Need epilepsy advice.

Max is a manx with no tail (rumpy). We suspect that he has some neurological issues due to shortened spine (he "hops" like a bunny since we got him at 2, previous owner said "always") and he has partial seizures related to this deformity especially when area over tail is touched or he runs too fast and bumps it while "hopping" - when we got max seizures were 5-20 a day for about 5-20 seconds.

We worked on reducing stimulation to rump area, and when he does have a seizure, giving him stimulation elsewhere/auditory stimulation (petting/shaking him, and calling his name) on his body shortened their duration. He is down to a few a week, ~5-10 seconds, and are stable. Our biggest concern with these really is that he likes to climb stuff and I fear him falling.

Vet said they are common with manx and not a huge concern cause they are likely spinal/hyperestesia/reflex. Max is on no medication.

-- The past few days, max has been lip smacking, fly biting, head shaking a few times a day (new for him). This is not correlated to blood sugars as it's when he has been high, low and normal. He had his teeth done, I tried to look, but couldn't see back into his mouth where they removed his back teeth. They also removed one of his front top canines, looked healed. No odor. Eats well. I don't see the skin-rolling, foot licking/biting afterwards that I see with his usual seizures.

I can't tell if this is dental related, a new seizure behavior (he's been stable with EXACT same steriotyped seizures for years), or something like nausea. Seems fine otherwise.

Any thoughts?

 

I would rule out dental issues such as resorptive lesions/roots at the vet with x-ray and proceed from there.

 

How long ago was the dental? Like BJ is suggesting, there may be an infection or a root could be remaining. If they didn't do post-dental x-rays, getting a film may answer that question. It could also be pain-related if the dental was recent.

The other issue with a dental is that both sedation and anesthesia are used. It takes a surprisingly long time for those drugs to clear out of the system. This could be a contributing factor.

 

It was on 12/15. I was thinking maybe it's just an unusual feeling for him missing the front canine, like he's drooling or something and reacting to that? Has anyone had this happen? I'll ask the vet if they took e-rays after, as if they missed a piece, he could have an infection or discomfort. I didn't consider the anesthesia, but that's interesting as I'm sure it can change behavior/alter his existing neurological issues.

He was doing it earlier today, and sneezed a couple times, but it seemed like it might have been stereotyped (not like my other cat sneezes), but I really couldn't tell.

This video (not of my cat) looks like what he is doing:

 

The lip licking suggests nausea to me. Have you got anything for that? Any Pepcid AC in the house? 1/4 of a regular Pepcid AC will reduce acid if that is the cause of nausea. It can take about 20-30 minutes to work.

Check with vet to be sure it won't adversely affect the epilepsy control.

 

I have some cerina left.

 

i was thinking nausea too. even people get a flood of saliva in their mouth if they feel nauseated. Any chance he has pancreatitis? Marje has a good post on it - look in the bottom of this post "Where Can I Find?" and look for Primer on Pancreatitis. Many, many diabetic cats have episodes of pancreatitis.

Cerenia is a good drug for nausea or vomiting. You could try one dose and if it eliminates the lip-licking, that *might* tell you that nausea is causing it. I'd take a look at the pancreatitis primer and see if it describes Max's symptoms. It might not be related to his epilepsy.

by the way, you didn't ask about his dosing, but he's getting pretty low. Since he's only been diagnosed since July 2014, he's considered newly diagnosed and you'd want to reduce his dose when he goes below 50. If a cat doesn't hold reductions, and you're having to go back up in dose, or a cycle of low numbers is really soon after a dose reduction (like in the first 3 or so cycles after you've just reduced), then sometimes you might not take a reduction when the cat goes under 50.

But Max hasn't had failed reductions and being newly diagnosed, I'd definitely be reducing his dose when he goes below 50. You said this happens in both low -high numbers, so they might not be hypo symptoms, but . . . neurological symptoms are on the list.

I'd reduce to 3.5u with his next shot.

This is the list of hypo symptoms from the Shooting and Handling Low Numbers sticky:

The symptoms to be concerned about include but are not limited to:

• staggering, uncoordinated movements, 'drunken' walk, wobbling, balance problems
• ataxia - usually lack of muscular coordination, but maybe changes in head and neck movements
• disorientation (yowling, walking in circles, etc.)
• twitching
• stupor
• convulsions or seizures
• coma

​

 

Please talk to your vet or if there is a local vet school where there are veterinary pharmacists before giving even over the counter medications. Some drugs will lower seizure threshold.

You might also want to check if there are any support groups for cerebellar hypoplasia. This is a neurological condition that effects movement. There are likely folks there that may be able to offer information about seizures.

 

I was going to ask about lowering his dose as he was on the fence with the BG levels, but we had decided to reduce, so I didn't bother to ask. He had a few high days/lower nights so I wanted to give it a day or two, but then the day readings went down as well. Funny, I had been using pens, but bought a vial just before all his reductions, and he keeps going down. I'm going to have a lot of insulin left over.

So his pancreas seems to be kicking in now more than it ever did before -- needing much less insulin. Has reduced insulin need triggered pancreatitis in other cats? He doesn't have s/s of what I'd expect to see, ie vomiting, high blood sugars, reduced appetite, but that doesn't always mean anything.

I'm going to try the cerenia when I notice he's doing it a lot again and see if it helps. It seems to come and go. But next week I'll contact the vet and see what she thinks, or if she wants to run some tests for liver/pancreas.

And Sienne, good point about the threshold. We used cerenia before (per the vet) when he was sick and there didn't seem to be any change. I wouldn't feel comfortable ever giving him something OTC without it being recommended by the vet (although she may not be aware of effects either unless she deals with a lot of epileptic cats). I have a good idea of medications in humans that reduce threshold, and I would imagine most (not all) are the similar in cats. His seizure threshold is also probably been lowered from the times he's been low recently, so that's a concern too. I'll look into the other support groups if his issues increase or I can't figure out this new behavior. The seizures have always been there but have for years been a non-issue.

 

If you can find a veterinary neurologist who you can run questions past, that may be a resource for you. In case you were unaware, Cornell Vet School's feline center will set up phone consultations. Their costs are very reasonable so that may also be a resource even if it's to help you problem solve or confirm what you're seeing.

 

not that I'm aware of - but pancreatitis can cause increased blood sugar. Inflammation, infection, pain - all of those can increase blood sugar.

Just wanted to add that the reason I suggested reducing by 0.5u this time is because your dose is relatively high. If Max continues down the dosing scale, I'd switch to reducing by 0.25u increments at 3.0u.

I looked back through the comments and don't see anything about when you've switched to new insulin vial/pens. That's great information to add in the comments section - sometimes it matters.

 

Oh, shoot, I should have added that to the spreadsheet. I don't remember the exact date. It's funny how insulin can be so different batch to batch.

I still gotta find some needles with half-marks, as I have horrible vision. I think walmart has the ones I need. The pharmacies around here are terrible and will not special order things that are supposed to be "generic", and force you to use their generic house brand. He's been tolerating the 0.5 reductions so well (and been reducing so fast) that 0.5 is probably appropriate until we start to level off and need some finer tuning, I'm sure we are getting close to that point, or maybe Max has just had enough with being a diabetic, and is going for OTJ.

Sienne, thanks! That's awesome information, as I'm not really sure that there are a lot of specialists near me. I'm in S.E. wisconsin so I think the closest specialists here would be out of Madison.

 

you might have a date on the box. If not, just start from here on out putting it in. You'll probably find it useful at some point.

Insulin shouldn't be different from batch to batch - but once in a while we can tell a difference in BGs. Probably the difference has to do with storing or handling, rather than manufacture. Recently Ozgood had insulin that had been repackaged and sold by Wedgewood Pharmacy in 1ml vials that was no good. Lantus is still under copyright so should never be generic or repackaged.

Couple of things people do to help see those tiny markings - you can stack drugstore reading glasses on top of each other on your nose. Yes, looks ridiculous, but you'd be amazed at how clearly you can see. I have a friend that does that for quilting and i tried it - it's amazing.

There are optic lenses you can use - @Anne & Zener (GA) used them and I'll let Anne or Liz give you the link.

Holding a white piece of paper behind the syringe can help.

Having a light source behind the syringe also can help.

Using calipers to measure has helped many people. Look at this link "Where Can I Find?", scroll to the "interesting posts" collection at the bottom, and click on the link for "dosing with calipers." Calipers are these little metal measuring arms that you set for your dose, then with every new shot you just put the plunger where the metal arm is set. They are cheap (maybe $4-7) but many folks like them. Once you have it set, you disregard the syringe markings and so it doesn't matter if you have 1/2unit marks or not.

If you're still having trouble measuring after trying out these tips, just say so. Likely someone else has figured out a way to do it - this place is full of ideas to make FD easier!

edited to add - some people use a magnifying lens that has a clip on it. People clip them onto a kitchen cupboard door so they can put the syringe behing the magnifying lens and have their hands free to adjust the dose. just fyi, we do know the markings tend to not be accurate from one syringe to another, so often people who even have 0.5u markings will still change to calipers.

 

This is what we used (on amazon)
http://www.amazon.com/Donegan-Optical-OptiVISOR-Headband-Magnifier/dp/B0068OSIIS
I think we had the 2.5X magnifier. Plus we used this magnifying lamp
http://www.amazon.com/Aven-26507-SB...id=1422121031&sr=1-4&keywords=magnifying lamp
with a white paper behind the syringe. AND we used calipers to measure the dose
http://www.harborfreight.com/4-inch-digital-caliper-47256.html
Hope this helps!
Liz