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

Seems better.....

Talk about your waffling.....

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

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

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

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

Something's wrong....

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



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

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

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

Experimenting

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

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

All amounts are estimated, sadly.

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

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

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

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

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

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

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

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

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

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

Not much new.

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

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

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

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

Nothing's ever simple.

With minimal comment

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

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

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

Crummy crummy crummy night.

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

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

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

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

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

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

I am whiny.

So much for that.

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

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

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

Three days!

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

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

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

Seizure Avoidance/Subversion?

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

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

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

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

Longer, louder, more violent.

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

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

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

I am exhausted.

Or this one.

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

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

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

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

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

No doubt about this one.

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

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

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

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

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

Did he have another seizure?

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

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

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

I had such high hopes.

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

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

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

Crap. Crap, Crap, Crap.