has good spring in his steps and waggy tail. Last year is ALP was around 1300 and ALT around 170. This year with no changes, the ALP went down to 800 and ALT stayed about the same as before. He’s a picky eater. His abdomen is distended, Vet said start of Cushing disease. Mickey’s only med is Omeprazole daily. Lately we noticed he gets restless at night, wanting treats but not his food, or another night he went around the house restless. Vet prescribed gabapentin, we think a bit of dementia. His hearing is poor as well. Now the the real problem he’s had brown/gold, yellow watery diarrhea for 5 days. He’s not interested in his food at all but does take his favourite treats. He’s always up in the night to drink and go out to urinate or poop several times a night leaving us with little sleep. Does this sound like late stage liver disease? We are contemplating letting him go.
Hi Brigitte,
I understand your concern for Mickey. I wish I could give you specific advice, but without examining your pup myself it is hard to make definitive conclusions and recommendations. Since his lab work has improved, it is hard for me to believe that his liver dysfunction could have progressed to a more advanced stage. It sounds like there may be something else causing (or contributing to) these symptoms. Please reach out to your vet and let them know about the diarrhea. They can do a quality-of-life evaluation and let you know if it is time to say goodbye or recommend further testing and treatment. Hoping you can find the answers you need to make the best decision for your sweet boy. Wishing you both comfort and peace.
My 14 1/2 year old CairnTerrier has an elevated ALP of 1700 and from a xray we just from out that she has an enlarged liver. The vet said she has had a history of of high ALP but because there have been no additional symptoms they never recommended additional testing until now. She was at the vet to treat her bloody diarrhea which she has had a history of for several years. This and a little arthritis and sensitive stomach have been her only issue. We are now faced with what to do as a next step.. She seems fine and walks 3 times a day and is active. With her advanced age we are hesitant to get an aggressive treatment and are really considering to just keep an eye on it since she is not showing any other symptoms (she has had some trouble on occasion with vomiting up her water) and just let her have a peaceful senior life. The vet did not give any simple ideas for treatment.
Hi Maureen,
I am sorry your senior girl is having issues with her liver. I understand not wanting to pursue a lot of testing or aggressive treatment. Palliative care is always a great option. At the very least, you could talk to your vet about starting a liver supplement. I have had great results with Denamarin in my own patients. It supports normal liver function, protects the liver from damage and helps with detoxification. Hoping you can find the best way to ensure your pup remains happy and healthy for as long as possible. Best wishes and good luck!
Our almost 13 year old Chihuahua Terrier mix is scheduled for surgery in 2 days for gallbladder removal. She’s had Cushings for almost 5 years with virtually no symptoms and no medication. We took her in for what we thought may be a UTI last week because she was leaking urine. Upon taking her in they did blood work and found her ALP levels to be extremely elevated at 3200 Her GGT is also elevated as well as her WBC, platlettes, and potassium. They also said protein was spilling into her urine. They suspected a gallbladder muscoele and upon doing an ultrasound, suggested gallbladder removal and biopsies of her liver/stomach. She’s been on Ursodiol for almost a year for previous gallbladder concerns, so this is the next step and hopefully it will solve some of her issues. Should we expect her Cushings to be worse now? Could not treating her Cushings have caused any of this? Any tips or advice? She doesnt act 13 at all so we really hope she has at least another 5 years. We don’t want this to be the start of her deterioration.
Dear Samantha,
I am sorry your senior girl is dealing with so many issues at once. I would not think surgery would cause her Cushing’s to worsen but I’m not sure we will really know what to expect until that time arrives. I do not think the gallbladder issues would have been caused by not treating the Cushing’s disease. My best advice is to take things one day at a time. Focus on getting through surgery and on the post-op recovery. Then with time you will know if the Cushing’s has remained stable or if treatment will be needed. Wishing your sweet girl all the best and please keep us updated on how she is doing!
First thank you for sharing all this info, it really helped me make sense of the blood test results. I couldn’t find a way to comment except for the reply.
My 8 yr old Azlan a GS, AUS, and Collie mixed , has had elevated liver enzymes but only the ALP, most recent was 485. Reading others comments they are sharing numbers in the 1000’s and so I’m wondering if I could change his diet along with liver supplements to see if that makes a difference. He was on the Denamarin for 30 days but no change in his diet. His weight has never fluctuated more than 3 lbs so no issue there but read how high protein food can affect liver enzymes. Another important note is he was tested for MMM due to indented head. Test came back as borderline. He’s never had any eating issues and has a talent of carrying 2-3 toys/bone at once and like I said no change in weight and he’s a pretty active dog. The vet wants to do a low dex test which will be costly and if that doesn’t show anything then an ultrasound which is even more costly. Just not sure what to do.
Hi Rachel,
I understand your concern for Azlan and think he is lucky to have you advocating for his health and well-being. Trying to find a cause for an elevated ALP can take a bit if trial and error and a lot of patience. I would bring up the topic of a diet change to your vet and see what they think. It is possible this could offer some great benefits. As for the other testing your vet has recommended, it sounds like a good plan of action, and I would be planning to do something similar for one of my own patients. Don’t forget you can always request a consultation with an internal medicine specialist if needed. I am hopeful that you will get some answers and be able to find a clear path forward. Wishing you and Azlan all the best. Feel free to leave an update and let us know how things are going if you have a chance.
Hello and thank you for being here.
My 13+ chi-mix rescue was put on Carprofen for arthritis almost 2 months ago. She did not have labs prior. I took her for labs yesterday and I’m puzzled by the results. First I’ll tell you, she does not want to go for long walks, and is somewhat lethargic, but she wags her tail, has a very good appetite, normal stool, no diarrhea or vomiting, no changes in behavior. She has been extremely thirsty and urinates OFTEN, Glucose is perfect.
Her labs:
AST 207
ALT 685
ALP 3628!!!
Cholesterol 373
Platelet count 940!!!
Cystatin B – High 164, but SDMA – Normal – 10.
Specific Gravity – Low – 1.016
Blood – High 3+
pH – low 5
Protein – High 2+
BUN – High 35
everything else is normal.
Bilirubin, GGT and Albumin – normal.
This seems odd. at first I thought liver & kidney injury from Carprofen, then it doesn’t look consistent with liver injury or disease. Someone mentioned Cushings Disease.
Can you make an educated guess as to what this may indicate. I understand it’s just a guess.
Thank you. – Concerning, scared, dog mom.
Hi Lisa,
I am sorry your girl is having these strange abnormalities on her lab work. It definitely seems like there needs to be more in-depth investigation with the liver. It may be worth stopping the NSAID and trying a different pain medication just to be safe. This would be a great discussion to have with your vet. There are liver supplements that help improve function and are protective that can be used try and decrease these values. Also, with the presence of protein and blood in the urine it could be a good idea to treat for a possible UTI. Of course, the most important part of evaluating a patient is the physical exam and without being able to personally examine your pup, I can’t make specific conclusions or recommendations. Hoping you can find the answers you need to navigate this unknown path. Wishing you both nothing but the best!