Chronic pancreatitis on a strict low-fat diet · osteoarthritis on monthly Librela, with owner-reported rear-leg collapse on toy sprints (living-room walk called “no lameness”) · complete cataracts both eyes · night frantic hunger not covered at trazodone 100 + gabapentin 200 · right otitis on Posatex · ALKP still high after pred (218 on 10 Jul) · triglycerides back in range · Cushing’s already ruled out · September 2026 lab recheck still due
He is highly food-driven and stoic. Panting that stops with food is behavioral. Panting that persists is medical. Frantic licking can be nausea. Hard/distended belly plus unrelieved panting is a bloat watch. Do not feed nighttime crying — it is trained solicitation, not a pancreatitis flare.
Rear legs fail when he sprints after a toy. Household tries to prevent running. Kushner 25 Aug wrote full ROM, normal gait, no apparent lameness on a living-room walk. Both can be true. Do not drop OA/Librela because the walk looked fine.
Prayer position for ~1 year is treated as adapted rest unless activity, appetite, or play drop.
Comfy problem lists (Jul–Aug) do not name pancreatitis and do not document the toy-sprint collapse. It is still his primary medical condition.
DOB: Comfy Digitail 7 Nov 2011. Home Vet Shepherd export 31 Mar 2012. Use 7 Nov 2011 unless records are reconciled.
Eyes: Guzman 31 Mar 26 nuclear sclerosis. Kushner 15 Jul incomplete cataract. Kushner 25 Aug complete/mature OU. Functional vision reduced.
Weight: 33 lb (14.97 kg) 13 Apr 26. 32 lb Jul–Aug 26.
Teeth: Guzman 31 Mar moderate calculus/gingivitis. Kushner exam text “no tartar” while Digitail still codes tartar accumulation.
Chronic pancreatitis is the primary condition. Last prednisone 2 Jun 2026. Night restlessness after that was framed as steroid withdrawal plus conditioned feeding.
AUS 13 Apr 2026 (David Bruyette, DACVIM, for The Home Vet): pancreas normal in size and echotexture. Liver enlarged and hyperechoic. Gallbladder moderately distended with sludge, thin wall, CBD normal. Kidneys R 4.0 / L 5.0 cm. Adrenals R 0.47 / L 0.53 cm. No free fluid, no lymphadenopathy. “Largely unremarkable” — asked for current CBC/chem/UA.
Jan 2026 vomiting with low HCT; recheck HCT improved; infectious anemia testing negative; US at that workup diagnosed pancreatitis.
3–4 small low-fat meals. Last meal ~8–9 pm. A parked 6 pm meal is allowed. No encore snacks for crying.
Never: salmon, duck, lamb, Greenies Pill Pockets, peanut butter, Royal Canin / Science Diet standard lines, Under the Weather hamburger/bone broth.
Safe rotation: Koha LID bland (chicken/rice/pumpkin). UTW chicken/rice/pumpkin or turkey/oatmeal/sweet potato only (flare). SquarePet VFS Low Fat (daily candidate). Blue Buffalo True Solutions Blissful 3% fat. Honest Kitchen One Pot Chicken Stew. Stella & Chewy’s chicken bone broth. Pills in boiled chicken breast — not peanut butter.
Cerenia 16 mg for flares only, 3–5 day courses. House-call SQ Cerenia / ondansetron / fluids if he will not eat or is nauseated.
Osteoarthritis (hips / axial) treated with Librela (bedinvetmab) 22–44 lb vial SQ. Last 25 Aug 2026 right front. Prior 15 Jul, 31 Mar (Home Vet 10 mg listed). Next ~25 Sep. Do not give Librela and Cytopoint the same day — alternate ~2 weeks if both are needed.
Guzman 31 Mar: slow, deliberate sit, reluctant to sit quickly, pain score 0/4, BCS 5/9. Kushner 25 Aug: full ROM, no lameness on a living-room walk. Owner still sees rear-leg collapse on toy sprints.
Cytopoint 40 mg 9 Jul 2026 and 13 Apr 2026 (skin, not joints).
Both eyes mature/complete cataracts as of 25 Aug. Pupils equal, round, reactive. No corneal disease noted. Decreased hearing noted Mar 2026. Keep furniture still; night lights; non-slip floors.
Right ear 25 Aug: moderate erythema, mild brown debris, mild swelling. Posatex 7.5 g — 6 drops AD SID × 7 days. Left ear clean.
Splenectomy in California for a benign splenic mass (before summer 2024, likely 2022–2023). Separate historical item: right TPLO Aug 2023 after a CCL rupture. Stable 3 cm soft sternal fatty mass on recent exams.
15 Jul plan: split Reconcile to 1 tablet AM + ½ tablet PM, then possibly stop trazodone. That split had not been started as of 25 Aug. Wean night meds — do not stop cold turkey. He is already on fluoxetine; keep trazodone in the published combo range (~8 mg/kg). 16 mg Reconcile is the labeled 32 mg tablet for his weight band — do not double the daily fluoxetine.
TG 1232 is Surf City Mar 2024 (gross lipemia). 835 is Comfy 19 Jun, 17 days after last pred. 168 on 10 Jul is current. Jan HCT 29.8 is in-house and may be artifact; IDEXX that month was 36.6. Do not start levothyroxine from the July T4 0.6 alone.
| Date | Lab | TG | ALKP | T4 | HCT | PSL / cPL | Note |
|---|---|---|---|---|---|---|---|
| 21 Jan 23 | Antech | 193 | 55 | 1.8 | 50 | 31 | |
| 26 Feb 23 | Antech | 461 | 63 | 1.2 | 47 | 34 | tense abdomen |
| 3 Sep 23 | Antech | 521 | 61 | 1.2 | 48 | 37 | |
| 8 Oct 23 | Antech | 240 | 173 | 1.3 | 40 | 36 | |
| 24 Mar 24 | Antech | 1232 | 216 | 0.7 | 37 | 42 | gross lipemia · fT4 ED 13.1 normal |
| 13 Jun 25 | VCA Antech | — | 63 | — | 38 | — | HGB 11.5 L |
| 1 Dec 25 | IDEXX | — | 125 | 0.9 | 35.7 | 75 | Spec cPL · USG 1.012 |
| 2 Jan 26 | IDEXX | — | 117 | 0.7 | 36.6 | — | Cr 1.6 · SDMA 15 · fT4 0.5 L |
| 23 Jan 26 | in-house | — | 162 | — | 29.8 | 103 | cPL · HCT may be artifact (MCHC 48.7) |
| 16 Feb 26 | IDEXX | — | 182 | 1.1 | 36.6 | — | |
| 30 May 26 | Antech | 449 | 159 | 1.5 | 37 | 43 | |
| 19 Jun 26 | Antech | 835 | 231 | — | — | — | ALP+TG only · 17 d after last pred |
| 10 Jul 26 | Antech | 168 | 218 | 0.6 | 38 | 22 | current · glucose 68 L |
TG ref 29–291. ALKP Antech 5–131, IDEXX 5–160. T4 Antech 0.8–3.5, IDEXX 1.0–4.0. Bond/VCA panels did not report TG. Jan HCT 29.8 is in-house; IDEXX that month was 36.6. Do not start levo from T4 0.6 alone.
| Structure | Finding |
|---|---|
| Pancreas | Normal size / echotexture · no US pancreatitis |
| Liver | Enlarged, hyperechoic · no focal lesion |
| Gallbladder | Mod. distended · sludge · thin wall · CBD normal |
| Kidneys | R 4.0 cm · L 5.0 cm · no stones |
| Adrenals | R 0.47 · L 0.53 · normal for 10–30 kg |
| Spleen / LN / fluid | Normal · none · none |
Primary now · Dr. Gregory Kushner · Miami housecalls · 2026
| Date | Why | What changed |
|---|---|---|
| 25 Aug 26 | Librela + nights | Librela SQ · Posatex AD · trazodone ≤150 (200 fly) · gabapentin ≤300 · complete cataracts · no lameness on walk |
| 15 Jul 26 | Librela | Post-LDDS diarrhea resolved · Reconcile still 16 mg SID · advised AM + ½ PM split · incomplete cataract coded |
| 10 Jul 26 | Antech SuperChem | TG 168 (in range) · ALKP 218 H · T4 0.6 L · HCT 38 · PSL 22 · glucose 68 L |
| 9 Jul 26 | Follow-up | Cytopoint 40 mg |
| 19 Jun 26 | Antech ALP+TG | TG 835 H · ALKP 231 H · 17 days after last pred (2 Jun) |
| 30 May 26 | Antech SuperChem | TG 449 H · ALKP 159 H · T4 1.5 · HCT 37 · PSL 43 |
Former Miami · Dr. Guzman · closed to him · Mar–Apr 2026
| Date | Why | What changed |
|---|---|---|
| 13 Apr 26 | AUS + Cytopoint | VDIC US: pancreas normal, hepatomegaly, GB sludge, “spleen” reported · Cytopoint 40 · 33 lb |
| 31 Mar 26 | OA / Librela consult | Librela 10 mg for OA · gabapentin 100s · night 3 am restlessness · nuclear sclerosis only |
NYC Chelsea / Lower East Side · Nov 2025–Feb 2026
| Date | Why | What changed |
|---|---|---|
| 15 Feb 26 | Anemia recheck + Librela | Post-AMC pancreatitis · HCT 36.6 · ALP 182 · T4 1.1 · incomplete cataracts · Reconcile still on · Librela 10 mg |
| 23 Jan 26 | Shake / pant after raw | Cranial abdominal pain · HCT 29.8 · cPL 103 (unlikely) · rads no obstruction · i/d Low Fat · rec AUS |
| 29 Dec 25 | Diarrhea | Metro + Cerenia + fluids · later labs 2 Jan: SDMA 15, Cr 1.6, T4 0.7 |
| 25 Nov 25 | Lethargy after Miami→NYC | Overdue Librela given · HCT 35.7 · USG 1.012 · CDS called less likely |
Schwarzman · Jan 2026 · report not in Drive
| Date | Why | What changed |
|---|---|---|
| Jan 26 | Vomiting + low HCT | Infectious anemia panel negative · HCT later improved · abdominal US diagnosed pancreatitis (source of the chronic-pancreas label) |
Miami Beach · 2019–2025 · Reconcile start
| Date | Why | What changed |
|---|---|---|
| 5–13 Jun 25 | Night panting / pain | Stop selegiline · start Reconcile 16 mg 19 Jun · cataracts OU · Pellicane: 70–80% vision, not the panting driver · Librela |
| 22 May 25 | Pain increase | Meloxicam + Cytopoint 40 (he was also on Librela — do not restack NSAID + Librela) |
| 2019–2020 | New pet / atopy | First Cytopoint 1 Feb 2020 · asymmetric kidneys on palpation 30 Oct 2019 |
Huntington Beach, CA · 2023–2025
| Date | Why | What changed |
|---|---|---|
| 2024–2025 | OA / skin / ears | Monthly Librela + Cytopoint · recurrent otitis · Epi-Otic weekly from Oct 2024 · Meloxidyl label: do not give with Librela |
| 24 Mar 24 | Annual labs | TG 1232 H · ALP 216 · T4 0.7 with normal free T4 · PSL 42 (pancreatitis unlikely) |
| 27 Oct 23 | OncoK9 | Cancer signal not detected |
| Aug 23 | TPLO right | After COCEAH 31 Jul confirmed R CCL rupture (missed car jump May 23) |
| 26 Feb 23 | Tense abdomen | First high TG in these files: 461 · r/o pancreatitis vs GE · PSL 34 |
Haven Bay / The Home Vet (Dr. Guzman) is no longer the vet of record. Older Shepherd export and the April US still live in Drive. Peptides are not on Kushner’s menu. Do not start research injectables. Oral BPC, if ever used, is a gut product — it will not replace Librela or stop toy-sprint collapse.