Well, Milkshake now has hyperthyroidism.

Diagnosed last week, after I'd taken him to the vet because he had a terrible "cold" and he just wasn't acting right.  (I have such good instincts about when there's something wrong with the cats; I may not know what it is, but I can sure spot that it's not good!)  The vet could feel the enlargement in his thyroid, and bloodwork showed the increase in thyroid levels.  I have to get a copy of the report - unlike when Dr. Dodds was doing all of the bloodwork for Milk and for Busy for the last three years or so, the lab my vet uses doesn't seem to feel that the client should get his/her own copy.  He will be starting methimazole last week.  My vet had reacted negatively when I wanted to get the I-131 treatment for Busy, and he didn't mention that awful Hill's Y/D diet, thankfully; I did ask about the ear-ointment form of methimazole, but he said that it isn't nearly as effective as the pills, and since Milk's so easy and cooperative about pilling, I'm not going to worry about that right now.  I did just see a mention on Dr. Peterson's (the feline thyroid expert) blog that cats who have the radiation treatment as opposed to the medication live some significant percentage longer.  (I want to say it said "70%", but that seems like a lot.  I will go back and see if I can find the article again.) 

I'm not happy about this.  We were so lucky to have gotten treating the epilepsy successfully and his being seizure free for 10 years. 

bloodwork 1/16/14

Phenobarb level done by Antech - for a ridiculous price of $140, when it could have been done for $70 at Hemopet.  Result was 23, which is good and pretty much his regular level.  Therapeutic blood levels are 15 to 45.

Bloodwork was done in office, which I'm not crazy about, but compared to what Antech charges for it's basic bloodwork, it didn't matter much.  I haven't been getting the Keppra levels done at Auburn for the last year or so because I thought that they were doing it in order to help establish the feline levels for the drug.  Apparently not; every report included levels based on the human numbers.

Here's the report:

ALB      3.9       range - 2.2-4.4
ALP      27        range - 10-90
ALT      153*    range - 20-100
AMY     819     range - 300-1100
TBIL      0.3      range - 0.1-0.6
BUN      23       range - 10-30
CA++    9.3      range - 8.0-11.8
PHOS   4.0       range - 3.4-8.5
CREA   1.2       range - 0.3-2.1
GLUC   102      range - 70-150
NA+      140*   range - 142-164
K+         3.7      range - 3.7-5.8
TP         6.9       range - 5.4-8.2
GLOB   3.0       range - 1.5-5.7

QC    OK
HEM 0, LIP 0, ICT 0

I was expecting the ALT, which is always elevated because of the phenobarbital, to be even high than normal, because for the last month or so, he hasn't been getting the Marin twice a day.  The company is no longer making the Marin tablets, and the "sprinkles" which have replaced them aren't appropriate for a cat who's as reluctant an eater as Milk is.  I bought a liquid milk thistle, and got suggestions from Cody, a friend on the Feline EpiKitty Board as to dosage, but for some reason, I can't bring myself to give it to him.  I was avoiding starting him on Denosyl because it's so expensive, but maybe that's the only resource.

Other than the bloodwork, the vet felt that he weighed 9 pounds, 6 ounces.  I have this wonderful and terribly expensive Japanese scale that Hope sent me a couple years ago, and the cats NEVER weigh the same at home as they do at the vets.  I haven't weigh Milk at home for several weeks, so I'm not arguing about this one, but I'm not sure I agree with 9 pounds, 6 ounces.

Still some indications of conjunctivitis, although his eyes are so much better than they were before I started giving him the tetracycline drops that the emergency hospital gave BooWeenie.   Other than the eye stuff, he doesn't really have any leftover stuff from the horrible epidemic of 2013.

Poor little cat is absolutely catatonic from the minute I put him in the carrier.  I guess we should be grateful that he only has to go to the vet every six months..........

Still losing weight and a black lump

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

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

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

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

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

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

Is Vitamin B12 a "miracle drug"?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

My sweet Milkshake, in his favorite heated bed.

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

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

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

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

Where has all the poundage gone? Long time pass-sss-ing.....

Well,  I stopped giving Milks the cyproheptadine two weeks ago.  Tapered it for the previous week.  And, while he is still mildly interested in food, he is losing weight again.  I need to talk to Dr. G and see if he feels that there would be some problem with using the cypro on a fairly regular basis.

I have been noticing some odd behaviors lately, too.  Some things remind me of hyperesthesia - he is slightly resistent to being stroked down his back recently, and kind of shrinks from touching,  and he has started doing some really strange stuff with his tail....  It's almost like he doesn't realize that his tail is attached to him any more or something.  Very odd.  

Still bizarre missing weights....

Came back here a couple minutes ago, and once again, there is no weight data since December 2, 2011.  I KNOW I added several when I made the last post.  And I just added a weight for today, and one for last month, and when I went back to look, they were gone!  The Haunted Blog  List......  I redid them, and they're still there, as of 6:34 PM, 5/2/12.    We'll see....  It'd be different if it didn't MATTER, especially since he is actually gaining weight.  Some of the missing weights were among the lowest ever - barely over 8 and a half pounds.

I am still giving him cyproheptadine - 1/4 tablet twice a day, shortly before he is fed.  I don't see any negative side effects from the medication, which is wonderful.  Occasionally, I skip a dose, and he seems somewhat less interested in eating, so I guess it's still working properly. 

Weight records?

I just went to add another weight (today's) to Milk's record on the side here, and discovered that all of the 2012 weights have disappeared.  I can't figure it out.  And I know, because I've been concerned about his weight for months, that I was recording them.  Very strange.  Even worse, two weeks ago, he had been eating so little on his own that I started giving him 1/4 tablet of cyproheptadine, and, although my perception was that he was still eating very little, the last time he was weighed at the vets, he was up to 9 pounds, 4 ounces!  (Although, I never think that the vet's scale is accurate.....)  Anyway, four or five days ago, I stopped the cypro, and once again, he's not eating much, particularly in the morning.  My only hope is,  the cats all free-feed, so maybe he's up nibbling at leftovers all night long.  I don't know....


Somehow - of course, I suspect Busy - Milk's got a quarter size wound on his lower back.  It appeared out of the blue a month ago, and unfortunately, it's in a location where he can actually reach it and lick and lick at it.  Unlike the gnawing that Busy used to do on Milkshake's neck, which at least had the chance to heal.  These sores are larger, and always red from being abraded by his tongue.  I have been putting vaseline on it, in the hopes of helping it to heal without using something that might hurt Milk if he licks it.  Ha, "if".  I tried putting a little sweater on him, but he was totally incapacitated for an entire day by the "weight" of the sweater - that dumb thing cats do when you try to put clothes on them:  "Oh, this is so heavy , I can't move."  It did heal up and disappear once for about two days, but it's back again.

I believe Milkshake is still missing Scruffy.  He hasn't resumed his usual habits - where he sleeps, who he snuggles up again, the eating problems.  It hurts my heart to think he's sad and doesn't understand.  


We had bloodwork done in the vet's office for the regular stuff, and sent samples to Auburn for phenobarb and keppra testing.  Although I haven't seen the actual results from the vet yet, he called and said that everything was absolutely normal.  The phenobarb level was down slightly to 26.8, which is very good, as the range is 15 - 45 for the mid-therapeutic range for dogs and cats, and the keppra/levetiracetam level was, well, it is what it is, and has been. It was 23.4.  The therapeutic range (established for humans) is 5.5 - 21.   The report said:  "The concentration of levetiracetam mid-interval is in the high therapeutic range most commonly associated with seizure control in humans.  The relevance of these concentrations to canine or feline epileptics has yet to be confirmed."  They talk about peak and trough levels, but, especially since Keppra (the brand name - it's shorter!) is actually intended to be given TID, I don't see the relevance of those levels because Milk's only getting it twice a day.  


 I'm not changing a thing with his anti-convulsants.  

Milk's buddy is gone....

Scruffy left us on Monday, March 5, 2012.  Milk is plainly aware that he's gone, and seems kind of restless.  He has been spending a lot of time in the new heated cat bed I bought a couple of weeks ago, and on the kitty pi in the living room where he and Puffy would spend hours all curled up together.  We're all mourning.

Missed the anniversary!

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

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

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

I have another theory......

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

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

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

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

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

phenobarbital level      29.3      (reference range:   15.0-45.0)

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

QC       OK
HEM    0         LIP    0        ICT   0

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

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

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

Feeling vaguely uncomfortable

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

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

Milk and his friends

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

 

Milk and Busy

 

Milk and Burble

 

Milk and Baby Squits

 

Milk and Scruffy

 

Milk and Punkin Duncan

 Milk and OneBun

Milk and Cinnaminnie

Milk and Pipper 

No News is GOOD news!

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


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

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

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

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

A milestone!

 

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......

This email just arrived:

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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.

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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......