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.
