Keppra is working(?)

I'm almost afraid to post anything about this. Don't want to jinx what looks like it might be successful. Milk started the liquid, grape-flavored Keppra (I apologize to him every time I squirt it into his mouth) on Saturday, August 25, 2007. I was able to use the prescription that Dr. L gave me for Canada to buy a bottle of the liquid at a compounding pharmacy on Friday, but the pharmacist added chicken flavor to the grape flavor, and I couldn't bring myself to give him that horrible crap. So, on Saturday, Dr. G. called in a prescription for a couple days' worth of the liquid Keppra until I can talk to Dr. L.

So far, so good. (It's Friday, one week later.) No seizures. But my life has disappeared. He's still not eating, so I'm still bottlefeeding him four times a day. (He will eat treats, thank goodness. Bribery exists.) I did switch from AD (full of all sorts of liver and chemicals) to Wellness, which seems to have been an okay idea. Then he gets .9 ml of grape Keppra liquid three times a day - has to be every 8 hours exactly. He hates this. I have to capture him, wrap him in a towel, and then figure out a way to squirt the Keppra into his mouth without getting it all over both of us. The last two doses, I have no idea how much got into him - it was all over my chin and shoulder, and there is, of course, no way to know how much was wasted, or what the actual dosage given was. Then we add the lowered phenobarbital dosage of 12mg BID, which also is supposed to be at exactly 12 hours apart. In between that, I feed the other three, and test and shoot Scruffy whenever. I've got - with luck - (it didn't work today because Scruffy for the first time in weeks was actually dropping - way too fast and too much, but dropping - when I wanted to go out) four hours in the afternoon for my life. I can't figure out a better schedule for Milk's medication, either. I don't want them too close together, in case one or the other makes him throw up. I'd rather not be chasing him around all day to shove stuff into his mouth. I asked Dr. L this afternoon when he will be able to switch from Keppra liquid to pills, which would hopefully be cheaper, and which would definitely be more dependably dosed, and less messy and less repulsive to poor little Milk. She said, given that he still won't eat, it's going to be quite a while, since she's basing the dosage on his weight. I don't know what they'll do if he starts to have seizures again. The phenobarb is to be lowered again on Monday or Tuesday, with a goal of having him on 8mg BID. She didn't say anything about increasing the Keppra. Maybe she wants to see if he has a seizure first. He's much less clumsy and uncoordinated, he's not sleeping as much, and he's more active. If only he'd eat...

Shocking lab report

Well, Milk had his appointment with Dr. L on 8/23/07. She didn't have much opportunity to observe him walking, as he was too scared to do much but slink around, flatter than a pancake. His weight on their scale was down to 9 pounds, 8 ounces. She wants to add Keppra to his medications, and calculated that he would need, based on his weight, 90mg three times a day.

On 8/24, a technician called and said that the blood work results were back, and there "didn't appear to be any liver failure yet." I thought that was a kind of peculiar remark, until she then said that his phenobarb levels were 56. FIFTY SIX. (The standard, which was established on dogs, is 15 to 45, and cats are supposed to be as close to 20 as possible. ) I was stunned. He's been essentially on the same dosage (well, right now, he's taking 4mg/day more than in the beginning) for going on five months. The last pheno level was 25.6. At any rate, the phenobarb was to be cut back - per Dr. J, who isn't the actual doctor we saw - to 16mg AM and 8 mg PM. (Someone suggested on the epifeline board that it'd be better to do 12 and 12. I don't understand their emphasis on making the dosages even, but it's doable. I still have a bunch of those little skinny pills from Costco that can be easily broken into quarters. The small but very thick pills from CVS - it wouldn't be possible with them, I don't think.)

After a whole mess that I don't even want to think about - but which ended up with me paying $55 for chicken AND grape flavored liquid Keppra - makes me shudder just thinking about that mixture! - on Friday afternoon at a compounding pharmacy in Avalon - I am really unhappy about the whole thing, and even though this guy has the prescription, I'm not going back there - I heard from Dr. J., Dr. W in Ohio, and Dr. G, all within the space of an hour or so on Saturday. Dr. L, our actual IM physician, is to be back in on Monday, the 27th, so I assume I'll hear from her then. I want to know how close Milk is to being able to use a standard (non-compounded) amount, preferably in pill form. The grape liquid is torture for both Milk and I. The amount is large enough to make the plunger of the syringe be almost all the way out of the barrel, and I have not yet been able to get the whole dosage into him in one try. He doesn't foam, which is a blessing, but he really doesn't like the stuff, and I would prefer to give him pills that I don't have to pay an arm and a leg for. Between the 3 times a day Keppra and the 2 times a day phenobarbital and the 4 feedings a day, Milk has gotten to the point where, when I walk in his direction, he speeds up his wobbly little bod and disappears. He did eat a little from his own bowl yesterday morning, but not enough. I'm going to change from AD to Wellness for his bottlefeeding; practically the only ingredient in AD is liver from pigs and cows and chickens, etc. At almost $2 a can, I'd really rather he had better quality food.

On the positive side, with the decrease in phenobarbital and the addition of Keppra, he seems to be navigating a little better. The appetite still needs work, although he's more than willing to eat all the treats I offer him - working on making that a more effective bribe! He's been successfully jumping from the back of the armchair over to the back of the couch, which I don't think he would have been able to do a week ago. And he seems a little more alert. Now if he'd just EAT.

Oh, where, oh, where has his appetite gone?

We have about reached the point where Milk's not eating much of anything on his own. Even the dry that I put down for him to eat after his pill usually ends up getting eaten by Busy or Burble. So wonderful, I'm damaging THREE cats, instead of just one.... Feeding him four times a day with the AD - an entire can - seems to make it possible to maintain him at 9 pounds, 14 ounces. Sunday, I only fed him three times, and he lost 3 ounces that he can hardly afford. He's a fur bag full of bones. A lot of nights (and very early mornings!) he and Burble and Busy go careening around all over the house. The last couple days, not so much - he seems sort of weaker, and is definitely wobblier. He had a terrible fall off the cat tree. I'd just poked Scruffy's ear, so I couldn't get up in time, and in literally a split second, Milk jumped up, slipped, hung on with one claw, and then fell about three feet and landed flat on his back. I couldn't get to him before he got back up. He seemed to be okay - more surprised than anything. He never seems to remember that he's likely to fall until it's too late. I'm sick to death of watching him be unable to do all the stuff he worked so hard to do after he first came here.

I posted on the epifeline board today to ask about Keppra. I wanted to know if it replaces phenobarbital. (Wouldn't that be wonderful!) There were a bunch of posts from January from people using Keppra, and it seems as though some of the cats were wobblier on it, and at least one lost his appetite. That's not good news. Someone also posted (from Germany) that someone - an authority, I assume, although I didn't recognize the name - preferred Topamax to Keppra. I hadn't seen that before. I just want something that will let my cat be himself again, and make him want to eat. The smell of AD is turning my stomach. It's everywhere - not just the smell, the AD - it sticks to my watch and to my clothes, and to poor little Milk's fur. Fortunately, Busy has decided that it's his job to clean up after Milk eats. He licks and licks and gets all those lumps of food off the little boy. (Busy can use a few extra calories, too.) It's a good thing - I would hate to have the specialist see him on Thursday with that stinky food all over him. It's almost impossible to wipe it off - it just turns into smaller lumps and clings all the harder to his fur.

I'm nervous about Thursday. I don't want to leave him there for them to do stuff to all afternoon. He's such a shy little cat, and he feels lousy. How do I know they'll be nice to him? What kind of awful things are they going to do? How is he going to understand any of this?

This is not going well.

I love pictures of Busy and Milkshake together. The contrast of their fur, and the cuddling they do is so appealing. I like, too, that it's a very similar kind of nurturing relationship to the one Busy and Britty had for the first five years of his life.

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It has become increasingly difficult to get Milk to eat. Wonderful Hope sent me a scale that actually tells you what the weight is in understandable numbers (as opposed to the one I've been using that doesn't), and he's down to 9 pounds, 14 ounces. Back in March, before he started having seizures, he weighed something close to 12 pounds on my other weird scale. He's very wobbly - when he shakes his head, the way cats do, he can hardly stay on his feet. I've been getting at least a jar of baby food meat, mixed with lactose free milk, into him every day, but it's clearly not enough maintain his weight, it doesn't contain all the nutrients he needs, and I guess I'm gonna have to see if Dr. G. has any AD at his office. The only things Milk will willingly eat are treats; not much nutrition there, either. I now have three different kinds of dry food to give him with his pills - Wellness Core, Nature's Variety Chicken and Rice, and Wellness Kitten. He seems to prefer the NV, although as of yesterday, he doesn't eat more than two or three pieces of any of them. Maybe I should go out and buy a bucket of Meow Mix or something.

Okay, I got ten cans of AD this afternoon, and so far, have gotten about a half can into Milk. He also ate a few little pieces of baked chicken breast, and a bunch of treats. I'm going to weigh him often.

We have an appointment on August 23rd with the internal medicine specialist (not the doctor that the Ohio State neurologist recommended - when I said that I was told specifically to see him, the receptionist said that my appointment was with his associate. Which might be okay anyway; I know two people who took their cats to the original doctor and were not happy with him. He's supposed to stay the whole day, although I don't know what for exactly. The estimate was somewhere around $500; with ultrasound (which I'd been told wasn't useful for diagnosing the cause of seizures, so maybe the receptionist just made it up), $1200, and with the MRI (which I believe they don't even DO at this office), $2200.

The dosage reduction last week (1/4 pill less each day) seems to have been not a problem, thank goodness. As far as I know, he hasn't had any seizures since the reduction, and I haven't seen any of the "mini-seizures" - the odd behaviors that didn't include the seeming loss of awareness and foaming of the real thing. I wish I knew how rare a result this almost total lack of appetite is with phenobarbital. I have to assume that the phenobarb is the cause, because his appetite diminished immediately after he started taking the stuff.

I was just reminded of one of little Milk's funniest habits (which has disappeared, along with virtually everything else about him that was so wonderful) - he was the self-appointed litter box monitor. He'd sit in the kitchen and watch for the others to use the box, and then he'd make sure everything was properly buried. He'd scritch and scritch and scritch, and the other three would watch him like he was nuts....

This is really getting me down.

Making progress, hopefully.

The veterinary neurologist from Ohio called me back this morning. She isn't in practice any more, so she doesn't need to see Milk. She recommended making an appointment with Dr. J., the IM specialist in Etna. (Which required a referral from Dr. G.) I called them, and their earliest appointment, assuming that I get the referral in, is the last week of August. Which isn't too bad at all. Dr. W., the neurologist, also recommended that I give Milk the herbs that the animal communicator gave me - Gava and Cudweed. She said that they do not impact the phenobarbital. She also suggested the possiblity of using Keppra with the phenobarb, in the hope of reducing what is quite a large dosage. She is concerned with the dosage, and with the weight loss and lack of appetite. So, we're all on the same page, I guess. She was very nice, and is apparently doing this for free....... (She also mentioned that she has been experimenting with a carbohydrate called PSP that is supposed to have a very significant effect on FD. Now that'd be a blessing, too.)

I called Dr. G. and requested a referral, which the technician said she'd send out this afternoon. So tomorrow I'll call and make the appointment. I am pretty sure that this is the same doctor that I was referred to for Scruffy back when they thought that he had FIP, or when he was first diagnosed with diabetes, or something, and the initial appointment was like $800 or something. But, Milkshake's circumstances are so dire at this point that something has to be done. This is unbearable.

Weak and starving both?

Milk's had two very bad days. He has fallen repeatedly. His back legs just don't support him. I don't know if this is caused by the phenobarb; other people on the epi-feline message board also said they had rear leg weakness. But maybe, maybe this is because he's not eating enough, too? The last thing I want to do is recreate his days of being starved. He's so skinny. I weighed him this morning, on that stupid scale that the ounces only go up to .9. The last time he was at the vet's, he weighed 9 pounds, 15 ounces. I'd weighed him at home before we left, and he was 9.9. This morning, on my stupid scale, he was 9.8. Not a lot, I guess - although who knows what he actually weighs, but it's still a loss. Even when I give him two dozen or so pieces of Wellness Kitten dry with his pills, he never finishes more than half. I'm thinking that I need to get some baby food and start bottle feeding him. I don't like poking syringes in their mouths. Or should I ask Dr. G. for cyproheptadine? How come the appetite stimulant part of phenobarbital isn't working at all for him?

Giving him phenobarb is getting more and more depressing; he's still a zombie from the previous dose, and it's time for the next one. Am I supposed to choose for him between this state of being totally out of it or having seizures that have the potential to increase in frequency and severity? I don't want either one for him. I have been periodically giving him one 1/4 tablet instead of two per day(the last dosage increase), which I know isn't recommended, but this is so hard to watch. He hasn't had any seizures since the last increase on July 19, but the cost to him has been enormous. He rarely plays, he falls all the time, and his interactions with the other cats is frequently very agressive and unpleasant when he is awake - a lot of neck-chewing and everyone meowing. Sleeping, he's snuggled up against one of the others just like he used to be when his life was actually a life. The communicator said that it's important to be positive and to affirm the good parts of his life, but truthfully, all I see is a poor little cat that has had a horrible beginning, a decent "middle", and back to horror again, and he's only two years old. I can't watch him wasting away.

The Animal Communicator

Hope, and Dale, and Linda (and Wild Thing) got together and gave me an hour with Morgan the animal communicator for my birthday. The appointment was this afternoon. I was a wreck, thinking that all four cats would tell her that I make them crazy and they'd like to live elsewhere. But she said they like me, they realllly like me. (HA!)

We talked a long time about little Milkshake. He wanted me to know that he'd been with me before, when he had another life. (I wish I'd thought to say, "What life?" - I think so slowly on my feet.) I think he was actually my beloved Black Kitty, who died in 2000. It would seem to explain the instant attachment I felt to him, even in his cage at PetSmart. Anyway, she did a "body scan" on Milk, and she said she saw inflammation and pressure in his head, but no tumor. She suggested the use of two herbs - cudweed and gaba, I think they were (boy, did I have those names screwed up!) - that she'd used for animals with seizures before successfully. I'm willing to try them, although I don't know how I could tell if they were working or not since he's taking phenobarbital. Maybe I could call her again and she'd get him to tell her? It was very touching, and made me cry again and again. There is something undeniably connecting me to this little white cat; I've never had eye contact with a cat before like with him. Phenobarb has sadly taken away some of the things that were most meaningful with him, but maybe they'll come back eventually. She said that he does love the other cats, even Burble. My mind doesn't retain stuff much any more, so fortunately, Dale was recording the conversation at her radio station, and I'll be able to refresh my memory when I get the CD. Another significant thing Morgan said was that Milk's got four or five vertebrae that are severely out of whack and causing him pain. (Could that be contributing to the rear leg weakness? Or could all the falling down have added to the problem?) She said that he said he feels "hazy" before a seizure, but that he "goes away" from his body during one, so it's not scary to him. She also has a friend who teaches neurology at the Ohio State Vet School, but is in private practice, and suggested that I call her friend - Sue W, I believe her name was - and ask her to look at Milk's blood work and tests and stuff and consult with Dr. G. She's in Columbus, which is about a two or three hour drive - so maybe she'd be a possibility for an actual hands-on visit. She practices "integrative" medicine - both the allopathic and the homeopathic, I think Morgan said. (Every time I think about using herbs, I remember the Chinese herbs that kind Dr. Doug had made for Scruffy - a liver flavored liquid that made him foam and foam, and an incredibly stinky pill that was so enormous that even cut in half, I couldn't get it down Muffer's throat. I hope that these herbs are more palatable.)

Little Milk's not having a very good day today. He seems weak and pretty out of it. He's been asleep almost the entire day. And he ate almost nothing but a little of the dry food that I gave him with his pills. He's really back to the "bag of bones" stage. Morgan suggested giving him milk. (Actually, she said, "The word "milk" keeps coming to me." I said, "Well, yeah, that's his name." Anyway, she thought he might enjoy having some milk - and if he'd drink it, I'd be glad to give him some of Rege's lactose free stuff. Any extra calories are welcome.) I want him to be okay. Now.