Monday, August 22, 2011

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.