Hi Sharon,

Nice to see Blaze's ACTH has come down!  We recommend retesting ACTH 3-4 weeks after you reach your target dose. You increased on 4/1/15 and drew labs on 4/30 so yes, he's been on the pergolide long enough that you should be seeing a true refection of the effect of the current dose.  

I would be hesitant to increase his pergolide at this time, as we are still in the seasonal low.  I would, however, monitor his symptoms very carefully as the summer progresses, and retest his ACTH into the seasonal rise in late July-August, to see if you need to increase the perg.  Read Patti's message on monitoring symptoms here:  https://groups.yahoo.com/neo/groups/EquineCushings/conversations/messages/111988   

https://groups.yahoo.com/neo/groups/EquineCushings/conversations/messages/88305 

I don't see the Leptin listed in your CH, only in your message.  Can you add it to your CH so it's there for quick reference later?  So his leptin is high at 8.46, and he is fat with a BCS of 9.  That information combined with Dr Kellon's comments in the above link and this statement in the explanation of the leptin on the Cornell labs "An intermediate to high leptin concentration without hyperinsulinemia may indicate that the horse is overweight or obese and at risk for developing EMS or is being treated for EMS." indicates to me that he needs to lose weight to get back into the "normal" range.  Maybe others have different thoughts on that.

I wouldn't worry too very much yet that he is not completely shed out.  My two geldings, neither one PPID have not completely shed out.  My Spiral, QH-nonPPID/non-IR, still has winter coat on his legs only and the pony, IR/nonPPID, still has some on his sides, under belly and legs.  Pretty sure they will be completely shed out in the next week or 2.