Milk's buddy is gone....

Scruffy left us on Monday, March 5, 2012.  Milk is plainly aware that he's gone, and seems kind of restless.  He has been spending a lot of time in the new heated cat bed I bought a couple of weeks ago, and on the kitty pi in the living room where he and Puffy would spend hours all curled up together.  We're all mourning.

Missed the anniversary!

October 1 - three years since Milk's last seizure!  Certainly well worth celebrating, huh?

Nothing much else new with him.  He's a little less adept at jumping up  on things than he was; I still can't decide if it's a perception thing, or if there's something mechanical/physical going on.  Sometimes he'll miss the jump twice, and the third time, hop right up there.  He does some odd stuff, too, like very obsessive tail-chasing/biting (when he's laying down only).  I've been feeding him separately from everyone else, in the living room where I can watch him eat and make sure no one eats his food until he's done with it.  He gets a handful of kitten chow with the canned food, and eats fairly enthusiastically.  He has developed the unfortunate (when there are 10 other cats eager to eat that dry food!) habit of eating for a couple minutes and then wandering away.  If I weren't sitting by his dish with my trusty squirt bottle, there wouldn't be anything left when he came back....

My sweet boy just came to sit on the keyboard and accept any and all tributes to his wonderfulness.  Happy anniversary, Milk, and may there be many, many more!

I have another theory......

I always have theories, I just never have any way to prove or disprove them......

Anyway, I have been concerned about Milk's weight loss for some months now.  Although I had planned to have his phenobarb levels checked back in June or July, other things happened, and we didn't get to the vet for the bloodwork until August 2.  (My birthday!  Some gift to myself.)  I have been having his blood sent to Auburn University for phenobarb and Keppra/levetiracetam level testing for two years or so.  My impression was that Auburn, which is apparently the only place doing Keppra testing for animals, was using their results to establish the norms for cats, who currently receive bloodwork results with the reference ranges for humans attached.  However, because there still don't appear to be any feline norms, I just thought this time I'd only have the phenobarb level done by Antech and have the vet run a "vetscan" on his in-office machine.  I have been wondering about Milk's liver functions for some time because of the phenobarb, and it's been a while since they were checked.  That said, I don't really know how accurate the vet's machine is....

The background of this concern is, Milk has continued to lose weight.   His appetite is variable; sometimes, particularly if there are Temptations or dry food involved, he's VERY enthusiastic.  Other times, I put down his dish and he just wanders away, without even sniffing it.  He's not assertive, and occasionally, one of the others decides to share his food, and he will generally just leave and find another dish.   In addition, he has had a paradoxical reaction to phenobarbital since he started on it - anorexia.  (Lots of stuff about this in the posts here from 2007.)

Hence, my current theory:
What's going on here is a "vicious circle".  The phenobarbital decreases his appetite, which causes weight loss, which increases the effect of the amount of phenobarb circulating in his blood, which further affects his appetite and his weight. There's a formula for determining the presumptive correct dosage of phenobarbital -   2 - 4 mg/kg.  So, by that formula, Milk's appropriate minimal dosage going by his current weight  (a puny 8 pounds, 8 ounces this morning) would be  7.7mg BID .  Which is pretty much exactly what he gets - about a half tablet twice a day.

The bloodwork done on August 2, 2011, had the following results:

phenobarbital level      29.3      (reference range:   15.0-45.0)

ALB              4.2            (reference range:     2.2-4.4)  
ALP              29              (reference range:     10-90)
ALT              234  *       (reference range:     20-100)
AMY            903            (reference range:     300-1100)
TBIL            0.3              (reference range:     0.1-0.6)
BUN            23               (reference range:     10-30)
CA++          9.3              (reference range:      8.0-11.8)
PHOS          3.1  *         (reference range:      3.4-8.5)
CRE            1.3              (reference range:      0.3-2.1)
GLU            92               (reference range:      70-150)
NA+           146              (reference range:      142-164)
K+              4.2               (reference range:       3.7-5.8)
TP              6.7               (reference range:       5.4-8.2)
GLOB        2.4               (reference range:       1.5-5.7)

QC       OK
HEM    0         LIP    0        ICT   0

I wish that the vet's machine had produced an AST level as well.  That said, I'm not all that worried about the ALT's elevation.  That value has been elevated since the beginning of phenobarbital administration; it's not horribly high, and bile acids testing, which is, I believe, actually of more value in determining the liver status, has always been in a normal range.  I have been giving Milk 1/2 a tablet of Marin (milk thistle) every day for more than a year.  After this bloodwork, I increased it to a whole tablet; we'll see if that makes any difference.  At this point, there is nothing more to be done about the ALT - I'm not willing to make any changes in his phenobarbital dosage, barring major worsening of liver functioning.  Most attempts to reduce phenobarbital dosages based on the experience of the Yahoo EpiKitty Board seem to result in the re-emergence of seizures that are even worse than they were before being controlled.  And we don't want THAT.

The next question - is there a significance to the low phosphorus value?  I have no idea.  The vet didn't mention it when he called to report the results.  I googled, and came up with lots of references to feline renal failure with HIGH phosphorus levels, but LOW - well, I saw IBD mentioned, with intestinal symptoms that Milk doesn't have, and lymphoma.  Which made me gulp.  I need to find out more about the phosphorus stuff, obviously.

In an effort to put a little weight back on my sweet Milkshake, I bought a ton of jars of baby food meat.  (Boy, that stuff is expensive!)  It's not a whole lot of calories added to give him a jar per day, but I think every little bit helps.  Hopefully.  And I'm adding a little bit  -  a tiny, guilt-producing, fear-inducing amount  -  of dry food to his canned stuff.  He eats the dry more enthusiastically, and  nuzzling around in the dish of canned stuff looking for it seems to keep him eating a little longer.

Feeling vaguely uncomfortable

I have been trying to convince myself that there's nothing going on with Milk.  Unfortunately, I'm just not sure that's true.  I weighed him this morning- you wouldn't think that just a few ounces (4!) would make a difference in his appearance, but he feels significantly more bony these days.  And his ability to jump - already severely not-what-it-used-to-be -seems to have diminished.  I can't decide if the problem is that his judgment of how high he needs to jump has become more impaired, or if he has some sort of rear leg weakness going on, or what.  It will frequently take two or three tries to get up on the kitchen counter to get his pills.  He always seems "surprised" when he falls, but gets back up and tries again.

He's scheduled for more bloodwork next week to check his medication levels.  I want to be sure THIS time to have the vet do his in-office blood analysis just to check the liver functions.   It's so traumatic to take him to the vet;  I don't know if it's worth doing another bile acids test or not.

Milk and his friends

My little Milkshake is sort of the Venus FlyTrap of cats - he just sits around, waiting until he sees one of the others getting ready for a nap, and KABOOM - he's there in a flash.

 

Milk and Busy

 

Milk and Burble

 

Milk and Baby Squits

 

Milk and Scruffy

 

Milk and Punkin Duncan

 Milk and OneBun

Milk and Cinnaminnie

Milk and Pipper 

No News is GOOD news!

Nothing much new to report, and truthfully, that's such a relief!  Milk continues to  - KNOCK WOOD - be controlled on (approximately - the vagaries of chopping up pills make it somewhat uncertain) 8mg of phenobarb and 125mg of levetiracetam (generic Keppra)  BID.   His weight continues to be under 9 pounds, which doesn't make me happy, but he's an eager and willing eater these days.  I have noticed recently that he's not jumping very well - it frequently takes two tries for him to get to the counter for his pills, or to jump onto the bathroom sink.  He has been wobbly ever since he started on phenobarbital, so I assume that's just his natural state now, sadly.   


We have quite a few younger cats now (the Big Kittens and the Little Kittens - all under two and quite obnoxious).  Milk hasn't developed a relationship with any of them, although he will occasionally curl up with Stinky, the most feral of the kittens.  His primary attachment is to me, and then to Scruffy.  He loooooves his Scruffy!  He will drape himself over The Puffer at every opportunity.  It always makes me laugh, and feel glad that Milk has his kitty friend.  In a lot of ways, he reminds me of the elementary school age kid who doesn't quite fit in - he tends to stand around and watch while the kittens are thumping and bashing around, as though he'd like to join in.  He probably knows that he wouldn't be able to keep up with them, I suppose.  He stands safely on the sidelines, which is a good thing.

I keep thinking that I should take a video of Milk getting his pills.  This little cat, who made me cry out of frustration about not being able to give him his medication a couple years ago, is way beyond cooperative.  All it took was the generous offer of Temptations treats and a little Pill Pocket.  Now, I call him and shake the Temptations box, and before I know it, there he is, sitting in front of me, just waiting for me to poke the pills down his throat and give him his water before and after.  

I'm still surprised when I realize how long it's been since Milkshake had a seizure, and how fortunate his control has been.  I would like to credit the Yahoo EpiKitty group  (http://pets.groups.yahoo.com/group/epi-felines/) for their support and friendship, if I haven't already.  It was really helpful to find that there were other people struggling with the nightmare of being awakened in the middle of the night by a beloved cat having a seizure. 

We celebrated the five year anniversary of Milkshake's adoption a couple weeks ago.  Five years of my sweet white kitty's presence and all the pleasure he has given me.  It was a lucky day that I stopped to look at that kitten in PetSmart, for both of us.

A milestone!

 

Yesterday marked a special day for Milkshake - it was his second anniversary of being seizure-free!  It brought back all sorts of memories of the nightmarish year of his suffering seizure after seizure - the frightening awakenings in the early hours of the morning, the horrifying noises, the violence of the muscular contractions, the vulnerability of this little cat to whatever was so horribly wrong in his brain.   It makes my stomach clench just thinking about it.  I was so superstitious about seizures returning that I could hardly bring myself to even mention how long it had been.  I remain nervous about it - the latest dose reduction of Keppra, while involuntary and seemingly effective - is still traumatic.  It's been two years and I still wake up in the middle of the night thinking that I'm hearing Milk seizing.    But, fingers crossed, he will continue as he has been for the rest of his hopefully very lengthy life.


Milk just turned 5 around August, I calculate.  His first year included serious malnutrition and life-threatening neglect of his health.  He was kept briefly in a shelter, and then in a cage at PetSmart, where I found him, sad and sick and frightened and yellow with urine stains.  It took months for him to reach a normal weight, to overcome the respiratory and eye infections he had.  But from the time I brought him home, he showed no sign of bad effects of the horrors he'd experienced as a tiny starving kitten.  He was so affectionate and so eager to snuggle up to me and the other cats.   And of all the cats we've had/have, I don't believe that there is one who would have tolerated being "pilled" four times a day as well as Milk has.  (To the manufacturers of Temptations and Pill Pockets - you have my eternal gratitude!)  At pill time, he hops up on the counter, I hold open his mouth, give him a squirt of water from his kitten bottle, pop in his pills, and give another squirt of water .  No fussing, no fiddling - he's totally focused on the box of Temptations that's sitting beside him.....


I feel very fortunate to have found my Milkshake.  I have had cats for years, most of whom I loved and enjoyed.   (Tootie and Cinnaminnie, cover your ears!)    But there is something special about Milk that reaches some deep part of my cat-loving heart.  I hold him there with pleasure and gratitude and joy that I have been given the privilege of caring for him and loving him.  My sweet white kitty.......

There are recommendations, after all......

This email just arrived:

******************************************************************

Auburn University
College of Veterinary Medicine
Clinical Pharmacology Laboratory

Updated results for Accession 2010-46053

Accession Informtion
Accession Number:   2010-46053
Internal ID Number:

Veterinarian:       Dr. Donald G

Date Received:      8/26/2010
Date Updated:       8/31/2010 3:21:22 PM
Animal Name:        Milkshake
Owner Name:        Species:            Feline

Results
Test: Feline Phenobarbital,  (mcg/ml)
Result: 26.1
Normals: 15 - 45
Last Updated: 8/27/2010

Recomendations
The concentration of phenobarbital is in the mid therapeutic range (15 to 40-45 mcg/ml) most commonly associated with seizure control in dogs or cats.

The current concentration is about 25% less  compared to the last recheck.

If all is well, maintain the current dose and current drug concentrations.  Re-check at 6 to 12  month intervals, or in the event of therapeutic failure.

Thank you for your continued support of our laboratory. It is much appreciated.  August 30, 2010 DMB

 
Test: Feline Keppra,  (mcg/ml)
Result: 32.5
Normals: 5.5 - 21
Last Updated: 8/26/2010

Recomendations
The mid interval concentration of levetiracetam is in high to above the high therapeutic range most commonly associated with seizure control in humans (5.5 to 21 mcg/ml). The relevance of these concentrations to canine or feline epileptics has yet to be  confirmed.

The half-life of levetiracetam is short (1 to 8 hr) and may drop  > 75% during an 8 or 12 hr dosing interval. Consider collecting both a peak and trough such that a half-life can be used to predict the lowest concentrations that occur during an interval.

Accordingly, althouth the current concentration is approxiamtley 40% lower compared to the last recheck, these comparisons can not be made unless the previous sample also was collected at 4 hrs.  If only one sample can be collected, then consider collecting a true trough (just before the next dose) such that the lowest concentration to
which the patient is exposed during a dosing interval can be verified.


If all is well, maintain the current dose and current drug concentrations.   Re-check at 6 to 12  month intervals, or in the event of therapeutic failure.

Thank you for your continued support of our laboratory. It is much appreciated.  August 30, 2010 DMB

Additional Recomendations: Multi-Test Discount
UPS 1z5vx3572310064219
 
Comments:                  4hrs post.  Seizure free since 10/1/08.

Levetiracetam dosage (125mg) reduced to BID (from TID) on July 1, 2010. Current dosage 125mg (approx) at 10AM and 10PM. Phenobarbital given at the same time, approx. 8mg BID. Continuing weight loss despite very healthy appetite. Appears to have some balance/strength issues. No other drugs.  Controlled.

 ******************************************************

I'm quite happy with the phenobarb levels.   Dr. G, has felt for some time that I should be aiming for reduction of the amount of phenobarbital, rather than trying to lower the Keppra/levetiracetam dosage, but I'm really hesitant to even consider that, because it's my admittedly unscientific feeling that the phenobarb is what's working at this point.  I don't actually understand the recommendation about the Keppra and trough levels, even though I've reread it six times.  What difference would it make to know the lowest amount of levetiracetam available over the 12 hour period?  I must be missing something here.  Maybe they mean that knowing the lowest amount available/functional would indicate if further reduction might be possible?  I have no idea.

At any rate, I am (with fingers crossed!) feeling pleased that  #1 - most of all! - there have not been any seizures for 700 days!, and #2 - the dosages have been significantly reduced and still appear to be working effectively.  I don't know, at this point, what more I could ask.  Well, except for maybe Milk could gain a couple of pounds, and Busy could stop chewing on his neck,  and he could be just a smidge less wobbly......

Finally!

At last, I managed to get Milk's blood sent to Auburn.  (I took both Milkshake and Scruffy to the vet for the same appointment and purpose.  Scruffy started spitting and hissing before we even started to drag him out of his carrier, where as my sweet little Milkshake, practically catatonic from the trip in the car, the traffic noises, and strangers trying to handle him, laid down on a towel fragment  - I forgot the kitty pi this trip - and just shivered uncontrollably non-stop.  Like two different species, they were!)

My intention was to have blood drawn also for the vet to use his own machine for analysis - I wanted to see what the liver values looked like, because I've been giving Milk Denosyl on a mostly regular basis for weeks now.  Unfortunately, I forgot to ask, and it's such an ordeal getting blood out of him, even from the vein in his neck whose name I can't recall right now.  Tiny little veins in his wispy body......

Anyway, here are the results from Auburn:

Date Updated:       8/27/2010
Animal Name:        Milkshake
Owner Name:         Guckert
Species:            Feline

Results
Test: Feline Phenobarbital,  (mcg/ml)
Result: 26.1
Normals: 15 - 45
Last Updated: 8/27/2010

Test: Feline Keppra,  (mcg/ml)
Result: 32.5
Normals: 5.5 - 21
Last Updated: 8/26/2010

Phenobarb level is good!  Keppra level, well, considering that the Keppra dosage has been reduced by 1/3 (125mg),  I'm not particularly unhappy with that either.   Given that the Keppra  standards are based on human data, I'm not going to worry about it.


One of the options on the Auburn analysis application is "Do you want suggestions/recommendations?"  I checked that, hoping that maybe there would be some interesting suggestions.  (Aside from something like, "Wow, that's a lot of Keppra!")   What I got was just an email report of the results.  Maybe Dr. G. will get something more detailed because he's a professional?  I hope, I hope.

And next, to see what the bill turns out to be....... 

Finally dropped that 6PM dose of Keppra.....

Not intentionally - I probably never would have screwed up the courage to do it unless forced to by a crisis.  Which was, unfortunately, exactly what happened:  my mother had a heart attack on June 27.  With the ensuing hospitalization and the irregular hours I was spending at home, there was no way to get that 6:00 levetiracetam into Milk.  Actually, for more than six weeks, there has only rarely - almost never, actually -  been a 10:00 PM dose of phenobarb, either.   Without alternatives, I settled for twice a day dosing, whenever those two times might occur.  So, we're now down to somewhere between 9:00 and 10:00 AM for the first two pills, and somewhere between 10:00 and 11:00 PM for the second two.  It seems to be working.  Fingers crossed. Because the keppra generic is a large chunk of pill, I appear to have stopped giving him the liver-protective Denosyl that I do think can be a benefit to him.  Seeing if using it had reduced his ALT/AST levels, which have been elevated since he started on phenobarbital was one of my goals in doing the bloodwork.  Didn't happen........                           

I had arranged to bring Milk to the vet for blood-taking to send to Auburn to check his phenobarb and keppra levels.  The University has some sort of new arrangement that requires that the vet's office have  special address labels or something; at any rate, by the time the stickers had arrived at Dr. G's office, I was into spending all my time at the hospital, and the bloodwork never got done.  Hopefully, within the next week or two, I will be able to get Milk there and get the stuff done. 

He has seemed wobblier in recent months.  I have seen him attempt to jump up on the bathroom sink or the kitchen counter and fall at least once a week. (Did he misjudge the distance?  Was he too weak?)   He seems scrawnier than ever, although I weighed him tonight and he was 8 pounds, 13 ounces - not a wonderful weight for a cat as tall and long as he is, but not as awful as it might have been.  His appetite is very sturdy.   He has also - to my sincere distress - been doing a good bit of aggressive chasing of OneBun and even mimicking Busy's gnawing on his neck.    (Despite the addition of  prozac to Busy's daily routine, Milk turned up with a new dime-sized scab on his neck last week.)

Anyway, as far as I can tell, there is no indication that any seizures have occurred even with the reduced dose of levitiracetam (generic keppra).  He still sleeps every night draped over my ankle, and he tends to be the one who wakes me in the morning, standing on my chest.  It is such a relief and pleasure to realize that we're coming up on two years since his last seizure (on October 1.)

Going well.

Decreasing the phenobarb was apparently successful - now, if only I had the courage to drop one of the Keppra doses. But, I don't.

A scary experiment

Where has the time gone? I was shocked to see that I haven't posted about Milkle since Halloween......

Milkshake has continued to lose weight, although his appetite is excellent and enthusiastic. (Weight records are in the sidebar to the right.) On 12/15/09, I took him to Dr. G because Busy had gnawed another large area on Milk's shoulder. It was big, and deep, and I was worried about infection. At that point, he weighed 8 pounds, 11.5 ounces on the vet's scale. We discussed having the blood testing for phenobarb and keppra done then, but I wanted to send them to Auburn, which meant that the sample had to be taken at the beginning of a week. So, I put it off, and the vet gave me a tube of something or another to put on the wound. (It looks like it was something called Animax or AnimX ointment.) Anyway, the bitten area healed just as the others have, without further fiddling around.

On 12/21/09, I took Milk back to the vet. He hadn't eaten on his own for several days. His weight was down to 8 pounds, 9.5 ounces at the vet. He just literally got up one morning and refused to eat anything. I started bottlefeeding him - first Fancy Feast, and then I bought baby food meat and EVO canned. There didn't seem to be anything specific going on. It was my distinct impression, though, that he was in pain. He was spending ALL of his time in the meatloaf position, with his head hanging off the window ledge in front of him. Very abnormal behavior. We decided to do bloodwork - regular stuff on the vet's machine for immediate results, and to send away a sample for an fPLI test. Here are the results of the vet's testing:

ALB - 4.1 (2.2 -4.4)
ALP - 30 (10-90)
ALT - 202 (20-100)
AMY - 920 (300-1100)
TBIL - 0.3 (0.1-0.6)
BUN - 21 (10-30)
CA++ - 9.7 (8.0-11.8)
PHOS - 3.4 (3.4-8.5)
CRE - 1.5 (0.3-2.1
GLU - 91 (70-150)
NA+ - 151 (142-164)
K+ - 4.6 (3.7-5.8)
TP - 6.5 (5.4-8.2)
GLOB - 2.4 (1.5-5.7)

QC - OK
HEM - 0
LIP - 0
ICT - 0

As usual, the ALT was quite elevated, although not as high as it has been in the past. The assumption is, these results are because of the phenobarb's affect on his liver. (I had previously been giving him Marin, but somewhere along the way, stopped.) While I would sincerely like to try stopping the 6:00 PM Keppra dosage, Dr. G. thinks that lowering the phenobarb is the way to go. I have mixed feelings, because I am afraid that, while Keppra has clearly contributed something to his lengthy period of being seizure-free, I think it's the phenobarbital that has been the most effective agent.

Dr. G. gave me a prescription for buprenex. Since he didn't have it in his office, his technician made a huge effort, and located another vet office that would fill the prescription. (Drugstores don't carry it, and none of the ones I talked to were interested in ordering it for me.) It seemed to make an immediate improvement. He had three doses, and while he still wasn't eating, the meatloafing was sharply decreased. The fPLI results were returned on 12/30/09 - 1.3 (range .1-3.5) So, whatever was going on with Milk, it was apparently not pancreatitis. He began to eat normally again, on his own, on 12/28/09.

To get back to the "experiment" - on 1/6/09, I dropped the additional 1/2 tablet of phenobarb that Milk had been getting at night for quite a while. (Uneven dosing has not been recommended, but it seemed to be working.....) And so far, so good. I've added Marin back into his daily pill routine, also. As there seems (**antijinx**) to have been no seizure activity after the dosage cutback, I'm going to wait a while to have more bloodwork done - going to the vet is such a traumatic event for Milk that I don't seen any point in doing it again so soon. Just keeping the fingers crossed.

On the home front, one of MommyKitty's kittens, OneBun, was "adopted" back from Animal Friends a week ago, and Milk's not a happy camper. I can't figure out why - he wasn't bothered by the kittens before, although he had never made the attempts to snuggle with any of them the way he does with the big cats. And he doesn't seem to be reacting particularly negatively with Pipper or Stinky, the other two kittens. Maybe it's the Animal Friends/PetSmart/Whatever smells that poor Oney had when he came home or something. At any rate, they still have not managed to resolve their relationship.

Halloween!

It's Halloween! And, once again, my sweet Milk is a most cooperative feline model.

Things are still going along quite well for him, thank goodness. We've got another seizure-free month under our belts. (Well, since neither of us wears a belt, that's not a particularly apt image, but, you know...)

Although he's eating enthusiastically, his weight is still a minor concern. He's a very long, tall cat - particularly considering the early malnutrition - and when he weighed 12 pounds, he was a perfect size. None of this you-can-feel-every-one-of-his-ribs-and-veterbrae then. But that seems to be the only worry for right now. He does need to have both his phenobarb and keppra levels tested again, but I am feeling (surprisingly!) confident that he will be in a good range on both. Hopefully. Well, maybe "confident" is slightly overstating my attitude. "Confident" is not generally in my range of emotions. But maybe, just maybe, his keppra level won't be in the 50's and his phenobarb level won't be in the 30's. Oh, I hope......

One more picture. I just love the way he looks like he's laughing and winking in this one - it's rapidly becoming one of my all-time favorites. There are no words to describe how much I love this skinny little happycat.




Hi, Marianne!

MAJOR MILESTONE!

Just slide your eyes to the right, and notice that the yellow box says, "365 days since Milkshake's Last Seizure" on his little calendar doohickey! ONE YEAR! Amazing and wonderful and shocking and stunning and just plain lucky!

We've had our ups and downs with this disorder. Phenobarb levels that were scarily high, a year-long battle with phenobarb-induced anorexia, continued seizures that seemed to be getting increasingly violent....... The addition of Keppra wasn't an instant solution, but seems to have made a very significant contribution to getting to this point. When I felt that the phenobarb dosage HAD to be reduced because of the anorexia and the rising liver values, it appeared that increasing the Keppra was the only alternative. The neurologist I consulted when the IM doctor here refused to consider increasing Milk's dosage said to give him "what it took", because Keppra and its functioning in epileptic cats were basically still pretty much a mystery. And we got up to fairly scary amounts of Keppra - every time I brought Milk in for bloodwork, a technician at my regular vet's reminded me that he was taking more Keppra than she did! Back in February of 2009, the last bloodwork indicated that his Keppra level was almost 53; despite the fact that there are actually no standards for cats on this drug, the high end of the human range is significantly lower than 53. It made me nervous. So, I started lowering the Keppra dosage. (I had been dosing him by using the "chunk method" - we had 500 mg pills, chopped in quarters for the basic 125mg dosage, plus a "chunk" of a quarter pill chopped in half. Very inaccurate method of selecting a dosage, but the best I could do without grinding and measuring and whatever else would have been involved in trying to be precise and exact with this medication.) Within a matter of weeks, all of the "chunks" were history. And then we changed from the Canadian generic Keppra to the American one, which was significantly smaller; I don't know if that meant that there were fewer fillers or what, but he's definitly getting less of whatever is in them than he was. And so far - knock on wood and do whatever else might protect my little white kitty and keep him seizure free - it's all working.

None of this has been simple. For the last year and a half, my life has revolved around Milk's medications - first twice a day, and then, for more than a year, four times a day. (I would desperately like to try eliminating that 6:00 PM Keppra, but I'm too afraid to make any more changes at this point.) We went through a horrible period where I would spend HOURS every day, attempting to capture Milk in order to pill him. The solution turned out to be simple - bribery. He discovered that he really really liked Temptations treats, and suddenly, with that amazing internal clock that cats have, he was around when it was pill time. No more tears of frustration (mine, not his!), no more multiple trips up and down the steps, no more trying to sneak up on him from behind. It was wonderful. We're not so good about sticking precisely to the schedule - sometimes his pill - that stupid 6:00 one! - is a couple hours late. But, so far, so good.

I will never be happy about the effect of phenobarbital on my cat. He is still wobbly and uncoordinated. If he's walking along and he decides to shake his head, he has to quickly get into a wide stance to keep from falling over. He falls fairly frequently because his body doesn't go where he thinks it's going to go. He is normally alert now, and doesn't sleep more than any other cat, but physically, I see the action of the phenobarb in everything he does. Would I sacrifice the absence of seizures if it meant that he could have normally graceful cat movements? Nope. He has other quirks - he eats huge chunks of the other cats' fur when he can find them like it's a delicacy; he's a gnawer - the corner of my desk drawer and the crank for the window have his teeth marks all over them. He loves toast crust. And he loves snuggling with Busy and Scruffy and Burble. (NOT Minnie and Tootie - he's terrified of both of them!)

I have a terror that I'm going to jinx things by talking about it, but I'm so thrilled and happy and yes, blessed, that Milkshake has been spared the horrors of those seizures that I guess I am willing to take the risk. He is my treasure, one of only three very special cats who went straight to my heart from the very first minute I saw him. Taking care of him has been scary and has demanded a lot of rearranging of plans and "life", but I would do it all again a hundred times. He was truly a gift to me, and I am so grateful to have him.

I knew it.

Brought the baby scale back home yesterday, and weighed Milkshake the minute I set the scale down. Eight pounds, ten ounces. Close to half a pound less than in April. What I can't figure out is, he's eating very enthusiastically at every opportunity. He cleans his plate, and makes repeated trips to see what everyone else has left. He has even starting eating bits of people food, which should probably bother me, but doesn't - I'm just delighted to see him enjoying any food. The one problem he has around eating - and it's a Tootle problem - she's so aggressive, and he's terrified of her. She will come and sit a couple of feet from Milk while he's eating, and within a matter of seconds, he will wander off and allow her to finish his dish. If I chase her away and put him back down in front of his food, he will eat until the next time she shows up. Moving the dish (and Milk) around to what may seem like safer places isn't much use; he's still the most vulnerable of the six cats and they all know it.

I could start bottlefeeding him once a day to see if he gains any weight, I suppose. Truthfully, I hate the thought of it, and I wouldn't want to do anything that reduces his own newly-functional appetite....

We are 20 days from his one year seizure-free anniversary. I can't believe it! I would love to try lowering the medication, but I'm too afraid to do it. This seems like a disorder where, if something is working, you don't screw around with it unless it's absolutely unavoidable.

I do want to make an appointment for bloodwork for him in the near future.

It's been a month + since the last post?

I'm shocked. I guess because life here has been careening along at a stomach-turning pace or whatever. Well, "careening" and "stomach-turning" are sadly appropriate, at least.

Not much new with my little Milkshake, who continues to eat enthusiastically on his own, but who appears to be distinctly losing weight. (I loaned my wonderful Japanese scale that Hope gave me to my daughter-in-law, thinking that she might want it to weigh our lovely new granddaughter, Gracie. Now I'm wishing I had it back, because I'm pretty sure she's not using it anyway...) He seems perfectly normal in all other ways. He needs to have his phenobarb and keppra levels tested again, maybe next month. I'm looking forward to seeing what the keppra levels are - if they've improved/been reduced significantly, because he continues to be on a reduced overall dosage, plus the US generic levetiracetam pills are significantly smaller than the previous Canadian ones.

Two days ago, I picked Milk up to put him on the counter to give him his pills, and discovered that Busy has apparently started gnawing on him again. There is a fairly large open wound - size of a dime, maybe - on the side of Milk's neck. Previous Busy attacks were on the back of his neck, closer to the shoulder blades. I don't know if this is a seasonal thing with Busy or what. He seems to be having his own problems lately - he is incredibly clingy. I think that we have just been in such a state of upheaval around here that none of the cats is living what would have been a normal life a couple of months ago. We need to get back to that state of what passed for "normality" as soon as possible - the commotion has hurt all of us.

I have been really surprised that Milk has shown so little interest in the kittens. Given his attachment to and need for physical contact with the other cats, I would have thought that he'd be spending a huge amount of his time sitting at the screen door to the bedroom, communing with the five little guys. Probably if they were out where he could get his paws on them, it'd be a different story.

We are just slightly more than 11 months from the last seizure. (Didn't get to see the Seizure CountDown box before typing this.) Hoping desperately that this streak continues......



*Hi, Marianne!

so far, so good, part II

It has been more than a week - two weeks, maybe, since we started the American generic levetiracetam, and it seems to be working just fine! I'm very relieved. There are significant differences between the previous brand from Canada - the shape of the pills, the thickness, and particularly the overall size. The US one is much smaller, and a better shape for cutting. It does worry me a little, because it seems as though I must be giving him much less than previously, but there must have just been a whole lot of fillers in the Canadian drug. Going to continue to keep my fingers crossed that everything stays just the way it is.

Someday I'm going to write something about this subject and it's not going to make me shudder with superstition and the need to toss salt over my shoulder.....

just stuff.......

I was sitting here at the computer the other night, watching while the cats ate. And I realized I was smiling to myself because not only was Milkshake, the "former" anorexic, eating willingly, once he'd finished his own plate, he had wandered oh-so-casually over to Minnie's dish and polished off hers, too. Until I had him, and feeding him was such a crisis for so long, I never really thought about the cats' eating. I put it down, they gobbled it up, The End. At any rate, although he's not gaining any weight - at least he's not losing any noticeable amounts, and HE EATS. Like he actually enjoys it again.

There are a mere 3 of the levetiracetam (generic Keppra) pills from Canada left in the bottle. That's twelve doses, three times a day - four more days. I'm nervous about starting over with the American generic. I know that it's not recommended that non-brand name anticonvulsants be used, in the first place. I don't know what/if there will be a difference - aside from the visual aspects - between the US and Canadian generics. The US one - which ended up to be more than $30 cheaper than the original quote from Costco (a mere $94.73 for 200 500mg pills - and $130 less than I had been paying for the Canadian drug!) is a different shape. It's got rounded ends, which I would think would be better in terms of chopping the pills in quarters. There is a score line across the center, too - another plus. I haven't cut one yet, so I don't know if there's going to be a lot of "dust" when these new ones are cut, or not; there were frequent tiny little bits all over the place with the Canadian brand.

Aside from brand differences, I'm nervous about the dosages, too. We're pretty much down to giving (approx.) 125mg TID, which is quite a reduction from almost a year or so ago. I'm terrified that this change might set off another series of s******s. (Phenobarbital dosages have remained the same - 1/2 tablet in the AM, 3/4 in the PM.)

Time will tell, I guess.

Just one of my favorite pictures of Milkshake....

No particular reason for this, I just came across it tonight and thought I'd stick it in here. It does make him look kind of tiny, when, although he's skinny, he's really tall and long.

Fearful

I didn't realize it's been a month since I last posted here. There've been a lot of not-so-happy things going on; I've been distracted, I guess.

I am seeing odd behavior from little Milk this spring. He's always been a shy cat - never around if the doorbell rings, or if the mail truck pulls into the driveway. And he's not the kind of cat who sits at the top of the steps to greet visitors. But, he's way beyond that this year, and I can't figure out why. He's even reacting with fear and withdrawing when he hears Rege open the garage door. He seems hypersensitive to noises outside. And the things he enjoyed last summer and spring (before the windows and door were closed all the time), like the turkeys gobbling and the birds at the feeder - a lot of the time, he sits on the window ledge, but he appears to be poised for flight, not to just watch the birds.

There really hasn't been much in the way of change for him. He's still not crazy about Cinnaminnie and Tootle - they're both too aggressive for him, and he tends to avoid them. But that's been the pattern for the whole almost-one-year that they've lived inside. Probably the big change has been the decrease in his medications - but you'd think that would make him more normal, not less. I don't know. His balance is still off; he's as likely to tilt over when he's walking along as not. And he's been spending a lot of time sleeping in the closet in Stephen's room. I miss having him beside me. Tonight, I looked for him for more than an hour, walking from room to room jiggling his treat bowl as an enticement. I still have no idea where he was. I crawled all over the place, looking under the furniture and in the closets, and there was no sign of him, until he showed up in the kitchen, yawning and stretching.

And the stupid feline acne has returned multiple times. Every time I think I have it cleared up, it shows up again. He really hates the medicated Stridex pads, and I'm nervous about them because they have salicylic acid in them, which is the same stuff (I think - but then, what's "acetylsalicylic acid"? Maybe they're not the same - anyway, I don't want to take a chance.) that's in aspirin and is toxic to cats. I try to be very careful not to get any of the liquid anywhere near where it might end up in his mouth, and I rinse and dry his chin after I clean it. Poor little guy - he never gets a break.

Burble's fourth birthday is next week, May 3, which means that Milkshake's around three and a half. (I never can remember this stuff. I think I'll just record it here periodically.)

Oh, and hi, Marianne!

Generic Keppra (levetiracetam) information

Generic Keppra - levetiracetam - is now available in the US. I normally order 200 500mg pills from Canada, so they last me quite a while, and I hadn't priced the new generic, until today. ****ETA: Blog entry for 6/09 shows the actual Costco price of $94.73 for 200 500mg pills!!!

I was picking up Milk's phenobarb at Costco this afternoon, so I asked for a price for generic Keppra. And was shocked! About $100 less than I have been paying from Canada, and I don't think that the AAA discount was applied. (Sometimes Costco says that their prices are already so low that they don't give the extra discount.)

This is the total cost the pharmacist gave me for 200 500mg levetiracetam pills at Costco: $129.70!

On-line, the prices apparently include the cost of shipping and handling - here are their generic on-line prices for 500mg pills:

30 pills - 28.71
50 pills - 43.55
100 pills - 81.91

(I don't know if doubling this price would be the actual charge for 200 pills or not, but that would be a whole lot more than $129.70! It makes me think maybe the pharmacist made a mistake, but I asked her to doublecheck, and she said the $129.70 was correct.)

I just opened the second Canadian bottle of 100 tablets, but it makes me feel like I should rush out and buy some more at Costco RIGHT NOW!

A day late.....

Last night, around 11:15 PM, was the moment of the second anniversary of Milk's first seizure. Not such a happy event, needless to say, but there is some comfort to be taken now, I guess, from the fact that he's still here, he's still sweet and loving, and it's been a good while - *anti-jinx* - since you-know-what. I had NO idea what to expect that first night, which was probably a good thing..... I want to thank all those who gave me moral support to get through the hard patches here.

So far, so good.

I am, as usual, afraid to actually SAY anything about Milk's seizures. *anti-jinx* all over the place. I'm a little vague on the exact dates/times/etc, but since the return of the bloodwork a month or so ago, with numbers that I wasn't crazy about, I have reduced both his phenobarb and keppra by a small amount. We're still dosing by the "chunk method", which is an inefficient way to do it, I realize, but it seems to have worked for the last 7 months or so. He now gets:

10:30 AM - 1/2 phenobarb tablet (8mg.approx), 125mg (approx)levetiracetam (generic Keppra), and 1/2 Marin tablet. Depending on the size of the 125mg "chunk", sometimes I may add a smaller 1/8 tablet chunk, just for good measure. (Just as an aside, the phenobarbital is made by WestWard pharmaceuticals, which is located in, amazingly, that rich Arab country in Africa - oh, I hate my memory, or lack of it these days - where they built the indoor ski resort, and the giant hotel, and all the American universities have branches now? DUBAI!! Someone from there looked at one of these blogs... crap. When I remember it, I'll come and edit this. Anyway, these pills are better - although they're harder to find, and Costco charges more for them than CVS does for the other brand - but these are a flat, thin pill. The other ones are so small and tall/thick that splitting them into two, much less four pieces would be impossible. And the levetiracetam comes from www.universaldrugstore.com in Canada. I haven't priced the new USA generic Keppra, but someone else said they were still $1 a pill....)

6:00 PM - 125mg Keppra, 1/2 Marin tablet. (Occasionally, I give him 1/4 tablet of Pepcid AC here, because the Marin can cause stomach upset unless there's food in there, and Milk's eating is a little erratic, to say the least. He does eat on his own, but very rarely the minute I put his dish down, and he's likely to graze most of the day from that first feeding. He's one of the most enthusiastic consumers of the raw chicken/supplements - he loves his chunks.

10:00 PM - 3/4 (approx. 12mg) phenobarbital

2:00 AM - 125mg Keppra + 1 chunk (approx 1/8 of a 500mg tablet). Now, my math is poor, but I think 500mg divided by 8 equals about 65mg, which seems like so much more than one of those little chunks could possibly be..... I don't know. At any rate, I am still using uneven dosages, which is frowned upon, but it makes sense to me because almost all of his seizures were in the very early morning - so, I want to make sure that there's plenty of medication keeping his brain in order during the night. It might not be correct, but until something happens to convince me that I'm wrong, I'm going with it, because, as I said above - "so far, so good...."

This is the Annual Spring Neutered Male Crazy Period around here. And this year, we've added the presence of Cinnaminnie - unspayed Feral Female Extraordinaire, and her slightly nightmarish - but at least SHE's spayed - daughter, the lovely but exceptionally grumpy and aggressive, Toot the Tortie. So, now, the battle is between crazy and mean, apparently. Tootle and Minnie are both quite fearsome to the boys; a significant part of their days is spent chasing shrieking males twice their size up and down the steps. Tootie has devoted most of her attention to Burble lately. He outweighs her by a good five pounds, and is three times her size, but she doesn't let that deter her. She butts him aside from his food, she growls at him any time he walks by, and she will sit in the doorway to the bathroom, where he likes to explore the closet, waiting for him to show up so she can launch herself upon him. Minnie's favorite target is poor Scruffy, who has never bothered anyone else, ever. I watch The Girls carefully to make sure they're not aggressive with Milkshake, because he's still wobbly enough that I don't want him falling off something whilst trying to escape their not-so-loving attentions.

I guess, as Johnny Carson used to say (or DID he?), And so it goes...... Maybe it was Red Skelton. (I touched Red Skelton once. Well, actually, I bumped into him coming down the steps into the formal entry in Thomas Jefferson's home, Monticello. That was in the days before celebrities had entourages, I guess. Nothing like a little free association every now and then, right?) Or maybe it was Charles Couralt who used to say that...

The other day, a very interesting person who owns a bunch of ferrets, one of whom is diabetic, posted a picture on the Feline Diabetes Message Board. I don't know where she got it from, and I am frankly ashamed that I didn't ask her if I could "borrow" her picture, but it struck me as being SO funny, I could hardly see straight. So, on this note, I'm done for today:

Such a nice comment ( #2)

And this one, which came today from my too-faraway-to-hug internet friend, Linda:

"Those of us who have been truly owned by a cat do know that look that passes between us. Not ever having children I can't be sure, but I always think of it as the same kind of bond exists between a parent and a child, only better. To look at them and have so much love in your heart that you feel like your chest will burst."

I don't want to be sloppy about all this, although sloppy is one of my most well-developed attributes, sadly. But I've been really upset for two days about the story on the internet about the kid who put a video of himself torturing his cat on YouTube. I can hardly bear to think about the whole mess. The nightmarish kid, the poor cat, the parents who are going to have to try to "fix" this kid......it all makes me sick.

But - it makes me feel better about the world and all the sad and unpleasant things in it to know that there are people like Linda and Leeta and Hope and Marianne (and, I guess, me and a ton of other people on the Feline Diabetes Message Board, and the Yahoo Epikitty Board and wherever) who do care and who find love and satisfaction and reward beyond description from the sentient furry beings who share our lives. Sometimes things DO work out just right, I guess.

such a nice comment........

There have only been a few comments to the blogs for my two cats. And they've been mostly from people who "know" the cats. Well, or who know me.... Anyway, tonight, there was the following really nice comment from "Leeta." It made me cry. Let me post it here, and then I'll explain.

leeta said...

I just wanted to tell you that I love your relationship with Milk. I don't even quite know how I managed to end up here (seems to me last conscious moment I was looking at something with Verizon billing and I guess I wandered a bit! LOL!) but I am glad that I did. So many things reminded me of so many days with my baby girl Miss Kitty. She didn't have epilepsy but that was one of the few things she didnt have. The last year of her earthly life she had two strokes and congestive heart failure but right through it all she wanted to keep going. Until well, I guess that one day or really a couple days before, she got tired or just didn't want to keep doing it. Its been 1 year and almost 3 months since I've gotten to see her little kitty face shining up at me, containing all the love in the world, and not a day goes by that I don't miss her. I hope that Milk lives another 20 years or so, long enough for them to figure out how to give them human lifespans so that you guys can grow old together. Relationships like that should never be apart. Thank you for posting your blog. It is beautiful.

March 4, 2009 3:11 PM"

I am so touched by this nice person's taking the time to make this comment. And for her to talk about her Miss Kitty's face "shining up at me" - sometimes you sort of think that the way you feel about your cat might just be a smidge over the top or something. The "crazy cat lady" syndrome. SO, it's nice to have someone else freely talking about her love and affection for her cat, and to think that we all are not (necessarily!) crazy or nuts or emotionally stunted or whatever. We just love them. Right? Thank you, Leeta, and I hope that Miss Kitty sends you another cat for you to love desperately and wholeheartedly, and to love you back...

Still not sure.....

what to do about all these medication issues, and so far, Milk is still seizure free but very wobbly.

The urine bile acids test required a very small amount of urine. Results were reported practically the minute they got to Antech in New York. (Literally. The specimen was dropped off at the vet's about 1:30 PM on Monday, and the results were faxed back at 7:30 the next morning.)

Here's a copy of the results:

"Urine Bile Acid: Creatinine Ratio (USA-UCr)

Bile Acid (Urine) ******* 21.2 umol/L
Creatinine (Urine) ***** 400.6 mg/dL
UBA/UCr ************* 0.5 ********* reference range: <4.4


In order to permit measurements of bile acid in urine specimens collected at arbitrary times, urinary creatinine levels must also be obtained. The concentration of urinary bile acids in urine is calculated as follows:

the concentration of urinary bile acids (umol/L
------------------------------------------------ x10
the concentration of creatinine (mg/dL)

False positives may occur with specimens that contain elevated amounts of ascorbic acid."

So, this appears to say that bile acids are fine, but I guess the next project is to find out exactly how this test relates to the elevated blood ALT level from last week's bloodwork. I'm not sure if what the two tests measure is even related. It was my impression that the ALT can be a reflection of inflammation or stress anywhere in the body, but Dr. G. said that it's only a reflection of what's going on in the liver.

I feel a pressure to try to reduce both the keppra and phenobarb levels, but I'm not sure that's safe or reasonable to do. I certainly don't want to do them both at the same time. I feel more urgency to see if the phenobarbital can be reduced back to the dosage it had previously been at in August, (when it tested at 26) because I do think that the symptoms now - wobbliness and incoordination and erratic appetite - have typically been phenobarbital-related in Milkshake.

The Dilemma

I was afraid of this. The Keppra and phenobarb levels came back this afternoon from Auburn. The bad news is the phenobarbital levels are 33.8, and the Keppra levels are 52.7. While I'm not so surprised about the phenobarb numbers - not HAPPY about them, but they were somewhat expected, given the physical difficulties I've been noticing for a couple weeks - the Keppra levels were something of a unpleasant surprise. (The technician I talked to at Auburn last week said to make a note to Dr. Booth, who's apparently in charge of their lab, asking about whether they have developed feline levels, or if they are still using the human numbers. However, when I got to the vet with Milk on Tuesday, the technician had made her own copy of the form for Auburn, and I wonder if she copied my question to Dr. Booth on the one she made? At any rate, there was no response from Dr. Booth.) The odd thing is, I've been cutting back the Keppra for the last three weeks or so. Milk now gets 1/4 and approx. 1/8 of a 500mg pill TID. That's about 187 mg each dose, I think. Significantly less than before. (Or not, depending on the accuracy of the previous math.......)

In the end of August, '08, when Milk had that run of three or four seizures over the course of a little more than a week, we increased his phenobarb dosage from 1/2 of a 15/16mg pill in the AM and 3/4 of a 15/16mg pill in the PM to 3/4 at both times. It seemed to work, and even though he had a couple of seizures at the end of September/October, I didn't make any changes in the amount of phenobarb, and he's now made it for 141 days since the last seizure. And, in the real world, 33.8 isn't way out of whack for phenobarb levels. Except, as Dr. G. said, except for Milkshake. The combination of the pheno levels at almost 34 and the ALT in the 200's certainly seems to imply that something's going on with Milk's liver. I guess that makes doing another bile acids test imperative. (Have not seen this cat near the litter box ONCE since we decided to do that testing. NOT ONCE.) I think I'm also going to add another 1/2 or whole marin every day.

Dr. G. wondered when he called tonight with the results if we should send a copy of them to Dr. L - the IM vet I didn't care for at all, and who said that she'd never approve giving a cat more than 125 mg of Keppra unless their weight justified it - or to Dr. A, the neurologist in Ohio. He was a consultant, rather than a person who seemed to intend to have a long-term relationship as Milkshake's doctor. I think Dr. G. would appreciate having someone to consult with about this whole mess. Now that there's actually a neurologist in Pittsburgh, maybe I should ask for a referral? The trouble is, I don't want to have to go through the pressure to have an MRI again, or to put Milk through any number of unpleasant tests and appointments unless it's unavoidable.

Nothing's ever simple, and sometimes it really stinks.

Bloodwork

I've been concerned about the increasing wobbliness Milk's been showing, and it's been about 5 months since his last phenobarb levels were done, so, I've decided to combine the phenobarb and Keppra testing, and have the vet do his local office testing for a regular CBC. My poor little white cat - he was quivering so hard it was visible the entire time we were in the office. And, while the vet did attempt to get the blood from Milk's thigh, he couldn't get enough. So, now Milk's got the shaved neck. I can't imagine what it must be like to see some total stranger coming toward your neck with a syringe, while another total stranger is holding you so you can't move. Poor cats.

Anyway, Dr. G. just called - didn't give me all the results, but I will ask for a copy the next time I'm down there. I had told him that I was interested in liver function results, and it turns out that the ALT was in the 200's - normal goes up to around a hundred. He suggested that, if I'm concerned, we could do a bile acids test; the original one, when Milk was diagnosed, was not done fasting, and we didn't do the preprandial/postprandial version. I told him that Antech can now do the urine Bile Acids test, which I would prefer. So, I think when they let me know how much they need, I'll have to devote myself to collecting a specimen. I am almost certain that a sterile test (using cystocentesis) isn't necessary, which would be nice; I'd rather not have to take Milk anywhere for as long as possible. (Turns out they need just a teeny 1 ml of urine - I asked Dr. G how much that is - no head for metric measurement - and he said a teaspoon is 2.5ml. I'm a little out of practice for catching urine since Scruffy's been off insulin, but I think I can probably do it, although Milkshake's not nearly the carefree pee-er that Scruffy was, and he doesn't seem as regular about it.

I have kind of wondered about the phenobarb levels. Before, whenever his levels were around 26, he usually started eating on his own again. So, I've been going along, thinking that, since he's eating with a degree of enthusiasm, his phenobarb levels must be okay.....Not necessarily true, I suppose. Rats.

Well, another 60 dollars for the urine bile acids test, which is worth doing, I guess. I've been giving him 1 Marin pill a day; I could increase it, after we see what the phenobarb levels are. I just don't think that reducing or removing phenobarbital is possible for Milkshake. Not without setting off a whole cascade of seizures, I'm afraid. And undoing all the seizure-free times he's had in the last six months.

I have a vague memory that ALT is responsive to stress and infection somewhere in the body - maybe the stress of today's visit, or the beginning gingivitis might have had an influence?

Dr. G. asked me how and what Milk is eating these days, and when I said he's eating enthusiastically for the first time in three years, and he's getting half Fancy Feast and half raw, Dr. G sort of collapsed in shock against the wall and started stuttering about salmonella and e coli. (When he asked if there was a less disease-prone animal than chicken to feed raw, I said, "Well, yeah, they've got rabbit and now there's frozen ground mouse." It was cruel; I shouldn't have done it.

The third adoption anniversary

Well, the good news is, no tears this year.. The bad news is, I completely forgot about the anniversary until about five minutes ago. Which doesn't, of course, mean that I don't care about the milestone. I just have a really lousy memory and not much interest in the calendar. Plus, I actually finally managed to get Milk trained to show up when I jiggle his tupperware container of TempTations. Thank goodness.

I have been a little concerned about him in the last couple weeks. Milk seems wobblier than he's been for quite a while. He is eating fairly enthusiastically, which is wonderful. He even gained an ounce since last month. Still, there are small but noticeable balance issues, for instance. God forbid he should decide to shake his head when he's in any position but lying down. I have an appointment to do phenobarb and keppra level bloodwork. Anyway, I have dropped the second chunk of Keppra with his 2AM set of pills, and it doesn't seem to have made any negative impact. I'm just afraid to take the chance of setting off a whole wave of uncontrollable seizures, when things have been going so well for so long.

On a happier note, as the picture above shows, Milk has finally gotten semi-close to Cinnaminnie. Not touching her, but in the vicinity. Not much chance of his ever accomplishing that with Tootle, though....

No funding for the study...

Just noticed this post in the epikitty site:

Re: Clinical trial evaluating new anti-epileptic drug in cat

Hello again. Well I have good news and bad news.

The good news is that our study protocol was approved by the Cornell
IACUC, meaning that we have permission to proceed.

However, the bad news is, we didn't get funding.

so the aims of the study may change a little. Most of the funding was
aimed to allow people to have a MRI and CSF tap on their cat. Since we
cannot do this now the "requirements" will have to change.

Instead the study title will be changed to "suspected epilepsy", based
on their neurological exam and length of time they have been seizuring.

What does this mean for you guys?
-basically, we'll start with the cats who are already on zonisamide
and try to come up with some statistics with those guys first.

-therefore, for those of you who have your cat on zonisamide already
and still would like to participate, please send me an email to my
yahoo account. It will be easier to track everybody since the message
boards can get kinda "messy" at time.

thanks again,
David




I think there was only one cat on zonisamide in the epikitty group, and they were in Arizona, so it would be unlikely that they'd be able to get to Cornell for examination. It's not very clear from Mr. Brewer's post exactly what the purpose of the study would be in its revised state; I assume it would still be to look at the use/value of zonisamide. Maybe there will be more information in the future. To my mind, the MRI and spinal tap requirements were a negative; I really don't want to do that to Milk...

In other developments, the wonderful little muscle shirt from Sandy and Black Kitty arrived - it is so nicely done! It fits very well, too. Gotta get a picture of it.

A major achievement! And an "ugh".......

Today is Day 102 since Milk's last seizure. (I am truly afraid about acknowledging it, but it's such big news for him!) It is the longest period of time he's gone between seizures in the nearly two years he's been an epileptic.

I started to figure out how many days in 2008 he was seizure-free. The math got me down, but he had - the most notable figures - one period of 84 days, and one of 102 days, and this one (102+) that will hopefully go on and on and on. He had 13 seizures during 2008 - almost the same numbers of seizures he had during the first week or so before he started on phenobarbital in 2007! There were 37 seizures in 2007, between March 23 and the end of the year. Three cheers for large doses of Keppra?

There is a record on the right side here of his assorted dosages and any changes that were made. After the breakthrough seizures in August, 2008, I did reluctantly increase again the 1/4 tablet of phenobarb that I'd reduced previously. It's been about four months since he had his phenobarb blood levels done, so I guess that's the next task. I suppose, if they're taking blood anyway, we should get his keppra levels done, too. I would like to know first if they've completed their studies at Auburn to see what the norms for cats on Keppra are, though. I believe, however, that no matter what the Keppra levels are, I wouldn't make any changes in his dosage. Comparing the potential damage done by multiple grand mal seizures to anything that seems likely to happen from Keppra usage, I think that the seizures pose a much greater threat to his well-being.

The UGH - a week or so ago, I noticed that Burble was scratching his chin with his back leg, and that he'd yip while doing it. He's kind of an oddball, and it never occurred to me that there was a reason for the scratching, OR the yipping. Anyway, when I eventually looked at his chin, there was a huge glop of dried blood, and a sort of raw looking triangle under his chin. I cleaned it off, and assumed that it was caused by the scratching. Then a couple days later, I noticed that he had a little patch of raw skin over near his lip, too. I googled, and found references for all sorts of repulsive, difficult-to-treat stuff like "miliary something or another" and "rodent ulcers".... But, when I asked a vet tech on FDMB, she said - "Ah, feline acne." Usually caused by plastic bowls, I thought. Which was the reason I have been using paper bowls by the dozens for years. But, she said, it's not necessarily what the bowl is made of - it's the fact that the chin is the dirtiest place on a cat, and the hardest for them to clean, and a bowl makes for more unreachable food on the chin. She recommended flat dishes for feeding. (And I have $75 of paper bowls downstairs! I wonder if there's some sort of ornament I could turn them into....) My cats all like their food very soupy with extra water, which would seem to be a minor problem with using plates for feeding, but I suppose it's manageable. She also said that Stridex pads can be a useful treatment. She didn't mention that there were 443 different KINDS of Stridex pads sitting on the shelf at the grocery store. I ended up buying the one that said "Original" on the label, although I don't know if it's safe for a cat or not - considering the licking and fiddling around that goes on after cleaning the area with the Stridex. Now I've started cleaning the chin and then rinsing it with clear water to try to remove the alcohol and whatever else is in there that might be licked up.

Anyway - lost track of where I was going with this - yesterday morning, I noticed that Milkshake's little chin had a sort of gray look to it. He's normally sparkling white. And, sure enough, when I got close to it and separated the fur a little, there were the tiny little black spots. (Referred to as blackheads in some of the articles I read about feline acne.) I cleaned it up with a little soapy water, and was surprised at the amount of blood that was on the paper towel. So, I gave him two Stridex treatments over the day, and as of this morning, his chin does look a little less gray. This is really annoying. I KNEW that plastic bowls were a problem. I use a big Correlle bowl for water for them, and purposely chose the paper bowls for their food.

I did find this very good article on Omega Fatty Acids http://www.peteducation.com/article.cfm?c=1+1400&aid=665 which suggests that Fatty Acids are helpful in clearing up feline acne, so I guess I will start adding some to everyone's food. I'm getting quite a collection of feline supplements and medications here. There are many other benefits to the Omegas, apparently, as long as the ratio of Omega 3 to Omega 6 is correct.

This crew of cats has had MORE weird stuff wrong with it than any other cats I've ever had in forty years. I have a theory (one of many, sadly) that the more attention you pay to your cats, the more diseases you'll detect. Maybe ignorance IS bliss......

Happy MilkshakeDays!

(That's actually not something sticking out of Milk's ear - it's the ribbon from the hat, which is, in reality, behind his head.)

Merry Christmas from the World's Sweetest Cat.

We are approaching a Longest-Time-Between-Seizures record here, but I'm not going to jinx it by mentioning the actual number. Just keep your fingers crossed for us.

Milkshake's Beginnings......

I came across pictures tonight from the day I dragged home this incredibly sick, pitiful looking little cat. Almost three years ago. And I wonder what I would have been thinking if I'd known that his life here was going to turn out the way it has.....

















It's hard to even look at these pictures. (They're clickable.) He was so urine-stained and filthy. His eyes were oozing black stuff. There was so little flesh on him that those two big bones - his breastbone and his shoulder blades - stuck out sickeningly. His knees banged together and he swayed when he walked because there was so little muscle tissue left that there wasn't anything to keep his legs straight and in place. He had the same big belly you see on tiny African kids who are starving.

Oddly, he really wasn't afraid. Maybe he'd been through so much that he already knew that there was nothing he could do to protect himself. Or, maybe he sensed that he was going to be loved and cared for finally; that he was going to be my "heart kitty." I picked him up at PetSmart, paid his fee and gingerly put him in the carrier. We went straight to the vet, where he was examined, given an antibiotic injection for the respiratory infection that made his breathing actually audible, and got drops for his eyes. After two weeks at the Humane Society free-feeding dry and pouched food, he weighed barely 3 pounds - and he was 7 months old. Back into the carrier, and then into the calm and warmth and quiet of the extra bedroom, where he was willing to just lay on the bed for a couple of hours before getting up to look around. I was both sad for him and angry at what people who were supposed to be taking care of him had done to him. He really was an innocent victim. And yet, someone had rescued him from the "home" where he was starving and filthy. Someone had put him in that hidden cage at PetSmart, and someone had led me to make a beeline for him. So, maybe things did work out just the way they were supposed to, although it makes me sad to think of how awful his life must have been, and how tenacious he had to have been to have survived as long as he did. And what an amazing thing it was that he was such a sweet, loving little kitten despite what had happened to him.

And he's still a wonder, with eye contact that amazes me every day. And the most tender way of reaching out with his long, thin leg to pat me. And snuggling into my elbow to nap. Someone said he's my "familiar." Like witches supposedly had. Could be. I just know that scrawny and epileptic and shedding tons of white fur that seems to have an adhesive quality to it, he's amazing and wonderful and makes me happy every single day that I found him and have the privilege of cherishing him.

A Busy Deterrent (hopefully!)

I noticed a post on the FDMB by a wonderful person named Sandy, who had a picture in her signature of her cat, Black Kitty, after some surgery. And he was wearing what looked like it might be the answer to the Busy-gnawing-Milk's-shoulders problem! So, I wrote to her and asked her where she'd gotten the wonderful protective garment, and she said she'd made it herself. And she was willing to make one for my little Milk!

This weekend, the prototype arrived. And it's perfect! It was stretchy enough to put on him easily, it's tight enough to stay in place and protect those bare little shoulder blades that Busy seems to think are so tasty, and it actually looks like a "muscle shirt". Well, not that Milk has much in the way of muscles, but the idea is still there. He's still staggering around the house like it weighs 20 pounds - cats are such hypochondriacs. But I think that this may be the solution to the problem, and maybe it'll keep Milk warmer, too, this winter. He's spending most of his time napping in a kitty pi on a heated mat.

I'm thrilled! and grateful! and about to decide what color kitty pi to send the gorgeous Black Kitty in thanks!

More information on the study

(Anyone reading this who might be interested can contact Dr. Brewer - information is in previous post, I believe.)

Hello again, I'm very excited about all the responses I've been

getting about the use of zonisamide for cats. I wanted to reply to

give some more details on the study. here are some things for you guys

to think about in the meantime while we are still waiting on approval

of the this project.

requirements:

1. diagnosed with idiopathic epilepsy (meaning that seizures can't be

due to other diseases such as viral, tumors, infections, etc); because

of this, ideally cats will have a normal MRI and spinal tap performed.

pending our trial approval, we may be able to offer financial

assistance for this aspect of it.

2. owners must have a WRITTEN seizure log for the past 2 months prior

to starting the zonisamide showing at least 2 seizures per month and

maintain a log during the study

3. ideally each cat will be evaluated by the neurology service at

Cornell. As this may be difficult for some to do, as long as your cat

is evaluated by a board certified neurologist, we may be able to

coordinate through them and have your records faxed.

4. routine blood work (CBC, Chem, U/A, and zonisamide level) will need

to be obtained at 0, 30, 60, and 90 days.

5. no changes to other seizure meds (ie phenobarbital) dosages can

occur in the 2 months prior to starting the trial and during the trial.

I know that all of these requirements may causes some problems for

some of you, but please understand that when performing clinical

trials, it's crucial to have some degree of consistency in order to

prove a drug is effective or not.

as discussed, we are hoping to get the approval and hoping funding

within the next 2 months. Hopefully, most of you will be able to make

it up to Cornell to be evaluated. if you can't and still would like to

be a part of the study, please see if there is a board certified

neurologist in your area that we may be able to work through.

look forward to working with you all!

David

While I'm interested to see if zonisamide might be a more reasonably priced, easier to use seizure medication, I don't want to put Milk through an MRI and spinal tap - at our own expense! - or a trip to Cornell - my son went to lacrosse camp there, and it was a nine hour trip. With the pitiful mileage my car gets, it would cost hundreds of dollars just for gas. To say nothing of the wear and tear on the world's most frightened little white cat.

Nothing's ever simple.