Overall, I’m pleased with the direction Audi is heading, but I still feel like “normal” or “healthy” is just beyond our grasp.  During the rise, his ACTH was still a tad high, at 31.1 pg/ml on 3 mg CP, and he was still symptomatic.  When I posted for advice, Dr. Kellon recommended holding the CP dose where it was and retesting around the new year.  Further, I got some good (although not easy to hear) advice about new ways to address his trim, possible pain levels, and diet.  I’ve done my best to implement all those suggestions:

*Trim:  My wonderful trimmer, Lisa, popped in here and was able to have some constructive discussions with you all.  Audi has had 2 trims since that time.  I should have photos to post shortly.

*Pain control: Along with modifying his trim a bit, I also started him on PQ, initally at a 2x dose but more recently at a single scoop per day.  We’re also trying him in hoof boots on all 4, whereas he was previously only booted on the fronts.  He seems to love his new boots and looks considerably more comfortable in them.

*Diet:  The criticism was that our hay might not be digestible enough for him.  He is now on a minimal amount of hay, just 5 lb/day, with another 20 lb made up of highly digestible bagged products.  Complete details are below and also in CH.

Although Audi is technically due for a retest, I kind of hate to bother with that right now since he’s still not looking as well as I’d like.  I’d very much like to move toward closer monitoring of symptoms for making treatment decisions and bloodwork done less frequently, about twice per year.  To that end, I made myself a spreadsheet to score and monitor his PPID signs.  I hope to keep it updated every couple weeks or so.  It’s posted in his CH, as are some new photos.

As you’ll see from the spreadsheet, there is a lot to be hopeful about.  Audi is moving better and gaining some weight, among other positive changes.  However, I do feel as though I’m shoveling quite a lot of high quality food into him with only modest gains (+/- 20lb in nearly 2 months, if the weigh tape is to be trusted), and although I am lightly exercising him, I don’t feel like his muscle mass or tone is improving much.  His eyes are also bothering him quite a lot right now, and his skin never fully cleared up.  He still has good days and bad days with regards to his activity and attitude, and he sweats when the temp goes over about 70F.  

So where do we go from here?  Should I bite the bullet and get more bloodwork done?  Or does it seem like he could benefit from a higher dose of CP?  How does his diet look now?

CH is up to date.  He is in Scoot Boots 24/7, and his current diet is:

5 lb hay

15 lb ODTBC

3 lb RSR beet pulp

1 lb ground flax

1 lb wheat bran

Finally, I don’t necessarily consider it a PPID issue, but he’s been having smelly cow patty manure for a little while now, along with loud gut sounds and a bit more gas than ususal.  What to make of that?  Does anything in his diet seem likely to be the cause?  (Although he developed the loose manure after being on the current diet for over a month.) Should I try him on a probiotic?  He was last wormed Nov 19.  None of this seems to bother him.

As always, thanks!