Reposting(2nd try): ACTH Results Back


Stephanie Stout
 

Hi All,


I would love your advice please - I just got King's ACTH & Insulin results back from Cornell. He is on 4.5mg Pergolide(1x per day) from Pet Health all spring/summer with a very strict low S/S diet. His ACTH on his test in December was 30.2 pg/mL(reference range of 9-35) and his newest results from 9/14/15 is 49.2 mg/mL. He foundered in all 4 feet last September/October as I had no idea he was Cushings and IR until he went into kidney failure first, and then really severe laminitis a couple weeks after. He has a 9 degree rotation in both fronts, and a couple degree rotation in both hinds. 


I am thinking that his Pergolide should be raised to prevent any farther rise/laminitis problems during the seasonal rise? How much would you raise it? 


Thank you so much!

Stephanie & King

Oregon

Oct 2014

ECHistory8



Nancy C
 

Hi Stephanie

I'm sorry I thought this was answered.

How much to go up and if it is needed seems to be the eternal question this time of year.  You're doing a good job monitoring his blood work.  Are you keeping track of symptoms as well? Both of these areas are really important when deciding how much to go up.

If you are seeing additional symptoms, then I would dose until they subside.  My symptoms keys are crest, smegma, goopy eyes, loss of topline, but there are others. I would probably start with raising 1 mg in 0.5 increments, but it could take more.  Or less.

If in the funds retest after three  weeks of reaching your target dose.

Because he has had renal failure, thrombosis, laminitis and rotation would want to know you are working closely with your current vet and make sure you get his/her input.

Recommend you reacquaint yourself with the seasonal rise and pergolide docs here

Seasonal Rise

  Pergolide

 

Nancy C in NH
ECIR Moderator 2003


Learn more at the 2015 NO Laminitis! Conference in Georgetown, Texas, November 6-8.
Guest Speakers

 






---In EquineCushings@..., <KWPNDRESSAGE@...> wrote :

Hi All,


I am thinking that his Pergolide should be raised to prevent any farther rise/laminitis problems during the seasonal rise? How much would you raise it? 


Thank you so much!

Stephanie & King

Oregon

Oct 2014

ECHistory8



lj friedman
 

In reading this post, I was wondering if renal failure is associated with Cushing's or IR? LJ Friedman San Diego November 2014


Stephanie Stout
 

Hi Nancy,

Thank you so much for replying. I try really hard to watch his symptoms closely, as I see him several times a day(he's at home). I have noticed that his crest has increased a little over the past couple weeks. I'm planning to start by adding .5mg(starting today), and then adding another .5mg 4-5 days after so he will be on an added 1mg. Does that sound appropriate/good to you? 

I would love to retest 3 weeks after I reach the 5.5mg, but I will have to see if I can do it financially. 

The vet is a whole topic in itself - I am struggling/arguing with the vet that I have started working with since she is convinced that the ACTH reference range from Cornell is up to 105(!!) so he doesn't need anymore Pergolide. I finally got her to write the prescription for the .5mg last week by explaining that I'm on this group, and that King needs more Pergolide for the seasonal rise(we will see what happens when I have to do a refill). 

@LJ I will never be able to prove/confirm it, but I believe that he went into kidney failure because his PPID and Insulin levels were so high originally. His kidneys(knock on wood quick) have been WNL and fully functioning for over a year now. He has been doing GREAT, I'm so proud and thankful to this group!  

Thanks all! 
Stephanie & King
Oregon
2014
ECHistory8

 







Claudia Goodman
 

>>I would love to retest 3 weeks after I reach the 5.5mg, but I will have to see if I can do it financially. 

Stephanie, I also have been trying to get the pergolide dose right during seasonal rise. I tested back in July, and my mare mare had already unexpectedly jumped just beyond the normal range, so I immediately raised her .5mg pergolide to 4.0 mg. I have to make a point of saying no changes in symptoms were at all apparent, which for her is loss of brightness, first and foremost.
 
Tested again at end of August and she continued slightly upward, so I increased dose .5 mg to 4.5, for a few weeks and again to 5.0 mg pergolide. No symptom changes have been seen.

I plan to test her the end of Sept, believing that she is controlled for now, but I do want to see for sure that she stays controlled during the rise, so will test again. My goal is to keep her under the 35 pg/mL ACTH high end of normal during seasonal rise, believing that the more tightly controlled we keep them, the better off they will be long term.

I think once we see how seasonal rise affects a horse's ACTH values, it is a bit easier to judge how to dose in subsequent years. I learned from last year's pattern that I needed to go up 2.5 mg to keep my mare controlled during the rise. And after seasonal rise, she needed more pergolide (3.0 mg) than before the rise started (2.0 mg).  
Best of luck with King. 

Claudia & Silhouette   2014   California central coast

https://groups.yahoo.com/neo/groups/echistory8/files/Claudia%20%26%20Silhouette/