I did create a case for this guys, but wasn't sure if my question would get reviewed/answered that way or if I needed to also submit a question on the general forum. Sorry if I am doubling up.
Benny has been diagnosed (2016) with Mitochondrial Myopathy which is an extremely rare mitochondrial disease where it sounds like cellular metabolism is deranged leading to a host of possible manifestations clinically. Benny's symptoms have come and gone in a cyclical manner over the last few years, but he’s now in an episode that is the worst that it’s been since his initial diagnosis in 2016. He falls down on the wood floors, is ataxic and can’t exercise normally. His rear leg muscles are totally atrophied. He’s an 8 year old border collie and can now only handle very short walks without becoming extremely fatigued. Additionally, he’s also biting/scratching obsessively since about a week ago. He also suffers from seizures (1 episode (7 or so “cluster” seizures in one episode) every 6 months or so.
He is taking Keppra (extended release) BID, CBD and a supplement called Mitochondrial recharge. He eats honest kitchen chicken dehydrated food. Lately, with this last episode he is not really wanting to eat and needs to be coaxed at each meal.
On PE he was bright and happy. Paretic in hindlimbs- hopping gait with limbs often crossing underneath him. He has mm atrophy in both hindlimbs, but no pain I could detect. His pruritus was hard to elicit, but o reports he is really struggling with that almost constantly and it seemed to come out of nowhere- no history of any skin or itching issues perviously. He had a hotspot/crusted are on the left caudolateral abdomen, but no other skin abnormalities or parasites I could detect. PULSES- weak, deep, slippery, wiry (when strengthened) TONGUE- slightly on the dry side, deep, darker pink
He is intolerant to the heat and when he has relapsed it has been in the summer months.
His last seizure event was 2 months ago. The seizures are suspected to be related this this disease and while infrequent occur as status epilepticus/cluster events that require hospitalization to stabilize.
For acupuncture: BL18 (t) didn’t do much but left in, BL20 (t) did strengthen the pulse some but not a ton, BL40 (t) helped, can feel pulse better, GB34 moderated/evened pulse, GB20 tonified made pulse worse, sedated improved pulse, GV14 sedated improved pulse.
My Chinese Medical diagnostic skills are definitely lacking sophistication (and possibly accuracy as well :)), but I was left with the impression of a disconnect between the upper and lower body. It seems like a SP qi def (with mm wasting and lack of appetite +/- damp) and TB obstruction at least in part because it seems like heat and yang energy are trapped in the upper body and head (seizures?) while the lower half and periphery is lacking circulation- itching, paresis. hotspot. He does have a lot of nighttime restlessness as well. Also the tongue and pulse really didn't match on initial eval. The pulse was barely palpable it was so weak and the tongue reflected more heat and less stagnation than I would expect.
I am also not familiar with this disease and wonder if the cellular metabolism aspect of it would change the herb approach. I was thinking about CHJLGMLT as maybe a safe place to start given the picture and also the relationship to heat, but with such a weak starting pulse I am not sure. I didn't pick up a lot of wind in the pulse either, but wonder about the need to address that as well. The pulse did get more superficial as it got stronger with needles, but not sure how useful that is as an indicator.
Thank you so much for this forum and any guidance you have to offer!
Kelly