The timing of the first lameness screams PPID being the underlying cause as that would be the prime time for the seasonal rise to be affecting her. Really encourage you to post those xrays and pics of her feet. The blood spots in the soles are evidence of older trauma growing out. Whenever there are hoof issues making sure the trim is scrupulously perfect is the way to go rather than to leave things as they are until later.
Yes, pain can influence insulin/glucose values but in this case it is more likely that the I/G were already elevated and causing the pain.
The 12pmol/L upper normal value for your lab is 20% higher than the ones we see here regularly. Normal readings should fall somewhere in the middle of the range so would want to see something like 4-5pmol/L in a horse that is well controlled. It is good that her ACTH has come down but by the sounds of it, she is still not well controlled enough FOR HER as she is experiencing quite a bit of pain now.
The insulin and glucose values that she had in May were still much too high and showed her to be severely IR and at serious risk for laminitis. Her insulin (142) was 14 times what a healthy insulin(10) should be and her glucose was bordering on diabetic. Again, your lab's ranges on the glucose are higher than has been found to be healthy. Top of the healthy range would be 5mmol and Pauli was at 5.5. This put her in the category of balancing precariously on the edge of a major laminitic episode and only needing the slightest nudge to tip her over that edge. It sounds like the seasonal rise did just that.
The only dose of Prascend (pergolide) that is correct is the one that controls the ACTH. In most horses, this is achievable but you need to get on top of it as soon as possible. It appears that Pauli's dose really needs to be increased to make this happen, which is what your vet agrees with as well.
Her tight muscles and not wanting to be touched are classic for a horse with laminitic pain because she is using her whole body to attempt to keep as much weight off her feet as is possible. This would make her muscles rigid, her attitude crabby and her gait stilted. Good that you are going to have the nerve blocks done.
Hang in there.
Lavinia,Dante, George Too and Peanut
Jan 05, RI
EC Support Team