Re: ACTH and Insulin Testing Help/Questions
I see that LeeAnne uploaded your CH before, which is probably why you can't delete it. I will shoot her an email. Thanks for the updated one.
What a mess with getting King's labs drawn! 54" of snow--ugh!
A few ideas/thoughts....
I wish I could comment on the confusion with the blood, but that's a real mess. I can't imagine that Cornell would have actually run the ACTH on whole blood. Again, the ACTH results would have been artificially low if the blood was not handled properly. I agree that at this point you are just going to have to bite the bullet and pay to rerun the blood work. Maybe the old vet would consider reimbursing you if she didn't process the blood correctly.
How old is your pergolide? Do you order only 30 days at a time and store it in the fridge, as recommended to ensure maximum potency? Have you asked Pet Health to provide a potency test and an expiration date on the pergolide? I see that the ACTH dated 2/15/2017 was done in the PM. How long after the last dose of pergolide was that? How does it compare to the one done in August (no time noted on that one)?
We do normally recommend that the pergolide be given in one dose, but have found over the years that some horses, can benefit from adding a second smaller dose later in the day (assuming you are giving the 20mg dose in the morning).
As far as waiting to increase his dose, I would ask the vet that is coming today to sell you some of Prascend that you could use to increase his dose after she does the blood draw today. Maybe you could buy just part of a box from her. You already know King's ACTH is high, just not really how high. That will give you some time to either order some smaller compounded capsules to use for increasing his dose, or settle on a new dose to order. You could also use it to add a second smaller dose later in the day if you want to try that. Sometimes you just have to do some experimenting to see what works best. They are all so different and work hard to keep us on our toes! I might give the vet a call early and make sure she has has some Prascend in her truck.
Are you keeping a journal on King? It can be really helpful in determining if he needs an increase in pergolide in the absence of an ACTH test. Read this post by Patti for some really great tips: https://ecir.groups.io/g/main/message/111558 Weight loss and declining energy are classic signs of elevated ACTH. Read more here: https://ecirhorse.org/physiology-ppid.php Lots of folks use symptoms to make pergolide increases. Of course, it doesn't replace testing, but can sure help. If you get into the same conundrum again, of not being able to get the testing done in a timely manner, you can use the journal to track his symptoms and make pergolide increases until you can get him tested.
I see in your CH that you are using Haystack Low sugar/starch grain. Is this the one? http://haystackfeeds.com/?page_id=69 That actually looks like a decent carrier for your supplements, low sugar and starch, and at one cup/day, should be just fine. It does contain some alfalfa which some horses are sensitive to and rice bran which has an upside down Omega 3:6 ratio, but if feeding ground flax seed it should be OK. I don't see that you are feeding King any flax seed. Would definitely want to add 2-4 oz of that to his diet to replace the Omega 3's and 6's lost when grass is cured into hay. I see your hay analysis, but I don't see any mineral supplementation in your CH. It's really important to get your minerals balanced to your hay. Maybe you just forgot to add that? If not would consider at least adding one of the the following until you can get your hay balanced.
California Trace: http://www.californiatrace.com/
Arizona copper complete: https://horsetech.com/arizona-copper-complete
Uckele's U balance foundation: http://equine.uckele.com/vitamin-mineral/u-balance-foundation.html
Best to get your minerals balanced to your hay, but one of these can hold you until you do that. Would also make sure his trim is really tight. With his ACTH and insulin so high he is at high risk for laminitis. A really tight trim can't prevent that but can be really helpful if it does occur.
Hang in there Stephanie!
Maggie, Chancey and Spiral in VA
EC moderator/Primary Response