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 there!
My little Chaplin is a 12 year old mixed rescued dog. He weights 17 lbs.
He has been living with a heart murmur which he’s been taking Pimobenden for.
I’ve also been giving him some supplements. Co Q10, salmon oil, probiotics and CBD oil.
He’s full of life, very active, drinking and eating normally. Nothing out of the ordinary until a couple of nights ago.
As he napped beside me, all of a sudden he woke up crying in pain. For the next few minutes he sat with his back curved, his tail between his legs and he would slightly fall to one side. After those few minutes he was back to his normal self and has been acting normally ever since.
His blood work came back with ALT 124, ALP 328 and Lymphocytes 1.0 and everything else was normal.
Do you think there is a reason for worry?
Hi Elizabett,
I am sorry Chaplin experienced this worrisome episode a few days ago. Without examining him myself it is hard to make specific conclusions. From what you describe I am a bit suspicious it could have been seizure activity. Dogs with seizures will often have normal lab work. This may have been a one-time event and hopefully you won’t ever see it again. If you do, the most helpful thing would be to see if you can catch the episode on video. Getting to witness this firsthand would help your vet in making a definitive diagnosis. Praying your sweet boy is feeling well and living his best life. Bless you both!
Hello! Our 10 year old terrier/spitz mix had a trend in Alk Phos from normal, to 250, 950 over 2 years in her pre-dental bloodwork., otherwise completely normal labs and acting healthy and happy. We did an US which was normal with mild gallbladder sludge detected. The Vet started her uraodiol, and we repeated in 2 months. Unfortunately it went even high to 1183 and rhwy would not give anesthesia for dental, and told next steps are a CT or FNA. We got a second opinion, and we’re told evated Alk Phos isn’t worrisome with a normal US and likely coming from a dental infection. New vet is going ahead with dental due to 2 likely infected teeth, and is fairly confident it will reverse issue.
Hi Julie,
I understand your concern for your senior girl with this increasing liver value. It is true that dental disease can cause the liver enzymes to be elevated and a dental cleaning can sometimes resolve the issue without further treatment. I would offer one word of caution. The presence of gallbladder sludge can lead to other more worrisome issues and needs to be closely monitored. I am not sure I would label these ultrasound findings as “normal”. I am glad you have found a vet with whom you can place your trust and work together to restore your pup’s health and well-being. Wising you all the best and praying for a smooth and successful dental procedure.
Hello everyone,
I’m reaching out for advice and to share our experience with our 6-year-old German Shepherd, Tyson, who is currently battling severe liver disease. We recently received his latest blood test results, which are quite concerning.
**Key Laboratory Results:**
– **ALT (Alanine Aminotransferase)**: 4800 IU/L (normal range: 10-125 IU/L)
– **ALP (Alkaline Phosphatase)**: Above 6000 IU/L (normal range: 23-212 IU/L)
– **Total Bilirubin**: 2.1 mg/dL (normal range: 0.1-0.6 mg/dL)
– **Creatinine**: 4.2 mg/dL (normal range: 0.6-1.6 mg/dL), indicating Grade III acute kidney disease
Additionally, we’ve noticed Tyson’s eyesight deteriorating rapidly, almost to the point of blindness.
We are deeply worried about Tyson’s health and his eyesight, and we would greatly appreciate any advice, shared experiences, or recommendations on managing such severe liver conditions.
Thank you all in advance for your support and guidance.
Dear Abhay,
I am sorry Tyson is experiencing these severe elevations in his liver and kidney values. With both organ systems being affected and this happening so acutely, I would strongly recommend testing for leptospirosis or tick-borne diseases. Is there any chance he could have been exposed to a toxin or poison? An abdominal ultrasound may be warranted, and I would also ask about a referral to an internal medicine specialist if needed. Hoping you can quickly get some answers and find a clear path forward with treatment. Wishing you all the best and praying for a positive outcome.
My dog is an 18 yr old doxie he has had a tooth problem for approx 1 yr plus due to his age I do not feel comfortable putting him under anesthesia so the doctor has been giving me periodically. Clementa myosin to treat his tooth infection after each round his tooth seem to get better, and then just reappear again a few months later, as you could see the swelling under his eye when he gets worse, I had blood work done recently to check for any type of infections or to see if safe to get the tooth extracted ! His results were all normal except the following high on ALT 207. Alk 385 WBC 30.9 platelet count 450 differential Absolute Neutrophils 2557.4 Bands 618. And a low T4 <0.5 so the vet put Sam on a liquid antibiotic called Amoxicillin w/clav 200mg / 5ml thyroxin 0.1 mg 2x daily and pro hepatic cat/small dog And When the amoxicillin ran out he was givenh zydaclin for his tooth again as it looks like it popped due to blood all over my bed from his mouth and swelling has gone down under his eye My question is does he need to be on the pro hepatic and thyroxin for long term if so those too meds are gonna cost too much every mo so are they necessary? I asked the vet and they said yes I guess in your opinion does this sound right ? And would you recommend him getting that tooth pulled at 18 yrs old ? And how bad is his blood work ? Liver and thyroid?
Hi Leann,
I understand your concern for your senior Dachshund with this ongoing tooth issue and lab work abnormalities. Unfortunately, without playing a personal role in his medical care, it is hard to make specific conclusions and recommendations. The pro hepatic sounds like a supplement to try and help the liver function better. While this is not a mandatory treatment, it could be the only thing available to help prevent liver function from worsening and keep liver failure from occurring. The thyroid medication is definitely for life, as untreated hypothyroidism can eventually degrade your dog’s quality of life. I am not sure if having the tooth extracted is the best course of action for your pup. But I do know that removing the tooth is the only way to completely resolve this issue and age alone should not be a deterrent to anesthesia. I will attach links to other articles with more information and great comments from other readers. Hoping you can find the advice you need to make the best choice for you and your sweet boy.
1. Is My Dog Too Old for Surgery?
2. Is My Dog Too Old For Anesthesia?
3. Senior Dog Tooth Extraction: What to Expect
4. How to Recognize a Dog Tooth Abscess and What to Do About It
My 8-9 yr old little terrier mix had her annual exam and bloodwork on 5/21/24. All results came back in the normal range except positive for heartworm. Her ALT was 24, ALP 8. She was put on doxycycline, which made her extremely ill. Her Heartgard case required a confirmation test for heartworm in order to pay for the treatment. One week later on 5/29/24 her heartworm test came back negative and her ALT skyrocketed to 4335 and ALP 1255. I don’t know what to do for her. I feel the doxycycline is making her very sick.
Hi BT,
I am so sorry your little pup is having these severe issues with her liver. It is hard for me to get the full picture of what is happening without being personally involved in your dog’s case. If the confirmatory heartworm test was negative, then I guess I am a bit puzzled as to why the doxycycline is still being used since it was part of the heartworm treatment. I am not sure if the medication is to blame for your girl’s elevated liver enzymes, but think more investigation is needed. Does your vet have the ability to do abdominal ultrasound? Hoping you can get the answers you need to restore your dog’s health. Feel free to keep us updated on how things are going. Best wishes.
thank you for this opportunity: 2 weeks ago, my 6 yo ?(previously healthy) Morkie ” George” had a massive seizure. At first I thought he hadn’t survived it, then thought he’d had a stroke as recovery was very slow. It was frightening. He saw an out of hours vet and commenced medication to control seizures. Pexion 100mg bd. His blood work came back with ^ALP >1200. Everything else ok apart from ^ cholesterol. His urine on dipstick is full of protein. A few days later the abdominal scan was found to be normal. His (sorry forgot the name) straved -blood- feed- blood test ” was a slightly elevated but the lab had reported not abnormal enough to warrant further investigation”.
During this time the Pexion has been increase to 150 MG bd to get better seizure control. I’ve just sat with him at 315am uk time having a massive seizure. it’s heartbreaking
and I’m at a loss as to what’s going on. How life has changed in 2 weeks.
I’d value your opinion
thank you Donna
Hi Donn8,
My heart goes out to you as you face this worrisome situation with George. While I am not familiar with Pexion (it is not available in the U.S.) it is common for some dogs to need more than one seizure medication to get things under control. If there is any way you can schedule a consultation with a veterinary neurologist, that could be very helpful. How are things today? Is your boy feeling better or is he still struggling? Hoping you can find the answers you need to help get him stabilized. Praying for healing and a positive outcome.
Bandit my 10 year old female Shih Tzu was acting very lethargic. did not eat for 48 hours, nor would urinate. off to the vet we go. Blood work and urinalysis is done. Everything is normal except for ALP 5718! way high. Next step ultrasound, all is good there also. Sent home to keep an eye on her.
Still very lethargic and not urinating as she should be. I am very worried and don’t understand why her ALP is so high and Dr doesn’t know why, nor give her any medication to bring it down. HELP!
Hi Gloria,
I am sorry Bandit is facing this difficult situation and you are left with more questions than answers. Without playing a personal role in her medical care it is hard to make specific conclusions and recommendations. I encourage you to talk to your vet about staring a liver supplement/protectant. Even if it doesn’t help, it shouldn’t hurt. Also, it may be time to ask for a consultation with a specialist. Hoping you can get some answers and narrow down the cause. Feel free to leave an update and let us know how Bandit is doing. Bless you both.
My vet told me to get Denemarin from Costco. It’s a supplement for elevated liver enzymes. Costco carries at the pharmacy.
Hi Doctor,
My very loving over extremely healthy active 15/16 year old mixed pup Lucky, we walk at least 1.5 miles a day but lately he’s been slowing down a bit and panting a lil more. I took him to the vet about 6 months ago, blood work at that time was fine. They suggested an oral trio heartworm/tick/flea med. He had a few crystals in his urine so they suggested I try wet food (i was cooking food for him because he had his teeth extracted 3 years ago. chicken breast and sweet potato.). He had a reaction to something. Excessive itching, skin bumps, yeast action, some bleeding. Which turned into swelling/licking/scooting anal area. Discontinued wet food and treated with Apoquel and medicated shampoos biweekly to weekly. Apoquel helped but discontinued after two bottles due to cost. Skin seemed to be getting better dog was sleeping better and less itching but he started having bloody stool. Took him back recently he had a skin infection and anal gland infection. I think because of the trio med but after comprehensive senior dog bloodwork ALT 134, ALP 434, GGT 24, TBilirubin 0.4. I have been really spoiling my dog with treats and steak dinners. Could this be related to the allergic reaction or is the allergic reaction indicative of something else. Vet thinks Cushings, Liver disease, Cancer, or hypothyroidism and wants to test for all but at 16 and really active and happy I don’t know even if he had any of the above if I would treat for it. I know you’re not my Vet and not treating Lucky but would a wait and see be appropriate in this case? I am hesitant to get the US Abd or other comprehensive testing for Cushings. Your thoughts are greatly appreciated. Thank you for taking your time to read this.
Hi Meera,
I am sorry you are facing this difficult situation with Lucky. Anything newly introduced into your dog’s diet could cause an allergy flare up if he is sensitive to the ingredients. It is hard to narrow down a specific cause with so many changes occurring at the same time. It is always ok to forgo testing and treatment as long as you pursue palliative care. The goal of any course of treatment should always be your dog’s comfort and well-being (quality of life over quantity). If Lucky is still experiencing these worrisome symptoms, I am not sure it is in his best interest to just wait things out. Something needs to be done to restore his health or offer relief. If you wanted to pursue testing, an abdominal ultrasound could be a great way to get some answers. I hope you can get the advice you need to make the best choice for everyone involved. Wishing you all the best and praying for a clear path forward.
Dr. Buzby, Thank you so very much for all of your in depth articles. I have a 14 1/2 year old mix rescue. I have had Lucy since 2011. She averages 70 lbs and is pure white. We believe her to be pit bull and lab? In 2019, after the loss of our best friend, Joseph the bullmastiff, Lucy had several “episodes” in succession. It was 4/3/2019, she came in from morning bathroom and like a windup toy running out of steam crumpled down and curled tightly to the right. All that moved were her eyes, darting all around. After about 30 sec she ‘released’ and wanted to play. She had 3 more within a half hour. Fast forward to current day. Lucy has exhibited what I know now are precursors, off balance and shaky eyes, but I will catch it and it seems that probiotics always make things better and making sure no one gives her food. A few months ago the doctor wanted a blood panel due to showing signs of thyroid issue. Her ALP was over 800, and she had hyperthyroidism but her kidneys et. al were fine. I took her back and her thyroid has leveled out but the ALP has only dropped to 760. Lucy does have large lumps, the largest inside of her rib cage closest to her belly.
I am not writing for advice, unless you feel inclined. I am writing to let the public know that staying in abusive relationships not only harm them, but can slowly kill you best friend. I hold myself accountable for Lucys condition. I finally was able to have my vet fully comprehend the level of captivity I have endured for almost a decade, and unfortunately Lucy has too. She deserves a medal and I promised her a mommy that doesn’t cry and a place where we can be safe and not afraid to laugh. And that’s what I am on my way to do for her right now. She is my only friend and my only family and I hope that of someone reading this is being subjected to abuse, please get away. I wont say it will be easy or better, but if you have a life depending on you, it will be better for them. No more excuses.
Dear Debra,
I commend you for having the strength to make some very tough decisions to improve the quality of life for yourself and Lucy. You are such an inspiration to me for having the courage to take a stand and speak out about your experience. Thank you for sharing your story with us. I hope you and your sweet girl have found some peace and are headed for brighter days. Wishing you nothing but the best and give Lucy a hug for me! ♥
Hello. I am hoping you could help me with my 10 year old maltipoo whose ALP was 1250 5 months ago. A year and a half prior, he was at 350. We put him on Denamarin 5 months ago and his level is at 900 today. The vet said all of his other bloodwork was fine. Should I be concerned? What could it be? His ALT was normal along with all other typical lab work. Thank you in advance!
Hi Alina,
I understand your concern for your pup with these changing ALP levels. What a blessing the Denamarin seemed to help and now the results have decreased. As the article states, there are many things that can cause the ALP to be elevated. Unfortunately, without playing a personal role in your boy’s medical care I can’t make specific conclusions. Hoping things will continue to head in the right direction and praying for complete resolution to this issue.