No seizures, but......

So far, so good - no seizures since July 19. (That's 5 days. Yippee.) The increased amount of phenobarb so far seems to be controlling the seizures, but Milk's spending an awful lot of his daytime hours under the bed, and his rear leg "weakness" has doubled or tripled. He's fallen off just about everything he tried to jump up onto for the last day or so. If I pick him up to set him on the floor, his back legs just sort of collapse under him. Walking across soft surfaces , he's hardly able to manuever. Given the loss of muscle tissue when he was rescued and the consequent walking problems then that seem to resolve themselves with adequate nutrition, I wonder if he is having more severe problems now. Especially since his appetite has been so negatively affected by the medication. I reread the Patient Information sheet that comes with the phenobarbital, but it doesn't mention "rear leg weakness". (Probably because humans don't HAVE rear legs........) I am concerned. I searched for "rear leg weakness" on the Yahoo epifelines website - where I distinctly remember reading something about it, but couldn't find anything except a discussion a day or so ago in which four people agreed that their cats had it, too. I was spending so much time and energy trying to ensure that Milk didn't fall during a seizure, and now I'm worrying about the non-seizure times, too. This poor sweet little cat. It's not fair. I'm thinking that, even though Dr. G. said it was okay to give him the extra 1/2 tablet once a day, I'm going to divide it in two and give 1/4 tablet twice a day. Although, it doesn't make sense to me - if they don't have to worry about how long it's been before/after a shot when they do the bloodwork because the amount of phenobarb in the blood evens itself out, what difference does it make if the two daily doses are uneven?

#18, #19, #20, #21, #22. Enough, already.

Seizure #18 - 7/15/07, 5:14 AM. He was sleeping, I assume. I don't know how long it had been going on when it woke me up, but this seemed like a short one. He was just laying on his side, and once I wiped the foam off his face and neck, he put his head back down and just laid there. It crossed my mind to wonder if he was still breathing. He was, thank goodness. There had been foaming, jaw snapping, and some body jerking. It took him a while - probably nearly a minute - to get up and start pacing. He moved really fast when he did, and by the second round, when he'd returned to the kitchen, I had food ready for him. He immediately stopped to eat, and I went back to bed because I thought that would be the end of it. Not. Burble refused to let Milk alone. And Busy joined in. From 5:15 to a little after 7:00, they were thumping and racing and banging into things, up and down the steps, meowing, and carrying on. I was so afraid that it would trigger another seizure. I got to pet him a half dozen times when he paused in exhaustion, but he wouldn't sit on my lap, and Burble wouldn't stay away.

So much for my different manufacturer theory. He had both pills yesterday from the brand new/old manufacturer prescription that I picked up yesterday morning. Maybe they just haven't had time to start working? How much delusion can I churn up here? I'm thinking, since I have to go to the dentist tomorrow afternoon and maybe we could see if the phenobarb blood levels are deficient today while the pills are new - maybe it'd be worth taking him down there this afternoon. I supposed they'd have to hold the blood till tomorrow afternoon anyway.

Seizure #19, 7/15/07, 9:00 PM I didn't see this one, but Milk came into the kitchen meowing his seizure meow - frantic and urgent - and started looking for a bowl of something to eat. When I got close to him, his fur was soaked, all down his chest and up around the back of his head. When I went to the kitchen to fix their food, he was asleep in a Kitty Pi on the couch. I hate hate hate when he has to come to after a seizure and I'm not there to clean him up and feed him right away.

#20 7/ 17/07, 8:15 AM Mild seizure. He woke me because of the foaming sounds, but he was sitting, leaning against the back of the couch, and there was very little jerking - very little movement of any kind, actually. I wiped up the saliva, and he just sat there. I left the living room twice, and he still didn't change position. He did eventually jump down, but skipped the pacing and meowing. He found the remnants of last night's late night snack and tried to eat it, so I gave him a can of FF, which he ate. Then he and Burble did a lot of running around and he meowed quite a bit. Sometimes it seems odd that he is so much more coordinated and active directly after a seizure than he normally is on medication. I wonder if that's significant.

Took him to Dr. G. yesterday afternoon to have bloodwork done for phenobarb levels. The results will hopefully be in this afternoon, although I'm not sure what the possible responses will be. His levels were already high the last time, and he wasn't having seizures at all then. This really stinks.

Blood work results came back on 7/17 - phenobarbital level is 25. (Can't remember if there's a decimal there or not.) So he does, at the present moment, have slightly less of the drug circulating in his blood than he did when he was seizure free. However, if the blood level is supposed to be as close to 20 as possible, which is what I have read, is that a problem with increasing the dosage? Dr. G. wants to begin by increasing the dosage by another 1/2 tablet - that'd be around 24 mg one time a day, and 16 the second. Which comes to 40 mg total, I believe. I think the accepted dosage is .2 -.4 mg/kg of weight. He weighs almost exactly 10 pounds - down from 12 pounds the week before the seizures started, by the way. So, he'd be close to the maximum dosage. I don't know. I just want the multiple seizures a day/week to stop. Right now.

Seizure #21 - 7/19/07 at 8:00 AM. Now this was an odd one. He had been asleep on the footrest of my chair. There was a minimal amount of just about everything by the time I realized it was happening. Not a ton of foaming, hardly any jerking, but while I was wiping his face and chest, he made a horrible growling/moaning sort of howl - only the second time he's ever made noise during a seizure. And it seemed totally involuntary. He really didn't appear to be aware that he had done it, or that he'd even heard it, although the other three cats all came running to see what was going on. Once I had his face wiped off, everything just stopped. It had been only a matter of seconds. He just laid there, totally relaxed. There was none of the usual after-seizure activity - no pacing, no meowing, no eating. He seemed alert, though, more than usual. After a few minutes, he jumped down. And in about 15 minutes, I had his food ready, and he did want to eat. (He has so little appetite on phenobarb that about the only time he really eats enthusiastically is after a seizure.) He's still wandering around a half hour afterward in total silence, which is unusual.

It would appear - or my GUESS is - that the increased dosage is actually affecting both the length and severity of his seizure. I don't know how to explain that awful noise. Maybe it was coming from a different part of the brain or something. So maybe there's some hope that giving what seems like a LOT of phenobarb - especially when he's lost so much weight (2 pounds since March when the seizures began) will actually control them again. Hopefully.

Seizure #22: 7/19/07 2:15 PM or so. Enough already. Milk just came out of the bedroom, walking kind of tentatively. I'm starting to recognize when something's happened. Sure enough, his chest was soaked. And as soon as I mopped him up, he started his seizure meow and headed for the kitchen. He's very wobbly this time, though, and he threw up a tiny little bit after he ate - he's never had a hairball, but maybe.... Tiny little bit of pacing and meowing.

Another new prescription

(Is this little cat cute, or WHAT?!)


I've managed to convince myself that this round of seizures has started because of the different manufacturer of the last prescription. I talked to Dr. G. this morning, and he said that it's highly unlikely, but he was willing to indulge me and give me a prescription to get phenobarb manufactured by "Qualitest" again. (The stuff from Costco was made by Wade-Ward.) It's silly, but since giving him one of the new pills at noon, I'm so much more relaxed this afternoon. He's been asleep for five hours, and NO SEIZURES. In fact, the extended sleeping could be a sign that this phenobarb is working better than the last stuff, which really didn't seem to have any of the side effects of the original brand at all. You might think that that's better, but not if "no side effects" also means "nothing keeping the seizures controlled," right?

I also asked about bringing him in today for bloodwork, but there wouldn't be much point in doing it today because phenobarb levels are apparently one of the tests that Antech doesn't do every day and it's a weekend. As I recall, it took three days the last time to get results. So, I'll just take him on Monday or Tuesday. That will mean that the measurement will be of the Qualitest pills, but that's okay, I guess. It would have been interesting to have a measurement of the effectiveness of the ones that weren't working, though.

And another one or three....

Seizure #16 on 7/12/07 at 8:15 PM.

Milk was sleeping on my computer chair when it started. This time, the seizure included mild jerking of his body, as well as the foaming. He let me pick him up and clean his face off, and then wanted down to pace. After a minute or so, he began the meowing, too. He ate an entire can of cat food, and then did more pacing and meowing with much more volume and urgency.

I had talked to the vet today about the apparent mini-seizures (which this one was NOT); he seems unconcerned as long as they're occurring occasionally, but he doesn't seem to see it as an increasingly distressing problem, which I do. Probably because I"m watching the horror go on. (I know that medical people define "controlled" seizure activity as happening once a month or so; we're way beyond that already, though.) I mentioned getting phenobarb blood levels done again, and he thought that it wasn't necessary for another few weeks.

I am seriously thinking about having the MRI done. The problem is, I don't know if we then become long-distance patients of a neurologist who will never actually see Milk in person or not. And if not, are we any better off? Should I contact Ohio State, where people who've been there complained about the waiting and the student involvement? I don't know what to do. I just know that I'm getting scared at the reappearance and the frequency of seizures that is going on, and someone needs to do something. I'm starting to think that maybe I should get a prescription for the rectal valium to have on hand in case this gets out of control. Tomorrow, of course, is Friday, when the vet is closed.

Miniseizure #17, 7/13/07 at 8:30 PM Again he was napping in my computer chair. I had just started to test Scruffy, so by the time I got done and found the camera, Milk was pretty much done. There was foaming, and some jerking and jaw snapping, but by the time I got there, he was still. Sort of out of it, and staring into space. He got down and paced from the kitchen to the living room and back again, with a little meowing, and then wanted food. He ate almost a whole can of Fancy Feast. It's interesting that his physical control and coordination seem to be a little better/steadier after a seizure.

It has occurred to me that the miniseizures and the regular seizures have started again since I got a new prescription for phenobarb from Costco last week - on July 7th. It was a different size and shape pill (and a 16.2 mg pill, according to the pharmacist at CVS) from the one I got at Giant Eagle, and the manufacturer's name on the label was different. I didn't note here exactly when I started noticing the "mini-seizures", but it has been within the last week. I called the pharmacist at CVS tonight and asked her if it might seem likely that the difference in generics might affect seizure activity, and she seemed to think it was a possibility. I plan to take Milk to the vet tomorrow to get blood to check his phenobarbital level, and I want to ask for another prescription to get the previous brand of generic at Giant Eagle again. It would be awful/wonderful if the problem turned out to just be the brand of phenobarb.

A short video of the post seizure period tonight:

http://s142.photobucket.com/albums/r109/olgemac/Milkshake/?action=view&current=3f429532.flv

Mini seizures? Partial seizures? What's going on here?

At least three times since the last dosage increase - which I thought was working well, silly me - Milk has had episodes where I found little wet spots under him. I couldn't figure out where they were coming from, although I was pretty sure they weren't urine. And I had also seen the "wake up from a sound sleep and attack the neck of one of the other cats" activity several times. Finally, at 4 AM this morning (Seizure #15 on 7/12/07), I put the pieces together.

Around midnight, he had jumped on Burble and bitten his neck. There didn't seem to be anything else notable going on then, though. During the night, he was asleep between my ankles. I woke up to the sound of his foaming, which seemed to have just started, and the beginning of the jaw snapping. There was no activity from the rest of his body, though. He just laid there, looking relaxed. I got a kleenex and wiped off his face and chest, and he made a minimal effort to avoid my hand, but he didn't get up or move away. He sort of stared into space for quite a while. And all of a sudden, it hit me. He was having a seizure - but it was different from the previous ones, maybe because of the amount of phenobarbital he's taking now. He didn't progress to the body jerking, or the pacing or meowing. Just to check my theory, I went out to the kitchen and put down a can of food for him, and sure enough, he sat there and ate the entire bowl - exactly what he did post-seizure before.

For the last week or so, he has had definite rear-leg weakness. Yesterday, he fell trying to jump onto the bathroom sink, which hasn't happened since the beginning of phenobarbital. His balance is off, and he's not very accurate about where he's putting his back feet; every trip across my desk or the couch is an adventure, because I never know if he's gonna end up on the floor or what. Thankfully, he's spending almost no time in the cat tree. His appetite is definitely improved, and he's developed a taste for baked/boiled chicken with his pill. (He will no longer eat the Pill Pocket on his own, though; I have to pill him.) Although my scale has said that he weighs 9.9 pounds (the dumb thing only goes up to .9 for the ounces, so I don't know what that weight actually is) for almost two months, he's really back to the bag-of-bones feeling again. That big bone in his chest is huge and pretty much totally unpadded. I was feeling hopeful because, even with the increased dosage, he's cuddling with the other cats again. It had crossed my mind to ask the vet if, when I went to pick up Scruffy yesterday after his dental, I could bring Milk in to have bloodwork done to see what his phenobarb levels are. I was glad I hadn't done it when we got into the huge rainstorms, but I guess it should be a priority.

I wish there was a neurologist closer than hours from here. I just don't know if I can realistically consider $1300 for an MRI. I'm thinking that maybe it would be worth doing the "video neurology consult", although that's not gonna show if there's anything going on inside his brain. I don't know what to do. I feel like I'm not taking adequate care of him, and now I'm scared if he's having even these "mini-seizures" more often. Is each one doing more damage? How much more doped up is he going to have to be? How come this is happening?