🐾 Oreo HQ v2 — vet day

Timeline

• NEW — he has not eaten today. Offer his usual food, but do not force-feed. Call the clinic now and tell them; note the last time he ate and whether today’s medicines were given. Keep the collected stool sample refrigerated.
• Later, before leaving — take the fresh rear-bump photo, check for the possible second bump, and print Room sheet — ~5 pages.
• Final door check — PACK THE STOOL FROM THE FRIDGE. The other visit items are already with him/ready.
• ~1:55 PM — into the carrier calmly (back him in rear-first if he resists), towel over the top
• ~2:10 PM — Uber. RI → LIC is 15–20 min. Keep the carrier level, belted, covered, off a hot seat.
• 2:30 PM — arrive.

After

• Open the carrier in his quiet room and let him hide. No forced handling, no bath — don't wash off the clinic smell.
• Get the written methimazole Rx → Chewy Pharmacy.
• Place the Chewy order with whatever is approved today (see 🛒 Buy).
• Log the answers here: joint-supplement pick, melatonin product + dose, murmur/echo decision, BP result, phosphorus + IRIS stage, SDMA recheck timing, the food verdict, which grooming bottles are cleared, and the recommended 24/7 ER.

1 · Loud yowling his #1 issue

• You recommended melatonin 2–6 mg at night in November — I never started it. Should I, and which product?
• The dose trap: the cat-marketed chews (NaturVet Quiet Moments, VetriScience Composure, Pet Naturals) carry a trace dose or none at all — nowhere near 2–6 mg. The only clean way I can find is a plain human capsule, xylitol-free, opened onto his food. Is that what you meant, or do you want to dispense/compound it?
• Start at 2–3 mg given his kidneys, or go straight higher? Does it need flagging against the T4 recheck or the murmur?
• Rule out the drivers: thyroid in range? BP? pain? nausea? cognitive?

2 · Arthritis / left-leg limp

• Get the Solensia caught up today?
• Daily oral between shots — not gabapentin (he seemed more restless and vocal on it before). Amantadine? Onsior, if kidneys are current?
• The limp: left leg, and the foot appears to rotate/turn as he sets weight down. Hip, stifle, hock or paw — and is imaging worth it?
• Which joint supplement do you actually recommend? I have options in the 🛒 section below — Dasuquin, Cosequin, Antinol, omega-3 alone, or Adequan. Then size, daily dose, loading phase, and whether it's safe with his CKD history + methimazole.
• Omega-3 — which product and what mg/day? You said Nordic Naturals in Feb; Welactin Feline lists 160 mg EPA / 105 mg DHA per scoop, which is easier to dose to a target. Your pick?

3 · Bloodwork & heart

• Thyroid — clean on-meds T4 recheck. The Nov 7.9 was drawn after ~5 days off meds, so it isn't a real read. Fresh written methimazole Rx for Chewy Pharmacy.
• Kidneys — recheck SDMA (was 16.1, mildly up) + creatinine. The lab advised a 2–4 week recheck in November and it was never done.
• Add serum phosphorus to the panel. It was never run, and it's the number the whole food question turns on — a low-phosphorus diet is only indicated if his phosphorus is actually climbing. What IRIS stage does today's bloodwork put him at?
• Blood pressure — check while he's in. Ties to both the thyroid and the yowling.
• Heart murmur II/VI, r/o HCM — echo and/or proBNP now, or hold?
• Urine — November UA showed occult blood, likely a cysto artifact. Worth a recheck?

4 · Constipation & food

• Miralax 1/4 tsp BID — he still strains, paces and vocalizes before going, and sometimes goes at the box edge. Fine-tune the dose?
• He's on the new low-entry KittyGoHere box now; warm water gets stirred into every pâté meal; dry is being wound down.
• Food — should he switch at all? He's on Fancy Feast Classic pâté twice a day with warm water stirred in, and he eats it reliably. Is there any reason to change that, given the hyperthyroid + CKD history and the constipation? The one number that separates the options is phosphorus — table below. Does his phosphorus / IRIS stage today justify moving him, and if so, do you want an OTC low-phosphorus senior food or a true therapeutic renal diet?
• The counter-argument, out loud: he's 20, he eats reliably, and the failure mode of a switch is that he eats less. Two of the three options below are also gravy / thin slices, not pâté — a texture change on top of a food change. Is a diet change worth that risk right now, or does it only make sense if the labs say so?
• Litter — Frisco Tofu is out of stock. Is staying on Dr. Elsey's clay fine, or is a softer litter worth chasing for his paws/kidneys?

The three you photographed at the pet store on Jul 21, laid out like the 🛒 Buy cards so it's the same easy reference. Nothing bought.

Purina Pro Plan Adult 11+ Salmon & tuna / chicken & beef. Phosphorus 1.80% DM.
Verdict: not a real change — basically what he already eats.

⭐ Royal Canin Aging 12+ Controlled phosphorus, protein held high. ~0.54% DM.
Verdict: the only one that's genuinely different — but it's gravy/slices, not pâté. This is the one to ask about.

Royal Canin Digestive Care Loaf, by the case. 1.11% DM.
Verdict: "digestive" ≠ laxative. Miralax + warm water already does that job.

Phosphorus, side by side the actual difference

Dry-matter basis, from each manufacturer's published figures. Renal diets are typically restricted to roughly 0.3–0.6% DM. Values vary by flavour and by loaf-vs-gravy format — please sanity-check these.

⚠️ Sources: manufacturer product pages and Chewy Q&A, not the cans in hand. Confirm against the label before buying.

5 · Smaller, if there's time

• Rear bump — you called it a benign sebaceous cyst from a photo in Feb. Recheck it in person.
• Flaky, dry coat + the 3 grooming bottles. All three are Dog City custom-label bottles and all three read "for dogs or cats" on the label — the actives and the published ingredient lists are below. Bringing the actual bottles.

  

  My recommendation — the 3 bottles

  1. Use the Hyliderm +PS mousse; it's the safe, easy one. Leave-on, no rinse, no bath, no salicylic acid to speak of — right for a 20-year-old arthritic cat.
  2. Get explicit permission before using the 2% salicylic-acid shampoo. That's the one with a real question attached, and it's the one that needs a full wet bath.
  3. Don't flush his ears just because you own the flush. Ask whether there's anything to treat first.
  4. Ask the doctor to name which single product to use, and how often — otherwise you'll own three bottles and no plan.
  5. Raise the omega-3 in the same breath. Flaking is often fixed from the inside; that's cheaper and gentler than bathing him.

  Why — the reasoning, kept in full: the species worry is off the table — all three bottles read "for dogs or cats" on the label, and they're Dog City custom-label versions of standard veterinary dermatology formulas (Hyliderm +PS is an FDA-listed product; the anti-dandruff shampoo matches the VetraSeb CeraDerm Sicca SA formula family). The residual concern is salicylate sensitivity: cats are meaningfully more sensitive to salicylates than dogs, and anything left on a cat's coat gets ingested during grooming. Against that, VCA lists topical salicylic acid as an accepted treatment for seborrheic disorders in cats, and identifies coal-tar combination products as the formulation cats must not receive — none of these three contains coal tar, which removes the single clearest contraindication. So 2% is plausibly fine and is sold for cats; it is still worth one direct sentence of confirmation rather than an assumption. Separately, the flaking itself is a finding, not just a cosmetic issue — a flaky coat was recorded at the November exam alongside the muscle wasting, and in a senior cat it commonly reflects hyperthyroidism, kidney disease, or simply that he has stopped grooming himself well because it hurts to twist. Treating the surface while ignoring that would be the wrong move, which is why the "is this dry skin or a symptom" question is on the list. The concentrations above are read off the bottles in the photo; the ingredient lists are from published labels for the matching formulas, not from these exact bottles — which is the whole reason to physically bring them.

  Bottle	Active	What it actually is	Published label
  Oti-Soothe Advanced Cleanser 8 fl oz	Salicylic acid 0.15% + ceramides 1/3/9, avenanthramides	An ear flush, not a shampoo. Cleans/dries/deodorises the canal.	drugs.com label
  Anti-Dandruff Shampoo 16 fl oz	Salicylic acid 2%	A wet bath shampoo for seborrhea sicca — needs a full bath and rinse. Same formula family as VetraSeb CeraDerm Sicca SA (2% SA, ceramides, oat, aloe, cucumber-melon).	drugs.com label · equivalent
  Hyliderm +PS Mousse 6.8 fl oz	Phytosphingosine salicyloyl 0.05%	Leave-on, no rinse — the only one of the three that doesn't need a bath. Water, polysorbate 80, glycerine, PEG-8 dimethicone, hydrolyzed oat protein, sodium lactate, linseed oil, palm oil aminopropanediol esters, safflower oil, squalane, fragrance, aloe, methylisothiazolinone.	DailyMed (FDA)

  Ask:

  • Is 2% salicylic acid OK on a cat who grooms himself? VCA lists salicylic acid topical as used for seborrhea in cats, and flags coal-tar combinations as the thing cats must not get — none of these three contains coal tar. But cats are more salicylate-sensitive than dogs. Do you want him on the 2% shampoo, or just the leave-on mousse?
  • Is a full wet bath even a good idea for a 20-year-old arthritic cat — or does the flaking get handled by the omega-3 from the inside and the mousse on top?
  • Should I be flushing his ears at all? Nothing is wrong with them that I can see. Is the ear cleanser a solution looking for a problem?
  • Is the flaking just dry skin, or a sign of something — thyroid, kidneys, or that he's stopped grooming himself well?
  • Any of these three you'd tell me not to use on him?
• Occasional hairballs — Laxatone worth it?
• Dental advice short of anesthesia. I own no toothbrush or toothpaste — what should I buy?
• Catnip — safe alongside methimazole?
• Toys: he plays with string almost exclusively and Dr. Gerber flagged string/cord as a linear-foreign-body risk. Is a Cat Dancer (springy wire, cardboard tip, no cord at all) the right swap? He's deaf, so bells and crinkle do nothing — motion and scent are what reach him.
• Cat grass — safe in a dementia cat, given the foreign-body warning? Which setup?
• The leftover unmarked Costco BBQ wood pellet bag — any chance that's safe as litter, or a hard no? (My assumption: hard no — unknown wood, possible softwood phenols, flavor oils, mold in an old bag, and hard on arthritic paws.)
• Which 24/7 emergency hospital do you recommend? We're on Roosevelt Island; LIC is easiest, UES fine.

The bed — which of the 3 you're comparing? your call, no vet needed

⭐ Frisco Quilted Orthopedic Pillow — the pick Flat memory-foam mattress, washable cover, no walls. Matches how he lies. Buy Small.
Chewy 258679

Bedsure Orthopedic Bolster Sofa Ortho foam base — but bolstered (raised sides). Good bed, wrong shape for a cat who avoids walls.
Chewy 1621382 · skip

Frisco Self-Warming Bolster, Round "Self-warming" = passive mylar reflector, no plug. Also bolstered. Same shape problem.
Chewy 192021 · skip

FurHaven Classic Cushion — Amazon backup Flat tufted foam, same logic as the Frisco pick. Only if Amazon is easier. Change size to Small.
Amazon

Also waiting on the visit hold

Melatonin 3 mg, plain capsule Xylitol-free human capsule, opened onto food — the only clean way to reach the 2–6 mg recommended in November. Confirm the product and dose first.
Amazon · not sold on Chewy

Raised tilted bowl He slips on the tile while eating. Ceramic, 15° tilt, ~4″ high. Not the Frisco Triangle Diner in your tab — that's a single 6-cup dog-sized bowl.
Necoichi

Cat grass — the 2 you're weighing ① Self-watering, soil-free, anti-mold lid — Amazon.
② Grow-it-yourself kit w/ 3 containers + seed + soil — Amazon.
① is less mess and no soil to dig; ② is cheaper long-term but real dirt. Ask first either way — Dr. Gerber warned about plant matter + obstruction.

ökocat Super Soft Only if a softer litter is worth chasing. Frisco Tofu is out of stock; Chewy carries this. Clay is fine — no urgency.
Chewy · Amazon

1. One or two clearest limp clips showing the left leg turning as he bears weight — ideally one side view and one walking away. Skip the general resting clips.
2. Fresh rear-bump photo plus a separate photo if you find the possible second bump.
3. This v2 page for the feeding, bed, litter and tub-step photos; no need to curate those separately in Photos.

The older album “Oreo — vet video review” remains below as backup. The Jun 12 walking-across-rug clip is the best older gait candidate.

Problem list Court Square, 11/3/2025

• Hyperthyroidism — on methimazole
• History of CKD
• Heart murmur grade II/VI — r/o HCM (echo/proBNP still undecided)
• Suspected OA — stiffness, crouched gait, muscle wasting; managed on occasional Solensia
• Deaf
• Dental disease — mild gingivitis, worn canines, score 1–2/4

Doses on file

Bloodwork, 11/3/2025

• T4 7.9 HIGH — but drawn ~5 days off meds, so not a clean read. Free T4 >100.
• SDMA 16.1, mildly up — lab advised rechecking SDMA + creatinine in 2–4 weeks. Never done.
• BUN 26 / creatinine 1.2 — normal. Glucose 101 — normal, no diabetes.
• UA via cysto: occult blood 3+, RBC 11–20 — likely a collection artifact. Low platelets = clumping artifact.
• Exam: BCS 4/9, grade II/VI systolic murmur, hind-limb stiffness, crouched gait, muscle wasting, flaky coat.

Where the phosphorus figures came from

• Royal Canin Aging 12+ — RC's own product page states the formula has controlled phosphorus; published figures ≈ 0.10% as fed / 0.54% dry matter (Ca ≈ 0.74% DM). Guaranteed analysis: protein 9.0% min, fat 2.5% min, fibre 1.8% max, moisture 82% max → ≈ 50% protein on a dry-matter basis. royalcanin.com
• Royal Canin Digestive Care loaf — 0.19% as fed / 1.11% DM (3 oz can); 0.21% / 1.19% DM for the 5.1 oz. GA: protein 7.2% min, fat 1.6% min, fibre 2.5% max, moisture 82.5% max. Chewy Q&A
• Purina Pro Plan Adult 11+ classic — 0.42% as fed / 1.80% DM (Ca 2.31% DM). Chewy Q&A · Purina spec sheet
• Fancy Feast Classic pâté — varies by flavour: Chicken Feast 2.00% DM, Tender Beef 1.87% DM, Chicken & Liver 2.16% DM; protein ≈ 45–50% DM. FDMB nutrient table · Cat Food Advisor
• Therapeutic renal diets — restricted to roughly 0.3–0.5% DM phosphorus, e.g. RC Renal Support, Hill's k/d, Purina NF.

⚠️ All of the above are manufacturer pages and retailer Q&A, not the cans in hand. Phosphorus is not on the guaranteed-analysis panel by law, so these come from company-published figures and vary by flavour and by loaf-vs-gravy format. Verify against the actual label before buying anything.

Where the grooming-bottle figures came from

• Actives and "for dogs or cats" — read directly off the three bottles in the photo (SA 0.15% · SA 2% · phytosphingosine salicyloyl 0.05%).
• Hyliderm +PS Mousse — full FDA-listed label, active + complete inactive ingredient list, "for use on dogs and cats only", leave-on directions. DailyMed
• Oti-Soothe Advanced Cleanser — salicylic acid 0.15% plus ceramides 1/3/9 and avenanthramides; an ear-canal cleanser for dogs or cats. drugs.com veterinary label
• Anti-Dandruff Shampoo, SA 2% — matching formula family (2% salicylic acid, ceramides, oat kernel extract, safflower seed oil, aloe, cucumber-melon fragrance). drugs.com label · VetraSeb CeraDerm Sicca SA
• Salicylic acid in cats — VCA lists topical salicylic acid as used for seborrheic disorders in cats, and flags coal-tar combination products as the ones cats must not receive. Cats are more salicylate-sensitive than dogs generally. VCA

Photo audit — what's actually in the camera roll

• Swept every photo Jul 15–22 (200 images). No Fancy Feast photo exists — the "Premium ___" can that was on the old bring-list was never photographed. It's been removed from this page; the Fancy Feast is simply the baseline he's already on.
• What was actually shot on Jul 21, ~9:25 PM at the pet store: Purina Pro Plan Adult 11+ (salmon & tuna, chicken & beef) and Royal Canin Aging 12+ / Digestive Care — the three photos in section 4.
• Jul 21, 1:33 PM: the three grooming bottles — now in section 5 with the labels transcribed.
• If the Fancy Feast can is only on the phone, AirDrop it and it goes on the page.

Pre-print check run 2026-07-22

• No gendered pronouns left on the page — rewritten neutral/second-person throughout ("the doctor", "you").
• All 8 referenced images resolve; all 7 nav anchors match a real section; HTML tags balanced.
• Photos use object-fit:contain everywhere, so nothing is cropped.
• Print CSS: header prints black-on-white (no ink-heavy bar), nav hidden, links print as plain black, photo grids drop to two columns, and cards, table rows and list items are all set not to split across pages.
• The old oreo-vet-visit-guide.html still had a live "Print Doctor Sheet" button on outdated content — disarmed, and it now points here. Print from this page only.
• Do this once: print to PDF and eyeball the page breaks before printing for real.