There are basically three approaches to increasing pergolide during
the seasonal rise:

- Proactive: Up it before you see problems.
- By blood work.
- By return of symptoms.

Unless you're lucky (make that unlucky!) enough to have an elevated
blood glucose that you can follow easily with a glucometer,
monitoring by regular blood work is not in the cards for most people -
but strategically scheduled ACTH can be extremely helpful.

In real life, most people end up with a combination of a proactive
increase then dose adjustment by symptoms. Unfortunately, there are
no rules for how to increase the dose. Personally, I tend to be
aggressive with it, especially in horses that have a history of fall
laminitis and have had PPID for a number of years. These cases can
get away from you very quickly and they're not likely to respond to
small increases and long intervals between increases.

The truth is we're all still stumbling along in how best to deal with
the seasonal ACTH rise, how to incorporate the new information on how
horses metabolize pergolide, seeing a lot of individual variation.
That said, we're seeing a lot fewer horses slipping into severe
laminitis in this period, catching horses much earlier in the process
and reversing it earlier with pergolide increases. The story sharing
and data sharing that goes on here is absolutely invaluable.

Getting back to Teddy, if you could get an ACTH run at this point you
would have a better idea of how much effect your current dosage is
having. An alternative would be to take it up to 1.5 and if you don't
see improvement in a week or two get the ACTH then. Alternatively,
since Teddy has a long history of IR you could follow his response
with insulin since his diet is now well controlled. Teddy likely had
PPID for a while before he was diagnosed since he already had the
coat changes. I would be at all surprised if 1.5 mg isn't enough
either.

Eleanor
www.drkellon.com