Elevated ALP

My MO says that it is something to watch, but if I'm asking how concerned he is at this point, the answer would be “not very much." He said that if I am asking if it's in my bones, the recent bone scan showed nothing of concern. I told him I don't trust imaging because the imaging all missed the ILC in my breast and nodes. He explained that bone scans look at different things. It looks at the turnover in the bone....basically the bone is “making room for" the cancer, and the bone scan detects those changes in (I think he said) calcium deposits or something. I might not have that exact, but basically bone scan is not relying on detecting the cancer itself, but rather the changes In the bones as a result of cancer. He said is it 100 percent accurate? No. But by the time cancer in the bones gets big enough to change the AP, he would expect to see it in the bone scan. I also asked if surgery could change the AP reading (I had two surgeries between my Feb and July labs) and he said absolutely. On the increase in ALT and AST he said that was not a concern. You can run ALT and AST at two different times the same day and get very big differences. I'm still really scared. Any input out there? Edited to add; I also asked if the massive ibuprofen I took after surgery could change the AP and he seemed skeptical about that. Said “potentially.”

Narcotics and antibiotics both after my mastectomy. And I took a pretty good amount of ibuprofen for a lengthy period after I stopped taking the narcotics. I still have a good bit of inflammation on one side, and stitches struggling to dissolve. But I'm 9 weeks out of surgery. Should the surgery still be affecting the labs?

On Calcium and Vit D, my calcium is solidly midrange. Vit D unknown, though I did start taking supplements for both after I started the letrozole.

The rest of my labs, including calcium, were fine I was told. What needs to be done to track this down? I asked for Vit D test. I don't know what else I should be doing. I had a bone scan in June, an abdominal CT in June. Both clear. I just never trust imaging because it missed my ILC in the breast for so long. Is there something else that can be/needs to be done? Anybody know?

Feeling so scared. If there were Mets causing my ALP rise, wouldn’t it show on the Bone Scan and CT I just had in late June? The CT said the “Liver enhances normally without any suspicious lesions.“ The ALP had already risen when I had those tests.

Yes. It actually increased 11 in three weeks. I've been over and over my last CT and bone scan and of course pulling all sorts of things out to worry about. The CT noted an enlarged left supraclavicular node, and a periaortic node, both below the threshold for lymphadenopathy. My MO said it was to be expected as I was just out of surgery, but of course now I'm wondering. CT also noted two bone lesions which MO said were tiny and were bone islands. Literally nothing else was mentioned on CT except post ALND axillary changes. Everything else is normal normal normal normal. But I'm so scared. I was taking a lot of pain meds when I got that first high ALP. And I’ve had two chemo infusions since then. None of my other labs are off except glucose. It’s always high.

BevJen and JavaJana thank you both. I haven't talked to my MO yet, but he did text shortly after my PET today that it was “normal." Still worrying but a little bit less than this morning. After I have a chance to ask specific questions, hoping I will be able to let it go. So hard to do. Edited to add: I talked to him. He said nothing lit. That sometimes the ALP rises due to chemo, inflammation etc and that’s what we should assume has happened in my case.