Aloha

Forgive me if I am asking things that have been covered.  I did do a quick search but did not find an answer.  But there is so much data on this wonderful site that I could have missed it.
I have been trying since October to do blood work on Lulu.   In October one vet came out.  She did not spin it in 4 hours and forgot to send it, froze it and sent it in a couple of weeks later.  So, I don't trust the numbers on that.   Then I had another vet come out who lives closer.  She is a small animal vet, and only came out as a favor for me.  After several tries, she did get the blood, sent it in, but sent it in the wrong tubes.   She came a second time and couldn't catch the vein this time.  Then I had another vet come out, who got the blood, but isn't equipped to spin and send, so brought to my small animal vet to finish it off.  Again, something in the handling went awry.   Recently I had yet another vet come out, draw the blood and send it in, but they didn't follow my directions and sent it to UC Davis lab that doesn't do the insulin.   They are coming out on Monday again to give it another go.  But where I am going with this is I don't know her numbers despite trying.  
I live in Hawaii at about the 1200' elevation.  So, we do get colder in the winter.  We have had a couple of nights in the low 50's, maybe even a high 40.  Is this enough to set off a winter laminitis event?   Most nights in the high 50's, low 60's this time of year, but the odd night does dip down there.  She is in a covered 10-20 stall with half walls.  This was for air flow as I deal more with heat than cold issues.  
I have also been in the habit of grinding my metformin for the day all in the morning.  I set up the two syringes in the milk of magnesia.  I put the night dose in a refrigerator for the day and when I get home from work have it all prepped.  Would this practice possibly have reduced the effectiveness of the metformin?   
Other than that, I am following the emergency protocol pretty closely.   She gets the Triple crown balanced timothy cubes.  I have taken her off the timothy hay as that is untested and since Tractor Supply is one of my few sources I have never tested as they don't seem to get from the same locations when it is shipped per the local manager.  She also gets beet pulp RSR.  

Any thoughts are appreciated.  

Mahalo

Rose




--
Rose D in Hawaii 2022

case History:  https://ecir.groups.io/g/CaseHistory/files/Rose%20and%20Luluka
Photos:  https://ecir.groups.io/g/CaseHistory/album?id=277362

Hi Rose,

According to some horses here, the temperatures you mention are enough to set off winter laminitis.
But here's a good read,for more info,from Dr. Kellon.
https://drkhorsesense.wordpress.com/2022/12/20/hoof-pain-triggered-by-cold/


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Lorna in Eastern Ontario
2002

Hi Rose. If I am understanding your post- Lulu has painful feet? if that is a yes....we recommend in cold temps less than 40-45 degrees, to wrap the legs- shipping  fleece lined wraps are fine and boot some wool socks on with boots to keep the hooves warm.  The metformin sounds like it should be fine in the milk of magnesia  Metformin 08.08.20 FINAL (groups.io)   
--Take a look at the link I attached for details on metformin. I'm not sure how long Lulu has been on the metformin, but getting that insulin checked is really key to ensure its still working for her.

I'm sorry your having trouble with the vets following the lab protocol and procedure. Unfortunately, I double check every step ( including asking about the lab tubes and with 2 horses, I double check the names on the tubes too) and include a small cooler with ice, so that they can put it right on ice and not stand there and talk to me while it stays warm in their hand. I also have a copy of the procedure so I can share it with my vet before and during the visit. Especially a vet that is new to me and my horse. I have also asked them specifically if the tube will get back to the office in a timely fashion and I have offered to drive it back so that we can follow the protocol as much as possible...when I offer the cooler and the driving...they get the message that I am not fooling around. these tests can get expensive and I want to make sure they are accurate, and I tell the vet that too...
Trisha DePietro
Aug 2018
NH
Primary Responder
Dolly and Hope's Case Histories
Dolly's Photos 
Hope's Photos 
HOW TO SEARCH THE ARCHIVES: https://ecir.groups.io/g/main/wiki/1993     

Aloha

Thank you for your replies.  Yes she appears to have hood pain and is walking very slowly.  On the blood draw every single vet that has come out has been given a copy of the protocol from the group and verified that they knew it and were following it.  Hoping that the vet that comes out today finally has it so I know her numbers.  In the meantime was going to put her on the jherb.  

I have read the metformin protocol but am still not clear as it does say the metformin can have reduced shelf life.  However my process of grinding a days worth in the morning and preparing the syringes.  Do you think that would reduce the pm effectiveness? 

mahalo Rose 
--
Rose D in Hawaii 2022

case History:  https://ecir.groups.io/g/CaseHistory/files/Rose%20and%20Luluka
Photos:  https://ecir.groups.io/g/CaseHistory/album?id=277362

Rose....I don't think grinding the pills in the am and administering the powder in the pm will have much effect on the potency of the pills. I looked at both our site and the site where I work and I couldn't find anything specific. 

As long as you store the medication at the appropriate temps, I think it should be fine for that time frame. The other piece to know about metformin is that eventually, it doesn't work for horses. Again, each horse is different, but in this scenario its not about shelf life, it is about long term efficacy. 

The sooner you get an accurate insulin test done, the sooner you will know if its working for the insulin. I am assuming, that because you have gone to Metformin, changing your diet to low sugar, low starch, less than 10% was not working for you?
--
Trisha DePietro
Aug 2018
NH
Primary Responder
Dolly and Hope's Case Histories
Dolly's Photos 
Hope's Photos 
HOW TO SEARCH THE ARCHIVES: https://ecir.groups.io/g/main/wiki/1993     

Hi, Rose. What we mean when we say metformin often loses some effectiveness with time is that it seems to stop working well after a while. This isn't a reference to the specific pills losing potency.

When you say, "my process of grinding a days worth in the morning and preparing the syringes, " are you keeping the metformin powdered in the syringes and mixing with a wet carrier in the syringe (like milk of magnesia) right before use?

I've ground metformin in advance with no decrease in results. I mixed with MOM right before syringing.
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Cass, Sonoma Co., CA 2012
ECIR Group Moderator
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