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.
