Note: groups.io will be down for maintenance on Wednesday, October 5th, starting at 9AM Pacific Time (4PM Wednesday October 5, 2022 UTC), for approximately one hour.
Re: Recommendations on starting Metformin and Prascend
I can see the vet needing to order TRH and waiting 2 weeks for that to come in, but the insulin should be doable without delay. You could just ask for insulin and glucose (and baseline ACTH if you're suspicious of PPID).
Since she's still in pain, I think it's critical to get insulin now and then start her on Metformin right away while you are waiting for the insulin result, and schedule a retest after 2 weeks on Metformin.
Jamie's trim also needs work and could be responsible for some of the pain, so if you post a full round of hoof photos as described here, you can request markups to guide your trimmer.
Kirsten and Shaku (IR + PPID) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
Shaku's Photo Album