An 8-year-old, F/S, 77 lb, Pitbull terrier was presented at RDVM for decreased activity level and behavioral changes. Blood work was performed and showed an increase in ALKP. The patient also had a dental cleaning recently where they extracted multiple teeth and put her on oral Tramadol. Owner says that she was “normal” on March 20th but has slowly been declining. Repeat blood work showed an increase in ALKP. Unable to perform physical exam due to hyper response. Owner reported the patient had become very head shy and aggressive with other dogs and had drastically changed in personality. RDVM recommended a brain CT scan and it was decided to include the liver due to increased ALKP.