"Marginal" ACTH, increase prascend or not?


 

Mahjiino  suffered a new bout of laminitis in may. He's on low NSC hay and off pasture for many years. The only explanation for this sudden laminitis seemed to be PPID worsening. Vet suggested increasing his prascend dose from 4 mg / day to 5 mg / day, even though we didn't have updated bloodwork at the time. We increased to 5 mg/day, and thankfully he got through the laminitis with no changes on hoof x-rays. Within a few weeks he was doing a lot better and is now completely sound and happy! 

To evaluate the increased Prascend dose we got new bloodwork 6 weeks after the increase in dose. ACTH came back slightly high at 31,8 Pg/ml (normal range <30, "marginal" 30-50, high >50). 

He was diagnosed with ppid in 2013. Even though his insulin levels never have been high, his first response to increases in ACTH seems to be laminitis, with no other changes in symptoms beforehand. He's on a low NSC diet and off pasture, on a smallish paddock paradise track system with as close to no grass as possible. 

The question is: 
Would you recommend increasing prascend to 5,5 mg/day considering his slightly high ACTH now? My vet wasn't certain, as it's only slightly above normal. I am afraid of the risk of new bouts of laminitis and am thinking I'd rather be safe on a higher dose than sorry. He's tolerating Prascend well without any obvious side effects. 


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Stine, Norway, 2013
https://ecir.groups.io/g/CaseHistory/files/Stine%20and%20Mahjiino/Mahjiinocasehistory.pdf


Eleanor Kellon, VMD
 

Do you have radiographs to confirms this is laminitis and could you post them?
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Eleanor in PA

www.drkellon.com 
EC Owner 2001


 

https://drive.google.com/folderview?id=1Cxmi_zaIkXtTo8rPMcxWSVmZPgc1qLQc

Here's the new x rays which proved no sinking or rotation thankfully (trimmed to correct long toes and negative palmar angles after this). Clinically he was extremely lame on all four, stood leaning back in a "laminitis posture", refused to lift one leg off the ground and spent a lot og time lying down the first day. Very hot hooves and strong pulsation the first week. Definitely looked laminitic with severe pain, but started management early (soft bedding, soaked hay, box rest, cooling). 
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Stine, Norway, 2013
https://ecir.groups.io/g/CaseHistory/files/Stine%20and%20Mahjiino/Mahjiinocasehistory.pdf 


LJ Friedman
 

5.5 prascend is expensive.  any access to compounded pergolide ??
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LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse( over the rainbow) and majestic ‘s Case History 
Jesse's Photos

 


 
Edited

No access to compounded pergolide here in Norway.. He's worth the price. <3
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Stine, Norway, 2013


 

Hi Stine,
I edited your case history links in a few of your posts here so we could open them.  All it took was a ‘return’ after the entry and then pressing save.  Could you please do the same to your signature on your signature page so they won’t need to be changed for each post.  Also, if you could create a photo album in the case history folder, load the Xrays in there and include a link to those In your signature as well, that would be most helpful.  You could actually add the link here to your signature as a photo album until you figure out how to create a new one.  This way, we can find those radiographs more easily.  

If you don’t hear from Dr. Kellon, I would post with both her name as well as Lavinia’s in your heading.  Lavinia is our hoof guru.  As you pointed out, the negative palmar angle needs attention but I’m not sure it can be corrected in a single trim.  I’d also like to hear from them as to whether that might be the source of his pain.
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Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo