Hi. I am in process of updating Ruby's history, with new x-rays, diet, etc. The short story is that she is feeling great. I just had her ACTH tested a couple of weeks ago, and it came back at 45 from Cornell. She had been on 2 mg of Prascend, so I have increased her to 2.25. How far should I go before retesting? I am going to get the whole panel with glucose, etc., once we reach a retest point for the ACTH. Again, thank you for all of the help you have all given. It is incredible to have my near dead horse back to running and jumping again.
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Sue and Ruby, high desert, central Utah, 2017
Case History https://ecir.groups.io/g/CaseHistory/files/Sue%20and%20Ruby 
Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=272221

Sue,thanks so much for reporting such good news.
Go Ruby!!
And well done you!

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Lorna in Eastern Ontario
2002

Hi Sue. That's great news...Its so nice to hear from folks and know that their horses are doing well :) 
As far as ACTH goes- Whenever you make an adjustment to the Prascend ...you should wait 3 weeks before retesting.
ACTH levels in the high teens, low twenties is  the goal throughout the year including during the seasonal rise.


Trisha DePietro
Aug 2018
NH
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Primary Responder

How high should I take her dose prior to retesting?
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Sue and Ruby, NE Utah, 2017
Case History https://ecir.groups.io/g/CaseHistory/files/Sue%20and%20Ruby 
Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=272221

I would go up 0.5 mg since your last test.  By the time you retest it should also have dropped naturally, too, because we are now 1 month past the high point of the seasonal rise.

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Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
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Hi Sue,
While you’re updating the CH, could you take a look at the bute, please?  I assume you discontinued it after the last time you gave it?
Also, the only test result I saw for insulin is extremely high.  Are there others I missed?   Knowing how high it might be, your vet can ask Cornell to report what the level is above 200 on the next test.  I don’t see that you give her any drugs to try to decrease it, such as metformin.  With this in mind, I would be more generous with increasing the pergolide (Prascend) to see if it helps to decrease the insulin.  I don’t really think you can expect a dosage increase of 0.25mg to have much of an effect, on either ACTH or insulin.  The Prascend tablets are scored to be divided in half, which means that breaking it along the scoring should give you two very similar doses but breaking it further may not.  You can dissolve the half in a small amount of water and divide that into two portions.  The vast majority of horses won’t respond poorly to an excess of pergolide, should that end up being the case.  And, if you find that increasing the dose doesn’t decrease either ACTH or insulin, you can always cut it back.  
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