vet visit scheduled for tomorrow, could use some suggestions.


quick bacground: mare is 18, diagnosed IR about 3.5 years ago (that's
the last time she had glucose insulin done). in july she developed
laminitis, we already had a scheduled visit w/ lameness vet for an
unrelated injury and at that time they ran ACTH which came back at 65.
they suggested Pergolide, i hesitated, in september she once again
developed laminitis, totally unprovoked and without any exposure to
grass (her usual trigger). called the lameness vet, got a script for
Pergolide, she was started on it a week ago on Sunday at 1 ml per day.

so i don't really have much confidence in the lameness vet handling
the metabolic problems. i was shocked they didn't run the
glucose/insulin in july and i just generally don't get a good vibe
about their level of knowledge re IR or Cushings.

so i scheduled a visit w/ a local vet who appears to have a lot of
metabolic clients. during my initial phone conversation he asked
questions which lead me to believe he is knowledgeable re metabolic
problems. so he's coming tomorrow. at this point she's been on the
Pergolide for 1 week. i still feel digital pulses despite soaked hay.
they're not strong but they're not what her normal either. i've read
through the files so i can have a somewhat educated conversation with
him tomorrow.

my three main questions are:

1) w/ the most recent ACTH test from July and her just being started
on Pergolide, does it make sense to run another ACTH at this time or
is it premature?

2) does it make sense to increase her Pergolide after only 1 week or
should we give her more time to show a response?

3) are there any other tests, besides running insulin glucose that i
should request at this time?

i'd also appreciate any other thoughts you may have as to topics that
i should address during this visit.

thanks in advance!


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