Feeding Cushings pony

Hi, I’m going to the mill this afternoon to get advice but thought I’d check on here first. We have got a lovely 13.3 sec b for my daughter, been there and done it. Hunts, show jumps etc. Have weekly lessons and do regular shows etc. He was showing signs of cushings so decided to test, he does have it. Have changed diet, started meds etc. But instructor and I both feel he needs a bit of boost from feed. Obviously low sugar/starch etc due to the cushings. He’s a good doer, body score 5-moderate, can feel ribs but not see them. But has pot belly appearance I believe from the cushings, but would love this to go!

If anyone knows any safe feeds to give him a kick up the ….

Thank you.
Try APF supplement for the veil. Agree he may need a break until he is feeling better.
 
You can get free labs for ACTH (so you only pay for the vet physically pulling it, not the testing of it) so you could do that now, if it's still borderline redo TRH in Jan/Feb, but you have to be aware that Chaste berry will lower ACTH in 33% of cases, so if you are feeding PPID supplements with it in that could skew your results.
Thanks. Wow.
You shouldn't really feed chaste berry (main active ingredient in that supplement) and prascend together, one is an antagonist, the other an agonist, they work in opposite ways on the same receptors, which can mean they counteract each other working at all.
Thank you. Great information esp on free labs for ACTH and how the chaste berry and prascend cancel each other out. Esp since I had planned to start the supplement today or tomorrow. Are you familiar with this supplement? Your thoughts? Yay or nay?
 
Sounds like a good plan as long as my vet is willing to test for ACTH. He is kind of like his way or the highway with everything. But that gives me something to think about. Again, my mare looks good and is sound. She is 25 so she looks older. A bit of loss of topline but that is mostly since I retired her. I need to get her in an exercise program and a little bit more than just turnout. A little bit of belly. Other than that she acts like a happy healthy girl. I have read about horses with such bad problems with Prascend. They don't want to move, they won't even lead forward, horses that used to come to the gate no longer even look interested in moving. I was looking for a possible alternative when I came across the Pituitary supplement. Also considering getting a second opinion from a local vet. She is feeling good and eating good and I don't want to create more problems for her. Her coat looks normal and good and shiny. Not long, not curly. I want to be careful not to do anything that could hurt her. Below is an article I read from the holistic horse. Your thoughts?

For horses with PPID or insulin resistance, chaste tree berry should be fed in conjunction with a low-NSC (non-structural carbohydrate) diet. If the diet isn’t appropriate, you may not see much effect with chaste tree berry.

Another great thing about this herb is that it has no known side effects. Chaste tree berry can be fed in conjunction with most medications, though steroids may weaken its effect. It is often considered a safe alternative to Pergolide, the drug commonly used to treat PPID horses, as well as Regumate, a drug often used to suppress heat cycles in ‘moody’ mares.

The only instance in which chaste tree berry is NOT recommended is for pregnant mares.

At The Holistic Horse, we offer Organic Chaste Berry Powder in a 1 lb. package and recommend feeding 1 – 3 teaspoons per day (1,200 – 3,600 mg) for a 1,000 pound horse. Chaste tree berry is also a main ingredient of the Balance blend in our Signature Line of equine herbal products.

If you have a horse either diagnosed with or showing symptoms of PPID, insulin resistance, or hypothyroidism, or if you have a ‘moody’ mare or aggressive gelding or stallion, chaste tree berry may very well be the herb which can make a huge difference in their health or behavior.
 

A daily dose of chasteberry for horses diagnosed with Cushing’s was found to: [3]

  • improve coat quality
  • improve energy levels
  • improve mood
  • reduce laminitis
  • reduce abnormal fat deposits
In an anecdotal case report, Dr. Eleanor Kellon, VMD of the ECIR Group describes 10 horses with Cushing’s disease showing improvements after several weeks on a commercial product containing Chasteberry extract.

All 10 horses exhibited rapid shedding of the abnormal coat within 2-3 weeks of treatment. Horses that presented with low energy levels, depression, and pain due to laminitis before treatment showed improvement in these symptoms.

Several of the horses examined in this report also experienced improved insulin and glucose levels, suggesting benefits for metabolic health. The changes in insulin signaling were particularly noticeable in younger animals. [9]

Chasteberry vs. Pergolide​

Pergolide is the pharmaceutical drug most commonly used in horses to treat symptoms of Equine Cushing’s Disease. Pergolide is an ergoline-based dopamine receptor agonist that is used in humans to treat Parkinson’s Disease.

Many horse owners seek out Chasteberry as a natural alternative to pergolide, but this herb is not approved as a replacement for pergolide treatment.

If you suspect your horse is developing Cushing’s symptoms or has recently been diagnosed with early Cushing’s/PPID, speak with your veterinarian about using chasteberry to improve symptoms before administering pergolide or in combination with pergolide.

Early vs. Advanced PPID​

Chasteberry appears to be more beneficial in horses with early PPID, but may not be as effective as pergolide in horses in advanced stages of the disease.

One study showed no benefit of a commercial chasteberry product in PPID horses when it was compared to pergolide and showed deterioration in PPID symptoms in some horses. [10]

In this study, 14 horses with Cushing’s disease were given chasteberry extract daily for between two to six months. The horses were also treated with a high dose of pergolide either before or after receiving chasteberry.

In this comparative study, only one of the horses saw an improvement in their condition relative to treatment with pergolide.

These horses had advanced PPID, meaning that their symptoms has been present for a longer period of time or were more severe. Horses with advanced PPID are less likely to have symptoms resolved by chasteberry alone and require pergolide therapy to see significant clinical benefit.

The authors of this study acknowledged that the manufacturer did not provide details regarding chasteberry concentration or other active constituents and the investigators did not test the product. It is unclear how much was given and what other ingredients were in the product. [10]

PPID Study with Horses and Ponies​

In another study, a commercial chasteberry product was tested in 38 horses and ponies with PPID. The equids were divided into three groups: [11]

  1. Animals that had never received treatment and were given chasteberry alone for six months
  2. Animals that had never received treatment and were given chasteberry plus pergolide for six months
  3. Animals that were already on pergolide continued taking this drug alone for first 3 months and then were given pergolide plus chasteberry for the final 3 months
Blood tests and assessment of clinical symptoms were conducted before treatment, at 3 months and after 6 months. Chasteberry treatment alone improved clinical scores in the horses after three months and this improvement continued to six months.

The researchers observed normalization of the hair coat and behavioural changes with owners noting that the horses and ponies were more lively and alert. All horses showed improvement in Cushing’s symptoms as determined by a scoring system.

Adrenocorticotropic Hormone​

Horses with PPID have pituitary glands which overproduce adrenocorticotropic hormone (ACTH) resulting in many of the symptoms associated with this disease. The study results showed that chasteberry therapy alone did not improve ACTH levels. However, it has been established that pergolide does lower ACTH.

Therefore, chasteberry should not be considered a complete replacement therapy for pergolide but can be used as an adjunct therapy to support improvement of symptoms.

That being said, the main outward sign of elevated ACTH (excessive hair growth and failed shedding) was improved by Chasteberry. [11]
 
@Dori2021 is that your Section B Welsh in your #23 post, and is that a current picture since you have had her on Chasteberry? If so, how long has she been on Chasteberry?

My Cushings horse has been on Prascend since 2019 without issue. No depression, no going off feed, not droopy. His cortisol numbers were three times higher than high/normal and the vet still started him at only 1/2mg daily. I took that one step further and fed him a 1/4mg twice daily for a few months.

He is still on half tablet but the vet came to draw blood today and confIrmed my silent thoughts that the Prascend May have to be increased.

I don’t know of other stressors affect the pituitary gland’s function or its failure but,this horse (26 years) lives with a twice fractured sacrum, survived serious founder in 2012 from insulin resistance, and between Spring 2020 and spring of this year x-rays show Low Ringbone has developed.

I had once tried Chasteberry on a horse with EMS and it was an epic failure. I am happy to know you feel you are having success with it but, if your Welsh Pony has been on it for awhile, she should not have all that excess hair:)
 
@Dori2021 is that your Section B Welsh in your #23 post, and is that a current picture since you have had her on Chasteberry? If so, how long has she been on Chasteberry?

My Cushings horse has been on Prascend since 2019 without issue. No depression, no going off feed, not droopy. His cortisol numbers were three times higher than high/normal and the vet still started him at only 1/2mg daily. I took that one step further and fed him a 1/4mg twice daily for a few months.

He is still on half tablet but the vet came to draw blood today and confIrmed my silent thoughts that the Prascend May have to be increased.

I don’t know of other stressors affect the pituitary gland’s function or its failure but,this horse (26 years) lives with a twice fractured sacrum, survived serious founder in 2012 from insulin resistance, and between Spring 2020 and spring of this year x-rays show Low Ringbone has developed.

I had once tried Chasteberry on a horse with EMS and it was an epic failure. I am happy to know you feel you are having success with it but, if your Welsh Pony has been on it for awhile, she should not have all that excess hair:)
Can I ask what kind of blood draw your vet used? Did he check ACTH levels or do a TRH stim test or another type of test? My horse had 2 stim tests this year. They warned me it would drop her glucose level. It did. Normal is 68-120 nd my mares is now 18. She has never been insulin resistant is a tb and I am thinking not a good time to drop her NSC's. Concerns me about doing all these TRH tests they want to do. Just something else to worry about, like I needed that too. Lol... I am beginning to think the ACTH test would be good for my mare (if my current vet will do it). Also thank you for the info on how you are giving Prascend. My vet told me to just start her on 1 pill a day and there should be no side effects. I wish he believed in the less is more theory. At this point still trying to decide what I am going to do. I have a happy and healthy mare and don't want her to get bad side effects and feel crappy. Also read of a possibly aggressive behavior side effect. Read about horses who don't want to move at all when on Prascend and when you try to lead them the will rear up rather than move forward. Yikes.
 
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You can get free labs for ACTH (so you only pay for the vet physically pulling it, not the testing of it) so you could do that now, if it's still borderline redo TRH in Jan/Feb, but you have to be aware that Chaste berry will lower ACTH in 33% of cases, so if you are feeding PPID supplements with it in that could skew your results.
Thank you again for that info. I will try to get a vet somewhere if not my current one to test her ACTH. Good idea. I cannot rush into this Prascend medicine. I am trying so hard to do what is right for her. After all the reading I have done I am thinking this should be my starting point and go from there. I do wonder if I do the Chasteberry supplement if that will help her as she gets older (she is 25 now). That supplement sounds great by the reviews but I am more trying to really do the right thing for her even if it means getting over my fear of Prascend. I remain in limbo for now, not going to let my vet pressure me into a decision. I guess will try to get an ACTH test. This is a very scary disease. I have to say my mare has also always been sound never any hoof issues, thank goodness. Trying so hard not to make things harder for her (and me).
 
My horse had a bad reaction to the Prascend to start with, he started on only half a tablet but the vet took him off for a break and then restarted him on a quarter.

Second time round I also got the supplement that Jessey mentions and he was absolutely fine and showed no reaction even when we upped the Prascend again. I stopped giving him the supplement when we were sure he was coping OK and he stayed well. The veil, as they call it, is only temporary while they adjust to the medication.

It took my horse 6 months-ish to regain ground back to his pre-Cushings self but that was nothing to do with the veil, it was simply recovering from the effects of the disease itself.

I'm not saying you should definitely go down the Prascend route if you don't want to, but don't be too worried about the veil, it's only a short stage in the grand scheme of things and you always have the option of taking them off the medication if you want.
 
Can I ask what kind of blood draw your vet used? Did he check ACTH levels or do a TRH stim test or another type of test? My horse had 2 stim tests this year. They warned me it would drop her glucose level. It did. Normal is 68-120 nd my mares is now 18. She has never been insulin resistant is a tb and I am thinking not a good time to drop her NSC's. Concerns me about doing all these TRH tests they want to do. Just something else to worry about, like I needed that too. Lol... I am beginning to think the ACTH test would be good for my mare (if my current vet will do it). Also thank you for the info on how you are giving Prascend. My vet told me to just start her on 1 pill a day and there should be no side effects. I wish he believed in the less is more theory. At this point still trying to decide what I am going to do. I have a happy and healthy mare and don't want her to get bad side effects and feel crappy. Also read of a possibly aggressive behavior side effect. Read about horses who don't want to move at all when on Prascend and when you try to lead them the will rear up rather than move forward. Yikes.

@Dori2021 All of the vets in my area will only do the ACTH test - general all animal vets to the lameness vet, to the sports medicine vet:)

The general vet was here yesterday to draw blood on both horses (ACTH), so I asked him about the TRH test as I had not heard of that untIl this conversation, so thankyou 👍😎👍😎

He said they (his clinic) do that mostly on dogs, to test them for Cushings, which affects adrenal glands on dogs. He said it is safe to do on horses and I replied “no thank you, I don’t care what it is, I’m not injecting anything into my horses as a test method for a disease”, , lollol

2. Based on everyone’s comments on here, it is clear that even cutting the Prascend dosage back at the beginning, some horses can suffer the veil for a short period of time.

I believe diet may also help reduce the effects. Feeding the horse as if it is IR could be a big help in reducing or eliminating the veil affect. Joker was IR seven years before he developed Cushings, so he was already on a very strict diet. The only thing he gets out of a bag is Timothy pellets, which are the carrier for his supplements. His vit/min supplement is condensed, no soy, no added iron. His is a custom mix, formulated especially for him, he gets a total daily amount of ~190 grams (~7 ounces) daily.

The company’s standard vit/min supplement is also soy-free, no added iron but the horse only needs three ounces (~85 grams) daily.

3. Cushings does not go into remission like insulin resistance can. The drugs (or herbs) only slow down the eventual complete failure of the pituitary gland; that can take anywhere from many months to several years - again it depends on the horse.
 
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@Dori2021 All of the vets in my area will only do the ACTH test - general all animal vets to the lameness vet, to the sports medicine vet:)

The general vet was here yesterday to draw blood on both horses (ACTH), so I asked him about the TRH test as I had not heard of that untIl this conversation, so thankyou 👍😎👍😎

He said they (his clinic) do that mostly on dogs, to test them for Cushings, which affects adrenal glands on dogs. He said it is safe to do on horses and I replied “no thank you, I don’t care what it is, I’m not injecting anything into my horses as a test method for a disease”, , lollol

2. Based on everyone’s comments on here, it is clear that even cutting the Prascend dosage back at the beginning, some horses can suffer the veil for a short period of time.

I believe diet may also help reduce the effects. Feeding the horse as if it is IR could be a big help in reducing or eliminating the veil affect. Joker was IR seven years before he developed Cushings, so he was already on a very strict diet. The only thing he gets out of a bag is Timothy pellets, which are the carrier for his supplements. His vit/min supplement is condensed, no soy, no added iron. His is a custom mix, formulated especially for him, he gets a total daily amount of ~190 grams (~7 ounces) daily.

The company’s standard vit/min supplement is also soy-free, no added iron but the horse only needs three ounces (~85 grams) daily.

3. Cushings does not go into remission like insulin resistance can. The drugs (or herbs) only slow down the eventual complete failure of the pituitary gland; that can take anywhere from many months to several years - again it depends on the horse.
Wow. Excellent and helpful post. Thank you so much. I really wish my vet had pulled ACTH blood tests FIRST, instead of the TRH during seasonal rise (and based his decision on that). On dogs! Wow! You were so right not to allow them to do TRH, esp during seasonal rise. It sounds as though you have a very good vet you can trust which is wonderful. My vet is very pro Prascend and seems very pushy about this and his manner in general. My first visit he pushed me to give my horse 2 non-core vaccines in addition to the core vaccines I wanted, and I did it even though I didn't want to!! Hard to explain how pushy he is. One of the vaccines is off label and for dogs and was discontinued even for dogs due to a problem and also is for a disease I have never had an issue with. The other vaccine was for a disease that was prevalent in a state far south of me and not an issue at all in my state. He said he was "from there". I think he is a very good vet, he is just too pushy for me and doesn't take no or input for an answer very well. When I asked him if there could be any side effects from Prascend he said no! This makes this entire thing even more difficult for me. I also wish he had said to start her on a quarter pill instead of jumping into giving her an entire pill each day to start.

The difference for me from my former vet is stark. She used to tell me my tb could not get enough NSC's. Feed her up! We actually had her looking very good until my hay supplier ran out of second cut hay this past winter. That caused a big weight drop in her. I would mix second cut in with her first cut hay and that really had her looking good. Of course, once they drop weight it is so hard to get it back on. So not really sure if that weight drop is from not having her usual second cut or as vet says Cushings. Also I have only just started with this vet and only seen him 3 times so he is new for us.

I am so glad to learn about Jesse's supplement for the veil (in case I do start Prascend at some point) without being pressured into this and everything else. My mare is so important to me, I don't want to make a mistake on this. I have owned her for 22 years and she has always been a big (16.3) strong healthy thoroughbred mare with no issues at all. Ever! So all of a sudden I have this and am trying to do what is right for her.

The TRH test really dropped my mares glucose number down to 18 (should be between 68-120). I agree totally with your statement to feed the horse as if it is IR could be a big help in reducing the veil. I also think even though she is not IR at all, it will be a help for her if she is pre cushings. I just am not sure if I should do this with her glucose so low right now.

Your most important point #3 is the main point for me and well made. Thank you so much for taking the time for all this great advice. This site is so helpful. I really appreciate it and everyone's help.
 
Sounds like a good plan as long as my vet is willing to test for ACTH. He is kind of like his way or the highway with everything. But that gives me something to think about. Again, my mare looks good and is sound. She is 25 so she looks older. A bit of loss of topline but that is mostly since I retired her. I need to get her in an exercise program and a little bit more than just turnout. A little bit of belly. Other than that she acts like a happy healthy girl. I have read about horses with such bad problems with Prascend. They don't want to move, they won't even lead forward, horses that used to come to the gate no longer even look interested in moving. I was looking for a possible alternative when I came across the Pituitary supplement. Also considering getting a second opinion from a local vet. She is feeling good and eating good and I don't want to create more problems for her. Her coat looks normal and good and shiny. Not long, not curly. I want to be careful not to do anything that could hurt her. Below is an article I read from the holistic horse. Your thoughts?

For horses with PPID or insulin resistance, chaste tree berry should be fed in conjunction with a low-NSC (non-structural carbohydrate) diet. If the diet isn’t appropriate, you may not see much effect with chaste tree berry.

Another great thing about this herb is that it has no known side effects. Chaste tree berry can be fed in conjunction with most medications, though steroids may weaken its effect. It is often considered a safe alternative to Pergolide, the drug commonly used to treat PPID horses, as well as Regumate, a drug often used to suppress heat cycles in ‘moody’ mares.

The only instance in which chaste tree berry is NOT recommended is for pregnant mares.

At The Holistic Horse, we offer Organic Chaste Berry Powder in a 1 lb. package and recommend feeding 1 – 3 teaspoons per day (1,200 – 3,600 mg) for a 1,000 pound horse. Chaste tree berry is also a main ingredient of the Balance blend in our Signature Line of equine herbal products.

If you have a horse either diagnosed with or showing symptoms of PPID, insulin resistance, or hypothyroidism, or if you have a ‘moody’ mare or aggressive gelding or stallion, chaste tree berry may very well be the herb which can make a huge difference in their health or behavior.
This picture is NOT MY HORSE! Just to clarify. This was a picture included in the article on Chasteberry I copied and pasted above. My mare is a thoroughbred and does not look at all like this.
 
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My horse had a bad reaction to the Prascend to start with, he started on only half a tablet but the vet took him off for a break and then restarted him on a quarter.

Second time round I also got the supplement that Jessey mentions and he was absolutely fine and showed no reaction even when we upped the Prascend again. I stopped giving him the supplement when we were sure he was coping OK and he stayed well. The veil, as they call it, is only temporary while they adjust to the medication.

It took my horse 6 months-ish to regain ground back to his pre-Cushings self but that was nothing to do with the veil, it was simply recovering from the effects of the disease itself.

I'm not saying you should definitely go down the Prascend route if you don't want to, but don't be too worried about the veil, it's only a short stage in the grand scheme of things and you always have the option of taking them off the medication if you want.
Thank you for your post. That is VERY helpful and reassuring. Very good to know. Explains the disease very well. Thank you. I will keep that in mind!
 
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I think you are getting tests confused, you do not inject anything (def not steroids) to do the basic ACTH test, it's a simple blood pull to look at ACTH levels in the blood. There used to be a Dex supression test, but it's so ineffective for PPID testing it is never used now (although they do use the corn syrup test in EMS testing which is similar but no lami risk). TRH Stim Test is where they take a baseline blood pull, then inject with TR Hormone (basically at no risk, Rossdales quoted above did mine as they are my everyday vet) and then take another blood pull 10 mins after to see the difference. Its much more accurate and will show up borderline PPID when basic ACTH will miss them outside of the seasonal rise. The problem with PPID is that if ACTH is left high it will accelerate the disease, so even if they look good outside you need to manage the hormone dysfunction to slow its progression, I'm not judging, I have gone both routes in the past.
THANK YOU! This is EXACTLY the information I needed to understand at this point in time. Your help is so much appreciated!!!!! You speak from a unique perspective having gone both routes.
 
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This picture is NOT MY HORSE! Just to clarify. This was a picture included in the article on Chasteberry I copied and pasted above. My mare is a thoroughbred and does not look at all like this.
Thank you for clarifying that - I was having heart failure, lollol.

Ditto @Jessey the ACTH is a simple blood draw, nothing is injected into the horse:) Speaking of which I am still waiting for test results from week ago today.

The vet also vaccinated one of my dogs while he was here but didn’t leave the rabies tag & papers. The clinic is only ~22 miles away but it’s a hard 22 miles, mostly on winding back country roads, so I’m not enthused about making a trip for the dog stuff then another trip for the horse stuff😞. The other dog also has to go to the clinic, as she weighs ~100 pounds and can spin on her butt faster, to avoid needles, than a barrel horse can run barrels. It is a vision to behold😂😂. There is no way I can hold her still, lol. Oh - and DH has to leave work to help push/pull her out of the car as she seems to know any building that doesn’t look or smell like fast food hamburgers can’t be good😂🙄
 
My horse has been tested twice this year with TRH Stim test. Has not had a blood test for ACTH yet. I am going to ask for one. In January 2021 TRH Stim test was 85 (normal range). In early October TRH Stim test was 773. What do you all think of those numbers? I don't want to put her on a lifelong treatment based on a test that is not supposed to be done during seasonal rise due to elevated, incorrect values. I will ask for the ACTH blood test next.

In the meantime, I have put her on Poulin Carb Safe pellets which contains Chromium to help level out sugar and insulin spikes.

I am lowering her sugar and putting her on Poulin Carb Safe which is only 2.5% starch, 2.9% sugar. It also includes Chromium. Chromium is an essential trace element for horses, playing an important role in supporting healthy metabolism of carbohydrates in the diet. As a component of Glucose Tolerance Factor (GTF), chromium helps activate insulin receptors, improving glucose uptake in the cells, and helping to maintain normal blood sugar levels. In short, chromium puts glucose to work where it is most effectively used by the horse for immune function, growth, performance and overall health.
 
@Dori2021 you must be in the U.S. north of the Mason-Dixon in order to buy Poulin Feeds?? I looked at their horse products and they seem to be some of best out there.

I’m going on memory but I think they are still a family owned company and their horse feeds are a fixed formula, which is great and we don’t see much of these days:)

The carb safe does not have added iron which is a good thing.

What would nix this feed for me is that it uses soybean oil for its protein source. One of my horses is soy and grain sensitive and the other one is the one with metabolic issues and foundered pretty bad nine years ago.

I still think it could be a good feed for horses not in the depths of IR, just keep an eye on your horse for any out of the ordinary behavior or warm hooves:)

Regarding the TRH rest results — that’s a gigantic disparity in numbers from January to October. I would have my doubts as to the accuracy if this were my horse.
 
My horse has been tested twice this year with TRH Stim test. Has not had a blood test for ACTH yet. I am going to ask for one. In January 2021 TRH Stim test was 85 (normal range). In early October TRH Stim test was 773. What do you all think of those numbers? I don't want to put her on a lifelong treatment based on a test that is not supposed to be done during seasonal rise due to elevated, incorrect values. I will ask for the ACTH blood test next.
You should get 2 figures for the TRH test, a before and after (one for each lot of blood pulled) and also you'd need the reference range for the specific lab they are being sent to, not every lab does the test in the same way so they may not be comparable to one another unless the same lab was used for both.

I would suspect the October one was high because it is during the seasonal rise, but weather or not it was abnormally high for the time of year you'd need the labs reference range to know, and as already mentioned it isn't very accurate during the rise (from summer solstice to clock change ISH in the northern hemisphere, but tails off until the winter solstice) because the reference ranges have not been well established.

The TRH stim test is the 'better' test, when done outside of the seasonal rise, it's much more sensitive.
 
So do you think the TRH stim test is better than getting ACTH bloodwork pulled? Sounds like that is what you are saying. Very interesting about needing the 2 figures for the TRH test. Thanks for explaining.
 
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