Good Morning,

 I am hoping for confirmation or information about what I am seeing in my horse, Cato. Initially (in 2010) I had a hard time understanding how he could be so sick with mid-normal ACTH values, but it was indeed the case. Once I got my head wrapped around that, I have been "treating the horse, not the numbers" with spectacular results. Cato has regained his weight and topline, been comfortable and working, silky coat, clean sheath, etc., and life has been good. :>) His compounded perglide dosage has increased from 8mg to 12mg daily in that time, based pretty much solely on signs and symptoms. We check his ACTH (always below 25), Insulin (always below 12 until this time) & G, once or twice a year, have gotten a baseline leptin value, which was 2.61.

Beginning in late August of this year he has displayed all the signs that prompt me to increase his pergolide, i.e.: inappetance/refusal to eat anything but hay, two minor ERU flares, coat coming in rough not silky, slight hoof tenderness, sheath needing frequent cleaning. I increased dosage from 11 to 12 mg with no noticeable results, so we sent blood to Cornell early in October with the following results:

ACTH - 16.5 pg/mL

Insulin - 13.83 uIU/mL

Glucose - 73 mg/dL

These numbers, while not substanially different from his results in April when he was in great shape, result in proxies of:

GI ratio - 5.28

RISQI - 0.27

MIRG - 9.48

I have been soaking his hay since beginning to feed this year's new crop approximately a month ago. Just received the hay analysis with ESC of 9.7% and starch of .5%. He gets his flax/mineral supp sprinkled on the wet hay.

Our vet called yesterday suggesting a chem panel, which I have agreed to, to check for any other problem. He too observed all the symptoms I mentioned when he last drew blood and agreed that, compared to April, Cato was definitely "off".

My "gut" says to just increase his pergolide some more, but the numbers are really giving me pause. Can anyone reassure me that it is possible that he needs even lower ACTH to relieve symptoms? Any similar horses out there? I read digests faithfully, even though I haven't needed to be active asking questions for quite some time. But this is a problem I have not seen discussed. I'm quite familiar with the "The correct dose of pergolide is the one that controls ACTH", quotation, but not with the definition of "control".

I apologize for not including history link - the one I have doesn't work anymore, I assume due to neo intervention since I last used it. I can't even find our history to update it, thought it was in ECH5, but must be confused, as I can't find it there. Will search earlier files when I get the  chance. Meanwhile I hope I have given enough information to begin a discussion of "just how low can you go" . . . .

Thank you,

Melinda and Cato

IN                2010