Katharine's Reaction to Phenobarbital and Jimmy's Reaction to Katharine

Katharine is doing better. When she gets her pill, within 15 minutes, she slows down into a trance like state which lasts about 15 minutes. She's aware but is quiet and usually lays down. Then she slowly comes around to a more normal activity level within two hours. That's how it worked last night and this morning.

And her spinal tap is clear. So, she will have a gastro ultrasound and phenobarbital and we'll go from there. And her breathing rate is finally more normal, around 30 instead of 40-60.

Yesterday, after coming home from the ER, she was very hyper despite her med and needed me to be with her, to pay attention, to pet her, to reassure her, etc. And she was always vocal. When I moved from room to room, she followed and was very vocal. Once she fell asleep, if I moved, it would disturb her and she would start the crying/pet me process all over. She finally fell asleep around 1. Then I did around 2. When I woke up at 3, she followed me to the other room until she finally settled down. She was also more steady on her feet and could jump up and down more easily. I felt reassured enough to leave the house for a couple hours of shopping. She was in the window seat in the bedroom when I left and was not anxious (I could see her from outside.) She was calm when I returned. And she was calm last night.

I kept her isolated upstairs during the day, although she had the full run of the second floor. I let her downstairs in the evening but only to the living room. This morning I let her downstairs. I wiped her down with a wet wipe so that she wouldn't smell like the ER.

That vet smell doesn't bother her sisters but it bothers Jimmy. He growls, hisses, sniffs the trail like a dog and howls if it's too strong. Those smells have always bothered him. He has in the past, acted like this when I brought Myrna home from the vet (and she went so frequently that it became a huge issue that we had to mitigate when we returned home.) We quickly learned to not go too far into the house with our shoes on and to take them off at the door. Nor could we set down the crate. I would release Myrna into the front hall and set down the crate and close the door. Then I would clean the floor with cleanser where I first came in and wipe off my shoes as well. Then I would clean the crate and wipe down Myrna. She would be isolated for a couple of hours or so until she smelled like home. Jimmy would still sniff and hiss but then he would quickly lose the trail of strange scent. If I was successful, Myrna would smell neutral and he wouldn't bother her. If I wasn't, he would sniff and hiss at her and swipe. This morning, he sniffed Katharine and looked puzzled, then sniffed the floor where she had walked and followed her trail. Then he gave up, and walked away. When I first brought her home Thursday after the MRI, he was in the front hall and sniffed and hissed and growled at the crate (Katharine was inside) and then ran off, so totally upset.

Time Is Wasted

I realized when Katharine got sick May 13/14, that once again, my to do list has been interrupted and I realized how much time I've wasted not getting to it. When Myrna was sick, I devoted my time and life to her. I got things done when she was well which happened for what seemed like long stretches. But not that last year, when she needed more of my time. I have my excuses. There have been many things going on that have taken up my time since the holidays. But I have wasted a lot of time. And just when I was about to make time for that list-and not just clean the yard but serious, life goals-Katharine became ill. She has been to a vet seven times since May 13/14. And she will go a few more before we figure this out. I don't think even Myrna had that record. When Katharine is stable and more secure, I will have to make time to get back to that list.

Katharine Had an MRI and More Seizures

Katharine's MRI today was clear-no tumors, no bleeding, nothing that indicated any changes in the brain to cause seizures. They did a spinal tap to see if there is any inflammation. If that is clear, then blood work to rule out certain diseases and issues and an echo of her gastro system and anything else will be performed. The vet said to continue gabapentin and to keep an eye out for any seizures. If they occur, to give her more gabapentin. If there are too many close together, then they will put her on phenobarbitol. But she had been clear for a week and we did not expect her to have any more seizures.

I brought her home and 40 minutes later, she had two seizures a few minutes apart. Each lasted for a minute. I filmed both. By the end of the one in the video, I knew she had to be seen by a vet. Then she had one in the car. I took her to an ER, a new one recommended by the oncall staff of the neurologist's office only because it is close to the neurologist's office. In the end, they decided to keep her overnight, give phenobarbitol as a steady, slow dose, give fluids, run some blood work, etc.

While the new ER is 20 minutes away, I should have gone to our ER that we favor that is 40 min. away, especially because Katharine is now staying overnight in an unfamiliar ER. The new one is shabby but at least the people are nice. But the new one kept me waiting for an hour before someone came in to get her history. Then I was alone for another hour before someone came in to say the vet would be in soon to talk to me. Then I was alone for 30 min. before he did. Yes, he was busy. Yes, they had had many other more critical pets before mine. But at our usual ER, they whisk the pets to the back before spending 10 min. checking in the pet. Then 10-15 min. later, someone comes out and gives an update and asks for history. Then 10-15 min. later, the vet comes in to say what they've seen, what they'd like to do, etc. Then 30 min. to an hour later, they let you know what is going on, results of tests, what they recommend, etc. The focus is on the patient. Only at the end do they ask for money.

I will pick her up in the morning and she'll come home unless the neurologist wants to see her again.

Katharine Saw the Neurologist Today for the May 14 Incident

Katharine saw the neurologist today for an exam. He manipulated her legs, watched her walk, then tested her facial responses by flicking his fingers and using a long Qtip to touch her face. He saw right sided decreased response in face and legs as we noticed when she had her episode May 14. If it's a seizure, he believes it could be a left side brain tumor (as with humans, the left brain controls the right side of the body, etc.) Tomorrow she returns for the actual MRI and if that is clear, then a spinal tap to look for inflammation/infection. She was NPO this a.m. in case they did the MRI but they couldn't today due to two emergency cases. She'll be NPO tonight again as of ten p.m. So, she's just now, at 1:46 EST, eating for the first time today. Tomorrow, she goes in at 9 a.m. and will be there for the MRI all day. The MRI will take about four hours from start to finish. Then she'll go to recovery and then she will be released about 5 p.m. or later depending on when the MRI actually begins.

The cost: $2000 for the MRI and an additional $500 for the spinal tap. She will be under anesthesia for both. If she has a tumor, surgery will be required. No, I didn't ask for the price. I can imagine that it's twice the cost of the MRI. While concerned about the cost, I'm far more concerned about Katharine. At least we know her heart is in good shape and she can withstand the operation. So, we'll know more tomorrow. For today's exam, I wrote up her medical history, medication list, gave copies of the ER/cardio/vet tests related to the May 14 episode, and copies of past blood work just in case it was useful. Writing up a detailed history and current medication list always helps the new vet or vet specialist get a better picture of the cat's history, especially if there have been any illnesses.

Update on Katharine: No Clot, No HCM, but No Reason to Be Sick Either

Update on Katharine-nothing. Cardio recheck showed nothing. Praise the Lord! There's no murmur presenting at all; no SAM; no thickening; no reason to throw a clot. Unlike with humans, pets do not get clots at all unless there's an injury to the area (the leg) or there's heart disease or cancer or some other disease that would produce hypercoagulation. It's possible she had a clot in the leg. But Dr. D, the cardio, reviewed the video we had of Sunday/Monday and Katharine was not in pain-which a clot in the leg would have produced.

It's possible she had a seizure and the leg was part of the process but not physically affected or somehow had neuropathy due to a seizure or something. (https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/symptoms-causes/syc-20352061)

Xrays show no signs of other disease but she will need an MRI and one is scheduled for next week.

At the cardio, they ran a urinalysis and there was no glucose (which was high in the blood but could be due to physical stress of the situation and the visit to the ER. If she was diabetic for example, the glucose would be in the urine as well.) And there's little protein-which could be from using a needle to draw the sample-the sample being mixed with some blood which is protein.

So we are now doing a albumin/creatinine ratio test:

"The urine albumin test or albumin/creatinine ratio (ACR) is used to screen people with chronic conditions, such as diabetes and high blood pressure (hypertension) that put them at an increased risk of developing kidney disease...Virtually no albumin is present in the urine when the kidneys are functioning properly. However, albumin may be detected in the urine even in the early stages of kidney disease...Most of the time, both albumin and creatinine are measured in a random urine sample and an albumin/creatinine ratio (ACR) is calculated. This may be done to more accurately determine how much albumin is escaping from the kidneys into the urine. The concentration (or dilution) of urine varies throughout the day with more or less liquid being released in addition to the body's waste products. Thus, the concentration of albumin in the urine may also vary..."

She's still on gabapentin. She's showing no other signs of recurrence. I have her on Renal K potassium gel and powder since her potassium level was 3.7-something not seen except with Myrna who was on high levels of lasix as well as potassium.

We will continue to monitor.

Katharine Hepburn in the ER at 1 a.m. Due to Rear Leg Lameness and Fainting

I've written about this before: cats (and someone once told me kids) end up in the ER middle of the night, rarely during the day. Katharine Hepburn was in the ER at 1 a.m. last night/this a.m. Around 11:30 p.m. she suddenly seemed to be lame in the rear right leg. She kept hobbling around; then it seemed fine; then she would lay down and hold it up. We watched her for awhile and it was on and off. So, we put her in our room to monitor her. To me, she appeared to walk not on her pads but on her hocks-the part of the leg connected to the pads. Cats will sit on these for sure but when they walk, they should be on only their pads. After about ten minutes in the room, she became disoriented, couldn't stand up, seemed to fall over, etc. It reminded me of what Myrna did back in 2009 when she first ended up in the ER due to HCM. So, we left and by the time we get to the ER it was 1 a.m.

They kept her for two hours. They suggested she had a seizure or threw a clot. They put her on oxygen just in case. They took a CBC/chem panel, an xray, and a heart blood test-the proBNP test (potentially shows signs of heart disease but it can be a false negative and does not say WHAT is wrong which is why an echo is what the cat really needs), and did a Doppler reading on the arteries in the legs. ALL of it came back negative for any particular reason. As far as they know, the heart looked fine in the xray (you can determine size with an xray and see if there is congestion.) The blood work was almost normal but the Lactate (similar to CPK level which is a muscle enzyme) was HIGH. This is what happens when the body has reduced oxygen levels and the muscles kick out something with which to compensate. This is an acid level test which measures lactate acidosis.
Here's an interesting article/paper:
http://www.vetlab.com/Hughes%20IVECCS%20What%20Does%20it%20…

So, clearly something happened to reduce oxygen and cause lameness but what? I called the cardio's office while there and left a message. They called this a.m. and we will see them tomorrow. Katharine has an annual cardio checkup due to a slight murmur and because she's Myrna's sister. This would have been in June or July anyway. The other thing they suggested was to get an MRI so we will make an appointment for a local vet to do an MRI. And we need to retest her lactate level when she's not sick.
They gave her a pain med Gabapentin for three times a day. It's a pain/anti seizure med.

So, that's all we know for now.