The following are real life cases of Dogs that have been treated by Dr. Mike Richards, DVM.
Reason for Elevation in Alkaline Phosphatase and ALT Levels
Difference Between Rises in ALT and Alkaline Phosphatase
Causes of Increase in Alkaline Phosphatase
High ALKP Levels and Diet
Should I Be Concerned About Elevated Alkaline Phosphate?
Are Increased Alkaline Phosphatase Levels a Sign of Cushing's Disease?
Reason for Elevation in Alkaline Phosphatase and ALT Levels
I am a new subscriber and had written my initial question to you about my 7-year-old male Standard Poodle, Nicky. Briefly, he had recent pre-dental blood work that revealed elevated ALKP (295 U/L, reference range 23-212) and ALT (777 U/L, reference range 10-100). Bile Acids were 29.3 UM/L pre-meal (reference range <13) and 27.7 post meal (reference range <25). The rest of the findings were contained within my initial note. He weighs between 45.5 and 47 pounds normally and has always been very lean. There has been no weight loss, no excessive drinking, no excessive urination, no diarrhea and no vomiting. He has a good appetite and has been normal and active in every way. Since my initial e-mail, Nicky has had the chest and abdominal x-rays and ultrasound with liver biopsy. Chest and abdominal x-rays, were normal. Ultrasound showed no obvious problems, but the internist said that the spleen was slightly enlarged. The gallbladder was normal in appearance. The stomach appeared normal. She could not adequately visualize the pancreas. The liver was of normal size. She said there were some changes in the echogenicity on the left side of the liver which were pretty uniform (no distinct masses or nodules). She obtained several ultrasound-guided biopsy samples from that area, which she felt to be of very good quality for submission and analysis. On gross visual inspection, she said that all of the samples looked like normal liver tissue with no obvious discoloration or changes. The internist said that she hoped the biopsy would help to diagnose or rule out certain conditions such as cirrhosis, hepatitis, benign nodularity, copper storage abnormalities and cancer, though she thought that the latter was a more remote possibility (but, in the interest of full disclosure, she said she was running through all the possibilities). By history, one year ago, Nicky had GDV and emergency surgery which included a gastropexy. At the time of surgery, a 2-inch by 3-inch section of his stomach had to be resected due to devitalization of tissue. He had splenomegaly at that time, as well. His recovery has been uncomplicated and he has been active. I would be interested in your thoughts as to whether the GDV could, in any way, have caused or contributed to the present elevations in liver enzymes and the changes noted (and vaguely described my me) on the ultrasound; your thoughts as to differential diagnoses; your thoughts as to whether you think it possible that these findings may be transient and benign, representing something that may already be resolving itself or working its way out of his system (and if so, what types of things can cause changes such as these?) I would add that we have another, larger, Standard Poodle and the two of them had been out in the yard running and playing together in the two weeks prior to the initial pre-dental blood work. Due to extreme cold and inclement weather, they had not been able to do that for nearly a month. Though tired from play, neither dog appeared to have been injured while at play.
We have had a number of patients who have had elevated liver enzyme levels that were discovered because we drew blood without any expectation of finding liver disease. Some of these patients had vague signs of illness but nothing that pointed towards a diagnosis. Others had blood drawn for reasons such as presurgical cautiousness or because of signs of another illness. Many of these patients have gone on to have normal liver enyzme levels on later testing. We never could come to a final diagnosis as to what happened to cause the liver enzyme elevations in the first place in several of these dogs, although the complete recovery from elevated enzyme levels made that almost unimportant. Anything that causes the death of a number of liver cells will raise the ALT and AST levels. This includes trauma, toxins, bacterial infections, lack of blood flow to a portion of the liver for any reason (blood clots, low blood pressure, portosystemic shunts), bile duct blockages, pancreatitis and many other conditions. It would not surprise me if adhesions to a surgical site couldn't occasionally cause enough damage to lead to rises in liver values, although I can't actually recall confirming that as a problem in any patients in our practice. We have seen small abscesses at the site of intestinal resections (where we removed a small portion of the intestine) that smoldered on for very long periods of time, causing subtle clinical signs. If that has happened in the neighborhood of the liver it seems possible that it could cause rises in liver enzyme levels. Anesthestics will sometimes cause liver damage and it is my understanding that this can sometimes be an ongoing problem for a few months and sometime even longer, when it occurs. I believe that I saw this effect in some patients when using methoxyflurane early in my practice career. I can't recall suspecting this problem with either halothane or isoflurane but have spoken with vets who feel it is a possible problem based on cases they have had. Those are the things that I can think of at this time that might lead to liver damage associated with an abdominal surgical procedure. I hope that you have the biopsy reports by now and that they have been helpful in determining what might be going on -- or that you are seeing a drop in the ALT and AST, even if there is no explanation.
Learn more about Elevated Alkaline Phosphatase Levels
Difference Between Rises in ALT and Alkaline Phosphatase
I have a 7-year-old male standard poodle named Nicky who recently underwent routine blood chemistry screening prior to dental cleaning. Results revealed elevations in ALKP (295 U/L , Range 23-212) and ALT (777 U/L, Range 10-100). Cholesterol was listed as high normal (316.0 mg/dl, Range 110-320). Chloride was high normal as well (122.0 mmol/1, Range 109-122). ALB, AMYL, BUN, Ca, CREA, GLU, PHOS, TBIL, TP and GLOB, Sodium and Potassium were all within normal limits at mid-range values except for AMYL, which was low-normal (555 U/L, Range 500-1500). It doesn't appear that the screening included AST/SGOT or Gamma Glutamyl Transferase. He has shown no evidence of illness; does not drink or urinate excessively; does not vomit; shows no decrease in food consumption and has a good appetite. Active in play when outside. Physical examination by our veterinarian revealed no abnormalities, no enlargement of lymph nodes or liver; no tenderness to palpation. Due to the liver enzyme elevations, and since he had already fasted as a prerequisite for the dental procedure, Bile Acids were tested. Fasting level was 29.3 UM/L, Reference range given was less than 13. One hour post-meal, Bile Acids were 27.7 UM/L, Reference range given was less than 25. His past medical history is significant for Bloat in November 1999. Surgery with gastropexy was performed. Surgery revealed that a 2-inch x 3-inch section of his stomach had been devitalized due to the torsion, and that area was resected. He also had some splenomegaly as noted during surgery. His recovery was largely uneventful and he has done very well since that time. We have scheduled an ultrasound examination due to the liver enzyme elevations coupled with the Bile Acid study abnormality. It has not yet been done as of this writing. My questions are threefold: l.) Is it possible (or have you seen in your practice) any disruption in hepatic function caused by the physical trauma and circulatory deficits produced during GDV prior to surgical intervention? a.) Could this account for these recent laboratory findings regarding the ALT and ALKP elevations and Bile Acid Assay results? 2.) How significant are these laboratory findings in an otherwise normal-appearing and normal-acting dog? 3.) Given this scenario, what are the possible differential diagnoses? I should add that this is the first blood chemistry screening that we have done since November 1999. To the best of my knowledge, prior blood tests have all been reported to be in the normal range. Thank you in advance for your kind assistance in this matter.
I think that the best way to approach your questions is to explain the differences between rises in ALT and alkaline phosphatase and give you a list of causes for both conditions and then work from there. ALT is short for alanine transferase. This is an enzyme that is present in the cells in the liver. In order for it to be found in elevated quantities in the blood stream, liver cells have to be leaking the enzyme. So rises in this enzyme indicate damage to liver cells sufficient to cause them to leak the enzyme. Rises in ALT, even large rises, can occur due to problems that don't cause much change in liver function, though. Trauma, liver toxins, blood clots and other insults to the liver which damage a large number of cells in a small area of the liver may produce high rises in ALT that are essentially meaningless, as the liver will recover with no problem. On the other hand, chronic liver diseases that constantly produce damage to the liver but do so slowly may never cause strong rises in the ALT levels even though liver function is deteriorating significantly. ALT levels may rise or fall fairly rapidly, as the half-life of the enzyme in the blood stream is less than two days. Causes of increased serum ALT levels include almost all forms of liver disease (chronic active hepatitis, cholangiohepatitis, liver storage diseases, portosystemic shunts, etc.), trauma, cancer, ischemia (loss of blood supply for any reason to part of the liver, including blood clots), toxins, drug reactions (phenobarbital, corticosteroids, griseofulvin, primidone, rarely antibiotics), hyperadrenocorticism, severe anemia and hypotensive shock. ALKP is shorthand for serum alkaline phosphatase, also a liver enzyme and sometimes referred to as SAP, as well. This enzyme is present in tissues other than the liver, especially bone. Rises in SAP that relate to the liver usually occur when there is some form of slowdown or blockage in bile flow. This can be a problem in the liver, in the bile ducts, the gallbladder or the intestine around the areas in which the bile drains into the intestine. Problems that can result in rises in SAP include growth (from bone changes), hyperadrenocorticism, drug reactions (especially phenobarbital and corticosteroids such as prednisone), most forms of liver disease, gall bladder problems (stones, inflammation, rupture, infection), bile duct problems (pancreatitis inflammation or scarring, cancer of the bile ducts, liver cancers, toxins, diabetes, heart failure (due to circulatory problems in the liver), trauma, systemic or liver infections and really severe bone infections. One form of liver disease, nodular hyperplasia, causes rises in alkaline phosphatase levels but rarely causes any clinical symptoms, even through it is a chronic disease and may be present for long periods of time. Usually, there is not much rise in ALT when nodulary hyperplasia of the liver is present, though. I would be pretty surprised if the bloat was related to the current problem except for the possibility of scarring of the area around the portion of the stomach in which part of the stomach wall was removed that could conceivably be contributing to a bile duct blockage or partial bile duct blockage. I think that you have to take an ALT rise of this magnitude seriously enough to pursue the testing that you have done already (bile acids and ultrasound exam) and I think that in a seven year old dog in which a repeat blood sample a week or so later continued to show similar elevations in ALT and alkaline phosphatase I would strongly advocate a liver biopsy. This would allow the best management of any chronic liver diseases which might be present. At least once a year we have a patient whose liver values are very high, which we find on routine lab work or as part of a blood panel we have run due to vague signs of illness, even though there was not any strong indication of liver disease being present. Many of these patients have resolution of the high lab values within 2 weeks or so and most of the time they don't return. We never find out what happened to these dogs but since they are better, there is consolation in the outcome. I hope that you and Nicky do get a good outcome from this.
Causes of Increase in Alkaline Phosphatase
We're hoping you can help us out with what seems to be a medical mystery with our Scottie, Alistair, and Westie, Max. In October 1999, Alistair had his first and only seizure, 20 seconds of shaking and vocalizing, as well as a loss of use of his hindquarters. Immediately following, he seemed better, got a drink of water, then lost control of his bladder. We took him to our emergency veterinary clinic, but by then, he seemed fine. However, his blood work showed an alkaline phosphotase count well over 800. Two weeks later, it was 998. Our vet recommended an abdominal ultrasound, which showed no masses. He then underwent a liver biopsy, which also indicated no disease. By this point, his alk phos was nearly 1,500. He has taken Lipoform and SAM-e, but neither dropped the alk phos count significantly. Since he showed no signs of illness, we decided to test him again in six months. That test, run Nov. 27, shows his count to now be 2,000, although he still acts fine. However, now our Westie, Max -- whose alk phos count was 84 in November 1999 -- is now having problems, His blood work shows an alk phos count of 994. Both dogs are rescue pups. We presume Alistair is about 7, because he seemed to be a year or so when we got him in July 1994. Max is 6, born in November 1994. Max took Prednisone throughout the summer for allergies, which we know could cause his high count. However, it seems suspicious that both dogs have alk phos problems. Do you know of any environmental causes for high alk phos results? We have other blood test results as well, but don't know which ones would be germane to this situation. Our veterinarian is aware that we are checking the Internet for information, and has no problem with our efforts. We also would not proceed with any medical procedures without talking it over with him, or with the specialists we consulted for Alistair. We would appreciate any help you can give us. It breaks our hearts to think that there is something in or around our home that is poisoning our boys.
The four most common causes of increases in alkaline phosphatase, in the absence of rises in other liver enzymes or evidence of liver disease are 1) young dogs (growing dogs) have higher alkaline phosphatase levels 2) hyperadrenocorticism (Cushing's disease) 3) hepatic nodular hyperplasia ( a benign condition) and 4) drug interactions. The drugs that are most commonly associated with rises in alkaline phosphatase levels are corticosteroids, phenobarbital and primodone, but other medications can have this effect. I am not aware of any environmental factors that cause rises in alkaline phosphatase levels independently of other liver enzymes. The usual approach to isolated rises in alkaline phosphatase is to rule out drug therapy, then to rule out hyperadrenocorticism and finally to rule out benign hepatic nodular hyperplasia, if possible or desired. Unfortunately, this often requires surgical exploration of the liver because the nodular hyperplasia does not always show up on ultrasound exam or biopsy of the liver. Since this is a benign condition and you have already ruled out other liver diseases with the biopsy, at least to the extent that is possible, it seems reasonable not to do anything except consider the other possibilities, at this point. Many dogs have elevated alkaline phosphatase levels for long times during their life without any clinical signs ever emerging. Hopefully this will be the case for Alistair. Max's problem is more likely to be due to the corticosteroid use, but the levels should drop within a few weeks of discontinuing these meds, so you can check for drops during the seasons it is not necessary to medicate Max.
I have e-mailed you before about my dog, Luke, who is 12 years old. But here's the latest. Today he had his blood tested because over the past 8 years, his Alkaline phoshatase (sp) level has ranged from 600 to 1200. My vet suspected Cushings but Luke had (has) none of the outward symptoms - I had an ultrasound done as well - it was normal. My vet talked to an endocrinologist ?? (I think that was the specialist- it's been a while) who said that if Luke isn't exhibiting any symptoms of Cushings, then just keep an eye on him because the treatment for Cushings treats the symptoms - not the disease. Well today his Alk. phosphotate (sp) level came back at 1600!!! This is the highest it's ever been. His ALT was 126. In Jan, he had a Bile Acids test which was normal (also when he had the ultrasound). His vet is going to check the internet to see if she can find out what to do next (other than repeat the ultrasound and bile acids test??) - what would you suggest? I told her I would check with my internet "connection" as well. Luke eats Science Diet Prescription R/D & eats a lot of rawhide treats. Any possibility that either of these could cause this reading? Thanks for your help/any suggestions for further testing/treatment!
The two most likely causes of alkaline phosphatase rising independently of other liver enzymes are hyperadrenocorticism and nodular hypoplasia, a benign condition that occurs in older dogs. I agree that it isn't necessary to treat hyperadrenocorticism unless the clinical signs are a problem, although I am currently trying selegiline (Anipryl Rx) when the cost is not prohibitive for the client, because there is some chance that it can slow the growth rate of pituitary tumors that cause some cases of Cushing's disease. Nodular hyperplasia of the liver does not require treatment. Bile acid response testing for liver function should be normal when this problem is present, despite the high alkaline phosphatase levels. Liver biopsy may help to determine if this is the condition that is present, although the biopsy sample must be taken from an affected area of the liver. This may require a surgical biopsy because the nodular hyperplasia may or may not show up with ultrasound exam. I know of no evidence that rawhides or r/d (tm) diet cause increases in alkaline phosphatase levels. Hope this helps.
High ALKP Levels and Diet
I have contacted you before relative to a high ALKP (1488) in my dog Brandy. In February 2000 the Alkp was 763. July 19,2000 the Alkp was 1488. In February I was advised to put the dog on a diet of 50% Hills Canine W/D and 50% Hills Canine L/D. Previously she was on a diet of Canine W/D. I have noticed no difference in ALKP in fact it has gone up 95%+. Do you feel that the L/D food is of any benefit to the lowering of ALKP or to the dog. Thank you, Ray Answer: Ray- I would be surprised if l/d (tm) diet would work to lower an elevated alkaline phosphatase level that is not accompanied by elevations in alanine transferase (ALT) or bile acids. I would be equally surprised if the l/d diet caused a rise in alkaline phosphatase levels. Even though the alkaline phosphatase level is rising it is often hard to correlate that with any significance in evaluating liver function. I would not be worried any more by an alkaline phosphatase of 1500 IU/L than I am of one of 750 IU/L. I think you would be OK switching back to w/d (tm) diet alone if you wanted to but it would be best to discuss this with your vet. Mike Richards, DVM 8/8/2000 Increases in alkaline phosphatase (ALKP) levels I have a Red Hound that is 10 years old. February 28,2000 from a lab test her ALKP (liver) was 763 July 19,2000 from a lab test her ALKP (liver) was 1488. From my vet I was told that the normals are 23-212 Her ALT in February was 26 Her ALT in July was 31 I am quite concerned about this as the dog seen to be very healthy with the exception of being a little over weight, her weight in this month is 83 pounds. What is your opinion on any action I should take in this condition of the dog.
The most common causes of increases in alkaline phosphatase (ALKP) without a rise in alanine transferase (ALT) are hyperadrenocorticism (HAC or Cushing's disease) and medications such as phenobarbital and cortisones. Another possible cause is hepatic nodular hyperplasia, a generally benign disorder in which nodules form on the surface of the liver. Sometimes other liver diseases will occur in which only the alkaline phosphatase level rises but this is less likely since your hound doesn't seem to be ill. Hyperadrenocorticism causes increased drinking and urinating, thinning of the skin, muscular weakness, a pendulous abdomen, increased susceptibility to infections and other clinical signs. If no signs of this disease are present, it is also questionable whether it is necessary to try to determine if it is present through lab testing. Nodular hyperplasia of the liver can be diagnosed by ultrasound exam in some dogs but may not show up in others. Surgical exploration and visualization of the liver may be necessary to diagnose this condition but this also seems excessive for a condition that is usually benign. So most of the time, in dogs with no clinical signs of illness but increases in serum alkaline phosphatase, we just monitor the situation and wait for evidence of a condition we can treat. If we are using cortisones or carprofen (Rimadyl Rx) we might try to find an alternative medication. If we are using phenobarbital we monitor the liver values on a regular basis but this is a common side effect of this medication and often no perceptible liver damage ever occurs despite the persistent high alkaline phosphatase levels. Your vet may have a different approach to this situation and certainly has a better idea of the total medical condition of your hound, so if there are differences in our opinions I'd advise putting more weight on the advice of the vet who has seen the patient.
Should I Be Concerned About Elevated Alkaline Phosphate?
I have a 12-year-old male cocker spaniel mix who has had an elevated alkaline phosphate (ALKP) for the past three years. His ALKP level has been as follows ALKP Summary Karl Barx
Date ALKP Weight in lbs.
- 6/4/00 1605 16.2
- 3/31/00 890 16
- 11/17/99 424 15.75
- 9/15/99 372 17
- 8/2/99 981 19
- 6/3/99 313
- 4/8/99 308
- 1/11/99 458
- 11/5/98 365 17
- 8/31/98 368
- 4/28/98 761 18
- 3/4/98 994 19
- 1/6/98 947 17
- 10/9/97 581 19
- 9/19/97 853 18
- 8/28/97 1438
The original high ALKP level was detected in pre-surgery blood work and since then he has been monitored closely. He was tested for Cushing s disease but the test came out negative. Our old vet prescribed metronidazole 250-mg tablets (he gets a half tablet every other day) and that seemed to bring the ALKP level down but it never got within the normal range. Most recently we moved and now we have a new vet. Prior to our move his ALKP level was up to 890 so we tried giving him the metronidazole every day for eight weeks to bring the level down. (This did work in the past.) Unfortunately, when we got to our new home and had his blood work done his ALKP was 1605. All his other blood values are normal (and have always been so.) The vet did an ultrasound to see if there were any masses or legions and she said everything looked really normal. I had her stop short of doing a liver biopsy because I was concerned about putting my dog through this when there was only this one elevated level and no other clinical (he acts like he feels great) or laboratory signs. Our old vet recommended Denoysl as something we could try so we are in the process of ordering that to add in to his drug therapy. I told our vet if we didn't see a reversal of the ALKP level in 30 days she could try the liver biopsy. He currently takes: Sentinel, 1 tablet monthly for heartworm and flea control Vetrazene, 1 tablet daily as a supplement to help his joints Efa-Caps 2 daily to help his skin and coat Metronidazole ½ 250 mg tablet every other day Enacard ½ 5 mg tablet every day for mitral valve regurgitation (which appeared stable when he was given his repeat echocardiogram in January of this year) He currently gets ½ can Canine WD canned food, plus 1/3 cup + 24 nuggets of Canine Control formula (Innovative Veterinary Diets to help balance his urine pH) daily. Is this level something to be really concerned about? What other tests could be performed to determine why this level is so high? Should we go ahead with the liver biopsy if the ALKP level continues to rise or remains stable? Our dog is really healthy, happy and active so I hesitate to do anything that is really invasive or uncomfortable for him. Any advice you have would be greatly appreciated. If I ve failed to provide any necessary information please let me know as I have a copy of his complete chart from our old vet. Thanks, Gaynol
There are dogs who have elevated alkaline phosphatase (ALKP) levels for a long time prior to any other clinical signs of hyperadrenocorticism. Other dogs have hyperplasia of the liver for no apparent reason and have high ALKP levels that do not lead to clinical disease. This can occur in stressful conditions from any cause due to elevations in cortisol levels, as well. My inclination in these cases is to run a bile acid response test to make sure that the liver is functioning normally and then wait to do anything else until symptoms of an underlying disease emerge, as long as I feel comfortable that we have ruled out another systemic illness to the best of our ability. If the bile acid response test is abnormal, then it is more important to me to get a liver biopsy done. However, I think that a liver biopsy is reasonable in this situation and your vet may have had experiences that make him or her believe it is important to do this test now. Denosyl SD4 (tm) is a form of S-Adenosylmethionine (SamE). This compound is advocated in the treatment of liver disease by several of the leading liver disease experts in veterinary medicine but I don't know if these recommendations are supported by objective research at this time. It is not likely to be harmful based on clinical experiences so far, though. Hyperadrenocorticism may take several tests to confirm and it is always good to keep an eye out for symptoms of other disorders that may be contributing to the problem, such as weight loss, increased drinking or urinating, lethargy, etc. Hope this helps some.
Are Increased Alkaline Phosphatase Levels a Sign of Cushing's Disease?
I have a 9 y/o Schipperke that has a tentative diagnosis of Cushing's. Back in Nov, she had elective surgery to remove a cyst on her upper eyelid. She had some "routine" lab work, pre-op due to her age. All of her lab work came back within normal limits, expect for her alk phos, which was off the scale at about 2000! She has no symptoms of Cushing's what so ever and continues to be a healthy and active dog. Based on that increased alk phos, my vet decided to do an ACTH stress test. That test result came back normal. Based on the fact that decided to wait and see. Now here in May, again Billie is the hill and trail runner (very active), healthy skin and coat, no ill effects noted what so ever...we do another blood test (urine too) and every thing is normal, except for her alk phos which is still off the scale at 2000 or so. This dog has the coat of a thick pile carpet and no pot belly. She has no increased thrist or appetite. She is not obese. She does not pant excessively. She has great skin. This time my vet decides to do a Dexamethasone challenge (low dose I believe). This time the 4 hr level of cortisol was depressed, but the 8 hr level was elevated to about 2.4. He felt this would indicate pituitary driven Cushing's, although the internal med special vet (consult) said that there are a number of false positive tests and according to her history (health and activity level) he would have a hard time labeling her as Cushing's. The next thing we measured was biliary salts fasting and then 2 hours after eating. Those tests came back with normal limits. Now the next step according to the vet, if I want to pursue this... is an abdominal ultrasound and true cut needle biopsy of the liver. According to my vet, there are certain histological changes in the liver associated with Cushing's and the liver biopsy would be the best way to determine this. Also the abd ultrasound would rule out any masses that may be present. My question ( and his too it seems), do you treat a dog for Cushing's that has no symptoms? How would you determine the effectiveness of the medication, if there are no symptoms to relieve? Is a high alk phos in and of itself problematic? Are the other zebra's out there that may be responsible for her high alk phos? Are we on the right track? Why subject her to an general anesthetic and liver biopsy, if she doesn't need to be treated anyway? Sorry for the long email, but I hope that you can give me some insight that I might not otherwise have access to.
I would tend to ignore this lab finding until there were clinical signs of some disease but lots of vets, and many pet owners, are not comfortable with this approach. I would not treat a dog for Cushing's disease with no clinical symptoms and this sort of lab work unless the clients just wanted to try selegiline (Anipryl Rx) since we have not had much problem with side effects with this medication.
Increased alkaline phosphatase levels occur as an idiopathic (unexplained) finding in some patients. If there has never been previous lab work done it is hard to say if this is the problem, or not. Dogs with idiopathic alkaline phosphatase levels often have this all of their lives. Other dogs have conditions such as nodular hyperplasia of the liver which usually causes no disability. Liver biopsy may be helpful in establishing a cause for this condition. Repeating the low dose dexamethasone testing may also be helpful in clarifying things. Waiting a month or two and retesting to see what the alkaline phosphatase level is then is probably acceptable, too. Your vet may have a reason to be more concerned about your dog than just this one lab test, so talk this all over and then work together to decide what is best to do.
Get additional information on Cushing's Disease
Michael Richards, D.V.M. co-owns a small animal general veterinary practice in rural tidewater Virginia. Dr. Richards graduated from Iowa State University's College of Veterinary Medicine in 1979, and has been in private practice ever since. Dr. Richards has been the director of the PetCare Forum...