milkshakethelittlewhitecat

Missed the anniversary!

2011-11-09T15:32:00.002-05:00

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!

2011-11-09T15:27:00.000-05:00

I have another theory......

2011-08-22T17:38:00.000-04:00

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

2011-06-11T18:45:00.000-04:00

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

2011-03-10T12:56:00.004-05:00

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!

2011-03-06T13:26:00.001-05:00

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.

A milestone!

2010-10-02T14:39:00.001-04:00

Yesterday marked a special day for Milkshake - it was his second anniversary of being seizure-free! It brought back all sorts of memories of the nightmarish year of his suffering seizure after seizure - the frightening awakenings in the early hours of the morning, the horrifying noises, the violence of the muscular contractions, the vulnerability of this little cat to whatever was so horribly wrong in his brain.   It makes my stomach clench just thinking about it. I was so superstitious about seizures returning that I could hardly bring myself to even mention how long it had been. I remain nervous about it - the latest dose reduction of Keppra, while involuntary and seemingly effective - is still traumatic. It's been two years and I still wake up in the middle of the night thinking that I'm hearing Milk seizing.    But, fingers crossed, he will continue as he has been for the rest of his hopefully very lengthy life.

Milk just turned 5 around August, I calculate. His first year included serious malnutrition and life-threatening neglect of his health. He was kept briefly in a shelter, and then in a cage at PetSmart, where I found him, sad and sick and frightened and yellow with urine stains. It took months for him to reach a normal weight, to overcome the respiratory and eye infections he had. But from the time I brought him home, he showed no sign of bad effects of the horrors he'd experienced as a tiny starving kitten. He was so affectionate and so eager to snuggle up to me and the other cats.   And of all the cats we've had/have, I don't believe that there is one who would have tolerated being "pilled" four times a day as well as Milk has. (To the manufacturers of Temptations and Pill Pockets - you have my eternal gratitude!) At pill time, he hops up on the counter, I hold open his mouth, give him a squirt of water from his kitten bottle, pop in his pills, and give another squirt of water . No fussing, no fiddling - he's totally focused on the box of Temptations that's sitting beside him.....

I feel very fortunate to have found my Milkshake. I have had cats for years, most of whom I loved and enjoyed. (Tootie and Cinnaminnie, cover your ears!)    But there is something special about Milk that reaches some deep part of my cat-loving heart. I hold him there with pleasure and gratitude and joy that I have been given the privilege of caring for him and loving him. My sweet white kitty.......

There are recommendations, after all......

2010-08-31T18:24:00.003-04:00

This email just arrived:

******************************************************************

Auburn University
College of Veterinary Medicine
Clinical Pharmacology Laboratory

Updated results for Accession 2010-46053

Accession Informtion
Accession Number: 2010-46053
Internal ID Number:

Veterinarian: Dr. Donald G

Date Received: 8/26/2010
Date Updated: 8/31/2010 3:21:22 PM
Animal Name: Milkshake
Owner Name: Species: Feline

Results
Test: Feline Phenobarbital, (mcg/ml)
Result: 26.1
Normals: 15 - 45
Last Updated: 8/27/2010

Recomendations
The concentration of phenobarbital is in the mid therapeutic range (15 to 40-45 mcg/ml) most commonly associated with seizure control in dogs or cats.

The current concentration is about 25% less compared to the last recheck.

If all is well, maintain the current dose and current drug concentrations. Re-check at 6 to 12 month intervals, or in the event of therapeutic failure.

Thank you for your continued support of our laboratory. It is much appreciated. August 30, 2010 DMB

Test: Feline Keppra, (mcg/ml)
Result: 32.5
Normals: 5.5 - 21
Last Updated: 8/26/2010

Recomendations
The mid interval concentration of levetiracetam is in high to above the high therapeutic range most commonly associated with seizure control in humans (5.5 to 21 mcg/ml). The relevance of these concentrations to canine or feline epileptics has yet to be confirmed.

The half-life of levetiracetam is short (1 to 8 hr) and may drop > 75% during an 8 or 12 hr dosing interval. Consider collecting both a peak and trough such that a half-life can be used to predict the lowest concentrations that occur during an interval.

Accordingly, althouth the current concentration is approxiamtley 40% lower compared to the last recheck, these comparisons can not be made unless the previous sample also was collected at 4 hrs. If only one sample can be collected, then consider collecting a true trough (just before the next dose) such that the lowest concentration to
which the patient is exposed during a dosing interval can be verified.

If all is well, maintain the current dose and current drug concentrations. Re-check at 6 to 12 month intervals, or in the event of therapeutic failure.

Thank you for your continued support of our laboratory. It is much appreciated. August 30, 2010 DMB

Additional Recomendations: Multi-Test Discount
UPS 1z5vx3572310064219

Comments: 4hrs post. Seizure free since 10/1/08.

Levetiracetam dosage (125mg) reduced to BID (from TID) on July 1, 2010. Current dosage 125mg (approx) at 10AM and 10PM. Phenobarbital given at the same time, approx. 8mg BID. Continuing weight loss despite very healthy appetite. Appears to have some balance/strength issues. No other drugs. Controlled.

******************************************************

I'm quite happy with the phenobarb levels. Dr. G, has felt for some time that I should be aiming for reduction of the amount of phenobarbital, rather than trying to lower the Keppra/levetiracetam dosage, but I'm really hesitant to even consider that, because it's my admittedly unscientific feeling that the phenobarb is what's working at this point. I don't actually understand the recommendation about the Keppra and trough levels, even though I've reread it six times. What difference would it make to know the lowest amount of levetiracetam available over the 12 hour period? I must be missing something here. Maybe they mean that knowing the lowest amount available/functional would indicate if further reduction might be possible? I have no idea.

At any rate, I am (with fingers crossed!) feeling pleased that #1 - most of all! - there have not been any seizures for 700 days!, and #2 - the dosages have been significantly reduced and still appear to be working effectively. I don't know, at this point, what more I could ask. Well, except for maybe Milk could gain a couple of pounds, and Busy could stop chewing on his neck, and he could be just a smidge less wobbly......

Finally!

2010-08-27T18:44:00.000-04:00

At last, I managed to get Milk's blood sent to Auburn. (I took both Milkshake and Scruffy to the vet for the same appointment and purpose. Scruffy started spitting and hissing before we even started to drag him out of his carrier, where as my sweet little Milkshake, practically catatonic from the trip in the car, the traffic noises, and strangers trying to handle him, laid down on a towel fragment - I forgot the kitty pi this trip - and just shivered uncontrollably non-stop. Like two different species, they were!)

My intention was to have blood drawn also for the vet to use his own machine for analysis - I wanted to see what the liver values looked like, because I've been giving Milk Denosyl on a mostly regular basis for weeks now. Unfortunately, I forgot to ask, and it's such an ordeal getting blood out of him, even from the vein in his neck whose name I can't recall right now. Tiny little veins in his wispy body......

Anyway, here are the results from Auburn:

Date Updated:    8/27/2010
Animal Name: Milkshake
Owner Name:    Guckert
Species: Feline

Results
Test: Feline Phenobarbital, (mcg/ml)
Result: 26.1
Normals: 15 - 45
Last Updated: 8/27/2010

Test: Feline Keppra, (mcg/ml)
Result: 32.5
Normals: 5.5 - 21
Last Updated: 8/26/2010

Phenobarb level is good! Keppra level, well, considering that the Keppra dosage has been reduced by 1/3 (125mg), I'm not particularly unhappy with that either. Given that the Keppra standards are based on human data, I'm not going to worry about it.

One of the options on the Auburn analysis application is "Do you want suggestions/recommendations?" I checked that, hoping that maybe there would be some interesting suggestions. (Aside from something like, "Wow, that's a lot of Keppra!")   What I got was just an email report of the results. Maybe Dr. G. will get something more detailed because he's a professional? I hope, I hope.

And next, to see what the bill turns out to be.......

Finally dropped that 6PM dose of Keppra.....

2010-08-09T00:05:00.002-04:00

Not intentionally - I probably never would have screwed up the courage to do it unless forced to by a crisis. Which was, unfortunately, exactly what happened: my mother had a heart attack on June 27. With the ensuing hospitalization and the irregular hours I was spending at home, there was no way to get that 6:00 levetiracetam into Milk. Actually, for more than six weeks, there has only rarely - almost never, actually - been a 10:00 PM dose of phenobarb, either. Without alternatives, I settled for twice a day dosing, whenever those two times might occur. So, we're now down to somewhere between 9:00 and 10:00 AM for the first two pills, and somewhere between 10:00 and 11:00 PM for the second two. It seems to be working. Fingers crossed. Because the keppra generic is a large chunk of pill, I appear to have stopped giving him the liver-protective Denosyl that I do think can be a benefit to him. Seeing if using it had reduced his ALT/AST levels, which have been elevated since he started on phenobarbital was one of my goals in doing the bloodwork. Didn't happen........

I had arranged to bring Milk to the vet for blood-taking to send to Auburn to check his phenobarb and keppra levels. The University has some sort of new arrangement that requires that the vet's office have special address labels or something; at any rate, by the time the stickers had arrived at Dr. G's office, I was into spending all my time at the hospital, and the bloodwork never got done. Hopefully, within the next week or two, I will be able to get Milk there and get the stuff done.

He has seemed wobblier in recent months. I have seen him attempt to jump up on the bathroom sink or the kitchen counter and fall at least once a week. (Did he misjudge the distance? Was he too weak?) He seems scrawnier than ever, although I weighed him tonight and he was 8 pounds, 13 ounces - not a wonderful weight for a cat as tall and long as he is, but not as awful as it might have been. His appetite is very sturdy. He has also - to my sincere distress - been doing a good bit of aggressive chasing of OneBun and even mimicking Busy's gnawing on his neck. (Despite the addition of prozac to Busy's daily routine, Milk turned up with a new dime-sized scab on his neck last week.)

Anyway, as far as I can tell, there is no indication that any seizures have occurred even with the reduced dose of levitiracetam (generic keppra). He still sleeps every night draped over my ankle, and he tends to be the one who wakes me in the morning, standing on my chest. It is such a relief and pleasure to realize that we're coming up on two years since his last seizure (on October 1.)

Going well.

2010-03-06T23:04:00.001-05:00

Decreasing the phenobarb was apparently successful - now, if only I had the courage to drop one of the Keppra doses. But, I don't.

A scary experiment

2010-01-25T14:41:00.000-05:00

Where has the time gone? I was shocked to see that I haven't posted about Milkle since Halloween......

Milkshake has continued to lose weight, although his appetite is excellent and enthusiastic. (Weight records are in the sidebar to the right.) On 12/15/09, I took him to Dr. G because Busy had gnawed another large area on Milk's shoulder. It was big, and deep, and I was worried about infection. At that point, he weighed 8 pounds, 11.5 ounces on the vet's scale. We discussed having the blood testing for phenobarb and keppra done then, but I wanted to send them to Auburn, which meant that the sample had to be taken at the beginning of a week. So, I put it off, and the vet gave me a tube of something or another to put on the wound. (It looks like it was something called Animax or AnimX ointment.) Anyway, the bitten area healed just as the others have, without further fiddling around.

On 12/21/09, I took Milk back to the vet. He hadn't eaten on his own for several days. His weight was down to 8 pounds, 9.5 ounces at the vet. He just literally got up one morning and refused to eat anything. I started bottlefeeding him - first Fancy Feast, and then I bought baby food meat and EVO canned. There didn't seem to be anything specific going on. It was my distinct impression, though, that he was in pain. He was spending ALL of his time in the meatloaf position, with his head hanging off the window ledge in front of him. Very abnormal behavior. We decided to do bloodwork - regular stuff on the vet's machine for immediate results, and to send away a sample for an fPLI test. Here are the results of the vet's testing:

ALB - 4.1 (2.2 -4.4)
ALP - 30 (10-90)
ALT - 202 (20-100)
AMY - 920 (300-1100)
TBIL - 0.3 (0.1-0.6)
BUN - 21 (10-30)
CA++ - 9.7 (8.0-11.8)
PHOS - 3.4 (3.4-8.5)
CRE - 1.5 (0.3-2.1
GLU - 91 (70-150)
NA+ - 151 (142-164)
K+ - 4.6 (3.7-5.8)
TP - 6.5 (5.4-8.2)
GLOB - 2.4 (1.5-5.7)

QC - OK
HEM - 0
LIP - 0
ICT - 0

As usual, the ALT was quite elevated, although not as high as it has been in the past. The assumption is, these results are because of the phenobarb's affect on his liver. (I had previously been giving him Marin, but somewhere along the way, stopped.) While I would sincerely like to try stopping the 6:00 PM Keppra dosage, Dr. G. thinks that lowering the phenobarb is the way to go. I have mixed feelings, because I am afraid that, while Keppra has clearly contributed something to his lengthy period of being seizure-free, I think it's the phenobarbital that has been the most effective agent.

Dr. G. gave me a prescription for buprenex. Since he didn't have it in his office, his technician made a huge effort, and located another vet office that would fill the prescription. (Drugstores don't carry it, and none of the ones I talked to were interested in ordering it for me.) It seemed to make an immediate improvement. He had three doses, and while he still wasn't eating, the meatloafing was sharply decreased. The fPLI results were returned on 12/30/09 - 1.3 (range .1-3.5) So, whatever was going on with Milk, it was apparently not pancreatitis. He began to eat normally again, on his own, on 12/28/09.

To get back to the "experiment" - on 1/6/09, I dropped the additional 1/2 tablet of phenobarb that Milk had been getting at night for quite a while. (Uneven dosing has not been recommended, but it seemed to be working.....) And so far, so good. I've added Marin back into his daily pill routine, also. As there seems (**antijinx**) to have been no seizure activity after the dosage cutback, I'm going to wait a while to have more bloodwork done - going to the vet is such a traumatic event for Milk that I don't seen any point in doing it again so soon. Just keeping the fingers crossed.

On the home front, one of MommyKitty's kittens, OneBun, was "adopted" back from Animal Friends a week ago, and Milk's not a happy camper. I can't figure out why - he wasn't bothered by the kittens before, although he had never made the attempts to snuggle with any of them the way he does with the big cats. And he doesn't seem to be reacting particularly negatively with Pipper or Stinky, the other two kittens. Maybe it's the Animal Friends/PetSmart/Whatever smells that poor Oney had when he came home or something. At any rate, they still have not managed to resolve their relationship.

Halloween!

2009-11-01T00:46:00.007-04:00

It's Halloween! And, once again, my sweet Milk is a most cooperative feline model.

Things are still going along quite well for him, thank goodness. We've got another seizure-free month under our belts. (Well, since neither of us wears a belt, that's not a particularly apt image, but, you know...)

Although he's eating enthusiastically, his weight is still a minor concern. He's a very long, tall cat - particularly considering the early malnutrition - and when he weighed 12 pounds, he was a perfect size. None of this you-can-feel-every-one-of-his-ribs-and-veterbrae then. But that seems to be the only worry for right now. He does need to have both his phenobarb and keppra levels tested again, but I am feeling (surprisingly!) confident that he will be in a good range on both. Hopefully. Well, maybe "confident" is slightly overstating my attitude. "Confident" is not generally in my range of emotions. But maybe, just maybe, his keppra level won't be in the 50's and his phenobarb level won't be in the 30's. Oh, I hope......

One more picture. I just love the way he looks like he's laughing and winking in this one - it's rapidly becoming one of my all-time favorites. There are no words to describe how much I love this skinny little happycat.

Hi, Marianne!

MAJOR MILESTONE!

2009-10-01T13:36:00.010-04:00

Just slide your eyes to the right, and notice that the yellow box says, "365 days since Milkshake's Last Seizure" on his little calendar doohickey! ONE YEAR! Amazing and wonderful and shocking and stunning and just plain lucky!

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.

I knew it.

2009-09-12T02:20:00.002-04:00

Brought the baby scale back home yesterday, and weighed Milkshake the minute I set the scale down. Eight pounds, ten ounces. Close to half a pound less than in April. What I can't figure out is, he's eating very enthusiastically at every opportunity. He cleans his plate, and makes repeated trips to see what everyone else has left. He has even starting eating bits of people food, which should probably bother me, but doesn't - I'm just delighted to see him enjoying any food. The one problem he has around eating - and it's a Tootle problem - she's so aggressive, and he's terrified of her. She will come and sit a couple of feet from Milk while he's eating, and within a matter of seconds, he will wander off and allow her to finish his dish. If I chase her away and put him back down in front of his food, he will eat until the next time she shows up. Moving the dish (and Milk) around to what may seem like safer places isn't much use; he's still the most vulnerable of the six cats and they all know it.

I could start bottlefeeding him once a day to see if he gains any weight, I suppose. Truthfully, I hate the thought of it, and I wouldn't want to do anything that reduces his own newly-functional appetite....

We are 20 days from his one year seizure-free anniversary. I can't believe it! I would love to try lowering the medication, but I'm too afraid to do it. This seems like a disorder where, if something is working, you don't screw around with it unless it's absolutely unavoidable.

I do want to make an appointment for bloodwork for him in the near future.

It's been a month + since the last post?

2009-08-28T12:30:00.003-04:00

I'm shocked. I guess because life here has been careening along at a stomach-turning pace or whatever. Well, "careening" and "stomach-turning" are sadly appropriate, at least.

Not much new with my little Milkshake, who continues to eat enthusiastically on his own, but who appears to be distinctly losing weight. (I loaned my wonderful Japanese scale that Hope gave me to my daughter-in-law, thinking that she might want it to weigh our lovely new granddaughter, Gracie. Now I'm wishing I had it back, because I'm pretty sure she's not using it anyway...) He seems perfectly normal in all other ways. He needs to have his phenobarb and keppra levels tested again, maybe next month. I'm looking forward to seeing what the keppra levels are - if they've improved/been reduced significantly, because he continues to be on a reduced overall dosage, plus the US generic levetiracetam pills are significantly smaller than the previous Canadian ones.

Two days ago, I picked Milk up to put him on the counter to give him his pills, and discovered that Busy has apparently started gnawing on him again. There is a fairly large open wound - size of a dime, maybe - on the side of Milk's neck. Previous Busy attacks were on the back of his neck, closer to the shoulder blades. I don't know if this is a seasonal thing with Busy or what. He seems to be having his own problems lately - he is incredibly clingy. I think that we have just been in such a state of upheaval around here that none of the cats is living what would have been a normal life a couple of months ago. We need to get back to that state of what passed for "normality" as soon as possible - the commotion has hurt all of us.

I have been really surprised that Milk has shown so little interest in the kittens. Given his attachment to and need for physical contact with the other cats, I would have thought that he'd be spending a huge amount of his time sitting at the screen door to the bedroom, communing with the five little guys. Probably if they were out where he could get his paws on them, it'd be a different story.

We are just slightly more than 11 months from the last seizure. (Didn't get to see the Seizure CountDown box before typing this.) Hoping desperately that this streak continues......

*Hi, Marianne!

so far, so good, part II

2009-07-14T23:53:00.002-04:00

It has been more than a week - two weeks, maybe, since we started the American generic levetiracetam, and it seems to be working just fine! I'm very relieved. There are significant differences between the previous brand from Canada - the shape of the pills, the thickness, and particularly the overall size. The US one is much smaller, and a better shape for cutting. It does worry me a little, because it seems as though I must be giving him much less than previously, but there must have just been a whole lot of fillers in the Canadian drug. Going to continue to keep my fingers crossed that everything stays just the way it is.

Someday I'm going to write something about this subject and it's not going to make me shudder with superstition and the need to toss salt over my shoulder.....

just stuff.......

2009-06-27T13:36:00.002-04:00

I was sitting here at the computer the other night, watching while the cats ate. And I realized I was smiling to myself because not only was Milkshake, the "former" anorexic, eating willingly, once he'd finished his own plate, he had wandered oh-so-casually over to Minnie's dish and polished off hers, too. Until I had him, and feeding him was such a crisis for so long, I never really thought about the cats' eating. I put it down, they gobbled it up, The End. At any rate, although he's not gaining any weight - at least he's not losing any noticeable amounts, and HE EATS. Like he actually enjoys it again.

There are a mere 3 of the levetiracetam (generic Keppra) pills from Canada left in the bottle. That's twelve doses, three times a day - four more days. I'm nervous about starting over with the American generic. I know that it's not recommended that non-brand name anticonvulsants be used, in the first place. I don't know what/if there will be a difference - aside from the visual aspects - between the US and Canadian generics. The US one - which ended up to be more than $30 cheaper than the original quote from Costco (a mere $94.73 for 200 500mg pills - and $130 less than I had been paying for the Canadian drug!) is a different shape. It's got rounded ends, which I would think would be better in terms of chopping the pills in quarters. There is a score line across the center, too - another plus. I haven't cut one yet, so I don't know if there's going to be a lot of "dust" when these new ones are cut, or not; there were frequent tiny little bits all over the place with the Canadian brand.

Aside from brand differences, I'm nervous about the dosages, too. We're pretty much down to giving (approx.) 125mg TID, which is quite a reduction from almost a year or so ago. I'm terrified that this change might set off another series of s******s. (Phenobarbital dosages have remained the same - 1/2 tablet in the AM, 3/4 in the PM.)

Time will tell, I guess.

Just one of my favorite pictures of Milkshake....

2009-05-13T23:00:00.003-04:00

No particular reason for this, I just came across it tonight and thought I'd stick it in here. It does make him look kind of tiny, when, although he's skinny, he's really tall and long.

Fearful

2009-05-01T00:27:00.002-04:00

I didn't realize it's been a month since I last posted here. There've been a lot of not-so-happy things going on; I've been distracted, I guess.

I am seeing odd behavior from little Milk this spring. He's always been a shy cat - never around if the doorbell rings, or if the mail truck pulls into the driveway. And he's not the kind of cat who sits at the top of the steps to greet visitors. But, he's way beyond that this year, and I can't figure out why. He's even reacting with fear and withdrawing when he hears Rege open the garage door. He seems hypersensitive to noises outside. And the things he enjoyed last summer and spring (before the windows and door were closed all the time), like the turkeys gobbling and the birds at the feeder - a lot of the time, he sits on the window ledge, but he appears to be poised for flight, not to just watch the birds.

There really hasn't been much in the way of change for him. He's still not crazy about Cinnaminnie and Tootle - they're both too aggressive for him, and he tends to avoid them. But that's been the pattern for the whole almost-one-year that they've lived inside. Probably the big change has been the decrease in his medications - but you'd think that would make him more normal, not less. I don't know. His balance is still off; he's as likely to tilt over when he's walking along as not. And he's been spending a lot of time sleeping in the closet in Stephen's room. I miss having him beside me. Tonight, I looked for him for more than an hour, walking from room to room jiggling his treat bowl as an enticement. I still have no idea where he was. I crawled all over the place, looking under the furniture and in the closets, and there was no sign of him, until he showed up in the kitchen, yawning and stretching.

And the stupid feline acne has returned multiple times. Every time I think I have it cleared up, it shows up again. He really hates the medicated Stridex pads, and I'm nervous about them because they have salicylic acid in them, which is the same stuff (I think - but then, what's "acetylsalicylic acid"? Maybe they're not the same - anyway, I don't want to take a chance.) that's in aspirin and is toxic to cats. I try to be very careful not to get any of the liquid anywhere near where it might end up in his mouth, and I rinse and dry his chin after I clean it. Poor little guy - he never gets a break.

Burble's fourth birthday is next week, May 3, which means that Milkshake's around three and a half. (I never can remember this stuff. I think I'll just record it here periodically.)

Oh, and hi, Marianne!

Generic Keppra (levetiracetam) information

2009-03-28T20:52:00.002-04:00

Generic Keppra - levetiracetam - is now available in the US. I normally order 200 500mg pills from Canada, so they last me quite a while, and I hadn't priced the new generic, until today. ****ETA: Blog entry for 6/09 shows the actual Costco price of $94.73 for 200 500mg pills!!!

I was picking up Milk's phenobarb at Costco this afternoon, so I asked for a price for generic Keppra. And was shocked! About $100 less than I have been paying from Canada, and I don't think that the AAA discount was applied. (Sometimes Costco says that their prices are already so low that they don't give the extra discount.)

This is the total cost the pharmacist gave me for 200 500mg levetiracetam pills at Costco: $129.70!

On-line, the prices apparently include the cost of shipping and handling - here are their generic on-line prices for 500mg pills:

30 pills - 28.71
50 pills - 43.55
100 pills - 81.91

(I don't know if doubling this price would be the actual charge for 200 pills or not, but that would be a whole lot more than $129.70! It makes me think maybe the pharmacist made a mistake, but I asked her to doublecheck, and she said the $129.70 was correct.)

I just opened the second Canadian bottle of 100 tablets, but it makes me feel like I should rush out and buy some more at Costco RIGHT NOW!

A day late.....

2009-03-24T11:20:00.003-04:00

Last night, around 11:15 PM, was the moment of the second anniversary of Milk's first seizure. Not such a happy event, needless to say, but there is some comfort to be taken now, I guess, from the fact that he's still here, he's still sweet and loving, and it's been a good while - *anti-jinx* - since you-know-what. I had NO idea what to expect that first night, which was probably a good thing..... I want to thank all those who gave me moral support to get through the hard patches here.

So far, so good.

2009-03-22T21:45:00.010-04:00

I am, as usual, afraid to actually SAY anything about Milk's seizures. *anti-jinx* all over the place. I'm a little vague on the exact dates/times/etc, but since the return of the bloodwork a month or so ago, with numbers that I wasn't crazy about, I have reduced both his phenobarb and keppra by a small amount. We're still dosing by the "chunk method", which is an inefficient way to do it, I realize, but it seems to have worked for the last 7 months or so. He now gets:

10:30 AM - 1/2 phenobarb tablet (8mg.approx), 125mg (approx)levetiracetam (generic Keppra), and 1/2 Marin tablet. Depending on the size of the 125mg "chunk", sometimes I may add a smaller 1/8 tablet chunk, just for good measure. (Just as an aside, the phenobarbital is made by WestWard pharmaceuticals, which is located in, amazingly, that rich Arab country in Africa - oh, I hate my memory, or lack of it these days - where they built the indoor ski resort, and the giant hotel, and all the American universities have branches now? DUBAI!! Someone from there looked at one of these blogs... crap. When I remember it, I'll come and edit this. Anyway, these pills are better - although they're harder to find, and Costco charges more for them than CVS does for the other brand - but these are a flat, thin pill. The other ones are so small and tall/thick that splitting them into two, much less four pieces would be impossible. And the levetiracetam comes from www.universaldrugstore.com in Canada. I haven't priced the new USA generic Keppra, but someone else said they were still $1 a pill....)

6:00 PM - 125mg Keppra, 1/2 Marin tablet. (Occasionally, I give him 1/4 tablet of Pepcid AC here, because the Marin can cause stomach upset unless there's food in there, and Milk's eating is a little erratic, to say the least. He does eat on his own, but very rarely the minute I put his dish down, and he's likely to graze most of the day from that first feeding. He's one of the most enthusiastic consumers of the raw chicken/supplements - he loves his chunks.

10:00 PM - 3/4 (approx. 12mg) phenobarbital

2:00 AM - 125mg Keppra + 1 chunk (approx 1/8 of a 500mg tablet). Now, my math is poor, but I think 500mg divided by 8 equals about 65mg, which seems like so much more than one of those little chunks could possibly be..... I don't know. At any rate, I am still using uneven dosages, which is frowned upon, but it makes sense to me because almost all of his seizures were in the very early morning - so, I want to make sure that there's plenty of medication keeping his brain in order during the night. It might not be correct, but until something happens to convince me that I'm wrong, I'm going with it, because, as I said above - "so far, so good...."

This is the Annual Spring Neutered Male Crazy Period around here. And this year, we've added the presence of Cinnaminnie - unspayed Feral Female Extraordinaire, and her slightly nightmarish - but at least SHE's spayed - daughter, the lovely but exceptionally grumpy and aggressive, Toot the Tortie. So, now, the battle is between crazy and mean, apparently. Tootle and Minnie are both quite fearsome to the boys; a significant part of their days is spent chasing shrieking males twice their size up and down the steps. Tootie has devoted most of her attention to Burble lately. He outweighs her by a good five pounds, and is three times her size, but she doesn't let that deter her. She butts him aside from his food, she growls at him any time he walks by, and she will sit in the doorway to the bathroom, where he likes to explore the closet, waiting for him to show up so she can launch herself upon him. Minnie's favorite target is poor Scruffy, who has never bothered anyone else, ever. I watch The Girls carefully to make sure they're not aggressive with Milkshake, because he's still wobbly enough that I don't want him falling off something whilst trying to escape their not-so-loving attentions.

I guess, as Johnny Carson used to say (or DID he?), And so it goes...... Maybe it was Red Skelton. (I touched Red Skelton once. Well, actually, I bumped into him coming down the steps into the formal entry in Thomas Jefferson's home, Monticello. That was in the days before celebrities had entourages, I guess. Nothing like a little free association every now and then, right?) Or maybe it was Charles Couralt who used to say that...

The other day, a very interesting person who owns a bunch of ferrets, one of whom is diabetic, posted a picture on the Feline Diabetes Message Board. I don't know where she got it from, and I am frankly ashamed that I didn't ask her if I could "borrow" her picture, but it struck me as being SO funny, I could hardly see straight. So, on this note, I'm done for today:

Such a nice comment ( #2)

2009-03-05T14:08:00.001-05:00

And this one, which came today from my too-faraway-to-hug internet friend, Linda:

"Those of us who have been truly owned by a cat do know that look that passes between us. Not ever having children I can't be sure, but I always think of it as the same kind of bond exists between a parent and a child, only better. To look at them and have so much love in your heart that you feel like your chest will burst."

I don't want to be sloppy about all this, although sloppy is one of my most well-developed attributes, sadly. But I've been really upset for two days about the story on the internet about the kid who put a video of himself torturing his cat on YouTube. I can hardly bear to think about the whole mess. The nightmarish kid, the poor cat, the parents who are going to have to try to "fix" this kid......it all makes me sick.

But - it makes me feel better about the world and all the sad and unpleasant things in it to know that there are people like Linda and Leeta and Hope and Marianne (and, I guess, me and a ton of other people on the Feline Diabetes Message Board, and the Yahoo Epikitty Board and wherever) who do care and who find love and satisfaction and reward beyond description from the sentient furry beings who share our lives. Sometimes things DO work out just right, I guess.

such a nice comment........

2009-03-04T22:19:00.002-05:00

There have only been a few comments to the blogs for my two cats. And they've been mostly from people who "know" the cats. Well, or who know me.... Anyway, tonight, there was the following really nice comment from "Leeta." It made me cry. Let me post it here, and then I'll explain.

leeta said...

I just wanted to tell you that I love your relationship with Milk. I don't even quite know how I managed to end up here (seems to me last conscious moment I was looking at something with Verizon billing and I guess I wandered a bit! LOL!) but I am glad that I did. So many things reminded me of so many days with my baby girl Miss Kitty. She didn't have epilepsy but that was one of the few things she didnt have. The last year of her earthly life she had two strokes and congestive heart failure but right through it all she wanted to keep going. Until well, I guess that one day or really a couple days before, she got tired or just didn't want to keep doing it. Its been 1 year and almost 3 months since I've gotten to see her little kitty face shining up at me, containing all the love in the world, and not a day goes by that I don't miss her. I hope that Milk lives another 20 years or so, long enough for them to figure out how to give them human lifespans so that you guys can grow old together. Relationships like that should never be apart. Thank you for posting your blog. It is beautiful.

March 4, 2009 3:11 PM"

I am so touched by this nice person's taking the time to make this comment. And for her to talk about her Miss Kitty's face "shining up at me" - sometimes you sort of think that the way you feel about your cat might just be a smidge over the top or something. The "crazy cat lady" syndrome. SO, it's nice to have someone else freely talking about her love and affection for her cat, and to think that we all are not (necessarily!) crazy or nuts or emotionally stunted or whatever. We just love them. Right? Thank you, Leeta, and I hope that Miss Kitty sends you another cat for you to love desperately and wholeheartedly, and to love you back...

Still not sure.....

2009-02-27T10:38:00.005-05:00

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.

The Dilemma

2009-02-19T19:11:00.005-05:00

I was afraid of this. The Keppra and phenobarb levels came back this afternoon from Auburn. The bad news is the phenobarbital levels are 33.8, and the Keppra levels are 52.7. While I'm not so surprised about the phenobarb numbers - not HAPPY about them, but they were somewhat expected, given the physical difficulties I've been noticing for a couple weeks - the Keppra levels were something of a unpleasant surprise. (The technician I talked to at Auburn last week said to make a note to Dr. Booth, who's apparently in charge of their lab, asking about whether they have developed feline levels, or if they are still using the human numbers. However, when I got to the vet with Milk on Tuesday, the technician had made her own copy of the form for Auburn, and I wonder if she copied my question to Dr. Booth on the one she made? At any rate, there was no response from Dr. Booth.) The odd thing is, I've been cutting back the Keppra for the last three weeks or so. Milk now gets 1/4 and approx. 1/8 of a 500mg pill TID. That's about 187 mg each dose, I think. Significantly less than before. (Or not, depending on the accuracy of the previous math.......)

In the end of August, '08, when Milk had that run of three or four seizures over the course of a little more than a week, we increased his phenobarb dosage from 1/2 of a 15/16mg pill in the AM and 3/4 of a 15/16mg pill in the PM to 3/4 at both times. It seemed to work, and even though he had a couple of seizures at the end of September/October, I didn't make any changes in the amount of phenobarb, and he's now made it for 141 days since the last seizure. And, in the real world, 33.8 isn't way out of whack for phenobarb levels. Except, as Dr. G. said, except for Milkshake. The combination of the pheno levels at almost 34 and the ALT in the 200's certainly seems to imply that something's going on with Milk's liver. I guess that makes doing another bile acids test imperative. (Have not seen this cat near the litter box ONCE since we decided to do that testing. NOT ONCE.) I think I'm also going to add another 1/2 or whole marin every day.

Dr. G. wondered when he called tonight with the results if we should send a copy of them to Dr. L - the IM vet I didn't care for at all, and who said that she'd never approve giving a cat more than 125 mg of Keppra unless their weight justified it - or to Dr. A, the neurologist in Ohio. He was a consultant, rather than a person who seemed to intend to have a long-term relationship as Milkshake's doctor. I think Dr. G. would appreciate having someone to consult with about this whole mess. Now that there's actually a neurologist in Pittsburgh, maybe I should ask for a referral? The trouble is, I don't want to have to go through the pressure to have an MRI again, or to put Milk through any number of unpleasant tests and appointments unless it's unavoidable.

Nothing's ever simple, and sometimes it really stinks.

Bloodwork

2009-02-17T16:44:00.006-05:00

I've been concerned about the increasing wobbliness Milk's been showing, and it's been about 5 months since his last phenobarb levels were done, so, I've decided to combine the phenobarb and Keppra testing, and have the vet do his local office testing for a regular CBC. My poor little white cat - he was quivering so hard it was visible the entire time we were in the office. And, while the vet did attempt to get the blood from Milk's thigh, he couldn't get enough. So, now Milk's got the shaved neck. I can't imagine what it must be like to see some total stranger coming toward your neck with a syringe, while another total stranger is holding you so you can't move. Poor cats.

Anyway, Dr. G. just called - didn't give me all the results, but I will ask for a copy the next time I'm down there. I had told him that I was interested in liver function results, and it turns out that the ALT was in the 200's - normal goes up to around a hundred. He suggested that, if I'm concerned, we could do a bile acids test; the original one, when Milk was diagnosed, was not done fasting, and we didn't do the preprandial/postprandial version. I told him that Antech can now do the urine Bile Acids test, which I would prefer. So, I think when they let me know how much they need, I'll have to devote myself to collecting a specimen. I am almost certain that a sterile test (using cystocentesis) isn't necessary, which would be nice; I'd rather not have to take Milk anywhere for as long as possible. (Turns out they need just a teeny 1 ml of urine - I asked Dr. G how much that is - no head for metric measurement - and he said a teaspoon is 2.5ml. I'm a little out of practice for catching urine since Scruffy's been off insulin, but I think I can probably do it, although Milkshake's not nearly the carefree pee-er that Scruffy was, and he doesn't seem as regular about it.

I have kind of wondered about the phenobarb levels. Before, whenever his levels were around 26, he usually started eating on his own again. So, I've been going along, thinking that, since he's eating with a degree of enthusiasm, his phenobarb levels must be okay.....Not necessarily true, I suppose. Rats.

Well, another 60 dollars for the urine bile acids test, which is worth doing, I guess. I've been giving him 1 Marin pill a day; I could increase it, after we see what the phenobarb levels are. I just don't think that reducing or removing phenobarbital is possible for Milkshake. Not without setting off a whole cascade of seizures, I'm afraid. And undoing all the seizure-free times he's had in the last six months.

I have a vague memory that ALT is responsive to stress and infection somewhere in the body - maybe the stress of today's visit, or the beginning gingivitis might have had an influence?

Dr. G. asked me how and what Milk is eating these days, and when I said he's eating enthusiastically for the first time in three years, and he's getting half Fancy Feast and half raw, Dr. G sort of collapsed in shock against the wall and started stuttering about salmonella and e coli. (When he asked if there was a less disease-prone animal than chicken to feed raw, I said, "Well, yeah, they've got rabbit and now there's frozen ground mouse." It was cruel; I shouldn't have done it.

The third adoption anniversary

2009-02-12T13:26:00.007-05:00

Well, the good news is, no tears this year.. The bad news is, I completely forgot about the anniversary until about five minutes ago. Which doesn't, of course, mean that I don't care about the milestone. I just have a really lousy memory and not much interest in the calendar. Plus, I actually finally managed to get Milk trained to show up when I jiggle his tupperware container of TempTations. Thank goodness.

I have been a little concerned about him in the last couple weeks. Milk seems wobblier than he's been for quite a while. He is eating fairly enthusiastically, which is wonderful. He even gained an ounce since last month. Still, there are small but noticeable balance issues, for instance. God forbid he should decide to shake his head when he's in any position but lying down. I have an appointment to do phenobarb and keppra level bloodwork. Anyway, I have dropped the second chunk of Keppra with his 2AM set of pills, and it doesn't seem to have made any negative impact. I'm just afraid to take the chance of setting off a whole wave of uncontrollable seizures, when things have been going so well for so long.

On a happier note, as the picture above shows, Milk has finally gotten semi-close to Cinnaminnie. Not touching her, but in the vicinity. Not much chance of his ever accomplishing that with Tootle, though....

No funding for the study...

2009-01-19T23:18:00.002-05:00

Just noticed this post in the epikitty site:

Re: Clinical trial evaluating new anti-epileptic drug in cat

Hello again. Well I have good news and bad news.

The good news is that our study protocol was approved by the Cornell
IACUC, meaning that we have permission to proceed.

However, the bad news is, we didn't get funding.

so the aims of the study may change a little. Most of the funding was
aimed to allow people to have a MRI and CSF tap on their cat. Since we
cannot do this now the "requirements" will have to change.

Instead the study title will be changed to "suspected epilepsy", based
on their neurological exam and length of time they have been seizuring.

What does this mean for you guys?
-basically, we'll start with the cats who are already on zonisamide
and try to come up with some statistics with those guys first.

-therefore, for those of you who have your cat on zonisamide already
and still would like to participate, please send me an email to my
yahoo account. It will be easier to track everybody since the message
boards can get kinda "messy" at time.

thanks again,
David

I think there was only one cat on zonisamide in the epikitty group, and they were in Arizona, so it would be unlikely that they'd be able to get to Cornell for examination. It's not very clear from Mr. Brewer's post exactly what the purpose of the study would be in its revised state; I assume it would still be to look at the use/value of zonisamide. Maybe there will be more information in the future. To my mind, the MRI and spinal tap requirements were a negative; I really don't want to do that to Milk...

In other developments, the wonderful little muscle shirt from Sandy and Black Kitty arrived - it is so nicely done! It fits very well, too. Gotta get a picture of it.

A major achievement! And an "ugh".......

2009-01-11T13:04:00.009-05:00

Today is Day 102 since Milk's last seizure. (I am truly afraid about acknowledging it, but it's such big news for him!) It is the longest period of time he's gone between seizures in the nearly two years he's been an epileptic.

I started to figure out how many days in 2008 he was seizure-free. The math got me down, but he had - the most notable figures - one period of 84 days, and one of 102 days, and this one (102+) that will hopefully go on and on and on. He had 13 seizures during 2008 - almost the same numbers of seizures he had during the first week or so before he started on phenobarbital in 2007! There were 37 seizures in 2007, between March 23 and the end of the year. Three cheers for large doses of Keppra?

There is a record on the right side here of his assorted dosages and any changes that were made. After the breakthrough seizures in August, 2008, I did reluctantly increase again the 1/4 tablet of phenobarb that I'd reduced previously. It's been about four months since he had his phenobarb blood levels done, so I guess that's the next task. I suppose, if they're taking blood anyway, we should get his keppra levels done, too. I would like to know first if they've completed their studies at Auburn to see what the norms for cats on Keppra are, though. I believe, however, that no matter what the Keppra levels are, I wouldn't make any changes in his dosage. Comparing the potential damage done by multiple grand mal seizures to anything that seems likely to happen from Keppra usage, I think that the seizures pose a much greater threat to his well-being.

The UGH - a week or so ago, I noticed that Burble was scratching his chin with his back leg, and that he'd yip while doing it. He's kind of an oddball, and it never occurred to me that there was a reason for the scratching, OR the yipping. Anyway, when I eventually looked at his chin, there was a huge glop of dried blood, and a sort of raw looking triangle under his chin. I cleaned it off, and assumed that it was caused by the scratching. Then a couple days later, I noticed that he had a little patch of raw skin over near his lip, too. I googled, and found references for all sorts of repulsive, difficult-to-treat stuff like "miliary something or another" and "rodent ulcers".... But, when I asked a vet tech on FDMB, she said - "Ah, feline acne." Usually caused by plastic bowls, I thought. Which was the reason I have been using paper bowls by the dozens for years. But, she said, it's not necessarily what the bowl is made of - it's the fact that the chin is the dirtiest place on a cat, and the hardest for them to clean, and a bowl makes for more unreachable food on the chin. She recommended flat dishes for feeding. (And I have $75 of paper bowls downstairs! I wonder if there's some sort of ornament I could turn them into....) My cats all like their food very soupy with extra water, which would seem to be a minor problem with using plates for feeding, but I suppose it's manageable. She also said that Stridex pads can be a useful treatment. She didn't mention that there were 443 different KINDS of Stridex pads sitting on the shelf at the grocery store. I ended up buying the one that said "Original" on the label, although I don't know if it's safe for a cat or not - considering the licking and fiddling around that goes on after cleaning the area with the Stridex. Now I've started cleaning the chin and then rinsing it with clear water to try to remove the alcohol and whatever else is in there that might be licked up.

Anyway - lost track of where I was going with this - yesterday morning, I noticed that Milkshake's little chin had a sort of gray look to it. He's normally sparkling white. And, sure enough, when I got close to it and separated the fur a little, there were the tiny little black spots. (Referred to as blackheads in some of the articles I read about feline acne.) I cleaned it up with a little soapy water, and was surprised at the amount of blood that was on the paper towel. So, I gave him two Stridex treatments over the day, and as of this morning, his chin does look a little less gray. This is really annoying. I KNEW that plastic bowls were a problem. I use a big Correlle bowl for water for them, and purposely chose the paper bowls for their food.

I did find this very good article on Omega Fatty Acids http://www.peteducation.com/article.cfm?c=1+1400&aid=665 which suggests that Fatty Acids are helpful in clearing up feline acne, so I guess I will start adding some to everyone's food. I'm getting quite a collection of feline supplements and medications here. There are many other benefits to the Omegas, apparently, as long as the ratio of Omega 3 to Omega 6 is correct.

This crew of cats has had MORE weird stuff wrong with it than any other cats I've ever had in forty years. I have a theory (one of many, sadly) that the more attention you pay to your cats, the more diseases you'll detect. Maybe ignorance IS bliss......

Happy MilkshakeDays!

2008-12-20T16:28:00.006-05:00

(That's actually not something sticking out of Milk's ear - it's the ribbon from the hat, which is, in reality, behind his head.)

Merry Christmas from the World's Sweetest Cat.

We are approaching a Longest-Time-Between-Seizures record here, but I'm not going to jinx it by mentioning the actual number. Just keep your fingers crossed for us.

Milkshake's Beginnings......

2008-12-04T20:50:00.016-05:00

I came across pictures tonight from the day I dragged home this incredibly sick, pitiful looking little cat. Almost three years ago. And I wonder what I would have been thinking if I'd known that his life here was going to turn out the way it has.....

It's hard to even look at these pictures. (They're clickable.) He was so urine-stained and filthy. His eyes were oozing black stuff. There was so little flesh on him that those two big bones - his breastbone and his shoulder blades - stuck out sickeningly. His knees banged together and he swayed when he walked because there was so little muscle tissue left that there wasn't anything to keep his legs straight and in place. He had the same big belly you see on tiny African kids who are starving.

Oddly, he really wasn't afraid. Maybe he'd been through so much that he already knew that there was nothing he could do to protect himself. Or, maybe he sensed that he was going to be loved and cared for finally; that he was going to be my "heart kitty." I picked him up at PetSmart, paid his fee and gingerly put him in the carrier. We went straight to the vet, where he was examined, given an antibiotic injection for the respiratory infection that made his breathing actually audible, and got drops for his eyes. After two weeks at the Humane Society free-feeding dry and pouched food, he weighed barely 3 pounds - and he was 7 months old. Back into the carrier, and then into the calm and warmth and quiet of the extra bedroom, where he was willing to just lay on the bed for a couple of hours before getting up to look around. I was both sad for him and angry at what people who were supposed to be taking care of him had done to him. He really was an innocent victim. And yet, someone had rescued him from the "home" where he was starving and filthy. Someone had put him in that hidden cage at PetSmart, and someone had led me to make a beeline for him. So, maybe things did work out just the way they were supposed to, although it makes me sad to think of how awful his life must have been, and how tenacious he had to have been to have survived as long as he did. And what an amazing thing it was that he was such a sweet, loving little kitten despite what had happened to him.

And he's still a wonder, with eye contact that amazes me every day. And the most tender way of reaching out with his long, thin leg to pat me. And snuggling into my elbow to nap. Someone said he's my "familiar." Like witches supposedly had. Could be. I just know that scrawny and epileptic and shedding tons of white fur that seems to have an adhesive quality to it, he's amazing and wonderful and makes me happy every single day that I found him and have the privilege of cherishing him.

A Busy Deterrent (hopefully!)

2008-11-24T15:48:00.003-05:00

I noticed a post on the FDMB by a wonderful person named Sandy, who had a picture in her signature of her cat, Black Kitty, after some surgery. And he was wearing what looked like it might be the answer to the Busy-gnawing-Milk's-shoulders problem! So, I wrote to her and asked her where she'd gotten the wonderful protective garment, and she said she'd made it herself. And she was willing to make one for my little Milk!

This weekend, the prototype arrived. And it's perfect! It was stretchy enough to put on him easily, it's tight enough to stay in place and protect those bare little shoulder blades that Busy seems to think are so tasty, and it actually looks like a "muscle shirt". Well, not that Milk has much in the way of muscles, but the idea is still there. He's still staggering around the house like it weighs 20 pounds - cats are such hypochondriacs. But I think that this may be the solution to the problem, and maybe it'll keep Milk warmer, too, this winter. He's spending most of his time napping in a kitty pi on a heated mat.

I'm thrilled! and grateful! and about to decide what color kitty pi to send the gorgeous Black Kitty in thanks!

More information on the study

2008-11-07T21:02:00.004-05:00

(Anyone reading this who might be interested can contact Dr. Brewer - information is in previous post, I believe.)

Hello again, I'm very excited about all the responses I've been

getting about the use of zonisamide for cats. I wanted to reply to

give some more details on the study. here are some things for you guys

to think about in the meantime while we are still waiting on approval

of the this project.

requirements:

1. diagnosed with idiopathic epilepsy (meaning that seizures can't be

due to other diseases such as viral, tumors, infections, etc); because

of this, ideally cats will have a normal MRI and spinal tap performed.

pending our trial approval, we may be able to offer financial

assistance for this aspect of it.

2. owners must have a WRITTEN seizure log for the past 2 months prior

to starting the zonisamide showing at least 2 seizures per month and

maintain a log during the study

3. ideally each cat will be evaluated by the neurology service at

Cornell. As this may be difficult for some to do, as long as your cat

is evaluated by a board certified neurologist, we may be able to

coordinate through them and have your records faxed.

4. routine blood work (CBC, Chem, U/A, and zonisamide level) will need

to be obtained at 0, 30, 60, and 90 days.

5. no changes to other seizure meds (ie phenobarbital) dosages can

occur in the 2 months prior to starting the trial and during the trial.

I know that all of these requirements may causes some problems for

some of you, but please understand that when performing clinical

trials, it's crucial to have some degree of consistency in order to

prove a drug is effective or not.

as discussed, we are hoping to get the approval and hoping funding

within the next 2 months. Hopefully, most of you will be able to make

it up to Cornell to be evaluated. if you can't and still would like to

be a part of the study, please see if there is a board certified

neurologist in your area that we may be able to work through.

look forward to working with you all!

David

While I'm interested to see if zonisamide might be a more reasonably priced, easier to use seizure medication, I don't want to put Milk through an MRI and spinal tap - at our own expense! - or a trip to Cornell - my son went to lacrosse camp there, and it was a nine hour trip. With the pitiful mileage my car gets, it would cost hundreds of dollars just for gas. To say nothing of the wear and tear on the world's most frightened little white cat.

Nothing's ever simple.

Interesting study and vicious attack

2008-11-06T14:07:00.011-05:00

First, the study:

This showed up this morning on the epikitty site:

Clinical trial evaluating new anti-epileptic drug in cat

Posted by: "dmbrewer1977" dmbrewer1977@yahoo.com dmbrewer1977

Thu Nov 6, 2008 5:53 am (PST)

Hello everyone, my name is David Brewer and I am currently a

veterinary neurology resident at Cornell University. We are getting

ready to launch a new clinical trial involving the use of zonisamide

to treat epilepsy in cats. Zonisamide is currently used in people

and dogs for the treatment of epilepsy. A kinetic and safety study

has been performed and this medication is well tolerated by cats,

however a clinical study evaluating its effectiveness has not yet

been performed. Benefits of zonisamide are that it can be giving

ONCE A DAY to cats, it's safe with minimal side effects, and is

inexpensive. If anybody is interested or would like more

information, please feel free to reply.

Here are some general requirements for the clinical trial:

-cat must already be on phenobarbital and have adequate blood levels

-must have a seizure log, and currently have a seizure frequency of

at least 2 seizures / month for the last 3 months.

-must be free of other illnesses

-clinical trial will last 3 months

As we all know, there are few medications out there than can be used

in cats for the treatment of seizures. This clinical trial will

hopefully show that zonisamide works. In my opinion, one of the

biggest benefits of zonisamide is that can be give once a day, which

can be a large relief to owners who have cats that are difficult to

pill ( I have 2 cats that are extremely difficult to pill). There

will be more information on this topic later, but mainly wanted to

see how much interest would be out there.

Thanks!

David Brewer DVM

Neurology / Neurosurgery Resident

Cornell University

Now, the idea that Milk's medication could be reduced to once a day - well, twice, including the phenobarb - is definitely attractive. Way more than attractive, actually, particularly since Milk's so generally uncooperative about letting me grab him four times a day for pilling. But, I guess he wouldn't necessarily be eligible for this study anyway, since he doesn't meet the number of seizures/month criteria. (Thank God.) The worst part of it would be whether it would be necessary to take him off either/both keppra and phenobarb in order to participate in the study. I don't think I could risk losing whatever precarious control we have now; his tendency to have the seizures get closer and closer together is too scary to take the chance, I'm afraid.

I did write for more information, and it will be interesting to see if it's possible to follow this study and see if it might be an option to replace Keppra.

As far as the Vicious Attack, I don't know WHAT I am going to do with Busy. He started gnawing on Milkshake back last spring. (I think it was before the girl kitties came inside, although I'm not positive.) I believe it's an offshoot of his eternal and unfulfilled desire to be the Alpha Cat around here. What he has done is to pick the most vulnerable, weakest of the other cats, and then torment him mercilessly. And poor Milk, who wants nothing more than to snuggle with everyone else every minute of the day, does not make any attempt to defend himself. He's scrawny, and all doped up, and his balance is not what it might be, and all Busy has to do is nudge Milk, and he's on the floor. The initial attacks were significantly less damaging. There would be a tiny - about the size of a dime - irritated, red area, usually on the upper shoulders/neck.

But since then, the damage that's being done is significantly worse. Milk now has three separate injuries that have sort of melded into one, two-inch long open wound.

And now, because the area is so much larger, he can reach it himself, and he's aggravating the injury by licking it. Whole chunks of skin and fur are being torn off. I tried putting neosporin on it - he wants to lick it off. I put a little tee shirt on him. He did the "Oh, I'm falling down, I can't walk with this awful heavy shirt on me" act, and then, even though it wasn't huge, and it was actually MEANT for small dogs/puppies, somehow he managed to get himself all tangled up in it, and the neckline in the back stretched way down to below the raw areas. I pinned the neck in a pleat to keep it in place and stop the sleeves from getting in the way when he walked. No go. I got out one of the walking jackets, which has a panel that goes from where it's attached at his neck to the larger band that goes around his stomach. The neck panel was in the perfect place, but it's a rather stiff nylon, and I didn't like the possibility of its rubbing against the sore spot. Plus, the more he wore it, the more the whole jacket shifted around, until there was nothing covering the injury at all. I am going to see if I can find a slightly smaller, differently shaped tee shirt that would be less likely to shift around and get wrapped around his legs.

I also tried to make Busy responsible for the problem. I put him in the bedroom when I had to go out. But, all the cats like to sleep on the bed in there, with the kitty pi's and the heated mat. And it's not fair for him to have the benefits, while everyone else is sitting sadly peering in through the screen door. I put Scruffy's cone on him. And in four minutes, he trotted into the living room, coneless. (I have no idea how he got it off. I've always said, if he had opposable thumbs, he'd rule the world. ) I watch him like a hawk. His favorite attack time is when I'm in the bathroom. I try to always take one of the two of them in with me, but that's not always possible, and it's horrible to sit and listen to Milk shriek and not be able to do anything.

There has to be a solution, but I have no idea what it is. I can't bear the thought of how much that skinless, furless area must hurt Milkshake.

(Hi, Marianne!)

Imperceptibly....

2008-10-14T23:26:00.003-04:00

Milkshake has started to eat. I can't say exactly when. Not a lot, and not particularly enthusiastically, but he shows up now in the kitchen at meal times, and even though he may not eat when I first put his bowl down, the chances are very good that he'll be back to sniff and eat a little bit two or three or four times. We've been out of the homemade raw food (except for some wonderful extra chicken chunks that Dian sent!) for more than a week now, between my getting sick and Scruffy's laser surgery, and Milk's probably the most enthusiastic raw chicken eater of the six cats, so I think when the raw returns, he' ll be delighted. I can't believe I have six cats.

What does this do to my previous, probably half-baked theory about his phenobarb level and the degree of anorexia? Don't know. And I really don't want to drag him to the vet yet again for bloodwork.

I also tested my "Are paint fumes a trigger?" theory again this week, with two days of painting the living room and hall. To my relief and delight - no seizures, although I woke up two mornings in a row CONVINCED that I'd heard him foaming and growling. Both times, he was just sitting there peacefully. (I'm a little embarrassed to bring this up, but I did have one MORE theory fermenting in my mind - the "Marin would be good for helping his liver to deal with the assault of phenobarbital every day" proposition. The jury's still out on that one, but I'm inclined to credit the Marin with contributing to the much longer periods between seizures, and to the less overwhelming numbers of consecutive seizures. I am absolutely convinced that milk thistle has been the salvation of my own liver, and I think it's helping my little Milk. And if it's not, I don't want to know. Sometimes, self-delusion can be a wonderful thing.....)

And sometimes, it's better to have your OWN napping place, where your "brother" can't show up after you're already settled and plop down on top of you:

Mustn't have been the paint....

2008-10-13T13:47:00.002-04:00

I was thinking that maybe the paint I'm using in the living room, etc. might have been a trigger for Milk that set off the last few seizures. I didn't have any record of when I painted. I did always make sure that the fan was on and the house was well ventilated, but.... Anyway, I painted quite a bit on Saturday, and - although I woke up Sunday morning again convinced I heard him starting to foam - but he wasn't; he was just sitting across the room from me, looking perfectly normal. Thank goodness.

Gonna have to decide what to do about the next order of Keppra. These 500 mg pills are huge and very unwieldy. I know several people who have the "triple beam" scientific scales, or whatever they're called, so they can give precise dosages. While I know that would be desirable, I don't know if I could manage it. Despite the significant difference in cost between the 500's and the 250's, the 250's were much easier to chop and give to him. I have plenty of time to decide, I guess; the best thing about the 500's is that the two bottles have lasted and lasted. He's still getting 1/2 marin tablet twice a day, too. I firmly believe that it's doing SOMETHING. Well, no, I don't know what, I just think somehow it's helping his liver process the phenobarb more safely. And I am convinced that these longer periods between seizures (knock on wood 13 times!) have some relationship to the marin. Whether they do or not is really irrelevant; the fact remains that I believe it...

This was so NOT a seizure.......

2008-10-06T06:34:00.004-04:00

but I have no idea what it actually was. (I have to preface this by saying that I've had a horrible cough and cold for five days and have been taking Sudafed pills. "Non-drowsy" - which means that I haven't had more than two hours sleep at any one time since last Tuesday, although I've done virtually nothing BUT sleep.) S0, suddenly I wake up, it's 5:45 AM, and Milkshake is standing, kind of hunched over and with his neck very oddly extended, between my knees, facing me. Picture those museum displays of the pre-historic sabre-toothed tiger - pointy head, sharp teeth exposed....... It reminded me of those really bad Japanese monster movies from the 50's, where the obviously fake plastic monster/dinosaur kept "lunging" at the shrieking victims. Despite the darkness, I could see that his mouth was open and his teeth were gleaming in the dark. (High praise for Dian's raw chicken chunks!) And, in the background, was this horrible, subterranean, rumbling, gurgling noise - a sort of combination volcanic/sewer kind of rumbling. So, because of the mouth action - is that called "rictus" - some sort of death movement of the muscles? - all I could think to do was to pet him ferociously, in the hopes of waking him up, unfreezing his muscles, and maybe subverting any possible seizure activity. He truly did seem to be getting ready to salivate all over the place, or maybe he had something stuck in his throat. I went from the top of his head to as far as I could reach down his back over and over again, all the while asking him repeatedly - and I'm sure, to his great annoyance - if he was okay and would he please NOT have a seizure. He moved out of my reach, and then again assumed that weird dinosaur position with his neck twisted out of shape and his mouth open and seeming to snarl. I leaned forward to pet him heartily again, at which point I realized that that subterranean rumbling was coming from ME - apparently the unpleasant disgusting glop in my lungs needed to reposition itself when I sat up. (I am trying to take some comfort here from the fact that it wasn't my CAT'S chest making a noise like that, although it's a stretch.) At any rate, he abruptly flopped down and tucked one leg behind his head and finished what may have just been an out-of-control grooming session. And then HE went to sleep.

And now it's ten minutes to seven and I'm awake and already stewing about Scruffy's surgery tomorrow. I really didn't need this. I guess I should just be grateful that it wasn't a seizure. Yeah, that's the ticket. Grateful.

ADDENDUM: And neither was whatever was going on at 8AM, I don't think. I had laid down on the couch after the previous episode, and was rudely awakened an hour later by a cat shrieking, and multiple cats slamming around and racing all over the place. It sounded like Milk's meow, and Busy is still chewing on Milk, although he's now expanded his menu to include Cinnaminnie and Tootle if he can get close enough to them. I called Milker, and he came rather uncertainly up the stairs. Seemed wobbly. BUT - his head wasn't wet, nor was any other part of his body. And I had to coax him into the kitchen, and then follow him back out to the living room with a bowl of FF. Therefore, I am declaring this event also as "No Seizure." With hope in my heart and exhaustion in my head.

I'm going back to sleep now because as the day rolls on, we get closer to having to pill and eyedrop Milk and Scruffy at 2AM, and Scruffy has to leave for the hospital at 7:15AM. Sleep now. That's my priority for today. And not dreaming about The Puffer and his laser surgery.

The Non-Magic #50

2008-10-01T09:15:00.003-04:00

Six days, two hours, 15 minutes or so. Quite a bit later in the morning than usual - so there was plenty of light to see him this time. All of these most recent seizures, say the last 5 or 6, have been different from the ones earlier in the summer before the 102-day break. The most striking difference to me, is the increased amount of time that it seems to take now for him to recover. It was an entire 24 hours after the last seizure before he was physically able to confidently jump or even walk up the steps to the window ledge. He was not only wobblier than usual, he didn't seem to have the coordination between his brain and his front legs. It is worrying. On the other hand, everything's worrying. My tolerance for all this seems to have significantly decreased, especially since my mother's diagnosis. One dying brain is all I can deal with at a time, I guess.

Today's event: Let's see. Started up with virtually no fanfare. Hardly any growling/snarling until well into the seizure and even then, the volume was much reduced. Salivation evident after it was over because the sheet and his head were wet, but I didn't see foam all over his face. A moderate amount of flopping. Longer than usual, I think, although that's subjective; sometimes I'm trying so hard to concentrate on remembering what he's doing that I'm not keeping good track of the time. I would guess this was at least 30 seconds, possibly longer. At least twice, the flopping slowed down and I thought he was done, but he wasn't. He was bouncing pretty high, but not particular violently, compared to other seizures. The end was very abrupt, as usual - it was like he was just deflated, popped like a balloon with a pin. And then there were a series of five or six very hard jerks that involved his entire body. And what seemed like eye contact with him - he looked SURPRISED, somehow; I don't remember ever feeling like he saw that I was there after a seizure before. Afterwards, he lay absolutely still for at least five minutes. Normally, he jumps down and heads for the kitchen to eat ravenously. Today, he jumped down, but he seemed confused about what he wanted to do. He started off in the wrong direction, and even when I called him to come the other way, to the kitchen to get something to eat, he seemed uncertain. He ate when I put a dish of Fancy Feast down for him, but not as intensely as normal. I left the kitchen to do something, and he didn't follow, but he apparently did stop eating - he was in the living room when I came back. He ate a little more, and then came and sat behind my chair. He climbed up onto the desk once, and seemed to want to go to the window ledge, but I was hesitant to let him make the jump, so I helped him get his feet onto the steps. He went unsteadily up the last step, turned around and came back down, and then just meatloafed on the rug. I went and got him a kitty pi because it's kind of cold here today - supposed to be a high in the 50's, I think - and he curled up in it. As I was typing that, he showed up on the desk again. He's so unstable that, while petting him, it's hard not to make him tilt over. I haven't been able to weigh him lately - (long story involving painting the living room and dining room) - but I'd guess that his weight is under 9 pounds. Possibly a good bit under 9 pounds. His spine is painfully prominent. I have been bottle feeding him once or twice a day for the last week. Multiple trips on and off the desk have been occurring now; he just stole my pen, but then didn't seem to know what he wanted to do with it.

Maybe the most striking thing about today's seizure was his eyes. I have never noticed before (the light's seldom sufficient) , but today, his pupils were hugely dilated for almost a half hour after the seizure ended. Gigantic and all black.

I'm kind of scattered these days - yeah, more than usual - and yesterday, I absolutely couldn't remember if I'd given him his 6:00 Keppra and Marin. (I even have a chart to keep track of his pills; I just haven't been doing it.) I tried every way I could to figure it out, but..... I could remember the AM pills, and a couple of the previous day's, but nothing for 6 PM. SO, around 8:30 PM, when it had occurred to me to worry about it, I ended up giving him another 1/4 and a "chunk" of Keppra. I was afraid that he'd seem overdosed, but he didn't act any differently the rest of the evening, so I'm left to wonder if maybe he didn't actually get extra medication, and maybe this seizure occurred because that dose was late? Seems unlikely, though. I'm thinking that it happened, well, because it COULD and DID. I just remembered now, too, while I was fixing this morning's load of pills for him, that the phenobarb last night was a problem - the counter had wet spots that I didn't notice were there until I'd put two phenobarb pills down in them, intending to break the pills in half. They turned into a chalky mess almost the second they got damp. Then a third one fell on the floor, and a fourth, my fingernail must have had a little water underneath it, and when I tried to crack the pill, it got wet on top, as opposed to the bottom. And, to top off a not-particularly-admirable performance as feline caretaker/medicator, the Pill Pocket - FINALLY loaded with the correct amount of phenobarb, fell out of his mouth and onto the floor, which required starting everything all over again. Not one of my finer moments.

All in all, I'm not so surprised by this seizure. Disappointed, and sad, and wishing it hadn't been, but it's become obvious that I have only the most minimal effect on the workings of my sweet Milk's sad little brain, and there's not much point in getting hysterical about it. And I'm sure the knot in my stomach will go away soon......

#49

2008-09-25T09:01:00.007-04:00

We were up to another 23 days since the last seizure when this morning's showed up. I'm always trying to find signs or symptoms that might indicate a seizure is imminent, but..... I think this one might have been a reflection of a failure of the "chunk system" of cat-medicating. I thought last night when I gave him his last pills that the 1/4 pill was kind of small, and the two 1/8 pills were not exactly "standard", either. But, that's not something that I can ever have control over, I guess, given the vagaries of chopping up the stupid pills. And maybe this one has been in the works for a couple of days - I did notice that for the last two days, I've had a hard time finding him for his 6:00 PM pills. But he's got that exquisite little internal clock, and I have no doubt that he knows exactly what time it is, and when pill time is. Anyway, I had trouble going to sleep last night, and was awake from 2AM to 4AM, and around 4:00, Milk got up from his usual position curled up between my knees and wandered off toward the sofa, where the four kitty pi's are still spread out. He's been snuggling again with Scruffy in his pi recently, so I figured that's where he was headed. At 6:30, I heard what seemed to be the end of a seizure. No snarling, but the foaming noise woke me, I guess. He was laying on his side, in one of the pi's, and he had another pi clutched between his front paws and his head was resting on the second one. His face and neck and side were soaked, as was the part of the pi where his head was. (No peeing, thank goodness. That's starting to become an obsession with me.) He was done with whatever physical stuff happened during the seizure, and was just laying calmly, jerking occasionally. To judge by the short amount of it I saw, it looked like a very mild seizure, but who knows. I talked to him and petted him, waiting for him to jump down and go look for food. It was at least a minute, possibly more, and when he jumped off the couch, he was really wobbly and almost collapsed. He bumped into the coffee table on his way to the kitchen, but by the time he got there, he was a little sturdier. He ate some of last night's dinner that was left while I fixed him a fresh can, and then eagerly ate it. He wandered around a while. I sat down in my chair to try to sleep some more because I had to take Scruffy to the vet in a couple hours, and Milk curled up and went to sleep again on my leg. He seemed fine when I woke him around 9:00 and gave him his pills early because I had to get ready to leave. He didn't eat much, and before I left, he had crawled under the couch. All the other cats were downstairs (where I had opened the sliding door in an dubious attempt to capture Scruffy), but Milk never came down. We've been back now for a little while - it's 1:00 PM, and there's no sign of Milk. Usually, he's sitting at the top of the steps when I come home.

While I was at the holistic vet's, (where I've taken Milk in the past for chiropractic stuff, which the animal communicator said he needed and Dr. K agreed) - I asked about acupuncture for his seizures. Dr. K was willing to do it, but said that it does require an "holistic exam" - $160- and a committment to follow-up appointments. I wondered how we would know if it was working or not, but I suppose the only way is that he wouldn't have any seizures. At any rate, I'm willing to try it. The medication route hasn't been vastly successful, and I think this is at least a possibility worth trying. They want Milk's records from Dr. G, and I gave them Dr. A's name and the clinic in Ohio, but they happened to have one of their referral sheets and his name wasn't on it - don't know what that means. At any rate, Milk has an appointment for November 5 at 10:00 AM. Not a wonderful time, since it takes almost an hour to get down there. I'll have to give him his pills at the doctor's office, I guess.

I get so discouraged every time he has another seizure. You get your hopes up, and then boom, it happens again. If it weren't for the subsequent anxiety about how many will follow and how severe and how close they'll be, it might all be easier to deal with. And if he didn't look so sad after a seizure - I guess the activity and the increased blood flow makes the pink parts of him so much pinker and more defined. It gives him a sort of haunting/haunted look, somehow - like he's outlined in blood or something. Or maybe I need to stay away from stores until Halloween's over........

One last further disturbing aspect after today's seizure - twelve hours later, I discovered that he still couldn't jump safely onto the bathroom sink, or the counter in the kitchen. He fell both times he tried. And when I gave him his 6:00 pills, he immediately threw them back up, with a small puddle of brownish liquid. I'm not sure what to think about either event.

Phenobarb's back.

2008-09-10T01:00:00.007-04:00

I can't understand - even with a wispy little cat like Milk - how such a tiny amount of phenobarbital can have such a huge effect. It's been - well, rats, I don't remember exactly how long (and I'm afraid this will disappear if I go to look at the blog) - maybe a week and a half or so? - since the seizures returned, and I increased the phenobarb to 3/4 of a pill both AM and PM. That's about 3mg more in the morning. The first few days, things seemed pretty much normal - and I have to say that it's been a week since he had a seizure. **anti-jinx** But, yesterday, he ate virtually nothing except for the bottles of EVO that I gave him, and today, he's really wobbly again. I didn't know that he was sitting on the back of my rocker tonight, and when I abruptly stood up, it practically flung him onto the floor - and he didn't seem to be able to do anything - claws, or reflexes or whatever - to maintain his position. I did weigh him a couple days ago, and he was 9 pounds, 1 ounce, but his rear legs and hips are really boney again. I'm aiming to give him two bottles a day and to hope that, because he loves the raw chicken chunks so much, he'll eat at least a couple of mouthfuls on his own.

Little Tootle has declared herself the Queen of the House. She has all of the boys intimidated, and poor Milk, who so much loves to snuggle and cuddle with the other cats, has never even gotten to lay a paw on her, much less schmuttzle. He looks longingly at her, and then, when she starts coming toward him, he's smart enough to take off as fast as he can.

Watch out, Milk - she's coming to get you!

You have to wonder........

2008-09-02T06:59:00.003-04:00

if this poor little cat can have had 48 seizures in 17 months - and was on quite substantial amounts of anticonvulsants for all but the very first 11 events - and if he should have a fairly normal lifespan of say, 15 years (although that's longer than any cat I've ever had has survived, it's still a reasonable length of time) , and if someone had the capability to do the math.... Well, the number of seizures Milk could possibly have in that scenario doesn't even bear thinking about, does it?

# 48. Four days, twenty-one hours and some minutes since the previous seizure. I guess I should be glad that it was four days, instead of two. I guess I should also throw away my lately-proposed theory about how milk thistle will stave off more seizures. Well, maybe it did - an extra two days? Highly unlikely, I suppose. At any rate - early morning again, very little warning - although there must have been quite a bit of salivation this time, because the sheet he was laying on was much wetter than it has been in recent seizures (but still, thank goodness, no peeing or pooping. I can live with saliva.) Volume and ferocity of growling was up, but flopping was still down significantly and didn't occur until close to the end of the seizure. Sort of sounds like a stock market report... The seizure lasted about 20 seconds, and he lay afterwards with his eyes wide open but not moving at all for about a minute and a half. Jumped down abruptly, raced into the kitchen to see what there was to eat. All pretty much standard. Which is quite a sad commentary, I suppose. I'm so tired right now that I can't even work up the usual indignation at whatever Power did this to my cat. Anyway, he ate about half of two cans of Fancy Feast, and a few bites of dry kitten food, and right now, almost an hour later, he seems pretty much his usual self. I know "They" say that the cats aren't aware of what's happening to them during a seizure, so it's more distressing to the humans. Not that that's much comfort.

* I meant to say, "Hi, Marianne!"

2 days, 3 and a half hours...... #47

2008-08-28T09:10:00.008-04:00

Oh, this is depressing. Really upsetting.

A very strange little seizure, this one was. It started very abruptly, with virtually no build-up salivation. (There was a spot of wet fur on his neck that was only the size of a nickel.) The growling was back, with a little less volume than before. The flopping - oh, the flopping. At one point, he flopped so high that he was almost perpendicular to the footrest. It was all I could do to contain him with the "wall of afghan" so he didn't end up on the floor.

Very short actual seizure - probably 15 seconds or so. The after-period (post-ictal?) - not so short. Slightly over 2 minutes before he moved again once the seizure stopped. One large jerk right after the seizure ended, that I think I caused - I was just going to pet him to comfort him, but never got close enough to touch him. He laid totally still, with his eyes wide open most of the time. (I have noticed - since I've been watching everyone's eyes because of Scruffy's problem - that recently there are occasions when his right eye is more closed than the left. This was one of them. I hope it's not more indication of neurological stuff. Dr. G. thought that the recent dark trail down both sides of his nose lately is herpes-related. It doesn't appear to be conjunctivitis; his eyes aren't red-rimmed.) When he got down, he appeared more coordinated than usual. Raced into the kitchen and started eating last night's leftovers. I started to fix him a fresh can of Fancy Feast, and he meowed plaintively the whole time I was getting it out and putting it in a bowl. He ate about half a can, then headed to the pantry for more/something else.

I thought that he seemed less uncoordinated this time, but he jumped up onto the bench and then came over to my keyboard, and he definitely was having problems navigating the trip. (Scruffy's logbook was there, and yesterday's mail. ) Twice he got as far as the end of the desk and then seemed to be hesitant to move onto either the steps or the window ledge - which usually is just a single step for him. He's just been sitting behind my chair for about 15 minutes now.

Although I couldn't find him Tuesday to take him for bloodwork, I did get him there yesterday. I HOPE they get the results back today - if the phenobarb level is low/low 20's, maybe it's (sadly) time to put back that 1/4 pill I took away in June. I would be sorry to see him lose his minimal interest in food again and to be staggering around, but he can't be having seizures every two days, no matter the ferociousness or the brevity of the event. I was very careful about the size of the Keppra pills all day yesterday, and of getting the pills at exactly the right time again, which didn't seem to make any difference. I am worried, because once the seizures start getting closer and closer, it's so much harder to get any sort of control again, and I'm terrified about having clusters. Back when all this stuff first started, he had two seizures on the same day on two occasions; one of them - he had two seizures in a row, about 10 minutes apart. Frightening.

Dr. G. just called with the phenobarb level - 26.4. Essentially the same range as the last test, and it does fit in with my theory about voluntary eating/seizures occurring/lower phenobarb level. We agreed that there was presumably plenty of room to increase the phenobarb by 1/4 pill - to 3/4 tablet (about 10mg) in both the morning and evening. He had been getting 1/2 in the am and 3/4 in the PM since 7/18. I had just given him his pills this morning, so I tucked another 1/4 tablet into him a few minutes ago.

It just occurred to me that about four or five days ago, I finished up the bottle of Marin ( milk thistle) that I've been giving Milk a half tablet of daily for the last couple of months. I wonder if that could possibly have something to do with the sudden recurrence of these stupid seizures.... Given his previous liver function difficulties because of the phenobarbital, (and my own experience with milk thistle that was extraordinarily successful), maybe ....

Or not, I suppose.

102 days, 3 hours, 52 minutes.........

2008-08-26T04:45:00.004-04:00

I feel like I did this to him. I told people today - a lot of people - that he was doing well. I should have just kept quiet and kept things to myself. When I was picking out the pill fragments for his last dose of Keppra at 2AM, the 1/4 pill was a little small, as was the "chunk", and I chose a 1/8 pill that was a little larger than usual on purpose, thinking that it might make up for the difference. And, when we were going to sleep, I got out the blue afghan for him to lay between my ankles, and I actually thought to myself, "Brother, how many seizures did he have on this...." Like foreshadowing. Not that there's anything that I could have done that would prevent it, I suppose. I truthfully don't believe that even if the pieces of the pills had been exact to the fragment of a gram, it would have kept this seizure from happening.

It was very different from the last 20 or 30 seizures. It makes me sick even to write all this. Although it seemed to go on forever, I started to count "one-a-thousand, two-a-thousand" shortly after it started, and I would guess that it lasted, at most 30 seconds, and possibly even a little less for the actual seizure. Aside from making a snuffling sound, like his nose was stuffed up - which I would guess was related to the foaming/salivation - he didn't make any noise. No growling or snarling. And while his body seemed a little stiff, he didn't flop violently like he had before. This was more like the first seizures he had, way back almost a year and a half ago. I was expecting all the horrors of the most recent episodes, and really didn't see anything similar. When the convulsing stopped, he lay absolutely still for so long that it crossed my mind that maybe he'd died. And then he started to jerk - he did it four times, big jerks - and I was terrified that he was going to have another seizure. And I can't remember where I put the liquid valium.... Or the catheter stuff from the emergency hospital. But that stopped, too, and he lay still for probably an entire minute. It's funny how long time is when something like this is involved; seconds seem like endless hours. Anyway, eventually he jumped down and headed wobbily - is that a word? - to the kitchen. I'd left four bowls with 1/2 can of Fancy Feast in each one, because the cats only had raw for their "dinner" tonight and I was afraid they'd be hungry during the night. He was pushing one of those bowls around by the time I got there. I asked him if he wanted fresh Fancy Feast and he peowed and came running over. He ate almost the entire can and was still looking for more, so I got out the raw. But it was cold, and I didn't want to take the time to warm it with hot water, so I mixed it with the leftover FF, added hot water, and put it down. He didn't want it. Anyway, he paced a while, and kept climbing unsteadily up onto my desk. He was standing with one foot on the keyboard when he sort of collapsed. There's not a lot of room for standing where he was on the keyboard shelf. I put him down, but he climbed up three or four more times. Eventually, he settled into the kitty Pi on the bench beside the desk, and now he's asleep there.

I am aware that I'm rambling. I can't even describe how upset I am about this. Not that I had any expectation that he'd be seizure-free forever or anything. But it was so nice not to feel like this was going to be hanging over us again. It's hard to describe, but having "another seizure" embedded in my brain affects the quantity and quality of my sleep. For days now, I've been waking up every time he moves during the night. It's like - even though there's nothing to be done about it - my mind thinks that if I'm alert enough, somehow that will keep the seizure from happening. I can't explain it. Every seizure he has is like a personal horrible attack on him that I can't help but feel that I should be able to save him from. And obviously, I can't . And geez, today he got all of his pills exactly to the minute on time, for a change. No chasing him around and pretending that I wasn't trying to grab him. No delays of any kind.

Okay, the one thing that the rational part of my head - that minute little corner that actually functions these days - is saying is the question of his phenobarb level, which I didn't take him to have checked. I've known ever since he started to eat on his own a few weeks ago that it was probably time to worry. I will have to take him tomorrow for bloodwork, just for my own satisfaction, to see what his phenobarb level is. Maybe it's gotten low, and if it doesn't allow a whole mess of seizures to happen, it could stay low? I doubt it, and he's even lost a few ounces - I just started giving him two bottles of EVO canned again today. What I want is - impossible, I know, but I can't help it - to be reassured that this isn't the beginning of one of those horrible periods when he has one seizure after another at ever decreasing intervals. Lots of the other epikitties seem to have a seizure here or there; he never did that. For Milk, once they started, they just kept getting worse and closer and scarier.

I don't want either of us to have to go through that again. And I can't prevent it if it does happen.

ETA: Lots of odd behavior after this seizure. Even a day later, he was still showing an excessive startle response to common things - the kitchen curtains blowing in the breeze, the noise of cars driving past out front - and hiding; he didn't even come out for Rege's treat routine, which is one of the highlights of his little life.

It occurred to me in the middle of the night....

2008-08-07T11:14:00.003-04:00

that Milk has started eating on his own again. Which would be wonderful - he has actually maintained his weight by himself for a couple of days - except that the last time he ate voluntarily, his phenobarb level had dropped to the point where he was also having seizures. Lots of them. I hate to do it to him, but I'm thinking that maybe he needs to have his blood levels checked again. I don't know how it works that other people's cats only get their levels checked every six months or even longer.....

This has been a bad week with the litter box problems . There doesn't seem to be any reason for him to be sick. I added - after taking samples from Toot and Minnie (who had worm treatments) - Albon (3ml SID), and a couple of small feeding syringes of probiotic yogurt, according to the vet's instructions. Which Milky reacted to as though I was feeding him poison. There are speckles/lumps of yellow and white sticky stuff all over the kitchen, and all over everything I've worn for the last 5 days. To say nothing of the adventure of capturing and squirting this stuff down Scruffy and Milk both. Little Toot doesn't object at all, for some reason, and she doesn't even have to be argued with about eating any of it. Just squirt and off she goes again!

Hopefully, if it didn't happen then.....

2008-08-03T10:38:00.005-04:00

it won't happen again. (Another seizure.) Last Thursday was the worst day we've had in months for Milk's refusal to let me get hold of him to pill him. It started with the 6:00 PM Keppra, which he didn't get until 8:00 PM. The 10:00 PM phenobarb and Marin, and the 2:00 AM Keppra - well, it took me until 3:15 AM to get them into him. I made a dozen trips up and down the steps. I got out every toy in the house, including the laser mouse, which he loves. I tried to trick him into heading down the hallway where all the doors were shut. I tried food. Bonita flakes. Temptations. Bread crust. (I know - he eats next to nothing, but he loves bread crust.) And nothing worked. At 3 AM, I couldn't keep my eyes open any more. I turned off the television and turned out the lights - which I'd tried earlier, unsuccessfully, thinking he'd be fooled into wanting to go to sleep, too. I must have dozed off, because the next thing I knew, there he was, rolled up in a ball with his head on my ankle. And I fooled him! I already had his water bottle and his loaded Pill Pockets sitting there, just waiting to be able to get hold of him. I'm hoping that the whole evening was just a momentary aberration and he'll knock it off forever.

79 days today. I always hate to even think it. Considering all the stuff I'm doing "wrong" with his medication - dissimilar doses, varying times, generic keppra - I'm feeling pretty lucky so far. Oh, I think I should erase that right now.

The eating has been much better since he's been getting raw - and his teeth, because he likes the chunks of chicken, are much cleaner and less yellow. Unfortunately, a couple days ago, he started having diarrhea. (I hate when people discuss their poop issues, but I now have THREE out of SIX cats with a problem, and no solution.) He didn't seem to have any adjustment problems to the raw from the beginning - he liked the Nature's Variety frozen raw, and he loves Dian's raw. SO, I have no idea what to attribute the problem to. I stopped giving everyone the raw chicken three days ago (much to Busy's delight - he hates everything that's not crunchy) , but the problem has continued to exist. I just collected "samples" from Minnie and Toot to take to the vet today (on the premise that maybe they're having a problem because of the worm treatmen), but 1) Milk hasn't been around them, and 2) he doesn't use their litter box. Scruffy and he do, however, use the same boxes. Maybe I caused the problem to become worse by taking away the raw - that would be ironic. I remember reading that yogurt (with probiotics) is good for the problem; but I'm pretty sure it said "full-fat yogurt", and all I could find was "low-fat yogurt". I wonder if whatever makes it low-fat is a problem for cats? At any rate, I've been giving everyone (except Minnie, for obvious reasons) two syringes of the yogurt every couple hours since last night. How I hope it works.

Dian's raw recipe....

2008-07-18T15:26:00.003-04:00

Last week - after a traffic ordeal that I can't even bear to think about, I brought home 15 pounds of raw chicken made by the caring, if still swollen, hands of Dian and Wheezer. (You have to belong to the Feline Diabetes Message Board to understand some of these arcane references.) Anyway, I had been giving the boy cats Nature's Variety Frozen Raw for well over a year, although not always on a daily basis. Milk did like it, and he was frequently very willing - well, for an anorexic cat -to eat the Nature's Variety Freeze Dried Raw sprinkled on his other food. (Which unfortunately costs $27 for a bag of 24 medallions. More than twice the price of the regular frozen raw... I don't know exactly how freeze-drying works, but apparently it's a very expensive process. Lots of electricity or something, maybe?)

The point of this is, the new raw chicken seems to appeal to Milkshake! He has been taking a few bites from each bowl all week - and I have caught him nibbling at other odd hours. There are chunks of raw chicken included in the recipe, which is supposed to be good for the cats' dental health. Unfortunately, out of the six cats here now, eating the raw mixed with varying amounts of Fancy Feast and Friskies, no one seemed to be much interested in the chunks. I've been finding them all over the house, dried out and bloody. Until this morning, when I noticed that Milk had a big chunk in his mouth and was chewing on it in a surprisingly enthusiastic fashion. If he continues to eat the chunks, it will hopefully significantly reduce the future necessity of his having a dental, since I don't even want to think about anesthesia for him.

The best news is, I weighed him this morning before he ate, and he was back up to nine pounds, seven ounces!

Two thoughtful comments from Gary F

2008-07-13T13:12:00.004-04:00

Hi, Gary F. (It always surprises me that anyone outside my immediate circle reads these things!)

This is the larger of Gary's two posts. ( A man after my own heart - I always remember more I wanted to say after I think I've finished...) I want to comment on his comment - wonder if he'll ever see this, though?

My first time writing: Sorry about your cat, you've shown a lot of love.

Thank you, Gary - I can't even put into words how much I have loved this little cat since the very first minute I saw him, half dead in the cage at PetSmart.

My cat Smokey is also on phenobarb for seizures. Thanks for posting the video, it helped.

(Kind of ghoulish, though, don't you think?)

My experience is as follows.

1) Don't try to stop seizures by experimenting. Seizures trigger when the cat is resting, and all you can hope to do is keep him comfortable and minimize the freq.

I have frankly been experimenting with his medication - which I know is not recommended, but to be truthful, it never made any sense to me that you had to always give the exact same dosage all the time - if the medication is intended to achieve a regular specific constant level in the blood, then what difference does it make to give another quarter or half pill periodically? It's all going to even out in the end, right? And because of the hazardous phenobarb level that Milk reached prior to starting the Keppra, I live in mortal fear that it might happen again. I have accepted that he's apparently not going to be able to be "controlled" without phenobarb, but I want the dosage to be as minimal as possible while still being effective. (The whole issue of phenobarb is complicated by the anorexia. Less phenobarb = more appetite = more seizures. It's a delicate balancing act, at best.)

1)Milkshake may be losing weight due to an open tooth and intense pain (May 16th chewing episode, teeth do break during seizures). Smokey had 2 open canines that were extracted and he perked up.

Nope, his teeth are excellent. I'm big on dentals for the cats, and I do have the vet check him each appointment. He's still very young, which I think helps. I don't know what I would think about the idea of anesthesia for him (to have a dental, for example.) Your Smokey didn't have any problem with it?

Milk's lost weight because he has been anorexic since the very first phenobarb pill. "Paradoxical reaction", I assume. He never got over the dopiness, or the incoordination or any of the other unfortunate side effects of phenobarb, either. I kept waiting for them to disappear, and they never did, until his liver function values were affected. Apparently, despite the large doses of Keppra, he needs the phenobarb to control the seizures no matter what.

2) Be consistent with the phenobarb doses and timing. Don't increase the night dose. Seizures are a barbiturate roller coaster with periods of highs, withdrawals and possibly headaches.

Too late, I'm afraid. ( **antijinx**) He has been on uneven doses of both phenobarb and keppra for weeks now, and so far, so good - we are approaching the longest time he's ever gone without having a seizure - it will be two months in a couple of days. That doesn't seem like a very long time, of course, but it feels like a real achievement - and a blessing for Milk - from here. As I said above, if the amounts of the drug in the blood are intended to level themselves out, then I really don't see what difference it makes. That said, I'm terrified that this switching to the larger Keppra pills is going to turn out to be a problem. Terrified.

3)Smokey is 14 lbs, and gets 10.5 MG of Phenobarb every 12 hours based on a blood target below 30. No Keppra. I have a laboratory grade scale that I bought from a local university salvage department for $35. (I can weigh the paper cicle cut from a 3 ring hole punch). I cut the tablets with a small wire cutter, then rub them on a mechanics file to grind them to my target weight. It takes time to find equipment like this. In the meantime get a $20 gunpowder scale (used for reloading ammo). Cut a plastic drinking straw to your pill target weight as your "transfer standard". Now you can check your scale week after week, because it will drift and hang up. (Don't use a cut pill for your standard, it absorbs moisture or can flake apart).

This is VERY interesting! (And my husband actually HAS a gunpowder scale - not that I'd use it for Milk, of course, since it's covered with gunpowder..... He's a skeet shooter. My husband, not Milkshake.) I do worry because no two pills ever end up the same size. I have a friend who grinds up all of her cat's pills and uses a special scale to weigh them. Her concern is the amount of filler in the pills, and that stuff about how generics are allowed to vary from the original brand name drug by up to 20%. I don't know if there's any way to know that kind of information, though. And I had heard about not using generics for brain problems, but didn't remember that until just recently. Keppra is an incredibly expensive drug - even the generic from Canada costs hundreds of dollars.

4) Put a dab of Nutri-cal on your finger and then in the cat's mouth at least 4 times a day to help him gain weight/vitamins. Then use an eye dropper to squirt fresh water in his mouth to hydrate him, even if he objects. Just like you'd do to a baby.

I bottlefeed Milk with a kitten bottle - he doesn't seem to mind, and I don't have to worry about damaging his teeth or injuring the delicate tissues in his mouth with a syringe. I feed him canned EVO Cat and Kitten food, which is a human grade cat food product. I have a (currently) diet-controlled diabetic cat, also, and I'm very cautious about what all the cats eat, and about making sure they have adequate hydration. I don't give any of the cats food that contains wheat gluten, and usually, they eat some raw along with the canned. Most days, I give Milk two 4 ounce bottles. Left to his own devices, unless his phenobarb level has fallen to 24 or under, he just doesn't choose to eat much of anything.

5) No one can catch Smokey for his 12 hour drugs except my wife and self. To do it we set the oven timer, and when it goes off we whistle like the timer. He comes out, jumps up onto the window ledge and waits for his pill and his treats.

I wish I could get Milk trained to respond like Smokey! I even bought a clicker.... The worst time we had in this miserable epilepsy journey was a couple months ago, when he absolutely refused to let me get hold of him for pilling. His pills were never on time, and I was getting NO sleep. That sort of settled down, and now, most of the time, I can get hold of him without a huge amount of difficulty. Once I've got him, he just sits on the counter and waits patiently until I've wrapped the pills in the Pill Pockets and gotten everything ready. (But if I get the pills ready first, and he hears the Pill Pocket bag crinkling, he's gone in a flash. No dummy!)

6)I use food coloring with a toothpick to put green dots on his morning drug dose and red dots on the night dose. If he spits the pill, I have a better chance of determing when he did it and what I should do about it.

What a clever idea this is!

Thanks for saving Milkshake. He's had a much better life than he would have with most people.

Thank you, Gary F, for the kind words and your suggestions. I think Smokey must be a lucky cat, too!

garyf

July 13, 2008 3:01 AM

Seems better.....

2008-07-06T21:51:00.003-04:00

Talk about your waffling.....

Well, I'm sure he's not blind, and he's not sleeping so much, and he's even been sleeping with me a couple of days in the last week. I asked Dian about the possibility that she might be willing to make her raw recipe to sell to me, and she says she is. She brought a sample yesterday, and Scruffy was the only one who was willing to eat it right off the bat. (And then he threw up. But he always throws up. Plus, he polished off the other three bowls during the course of the day.) By the evening meal, Scruffy was still enthused, Burble had given up and decided it was worth trying, and even my little Milk actually ate five or six bites. Which he did again this morning, and this evening. Not a lot, and it's mixed about half and half with Fancy Feast, but still a very good sign, hopefully.

He's still getting over Stephen's visit, sadly. All that time huddled under the couch, the poor thing. But he looks a little better. I upped the EVO bottles to two a day, and that seems to have helped significantly.

I brought little Toot out to converse with the Big Boys twice this weekend. The first time, Milk was napping on the bench beside the computer. I put her down beside him, and he really didn't react at all - he sniffed her, and she sort of hissed at him (having been hissed at efficiently by Scruffy a minute before.) And then she kind of snuggled into Milk's stomach, and he gave her a little lick- it was very sweet. They actually touched noses before Tooter jumped down. Milk has been hanging out around the screen door, like he's realized that there are two more candidates for him to snuggle up to somewhere along the way. And I've seen him actually sniffing Minnie right up against the screen. It'd be nice if the two girls would know right away that Milky will be their friend.

The new Keppra came in only five days, which was a wonder, considering the mixup in sending the prescription that delayed the order's even being placed for 8 days. I don't know if it was a good idea to order the 500mg pills or not - I was thinking that it would end up cheaper because they could be chopped up into more pieces, but their size isn't conducive to being easily chopped, I'm afraid. They are longer ( a little) and wider ( another little) , but the main size difference is in the thickness, which is impossible to do anything about. (Could I slice them in half across the middle? Doubt it.) And the math is going to be a definite problem. I am hoping that, like the dosage of both phenobarbital and Keppra he's getting now, I can get it close enough to a regular amount that will still hold off the seizures. Please. It's odd how quickly I get used to his not having seizures - like the reality of the disorder is so awful that it's worth doing almost anything not to have to think of it or something. He seems more alert the last day or two, which makes me worry about his phenobarb level dropping too low. Last night, he was all over the cat tree - dangling from one claw, hopping from the floor to the top in one jump, talking to himself while he walked all around it. You would never have watched that performance and thought that there was a thing in the world wrong with him. So, yeah, this is a great time to start messing around with his medication, right? He's got enough of the smaller Keppras to last less than a week, and will need a new prescription for phenobarb in the next few days, too. Fingers crossed.

Something's wrong....

2008-06-27T18:18:00.010-04:00

(I have to put this picture of my sweet Milkshake and Burble snoozing together up here. It's one of Milk's many charms that he loves his "brothers" so much. Okay, maybe a picture of Milk with Scruffy, too, and one with Busy, what the heck.... Only I never can get the pictures to end up where I want them to without a whole bunch of copying and pasting.)

Milk just isn't himself. He's sleeping a lot, and he's really wobbly. In addition, he has taken the "pile of bones in a fur bag" appearance to a whole new high. He just looks flat when he lays down. I weighed him this morning, and he was only 9 pounds, 4 ounces. It amazes me that there are cats like Hope and Wheezer who weigh only 7 pounds or so, and they look so healthy. Once Milk started getting food on a regular basis, he got really tall and long. I know he's a whole lot bigger than Wheezer. I don't know. He just doesn't seem right. And the decrease in Keppra - so far, crossing fingers and banging on the desk and **antijinx** - seems to be able to hold off any seizures. So, I don't know what to think. He did actually eat a couple of bites on his own this morning, which makes me nervous now, since the last time he ate voluntarily, he also had 6 seizures in two weeks because the phenobarb dosage had gotten below his "threshhold." I've been giving him one bottle of EVO a day for the last two weeks or so, but I guess I"ll try to up that. Lots more phosphorus to add to the problem....

Even odder, for a week now - since the last dosage reduction, actually - he hasn't been sleeping curled up between my ankles. He's done that for as long as I've had him; now all of a sudden, he's sleeping in the kitchen, usually in my computer chair, or on the window ledge. I want him back. I want the old Milk back. Whatever is going on is scary. I don't want anything to happen to him.

And then, having said that, a couple of nights ago, I noticed that he had black stuff from his eyes on the sides of his nose, and the normally pink tissue around his eyes was all red. Conjunctivitis - exactly what it looked like a couple of weeks ago when I took him to the vet. And got a bottle of Gentamycin drops. So, I looked around the kitchen, and there was a box with a label with no name on it, and the words "Gentamycin Sulfate .03% ophthalmic solution" on it. "For Veterinary Use Only." So, I shook it a little, opened it up, and managed to squirt one drop into his right eye, and two into the left. And noticed that it smelled really strong and bitter. Chemical. He jumped down indignantly and ran off into the living room. At which point, I thought - oh, no, what if I gave him the wrong medication? I am pretty sure that the bottle said "OTIC" on it - Gentamycin Sulfate "OTIC" .03%" OTIC - that means ears. But the box said the "ophthalmic solution" stuff. (I threw it away, so this is never going to be resolved.) Anyway, then I panicked because I noticed that the expiration date was 3/07. So maybe it smelled bad because it was expired? Did I put ear medication - EXPIRED ear medication - in my cat's eyes? Oh, I was a wreck. So, even though it was 1:30 AM, I called Hope and shared my hysteria with her. She was looking stuff up, and I thought maybe I should call the emergency hospital place. Which I did - after being on hold for 15 minutes, the person I talked to put me back on hold and asked a doctor there about the expiration issue - and said that the doctor wasn't hysterical about it and I should wash his eyes out with saline solution. Which would have been fine if I HAD any saline solution. Which, of course, I didn't. I did slosh around his face with regular water - chlorine, I know, but I didn't even have a bottle of bottled water to use........ He seemed okay. But he kept rubbing his eyes with his deformed little white paws. And then, to compound the confusion, I found - in the fridge - a second, smaller bottle of UNEXPIRED Gentamycin Sulfate, dated 07/09. Same other stuff on the box as in the bad bottle's box. No idea about the bad bottle itself. Anyway, now I'm convinced that I've blinded him. Maybe that's why all he wants to do is sleep. He can't see anyway. I try so hard to take good care of these cats. The miracle is that they're all still alive as I type this.

Experimenting

2008-06-23T12:39:00.003-04:00

Nervously, very nervously, but experimenting, nevertheless. I've pretty much given up the hope that I'm going to be able to wean Milk off phenobarb, possibly EVER. As desirable as that would be, I don't think that it's possible, and to continue to hope for it and to try to decrease again is just too risky. If the dosage he's on now can control his seizures (hopefully long-term), then I just have to accept the anorexia and the wobbliness and all the other side effects as inevitable. It makes me sad. However, I do think that maybe it might be possible to reduce the amount of Keppra (generic) he's getting, since there was the tiny increase in phenobarb that seems to be holding him. I'm antsy about it, but I think it's worth it. Because almost all of his seizures have occurred in the very early hours of the morning, I'm thinking that the most medication needs to be available to cover that period of the day. Plus, he has always been sleeping when he had a seizure, and during the day, he's awake much more of the time. So far, it's been about two weeks since I reduced him by one Keppra "chunk" - yes, a very imprecise measurement, but no dosage he gets is ever exactly like the one before or the one after..... I started at first to take away the chunk from the afternoon (6PM dose), but thought that maybe it might be better to try the AM dose instead, since he does get the additional phenobarb AND the big dose of Keppra at 2AM. And that seems to be working. (I'm afraid to even write this.) Two days or so ago, I removed a second "chunk" dosage, so now, at 10 AM and at 6PM, he's only getting the 1/2 and the 1/4 Keppra pills. I want so much for this to work, and I'm so afraid it won't.

Just in case, for some reason, MAYBE IF - someone else out there needs to give Milk his medication - here's his schedule as of today, June whatever, 2008:

All amounts are estimated, sadly.

10 AM
8mg phenobarb (1/2 of 16 mg pill)
180 mg generic Keppra (1/2 and 1/4 of 250 mg pill)

6 PM
180 mg generic Keppra (1/2 and 1/4 of 250 mg pill)

10 PM
12 mg phenobarb (1/2 and 1/4 of 16 mg pill)

2 AM
210 mg generic Keppra (1/2 and 1/4 and 1/8 of 250 mg pill)

I ordered the 500 mg generic Keppra pills this week from Canada. I am hoping that they will not be any more difficult to chop up than the smaller pills. The cost was enormous - $274, but I got free shipping and a $10 discount for having an order that was more than $250. Every little bit helps, I suppose. I can't picture exactly how much larger the 500's will be. I have a new pill chopper than I just hate because it jiggles the pill-to-be-chopped just before I click it shut, and the pieces NEVER come out the same size. In fact, I'm getting quite a collection of unusable little bits of Keppra; maybe I can sort of glue them together with Pill Pockets and make up a few regular size doses........

My fingers are crossed. And my toes, and ankles, and eyes and whatever else is flexible enough to move around.

Shhhh! (Still seizure-free....)

2008-06-11T10:54:00.003-04:00

I really don't want to blow the good luck - we're coming up on another month without a seizure, although yesterday and especially last night, his behavior was so peculiar that I was really nervous about whether it was significant or not. He was doing a lot of racing around, meowing, leaping, trying to chew Burble - all sorts of unusual behaviors, especially since he's been a little dopey-seeming lately. And his weight is dwindling again, along with his only-newly-found appetite. For a while, he was willing to eat as long as I crumbled freeze-dried Nature's Variety raw medallions on his food, but for the last couple of days, that's not sufficiently enticing. (Although the others can't wait for him to sniff and walk away so THEY can eat his share!) I guess we'll go back to bottle-feeding and see what happens.

The urge to reduce his medication just a smidge has come upon me - he was doing so well for a while there, but he just seems different now, and aside from the again-diminished appetite, he's sleeping for long periods during the day and evening when he would normally have been up and watching the birds and playing and snuggling. Two nights in a row, he's slept on my computer chair in the kitchen. While it's been incredibly hot and sticky and miserable here for a week, the air conditioning has been on and I don't think that whatever's going on with him is weather-related. Anyway, I digress. As usual. I just gave him his morning pills, and left out the additional "chunk" of Keppra that he has gotten three times a day since the last round of seizures. I just want to drop that one amount - the Yahoo seizure people recommend that dosages be identical, but it's worked so far to give two differing amounts of phenobarb, so maybe giving him a smidge less Keppra will be successful, too. Come to think of it - maybe it would be better to drop the chunk from the second (6PM) dose of Keppra, since he's already getting the lowered dose of phenobarb in the morning. I sure don't want to end up with him having seizures in the afternoon because he's low on both drugs in the AM. (This is the problem with being impulsive - second thoughts when things have already been screwed up.) I am praying not to precipitate another whole round of seizures, that's for sure. It is apparently not going to be possible to wean him off the phenobarb, but maybe, since it was increased just slightly, he can do with a little less Keppra. I don't know. Every experiment is scary because the potential aftermath can be so extreme.

Busy figured out how to open the door to my craft room (which I keep closed solely because Scruffy wandered in there TWICE and peed right on the rug! He's NEVER gone anywhere but in his litter box except for that.) And, in the picture above, little Milk found himself a nice soft place to nap. There's a huge pile of Fun Fur underneath him. Surrounded by unborn kitty pi's..... and enough yarn for an army of sleepy cats. I love this little white cat so much.

Not much new.

2008-06-03T23:42:00.002-04:00

No seizures since the "group" in the beginning of May that precipitated the small dosage increases in both the phenobarb and the Keppra. Seems - fingers crossed - to be working. I do feel that my theory about the sudden return of Milk's appetite (well, partially, at least) and the appearance of multiple seizures was right - it had to do with the reduction (for unknown cause) of the level of phenobarb in his blood. It was very difficult to bring myself to increase the amount again, even by as little as 1/4 of a pill - about 4mg- SID, but it seems to have worked. The last couple of days, he's been wobbly, though. (It's been three weeks or so from the increases, so I don't know what that means, and I really really hate to put him through more blood-drawing - the last time, they couldn't get enough from his thighs and had to use his jugular. ) And not eating as much. I thought I had more canned EVO in the pantry and could start giving him a bottle of it now and then, but it turned out to be the 95% stuff. I'll get more tomorrow. He does seem doped; he spent most of today sleeping. Usually, he's up and wandering around, snuggling with me or the other cats and watching the bird feeder. I can't decide if he seems dehydrated or not. When I give him his pills, I am squirting extra water into him. Not that that'll be enough, of course.

On the Keppra front - still haven't received a bill from Auburn. (And haven't gotten around to calling them, either - "I've been sick, " she whines.) And the 5-21 standards/levels do turn out to be the human levels - I didn't think that Auburn had said that they have enough data to set feline levels. I don't know how significant that is - I was so depressed that he was way over the human standards - what will I do if he's over the cat ones???

Two people (including the epileptic vet tech at my vet's office who takes Keppra herself) have mentioned recently that there is some regulation that generic drugs only have to contain 80% to 100% of the drug in order to be acceptable, and that with drugs that affect the brain, maybe that's a little too much variation? I never priced the brand-name Keppra at the Canadian Universal DrugStore where I buy the generic Keppra on-line. I guess I'll check next time I order. (Mylan Labs, in which I own a big 12 or 13 shares of stock, is supposed to release a generic version of Keppra in October. Big deal.) Just opened the second bottle of Keppra yesterday, so we'll have a month or so to go. I wish the stupid pills came in a shape that you could actually chop up to give varying doses. (Yes, I KNOW that's not what the drug companies want, but it's still annoying.)

The kittens - or a portion of them - I have NO idea what I'm doing with little Toot - will be moving to Rochester, New York on Saturday. I considered taking Milk with me, but I think the stress of being in the car, with all the assorted car noises and strange cats and Dian and Beverly - not the quietest of passengers - for such a long trip would be very hard on him. I just hoping that we can arrange the time so that I get back for his 6:00 Keppra.

Nothing's ever simple.

With minimal comment

2008-05-17T11:31:00.007-04:00

Keppra level returned from Auburn today (even though I haven't paid for the testing yet) - 38.2. Dr. G said (and I haven't seen the form they use to report, as to whether it has any more detailed information or what) that the approved level is 5-21. Which leaves us almost 2 times the maximum, although there's no way to know exactly what the basis for setting 21 as the max is. (And I think - it sticks in my mind - that those are the HUMAN numbers, which would make sense, since they had said that they don't have enough cats to begin to establish what dosages should be. So, I need to relax about that. I think I will call them on Monday - I know that Karen talked to a researcher there who said that they regard Keppra as being so safe and unlikely to cause side effects that they don't worry much about dosage. I am envisioning a horrified reaction anyway. And my ending up in tears, because we have virtually no options, since he was toxic on phenobarb before. And since, on this dosage of Keppra, he still had 6 seizures between 4/30 and 5/16.

Just as sickening, I increased the phenobarb just 3 or 4 mg BID (a tiny 1/4 pill) two days ago or so, and this morning, Milk's not even willing to sniff his food bowl. It was so wonderful to have him eating again on his own, and coming into the kitchen when everyone else did, and starting to look less emaciated. And not having to bottle feed him.

This is sickening. Stomach-turning, repulsively sickening. And unfair.

Crummy crummy crummy night.

2008-05-16T11:48:00.003-04:00

totally aside from/in addition to the seizure. Milk didn't sleep very well. He was up half a dozen times grooming and licking and making noises that I woke up thinking were pre-seizure. And then he got up at 5:30 and started pacing around. And gnawing on stuff. Back when he first started having seizures, I was convinced that he must have chewed on something with lead in it - he used to gnaw things then, too, but it had slowed down over the last few months. Now it's back again, I guess. He went from the window-opening-crank knobs to my yarn-winder handle to the plug for the lamp. He chewed on the edge of the table beside my chair, and on the drawer shelf of my desk. At the point at which he started endlessly licking the yarn in my afghan, I couldn't stand it any more, and put him on the floor. Maybe he's got pica. Too bad he'll eat all sorts of inanimate objects, but give him a bowl of FF, and he tries to bury it. I have given him two additional 1/4 phenobarb pills so far. Now to watch and see if he starts falling off the furniture again. And I have to call and beg for liquid valium for him today, too.

Then Burble had what must have been a massive hairball about an hour after the seizure, and I CAN'T FIND IT. He woke me up getting rid of it, and I know it's here somewhere...... A couple of weeks ago, he had a moderate sized hairball that he kindly left on the back of the couch. And I heard him throw up, and I actually saw it, but I got distracted and forgot about it. Until Andy and Michelle came to visit, Andy sat down on the sofa, and when he went to lay his arm along the back of it, Michelle jumped up and shrieked, "Oh, don't do that!" She thought it was poop, which is actually not a whole lot more repulsive than a dried up hairball. The whole episode speaks volumes about my housekeeping skills, or lack of them.

Busy spent more than a half hour during the night banging the doors of the cabinet under the kitchen sink. That's where the bin of dry food for the ferals is, and I've got a pair of twisted gumbands on the knobs so he can't open the doors all the way. But unfortunately, he can get his foot in between the doors and get them open just enough to SLAM after they get to a certain point. He knows he can't get in there, but he just keeps trying. Thank goodness he doesn't have opposable thumbs. He'd rule the world.

And my sweet Scruffy - well, suffice it to say, he was 146 this morning. I know he's going to drop, but how much I hate those numbers when he was so beautifully under 100 virtually all the time with Levemir. And no one who's still giving shots twice a day is interested in commiserating with someone whining about their cat's being OTJ. I wrote to Cindy and Tritone and said, I never expected him to be off insulin, and now that it's happened, I thought it would be a whole lot more FUN.

And the damned turkeys - they start gobbling at the bird feeder at 5:30. Not that there's any reason for them to expect that there will be seed for them at that hour. Not that there's ever BEEN seed for them at that hour. Hope springs eternal, I suppose, even if you're a big dumb clucking turkey. Which they are. And male-stupid beside - there's one that keeps "displaying" - that thing they do with all the feathers on their backs that makes you think about Thanksgiving and Pilgrims - every time a car comes down the road. He apparently thinks that he's so attractive that even vehicles will succumb to his featheriness. Geez.

I'd like to go off by myself for about a week and do only things that I want to do, when I want to do them. The ultrasound lab report said yesterday that I have - according to the receptionist at my doctor's office (who won't be my doctor much longer, since the company is changing from Blue Cross to UPMC - another whole set of crises) - "just a little bit of fat in your liver." I said, "Fatty liver disease?" No, just a "little bit of fat." It isn't able to show fibrosis anyway. Probably just a wasted 12 hour fast and insurance money. I still have to have the blood work.

I am whiny.

So much for that.

2008-05-16T00:36:00.004-04:00

Seizure # 45. Quite a surprise, as I had dozed off and Milk was curled up in my right arm. I don't know what woke me. When I looked over, he had a little foam dripping off his mouth, but he hadn't started to seize, so I quickly picked him off my arm and put him on my lap, with my hand firmly on his abdomen, hopefully out of reach of his claws. Which I trimmed last night, but which were still like razors. Very little movement of anything but his head - a lot of volume with the growling and snarling, and two very harsh, different pitches during the course of the seizure. When it was done - seemed longer than usual, although I'm not sure and I didn't think to look at the clock - he just lay against my stomach. I started to wipe him off, and it brought on a lot of tiny little jerks from his front legs and from his head, so I stopped. After about 4 or 5 minutes, he jumped down, very uncoordinated, and went to eat. He never eats quite right anyway, even when he hasn't just had a seizure - something about the way he licks up food isn't right - and this looked very awkward. He moved all around the bowl before he was done. And then he wanted more, so he checked out all of the other dishes while I fixed him a fresh can of FF. His coordination is still very poor, almost a half hour after the seizure. He keeps wandering around across my desk and keyboard. Which, come to think of it, he was doing earlier tonight. I had to go out around 7:30, and he was sleeping on the bench beside my desk. When I came back, around 10:00, he was still sleeping there. He got up to see what was for supper, but didn't eat anything. And he was doing the same kind of annoying wandering around on the desk then, too. Very persistent, up and down, onto the floor, onto the bench, onto the desk, knock over my (empty) mug, and around all over again. I wonder if that was significant behavior. There has never been anything in the past year+ that I could say seemed to be a signal that a seizure was about to occur.

I was feeling very glad this morning that I hadn't increased the phenobarbital. It seemed, silly me, like the Keppra increase was going to be sufficient. After all, three days without a seizure? Surely an indication of a cure..... Damn it. I think that I am going to increase the PB, by a small amount - maybe a quarter of a pill for this last dosage of the day at 2 AM and see if that helps. I hate to have to keep dragging him out for blood work, but I don't want to ever get the point where his liver is at risk again. And maybe the report from Auburn will suggest that it would be okay to increase his Keppra. (Although that didn't seem very successful last week when I tried it for one day. And although I don't know if that's even something that Auburn does. If they don't already have standards set, I suppose they'll just give an amount and add him to their database.)

My poor little white boy. When he's had a seizure, the pink areas around his eyes and ears get very discolored and bizarre looking. And his whole face gets sort of pinched-appearing. Plus, Dr. G. had to shave his neck to get the blood from his jugular this time because he couldn't get enough out of his thighs. Both of them. So his wispy little neck has this big gap in it where there's no fur at all. I'm not sure why this one has been so disturbing, but I don't usually cry after he has a seizure, and I'm sitting here now with tears rolling down my cheeks. I just want this to stop. I want him to have a normal life and I want to not have to worry about doing more damage with the stupid medications. It's so unfair to him.

Three days!

2008-05-15T14:42:00.002-04:00

Since the last seizure! I'm surprised and pleased. Interestingly (to me, at least) is the fact that he's doing the same thing he did one other time - I tried to go back and find it in the blog, but it was taking too much fiddling around..... Anyway, on each of these last three mornings with no seizures, he's awakened abruptly at 6AM and started roaming aimlessly around. Like it would have been a seizure, but didn't quite get all the way there. He waits till Rege gets his shower and passes out the treats, and then comes back and snuggles until the alarm goes off at 10:00. Today, he didn't even react to the alarm - I really think, if I hadn't had to grab him so I could be sure to get his pills in him on time, he would have slept for quite a while longer. We're all exhausted.

I did pick up a new prescription for the phenobarbital, but haven't increased the dosage. And if it's possible to avoid, I'd really rather not. It seems that the slightly increased Keppra has taken effect even with the previously ineffective phenobarb amount, which is wonderful, I think. (Unless they come up with recommended dosage levels for Keppra that he's way out of range on. A possibility, sadly.) Today, the tests at Auburn should be done. (And they have to send a bill, too, because I can't find my checkbook and they didn't want to use a charge.) I'm a little nervous, but at this point, no matter what their results are, if he continues to be controlled, I am not going to mess it up.

It would be nice to get another three seizure-free months out of this rearrangement...

Seizure Avoidance/Subversion?

2008-05-13T12:57:00.007-04:00

First - no seizure this morning, thank God. Although, I still didn't get any sleep, since Milk abruptly jumped down at 6:00 AM - prime seizure time- and started eating out of a bowl of food nearby. So, I had to get up and get him fresh food, and then sit and watch him for an hour and a half to see if he was going to have a seizure or not. Which led me to wonder, can a seizure be knocked off track by some distraction, for example, and then not occur? Since I wake up so immediately when he starts getting ready to have a seizure, I wonder if maybe there is something that could make his brain say to itself, "Oh, that's way more interesting than what I was GOING to do; I'll save this seizure for later....." Like, what if a seizure is just getting ready to start, and he sniffs something he just loves, or something horrible, say, or if - like the last two, I had to pick him up and move him to a safer place to have the seizure? Probably not likely. I'd gladly do all sorts of dances if it'd stop the process.

Yesterday afternoon, after much trauma and agony - Rege screwed up the printer AGAIN, and he never mentions that he's done it; in fact, he always denies that it was him, the jerk - I had made an appointment to take Milk to the vet to get bloodwork done 1) to send to Antech for phenobarb levels, to test my theory about why he's suddenly eating again and having seizures all over the place. (The phenobarb level has fallen to a place where it's not ruining his appetite, but it's also not controlling the seizures.) and 2) to Auburn for testing of the Keppra levels. Which takes at least 10 days, I guess. I couldn't print out the Auburn forms that I had to have because the PRINTER WASN'T WORKING, so I ended up emailing the pages to my friend Sandy, and then she printed them, I went to her house and picked them up, came home and packed up Milk in the carrier and we dashed off to the vet's. With the gas tank on EMPTY and the little gas tank picture all lit up. Story of my life. I'm still waiting to hear from Dr. G. about the phenobarb levels - usually, the results would be back by now. I don't know what I'll do if it turns out that the levels aren't low. I did try a day of increased (by another 1/8 pill) Keppra, but it really made Milk wobbly and uncoordinated. I hadn't ever seen side effects like that till the last increase at the beginning of May when this round of seizures began.

Okay - just got the phenobarb results :
24.? something-or-another-that-I-can't-remember-even-though-I-asked-Dr.-G.
-what-it-was-twice. SO, I do think my theory is right about the level having fallen to too low a point to effectively contribute to controlling his seizures. Now, the question is, how much do we increase the phenobarb by, if anything, before it screws up his eating again? Dr. G. thought that it might be worth trying to see if there's some sort of "pattern" to his seizures - like, it was three months with no seizures, and then a bunch of them, and wait to see if it was repeated. Well, #1, although I didn't say it to him - that's information that's visible with his seizure record (over on the left side here), and there's clearly NO pattern. And my tolerance for never getting more than three hours sleep is pretty much at its end. Plus - it's bad enough that most of his seizures have occurred when he was sleeping on me - what if it starts happening when I'm out? There was a guy on the epikitty board last week who said that his cat wedged itself between the wall and the couch and then had a seizure, and when he got home from work, the cat was covered with blood from bashing his head against the wall. I can't bear the thought of him having seizures (and frantically looking for food!) alone. I need him to be controlled as fully as possible. Period. If I have to go back to bottlefeeding him, so be it.

I still have to call and see if the IM vet will give me another vial of liquid valium. I hate the thought of even asking them. Plus, they are moving to their new office building in June, so the place is probably mass confusion. Nothing's ever simple.

Longer, louder, more violent.

2008-05-12T05:03:00.002-04:00

This is really getting me down - I fell asleep around 3:15, and here I sit at 5:05, having just weathered another seizure. Alarmingly shorter interval since the previous one, too. I had tried giving him the phenobarb separately at 12 hours for several days, and it didn't matter; he still had seizures. So last night and tonight, I just gave it at 2AM with the Keppra. No seizure yesterday morning, and one this morning. I am increasingly more convinced that there is a connection between his ability to eat again on his own and phenobarb dosage. I wanted to wait to send away his blood to Auburn and get both Keppra and phenobarb levels done, but maybe that 's not practical to do. I hope to go back to sleep in a few minutes, and when we get up again for the day, I'll print out the forms and call Dr. G.

Description of the seizure, before I forget: only two quick odd lip-licking sounds before it actually started, and again, he was snuggled into my armpit, so I had to get him moved. Which I just barely managed to do before he started practically roaring - very loud snarling. And unlike the last one, this was very physical - a lot of flopping around. For much of the seizure , which lasted probably 40 seconds, his tail was sticking straight up in the air, which struck me as somehow oddly humorous. I don't know how anything can seem funny when your poor little cat's flopping and banging and snarling uncontrollably, but there you have it. And then, which I have never seen before, he started to crane his neck backwards in a pretty alarming position. I kept my hand on his back - only the second time I've ever touched him during a seizure, so I didn't have to worry so much about him flopping onto the floor. When it ended, I had a kleenex that I started to wipe him off with, but it seemed to alarm him - two big post-seizure jerks when I touched him with it, so I just let him be. He laid quite peacefully for a good two minutes, and then jumped down and went to the kitchen to look for food. He ate about 3/4 of a can of FF, and a few pieces of dry. I wiped him up with paper towels. And now he's been circling around from the kitchen to the dining room, in the other kitchen door, up on my desk, and back down again. He's still quite wobbly, and it's been almost a half hour.

Tomorrow, also, I am going to do a dedicated search for the liquid valium/catheter stuff that Dr. L. gave me. I don't like the frequency increase that's going on here. I'm pretty sure the valium's expired, so I'll probably have to call and see if she'll give me another vial of it. If not, I don't know what I'll do, since Dr. G. doesn't have any. Wonder if you can get it from the drugstore?

I am exhausted.

Or this one.

2008-05-10T07:08:00.002-04:00

I think I'm being punished for being smug about how well Milk's seizures were being controlled for almost three months. With a vengeance.

This morning's was odd - very short, almost no flopping, but a ton of very harsh growling and snarling. It started without any warning - usually I wake up because he's starting to chatter his jaws, but not today. And even worse, he was sleeping snuggled up in my armpit, where I would have no ability to keep him from flopping onto the floor, or banging into the table, or who knows what. Plus, I didn't want him that close to my face and eyes while he was having a seizure. So, while he was snarling away, I couldn't think of anything to do but to pick him up and plop him down on my lap, where I could keep him in one place. Just a smidge scary. But he really didn't move at all. He continued to growl for just a few seconds. No clawing, no flopping, no bouncing around - just stiffness and noise, for probably not much more than 20 seconds. And then he laid with his eyes huge and round and black (pupils all dilated, I assume) for another minute or so. He jerked three or four times, and then just laid there. Eventually, he jumped down, without seeming uncoordinated, and I thought I saw him disappear down the steps. He always is ravenous after a seizure, so I figured I had a couple of minutes to fix him something to eat. (He used to pace after every seizure, around and around the living room and dining room and kitchen. Hasn't done that for many months, though.) Anyway, he wasn't downstairs, as it turned out, he was going from nearly empty bowl to nearly empty bowl licking up the food that I'd left out for overnight for Scruffy. I put down a fresh can of FF for him, and he ate about half of it. Then he started looking to see what else there was to eat. I try never to miss an opportunity to get food into him, so I gave him a tiny handful of EVO/Wellness dry, which he ate a little of, but by then, the other three had discovered that he was eating crunchies, and started jostling for position to wedge themselves into his bowl. He ate another 1/2 can or so of a different FF, wandered around across the computer desk several times, and then sat down behind me here, seeming perfectly relaxed and just fine.

I'm starting to get nervous about the frequency of this new round of seizures. I was hoping that increasing 1/8th Keppra TID would get things back on track, but apparently not. I can't remember where I put the liquid valium that the IM vet gave me - haven't seen her since she referred us to the neurologist in Ohio, and although I left her his most current seizure record the last time I had Scruffy at the Specialty Hospital, I never heard anything from her. I'm guessing, given that she only saw Milk that one time (although it cost me almost $400 for ONE APPOINTMENT that was pretty much useless), that she doesn't necessarily regard him as her patient. Would she give me a fresh tube of valium if I called? Don't know. There was a six month expiration on the stuff - which is long past. I don't want to panic, but we're sort of beyond a place where I have the least idea what to do, besides increase his Keppra again.

I do have a theory - related to the fact that he has just barely started eating voluntarily again in the last two weeks or so. I wonder if the phenobarb dosage - 1/2 pill (8mg) BID has become somehow ineffective - thus allowing the seizures to start again, and lessening the suppression of his appetite? He just had bloodwork fairly recently, but I suppose it would be worth it to not only check his phenobarb levels, but to send blood to Auburn and let them do the Keppra levels, too. I know that they'll do both, which will save the extra costs of Antech doing the phenobarb levels. Maybe that would be a good place to start. I'll have to call Dr. G. next week and ask them to get the blood pick-up/transportation arranged, and make copies of the information Karen posted from Auburn on the epi-kitty site. Which possibly leads to consideration of what to do if they say that he's on too high a dosage (even though it's not working any more?) I did notice - for the first time - with this last tiny increase in Keppra (generic) that he seemed to have more visible symptoms of the greater dosage. I had never really noticed any wobbliness or incoordination since he's been taking Keppra, although others had mentioned that their cats showed it. But this time, although certainly not even close to what phenobarb did to him, there was a noticeable difference. He was just starting to seem to be getting over it.

I wish this was something you could snap your fingers and Zap! it'd be gone..... I am frankly terrified about the possibility of cluster seizures and the frequency increasing.

No doubt about this one.

2008-05-06T09:34:00.003-04:00

8:05 AM. It started with a minimum of jaw-chattering, and I was expecting that there wouldn't be much foam, but his head and neck were soaked. This was very quick - maybe 40 seconds, but quite violent in the middle, when he was flopping around with his butt way up in the air. There was growling, but not as loud as before, I don't think. (I've managed to put all that out of my mind. ) He was laying on his side on the afghan, and his left rear claw got stuck in the yarn. (Which is relevant, I think, because just a few minutes ago, he got up from the window ledge and was limping terribly. Either he was limping because of the claw, or there's something wrong with his whole leg. It's alarming, whichever way. He walked like he'd had a stroke - his leg kept sort of folding in on him.) When the actual seizure ended, he laid there quite calmly. There was one large "jerk", but not the five or ten minutes of stuff that he used to do. He got down easily - without seeming uncoordinated - and went out and ate almost a whole can of FF. He was affectionate and wanted to rub and nuzzle afterwards.

I don't know what to think, or what to do now. When he had the first seizure the other day, I thought that maybe my adjusting the times of his phenobarb had finally caught up with him. (Instead of giving it separately at noon and midnight, a few weeks ago I started giving it with his Keppra at 10 AM and then with the Keppra again at 1:00 or 2:00 AM - just to cut down on the number of times I had to chase him around and shove things down his throat.) So, three days ago, I started giving him the 10:00 PM phenobarb again, by itself. I wouldn't think that that would make the difference, although, who knows? And now, do I try to increase his Keppra? He's getting approximately 3/4 of a 250mg pill (such a stupid oval shape for chopping in four.) I'm tempted to try to add 1/2 of that last quarter, but I'd never be giving the same dosage because of the shape - the top part is usually significantly smaller than the bottom. And the stuff is so expensive that I really don't want to waste any that I don't have to. Maybe I should try Karen's technique of using some sort of apothecary scale. I sort of hate to go right up to 250 mgs TID, for no particular reason other than that it seems like an awful lot. I wonder, too, if it has something to do with the phenobarbital. He's been showing a smidge of interest in eating lately - ever since I discovered that he likes the freeze dried Nature's Variety. He's not exactly "eating" when I put his food down, but he's taking longer to bury the bowl, and he does occasionally lick the stuff a little. Last night, I actually saw him eat five or six bites of FF. So maybe the phenobarb is having a reduced effect, both on his eating and on the seizure control? I hate to put him through more blood work - it's only been a couple of weeks since the last levels were done.

This is so upsetting. He was doing so well. It feels like we're right back to the beginning again. And I haven't learned a thing in the last year to make me think that I can deal with this any better now than I did then.

Enough whining. I guess I'll go and write to Karen and ask her about her scale and where she got it. I wonder if there's any function in trying to call the neurologist to see what he thinks.

Oh, and I've about decided that that wasn't a seizure the other day. Although maybe it was... Decisiveness, one of my best qualities. Anyway, there was meowing, and I've never heard him meow during a seizure, and the fur was sticky on his lower body, not near his head/mouth. Maybe Busy was just chewing on him again.

Did he have another seizure?

2008-05-03T12:43:00.000-04:00

I was sitting at the computer in the kitchen when Milk came and jumped up to walk across the keyboard. I noticed an odd looking patch of fur on his side - it was sort of stiff and sticking out. Like he'd been grooming, only not soft. I picked him up, and his tail was damp, as was his stomach. Didn't notice anything around his neck or head, though, where he usually has foam after a seizure. I sniffed him - didn't smell like urine. Maybe he was in the bathtub? I didn't hear any growling or snarling, although, I did think a little while ago that I heard a cat meowing. A lot. (Thought maybe it was Cinnaminnie outside.) I opened a can of FF - the ultimate test of seizure-having - is he willing to eat? And he sniffed it and licked a little of the food. Bad sign? Maybe. I got dry kitten food out for the ferals, and he came over and ate quite a bit of it. Another bad sign? I have no idea.

I walked all over the house, and didn't see anything that looked like a wet spot. If he'd had a seizure upstairs, I'm sure I would have heard him growling. Rats, this makes me sick. I don't know what to think. And it's only been three days since the last one. Do I need to think about increasing the Keppra? Or should I go back to giving the phenobarb at 12 hour intervals, despite the fact that it's been working fine for weeks now stretching it out to longer periods?

The weeks of peace and reduced anxiety about seizures have apparently come to an end.

I had such high hopes.

2008-04-30T20:46:00.002-04:00

Milk hasn't had a seizure since February 6, 2008. That's, let's see, almost three months. Two months and three weeks. Oh, how I was hoping... I was able to think that the two seizures in January and the one in February were just medication/dosing failures, and I do think they were. But this one - he's had all of his pills, at the regular times. I just gave him his second Keppras for the day at 6:30.

Can't really describe this one, because he was in his cave when it started. He growled really loudly, and then the cave started to rock, and by then I was over there, but didn't want to move him or anything. He didn't growl the whole time, and it seemed like a fairly short seizure. His head and neck were wet, as was the bottom of the cave, but I'm pretty sure it was just drool/foam, because there was no smell, and it was a very small amount of wetness. (I was worried, though, because Burble and Busy were definitely sniffing around suspiciously at the cave.) When it was over, he jerked just once that I saw, and then laid still for maybe forty seconds. When he came out, he was very wobbly. I called him to come and get something to eat, and he had already been nibbling on one of the food bowls from breakfast. He ate about 1/2 a can of Fancy Feast. He meowed very plaintively and loudly twice before he ate. I gave him a few pieces of dry EVO and Wellness - hate to pass up any opportunity for him to voluntarily eat. He ate them eagerly, too, and then went back to the FF bowl.

I was just thinking yesterday that it's such a wonderful thing not to keep waking up for every sound during the night. So much for that.... I hope - pray - beg - that this was just a breakthrough and not the beginning of another round of seizures that get worse and worse and closer and closer. There was discussion on the epikitty board about how much Keppra can be used, and I said - and I am pretty sure I still feel this way, although I certainly wasn't expecting it to be tested so soon - that I would not expect to hesitate to increase his Keppra if this dosage (about 187mg TID) didn't work any more. I am not interested in starting anything new, and I certainly don't want to increase the phenobarb if it's at all possible to avoid.

Crap. Crap, Crap, Crap.

Well, that's something!

2008-04-23T23:04:00.004-04:00

Yesterday, I was poking around in the cabinet under the kitchen sink, and I came across a foil bag of Freeze Dried Nature's Variety Chicken and Turkey Formula. (I remember being a little suspicious about why it was suddenly a "formula" when I bought it.) It's been there for weeks, I guess. Anyway, I opened the bag and found these dried-up, not-unpleasant-smelling "medallions" of yellowish stuff. So, I crumpled one of them over all the food dishes. (One medallion for all, not one for each, because it wasn't marked on the package, but I have a vague memory of being horrified by the cost of this freeze-dried stuff - more than $20, I think, so I'm not about to waste it.) When I set Milk's bowl in front of him, he started to bury it, and then he paused, and THEN, right before my very eyes, he actually ATE the freeze-dried stuff. Not all of it, but at least some. That's one of the few things he's eaten voluntarily in a year. He's had three meals since then, all with the Freeze-Dried stuff on them, and he ate it once more. I even gave him a little bit of the crumpled medallion and added a few drops of water, and he ate a little bit of it. (Busy came by and polished it off.) So that feels like a major step forward. It would be so nice if he'd just start eating again.

The "Eyes" have it.

2008-04-07T23:45:00.004-04:00

Conjunctivitis, that is. Poor Milk. Yesterday, I noticed that he had a big blop of clear water on the left side of his nose. I wiped it off. And a little while later, there was another one. Last night, there was a drop on the right side. Okay, I'm a little slow on the uptake, but it was clear that there was something going on. To say nothing of the sad look on his tiny little face....

Tonight, we went to the vet. Herpes-caused conjunctivitis. The rims of his eyes are a little pinker than usual, but nothing like they were when I first brought him home and black gunk was pouring out of both eyes. So now he's got eye drops added to the routine of stuff he really doesn't want me to do to him.

While we were there, I had them take blood for another phenobarb level test, too. I am hoping that it says that the levels are SO minimal that there's really no reason to even give him the stuff any more. (And then I want the report to include a guarantee that there will be NO seizures if I stop giving it to him. NONE.)

The last two days, he has actually eaten a bite or two when I put his bowl down. He does seem to like the Nature's Variety Frozen Raw. I was thinking that I should order some Feline Pride for him - it was so yummy looking; I bet he'd like it. If only it wasn't so incredibly expensive.... Anyway, the really bad news of the vet trip was that he's lost - according to the vet's scale, which I noticed still said "35" on it even when there was no cat sitting there - a half pound since the last time he was there - maybe a month or so ago. Down to 9 pounds, 2 ounces. I was feeling pretty good about his weight until tonight. He's certainly not anywhere near the sleek, wholesome cat he was before phenobarbital, but he seemed to have lost some of the "pile of bones in a fur bag" aspect. Maybe not. When I give him his last pills tonight, I'm gonna weigh him here. He's been pretty consistently 9 pounds, 13 ounces on my nice scale.

The other accomplishment, which seems to be working out VERY well - is that I did some fiddling around with his medication times, and now, suddenly, I feel like I'm starting to have a life again. He was getting Keppra at 10AM, 6 PM, and 2AM, and phenobarbital at 12PM and 12 AM. Five ordeals, plus two or three bottlefeedings every single day. I was trying to cram everything I needed/wanted to do into the hours between noon and 6:00. I was afraid about making the change, but so far, so good. And just not having to chase him around that extra two times a day has done wonders for my psyche, and hopefully for his, too. So now, we do Keppra and phenobarb at 10AM, Keppra at 6PM, and Keppra/phenobarb as close to 1AM as possible. (That's the time that he's still most likely to be uncooperative, for some reason.)

Now, if only the Spring Crazies would stop, we'd be doing pretty well. Damned Busy has taken to gnawing on Milk's neck the minute I head for the bathroom, and now Milk's doing - or trying to do the same thing to Burble. Only Burb's got a good four pounds on Milkshake - if he chooses not to be chewed on, Milk gets the worst of it. Males. Geez.

** 4/9/08 Phenobarb level - 27.2 Which is an improvement. Unfortunately, because I never manage to change only one thing at a time, I don't know if it's due to the reduction of the total amount of phenobarb daily, the addition of the Marin (which he hasn't had for about a week), or a combination of the two. I was really hoping that it'd be way way down and I could maybe cut the dosage in half again. It would be so nice if he'd eat on his own, and gain back some of the weight he's lost. And his right eye is still a sore-looking, squinty mess.

Another sad anniversary

2008-03-23T21:17:00.002-04:00

In about an hour and a half, it will be the exact moment of the anniversary of the first seizure my little Milkshake ever had. If I'd known then what I know now...... Well, no, I suppose it wouldn't have made much difference. Although, I would have not waited until he'd had 10 MORE seizures to start giving him phenobarb, that's for sure. Sometimes being "hopeful" is really not a good thing.

Maybe the most significant thing is that we survived this past year, and we know that we'll get through the next one, too. And the one after that, and..........

Antijinx

2008-03-22T13:05:00.003-04:00

It's been a month and a half since Milk's last seizure. (Whispering....) He seems to be doing very well, generally. Except for the not-eating, things have been quite normal for my little Milkshake. You should see him sproinging around the living room. Like he's got little tiny trampolines on his feet......

I am sort of fiddling around with the times of his pills - getting hold of him five times a day is a major pain in the neck. I can combine one of the phenobarbs with either the first or last Keppra, but the Marin needs to be given with food, so it's just as easy to put it in a pill pocket with the phenobarb and give him a bottle of EVO at the same time. I wish that I had the courage to try cutting the phenobarbital in half again, (which would be about 3 and 1/2 mg bid) with an intent to remove it completely, but I'm really afraid. Our experience has been that, with a dosage change, when the seizures start up again, they're even more resistant to being controlled. Karen from the epi-kitty board got forms from Auburn to report about the Keppra usage, and I'd like to have the pheno levels tested again, too, so I suppose that should be the next project. If his Keppra levels came back incredibly high, I would still not be inclined to lower his dosage, though; it's working now, it wasn't before at a lower amount, and I'm not willing to change things if it's not totally necessary.

Found a pill..........

2008-03-09T13:08:00.006-04:00

laying on the kitchen floor this morning. It appeared to have been in a Pill Pocket - the surface of the pill looked rough, like it had been exposed to dampness - and there was a little tiny chunk of brownish taffy-looking stuff on it. It was one of the 1/2 Keppra pills. No way to know how long it had been there, or who chewed the Pill Pocket off from around it. At least there hasn't been a seizure - oh, how I hope that's a good sign. As to how it got to the floor - who knows? I think I can only remember once in the last couple days that he managed to spit out a pill, which I know I picked up and pushed back into the corner of his mouth.

There has been a smidge of progress on the Food Front. Several times in the last couple days, I've seen Milk go over to one of the food dishes (I've become, somewhat to my surprise, a "free feeder" again) and actually eat a little bit. I've been giving them the Nature's Variety Frozen Raw again for about two weeks, and he seems to like it. Have to get some more. He seems less pleased with the canned/bottle EVO now, though. He liked the 95% beef EVO, but it was really greasy and fatty - those little blops of white fat! - and it didn't mix well with the water for bottlefeeding. I'm going to keep my fingers crossed. Things would be much simpler if he'd just eat on his own again - especially if I have to take him along to Erie or New York for Scruffy's potential eye surgery.

He's driving me crazy.

2008-02-16T11:21:00.003-05:00

It appears that we have a very minimal leeway for pilling with Milk. Two of the last three seizures seemed to have been specifically related to getting his pills late. That said, I am making myself crazy - and ruining what's left of my knees - staggering up and down the steps and lifting up the couch and trying to trick him into standing still long enough for me to grab him. We've got all the bedroom doors closed all the time (screwing up the furnace!) so he can't get under the beds. It doesn't help that he won't eat voluntarily, either; food is no incentive. Except Temptations treats, which he will only be fooled by if my husband rattles the bag. He's no dummy. (The cat, that is.)

Someone posted the other day on FDMB a website with clicker information. I actually BOUGHT a clicker back in November, but I have no idea what I did with it. (Story of my life.) Four dollars for what is essentially exactly the same as those little froggy clicker things they had when I was a kid, that cost a penny.... This is miserable five times a day for both of us. (Not the pilling, which isn't fun but is manageable - the catching/grabbing.) I'm about to see if I can find one of those short-handled butterfly nets Hope talked about.

And yet another problem - this poor little cat. Busy has spent his whole life - seven years - desperately wanting to be the Cat In Charge. And no one else has ever paid the least bit of attention to him. But Milkshake - smaller, wobbly, scrawny, vulnerable - the Perfect Target for the Putative Cat In Charge. Busy never misses an opportunity to knock Milk over, stand on him, and chew on his neck. Milk has two sores - dime sized - one on each shoulder. I was going to try to put neosporin on them or something, but I guess it has to be a substance that both cats can get in their mouths and won't hurt them. Going to get vaseline today. I thought about trying to wrap a scarf around Milk's shoulders, but that's too risky. He's a little wobbly on his feet still, and I'd be afraid that he'd fall and get hooked by the scarf or something. I have to drag one of them with me every time I go to the bathroom, especially - that's Busy favorite attack time. Bright cat, isn't he? - "My mother's incapacitated, I can gnaw on this little white cat."

Now - it's 11:38. He gets 1/2 phenobarb tablet, and a Marin pill, wrapped in a pill pocket - which he won't eat, it has to be pilled, too - and a 2 ounce bottle of soupy EVO canned Cat and Kitten Chicken and Turkey in 20 minutes. And about five minutes ago, he hopped up on the bench beside me here and curled up in a kitty pi. Will I be able to get hold of him? Will he slither away as though his fur is greased? Will this on-going contest of wills ever END? Scruffy's so cooperative about all the ear-poking; I hope THIS ONE never becomes a diabetic.

Okay, I'm going in now......

The 2nd Adoption Anniversary Meltdown

2008-02-08T13:09:00.005-05:00

February 8, 2006. The day I brought home the scrawniest, sickest, most malnourished kitten I'd ever seen. I've been thinking about what a wonderful two years we've had with Milkshake for days now, and trying to plan what to write here about him. And it hasn't turned out to be any of the things I thought it would be.......

Yesterday morning, he had another seizure. First one in three weeks, and third one in two months. And I'm pretty sure, as I said in the earlier entry, that it was related to the fact that I couldn't get my hands on him twice to give him his pills on time the previous night. So, I was determined to make sure to get them right from now on, because the more seizures they have, the more seizures they have, if you know what I mean. The "kindling" effect - it's like each seizure makes the path through the brain a little wider and easier to travel. Definitely NOT desirable.

Unfortunately, for some reason, Milk was determined not to cooperate. I did get the first two sets of pills in him - 10 AM and 12 PM. I usually give him his bottle of EVO with the noon pills, because that's when he gets Marin, which needs to be given with food. But, since he'd eaten so much after his seizure, he wasn't interested in eating, so I skipped the bottle and the Marin, thinking that I'd give them to him in a couple hours. And that was the last I saw of him for the entire afternoon. Normally, he's plastered up against me or one of the other cats. Not yesterday. Didn't come when I called. Didn't come when I got the feather toys out. Didn't come for Temptations. Didn't come to see why the front door was open when it was so cold and damp out. Twice, I saw his tail zip by behind the couch. Came time for his 6:00 pills, and I actually knew where he was: under the bed. Where it is totally impossible to get him, because there's only about a 4 inch space between the mattress and the floor, and because the stupid Select Comfort motor and stuff weigh a ton. You can't move it. So, I started the enticement all over again. Finally, he came out, but dashed downstairs. My knees are so bad that I try to do as little stair-climbing as possible, but I had to try to get him - it was now 7:00. An hour late. Three trips up and down the steps - no success. Finally, at 8:30, I thought - Aha! Bonita Flakes! I got the box out of the kitchen, took it and Busy and Burble - who are Bonita Freaks - into the bedroom, and waved the lid around so the aroma (disgusting - smells like dirty feet, but they seem to think the stuff is tasty) would waft down under the bed. And sure enough, a little white ear poked out, then a pink nose, and then a foot. He grabbed one piece of flake, and zipped back under the bed. I put a little more down, he came out far enough to grab, and I dragged him into the kitchen and pilled him. And fed him.

Unfortunately, there were still two more doses of pills to go. I started trying to casually get hold of him at 11:00 - preparing for the midnight phenobarb. No luck. Four more trips up and down the stairs. I called, I crinkled, I shook, I squeaked - nothing worked. And finally, I just sat down on the steps and sobbed. Did it help? No. And afterwards, I was mad at him. Really mad. I got the bonita flakes out again, and put the box on the living room floor, open. And let everyone else come and eat whatever they wanted out of it. Milk came over, tentatively, ate a little bit, and hopped up on the table beside my chair. I didn't want to lunge at him and miss, so I pretended I didn't know he was there. He walked across me, to the table on the other side, and of course, the minute I grabbed at him, he was gone. So I cried some more. (Still not the least bit helpful.) And decided to ignore him. Within fifteen minutes or so, he jumped up on the table, and this time, I was faster than he was. So that was one more miserable set of pills in him. The last ones were due at 2 AM. There was no way he was gonna let me grab him now. This was the worst day I've had with him. Ever. Finally, at ten minutes to three, I just turned out the lights, turned off the TV, and let him think I was going to sleep. I was so exhausted I did doze off once. Or three times. Anyway, at 3:30, he jumped up and flopped down with his head on my ankle - his normal sleeping position. I wasted not one minute getting hold of him. Took him in the kitchen, pilled him, gave him his bottle, told him how important it was for him to get the pills when he's supposed to and how mad I was at the horrible day we'd had, and I went to bed. Fuming. And totally worn out.

When I woke up this morning, there he was, sleeping like a furry log on my leg. If I get him real quick before he's awake, I can always get the first pills in him with no trouble. And, my mind must have been stewing over the problem while I was sleeping, because I knew what to do to hopefully make today go better - put his walking jacket and leash on him. He doesn't fall over with the jacket on - in fact, once he's used to it, he's the best walker of the four cats. But it slows him down a little. I had a soft short leash - I wouldn't leave it on him if I weren't home or in the room with him, but it worked just like I wanted it to. (Burble thought he'd gotten a pet of his own - he kept picking up the leash in his teeth and strolling along behind Milk. Funny.... ) Came time for the noon pills, he tried to get away, and I just stepped on the leash dragging behind him and got him! I could tell he wasn't happy, so after the pills and feeding him, I took the leash off. And then thought, oh well, might as well take the jacket off, too. (He has a sore on his neck that I didn't want the jacket to rub on, besides.) So, we'll see if I can get hold of him at 6:00. If not, I guess we'll have to leave the jacket on and be done with it.

And now I've spoiled his celebration day. Aside from the fact that the only time he eats voluntarily is after he's had a seizure, I don't even have a car today to go get him something treatful anyway. So, I guess this is as good as it's gonna get:

I love you, Milkshake, my sweet little pink and white boy. How sad it would have been if you hadn't been sitting in that cage at Petsmart waiting for me. I will do my best to take good care of you, and to thank you for your affectionate personality and your amazing eye contact and your snuggly cuddling. We've been so blessed to have you.

your mother, who loves you with all her heart and soul.

"Brotherly " love

2008-02-08T12:36:00.007-05:00

#40

2008-02-07T09:30:00.001-05:00

Dale asked me last night how Milk was doing, and I said that, excluding the two seizures back in January that I discount because I'd screwed up the time or he missed the pills, he hadn't had one since Dec. 1, 2007. I'm discounting today's, too. (How much self-delusion can fit on the head of a pin, or whatever those expressions are?) Anyway, the excuse this time is that I was doing something, and not watching the clock, and his midnight phenobarb wasn't given until 1:38AM. And then I compounded the error by - since it was so close to 2:00 AM, when he gets his last keppras, giving him the Keppra at the same time. So, one pill was almost two hours late, and the other ones were almost a half hour early. Is that a formula for seizures? Maybe. Apparently. Possibly. And he was odd during the night - woke me up at least four times, jumping around. Usually, he falls asleep, and that's pretty much it for the night. In the AM, he's so deeply asleep that I have no problem grabbing him to give him his pills at 10:00. So, anyway, while I'm really disappointed that it's happened again, there seems to have been a reason. Now I'm worrying about if there's gonna be another one, and how soon - it scares me to think that they' might be two or three days apart again.

Description of #40: very little preparatory jaw snapping. In fact, he was actually growling before I realized what was happening. And I couldn't remember what I should do - it seems like it's been so long since the last time. (Well, not really, only 3 weeks, but....) I didn't have my glasses on, so I don't know if there was a lot of foaming that got wiped off on the blanket; his face and neck weren't terribly wet by the time he started to eat. This was one of the milder seizures physically - very little flopping, and not the violent stuff from before. Growling, but more a less-ferocious continuous background noise than previously. And instead of the abrupt ending that the last three or four have had, when he stopped flopping and growling, there was more occasional jerking afterwards. Duration - oh, probably 40 seconds for the whole actual seizure, and maybe another 20 or 30 seconds before he was totally still. Then he just laid there for a minute or so before getting down to look for something to eat. No pacing. Quite a little appetite - he ate just about an entire can of FF, and then I gave him a little dry EVO and FF, too, and he ate almost all of that. (I can't bear to miss the chance to actually get a few calories into him.)

So, my conclusion this time was - timing error once again. It appears that there's a very close line between dosing that controls the seizures and the outcome when I screw that up. I had already decided that it seems that he's within a half-Keppra (125mg) of control with the present dosages. And now it appears that the timing of his medication is becoming more of a cause. On a couple of occasions, because I couldn't find him, he's gotten his pills as much as three hours late. Going by this seizure, that may be an increased risk now, for some reason. And also, this seizure makes me think that maybe totally removing the phenobarb might not be a possibility, no matter how desperately I want it to happen. There has been some discussion on the epikitty board about TID and BID Keppra, and the problems with phenobarb levels recently. I am pretty much convinced now that, unless his next bloodwork shows even worse levels, he should just stay on half a phenobarb BID and be done with it. (The last bloodwork was taken on the same day I had decreased the phenobarbital to a half pill, so even though it showed a higher level, it wasn't reflecting the current dosage. Hopefully, that'll make a difference. Hopefully.)

All in all, a very disappointing way to start a day.....

He ate!

2008-01-24T21:17:00.000-05:00

Well, sort of. I always put down a bowl for Milk when I feed everyone else, and he always either tries to bury it, or races to get away from it. Night before last, I gave him his bowl, and a few minutes later, I saw him stop in front of it, sniff, and then actually lick it five or six times! I was so excited. The next morning, he did the same thing. It's only twice in all these months, but maybe it's a start. This morning, I put a few pieces of dry food on top of the canned for him, but that wasn't enough to interest him - plus, as soon as Busy and Burble and Scruffy realized that there was dry on there (and how DO they know?), they jostled Milk out of the way, so even if he'd wanted to eat it, which he didn't, he couldn't have. But it's a start.

And the generic Keppra from Canada arrived on Tuesday afternoon - 7 days from the day I was notified that it had entered the US. I'm idly curious where it's been all that time. I feel a little bad that for years - since my beanie baby trading days, actually - I've had not-nice things to say about the Canadian Postal System. Maybe the problem isn't Canada - it's here?

Where is the Keppra?

2008-01-19T18:33:00.000-05:00

Because of the greatly increased dosage of Keppra (generic), I've used up the last prescription from Canada a long time before I expected to. And I wasn't aware, until it was too late, that there were no REFILLS on that original prescription. So, I called Dr. G and asked him to fax a prescription for 200 pills this time (should give me a little more than 2 months worth and they won't have to break up a bottle). Which he did. I debated about using a different Canadian pharmacy because of the free shipping issue, but when I figured out the prices, even with the $10 shipping charge, my pills were considerably less expensive than the ones that other people on the epi-kitty site were buying in Canada. So, I decided to stick with the original. They were able to send the pills out on Monday of this week - and I got a tracking number that shows that they entered the "destination country" at 5:53 AM on 1/17/08. So where are they? It's 1/20/o8 as I type this. It says "Expresspost" as the carrier - but I don't know if that's only in Canada, or here. I have enough for one more dose of generics tonight at 2 AM, and then I have enough of the 90mg compounded capsules that we started out with to give him 180 mgs TID for the next two days, which I hope will be close enough to his usual dosage. Tomorrow, I guess I'll call Dr. G and get another prescription for a local pharmacy. Trouble is, the 250 mg pills aren't usually kept on hand here in pharmacies, because most humans take the larger dosage pills...... I know that Sam's Club had to special order their Keppra pills and I had to wait over the weekend for them to get the 250 mg pills in. (Wonder if I used up all of those pills? I must have - I cleaned up the pill corner last week, and the only extra keppra there was the bottle of compounded capsules.)

I noticed that on the email notification of shipping, it says that if I give permission, they can ship from their "international shipping center." One of those is in Texas, the person I talked to a couple months ago said. If that's the case, why am I waiting for deliveries from Canada? Need to check on that. It probably has something to do with getting a generic that isn't available yet in the US, I suppose.

I'm sure there's a lesson to be learned from this: I have to make sure the next time that I reorder EARLY. EARLY. EARLY. But WHERE ARE THEY NOW?

PHEW!

2008-01-17T12:37:00.001-05:00

It happened again - I had to take my mother-in-law for a doctor's appointment, and Milk was nowhere to be found. I thought I'd wait and be "casual" until a half hour before I had to leave, in the hopes of being able to grab and pill him, but noooooooo...... So, the whole time I was gone, I was in a panic that he'd have another seizure the next morning - today, actually - since I don't know if it was the three-hours-late phenobarb pill on Monday that produced Tuesday morning's seizure. As it turned out, he was still among the missing when I got home. By the time I found him, managed the agony of kneeling on the floor, lifted up the sofa with my left shoulder and tried to grab one of his body parts with my right hand to drag him out, and then staggered to my feet again, his pill was two and a half hours late. So, I cleverly thought, I'll give him a smidge more phenobarb and see if that helps make up for the vanished hours. I still have a ton of the compounded 10mg capsules, so I gave him one of those, and - don't know if that's what did it or not - but anyway, no seizure this morning.

It should only be that simple and successful all the time. The little stinker has such an exquisite sense of time - he wanders through the kitchen at the exact time his pills are due every single day - that I know that these disappearances lately at pill time are intentional. Maybe he knows that the phenobarbital is doing major damage....

I have to go out this afternoon, but I was sneaky and grabbed him before I got ready to go. Not giving any more hints that it's time to hide.

#39 - short, but not all that sweet.

2008-01-15T07:49:00.000-05:00

6:45 AM. It started very abruptly, with virtually no salivation, but a little jaw-snapping. The flopping was significantly reduced in violence - in fact, this was the first time I ever touched him while he was having a seizure; I was afraid he was gonna fall off, so I just sort of grabbed him by his lower body - he was laying on his right side - and slid him back away from the edge. The noise was different, too - instead of the distinct separate snarls, he made almost a continuous moaning kind of sound. All in all, the seizure lasted probably not more than 15 or 20 seconds. When it ended, he lay absolutely still for at least two minutes, with fairly frequent body jerks for the first 30 or 40 seconds, and then nothing. Eventually, he jumped down and headed off to the kitchen to find food. His coordination seemed unaffected, and while he clearly wanted something to eat right away, he wasn't panicky about it or anything.

So, now I'm left once again wondering if this was my fault. I couldn't find him yesterday for hours - crawled around looking under the couch and under the bed and up and down the stairs, with no sign of him. I did all the little tricks that usually get him to come out, and none of them worked. Finally, when his phenobarb pill was three hours late, he just appeared out of nowhere. I've never understood the whole thing about having to give the phenobarb at exactly the same time every day, when you can do a blood test anytime at all on the assumption that the drug reaches a level in the blood that stays consistent. Anyway, was the late pill the cause? Or was it that I'd reduced the phenobarb dosage 20% (2mg. per dose) a week ago? Previous occasions that I reduced the dosage, it seemed to take about a week to show up in a seizure. While the last phenobarb blood level was in the acceptable range - 32.4 - it was quite a bit higher than it had been, and I don't want to take a chance on going back to the higher dosage if there is any choice at all.

I'm so sorry to have seen the wonderful five and a half weeks of no seizures end.

It was my fondest desire.....

2008-01-07T06:43:00.000-05:00

never to be sitting here again at the crack of dawn recording another damned seizure. But here we are, #38. I have been lulled into a false sense of security, right? I didn't even have the radar turned on for the preparatory foaming noises any more, so I don't know exactly what the beginning of this one was like. By the time I woke up enough to realize what was happening, he was flopping, and then the growling started, quite loud and vicious sounding. I didn't think to put my glasses on and turn on the light until after it was over, so I'm not sure about the salivation and other stuff. It seemed like it took forever to end, but that was probably because I was concentrating so hard (physically) on keeping him from flopping onto the floor. When it ended, he laid absolutely still for at least two minutes. Then he jumped down and headed off to look for something to eat. (Yay - food into him - I took advantage of an appetite that has been missing for days now, and after he ate about half a can of FF and wandered off, gave him some high-calorie, food-of-the-devil EVO dry.)

This may have been my fault. Five weeks seizure free. It seems almost miraculous. The signs that something was going on were there, however - and I even took him to the vet yesterday afternoon for bloodwork to see what his phenobarb level is. He has been wobblier lately than he has been for months. He fell off the cat tree twice in the last week - not when he was asleep, just didn't seem to physically have the strength to cling to it. When he shakes his head, he nearly tilts over. He has been eating virtually nothing voluntarily for days now. I'm back to bottlefeeding three or four times a day. And offering him everything under the sun to eat, (9 different kinds of dry food and another 7 of canned!) none of which he is interested in. Anyway, I have this need to reduce the phenobarb as much as possible because I'm afraid of what even the smaller dosage is doing to his liver. So, I thought I could go down to 1/2 of a 15mg tablet BID to replace the 10mg. compounded capsules. Only, and I don't know if this was solely inattention on my part, or what, but twice in the last 24 hours (10 separate doses of pills), I discovered one of his pills - once the 1/2 Keppra, and once the phenobarb tablet - outside his body long after I thought I got them into him. And now I'm on the verge of hysteria, afraid that this is going to precipitate one of those whole new series of seizures that happens when the medication dosage fails and it's harder to get control again. Puhleeze don't let that happen, God.

My poor sweet Milk.

Merry Christmas!

2007-12-18T19:38:00.001-05:00

The middle-of-the-night freight train

2007-12-10T19:09:00.000-05:00

Well, we're still having the periods of intense activity during the night. Every night. As I said before, better this than seizures...... In a way, it's kind of funny. He spends endless amounts of time either stealing the straws from my tea mug, or finding the out-of-the-way places he's hidden them, and triumphantly carrying them around all over the house. Twice last night, he woke me up - I thought he was having a seizure - the jaw-clicking - but it was actually the straw snapping when he chewed on it.

His need to always be snuggled up against one of the other cats has diminished recently, and now, he wants to be curled up in my armpit as soon as I sit in my chair. (Which does interfere with knitting.) It's very touching. He keeps trying to get closer and closer, and then he stretches his skinny little front leg out and pats me with his paw. Honestly, I am convinced that inside this wispy little white cat is some sort of miraculous being that I've been blessed to find. I look in his eyes and see - well, I can't even describe it. I was so driven to see him in that cage at Petsmart almost two years ago for some reason I can't explain, but I am absolutely positive that it was meant to be. And I am so glad.

Well, it happened again.

2007-12-03T10:58:00.001-05:00

Only earlier. Up at 4AM this morning - no seizure, but bouncing all over the place for two hours. I really wonder if this is related to the Keppra. None of my cats wakes me up anymore before the alarm goes off. And once he finally did get back to sleep, he was really out of it. I am worrying - hopefully unnecessarily - about this huge dosage. Although, I don't see any physical signs that there's anything going on aside from this weird middle-of-the-night thing. His coordination is quite normal, appetite about as stinky as usual, everything in general the same. I'd like to call and leave a message for Dr. Axlund to ask him if this is normal, and if he thinks that maybe we should do the Keppra blood test he mentioned somewhere along the way. Or someone who knows about Keppra. (I was even questioning the technician at Dr. G's, who takes it. Of course, she's not a cat....)

Also ordered the compounded phenobarb from the pharmacy in Michigan that Hope uses. I didn't even ask what the cost would be. I just hope that it gets here by Friday.

Curious/weird

2007-12-02T05:46:00.000-05:00

Milk just woke me at 5:20. Prime seizure time, but he wasn't having a seizure. He walked around on me a little bit, hopped on and off the furniture, and eventually raced around the living room. It was definitely odd behavior, but since it didn't seem to involve incipient brain damage, I wasn't about to discourage it. I thought maybe he'd want something to eat - if it was actually some sort of "substitute seizure" - but he really didn't. After maybe 10 minutes of activity, he hopped to the top of the cat tree tunnel - a good five feet off the ground - and just sat there, quite relaxed. At 5:40, he closed his eyes and started to nod off, which made me nervous for no particular reason. I went into the kitchen to record this, and he followed me, then went back out to sit on the short cat tree.

I'm not sure what to think. The timing makes me think that, if he hadn't awakened, this would probably have been a seizure, but I don't know if that's likely to happen or not. I would happily be awakened every day at 5:30 if he just wants to wander around and no seizures are involved.

He seemed to be feeling the effects of the greatly increased dosage more late yesterday. There were a couple of times that I noticed that he had a sort of hard-to-describe "startled" look on his face. (Yeah, I know, I know, but he did. Something odd about his eyes....) And when he was ready to go to sleep for the night, he just flopped down and never moved a muscle . No turning around to make a nest, no last minute grooming, just awake one minute and sound asleep the next.

It's possible that one of the other cats woke him at 5:20. I'm beginning to think that the four of them spend the night stomping around on top of me, and I'm such a sound sleeper that I just don't know it. I have noticed that the ones I start out with when I go to sleep are not necessarily the ones who are there when I wake up, no matter what time that is.

And now I kind of hate to go back to sleep - it's 6AM, though - because I'm afraid that I'll be unpleasantly awakened by snarling and growling in a half hour. Rats. Never satisfied.

And another one, huge dose of Keppra and all....

2007-12-01T05:07:00.001-05:00

#37 . Although, I want to make myself feel somewhat cautiously optimistic that it was "better", somehow. Near as I can figure, the new dosage of Keppra is 187mg and a little more. That's a lot, it seems to me; at least, it's a lot more than he was taking before, especially when you multiply it by TID. He's had four of the increased doses. But there was a noticeable difference in this seizure compared to the last four or five. It didn't take as long to get started - he did a small amount of preliminary jaw snapping, but the growling started almost immediately, and it continued as almost a high-pitched wail until it abruptly ended. The flopping was very strong - I was almost sure he was going to end up on the floor - but very quickly over. I would estimate that the entire seizure lasted somewhere between 20 and 25 seconds. It ended like the video seizure did - he just stopped flopping and growling, and laid still. There was a minimal amount of jerking after it was over, too - his tail did a sort of "whiplash" thing twice, but that was really pretty much the extent of it. He laid for at least a minute, possibly more. When he jumped down, he was more coordinated than he has been - he didn't fall or act shaky. He did start to walk off in the opposite direction of the kitchen, but when I called him to come and eat, he came and did eat. He seemed to want to walk, but it wasn't the pacing that I used to see with the earlier seizures, either; then, he would rapidly, almost seeming driven, walk in a huge circle all around the living room and kitchen. This time, he seemed more interesting in being in the living room/dining room than eating. Right now, he's meatloafing nearby. Waiting for me to finish this so he can go back to sleep, I guess. Except that the blanket's soaked.....

I don't know now who exactly to report this to. Dr. A., the neurologist from Ohio, said that Dr. L, the Internal Medicine vet from here, should be our contact, but I don't have any idea what her reaction to the dosage increase (and the lack of pressure to have an MRI) is. I feel like he's the one that should know that there are differences in this seizure, not that there's anything I want him to do or say, I suppose. But it would seem like he's the one who would know if the change means anything or not - if it represents positive improvement because the seizure was so much shorter, or if it represents negative/failure because it happened so soon after the last one, or if it doesn't mean anything at all. I wish I could just email him or something. I just realized that it's Saturday. Maybe next week, I'll call his office and ask what they think I should do. It would be different/better if I had more of a relationship with Dr. L., or if I could actually talk to her when I call, instead of relaying messages through a technician. And it just occurred to me that I don't know if there is any testing/bloodwork that should be done on a regular basis or what, to see if his liver's okay or his kidneys, since Keppra's processed through the kidneys, I believe.

Milk's been calmly sitting in the same place, looking around but not jerking or acting very post-seizure-ish for more than a half hour. I guess I'll record Scruffy's information and see if he needs to be shot, and then try to sleep a little more, till time for Milk's next pill. Not much of a life for any of the three of us, sadly.

Neurologist appointment in Akron.

2007-11-30T00:28:00.002-05:00

more to follow; just wanted to make sure the date got recorded.

Dr. Todd Axlund
Metropolitan Veterinary Referral Group
1053 S. Cleveland-Massillon Road
Akron, OH 44321

1-330-670-2358 (office)
1-330-666-2976 (main reception desk)

Also to remember:

Physician's Compounding Pharmacy
1-248-758-9100
1-248-758-1831 (fax)

ordered 3 mo. worth of compounded 10mg phenobarb capsules - great service. Cost $78.

And:

Universal Drug Services Ltd.
5B 851 LagimodiereBlvd
Winnipeg, Manitoba R2J 3K4

toll free #: 1-866-456-2456
toll free fax #: 1-866-783-4223

email: info@universaldrugstore.com
website: www.universaldrugstore.com

Free shipping is available for pet medications, but not for human ones. BUT - the price for the generic Keppra is still significantly lower than other Canadian drugstores even with the shipping.

(generic) Levetiracetam:

250 mg 150 tablets $179.50 +$10 shipping (10/12/07)
250 mg. 200 tablets $225.00 + $10 shipping (1/15/08)
250 mg. 200 tablets $225.00 (Coupon for shipping - $10) 3/18/08 (arrived in SIX days!)

#36.

2007-11-28T05:54:00.000-05:00

This one makes me question how long all of Milk's seizures have been. I had the camera sitting beside me, so I was able to video from shortly after it started until he jumped down. And it was around 3 minutes, which was a surprise. Very violent, very harsh growling.

Only three days since the last seizure. This is exactly what I was afraid of. I will call Dr. L. again, I guess, although she didn't offer any suggestions about what to do two days ago, except for the bile acids test, which I can't do now because he has to fast for 12 hours, and he has to eat after he has a seizure. Once again, there was a lot of physical movement, and I had to worry about his falling on the floor. There was less jerking after most of the activity ended than usual. He started to jump down and then was too wobbly, so he just sat and stared into space for a minute or so. I was distracted by trying to keep the camera on him.

I don't know if anyone would want to see the video anyway. It is very distressing. I'm feeling a little numb now. This seems to be way out of control, and I have no way to help my sweet boy.

Somehow, this video finally got uploaded. It's very disturbing, to me anyway. Anyone who watches might want to turn down the volume on their computer.

The Plan.

2007-11-26T14:43:00.000-05:00

Talked with Dr. L this afternoon. She feels that Milk is at the maximum dosage of Keppra that she has heard of cats using. We don't want to increase the phenobarb. There is another drug that might be a possibility, but she hasn't used it herself, or in combination with Keppra and phenobarb. She seemed to feel that, if a third drug were to be used (and I can't remember what it was called) - it should be prescribed and monitored by a neurologist.

I explained my concerns about Milk:

1) increased severity of seizures
2) increased frequency
3) diminished appetite, although it is improved somewhat

Dr. L feels that we need to get a post-prandial bile acids test done as soon as possible, and based on that (and the comparison between the previous test, which was pre-prandial), she would refer me to a veterinary neurologist in Akron. Where it would be decided, I guess, about doing an MRI and spinal tap. Neither of which I'm eager to do. The neurologist's name, I believe, is Todd Ecklund or Acklund - can't find the paper I wrote it down on a couple weeks ago. (Correction: Axlund.) He was a professor at Auburn. I asked if it was customary for seizures to escalate in severity, and if not, what it might mean. She said it wasn't necessarily usual, but since they don't have the information from an MRI to be sure exactly what's going on in Milk's head, there's really no way to know. She felt that, given his age, it was not particularly likely that he has a brain tumor, but that inflammation might be a possibility, along with something else that I can't remember. Speaking of possible brain tumors.... Anyway, I will have another bile acids test done this week, and then I guess we will go from there. She did say that the 25 he had on the previous bile acid test was not a huge reason for concern - that the area of 50 is more of a problem. I guess that's good news. I'm not totally convinced/positive that he was absolutely food free during the last test anyway. Although, Antech said that they do a "random" bile acids test that does not require fasting and retesting after food. I asked about the urine bile acids test, but Dr. L felt that it would be as traumatic to Milk to have the cystocentesis (and I don't know what Dr. G.'s experience with doing it is) as it would be to have the blood work done. I told her that I would prefer getting blood work done at his office because of the distance, the waiting time, the dogs in the waiting room, and the way that her technicians take the blood. She didn't react with horror.

I am in a state of panic about all of this. I couldn't sleep last night. I stayed up till 6AM, when I was so exhausted that I figured I wouldn't be laying there waiting for Milk to have a seizure. That is disfunctional, obviously. There has to be an answer to this. I feel like he's a bomb, ready to explode at the least provocation, and that there doesn't seem to be any solution. Even if we have the MRI, and it shows something fixable (affordable?), or if it shows something UNfixable, then what?

this was horrible.

2007-11-25T04:58:00.000-05:00

#35. Absolutely the worst one yet. Started off kind of slowly, laying on his side on a blanket between and parallel to my calves. By the time the growling and snarling started, he was also beginning to flop violently. He flopped (like a fish out of water) so hard that he sat himself up in the meatloaf position. I couldn't get to him because he was facing me, and all that snarling is very scary - lots of teeth showing. A couple of his claws were stuck in my right calf. And he kept bouncing and bouncing. I was scared that he was going to fall off onto the floor, and all I could think to do was to try to gather the blanket up tightly to try to keep him from falling and to pull him closer, but also to not have to get too close. It sounds like Three Stooges, but it was truly awful. And for the second time, I forgot to put the camera out before I went to sleep, but I don't think that 1) I would have been able to manage taking a video without letting him fall on the floor, and 2) I ever want to see that again. I was so afraid he would hurt himself.

It took about 30 seconds after the flopping stopped for him to come out of it. There wasn't the "moment of consciousness" that was so distinct the last two seizures. He still seemed out of it when he jumped down, and he was very wobbly on his feet. He went to the kitchen to look for something to eat. He ate about 1/3 of one can and then came looking for something else, so I opened another can. He's huddled on the living room floor right now, almost a half hour afterwards.

There were no indications that he was going to have a seizure today. No excessive sleepiness, no differences in food preferences, or activity level, no changes with medication (except that his second Keppra was about 45 minutes early because I had to go out.) Early, you wouldn't think would make a difference, right?

This was a rarity - a "full moon" seizure. I truthfully don't think that the moon phase seems to have anything to do with it. What does worry me is that it's only been six days since the last seizure. This happened before, where they kept getting closer together, until they got to the place where there was only two days between events. I do NOT want that to happen again. I can't say that I've seen anything in his personality or abilities or anything that has been damaged by having three dozen seizures in eight months, but it can't be doing his brain any good, and it's breaking my heart.

I am really upset by this one.

#34, damn it

2007-11-19T19:17:00.001-05:00

Totally out of the blue, except that it's been on my mind today that it's been almost 10 days since the last seizure. Is ten days going to be the time frame that has to be acceptable? Well, anyway, it's the 9th day. I was sitting in the kitchen when the growling started. Milk was sleeping in one of the caves on the heated mat in front of the furnace vent - could hardly get much warmer and snugglier. The minute he started growling, all three of the other cats came running, which has almost never happened. And, because he was in the cave - very soft, but confined area, with only two round circular holes at each end, he was thrashing around without much room for the flopping stuff he did during the last seizure. I manuevered the cave around so that he could work his way out of it. Then he could stretch out on the floor.

Lots of saliva this time. A LOT of jerking and body-snapping movement. Again, it seemed like a much more physical, unpleasant seizure than his norm. Even after most of the movements stopped and he was just laying on his side, there were still frequent hard jerks - of his torso, not of his extremities - no paddling movements. He lay for probably a minute unblinking, and then got up but was very wobbly. He didn't come into the kitchen for food until I called him, which is odd, too - usually, he's out here waiting for me to get him something to eat. He seems okay now. No pacing. Ate almost two whole cans of Fancy Feast. His appetite the last week or so has been very poor, and I've been bottlefeeding him again at least once a day, so eating that much is good to see. The only other thing of note today is that he has slept most of the day - in the cave, instead of with me or one of the other cats. He really seems to appreciate the heated mat. I guess I'll watch and see if extra sleeping happens before the next seizure. It might be helpful to have some idea of triggers/forecasters. Not that there's anything to do about any of it....

I would like to know if it's possible to just use Keppra by itself. And if his phenobarb could be decreased any more - I'm thinking that maybe he should have his levels checked again, even though it's only been a couple of weeks since the last test. And if the Keppra could be safely increased. And I don't have a mechanism for conveying information to Dr. L. about what's going on with Milk, either. I would like to be able to email her the seizure record, or this stuff, or whatever. Faxing doesn't seem to be something I'm gonna be good at.

A very different quality, somehow.

2007-11-10T07:10:00.000-05:00

This morning's seizure was very different from the last five or six. It was very short, and much more physical. I was going to say "violent" - but it wasn't really violent, I guess. He must have been laying on his side when it started, and the jaw-clicking that accompanies the salivation seemed to take a very long time to get going. I usually try to gently stroke and wipe him up and talk to him during a seizure, but he was a little too far away to reach. (And I'd had the camera sitting there at night for days now; forgot to put it out last night...) The "violence" was mainly his body flopping like a fish; there almost appeared to be a sort of rippling from his head to his tail. There hasn't been that much movement during a seizure for quite a while. Growling started a few seconds after the beginning of the seizure, and was much reduced in volume. This was a quick but mean one, I guess. Over rapidly and very abruptly, with a distinct moment in time when it appeared he was himself again, although he didn't move. After it ended, he just laid there, with his eyes wide open and unblinking for a good minute and a half. And then, he abruptly stood up, jumped down, and headed for the kitchen to eat.

It's been 10 days since the last seizure, which is good, not that it wouldn't be nice if it had been 10 weeks, or years...... He started the generic Keppra from Canada earlier this week, and last night, he had the last of the 6 month old phenobarb Vet Chews. He's a little wobblier these days than he was, say, a few weeks ago. And he's not eating as well. I've started giving him the occasional bottle of Wellness again; he won't eat it from a dish on his own.

Today he's scheduled for another chiropractic appointment. I was thinking that maybe I should cancel it, but upon further consideration, this might be a good time for the treatment, since his muscles and joints have been through this ordeal so recently. Boy, I hope he never has a seizure in the carrier.

A whole big screw-up with the medication

2007-11-06T10:33:00.000-05:00

We're coming to the end of the brand name Keppra, and at the same time, of the now-expired chicken-flavored phenobarb Vet Chews from BCP. I called the compounding pharmacy that was so unhelpful about fixing the liquid Keppra, and they were even more unhelpful about making me capsules with 10mg of phenobarb in them - they said they wouldn't do it; they would only make a 10mg liquid. We didn't have much luck with liquid before, and it was very traumatic for Milk (and for me!), so I guess we'll have to spend the $40 a month for Vet Chews. Tuna flavor, this time.

Milk won't eat the Chews - apparently regards them as being too similar to Pill Pockets - but they do make pilling him simpler. I asked Dr. G. to fax them another prescription, as the original refills had mysteriously expired (less than a week ago, of course) in only six months. I thought that everything was arranged, only to find out that, because phenobarb is a controlled substance, they have to have the actual prescription in their hands. I am HOPING that Dr. G's office was able to get the prescription in the mail yesterday, because I only have enough 10mg chews left to last until Friday. If the mail works efficiently, and BCP does the same and gets the chews in the overnight mail, hopefully, it won't screw things up any further. It's been another week since the last seizure. I could live with two a month. I'm a little nervous about the generic Keppra working the same, and they're larger than the brand name was. I wrap them in Pill Pockets and pop them into Milk's throat, so they should go down just like the other ones. If only they WORK like the other ones.....

A very unpleasant surprise

2007-10-31T05:40:00.000-04:00

Milk's been so "normal" lately that I really had sort of put seizures out of my mind. Well, not totally, but there was absolutely nothing that would have made me think that he'd wake me this morning in the beginning of one.

I'd guess it lasted about 30 seconds - it's hard to judge. There was a digital clock right there, and it said 5:20 when I first looked at it, and 5:21 when the seizure activity appeared to be over. This one continued the recent pattern of having very little physical involvement, but lots of growling/snarling. He was laying on his side, and never changed position at all until he got up to jump down and go to the kitchen to get something to eat. My mind was caught on his tail, which had extended out from his body in a sort of "c" shape when the seizure started, and just stayed in the same place the whole time. There was a moderate amount of foaming, not a ton. He ate most of two cans of Fancy Feast afterward, and then curled up on the floor, waiting, it appeared, for me to finish typing this.

I'm really disappointed, but at least it's been two weeks since the last seizure, instead of two days....

Chiropracty and bloodwork

2007-10-28T11:09:00.000-04:00

I took Milk on Thursday and had blood drawn to test his lead levels, phenobarbital levels, and bile acids. (I also wanted the ALT and AST, etc, but Dr. G. didn't seem to feel that that was significant if we had the bile acids.) Results came back on Friday: phenobarb level - 25, lead level - 0, and bile acids, 17. Previous bile acids result, done when he was first diagnosed, was 6.8. I don't know how significant this result is, though. He wasn't really fasted prior to the test, because he ate a few pieces of dry kitten food three or four hours beforehand. And there wasn't any feeding/follow-up blood test. The fact remains, the bile acids are supposed to be below 10. I assume that I'll hear from Dr. L next week when she gets her copy of the testing. I still don't know what this test shows about the condition or function of his liver, particularly after the excessive phenobarbital levels. I would like to know if there are supplements (milk thistle, actigall, etc ) that might be helpful for him to take. Not that I'm eager to give him a whole mess of new pills.

Saturday, we went to Dr. Doug for a chiropractic exam and treatment. There were a whole mess of vertebrae out of whack; I counted 9 times when the Dr. stopped and worked on an area. Milk was his usual sweet, silent little person - not a peep out of him during the two hours in the car, or while we were at the vet's. He was very glad to be home again, and ran around and let everyone else sniff him. He spent most of the evening napping in the dining room under the rocking chair; he just seemed worn out.

Eleven days without a seizure......

Phenobarb reaction again?

2007-10-19T16:20:00.000-04:00

I don't like what I'm seeing here. I've noticed a distinct increase in Milk's wobbliness earlier this week. This morning, he jumped up on the bathroom sink, and stepped off into space twice with one of his back legs. His appetite is decreasing again, too; I've been giving him a kitten bottle or two of Wellness again every day for a week.

I called the Speciality Hospital this afternoon, but Dr. L. wasn't in. Milk's supposed to have bloodwork done next week anyway - phenobarb levels, bile acids, and something else I can't think of. I made an appointment with Dr. L for him for Tuesday, but I am going to call Dr. G tomorrow and see if he might have time in the AM (before I take Scruffy to the chiropractic appointment) to do the bloodwork. I prefer his method of getting blood - he uses Milk's thigh, rather than the jugular or wherever it is the Speciality Hospital technicians have to make multiple pokes around his knees. Plus, I don't like them taking him away to do it; he's such a shy little person, and I think it matters to him to have me there. Additionally, someone posted the other day on the epifelines site that Antech has a - well, I don' t know what it's called - system, program, schedule - whatever - they do a bunch of tests all at once to determine blood levels of therapeutic drugs. Antech isn't the same company that the SH uses, but I'd rather know on Sunday if his phenobarbital level is high again than wait till the middle of the week. Plus, if I can't get him in to Dr. G on Saturday, I can do it Sunday and still be ahead of the report game.

I would like to know if there are people whose cats are just on Keppra. Or what about the person on the epifelines board whose cat takes 250mg TID of Keppra? Would that work for Milk? That 250mg cat weighs 20 pounds or something, though; Dr. L seemed to believe that weight is significant in Keppra dosing.

Speaking of which - the Canadian generic Keppra came today. It's been maybe four days since I got the email saying that it had been shipped. The whole experience - except for my faxing disaster - was relatively painless, and I will be happy to do it again. www.universaldrugstore.com. They were very pleasant and cooperative. Someplace in Manitoba. Interestingly, although the package came in a big plastic mailing pouch, and you could hear the pills banging around if you shook it, and it was addressed to me and to "pet Milkshake" - there was no indication anywhere on the bag that it contained medication.

Around 9:00, I heard a funny noise in the kitchen. I thought Milk was having a seizure. When I went to see, there was a huge dark yellow puddle of clear liquid all over the floor. And a smaller puddle beside where he was sitting. He plainly looked like he didn't feel well. There was no solid stuff in the puddles, and no sign of his 6:00 Keppra pill, thank goodness. He hadn't eaten anything at 8:00 when I fed everyone, and he kept licking his lips. Hope didn't think it was anything to get hysterical about, though. (I immediately was imagining liver failure from the phenobarb.) Anyway, when I got up the next day, there was a fairly large spot on the rug of orangish stuff - ick - with three very tiny little hairballs in the middle. So, presumably that's what the problem was. Hopefully. I had gone to the store for Pepcid AC last night, and gave him 1/4 tablet then, and another 1/4 with this morning's Keppra. He ate a few treats, although I didn't see him eating any cat food. He's peppier today anyway, so I guess that's what it was....

How come nothing's ever simple?

#31.

2007-10-17T14:51:00.000-04:00

This is really getting me down.

Sitting in the kitchen, reading on FDMB about Tucker's Mom's cat and valium. I heard the snarling/growling that now accompanies Milk's seizures. He had been napping in a cat bed under the rocking chair in the dining room. I couldn't get at him to wipe him up while the seizure was going on because he was sitting upright and the seat of the rocker was right at his head. I don't know how long it went on before the growling started - not too long, I don't think, because the other three cats all went racing out of the kitchen to go and stare at him. Very unusual. Not so much foaming this time, mostly on the right side of his face and his right front leg. He just sat there with an occasional jerk of his head and shoulders for a few seconds afterwards, and then came into the kitchen to look for food. All in all, this was a shorter seizure, the growling was much louder and more aggressive sounding, and the recovery period was quicker. I wonder if any of that is significant. Does this mean that the increased phenobarbital and Keppra together have not had much impact?

Supposed to go to dinner with the Hotel Ladies, but I don't like to leave him after a seizure. We were going to Max and Erma's, and the last time we were there, I couldn't find anything I liked anyway. The conversation would have been nice, though......

Guess I'll go and see if little Milk would like to snuggle. Sometimes he seems sleepy afterwards.

This is depressing.

2007-10-12T21:37:00.000-04:00

Dr. L. called late this afternoon. I told her that he'd had two seizures today. She felt that it would probably be necessary but hopefully safe to increase the phenobarbital again. I mentioned that I have 10mg VetChews I got from BCP. (Didn't know that it said on them that they expired 6 months after the date on the prescription, which is exactly October 30. Crap. On the other hand, how much difference could it make, would you think?) Milk wouldn't have anything to do with them when I first got them, and I wasn't sufficiently accustomed to pilling him to force them. I think they're worth trying - as long as they don't do any further damage to his liver. The major problem is the necessity for mail-ordering them, too - and the fact that they cost $40 for a prescription of 60 pills. I wonder if there's any sense in contacting the compounding pharmacy in Avalon to see about getting 10 mg pills or capsules.....

Just to reinforce with Dr. L what a dope I am, she wanted the dates and information about Milk's seizures since two weeks ago when I left her a copy after Milk's bloodwork. I, the eternal optimist or whatever, said that I'd learned to fax, and I could fax them to her. I'd been planning to do it on my own, and I had already figured out what I wanted to send and how I could print it out first and then fax it. And, once again, I spent two hours trying frantically to get the stupid fax to work. I tried over and over. I kept getting messages in the log that there was "no data" in the message, and printed-out captions that it was sent. I couldn't figure out how to get the printer to show me what exactly it faxed. Finally, I just gave up and called the dr's office, and explained that I'd been trying to send her a fax and I didn't know if it worked or not. The receptionist said, "Oh, honey, I'll go check for you." And when she came back, she said that there were dozens of pages from me hanging out of their fax machine. I said, "Well, yeah, but do any of them contain the "Seizure Record and Weight Record" for Milkshake Guckert?" And she insisted that they did. Oh, I hope so. I sat and read the directions and clicked all the stuff the printer said to click, and still had no idea what I'm doing. I can't understand how I managed to get anything to the Canadian pharmacy the other day, illegible or not.... Dr. L. was kind enough not to mention the excessive faxing when she called. I'll be getting a bill for wasting paper.

Milk's very agitated tonight. Jumpy at noises, and doing a lot of padding around and going up and down the steps. He didn't eat much. He slept most of the afternoon on my ankle in the recliner, smashed up against Busy.

Rats - I forgot the two most important things the doctor said: 1) to increase the phenobarb to 10mg BID - using the almost expired VetChews and to bring him in for bloodwork - liver function tests and bile acid testing - in two weeks, and 2) she's got a friend who's a veterinary neurologist and has opened a practice in Akron. Todd Axlund. I don't know anything about him, experience or qualifications or whatever. Akron's about the same distance as Cleveland or Columbus. It's doable. Dr. L did mention that it's probably going to be necessary to do the MRI at some point. I don't want to think about it. Me and Scarlett O'Hara.

#30

2007-10-12T11:41:00.000-04:00

Sitting in the kitchen, playing on Pogo, when I hear growling and snarling from the living room. I couldn't find Milk. The other three cats were all pointed toward the couch, though, and while I was looking for him, his little white tail emerged from under the couch skirt. It was awful, because I couldn't get to him - the couch is too heavy for me to hold up with one hand and try to do anything for him with the other. I could hear him banging against the frame of the couch. Probably about a minute long seizure. Then there was quiet, and eventually, he crawled out from underneath the couch. He was soaked. Even his right back leg was wet, for some reason, and his tail - much more than the usual places where he foams on his jaw and cheek and neck. He ate some more, fairly frantically - probably more than he's eaten all at once in months, and wandered around a little. He seemed alert and coordinated.

I called Dr. L, and she is supposed to call me back. A friend and I had planned to go gambling, but now I need to wait for her to call, and I'm not comfortable about leaving Milk here by himself. This is where my unresolved questions about "What's a cluster seizure?" and "Are all more-than-one seizures clusters and cause for panic and valium?" come up again. I haven't felt, other times when he's had more than one seizure - even the day when he had two distinct seizures in ten minutes - that they were connected or fueling each other or whatever. And it seems like the decision to use rectal valium should hinge on more than just the fact of the seizure occurring. Shouldn't the length and violence and timing be taken into consideration?

I always feel like the medical people involved think that I'm thrown into a panic about Milk's having an occasional seizure. Which isn't the case at all. I'd be perfectly satisfied to get to a point where he has one seizure a month. The question is - how do we GET to that point? I was thinking the other day, looking at the seizure record down the side of this blog - Milk's had, well, as of right this minute - 30 seizures, and for all of them but the first two weeks - around 9 seizures or so, he was on medication, lots of medication that doesn't seem to be working all that well. I don't think there's anyone else on the epifelines board who has had so many seizures in six months. Apparently, Milk's epilepsy is going to turn out like Puffer's diabetes - atypical and impossible to get a handle on. These poor cats - they would probably both have been better off if they'd ended up with someone more competent.

I gave Milk his first Keppra pill of the day a couple hours after the first seizure, and I just gave him his phenobarb pill a half hour after the second seizure. I HOPE that's enough medication to control things for the rest of the day, till the next pill. Please....

My shirt smells like Milk's saliva.

Well, this one was a surprise.

2007-10-12T05:25:00.000-04:00

And an unpleasant one, at that. It seems like every time I look at Milk and think how well he's doing, bingo - another seizure to add to the list. Twice yesterday, he climbed up and stood on my chest and looked into my eyes, and he just seemed so normal.

Description - I'd have to say this one seemed more "violent", and yet, in reality, he didn't move much at all. In the middle of it, he was actually bouncing up and down while laying on his side - there was huge amount of movement, but it was very small in scope. He was sopping wet all over with saliva by the time it was over. I think it's the growling that makes these last few seizures seem worse than the earlier ones - it gives me the sensation, listening to him and watching him, that he's angry or vicious or something. Which is clearly not true, of course. I didn't put the light on until he'd climbed down, so I don't know if there was all of the blinking and jerking of his head and eyes again, but I kind of think that there wasn't; at least, I didn't feel any movement at all once the seizure ended, and he was laying between my ankles. He laid afterward without moving or making any noise for almost three minutes - I had to restrain myself from poking him to make sure he was alive - and the seizure itself lasted less than a minute. He jumped down and headed for the kitchen to eat. By the time I got out a can of food and got it ready for him, he'd circled the living room/dining room/kitchen, but it didn't have the character of pacing that he used to demonstrate after a seizure. He ate and ate. I was typing this by the time he was done eating, and he came over and jumped up onto the keyboard and looked around. He seemed very alert and coordinated. His fur was a mess from the saliva - all stiff and sticking up in clumps. And now he's sitting on the arm of the sofa, surveying the territory.

The reaction of the other three is interesting. They have always seemed minimally curious during a seizure, but once the growling and snarling started, they now seem a little scared. Burble and Busy climbed up onto the couch and sat in their kitty pi's, and Puffy just sat in the middle of the floor staring. He was sleeping beside Milk when the seizure started, and it surprised me that I had to actually put him down to wipe up Milk - I would have thought that all the noise and jerking would have made him move on his own. They don't do any "checking" afterwards, either - no sniffing or watching him suspiciously or anything. Life just goes on....

This is the fourth day on the increased dosage of Keppra (brand name prescription from Sam's Club.) I have to hope that using the generic from Canada when it gets here doesn't make things worse. He's still getting 8mg of phenobarbital every 12 hours, too. That's five doses of medication spread out over 24 hours every single day, and yet the seizures keep coming.

I was just looking down below to add the date to the moon information, and realized from the previous post that it has only been since September 26 - a little more than two weeks - that Milk's seizures have included the creepy, noisy growling. I wonder if it's normal that the features of seizures change over time, or if it's a factor of the kind/amount of medication. Not that it makes much difference, one way or another. I'm still dreading waking up to find that he's peed all over the place. Puhleeze don't let that happen, God.

I'd like to be reassured that all of this isn't causing some sort of brain damage. Actually, I'd like it to just STOP. Period.

So far, so good.

2007-10-10T23:32:00.001-04:00

No seizures since 10/7. How sad to be happy about going three days without a seizure. At first, Milk seemed a little wobblier than usual (even for him these days), but today, he's pretty much back to normal. He seems more interested in food, too. Someone on the EpiFelines board said that her cat was inappetant on Keppra. Never know, I guess.

This afternoon, after fiddling around for an hour with my new found/lost faxing skills, I managed to get the prescription for the generic Keppra sent to Canada. They have some sort of rule about only sending unopened packages of pills, which means that what's on your prescription isn't necessarily what's in the order they send you, apparently, but that actually works to my benefit. I don't know how many pills exactly I'll be receiving. The prescription was for 45 pills, with two refills. The Customer Service person I talked to at Universal Drugstore.Com (who has a cat that's been newly diagnosed with asthma and a vet she's not very happy with...) said that the pills come in 100 unit lots, so I will be getting 200, I guess. Or maybe 150. I really don't care which - it gives me a little more flexibility about ordering refills and dealing with the Canadian postal system. The total price - and I don't know if this includes the $10 for shipping or not - is $179. Which is still much better than the US price (for the brand name Keppra because the generic isn't approved here yet); I was told on Saturday that 45 pills would cost $92.32, and when I went to pick them up on Monday, the price had increased to $107.something. I hope the generic works.

Seizure #28

2007-10-07T22:12:00.000-04:00

I didn't know this one was occurring until I heard Milk growling from the bedroom, and Busy and Burble went running in. Milk and Puffy must have been sleeping on the bed - they snuggle up in there frequently. There was a wide swath of spots on the bedspread from his saliva, and the cuticles of two claws. By the time I got there, he was laying on his side and was quiet. The only body motion I saw was a large amount of blinking and jerking around his eyes and his head. He lay still for a little while, then jumped down and went to look for food. No pacing. He meowed while I was getting his food, which hasn't happened before, and he ate most of the contents of three bowls. He groomed a little bit, and now he's sitting like a meatloaf behind my chair. I know that they say that people are not aware of what happens when they have a seizure, and the animal communicator said that he told her he just goes away from his body until it's over, but it makes me so very sad to think that this keeps happening to him.

I had a bad feeling about this today - he slept most of the afternoon and early evening in my computer chair, where I could see him from the living room, and I kept expecting that he'd have another seizure there, like the last one. He seems generally alert these days, but much of the physical stuff he's been doing since the last phenobarb reduction - leaping up onto the top of the cat tree, jumping from the wing chair to the back of the couch, chasing Burble up and down the steps - has pretty much disappeared. I don't know if he's aware that his balance isn't quite right again or what, but there is much less activity now.

I have the name and phone number and a form to fax to a Canadian pharmacy tomorrow. (If only I had a fax machine...) I have to call them to see if the prescription I have that is for an odd number of pills and only two refills is acceptable. (Their form says that they only ship whole bottles of pills - regardless of what the prescription says. Which could be a plus, actually. And that they prefer to fill three months worth of prescriptions at a time. I hope that I don't have to drag all the way back to Etna again to get more prescriptions from Dr. L.) The price difference is significant - 45 pills at Sam's Club - the cheapest around here, with the discount from the AAA - costs $92.32. ($2.05 per pill of the brand name Keppra - no generic in the US.) The Canadian price for 50 brand name Keppra pills is $72.50, or 1.45 per pill, and the generic pills are sold in lots of 100 for $112.50, $1.12 per pill. Shipping is an additional $10 unless the cost of the pills is more than $100. Which I could do, if I can get the prescription stuff straightened out. The length of time for shipping says to expect at least two weeks, which means that there's going to have to be a lot of planning and keeping track if this is going to work. And I'll have to figure out how to get the fax on the printer working....

There was a big argument about the treatment of cluster seizures in cats on the epifelines' board this week. I don't know for sure, but I suppose that Milk's seizures on several occasions would have been considered "clusters" - there were more than one in a short period of time. The worst was three, I think, in an 8 hour span. Dr. L did give me a vial of valium to use in case of status seizures. I can't even bear to think about it.

and yet another....

2007-10-05T17:56:00.001-04:00

I really don't like how the amount of time between seizures is decreasing. First it was 10 days, then 5, and now 4. It's been a long time since he had one in the daytime. Tonight's, he was sleeping on my computer desk chair. This one seemed to have a little trouble getting going, or something - I was in the living room, and I could tell that he was having a seizure, but aside from very minimal foaming, he seemed to be just laying on his side. It was very short, too - probably not more than 45 seconds. He moved very little, but the growling/snarling noise started about a third of the way into it. There was some mild shoulder jerking. When it was over, he let me wipe his face, and lay without moving - virtually in his original position - for about a minute. (Sounds short, but when it's happening, it seems endless.) He was making eye contact - in fact, his left eye was jerking - but I'm pretty sure he wasn't seeing me. Eventually, he jumped down. I got a can of food out for him, and he ate about 2/3 of it. No pacing. I added a little water and some dry food, and he ate almost all the rest. His coordination appears to be off now, which I didn't notice happening before. He's not walking quite right, and he's just sitting erect and looking around. Usually, there don't appear to be any lingering effects after a seizure. I wish I'd thought to grab the camera since it's daylight.

I have been a little worried for the last few days - Milk's balance doesn't seem to be as good as it was recently. I noticed that, when he shakes his head, there's that instant of "tilting" that I haven't seen since the phenobarb was reduced. It may just be the magnification of my concern about him, I don't know. He seems fine otherwise.

Just fifteen minutes before the seizure, I opened the envelope containing the Keppra prescriptions from the IM specialist. A little late, huh? I called Sam's Club, which had the best price ($93 for 45 pills - if they didn't make a mistake when I originally called them or something). They can order the pills in the 250mg size that we need, but it won't arrive until Monday. Which is very annoying, since all that time from last Saturday - when the phenobarb levels came back, until today (Friday) when the prescription arrived - was essentially wasted. I never did get to talk to Dr. L. She kept having technicians call me. I'd ask a question, the tech would say "Wait a minute", and then come back with the answer. I don't know why the doctor couldn't just have picked up the phone herself, when she was obviously standing right there. I still have a couple of things I wanted to ask her. Like, what about the liver function - I would have thought that they would have done those blood tests on Friday, too. And what about giving him milk thistle?

I hope he makes it through the rest of the weekend without any more seizures so we can start the increased Keppra dosage. And that I can find a Canadian pharmacy to fill the other prescription, and quickly (especially with the Canadian customs ordeals), since there are no refills on this prescription for Sam's..... There seems to be some sort of trust issue with this vet hospital and prescriptions; they wanted me to return the initial prescription they gave me - not just tear it up, but drive back down there and hand it to them. I'm hardly likely to abuse seizure medication that my poor cat needs desperately.

I have a huge knot in my stomach, worrying about how many more seizures he's going to have and how close together before we start the increased Keppra. And if it's going to work.

milkshakethelittlewhitecat

Missed the anniversary!

I have another theory......

Feeling vaguely uncomfortable

Milk and his friends

No News is GOOD news!

A milestone!

There are recommendations, after all......

Finally!

Finally dropped that 6PM dose of Keppra.....

Going well.

A scary experiment

Halloween!

MAJOR MILESTONE!

I knew it.

It's been a month + since the last post?

so far, so good, part II

just stuff.......

Just one of my favorite pictures of Milkshake....

Fearful

Generic Keppra (levetiracetam) information

A day late.....

So far, so good.

Such a nice comment ( #2)

such a nice comment........

Still not sure.....

The Dilemma

Bloodwork

The third adoption anniversary

No funding for the study...

A major achievement! And an "ugh".......

Happy MilkshakeDays!

Milkshake's Beginnings......

A Busy Deterrent (hopefully!)

More information on the study

Interesting study and vicious attack

Imperceptibly....

Mustn't have been the paint....

This was so NOT a seizure.......

The Non-Magic #50

#49

Phenobarb's back.

You have to wonder........

2 days, 3 and a half hours...... #47

102 days, 3 hours, 52 minutes.........

It occurred to me in the middle of the night....

Hopefully, if it didn't happen then.....

Dian's raw recipe....

Two thoughtful comments from Gary F

Seems better.....

Something's wrong....

Experimenting

Shhhh! (Still seizure-free....)

Not much new.

With minimal comment

Crummy crummy crummy night.

So much for that.

Three days!

Seizure Avoidance/Subversion?

Longer, louder, more violent.

Or this one.

No doubt about this one.

Did he have another seizure?

I had such high hopes.

Well, that's something!

The "Eyes" have it.

Another sad anniversary

**Antijinx**

Found a pill..........

He's driving me crazy.

The 2nd Adoption Anniversary Meltdown

"Brotherly " love

#40

He ate!

Where is the Keppra?

PHEW!

#39 - short, but not all that sweet.

It was my fondest desire.....

Merry Christmas!

The middle-of-the-night freight train

Antijinx