Welcome to our “Ask Dr. Paola” series, where every Monday we bring expert advice straight from Dr. Paola Cuevas (MVZ) to help our readers better understand their dog’s health and well-being.
Whether you’re a new pet parent or a seasoned dog lover, Dr. Paola is here to provide answers to your most pressing questions. From nutrition tips and preventive care to troubleshooting common behavioral issues, Dr. Paola is ready to offer insights that will keep your furry friend happy and healthy. Stay tuned for expert guidance on a range of topics that matter most to you and your dog, so you can make informed decisions and provide the best possible care for your canine companion. Have a question? Send it in here! 
Help! My Vet Suggests a Biopsy for My Dog!
“Hi Dr Paola,
I have a 10-year-old female mini Labradoodle named Riley. She weighs 14 pounds. We had Riley’s bloodwork checked recently, and her ALT was 1100 U/L and ALP 4400 U/L. She also had an ultrasound.
The vet has prescribed a medication starting with DEM (I don’t have it with me) for her liver. They said that she has liver issues, and they put her on special dog food for the liver. They also gave her an antibiotic.
What are your suggestions? I’m really upset because we had this done two weeks ago. The doctor is now recommending a biopsy, but I don’t want to put her through that. She also has weak legs.”
– Joanbe
Hello Joanbe,
I can understand why you’re feeling upset. In many laboratories, ALT values are typically below about 125 U/L and ALP values are often below about 150 U/L, although reference ranges vary slightly. If Riley’s ALT is around 1,100 U/L and her ALP is around 4,400 U/L, those are substantial elevations that indicate her liver deserves further investigation.
However, liver enzymes are not a diagnosis by themselves. Think of them as a smoke alarm. They tell us something is happening, but they do not tell us exactly what started the fire. ALT is released when liver cells are damaged, while ALP can increase with bile duct disease, certain hormonal disorders, medication effects, or other liver conditions. A dog with chronic hepatitis, gallbladder disease, a benign liver change, or even some endocrine disorders may have similar enzyme elevations, particularly hyperadrenocorticism, also known as Cushing’s syndrome.
This is why your veterinarian recommended an ultrasound and is now discussing a biopsy. The ultrasound can reveal changes in the liver’s size, texture, and surrounding structures, but it often cannot determine the exact cause of those changes. A biopsy provides a small tissue sample that can sometimes distinguish between inflammation, scarring, copper accumulation, cancer, or other liver diseases. The important question is whether the results would change Riley’s treatment plan or provide information that could improve her quality of life and long-term outlook.
The medication you mentioned that starts with “DEM” is likely Denamarin, a commonly prescribed liver support supplement that contains S-adenosylmethionine (SAMe) and silybin, a purified extract from milk thistle. It is not a cure for liver disease, but it can help support liver cells and is often used alongside a therapeutic liver diet as part of a comprehensive treatment plan.
It is also worth remembering that many dogs with liver disease can enjoy a good quality of life for months or even years with appropriate management, depending on the underlying cause. Because Riley is also experiencing weakness in her legs, her overall health and comfort should be part of any decision about additional testing.
If you are uncertain about proceeding with a biopsy, a consultation with a veterinary internal medicine specialist may help you better understand the potential benefits, risks, and alternatives. To get the most out of that consultation, ask your veterinarian for copies of Riley’s complete medical records, including her blood work results, urinalysis (if one was performed), ultrasound report and images, any radiographs, a list of current and previous medications and supplements, the liver diet she has been prescribed, and notes documenting her clinical history and physical examinations. Having all of this information available allows the specialist to evaluate the full picture and provide the most informed recommendations, helping you make a decision that feels right for both you and Riley.
Kind regards and best wishes,
– Dr. Paola
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Help! Does Your Clinic Take Care of Tooth Extraction?
“Dear Dr. Paola,
My adopted dog, Misha, is a mixed breed. She about 10-years-old and weighs around 20 lbs. Misha needs dental work, which could include tooth extractions. Could you please let me know if your clinic can take care of this?
Thanks.”
– Farid
Dear Farid,
Thank you for reaching out about Misha. At the moment, we do not have a physical veterinary clinic, so we are unable to perform dental procedures, cleanings, or tooth extractions. Dental work requires an in-person examination, anesthesia, dental radiographs, and any necessary treatment to be performed by a veterinarian at a local clinic.
If you would like guidance on Misha’s dental health, help understanding a treatment recommendation, or assistance preparing questions for your local veterinarian, you might like to schedule a consultation through Pangovet. Our veterinarians can provide educational information and discuss available records, but dental disease must be diagnosed and treated through an in-person veterinary examination. I hope Misha gets the care she needs and feels more comfortable soon.
Kind regards,
– Dr. Paola
Help! Should Dogs Eat Pork?!
“Hi Dr Paola,
Should dogs eat pork?”
– Pat
Hi Pat,
Yes, dogs can eat pork, provided it is plain, fully cooked, and offered in moderation. Pork is a highly digestible source of protein that supplies essential amino acids, along with nutrients such as B vitamins, zinc, and selenium. In fact, pork is a common ingredient in many commercial dog foods and veterinary diets. The concern is not the pork itself, but how it is prepared. Many pork products intended for people, such as bacon, sausage, ham, and seasoned roasts, contain high levels of salt, fat, spices, or preservatives that are not ideal for dogs.
As to whether dogs should eat pork, that is essentially up to their owner. Whilst all dogs need to consume a nutritionally balanced diet that includes proteins and carbohydrates, there are many different sources for those nutrients. Pork is one good source of protein, but there are other options as well. The most important thing is that your dog is getting the appropriate type and amount of protein in their diet.
If you choose to offer pork as an occasional treat, it should be thoroughly cooked and free of bones, seasonings, onions, garlic, and rich sauces. Raw or undercooked pork is not recommended because it may contain parasites or harmful bacteria. Think of pork like a rich dessert. A small amount can be enjoyed safely, but large portions or heavily processed versions are more likely to upset your dog’s digestive system. As with any new food, introduce it gradually and keep treats to a small portion of your dog’s overall diet.
Best,
– Dr. Paola
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Help! My Vet Suggests a Biopsy for My Dog!
