Still losing weight and a black lump

I've been weighing everyone I can get my hands on for the last couple months - particularly Busy and Milk, who are the most at risk.  Fortunately, they're the most cooperative, too.  Once in a while, you luck out.

Took Milk to the vet today for bloodwork to check his phenobarb level, and to have his other bloodwork done for the first time in quite a while.  I had wanted the vet to do it the last time we were at the office - months ago - but he didn't take enough blood, or didn't remember, or whatever.  Anyway, today he got plenty.  I don't have  a copy of the actual report from his Idexx machine in the office.  I always wonder/worry about calibrations, but.....  Anyway, he called after we got home and said that the only value that was out of order was - as usual - the ALT.  110.  Very close to the upper limit of normal, which is unusual.  Milk's weight was down, according to the vet's records,  a half pound.  He weighed 9.25 pounds on the office scale, another of the places I always wonder about calibration.  And I have this wonderful scale at home that Hope gave me a couple of years ago - I have more faith in it.  Just a couple minutes ago, I weighed him here in the dining room, before he ate dinner, and he was 9 lbs, 1 oz.  Pretty much what he's been fairly consistently since I stopped giving him the cyproheptadine.

Dr. G. was concerned about Milk's weight. He's afraid, if he does end up with some death-dealing illness (which seems to be happening with sickening regularity to my cats) that he won't have any reserves to fall back on;  he's a very tall, long cat, with next to no body fat.  Not all that much muscle, either, to be truthful.  I hadn't told Dr.  G. that I had discontinued the cyproheptadine back in June or whenever because of the increasingly bizarre behavior.  Today, when I mentioned that, he seemed to feel that, regardless of the behavior, he needed the weight, and therefore the appetite stimulant.  I forgot to mention the B12 injections, which are continuing on a weekly basis, and I did think they seemed to be making Milk a little more enthusiastic about eating.  The recommendations for cats and B12 injections is to give them weekly for six weeks, and then to continue them either weekly or bi-weekly.  Much as I hate giving both Milk and Busy the shots (God only knows why it didn't make me a wreck in four years of shooting Scruffy, probably because he could have cared less, I guess.)  I think it's worth it to continue the injections for both cats.  So, we came home and I dug out the bottle of cypro, and gave him the first 1/4 tablet tonight.  He'll probably be up all night making me crazy while he looks for food.

Milk has a chewed area on his neck that is the largest he's ever had.  Apparently Busy's illness has made him even more aggressive than before.  (He waits until I go to the bathroom, and then he starts chewing on Milkshake or Pinky or OneBun.  Quite the little planner, he is.)  And Milk has continued to be aggressive with Oney, especially.  OneBun never bothers anyone.  I don't know why they're both picking on him.    Anyway........  The other area of concern was this black lump that showed up on Milk's lower gum a week or two ago.  He didn't want me to mess around with it.  I don't want to see ANY black spots on a pink and white cat.  It was quite alarming.  Dr. G. looked at it and began discussing melanin, and meandered onto melanoma, while I was standing there dripping with sweat (IT WAS HOT!) and with this horrible aching in my stomach.  He noticed, though, when he looked more closely that there was a hair sticking out of the black lump.  (I should have taken a picture of it.  Rats.)    That made him think that it was most likely just a little chunk of acne-like stuff, and eventually he just picked it off Milk's gum.  A relief.  I had already told him that if there was something deadly in Milk's bloodwork, he was NOT allowed to mention it.  Too much trauma and disease already.

He should call about the phenobarb levels tomorrow.  I just realized I forgot to tell him how many hours post pill it was.  Rats.  I'm not sure what to expect this time - the last couple times, the phenobarb level has dropped from the 30's to the low 20's, as his weight has also dropped, which seems paradoxical.

Another $200+ for bloodwork.    Hemopet (where I'm sending Busy's blood now) makes Antech look  like they're really overcharging for their services, especially since Homepet farms out all of the non-thyroid bloodwork to their local ANTECH!  They must get quite the discount.

Is Vitamin B12 a "miracle drug"?

I spent some time recently thinking about giving Milkshake Vitamin B12.  He's done all right since the end of the cyproheptadine pills, but his weight has dropped noticeably  - all of the weight he had gained is now gone again.    And the unfortunately behavior that was of concern has pretty much continued unchanged.  He has become very aggressive with OneBun.  All that time Busy spent chewing on Milk's neck - well, now Milk is doing it to Oney.  He's much more vocal now than previously.  He frequently will meow plaintively, even when he's alone and just sitting there.  I don't know.

I have methylcobalamin pills.  (Cherry flavored, unfortunately, but I wrap them in half a pill pocket, so he doesn't have to taste them anyway.)  They didn't seem to produce much effect.  And he really doesn't need any more large pills to swallow....

When I decided to try B12, injectibles seemed like a good way to go.  (I hadn't thought about how long it's been since I was giving injections to Scruffy on  a regular basis.)  Busy has become what appears to be permanently hypoThyroid since he had the I131 radiation treatment, so I want to give him B12, too.  Neither cat has had the bloodwork to detect any B12 deficiency, although they both are in the very likely category, due to Busy's previous hyperthyroidism, and Milkshake's liver problems with the long term phenobarbital medication.  B12 is a water soluble vitamin, which makes it a little less worrisome.  At some point, I guess I'll have the testing done - it's quite expensive, and with all of Busy's thyroid problems, the cost of bloodwork is enormous.  

So, anyway, I spoke to Dr. G about getting injectible B12.  He gave me a prescription, and then I sat down at the computer to find a good place to order it from.  Because of Busy's more immediate medical problems, I ended up just getting the stuff at Costco's pharmacy, but was told - surprisingly - that there is a B12 "shortage."  All they had is the 1ml size vial.  Since the dosage of B12 goes by weight, Dr. G figured out that Milk should get .25ml once a week for six weeks.  Which is a dosage I have seen in a number of places.  For dogs, the recommendation is to then do once monthly injections, and then to quit after a couple more months.    For cats, the recommendation is to continue giving the injections after the initial six weeks, on either a weekly or bi-weekly schedule.  

I got U100 syringes, short needles, 31 gauge.  Just like the old days.  And I suddenly was afflicted with a huge case of nerves.  I knew the mechanics (although I was a little vague on where exactly Milk's scruff is, to say nothing of the fact that he's so skin-and-bones that it's not a very comfortable place to shoot.  I had shot Scruffy's insulin in his flank/side for most of his life as a diabetic, and that seems like it would be a better place for both Busy and Milk.  Fewer obstacles - like bones - in that area, and not much to interfere with tenting.  Anyway, for the first injection, I just wanted to do it and get it under my belt.  So, I got the syringe ready, put Milk on the counter, and laid out a pile of Temptations for him to munch on.  Did my best to get a good grip on his scruff, and injected him.  I think.  His beautiful white fur suddenly took on an unfortunate pink hue.  Blotches of pink all over the back of his head, up toward his ears, and down over his shoulders.  I didn't know if any of the stuff actually got INTO him.  He didn't react until nearly the end of the injection.  I'm out of practice, and I was shooting such tiny amounts of insulin with Scruffy;  .25 in these syringes is actually a pretty large seeming amount, because the barrel of the syringe is very narrow.  I don't have much of a grip on how fast to shoot it.  I have read that the combination B vitamin injectible is uncomfortable for the cat because it stings.  B12 is not supposed to.  Don't know.  Anyway, I got some unknown quantity into Milk, and aside from the neon pink fur, he didn't seem to be particularly affected.

The next morning, I was awakened by Milk standing on my chest.  Actually, he was DANCING on my chest.  If I had to guess what he was trying to tell me, it was "FEED ME!  NOW!"  A very unusual  situation with him.  Although he occasionally acts mildly interested in food (and definitely wants ham anytime), most of the time, he dawdles about coming to see what's to eat until someone else has eaten everything on his plate.  Or he eats a couple nibbles and wanders off.  But yesterday, he was very interested in eating.  I assume it was because of the B12.  If it was, I wish I'd thought about using it months/years ago.  I don't know how long each injection is going to last, or how the effect will turn out, but so far, it's looking like it has potential.  I would really like it if he could gain a little weight, although that brings up the problem of  his blood phenobarb levels.  

Ultimately, I ended up ordering a 100ml bottle of B12 from a website called http://www.vetdepot.com    It was an amazingly reasonable price of $4.97.  Plus $4.99 shipping.  I paid Costco $7.11 for a 1ml vial that I picked up at the store!  Amazing.  That amount, even shooting two cats, should last a huge amount of time.

Weight - down to 9 pounds on July 18.  Almost an entire pound since the last time I weighed him.    Bloodwork due sometime soon....

No more cyproheptadine, weight down..... :(

On May 13, 2013, I decided that I wouldn't give Milk the cypro any more.  With mixed feelings, because he was as as close to ten pounds again as he'd been in almost six years......  But the behavioral stuff was becoming more frequent and the thought of his having seizures again was too much.  His phenobarb levels have dropped significantly in the past year, from being in the mid-30's to the low 22's.  More weight would mostly likely mean even further reduction in phenobarb levels, which is a risk I'm hesitant to take. And the thought of beginning the whole phenobarb dose experimentation again is almost totally out of the question.

He doesn't appear to have any kind of reaction to the removal of cypro.  He seems mildly interested in eating, usually only for one meal a day, though.  He's more of a nibbler now.  And his weight has dropped fairly drastically already - I just weighed him and he's down to 9 pounds 8 oz.  He's unfortunately most willing to eat dry cat food/Temptations and anything that I happen to be eating - ham is right on the top of his life.  Canned cat food - not so much......

The odd behaviors continue.   Three days ago, Milk spend about fifteen minutes literally attacking his tail, and in between those attempts, he was doing a neck-stretching/twisting/eye-rolling/staring-at-the-ceiling thing that was frighteningly reminiscent of a seizure.  He has been waking me up several times a night for weeks now, meowing and attacking other cats.  There are what seem like aspects of hyperesthesia and compulsion that are much more pronounced than before.  It makes me so uncomfortable that I decided to decrease the cyproheptadine from 1/4 of a 4mg. tablet daily to every other day.

Last night, the meowing and jumping around all night was virtually non-stop. (Yesterday morning was a pill day.)  While I was trying to decide what to do, I remembered that the most recent phenobarb levels were the lowest ever.  The possibility that that change in phenobarb level, most likely related to the weight gain that I was so pleased with (!) , is behind the current behavioral changes seems very real.  I was always somewhat comforted by the fact that it has been so long since Milk's last seizure - almost five years! -  but I do believe that the next one could unfortunately be right around the corner.  And  I don't EVER want him to have another seizure.

I'm hesitant to do any sort of phenobarb increase because it does affect his eating negatively, and because it makes him so wobbly and uncoordinated.  But, the cyproheptadine is definitely expendable right now.  It's wonderful for Milk to be less skin-and-bones, to be able to stroke his back without bumping up and down on his spine, but I would prefer that he be wispy again to having seizures again.

I'm going to discontinue the cypro, keep an eye on his weight, and see what the phenobarb levels are when he has his next bloodwork.

My sweet Milkshake, in his favorite heated bed.

Still hanging in there........

Things continuing pretty much as usual with Milkshake. This week was the sixth anniversary of the arrival of the first seizure, back in 2007.  I still wake up sometimes in the middle of the night, thinking that I hear him having a seizure. The other day, I actually watched the video I had made that first year, and it still makes a knot in my stomach to see (and hear) it.

Toward the end of December, 2012, I started him back on the cyproheptadine.  He gets 1/4 of a 4mg tablet, once a day.  I had discussed it with the vet, who felt that there were no significant concerns about using it, and who agreed that keeping the weight on Milk was a good idea.  I give it to him in the morning, with his phenobarbital, Keppra, and Marin, and wait a half hour or so to let it "settle".   He grazes during the day - and attempts to hop up on the countertop for Temptations treats every time I go into the kitchen.  It doesn't seem to make huge difference in his appetite, but he does seem to be more motivated to eat small amounts on a frequent basis.  Which is good.

His last phenobarb level was somewhat surprisingly low - 22.5.  Instead of sending it to Auburn, we just used the Antech lab in New York that is the vet's regular resource.  I don't know if that's significant or not.  Another question may be that the blood was taken almost 9 hours after he got his pill.  He doesn't seem any more coordinated or alert or in any way different because of that lower level, but I don't know if I want to see it get any lower.   Otherwise, he still is showing occasional agression to the smaller cats, particularly if they're laying in what he considers to be "his" spot.  And he spends hours curled up on my right arm, which interferes with my knitting, but is just where I like him to be....