Hello again, 

After a whole process of what felt like pulling teeth, Zahr finally has his prescription for compounded pergolide (hooray!).

Although I did ask the vet to write the prescription as "X mg pergolide as pergolide mesylate" (and she did), the pharmacist said she'd need a new prescription from the vet if I wanted the 4mg of CP equivalent of 3mg prascend. So perhaps I misunderstood how that was supposed to be written? Since he is on 3mg prascend currently, I thought 3mg pergolide as pergolide mesylate would be converted from that to 3.9 (4) mg, but it does not sound like that is the case... (was it supposed to be written as 4mg pergolide as pergolide mesylate instead?)

The pharmacist told me that clinically there shouldn't be a difference between 3mg prascend and 3mg CP, which I argued I am not comfortable with for Zahr since he is so sensitive (and based on what this group has shared, I know to be inaccurate). But waiting for reworded paperwork from the vet to get a special order of 4mg CP, if the new prescription were sent in today, would get it here by the end of next week and pushes us back into August for the 3 week mark to test and wouldn't be useful at that point. I wound up ordering a 30 day supply of 3mg CP and will supplement him with an additional 0.5mg prascend daily, so that will work out to be about 2.8mg total after conversion (which I am not thrilled about, but I think this is the best I can do to get him tested in time). I'll work in the meantime to get the prescription sent in differently so that I can order the correct amount for next time.  

A couple more questions for the group:
1. Since we are changing medications, would it be ideal to alternate days between prascend and the CP for the first week so that is is introduced gradually?
2. How do other group members feed CP? Zahr currently gets his prascend syringed in the mornings because he won't eat it in his feed and he figured out pill pockets in one day. Will the capsules break down as effectively as the pink pills in cool water? 
3. When I get Zahr's ACTH tested, should I re-check insulin as well? I was thinking check to make sure that ACTH is controlled first, then re-check insulin after, because if the ACTH is still high I presume that will throw off his insulin numbers.

At this point I'm not sure precisely what day Zahr will be starting on the CP, but I think I'm going to go ahead and book his blood test for the last week of July since it can't be done any later. It may not hit the ideal 3 week mark, but I anticipate having to bump him up an additional 0.5mg on top of what he will already be getting at the point with prascend once the seasonal rise is in full effect. I'd prefer to get the numbers in while they are still semi-accurate rather than wait any longer.

Apologies for my own confusion and probably asking some of the same questions over again. Trying to get this prescription has been extremely frustrating with a lot of hurry up and wait, but at least we are on the right track now. Thank you again as always for the help and guidance!

--
Mikaela Tapuska in Calgary AB, 2021

Case History: https://ecir.groups.io/g/CaseHistory/files/Mikaela%20and%20Zahr

Photo Album : https://ecir.groups.io/g/CaseHistory/album?id=274255