### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Good day and greetings from Manila, Philippines! i recently had a check up with a Gulf country accredited clinic (but not ISO 9001 clinic) as a requirement for my Qatar work visa. my first thought that would put me into light is if i have UTI infection. When the result came out i was surprised that the problem with my medical result is an Elevated Alkaline Phostotase but all other results that is connected to the liver is normal. I was very skeptical with their medical result considering that my older had a history with them that she was diagnosed with Granuloma, but she has no history of TB, Bronchitis, asthma and most of all she doesn t smoke or had long exposures with secondary smoke. After a month with consulting with the Philippine Department of Health her Granuloma was diagnosed instead of an expanded artery in her lung thus she was clear for a fit to work clearance. On my case, when i consulted clinic s doctor, I asked him what could have caused my elevated ALP but instead he directed me to paying another set of tests. When i shared my knowledge on the normal levels of the ALP which i believe is 44-147 IU/L or 30-120 IU/L, the doctor again refused to acknowledge my question and instead directed again to paying another set of tests and he said that in their clinic, the normal level of ALP is 114. I even asked if its in IU/L and still he didnt answer me though he told me that the result is based on what kind of test it was given and when i asked if they do the standard procedure i didn t get any answer from him. i had a medical check up with my employer which a day apart from taking my medical with Gulf accredited clinic with also the same kind of tests. the results of both medical check-ups were given on the same day and the result was i was cleared and fit to work on my employer s medical check up with no elevated ALP as it was normal but it puzzled when the result of my ALP in the Gulf accredited clinic was different. i am hoping for your quick, and detailed response as i am very puzzle because honestly, i don t really trust their doctor on house. i may sound harsh but upon hearing other people who have healthy living but given sickness because of their results, it really bothers me a lot. thank you for your time and hoping to hear from you soon.

### output:

HIS UNDERSTAND YOUR CONCERNS.First I WILL SUGGEST YOU TO REPEAT YOUR ALKALINE PHOSPHATASE TEST IN A STANDARD RELIABLE LAB.IF IT IS CONFIRMED THAT YOU HAVE RAISED ALKALINE PHOSPHATASE THEN I Would SUGGEST FOLLOWING APPROACH.ALKALINE PHOSPHATASE IS PRODUCED FROM MAINLY 2 SOURCES LIVER AND BONE.LIVER CONDITIONS CAN EASILY BE EXCLUDED BY ULTRASONOGRAPHY WHICH YOU ALREADY MIGHT HAVE DONE.TO RULE OUT BONE DISEASE BLOOD TEST TO BE DONE ARE SERUM CALCIUM, VIT D LEVELS AND PARATHYROID HORMONE LEVELS.THE MOST COMMON CONDITION CAUSING RAISED ALKALINE PHOSPHATASE IS VITAMIN D DEFICIENCY WHICH CAN BE EASILY TREATED. I HOPE I TRIED TO PUT IT IN A SIMPLE MANNERISM U GOOD HEALTH!!PLY GIVE RATINGS IF YOU FIND THIS USEFULTHANKS Chat Doctor. 