Dale asked me last night how Milk was doing, and I said that, excluding the two seizures back in January that I discount because I'd screwed up the time or he missed the pills, he hadn't had one since Dec. 1, 2007. I'm discounting today's, too. (How much self-delusion can fit on the head of a pin, or whatever those expressions are?) Anyway, the excuse this time is that I was doing something, and not watching the clock, and his midnight phenobarb wasn't given until 1:38AM. And then I compounded the error by - since it was so close to 2:00 AM, when he gets his last keppras, giving him the Keppra at the same time. So, one pill was almost two hours late, and the other ones were almost a half hour early. Is that a formula for seizures? Maybe. Apparently. Possibly. And he was odd during the night - woke me up at least four times, jumping around. Usually, he falls asleep, and that's pretty much it for the night. In the AM, he's so deeply asleep that I have no problem grabbing him to give him his pills at 10:00. So, anyway, while I'm really disappointed that it's happened again, there seems to have been a reason. Now I'm worrying about if there's gonna be another one, and how soon - it scares me to think that they' might be two or three days apart again.
Description of #40: very little preparatory jaw snapping. In fact, he was actually growling before I realized what was happening. And I couldn't remember what I should do - it seems like it's been so long since the last time. (Well, not really, only 3 weeks, but....) I didn't have my glasses on, so I don't know if there was a lot of foaming that got wiped off on the blanket; his face and neck weren't terribly wet by the time he started to eat. This was one of the milder seizures physically - very little flopping, and not the violent stuff from before. Growling, but more a less-ferocious continuous background noise than previously. And instead of the abrupt ending that the last three or four have had, when he stopped flopping and growling, there was more occasional jerking afterwards. Duration - oh, probably 40 seconds for the whole actual seizure, and maybe another 20 or 30 seconds before he was totally still. Then he just laid there for a minute or so before getting down to look for something to eat. No pacing. Quite a little appetite - he ate just about an entire can of FF, and then I gave him a little dry EVO and FF, too, and he ate almost all of that. (I can't bear to miss the chance to actually get a few calories into him.)
So, my conclusion this time was - timing error once again. It appears that there's a very close line between dosing that controls the seizures and the outcome when I screw that up. I had already decided that it seems that he's within a half-Keppra (125mg) of control with the present dosages. And now it appears that the timing of his medication is becoming more of a cause. On a couple of occasions, because I couldn't find him, he's gotten his pills as much as three hours late. Going by this seizure, that may be an increased risk now, for some reason. And also, this seizure makes me think that maybe totally removing the phenobarb might not be a possibility, no matter how desperately I want it to happen. There has been some discussion on the epikitty board about TID and BID Keppra, and the problems with phenobarb levels recently. I am pretty much convinced now that, unless his next bloodwork shows even worse levels, he should just stay on half a phenobarb BID and be done with it. (The last bloodwork was taken on the same day I had decreased the phenobarbital to a half pill, so even though it showed a higher level, it wasn't reflecting the current dosage. Hopefully, that'll make a difference. Hopefully.)
All in all, a very disappointing way to start a day.....
