ACTH 77


larina.alton
 


Hi everyone,
I'm sorry, I am having a problem updating my folder. There is something going on with my computer.
 
Sedona Daisy was formally diagnosed with cushings in 2013. She is on Stabul 1 plus and timothy balance cubes, is not apparently IR and no laminitis so far. Glossy coat with some guard hairs, good weight. Her most recent ACTH (results in yesterday) is 77 with high end of normal at 35. Results are from cornell. Last October she was 95.7, normal range 35, also from cornell, but I was assured that 3x normal was the range for seasonal rise.
She is on 1 mg compounded pergolide. BUT I have had a lot of trouble with the boarding barn - there have been many times I have caught them not giving her her medication, a couple of times for a full week while I was out of town. This is not the only boarding barn I have had such issues with. I am looking around for somewhere new and am going out every day to feed it myself (this is not a long term solution because I have a lot of out-of-state travel for work), but in the meantime I am not completely certain whether the high reading could possibly be explained by the lax boarding barn or if she needs a higher dose. She seems to have been getting it about 6 days a week or so (I know).
Vet recommends increasing from 1 mg to 1.5. Does anyone have any thoughts?
Thank you in advance for your help and advice!!
Larina Alton
http://pets. groups.yahoo. com/group/ echistory7/ files/Sedona% 20Daisy/
Sedona Daisy, member since July 2013
Hennipen County MN


Lavinia Fiscaletti
 

Hi Larina,


It may not be your computer - Neo has been making things difficult again. If you continue to have problems, feel free to send your updates to one of us and we can get them into your folder for you.


I don't see any insulin results in the tests in your case history - are there any? I am only seeing some glucose and T4 numbers.


The barn staff is being negligent. If you have a boarding contract this may be actionable.


Daisy's ACTH is definitely not controlled - it is about 3 times what we would recommend it to be at this time of the year and the seasonal rise effect hasn't officially started yet. The information you were given regarding the Oct results was not correct - 95.7 is way out of the range to be considered "normal" even during the seasonal rise. How much pergolide was she on at that time and was the same boarding barn handling her meds?


Once on a targeted dose of pergolide, the ACTH should stabilize in 2-3 weeks time at whatever level the dose is controlling it to. Obviuosly, you cannot tell how much effect the pergolide may/may not be having as the barn staff is not fulfilling their obligation to make sure she receives her meds. Is there any way you could pay someone - a friend/relative/barn buddy - to make sure she gets her meds on a regular schedule? Not getting her meds regularly is allowing her PPID to progress and putting her at increased risk of laminitis. NOT something you want to do. Plus, when the schedule is erratic like that she may have issues with pergolide veil kicking in when she goes several days without meds then gets a full dose. That type of bouncing around with her endocrine system is certainly not healthy. I know you know this - just making a point for everyone else that is reading this.


Given how high her ACTH was and how elevated it is now I wouldn't see any harm in raising her dose to 1.5mg daily but you need to make sure she receives it daily as a larger dosage is also more likely to create larger swings when doses are missed then reintroduced and may cause other reactions.


Sorry, is that clear as mud?


Lavinia, Dante, George Too and Peanut

Jan 05, RI

EC Support Team




 





larina.alton
 

Yes, I know the barn is being negligent! I am very upset. And yes - I'm an attorney, I know I could take legal action but all I really want is to know my girl is getting the care she needs. I have appointments at two new barns to take a look at alternatives today and tomorrow.
 
Is going up by .5 dose quite a large step, or is that normal given how badly her PPID is apparently progressing? Is there any reason to try a lower step up to 1.25 or should I just go for it? Her mood seems ok. I heard from someone at the barn that it is about 1x a week that she is not getting her medication for the last three weeks, so while that is bad I am not sure it's enough to have her bloodwork this far out of whack. The progression may be due to some earlier lapses in Febrary and March, when I came back from out-of-state work trips to find that she had not been given the pergolide for the entire week I was out of town! Both times I said it was medically dangerous and that it was a risk to my horse's life and was told it would be taken care of. Good gracious, I could rant.  I have been so upset, but her weight was good, coat glossy, and she seemed happy and horse barns are hard to find so I was hoping not to have to move.
 
She had normal insulin in October 2013 (non-fasting, should be in her medical history but I still can't access the folder for some reason) and when I tested it in April 2012. Neither test was taken fasting. I did not get that re-tested, just the ACTH.
 
Thank you!!!!
 
Larina Alton
http://pets. groups.yahoo. com/group/ echistory7/ files/Sedona% 20Daisy/
Sedona Daisy, member since July 2013
Hennipen County MN


Lavinia Fiscaletti
 

Hi Larina,


As you say, at least it seems she is getting her meds 6 days out of seven. Certainly not ideal but a bit of an improvement. And at least it sounds as if Daisy is holding her own in general so that is also a plus.


PPID is a progressive condition no matter what you do. With medication, it appears to slow that progression to some degree. Daisy isn't necessarily progressing rapidly at this point, it may just be that the proper dose to control her PPID hasn't been reached and with the medication mishaps going on it is difficult to assess exactly where you stand. A .5mg jump in the dose is not a particularly large jump and 1.5mg total is quite common - one of my boys is currently on 16mg. If possible, I would recommend tapering the dose up to the 1.5mg - get (4) .25 mg capsules along with the 1.5mg capsules so that you can start with 1.25mg for 4 days then go to the 1.5mg. Will need to retest after consistent administration of 1.5mg to see where you stand. If she were mine, I would be planning on needing to go to at least 2mg during the seasonal period (maybe more) to maintain good control, then possibly being able to drop back down in late Dec/early Jan after the rise is over.


It appears that all the earlier ACTH testing was done at Michigan State. Unfortunately, we have found that there seem to be issues with false negatives from them so it is quite possible that Daisy has been PPID for a longer period than the positive test in 7/2013. We have had members send split samples to both MSU and Cornell and the results from Cornell consistently returned with higher values.


Know you are having trouble accessing your CH. Can you send the update to me and I can get it uploaded for you?


Hang in there. We know how stressful this must be for you.


Lavinia, Dante, George Too and Peanut

Jan 05, RI

EC Support Team


>>>>>>

https://groups.yahoo.com/neo/groups/echistory7/files/Sedona%20Daisy/






Mandy Woods
 

Larina,
Your ACTH is  twice over the normal range.  We are in the seasonal rise so Dedona’s  ACTH will go even higher.  Your vet is right suggesting you increase the pergolide for this part of the year.   You can have some capsules made that are 1.5 mgs so you give one pill during the rise.   I don’t think you’ll ever know if the barn staff is causing the problem.   IF Sedona was mine,  I would err on the side of caution and increase her pergolide for the rise.   Is there a barn mate you trust that visits his/her horse regularly that you could trust to give your mare her medicine?   Just thinking out loud...........
 
Mandy in VA
EC Primary Response
OCT 2003