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.
