A very unpleasant surprise

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

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

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

Chiropracty and bloodwork

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

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

Eleven days without a seizure......

Phenobarb reaction again?

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

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

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

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

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

How come nothing's ever simple?

#31.

This is really getting me down.

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

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

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

This is depressing.

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

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

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

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

#30

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

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

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

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

My shirt smells like Milk's saliva.

Well, this one was a surprise.

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

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

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

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

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

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

So far, so good.

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

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

Seizure #28

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

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

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

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

and yet another....

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

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

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

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

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

And another......

Well, aside from the time - 5:35 AM (how come these always happen when I've only had an hour's sleep?) - this was a pretty atypical seizure. He was lying on his side, and there was hardly any motion at all. Very little jerking of his shoulders until almost the end, and no movement of his legs at all. A minimal amount of foaming. Almost constant snarling sounds during the whole short seizure. And when it ended, he just lay there. His back was to me, so I couldn't see his face, but I could tell that his eyes were open. Otherwise, I would have thought that he fell asleep again. After three or four minutes, he jumped up and went over to an empty food bowl, looking for something to eat. No pacing. I gave him a can of FF, which he devoured quickly. When it was gone, he was still looking for food, so I gave him a few pieces of dry. He went into the living room after eating and sat in the meat loaf position.

A technician called from the Specialty Hospital on Saturday morning and left a message that Milk's bloodwork results were in. Unfortunately, and stupidly, she didn't leave the number for his phenobarb level in the message, so we've had another two days of stewing about whether the current dosage - 8mg BID - is still threatening his liver function. I don't know what number of seizures Dr. L. would consider acceptable or when she would make some dosage adjustment. Hopefully, I'll be able to talk to her today.

Every time Milk starts acting totally normal, bingo - another seizure.

I am depressed.

Addition: The phenobarb level was 21, which is good, except for the fact that he's had four seizures in two weeks and the interval between them is shrinking rapidly..... I was surprised that the vet didn't order liver function tests to be done at the same time, considering that the ALT and AST were way out of whack a couple weeks ago. And Dr. L didn't call, so I don't know if there's anything to be done about adjusting the medication, either. It was my impression that Keppra dosing is done strictly on weight, which would make it less likely that his dose would be increased, I guess. Hopefully, maybe she'll call tomorrow. Or I can leave a message for her. As much as I am not crazy about pushing more pills down his throat, I would also like him to be on Milk Thistle, too. (I'm convinced it's what saved my liver and put me into remission.)