Neurologist appointment in Akron.

more to follow; just wanted to make sure the date got recorded.

Dr. Todd Axlund
Metropolitan Veterinary Referral Group
1053 S. Cleveland-Massillon Road
Akron, OH 44321

1-330-670-2358 (office)
1-330-666-2976 (main reception desk)



Also to remember:

Physician's Compounding Pharmacy
1-248-758-9100
1-248-758-1831 (fax)

ordered 3 mo. worth of compounded 10mg phenobarb capsules - great service. Cost $78.


And:

Universal Drug Services Ltd.
5B 851 LagimodiereBlvd
Winnipeg, Manitoba R2J 3K4

toll free #: 1-866-456-2456
toll free fax #: 1-866-783-4223

email: info@universaldrugstore.com
website: www.universaldrugstore.com

Free shipping is available for pet medications, but not for human ones. BUT - the price for the generic Keppra is still significantly lower than other Canadian drugstores even with the shipping.

(generic) Levetiracetam:

250 mg 150 tablets $179.50 +$10 shipping (10/12/07)
250 mg. 200 tablets $225.00 + $10 shipping (1/15/08)
250 mg. 200 tablets $225.00 (Coupon for shipping - $10) 3/18/08 (arrived in SIX days!)

#36.

This one makes me question how long all of Milk's seizures have been. I had the camera sitting beside me, so I was able to video from shortly after it started until he jumped down. And it was around 3 minutes, which was a surprise. Very violent, very harsh growling.

Only three days since the last seizure. This is exactly what I was afraid of. I will call Dr. L. again, I guess, although she didn't offer any suggestions about what to do two days ago, except for the bile acids test, which I can't do now because he has to fast for 12 hours, and he has to eat after he has a seizure. Once again, there was a lot of physical movement, and I had to worry about his falling on the floor. There was less jerking after most of the activity ended than usual. He started to jump down and then was too wobbly, so he just sat and stared into space for a minute or so. I was distracted by trying to keep the camera on him.

I don't know if anyone would want to see the video anyway. It is very distressing. I'm feeling a little numb now. This seems to be way out of control, and I have no way to help my sweet boy.

Somehow, this video finally got uploaded. It's very disturbing, to me anyway. Anyone who watches might want to turn down the volume on their computer.

The Plan.

Talked with Dr. L this afternoon. She feels that Milk is at the maximum dosage of Keppra that she has heard of cats using. We don't want to increase the phenobarb. There is another drug that might be a possibility, but she hasn't used it herself, or in combination with Keppra and phenobarb. She seemed to feel that, if a third drug were to be used (and I can't remember what it was called) - it should be prescribed and monitored by a neurologist.

I explained my concerns about Milk:

1) increased severity of seizures
2) increased frequency
3) diminished appetite, although it is improved somewhat

Dr. L feels that we need to get a post-prandial bile acids test done as soon as possible, and based on that (and the comparison between the previous test, which was pre-prandial), she would refer me to a veterinary neurologist in Akron. Where it would be decided, I guess, about doing an MRI and spinal tap. Neither of which I'm eager to do. The neurologist's name, I believe, is Todd Ecklund or Acklund - can't find the paper I wrote it down on a couple weeks ago. (Correction: Axlund.) He was a professor at Auburn. I asked if it was customary for seizures to escalate in severity, and if not, what it might mean. She said it wasn't necessarily usual, but since they don't have the information from an MRI to be sure exactly what's going on in Milk's head, there's really no way to know. She felt that, given his age, it was not particularly likely that he has a brain tumor, but that inflammation might be a possibility, along with something else that I can't remember. Speaking of possible brain tumors.... Anyway, I will have another bile acids test done this week, and then I guess we will go from there. She did say that the 25 he had on the previous bile acid test was not a huge reason for concern - that the area of 50 is more of a problem. I guess that's good news. I'm not totally convinced/positive that he was absolutely food free during the last test anyway. Although, Antech said that they do a "random" bile acids test that does not require fasting and retesting after food. I asked about the urine bile acids test, but Dr. L felt that it would be as traumatic to Milk to have the cystocentesis (and I don't know what Dr. G.'s experience with doing it is) as it would be to have the blood work done. I told her that I would prefer getting blood work done at his office because of the distance, the waiting time, the dogs in the waiting room, and the way that her technicians take the blood. She didn't react with horror.

I am in a state of panic about all of this. I couldn't sleep last night. I stayed up till 6AM, when I was so exhausted that I figured I wouldn't be laying there waiting for Milk to have a seizure. That is disfunctional, obviously. There has to be an answer to this. I feel like he's a bomb, ready to explode at the least provocation, and that there doesn't seem to be any solution. Even if we have the MRI, and it shows something fixable (affordable?), or if it shows something UNfixable, then what?

this was horrible.

#35. Absolutely the worst one yet. Started off kind of slowly, laying on his side on a blanket between and parallel to my calves. By the time the growling and snarling started, he was also beginning to flop violently. He flopped (like a fish out of water) so hard that he sat himself up in the meatloaf position. I couldn't get to him because he was facing me, and all that snarling is very scary - lots of teeth showing. A couple of his claws were stuck in my right calf. And he kept bouncing and bouncing. I was scared that he was going to fall off onto the floor, and all I could think to do was to try to gather the blanket up tightly to try to keep him from falling and to pull him closer, but also to not have to get too close. It sounds like Three Stooges, but it was truly awful. And for the second time, I forgot to put the camera out before I went to sleep, but I don't think that 1) I would have been able to manage taking a video without letting him fall on the floor, and 2) I ever want to see that again. I was so afraid he would hurt himself.

It took about 30 seconds after the flopping stopped for him to come out of it. There wasn't the "moment of consciousness" that was so distinct the last two seizures. He still seemed out of it when he jumped down, and he was very wobbly on his feet. He went to the kitchen to look for something to eat. He ate about 1/3 of one can and then came looking for something else, so I opened another can. He's huddled on the living room floor right now, almost a half hour afterwards.

There were no indications that he was going to have a seizure today. No excessive sleepiness, no differences in food preferences, or activity level, no changes with medication (except that his second Keppra was about 45 minutes early because I had to go out.) Early, you wouldn't think would make a difference, right?

This was a rarity - a "full moon" seizure. I truthfully don't think that the moon phase seems to have anything to do with it. What does worry me is that it's only been six days since the last seizure. This happened before, where they kept getting closer together, until they got to the place where there was only two days between events. I do NOT want that to happen again. I can't say that I've seen anything in his personality or abilities or anything that has been damaged by having three dozen seizures in eight months, but it can't be doing his brain any good, and it's breaking my heart.

I am really upset by this one.

#34, damn it

Totally out of the blue, except that it's been on my mind today that it's been almost 10 days since the last seizure. Is ten days going to be the time frame that has to be acceptable? Well, anyway, it's the 9th day. I was sitting in the kitchen when the growling started. Milk was sleeping in one of the caves on the heated mat in front of the furnace vent - could hardly get much warmer and snugglier. The minute he started growling, all three of the other cats came running, which has almost never happened. And, because he was in the cave - very soft, but confined area, with only two round circular holes at each end, he was thrashing around without much room for the flopping stuff he did during the last seizure. I manuevered the cave around so that he could work his way out of it. Then he could stretch out on the floor.

Lots of saliva this time. A LOT of jerking and body-snapping movement. Again, it seemed like a much more physical, unpleasant seizure than his norm. Even after most of the movements stopped and he was just laying on his side, there were still frequent hard jerks - of his torso, not of his extremities - no paddling movements. He lay for probably a minute unblinking, and then got up but was very wobbly. He didn't come into the kitchen for food until I called him, which is odd, too - usually, he's out here waiting for me to get him something to eat. He seems okay now. No pacing. Ate almost two whole cans of Fancy Feast. His appetite the last week or so has been very poor, and I've been bottlefeeding him again at least once a day, so eating that much is good to see. The only other thing of note today is that he has slept most of the day - in the cave, instead of with me or one of the other cats. He really seems to appreciate the heated mat. I guess I'll watch and see if extra sleeping happens before the next seizure. It might be helpful to have some idea of triggers/forecasters. Not that there's anything to do about any of it....

I would like to know if it's possible to just use Keppra by itself. And if his phenobarb could be decreased any more - I'm thinking that maybe he should have his levels checked again, even though it's only been a couple of weeks since the last test. And if the Keppra could be safely increased. And I don't have a mechanism for conveying information to Dr. L. about what's going on with Milk, either. I would like to be able to email her the seizure record, or this stuff, or whatever. Faxing doesn't seem to be something I'm gonna be good at.

A very different quality, somehow.

This morning's seizure was very different from the last five or six. It was very short, and much more physical. I was going to say "violent" - but it wasn't really violent, I guess. He must have been laying on his side when it started, and the jaw-clicking that accompanies the salivation seemed to take a very long time to get going. I usually try to gently stroke and wipe him up and talk to him during a seizure, but he was a little too far away to reach. (And I'd had the camera sitting there at night for days now; forgot to put it out last night...) The "violence" was mainly his body flopping like a fish; there almost appeared to be a sort of rippling from his head to his tail. There hasn't been that much movement during a seizure for quite a while. Growling started a few seconds after the beginning of the seizure, and was much reduced in volume. This was a quick but mean one, I guess. Over rapidly and very abruptly, with a distinct moment in time when it appeared he was himself again, although he didn't move. After it ended, he just laid there, with his eyes wide open and unblinking for a good minute and a half. And then, he abruptly stood up, jumped down, and headed for the kitchen to eat.

It's been 10 days since the last seizure, which is good, not that it wouldn't be nice if it had been 10 weeks, or years...... He started the generic Keppra from Canada earlier this week, and last night, he had the last of the 6 month old phenobarb Vet Chews. He's a little wobblier these days than he was, say, a few weeks ago. And he's not eating as well. I've started giving him the occasional bottle of Wellness again; he won't eat it from a dish on his own.

Today he's scheduled for another chiropractic appointment. I was thinking that maybe I should cancel it, but upon further consideration, this might be a good time for the treatment, since his muscles and joints have been through this ordeal so recently. Boy, I hope he never has a seizure in the carrier.

A whole big screw-up with the medication

We're coming to the end of the brand name Keppra, and at the same time, of the now-expired chicken-flavored phenobarb Vet Chews from BCP. I called the compounding pharmacy that was so unhelpful about fixing the liquid Keppra, and they were even more unhelpful about making me capsules with 10mg of phenobarb in them - they said they wouldn't do it; they would only make a 10mg liquid. We didn't have much luck with liquid before, and it was very traumatic for Milk (and for me!), so I guess we'll have to spend the $40 a month for Vet Chews. Tuna flavor, this time.

Milk won't eat the Chews - apparently regards them as being too similar to Pill Pockets - but they do make pilling him simpler. I asked Dr. G. to fax them another prescription, as the original refills had mysteriously expired (less than a week ago, of course) in only six months. I thought that everything was arranged, only to find out that, because phenobarb is a controlled substance, they have to have the actual prescription in their hands. I am HOPING that Dr. G's office was able to get the prescription in the mail yesterday, because I only have enough 10mg chews left to last until Friday. If the mail works efficiently, and BCP does the same and gets the chews in the overnight mail, hopefully, it won't screw things up any further. It's been another week since the last seizure. I could live with two a month. I'm a little nervous about the generic Keppra working the same, and they're larger than the brand name was. I wrap them in Pill Pockets and pop them into Milk's throat, so they should go down just like the other ones. If only they WORK like the other ones.....