Dr. Kellon/Group,

I was just now emailed Pabatsa's labs from Cornell--updated in his CH. All values have decreased since getting him back on his original 3.5 mg after a vet not knowing Cushing's had me take him off it because he "Looks so good."

9/20/18:
ACTH 55
Glucose 93
Insulin 16.11
Leptin 10.54

8/10/18:
ACTH 91.4
Glucose 90
Insulin 24.94

If I need to increase what should I have the dose at? And, would I be able to take him back down after the rise?


--
Laura and Pabatsa in California
Feb 2012
Case History https://ecir.groups.io /g/CaseHistory/files/Laura%20a nd%20Pabatsa ( https://ecir.groups.io/g/CaseHistory/files/Laura%20and%20Pabatsa ) 
Pabatsa's Photos https://ecir.groups.io /g/CaseHistory/album?id=1740 ( https://ecir.groups.io/g/CaseHistory/album?id=1740 )

Hi Laura

This looks good for P, IMO. As always I bow to Dr Kellon and Clougher.

It appears he is at the top of seasonal rise for a normal horse. However, I'd want to make sure I was keeping an eye on any other symptoms.  Because Beau was so IR, I has to keep his ACTH in the teens to minimize laminitis. I'm sure you have noted that P has gone back to compensated IR. https://www.ecirhorse.org/ir-calculator-leptin.php

These two messages are oldies but goodies. Make sure you re-read Patty's on how to monitor scale of symptoms:

Increase Pergolide Message (Scale of Symptoms) by Patti https://ecir.groups.io/g/main/message?msgnum=111558

Seasonal Rise When to Test ACTH Message by Eleanor https://ecir.groups.io/g/main/message?msgnum=131880

Here is link to Liphook graph on seasonal rise  https://ecir.groups.io/g/main/files/3%20Cushings%20Disease%20-%20PPID/Liphook%20graph:%20PituitaryParsIntermediaDysfunction.pdf

If you do decide to increase, whether an increased dose can be brought back down after seasonal rise will honestly be up to him.  I'd retest  early in the year if it is in the budget.


--
Nancy C in NH
ECIR Moderator 2003
DDT+E = effective treatment for PPID and EMS/IR equines: https://bit.ly/2J4ZgYT

 

I agree with holding with this dose in P's case. He's not symptomatic and had a sizable drop in ACTH and insulin despite the seasonal rise peaking. Let him stabilize and retest in January before deciding if you want to try changing dose.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Thank you Dr. Kellon and Nancy. I will hold off on increasing his CP and keep him at a fresh 30-day supply of 3.5 mg CP. It's worked well for him since 7/2007. I learned a valuable lesson not to be repeated. I am no longer using any previous vets (we have a big selection here in S. California). My current vet is very well regarded and even told me to ask Dr. Kellon for whatever issues that Pabatsa may have regarding EC/IR !!!
--
Laura and Pabatsa in California
Feb 2012
Case History https://ecir.groups.io /g/CaseHistory/files/Laura%20a nd%20Pabatsa ( https://ecir.groups.io/g/CaseHistory/files/Laura%20and%20Pabatsa ) 
Pabatsa's Photos https://ecir.groups.io /g/CaseHistory/album?id=1740 ( https://ecir.groups.io/g/CaseHistory/album?id=1740 )