Well, after literally spending hours in front of target dummies playing with macros and found a solution that worked. I can't remember exactly what they were as I'm not at home right now....


I start off by putting down a death and decay then spamming the button.

(spam button)
/use 14
/use 13
/click BT4Button41
/click BT4Button42


BT4Button41
#showtooltip
/castsequence reset=Combat Icy Touch, Plague Strike, Pestilence, Null
/cast !rune strike

BT4Button42
#showtooltip
/castsequence reset=Combat Blood Boil, Howling Blast, Obliterate, Pestilence
/cast !rune strike

I think that BTButton42 might be a bit longer.....I'll check later tonight.

So the first sequence puts frost fever and plague strike on my target followed by a pestilence to spread that around. This macro will only run once during combat. The second macro does a blood boil to help grab the threat in the early stages of the pull. There's a little bit of time where my runes are on cooldown...at this point there's normally enough RP for a frost strike. Then comes a howling blast which as well as causing AoE damage/threat refreshes the timer on frost fever....obliterate to cause damage, then pesitlence. As I have glyph of disease, pestilence refreshes frost fever and blood plague. Then it goes back to the beginning of the second sequence. I have runestrike in there to fire off whenever it's available. I'm also spamming the frost strike button to fire that off when there's enough RP. I'm probably going to try to macro this in.

I'll often change target at this point....as I've gathered enough threat on the first one....the obliterates and frost strikes help gather single target threat.