I was super disappointed to get Khari's repeat ACTH back today after seven weeks on his full 1 mg dosage. It was 100, so not really any change from the 102 we started at in May. The glucose, insulin and leptin were essentially identical as well. I was surprised because he looks better: he has shed the little patches of remaining long hairs on his belly and upper legs, his crest has gone down a little and his shoulder pads are almost gone. The sheath swelling has decreased as well, though it is still not normal. His appetite is good - for hay and anything that does not contain pergolide - and he has plenty of energy on our 15 minute rehab walks. (I'm treating him for fibrotic myopathy.) He walks comfortably on the gravel lane as well so I think his feet feel ok for now.
I'm sorry but I cannot update my CH from work and my home computer is out of commission until I can afford to bail it out from the repair shop but nothing else has changed for him other than a slight increase in the rehab walking time and the elimination of the alfalfa pellets as carrier for his minerals. (I'm dissolving them in water and sprinkling on his hay.) These things should be helping, if anything, right? With the G/I values anyway?
I am confident the lab work was handled properly and shipped correctly - I had a long discussion about it with this vet before we did the first set of labs. I'm getting the blood drawn at home, a few hours after Khari's a.m. feeding and it is being taken directly back to the office just ten minutes from my place.
I have been struggling to get the Prascend into him from the beginning so it is slightly possible that he doesn't always get the entire dose. I was syringing it for a few days and that was easy enough the first day (he has never been a problem to worm), but the next day he began making a serious effort to avoid swallowing. I can't hold his head up and massage his throat simultaneously because he fights so hard to to get his head down & spit out the applesauce/Prascend mixture. He has rejected every hiding place (prune, date, piece of apple, piece of carrot) I have tried after the second day. He will eat it dissolved & dribbled over a large amount of LMF stage 1 but there is some dropping out of his mouth and he pushes it around in the bowl which makes the pellets crumble into powder which he won't eat and sometimes he loses interest before all the pellets are gone. I'm sure he would eat it on some molassed oats but I'm afraid to use that with his GI ratio of 2. On days when I'm pretty sure he didn't get the entire dose I've been giving him another .25 mg in the evening so, if he hasn't been consistently getting the 1 mg every day, I think its close. To think, I was worrying that I might give him too much by doing that!
Is this unusual? Does the total lack of response indicate that he will be one of those horses who require very large doses? Is there anything I can give him to "boost" the efficacy of the pergolide?
My vet is going to talk to the internal medicine person at the major equine hospital here and I expect they are going to recommend more testing because they already told me that they don't think the endogenous ACTH is the best method. I really can't afford more labs now; I don't even know if I can manage much of an increase in the Prascend. Or if I can get a larger dose into him.
I admit I'm feeling rather desperate right now and I don't know what else to do unless there a better way to get the Prascend into him that I haven't tried yet.
Jill, Khari & Jetty in Idaho