Missed the anniversary!

October 1 - three years since Milk's last seizure!  Certainly well worth celebrating, huh?

Nothing much else new with him.  He's a little less adept at jumping up  on things than he was; I still can't decide if it's a perception thing, or if there's something mechanical/physical going on.  Sometimes he'll miss the jump twice, and the third time, hop right up there.  He does some odd stuff, too, like very obsessive tail-chasing/biting (when he's laying down only).  I've been feeding him separately from everyone else, in the living room where I can watch him eat and make sure no one eats his food until he's done with it.  He gets a handful of kitten chow with the canned food, and eats fairly enthusiastically.  He has developed the unfortunate (when there are 10 other cats eager to eat that dry food!) habit of eating for a couple minutes and then wandering away.  If I weren't sitting by his dish with my trusty squirt bottle, there wouldn't be anything left when he came back....

My sweet boy just came to sit on the keyboard and accept any and all tributes to his wonderfulness.  Happy anniversary, Milk, and may there be many, many more!

I have another theory......

I always have theories, I just never have any way to prove or disprove them......

Anyway, I have been concerned about Milk's weight loss for some months now.  Although I had planned to have his phenobarb levels checked back in June or July, other things happened, and we didn't get to the vet for the bloodwork until August 2.  (My birthday!  Some gift to myself.)  I have been having his blood sent to Auburn University for phenobarb and Keppra/levetiracetam level testing for two years or so.  My impression was that Auburn, which is apparently the only place doing Keppra testing for animals, was using their results to establish the norms for cats, who currently receive bloodwork results with the reference ranges for humans attached.  However, because there still don't appear to be any feline norms, I just thought this time I'd only have the phenobarb level done by Antech and have the vet run a "vetscan" on his in-office machine.  I have been wondering about Milk's liver functions for some time because of the phenobarb, and it's been a while since they were checked.  That said, I don't really know how accurate the vet's machine is....

The background of this concern is, Milk has continued to lose weight.   His appetite is variable; sometimes, particularly if there are Temptations or dry food involved, he's VERY enthusiastic.  Other times, I put down his dish and he just wanders away, without even sniffing it.  He's not assertive, and occasionally, one of the others decides to share his food, and he will generally just leave and find another dish.   In addition, he has had a paradoxical reaction to phenobarbital since he started on it - anorexia.  (Lots of stuff about this in the posts here from 2007.)

Hence, my current theory:
What's going on here is a "vicious circle".  The phenobarbital decreases his appetite, which causes weight loss, which increases the effect of the amount of phenobarb circulating in his blood, which further affects his appetite and his weight. There's a formula for determining the presumptive correct dosage of phenobarbital -   2 - 4 mg/kg.  So, by that formula, Milk's appropriate minimal dosage going by his current weight  (a puny 8 pounds, 8 ounces this morning) would be  7.7mg BID .  Which is pretty much exactly what he gets - about a half tablet twice a day.

The bloodwork done on August 2, 2011, had the following results:

phenobarbital level      29.3      (reference range:   15.0-45.0)

ALB              4.2            (reference range:     2.2-4.4)  
ALP              29              (reference range:     10-90)
ALT              234  *       (reference range:     20-100)
AMY            903            (reference range:     300-1100)
TBIL            0.3              (reference range:     0.1-0.6)
BUN            23               (reference range:     10-30)
CA++          9.3              (reference range:      8.0-11.8)
PHOS          3.1  *         (reference range:      3.4-8.5)
CRE            1.3              (reference range:      0.3-2.1)
GLU            92               (reference range:      70-150)
NA+           146              (reference range:      142-164)
K+              4.2               (reference range:       3.7-5.8)
TP              6.7               (reference range:       5.4-8.2)
GLOB        2.4               (reference range:       1.5-5.7)

QC       OK
HEM    0         LIP    0        ICT   0

I wish that the vet's machine had produced an AST level as well.  That said, I'm not all that worried about the ALT's elevation.  That value has been elevated since the beginning of phenobarbital administration; it's not horribly high, and bile acids testing, which is, I believe, actually of more value in determining the liver status, has always been in a normal range.  I have been giving Milk 1/2 a tablet of Marin (milk thistle) every day for more than a year.  After this bloodwork, I increased it to a whole tablet; we'll see if that makes any difference.  At this point, there is nothing more to be done about the ALT - I'm not willing to make any changes in his phenobarbital dosage, barring major worsening of liver functioning.  Most attempts to reduce phenobarbital dosages based on the experience of the Yahoo EpiKitty Board seem to result in the re-emergence of seizures that are even worse than they were before being controlled.  And we don't want THAT.

The next question - is there a significance to the low phosphorus value?  I have no idea.  The vet didn't mention it when he called to report the results.  I googled, and came up with lots of references to feline renal failure with HIGH phosphorus levels, but LOW - well, I saw IBD mentioned, with intestinal symptoms that Milk doesn't have, and lymphoma.  Which made me gulp.  I need to find out more about the phosphorus stuff, obviously.

In an effort to put a little weight back on my sweet Milkshake, I bought a ton of jars of baby food meat.  (Boy, that stuff is expensive!)  It's not a whole lot of calories added to give him a jar per day, but I think every little bit helps.  Hopefully.  And I'm adding a little bit  -  a tiny, guilt-producing, fear-inducing amount  -  of dry food to his canned stuff.  He eats the dry more enthusiastically, and  nuzzling around in the dish of canned stuff looking for it seems to keep him eating a little longer.

Feeling vaguely uncomfortable

I have been trying to convince myself that there's nothing going on with Milk.  Unfortunately, I'm just not sure that's true.  I weighed him this morning- you wouldn't think that just a few ounces (4!) would make a difference in his appearance, but he feels significantly more bony these days.  And his ability to jump - already severely not-what-it-used-to-be -seems to have diminished.  I can't decide if the problem is that his judgment of how high he needs to jump has become more impaired, or if he has some sort of rear leg weakness going on, or what.  It will frequently take two or three tries to get up on the kitchen counter to get his pills.  He always seems "surprised" when he falls, but gets back up and tries again.

He's scheduled for more bloodwork next week to check his medication levels.  I want to be sure THIS time to have the vet do his in-office blood analysis just to check the liver functions.   It's so traumatic to take him to the vet;  I don't know if it's worth doing another bile acids test or not.

Milk and his friends

My little Milkshake is sort of the Venus FlyTrap of cats - he just sits around, waiting until he sees one of the others getting ready for a nap, and KABOOM - he's there in a flash.

 

Milk and Busy

 

Milk and Burble

 

Milk and Baby Squits

 

Milk and Scruffy

 

Milk and Punkin Duncan

 Milk and OneBun

Milk and Cinnaminnie

Milk and Pipper 

No News is GOOD news!

Nothing much new to report, and truthfully, that's such a relief!  Milk continues to  - KNOCK WOOD - be controlled on (approximately - the vagaries of chopping up pills make it somewhat uncertain) 8mg of phenobarb and 125mg of levetiracetam (generic Keppra)  BID.   His weight continues to be under 9 pounds, which doesn't make me happy, but he's an eager and willing eater these days.  I have noticed recently that he's not jumping very well - it frequently takes two tries for him to get to the counter for his pills, or to jump onto the bathroom sink.  He has been wobbly ever since he started on phenobarbital, so I assume that's just his natural state now, sadly.   


We have quite a few younger cats now (the Big Kittens and the Little Kittens - all under two and quite obnoxious).  Milk hasn't developed a relationship with any of them, although he will occasionally curl up with Stinky, the most feral of the kittens.  His primary attachment is to me, and then to Scruffy.  He loooooves his Scruffy!  He will drape himself over The Puffer at every opportunity.  It always makes me laugh, and feel glad that Milk has his kitty friend.  In a lot of ways, he reminds me of the elementary school age kid who doesn't quite fit in - he tends to stand around and watch while the kittens are thumping and bashing around, as though he'd like to join in.  He probably knows that he wouldn't be able to keep up with them, I suppose.  He stands safely on the sidelines, which is a good thing.

I keep thinking that I should take a video of Milk getting his pills.  This little cat, who made me cry out of frustration about not being able to give him his medication a couple years ago, is way beyond cooperative.  All it took was the generous offer of Temptations treats and a little Pill Pocket.  Now, I call him and shake the Temptations box, and before I know it, there he is, sitting in front of me, just waiting for me to poke the pills down his throat and give him his water before and after.  

I'm still surprised when I realize how long it's been since Milkshake had a seizure, and how fortunate his control has been.  I would like to credit the Yahoo EpiKitty group  (http://pets.groups.yahoo.com/group/epi-felines/) for their support and friendship, if I haven't already.  It was really helpful to find that there were other people struggling with the nightmare of being awakened in the middle of the night by a beloved cat having a seizure. 

We celebrated the five year anniversary of Milkshake's adoption a couple weeks ago.  Five years of my sweet white kitty's presence and all the pleasure he has given me.  It was a lucky day that I stopped to look at that kitten in PetSmart, for both of us.