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New ACTH, Seeking advice on dosage#file-notice

Sharon Bice
 

Hello!
Just received Tailight’s ACTH and Insulin results from Cornell: 

Her ACTH is 113 (reference 2-30) & Insulin is 20.15 (reference 10-40).
Her current compounded peroglide dosage is 2.

~ Would you suggest going up to 2.5 or 3 compounded? I can buy some Prascend to titer her up 1/4 tablet every… is it three days?  

Unfortunately, I have noticed her pot belly is coming back. She also has fat pads on her hind end which I am not sure why with that number for insulin. Otherwise, she is still exhibiting a willingness to be ridden. I am in the process of waiting for testing results of the hay (it was wet chem tested by the dealer but getting my own test with the bales I am currently feeding) I have been using now that she is back home on my property and also looking for new hay as this Bermuda is so fine and hard to feed in hay nets. She has not been moving around much on her 12 mainly dry lot, although there are lots of weeds this year, pasture. I will get her out more to be ridden, as well as feed her some cold brew to get her moving more (just kidding) ;) 

~Thank you in advance for your help! 
--
Sharon Bice
December 2020    Sandia Park, New Mexico

Taillight's Case History:  
https://ecir.groups.io/g/CaseHistory/files/Taillight%20Case%20History

Taillight's Photo Album:
https://ecir.groups.io/g/CaseHistory/album?id=257590

Sherry Morse
 

Hi Sharon,

Given the ACTH level is so far out of the normal range and we're heading into the rise I'd aim for at least doubling her dose as quickly as possible.  At this point you're very close to chasing the rise and you may not get her ACTH down where it should be but you do need to try.

Thanks,
Sherry and Scutch (and Scarlet over the bridge)
EC Primary Response 
PA 2014
https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet 
https://ecir.groups.io/g/CaseHistory/album?id=78891


Sharon Bice
 

Thanks Sherry!
I am overnighting Prascend today and will start her on 4 mg. Given that it is not compounded and is more than the 2 mg of compounded I am getting now. I am presuming more than doubling is okay. Also how should I give it to her? All at once tomorrow or should I go up gradually? Thx so much again, I am very surprised and worried about this number - hoping I can get it down. 
--
Sharon Bice
December 2020    Sandia Park, New Mexico

Taillight's Case History:  
https://ecir.groups.io/g/CaseHistory/files/Taillight%20Case%20History

Taillight's Photo Album:
https://ecir.groups.io/g/CaseHistory/album?id=257590

Kirsten Rasmussen
 

Agree with Sherry that you need to aggressively increase the pergolide dose.  That ACTH is waaaaay higher than you want it to be, and we are not at the peak of the rise yet (late Sept).  We usually recommend tapering up by 1/4 every 3-4 days, but you might get away with a faster taper, especially if you use APF.

--
Kirsten and Shaku (IR + PPID) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
 
Shaku's Case History
Shaku's Photo Album

Sherry Morse
 

I would do .5mg per day for 3-4 days and then go up if she tolerates that well. If you have APF start that now.
--

Thanks,
Sherry and Scutch (and Scarlet over the bridge)
EC Primary Response

PA 2014

https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet/Scutch%20Case%20History.pdf

https://ecir.groups.io/g/CaseHistory/album?id=78891

 

Sharon Bice
 

Okay thanks Kirsten and Sherry! I tested her on April 30th but now I realize I should test more in June as this was too late. Thankfully I am back living in the country so I can personally manage this and hopefully not get her so off track. I overnighted the APF so I will start it today with the Prascend, going up 1/4 or 1/2 not sure which but will see.

~ Should I retest in three weeks? I may be changing hay, or should I wait until say November to switch hay? Mine is super fine so it falls through the nets.
~ Should I be riding her if she is so off with her numbers? I guess if she is willing - I should go by her attitude? 
~ When do I know the right dosage for the rise & I am guessing a few months afterward? I will eventually order compounded medicine again as Prascend is unaffordable at higher dosage, but I wanted to get it here the next day/today (so ordered it yesterday) and compounded takes a bit. I have a few weeks left of 2 mg compounded. 

So sorry for all the questions!!! I hope to be able to help “newbies” here someday once I feel a little more confident in understanding all this & getting it right. I’m getting there thanks to you all! 

--
Sharon Bice
December 2020    Sandia Park, New Mexico

Taillight's Case History:  
https://ecir.groups.io/g/CaseHistory/files/Taillight%20Case%20History

Taillight's Photo Album:
https://ecir.groups.io/g/CaseHistory/album?id=257590

Kirsten Rasmussen
 

Yes, retest 3 weeks after reaching the doubled dose.  Her insulin is fine right now so I don't see an issue with riding or changing hay, as long as the new hay has similar or lower ESC and starch.

You could order compounded now as 4 mg pills to replace your 2mg prescription, then if needed continue to use Prascend to increase the dose.  Keep in mind that 1 mg Prascend = ~1.3 mg compounded, so if you're aiming for 4 mg compounded equivalent, you need to add 1.5 mg Prascend  (=1.9 mg compounded, + 2 mg compounded that she is already getting, for a total of 3.9 mg compounded).

--
Kirsten and Shaku (IR + PPID) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
 
Shaku's Case History
Shaku's Photo Album

Kirsten Rasmussen
 

With APF on board I'm sure you can increase by 0.5 mg at a time.  I would try that first.  You can always drop down to 0.25 if she goes off her feed.

--
Kirsten and Shaku (IR + PPID) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
 
Shaku's Case History
Shaku's Photo Album

abberdoo@...
 

Hi Sharon,  Sorry to barge in on your thread, but I was comparing your results to the results I have for my horse and thinking the 113 doesn't seem all that high compared to the 305 my horse came back at.  Then I saw your reference range and am wondering if you were looking at the pre-test range vs. the post-test range?   I see on my results the pre-test reference is 2-30 and the post is 2-110.  Maybe I am not reading this right, but I assumed that anywhere between 2-110 for post test would be considered "normal", so if that is the case and your test was done the same as mine at Cornell, then wouldn't that mean you are only 3 points above the reference?   

I am asking because I was told to give my horse 1.5mg by my vet and she was at 305, so am concerned she is not on a high enough dosage.  But, also, I am thinking if your horse was at 113 and the reference range is really 2-110 then does that warrant going up by 2mg?

I am not an expert by any means, I am just starting this journey, trying to make sure I understand how the tests and dosing works.


--
Lori J in NC 2022
Abbey's Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=276850 

Bobbie Day
 

Sherry Morse
 

Hi Lori,

Tailight was not tested via the TRH stim test.  113 was her actual ACTH so you need to look at the reference range of 2-30 and realize that she's way out of the reference range at baseline.  

As your horse was 305 after a TRH stim test that 1.5mg may be enough, but you'll only know by retesting her 3 weeks after she's on that dose and as we're already in August the TRH test is unreliable.

Thanks,
Sherry and Scutch (and Scarlet over the bridge)
EC Primary Response 
PA 2014
https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet 
https://ecir.groups.io/g/CaseHistory/album?id=78891


abberdoo@...
 

Thank you Sherry & Bobbie,  I probably should have looked at the test results in Sharon's photo album before posting my comment, sorry about that.  

--
Lori J in NC 2022
Abbey's Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=276850 

Sharon Bice
 

Hi Lori! 
No, you are not barging in, that’s how we all learn and get to be experts ;) I appreciate all the discussions here and I’ve learned so much on all kinds of topics that I didn’t know i needed to know about!  So I just did an ACTH test not the TRH Stim test. Perhaps that is what you did TRH Stim test? I think the 113 number my horse, Tailight, had is very high and agree with the feedback here. Im moving her up to 4 mg (approx) and then retesting three weeks later. Then again in I think early December to see if she really needs to be on that much year round. It is a bit still confusing for me after almost two years of learning…. But hopefully I won’t make the mistake of testing a little too late like I did here and next year plan to test mid June or even second week, instead of mid July. I’m sure someone will come into this thread who understands what the 2-110 test range means. I’m eager to learn. Good luck getting your horse up quickly and getting him/her better soon. It defiantly is a journey, but this group is the best place to be! 
--
Sharon Bice
December 2020    Sandia Park, New Mexico

Taillight's Case History:  
https://ecir.groups.io/g/CaseHistory/files/Taillight%20Case%20History

Taillight's Photo Album:
https://ecir.groups.io/g/CaseHistory/album?id=257590

Bobbie Day
 

Lori
Nothing to be sorry about!
I am guilty of that all the time, we’re all friends here.

--

Bobbie and Maggie 
Desi (over the rainbow bridge 7/21) 
Utah, Nov 2018
NRC Plus 2020, NAT, C&IR March 2021
ECIR Group Primary Response 

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Maggie
https://ecir.groups.io/g/CaseHistory/album?id=271156

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Desi 
https://ecir.groups.io/g/CaseHistory/album?id=78821

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