Elevated ALP, dog well - where next?

RE: Elevated ALP, dog well - where next?

Rob Loxley — Thu, 25 Feb 2016 15:45:04 GMT

I might get a urine sample and get them to measure water intake. Get the lab to run T4 cheap but may well need a TSH if low to rule out non-thyroidal illness. Scanning the liver to rule out a mass lesion. Ultimately how much chasing of the ALP does the client want to do beyond this?

RE: Elevated ALP, dog well - where next?

Martin Atkinson — Thu, 25 Feb 2016 10:17:29 GMT

[quote user="Lucy Fleming"]Ah yes - I should have mentioned that 'none of the above' was also a definite option!![/quote] I know I was just adding grist to the mill. I noticed CK was raised as well so that with raised ALP does suggest some muscle damage. With the 'funny turns' any possibility these are cardio-vascular? CK can be increased with cardiac muscle damage. Or I wonder if he's had some tonic-chlonic seizures the owners didn't see and got some temporary muscle damage from those. Just thinking.

RE: Elevated ALP, dog well - where next?

Lucy Fleming — Thu, 25 Feb 2016 10:00:30 GMT

[quote user="Martin Atkinson"]You could do any of these things even a brain scan as he's having odd neurological episodes but where will it take you?[/quote]

Ah yes - I should have mentioned that 'none of the above' was also a definite option!![quote user="Martin Atkinson"] Had he had NSAIDs before testing as that could have caused this?[/quote]

No, was sent home with nsaid after the appointment, but none given before bloods.[quote user="Martin Atkinson"]Some info on a blood count would be useful - did you perform one of them?[/quote]

Haematology was all WNL

RE: Elevated ALP, dog well - where next?

Martin Atkinson — Thu, 25 Feb 2016 09:57:44 GMT

[quote user="Lucy Fleming"]How would you approach this case? Scan the liver? Go looking for a bony lesion somewhere causing the dog's discomfort? Investigate for Cushings? Continue with the NSAID or stop pending further investigation?[/quote]You could do any of these things even a brain scan as he's having odd neurological episodes but where will it take you? Sounds unlikely to be Cushings unless he's symptomatic. You need to discuss the options and reasoning behind these tests with the owner and what if it is worse case scenario (tumours) how they would then want to proceed. IME older dogs can have a raised ALP for no apparent reason so I wouldn't get too excited about that. Had he had NSAIDs before testing as that could have caused this? I would buy some thinking time, give them as much pain relief as necessary to make him comfortable and re-test in a couple of weeks. The half life of ALP is quite long so you don't want to repeat too soon but at least you can see if it is going up or down and if anything else has changed. Some info on a blood count would be useful - did you perform one of them?