Talked with Dr. L this afternoon. She feels that Milk is at the maximum dosage of Keppra that she has heard of cats using. We don't want to increase the phenobarb. There is another drug that might be a possibility, but she hasn't used it herself, or in combination with Keppra and phenobarb. She seemed to feel that, if a third drug were to be used (and I can't remember what it was called) - it should be prescribed and monitored by a neurologist.
I explained my concerns about Milk:
1) increased severity of seizures
2) increased frequency
3) diminished appetite, although it is improved somewhat
Dr. L feels that we need to get a post-prandial bile acids test done as soon as possible, and based on that (and the comparison between the previous test, which was pre-prandial), she would refer me to a veterinary neurologist in Akron. Where it would be decided, I guess, about doing an MRI and spinal tap. Neither of which I'm eager to do. The neurologist's name, I believe, is Todd Ecklund or Acklund - can't find the paper I wrote it down on a couple weeks ago. (Correction: Axlund.) He was a professor at Auburn. I asked if it was customary for seizures to escalate in severity, and if not, what it might mean. She said it wasn't necessarily usual, but since they don't have the information from an MRI to be sure exactly what's going on in Milk's head, there's really no way to know. She felt that, given his age, it was not particularly likely that he has a brain tumor, but that inflammation might be a possibility, along with something else that I can't remember. Speaking of possible brain tumors.... Anyway, I will have another bile acids test done this week, and then I guess we will go from there. She did say that the 25 he had on the previous bile acid test was not a huge reason for concern - that the area of 50 is more of a problem. I guess that's good news. I'm not totally convinced/positive that he was absolutely food free during the last test anyway. Although, Antech said that they do a "random" bile acids test that does not require fasting and retesting after food. I asked about the urine bile acids test, but Dr. L felt that it would be as traumatic to Milk to have the cystocentesis (and I don't know what Dr. G.'s experience with doing it is) as it would be to have the blood work done. I told her that I would prefer getting blood work done at his office because of the distance, the waiting time, the dogs in the waiting room, and the way that her technicians take the blood. She didn't react with horror.
I am in a state of panic about all of this. I couldn't sleep last night. I stayed up till 6AM, when I was so exhausted that I figured I wouldn't be laying there waiting for Milk to have a seizure. That is disfunctional, obviously. There has to be an answer to this. I feel like he's a bomb, ready to explode at the least provocation, and that there doesn't seem to be any solution. Even if we have the MRI, and it shows something fixable (affordable?), or if it shows something UNfixable, then what?
