It’s so good to hear back from you, and especially with what sounds like a good report overall! I think you’re on the right track and will be hoping for continued improvement as time goes on. Since Coco’s symptoms are not yet as well controlled as you’d like, if her cortisol has not come down more at this next testing, your vet’s recommendation to lower her cortisol further makes sense to me. She is right that many specialized clinicians prefer a post-ACTH result that is around 5-6 ug/dL. And in honesty, even Dechra (Vetoryl manufacturer) recommends aiming for a post-ACTH level lower than 9 ug/dL if a dog appears to be generally well but Cushing’s symptoms haven’t resolved as much as hoped. Here’s a link to one of their treatment and monitoring publications. It’s lengthy, but if you scroll to the very bottom, you’ll find a flowchart that illustrates their treatment recommendations.
https://dechra-us.com/Files/Files/Su...chureFinal.pdf
So once again, I think you guys are doing great with hopefully more improvement to come :-))).
Marianne