Generic Keppra (levetiracetam) information

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.....

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.

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)

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........

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.....

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

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

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

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...

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".......

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!

(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......

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!)

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

(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

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....

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....

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.......

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

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

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.

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........

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

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.........

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....

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.....

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....

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

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