Hang in there, Terrie.  You have not let Dixie down.  In fact, you are going above and beyond what most owners will do.

It seems to me that things were on the upswing on Ertugliflozin, after you increased pergolide and came out of the seasonal rise.  Even though her insulin was fairly controlled, we really don't want ACTH to go above the mid-20s in these horses, so being very proactive or aggressive with pergolide is going to be important.

You will have to evaluate her quality of life and Dixie's desire to carry on or give up, and make your own decision based on what you see in front of you, not on reports from vets and others who haven't seen her, and that includes us.  But getting her medications in place (you are starting to get there, but the job isn't done yet with both pergolide through the seasonal rise and Ertugliflozin, especially with the setback of not getting your latest shipment) and maybe some trim adjustments could make the difference.  It seems to me her heels are a bit high on a couple feet, putting more pressure on to the tip of her coffin bone, and I wonder if she might be more comfortable if her heels were a bit lower, but of course you should wait for Lavinia or Dr Kellon's advise.

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Kirsten and Shaku (IR + PPID) - 2019
Kitimat, BC, Canada
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