Yes, it's probably a Neo thing on the link - although it did attach to your reply so who knows. When you have a moment, it would be helpful if you deleted the older history, as long as all the info in it is also in the updated version.
I'm with you on trying to wrap my head around a difficult case. One of my boys is currently on 16mg pergolide, which controlled his ACTH perfectly well during the rise last year but then his ACTH just started climbing again. At last check in April 2014, it was 225pg/ml (Cornell) and probably still climbing. That doesn't make sense as that is not a PPID driven rise. That was the same scenario as a year previous, when he had been on 12mg pergolide with solidly controlled ACTH during the rise but then lost it during the late winter and early spring.
His symptoms are an enlarged crest, more pu/pd and increased smegma production. His insulin and glucose are on the rise although diet is tight. But it doesn't appear to affect his attitude or soundness - yet. I'm terrified that laminitis is lurking around the corner.
I agree that as the base dose of pergolide gets higher, increases can be made more quickly and with larger increments, although my boy has never had an issue with pergolide veil. When I first tested him, his ACTH was 1088pg/ml. He went from no pergolide to 9mg in 6 weeks.
It's wonderful when you have a vet who will work with you and who trusts that you know your horse well enough to see changes that are red flags for trouble brewing. I am also lucky to have a vet that is willing to work with me.
You sound like you are extremely in tune with what Stormy needs. Obviously, frequent testing is the Gold Standard for monitoring status but that isn't always possible due to logistics and/or finances. We all do the best we can. Knowing your animal well is the best thing that you can do and is a legitimate substitute to use when balancing the costs and logistics with the need to provide top notch care.
Lavinia, DAnte, George Too and Peanut
Jan 05, RI
EC Support Team