Halloween!

It's Halloween! And, once again, my sweet Milk is a most cooperative feline model.

Things are still going along quite well for him, thank goodness. We've got another seizure-free month under our belts. (Well, since neither of us wears a belt, that's not a particularly apt image, but, you know...)

Although he's eating enthusiastically, his weight is still a minor concern. He's a very long, tall cat - particularly considering the early malnutrition - and when he weighed 12 pounds, he was a perfect size. None of this you-can-feel-every-one-of-his-ribs-and-veterbrae then. But that seems to be the only worry for right now. He does need to have both his phenobarb and keppra levels tested again, but I am feeling (surprisingly!) confident that he will be in a good range on both. Hopefully. Well, maybe "confident" is slightly overstating my attitude. "Confident" is not generally in my range of emotions. But maybe, just maybe, his keppra level won't be in the 50's and his phenobarb level won't be in the 30's. Oh, I hope......

One more picture. I just love the way he looks like he's laughing and winking in this one - it's rapidly becoming one of my all-time favorites. There are no words to describe how much I love this skinny little happycat.




Hi, Marianne!

MAJOR MILESTONE!

Just slide your eyes to the right, and notice that the yellow box says, "365 days since Milkshake's Last Seizure" on his little calendar doohickey! ONE YEAR! Amazing and wonderful and shocking and stunning and just plain lucky!

We've had our ups and downs with this disorder. Phenobarb levels that were scarily high, a year-long battle with phenobarb-induced anorexia, continued seizures that seemed to be getting increasingly violent....... The addition of Keppra wasn't an instant solution, but seems to have made a very significant contribution to getting to this point. When I felt that the phenobarb dosage HAD to be reduced because of the anorexia and the rising liver values, it appeared that increasing the Keppra was the only alternative. The neurologist I consulted when the IM doctor here refused to consider increasing Milk's dosage said to give him "what it took", because Keppra and its functioning in epileptic cats were basically still pretty much a mystery. And we got up to fairly scary amounts of Keppra - every time I brought Milk in for bloodwork, a technician at my regular vet's reminded me that he was taking more Keppra than she did! Back in February of 2009, the last bloodwork indicated that his Keppra level was almost 53; despite the fact that there are actually no standards for cats on this drug, the high end of the human range is significantly lower than 53. It made me nervous. So, I started lowering the Keppra dosage. (I had been dosing him by using the "chunk method" - we had 500 mg pills, chopped in quarters for the basic 125mg dosage, plus a "chunk" of a quarter pill chopped in half. Very inaccurate method of selecting a dosage, but the best I could do without grinding and measuring and whatever else would have been involved in trying to be precise and exact with this medication.) Within a matter of weeks, all of the "chunks" were history. And then we changed from the Canadian generic Keppra to the American one, which was significantly smaller; I don't know if that meant that there were fewer fillers or what, but he's definitly getting less of whatever is in them than he was. And so far - knock on wood and do whatever else might protect my little white kitty and keep him seizure free - it's all working.

None of this has been simple. For the last year and a half, my life has revolved around Milk's medications - first twice a day, and then, for more than a year, four times a day. (I would desperately like to try eliminating that 6:00 PM Keppra, but I'm too afraid to make any more changes at this point.) We went through a horrible period where I would spend HOURS every day, attempting to capture Milk in order to pill him. The solution turned out to be simple - bribery. He discovered that he really really liked Temptations treats, and suddenly, with that amazing internal clock that cats have, he was around when it was pill time. No more tears of frustration (mine, not his!), no more multiple trips up and down the steps, no more trying to sneak up on him from behind. It was wonderful. We're not so good about sticking precisely to the schedule - sometimes his pill - that stupid 6:00 one! - is a couple hours late. But, so far, so good.

I will never be happy about the effect of phenobarbital on my cat. He is still wobbly and uncoordinated. If he's walking along and he decides to shake his head, he has to quickly get into a wide stance to keep from falling over. He falls fairly frequently because his body doesn't go where he thinks it's going to go. He is normally alert now, and doesn't sleep more than any other cat, but physically, I see the action of the phenobarb in everything he does. Would I sacrifice the absence of seizures if it meant that he could have normally graceful cat movements? Nope. He has other quirks - he eats huge chunks of the other cats' fur when he can find them like it's a delicacy; he's a gnawer - the corner of my desk drawer and the crank for the window have his teeth marks all over them. He loves toast crust. And he loves snuggling with Busy and Scruffy and Burble. (NOT Minnie and Tootie - he's terrified of both of them!)

I have a terror that I'm going to jinx things by talking about it, but I'm so thrilled and happy and yes, blessed, that Milkshake has been spared the horrors of those seizures that I guess I am willing to take the risk. He is my treasure, one of only three very special cats who went straight to my heart from the very first minute I saw him. Taking care of him has been scary and has demanded a lot of rearranging of plans and "life", but I would do it all again a hundred times. He was truly a gift to me, and I am so grateful to have him.

I knew it.

Brought the baby scale back home yesterday, and weighed Milkshake the minute I set the scale down. Eight pounds, ten ounces. Close to half a pound less than in April. What I can't figure out is, he's eating very enthusiastically at every opportunity. He cleans his plate, and makes repeated trips to see what everyone else has left. He has even starting eating bits of people food, which should probably bother me, but doesn't - I'm just delighted to see him enjoying any food. The one problem he has around eating - and it's a Tootle problem - she's so aggressive, and he's terrified of her. She will come and sit a couple of feet from Milk while he's eating, and within a matter of seconds, he will wander off and allow her to finish his dish. If I chase her away and put him back down in front of his food, he will eat until the next time she shows up. Moving the dish (and Milk) around to what may seem like safer places isn't much use; he's still the most vulnerable of the six cats and they all know it.

I could start bottlefeeding him once a day to see if he gains any weight, I suppose. Truthfully, I hate the thought of it, and I wouldn't want to do anything that reduces his own newly-functional appetite....

We are 20 days from his one year seizure-free anniversary. I can't believe it! I would love to try lowering the medication, but I'm too afraid to do it. This seems like a disorder where, if something is working, you don't screw around with it unless it's absolutely unavoidable.

I do want to make an appointment for bloodwork for him in the near future.

It's been a month + since the last post?

I'm shocked. I guess because life here has been careening along at a stomach-turning pace or whatever. Well, "careening" and "stomach-turning" are sadly appropriate, at least.

Not much new with my little Milkshake, who continues to eat enthusiastically on his own, but who appears to be distinctly losing weight. (I loaned my wonderful Japanese scale that Hope gave me to my daughter-in-law, thinking that she might want it to weigh our lovely new granddaughter, Gracie. Now I'm wishing I had it back, because I'm pretty sure she's not using it anyway...) He seems perfectly normal in all other ways. He needs to have his phenobarb and keppra levels tested again, maybe next month. I'm looking forward to seeing what the keppra levels are - if they've improved/been reduced significantly, because he continues to be on a reduced overall dosage, plus the US generic levetiracetam pills are significantly smaller than the previous Canadian ones.

Two days ago, I picked Milk up to put him on the counter to give him his pills, and discovered that Busy has apparently started gnawing on him again. There is a fairly large open wound - size of a dime, maybe - on the side of Milk's neck. Previous Busy attacks were on the back of his neck, closer to the shoulder blades. I don't know if this is a seasonal thing with Busy or what. He seems to be having his own problems lately - he is incredibly clingy. I think that we have just been in such a state of upheaval around here that none of the cats is living what would have been a normal life a couple of months ago. We need to get back to that state of what passed for "normality" as soon as possible - the commotion has hurt all of us.

I have been really surprised that Milk has shown so little interest in the kittens. Given his attachment to and need for physical contact with the other cats, I would have thought that he'd be spending a huge amount of his time sitting at the screen door to the bedroom, communing with the five little guys. Probably if they were out where he could get his paws on them, it'd be a different story.

We are just slightly more than 11 months from the last seizure. (Didn't get to see the Seizure CountDown box before typing this.) Hoping desperately that this streak continues......



*Hi, Marianne!

so far, so good, part II

It has been more than a week - two weeks, maybe, since we started the American generic levetiracetam, and it seems to be working just fine! I'm very relieved. There are significant differences between the previous brand from Canada - the shape of the pills, the thickness, and particularly the overall size. The US one is much smaller, and a better shape for cutting. It does worry me a little, because it seems as though I must be giving him much less than previously, but there must have just been a whole lot of fillers in the Canadian drug. Going to continue to keep my fingers crossed that everything stays just the way it is.

Someday I'm going to write something about this subject and it's not going to make me shudder with superstition and the need to toss salt over my shoulder.....

just stuff.......

I was sitting here at the computer the other night, watching while the cats ate. And I realized I was smiling to myself because not only was Milkshake, the "former" anorexic, eating willingly, once he'd finished his own plate, he had wandered oh-so-casually over to Minnie's dish and polished off hers, too. Until I had him, and feeding him was such a crisis for so long, I never really thought about the cats' eating. I put it down, they gobbled it up, The End. At any rate, although he's not gaining any weight - at least he's not losing any noticeable amounts, and HE EATS. Like he actually enjoys it again.

There are a mere 3 of the levetiracetam (generic Keppra) pills from Canada left in the bottle. That's twelve doses, three times a day - four more days. I'm nervous about starting over with the American generic. I know that it's not recommended that non-brand name anticonvulsants be used, in the first place. I don't know what/if there will be a difference - aside from the visual aspects - between the US and Canadian generics. The US one - which ended up to be more than $30 cheaper than the original quote from Costco (a mere $94.73 for 200 500mg pills - and $130 less than I had been paying for the Canadian drug!) is a different shape. It's got rounded ends, which I would think would be better in terms of chopping the pills in quarters. There is a score line across the center, too - another plus. I haven't cut one yet, so I don't know if there's going to be a lot of "dust" when these new ones are cut, or not; there were frequent tiny little bits all over the place with the Canadian brand.

Aside from brand differences, I'm nervous about the dosages, too. We're pretty much down to giving (approx.) 125mg TID, which is quite a reduction from almost a year or so ago. I'm terrified that this change might set off another series of s******s. (Phenobarbital dosages have remained the same - 1/2 tablet in the AM, 3/4 in the PM.)

Time will tell, I guess.

Just one of my favorite pictures of Milkshake....

No particular reason for this, I just came across it tonight and thought I'd stick it in here. It does make him look kind of tiny, when, although he's skinny, he's really tall and long.

Fearful

I didn't realize it's been a month since I last posted here. There've been a lot of not-so-happy things going on; I've been distracted, I guess.

I am seeing odd behavior from little Milk this spring. He's always been a shy cat - never around if the doorbell rings, or if the mail truck pulls into the driveway. And he's not the kind of cat who sits at the top of the steps to greet visitors. But, he's way beyond that this year, and I can't figure out why. He's even reacting with fear and withdrawing when he hears Rege open the garage door. He seems hypersensitive to noises outside. And the things he enjoyed last summer and spring (before the windows and door were closed all the time), like the turkeys gobbling and the birds at the feeder - a lot of the time, he sits on the window ledge, but he appears to be poised for flight, not to just watch the birds.

There really hasn't been much in the way of change for him. He's still not crazy about Cinnaminnie and Tootle - they're both too aggressive for him, and he tends to avoid them. But that's been the pattern for the whole almost-one-year that they've lived inside. Probably the big change has been the decrease in his medications - but you'd think that would make him more normal, not less. I don't know. His balance is still off; he's as likely to tilt over when he's walking along as not. And he's been spending a lot of time sleeping in the closet in Stephen's room. I miss having him beside me. Tonight, I looked for him for more than an hour, walking from room to room jiggling his treat bowl as an enticement. I still have no idea where he was. I crawled all over the place, looking under the furniture and in the closets, and there was no sign of him, until he showed up in the kitchen, yawning and stretching.

And the stupid feline acne has returned multiple times. Every time I think I have it cleared up, it shows up again. He really hates the medicated Stridex pads, and I'm nervous about them because they have salicylic acid in them, which is the same stuff (I think - but then, what's "acetylsalicylic acid"? Maybe they're not the same - anyway, I don't want to take a chance.) that's in aspirin and is toxic to cats. I try to be very careful not to get any of the liquid anywhere near where it might end up in his mouth, and I rinse and dry his chin after I clean it. Poor little guy - he never gets a break.

Burble's fourth birthday is next week, May 3, which means that Milkshake's around three and a half. (I never can remember this stuff. I think I'll just record it here periodically.)

Oh, and hi, Marianne!

Generic Keppra (levetiracetam) information

Generic Keppra - levetiracetam - is now available in the US. I normally order 200 500mg pills from Canada, so they last me quite a while, and I hadn't priced the new generic, until today. ****ETA: Blog entry for 6/09 shows the actual Costco price of $94.73 for 200 500mg pills!!!

I was picking up Milk's phenobarb at Costco this afternoon, so I asked for a price for generic Keppra. And was shocked! About $100 less than I have been paying from Canada, and I don't think that the AAA discount was applied. (Sometimes Costco says that their prices are already so low that they don't give the extra discount.)

This is the total cost the pharmacist gave me for 200 500mg levetiracetam pills at Costco: $129.70!

On-line, the prices apparently include the cost of shipping and handling - here are their generic on-line prices for 500mg pills:

30 pills - 28.71
50 pills - 43.55
100 pills - 81.91

(I don't know if doubling this price would be the actual charge for 200 pills or not, but that would be a whole lot more than $129.70! It makes me think maybe the pharmacist made a mistake, but I asked her to doublecheck, and she said the $129.70 was correct.)

I just opened the second Canadian bottle of 100 tablets, but it makes me feel like I should rush out and buy some more at Costco RIGHT NOW!

A day late.....

Last night, around 11:15 PM, was the moment of the second anniversary of Milk's first seizure. Not such a happy event, needless to say, but there is some comfort to be taken now, I guess, from the fact that he's still here, he's still sweet and loving, and it's been a good while - *anti-jinx* - since you-know-what. I had NO idea what to expect that first night, which was probably a good thing..... I want to thank all those who gave me moral support to get through the hard patches here.

So far, so good.

I am, as usual, afraid to actually SAY anything about Milk's seizures. *anti-jinx* all over the place. I'm a little vague on the exact dates/times/etc, but since the return of the bloodwork a month or so ago, with numbers that I wasn't crazy about, I have reduced both his phenobarb and keppra by a small amount. We're still dosing by the "chunk method", which is an inefficient way to do it, I realize, but it seems to have worked for the last 7 months or so. He now gets:

10:30 AM - 1/2 phenobarb tablet (8mg.approx), 125mg (approx)levetiracetam (generic Keppra), and 1/2 Marin tablet. Depending on the size of the 125mg "chunk", sometimes I may add a smaller 1/8 tablet chunk, just for good measure. (Just as an aside, the phenobarbital is made by WestWard pharmaceuticals, which is located in, amazingly, that rich Arab country in Africa - oh, I hate my memory, or lack of it these days - where they built the indoor ski resort, and the giant hotel, and all the American universities have branches now? DUBAI!! Someone from there looked at one of these blogs... crap. When I remember it, I'll come and edit this. Anyway, these pills are better - although they're harder to find, and Costco charges more for them than CVS does for the other brand - but these are a flat, thin pill. The other ones are so small and tall/thick that splitting them into two, much less four pieces would be impossible. And the levetiracetam comes from www.universaldrugstore.com in Canada. I haven't priced the new USA generic Keppra, but someone else said they were still $1 a pill....)

6:00 PM - 125mg Keppra, 1/2 Marin tablet. (Occasionally, I give him 1/4 tablet of Pepcid AC here, because the Marin can cause stomach upset unless there's food in there, and Milk's eating is a little erratic, to say the least. He does eat on his own, but very rarely the minute I put his dish down, and he's likely to graze most of the day from that first feeding. He's one of the most enthusiastic consumers of the raw chicken/supplements - he loves his chunks.

10:00 PM - 3/4 (approx. 12mg) phenobarbital

2:00 AM - 125mg Keppra + 1 chunk (approx 1/8 of a 500mg tablet). Now, my math is poor, but I think 500mg divided by 8 equals about 65mg, which seems like so much more than one of those little chunks could possibly be..... I don't know. At any rate, I am still using uneven dosages, which is frowned upon, but it makes sense to me because almost all of his seizures were in the very early morning - so, I want to make sure that there's plenty of medication keeping his brain in order during the night. It might not be correct, but until something happens to convince me that I'm wrong, I'm going with it, because, as I said above - "so far, so good...."

This is the Annual Spring Neutered Male Crazy Period around here. And this year, we've added the presence of Cinnaminnie - unspayed Feral Female Extraordinaire, and her slightly nightmarish - but at least SHE's spayed - daughter, the lovely but exceptionally grumpy and aggressive, Toot the Tortie. So, now, the battle is between crazy and mean, apparently. Tootle and Minnie are both quite fearsome to the boys; a significant part of their days is spent chasing shrieking males twice their size up and down the steps. Tootie has devoted most of her attention to Burble lately. He outweighs her by a good five pounds, and is three times her size, but she doesn't let that deter her. She butts him aside from his food, she growls at him any time he walks by, and she will sit in the doorway to the bathroom, where he likes to explore the closet, waiting for him to show up so she can launch herself upon him. Minnie's favorite target is poor Scruffy, who has never bothered anyone else, ever. I watch The Girls carefully to make sure they're not aggressive with Milkshake, because he's still wobbly enough that I don't want him falling off something whilst trying to escape their not-so-loving attentions.

I guess, as Johnny Carson used to say (or DID he?), And so it goes...... Maybe it was Red Skelton. (I touched Red Skelton once. Well, actually, I bumped into him coming down the steps into the formal entry in Thomas Jefferson's home, Monticello. That was in the days before celebrities had entourages, I guess. Nothing like a little free association every now and then, right?) Or maybe it was Charles Couralt who used to say that...

The other day, a very interesting person who owns a bunch of ferrets, one of whom is diabetic, posted a picture on the Feline Diabetes Message Board. I don't know where she got it from, and I am frankly ashamed that I didn't ask her if I could "borrow" her picture, but it struck me as being SO funny, I could hardly see straight. So, on this note, I'm done for today:

Such a nice comment ( #2)

And this one, which came today from my too-faraway-to-hug internet friend, Linda:

"Those of us who have been truly owned by a cat do know that look that passes between us. Not ever having children I can't be sure, but I always think of it as the same kind of bond exists between a parent and a child, only better. To look at them and have so much love in your heart that you feel like your chest will burst."

I don't want to be sloppy about all this, although sloppy is one of my most well-developed attributes, sadly. But I've been really upset for two days about the story on the internet about the kid who put a video of himself torturing his cat on YouTube. I can hardly bear to think about the whole mess. The nightmarish kid, the poor cat, the parents who are going to have to try to "fix" this kid......it all makes me sick.

But - it makes me feel better about the world and all the sad and unpleasant things in it to know that there are people like Linda and Leeta and Hope and Marianne (and, I guess, me and a ton of other people on the Feline Diabetes Message Board, and the Yahoo Epikitty Board and wherever) who do care and who find love and satisfaction and reward beyond description from the sentient furry beings who share our lives. Sometimes things DO work out just right, I guess.

such a nice comment........

There have only been a few comments to the blogs for my two cats. And they've been mostly from people who "know" the cats. Well, or who know me.... Anyway, tonight, there was the following really nice comment from "Leeta." It made me cry. Let me post it here, and then I'll explain.

leeta said...

I just wanted to tell you that I love your relationship with Milk. I don't even quite know how I managed to end up here (seems to me last conscious moment I was looking at something with Verizon billing and I guess I wandered a bit! LOL!) but I am glad that I did. So many things reminded me of so many days with my baby girl Miss Kitty. She didn't have epilepsy but that was one of the few things she didnt have. The last year of her earthly life she had two strokes and congestive heart failure but right through it all she wanted to keep going. Until well, I guess that one day or really a couple days before, she got tired or just didn't want to keep doing it. Its been 1 year and almost 3 months since I've gotten to see her little kitty face shining up at me, containing all the love in the world, and not a day goes by that I don't miss her. I hope that Milk lives another 20 years or so, long enough for them to figure out how to give them human lifespans so that you guys can grow old together. Relationships like that should never be apart. Thank you for posting your blog. It is beautiful.

March 4, 2009 3:11 PM"

I am so touched by this nice person's taking the time to make this comment. And for her to talk about her Miss Kitty's face "shining up at me" - sometimes you sort of think that the way you feel about your cat might just be a smidge over the top or something. The "crazy cat lady" syndrome. SO, it's nice to have someone else freely talking about her love and affection for her cat, and to think that we all are not (necessarily!) crazy or nuts or emotionally stunted or whatever. We just love them. Right? Thank you, Leeta, and I hope that Miss Kitty sends you another cat for you to love desperately and wholeheartedly, and to love you back...

Still not sure.....

what to do about all these medication issues, and so far, Milk is still seizure free but very wobbly.

The urine bile acids test required a very small amount of urine. Results were reported practically the minute they got to Antech in New York. (Literally. The specimen was dropped off at the vet's about 1:30 PM on Monday, and the results were faxed back at 7:30 the next morning.)

Here's a copy of the results:

"Urine Bile Acid: Creatinine Ratio (USA-UCr)

Bile Acid (Urine) ******* 21.2 umol/L
Creatinine (Urine) ***** 400.6 mg/dL
UBA/UCr ************* 0.5 ********* reference range: <4.4


In order to permit measurements of bile acid in urine specimens collected at arbitrary times, urinary creatinine levels must also be obtained. The concentration of urinary bile acids in urine is calculated as follows:

the concentration of urinary bile acids (umol/L
------------------------------------------------ x10
the concentration of creatinine (mg/dL)

False positives may occur with specimens that contain elevated amounts of ascorbic acid."

So, this appears to say that bile acids are fine, but I guess the next project is to find out exactly how this test relates to the elevated blood ALT level from last week's bloodwork. I'm not sure if what the two tests measure is even related. It was my impression that the ALT can be a reflection of inflammation or stress anywhere in the body, but Dr. G. said that it's only a reflection of what's going on in the liver.

I feel a pressure to try to reduce both the keppra and phenobarb levels, but I'm not sure that's safe or reasonable to do. I certainly don't want to do them both at the same time. I feel more urgency to see if the phenobarbital can be reduced back to the dosage it had previously been at in August, (when it tested at 26) because I do think that the symptoms now - wobbliness and incoordination and erratic appetite - have typically been phenobarbital-related in Milkshake.

The Dilemma

I was afraid of this. The Keppra and phenobarb levels came back this afternoon from Auburn. The bad news is the phenobarbital levels are 33.8, and the Keppra levels are 52.7. While I'm not so surprised about the phenobarb numbers - not HAPPY about them, but they were somewhat expected, given the physical difficulties I've been noticing for a couple weeks - the Keppra levels were something of a unpleasant surprise. (The technician I talked to at Auburn last week said to make a note to Dr. Booth, who's apparently in charge of their lab, asking about whether they have developed feline levels, or if they are still using the human numbers. However, when I got to the vet with Milk on Tuesday, the technician had made her own copy of the form for Auburn, and I wonder if she copied my question to Dr. Booth on the one she made? At any rate, there was no response from Dr. Booth.) The odd thing is, I've been cutting back the Keppra for the last three weeks or so. Milk now gets 1/4 and approx. 1/8 of a 500mg pill TID. That's about 187 mg each dose, I think. Significantly less than before. (Or not, depending on the accuracy of the previous math.......)

In the end of August, '08, when Milk had that run of three or four seizures over the course of a little more than a week, we increased his phenobarb dosage from 1/2 of a 15/16mg pill in the AM and 3/4 of a 15/16mg pill in the PM to 3/4 at both times. It seemed to work, and even though he had a couple of seizures at the end of September/October, I didn't make any changes in the amount of phenobarb, and he's now made it for 141 days since the last seizure. And, in the real world, 33.8 isn't way out of whack for phenobarb levels. Except, as Dr. G. said, except for Milkshake. The combination of the pheno levels at almost 34 and the ALT in the 200's certainly seems to imply that something's going on with Milk's liver. I guess that makes doing another bile acids test imperative. (Have not seen this cat near the litter box ONCE since we decided to do that testing. NOT ONCE.) I think I'm also going to add another 1/2 or whole marin every day.

Dr. G. wondered when he called tonight with the results if we should send a copy of them to Dr. L - the IM vet I didn't care for at all, and who said that she'd never approve giving a cat more than 125 mg of Keppra unless their weight justified it - or to Dr. A, the neurologist in Ohio. He was a consultant, rather than a person who seemed to intend to have a long-term relationship as Milkshake's doctor. I think Dr. G. would appreciate having someone to consult with about this whole mess. Now that there's actually a neurologist in Pittsburgh, maybe I should ask for a referral? The trouble is, I don't want to have to go through the pressure to have an MRI again, or to put Milk through any number of unpleasant tests and appointments unless it's unavoidable.

Nothing's ever simple, and sometimes it really stinks.

Bloodwork

I've been concerned about the increasing wobbliness Milk's been showing, and it's been about 5 months since his last phenobarb levels were done, so, I've decided to combine the phenobarb and Keppra testing, and have the vet do his local office testing for a regular CBC. My poor little white cat - he was quivering so hard it was visible the entire time we were in the office. And, while the vet did attempt to get the blood from Milk's thigh, he couldn't get enough. So, now Milk's got the shaved neck. I can't imagine what it must be like to see some total stranger coming toward your neck with a syringe, while another total stranger is holding you so you can't move. Poor cats.

Anyway, Dr. G. just called - didn't give me all the results, but I will ask for a copy the next time I'm down there. I had told him that I was interested in liver function results, and it turns out that the ALT was in the 200's - normal goes up to around a hundred. He suggested that, if I'm concerned, we could do a bile acids test; the original one, when Milk was diagnosed, was not done fasting, and we didn't do the preprandial/postprandial version. I told him that Antech can now do the urine Bile Acids test, which I would prefer. So, I think when they let me know how much they need, I'll have to devote myself to collecting a specimen. I am almost certain that a sterile test (using cystocentesis) isn't necessary, which would be nice; I'd rather not have to take Milk anywhere for as long as possible. (Turns out they need just a teeny 1 ml of urine - I asked Dr. G how much that is - no head for metric measurement - and he said a teaspoon is 2.5ml. I'm a little out of practice for catching urine since Scruffy's been off insulin, but I think I can probably do it, although Milkshake's not nearly the carefree pee-er that Scruffy was, and he doesn't seem as regular about it.

I have kind of wondered about the phenobarb levels. Before, whenever his levels were around 26, he usually started eating on his own again. So, I've been going along, thinking that, since he's eating with a degree of enthusiasm, his phenobarb levels must be okay.....Not necessarily true, I suppose. Rats.

Well, another 60 dollars for the urine bile acids test, which is worth doing, I guess. I've been giving him 1 Marin pill a day; I could increase it, after we see what the phenobarb levels are. I just don't think that reducing or removing phenobarbital is possible for Milkshake. Not without setting off a whole cascade of seizures, I'm afraid. And undoing all the seizure-free times he's had in the last six months.

I have a vague memory that ALT is responsive to stress and infection somewhere in the body - maybe the stress of today's visit, or the beginning gingivitis might have had an influence?

Dr. G. asked me how and what Milk is eating these days, and when I said he's eating enthusiastically for the first time in three years, and he's getting half Fancy Feast and half raw, Dr. G sort of collapsed in shock against the wall and started stuttering about salmonella and e coli. (When he asked if there was a less disease-prone animal than chicken to feed raw, I said, "Well, yeah, they've got rabbit and now there's frozen ground mouse." It was cruel; I shouldn't have done it.

The third adoption anniversary

Well, the good news is, no tears this year.. The bad news is, I completely forgot about the anniversary until about five minutes ago. Which doesn't, of course, mean that I don't care about the milestone. I just have a really lousy memory and not much interest in the calendar. Plus, I actually finally managed to get Milk trained to show up when I jiggle his tupperware container of TempTations. Thank goodness.

I have been a little concerned about him in the last couple weeks. Milk seems wobblier than he's been for quite a while. He is eating fairly enthusiastically, which is wonderful. He even gained an ounce since last month. Still, there are small but noticeable balance issues, for instance. God forbid he should decide to shake his head when he's in any position but lying down. I have an appointment to do phenobarb and keppra level bloodwork. Anyway, I have dropped the second chunk of Keppra with his 2AM set of pills, and it doesn't seem to have made any negative impact. I'm just afraid to take the chance of setting off a whole wave of uncontrollable seizures, when things have been going so well for so long.

On a happier note, as the picture above shows, Milk has finally gotten semi-close to Cinnaminnie. Not touching her, but in the vicinity. Not much chance of his ever accomplishing that with Tootle, though....

No funding for the study...

Just noticed this post in the epikitty site:

Re: Clinical trial evaluating new anti-epileptic drug in cat

Hello again. Well I have good news and bad news.

The good news is that our study protocol was approved by the Cornell
IACUC, meaning that we have permission to proceed.

However, the bad news is, we didn't get funding.

so the aims of the study may change a little. Most of the funding was
aimed to allow people to have a MRI and CSF tap on their cat. Since we
cannot do this now the "requirements" will have to change.

Instead the study title will be changed to "suspected epilepsy", based
on their neurological exam and length of time they have been seizuring.

What does this mean for you guys?
-basically, we'll start with the cats who are already on zonisamide
and try to come up with some statistics with those guys first.

-therefore, for those of you who have your cat on zonisamide already
and still would like to participate, please send me an email to my
yahoo account. It will be easier to track everybody since the message
boards can get kinda "messy" at time.

thanks again,
David




I think there was only one cat on zonisamide in the epikitty group, and they were in Arizona, so it would be unlikely that they'd be able to get to Cornell for examination. It's not very clear from Mr. Brewer's post exactly what the purpose of the study would be in its revised state; I assume it would still be to look at the use/value of zonisamide. Maybe there will be more information in the future. To my mind, the MRI and spinal tap requirements were a negative; I really don't want to do that to Milk...

In other developments, the wonderful little muscle shirt from Sandy and Black Kitty arrived - it is so nicely done! It fits very well, too. Gotta get a picture of it.

A major achievement! And an "ugh".......

Today is Day 102 since Milk's last seizure. (I am truly afraid about acknowledging it, but it's such big news for him!) It is the longest period of time he's gone between seizures in the nearly two years he's been an epileptic.

I started to figure out how many days in 2008 he was seizure-free. The math got me down, but he had - the most notable figures - one period of 84 days, and one of 102 days, and this one (102+) that will hopefully go on and on and on. He had 13 seizures during 2008 - almost the same numbers of seizures he had during the first week or so before he started on phenobarbital in 2007! There were 37 seizures in 2007, between March 23 and the end of the year. Three cheers for large doses of Keppra?

There is a record on the right side here of his assorted dosages and any changes that were made. After the breakthrough seizures in August, 2008, I did reluctantly increase again the 1/4 tablet of phenobarb that I'd reduced previously. It's been about four months since he had his phenobarb blood levels done, so I guess that's the next task. I suppose, if they're taking blood anyway, we should get his keppra levels done, too. I would like to know first if they've completed their studies at Auburn to see what the norms for cats on Keppra are, though. I believe, however, that no matter what the Keppra levels are, I wouldn't make any changes in his dosage. Comparing the potential damage done by multiple grand mal seizures to anything that seems likely to happen from Keppra usage, I think that the seizures pose a much greater threat to his well-being.

The UGH - a week or so ago, I noticed that Burble was scratching his chin with his back leg, and that he'd yip while doing it. He's kind of an oddball, and it never occurred to me that there was a reason for the scratching, OR the yipping. Anyway, when I eventually looked at his chin, there was a huge glop of dried blood, and a sort of raw looking triangle under his chin. I cleaned it off, and assumed that it was caused by the scratching. Then a couple days later, I noticed that he had a little patch of raw skin over near his lip, too. I googled, and found references for all sorts of repulsive, difficult-to-treat stuff like "miliary something or another" and "rodent ulcers".... But, when I asked a vet tech on FDMB, she said - "Ah, feline acne." Usually caused by plastic bowls, I thought. Which was the reason I have been using paper bowls by the dozens for years. But, she said, it's not necessarily what the bowl is made of - it's the fact that the chin is the dirtiest place on a cat, and the hardest for them to clean, and a bowl makes for more unreachable food on the chin. She recommended flat dishes for feeding. (And I have $75 of paper bowls downstairs! I wonder if there's some sort of ornament I could turn them into....) My cats all like their food very soupy with extra water, which would seem to be a minor problem with using plates for feeding, but I suppose it's manageable. She also said that Stridex pads can be a useful treatment. She didn't mention that there were 443 different KINDS of Stridex pads sitting on the shelf at the grocery store. I ended up buying the one that said "Original" on the label, although I don't know if it's safe for a cat or not - considering the licking and fiddling around that goes on after cleaning the area with the Stridex. Now I've started cleaning the chin and then rinsing it with clear water to try to remove the alcohol and whatever else is in there that might be licked up.

Anyway - lost track of where I was going with this - yesterday morning, I noticed that Milkshake's little chin had a sort of gray look to it. He's normally sparkling white. And, sure enough, when I got close to it and separated the fur a little, there were the tiny little black spots. (Referred to as blackheads in some of the articles I read about feline acne.) I cleaned it up with a little soapy water, and was surprised at the amount of blood that was on the paper towel. So, I gave him two Stridex treatments over the day, and as of this morning, his chin does look a little less gray. This is really annoying. I KNEW that plastic bowls were a problem. I use a big Correlle bowl for water for them, and purposely chose the paper bowls for their food.

I did find this very good article on Omega Fatty Acids http://www.peteducation.com/article.cfm?c=1+1400&aid=665 which suggests that Fatty Acids are helpful in clearing up feline acne, so I guess I will start adding some to everyone's food. I'm getting quite a collection of feline supplements and medications here. There are many other benefits to the Omegas, apparently, as long as the ratio of Omega 3 to Omega 6 is correct.

This crew of cats has had MORE weird stuff wrong with it than any other cats I've ever had in forty years. I have a theory (one of many, sadly) that the more attention you pay to your cats, the more diseases you'll detect. Maybe ignorance IS bliss......