His history
8-year-old neutered male Shih Tzu mix
Theo's liver problem was found by accident, on bloodwork before a dental cleaning in November 2022. A biopsy in March 2023 showed his liver was storing too much copper. The first copper-binding drug, penicillamine, made him vomit, so treatment was built in stages: a home-cooked diet from a nutrition service, then prednisone, then Atopica (cyclosporine). His ALT first came back into the normal range in December 2024. Pancreatitis flares were then recorded between June 2025 and early 2026. In March 2026 his blood fats were above 1,000, and fenofibrate was started. At his August 25, 2026 visit he was doing very well. One step keeps being recommended and hasn't happened: a lower-fat diet.
A DNA test in January 2023 shows a mix of seven breeds and no increased-risk results. See his DNA
Theo's care lives in about 180 pages of PDFs, emails, and things said out loud in an exam room, across four different teams. Most of it agrees. The places it doesn't are the ones that matter: a spoken instruction about one medication never reached the written list, a lower-fat diet has been recommended at four visits and still hasn't been made, and a key lab result from his last visit was never recorded.
Steadywag doesn't hide what's missing or inconsistent. It shows it, so the right question gets asked at the next visit instead of being discovered in an emergency. We're sharing it, de-identified, so one real case laid out clearly can help other dogs and the families caring for them.
ALT liver enzyme on a log scale, with his medications and flares underneath. Scrolls sideways on a phone.
ALT is a stand-in marker: it can miss mild leftover copper.
Bloodwork before a planned dental cleaning found a high ALT. It kept rising with no outward signs. A March 10, 2023 liver biopsy found mild chronic lymphocytic hepatitis, with copper building up in liver cells.
Penicillamine made him vomit after morning doses, and it was stopped on June 30 while the nutrition service built a diet. In September 2023, zinc was taken out of the recipe and penicillamine was restarted. ALT still kept climbing.
Prednisone started at 10 mg, then was doubled in February 2024. Side effects were thinning tail hair, longer urination and weight gain. Atopica (cyclosporine) was started on October 11, stopped on October 16 after a suspected reaction, and restarted on October 29. His team and the family agreed the reaction may have been coincidental timing.
His liver values stayed normal. Four presumed pancreatitis flares are on record: June 2025, January 28 (the emergency visit), February 21 and February 28, 2026.
In March his blood looked milky, and a fasted test found triglycerides above 1,000 and pancreatic lipase of 1,039. Fenofibrate started on March 11, and triglycerides were 144 on March 31. Imaging showed bile duct widening that his team linked to pancreatitis. By June the suspected blockage had resolved. In August he was doing very well. The lower-fat diet had still not been done.
This was true of the February 21 and February 28, 2026 flares. The others began differently: in June 2025 vomiting and soft stool came first, and in January 2026 it was 24 hours without appetite.
Penicillamine caused vomiting in 2023. Atopica (cyclosporine) was stopped after a suspected reaction in October 2024, then restarted, and there has been no recurrence on the record. His team and the family thought the reaction may have been coincidence.
ALT fell from 2,431 to 424 in the 33 days after prednisone started. It first read normal (115) on December 5, 2024, after Atopica (cyclosporine) was restarted on October 29.
Timing only. The records don't show cause.
The recommendations are dated March 10, April 22, June 3 and August 25, 2026. The August report notes it had still not been done.
What one family has learned while caring for him. These are observations, not medical advice and not instructions from a veterinarian.
When a flare starts, the first thing we notice is that he doesn't want to eat. He also won't jump off the bed or go down the stairs on his own, so we carry him and set him down.
If he throws up even once and doesn't want to eat, he gets dehydrated fast. On one emergency visit he had vomited in the middle of the night, we got to the vet around 7 AM, and he was already severely dehydrated even though he had eaten and drunk normally the day before. So we act as soon as we see the first signs.
Worth asking your own vet: When should we come in? Ask his specialist for a plan for flare days.
A warm pillow or blanket around his belly seems to help him feel better during an episode. We don't know why, and it may not apply to every dog.
We keep a syringe on hand and offer small amounts of water, even if he doesn't want it. This is our own approach, not something his vet told us to do.
Worth asking your own vet: Is offering water by syringe okay, and how much? Ask your own vet.
Once he has gone a while without vomiting and has had some fluids and warmth, he usually shows interest in food within two to three hours. We start with small amounts and build back up to his normal meals over time.
Worth asking your own vet: When is it safe to restart his regular meals and medications after a flare? Ask his specialist.
On an off day with no vomiting, when his stool looks a little mucusy and he won't eat, an appetite stimulant his vet prescribed has helped bring his appetite back within a couple of hours.
Worth asking your own vet: His written list shows this medication as stopped. Is it still prescribed, and when should it be used?
Every dog and every illness is different. If your dog is vomiting, won't eat, or seems dehydrated, call your vet.
A spoken instruction that never reached the written list, a result nobody recorded, a recommendation still not done. Each one is kept visible on purpose.
Ursodiol: listed, not given
A spoken instruction never reached the written list
Specialist recheck · about 4 months from Aug 25, 2026
Fasted, so triglycerides can be read
9 records aren't on file
Including: The August 25, 2026 triglyceride result
Lower-fat diet still not made
Recommended in four reports since March 2026
His chart
ALT · since Nov 2022
In range59 U/L
Peak 2,431 in Dec 2023
Weight · since Jan 2023
+0.3 kg vs Jun10 kg
Body score 5 of 9
ALKP · since Jan 2023
In range135 U/L
A bile-duct marker. It rose in March 2026 and settled.
Steadywag