Hi Jane,

Thanks for the updated history - really helps. Kudos on keeping your senior boy doing so well.

Was his perg dose 2.5mg in May, 2014 when the ACTH came back at 35.3pg/ml? If so, he was just outside the normal range at the time of year when he was at his lowest level. Points to regular season dose needing to be raised some to get the ACTH back down toward the middle range at that time of year. That he had risen to 247 by July indicates an earlier and faster seasonal response. Jan levels have been good, even this year.

If he was mine, I would stay at the current dose for another week or so, then titrate down to 3.5 - 4mg by the beginning of Jan and retest in April/May at that dose. Would plan on starting to titrate up in June to get ahead of the rise this coming year.

Here is the new link to your case history - Neo has changed the links and your old one is no longer functional:

https://groups.yahoo.com/neo/groups/echistory8/files/Lad%20and%20Jane/