New labs in - advice on increasing Pergolide & arthritic pain relief


Hello -

ACTH 30.3
insulin 33.4

We just received Sunday's ACTH & insulin results drawn July 1. While both are down from results at the end of May, ACTH is still too high, & while I am relieved insulin has come down, it is still too high. I assume I should increase his Prascend again - we increased it to 2 tabs the end of May, so I assume to increase by another tab, for 3 total? When I increase, should I do it by 1/4 tabs, or with him on it already can I increase it more quickly? My vet is totally on board with switching to compounded pergolide, which I will do as soon as I run out of Prascend, although I have enough for about 2 months - just bought a box. I wanted to confirm how to write the script please when my vet orders it from the pharmacy. Will it be 3 mg pergolide as pergolide mesylate? 
Sunday has significant soundness challenges & he does not do well with devil's claw. I give him chondroitin, boswellia, curcumin, HA powder & jiaogulin. We think most of his discomfort now is coming from the hind end, possibly sacroiliac joint &/or sacrum. My vet would like to just use firocoxib, given his age & the benefit more movement would give him. I know Dr Kellon does not like long term use - could you please explain the technicalities & I will, as I always do, pass it on to my vet. Thank you. If firocoxib is totally off the table, do you have other suggestions besides what I already use & devils claw. 

With gratitude for everything you have done for Sunday & me, my thanks. 

Rozanne & Sunday
July 02 2019  Larimer County, Colorado
case history: 

Join to automatically receive all group messages.