The dog has significant muscle loss over all four extremities, rear worse than fore, but spinal musculature is robust and strong. Pulse was strong and incompressible bilaterally, not super wiry but maybe on the edge. Tongue was pink, maybe a little pale. Later when she had a coughing spell, it looked more lavender at the base from across the room. The episode was 2 days old by this time, and she was able to rise on her own, but movement on right side looked very painful, got worse the more she walked around. +/- heat in R elbow, elbows were very abducted, hocks camped in. Bright and lively nonetheless. Possibly some slight heat over T-L junction, but could not elicit any pain. No restriction of neck movement. Owner says she still shakes, but would tend to fall over. Muscle fasciculation is seen by them often. She has been panting a lot more than usual this summer, O thinks she is hot. Dog is definitely Wood constitution, no surprise there for the breed. My muscle-skeletal diagnosis is that she has been weakening in the hind for a long time, but now something episodic is affecting her right elbow, which leaves her only one "good" leg to stand on, so she stays down until she gets over it. Trauma? There is another rambunctious young dog in the house. Or maybe she falls sometimes when they are not looking, because her rear is so wobbly. When these episode occur, they "help" her with a harness on the front end, not the rear, and she does fine, which is telling.
Ancillary info: 1) every August and September, she gets "yeasty" in her ears and toes, which she treats with herbal compresses and always resolves with the cooler weather. 2) for past year or two, has episodic "coughing" spells, "sounds like something stuck in her throat", soft cough, always ends with wide open mouth big effort. I observed one of these. Plum pit sensation? 3) has long history of slightly elevated Alk Phos and ALT. Was worse when rehab vets at Cornell put her on NSAIDS, so they stopped. Most recent BW in May, liver enzymes were around 200, all else pretty normal. 4) owner has been giving CBD in micro-doses, she thinks it has helped--pain? 5) full of lipomas.
When I put together the signs, everything screams Liver channel, except: lipomas, the season of onset, hot weather exacerbation and history of damp heat seasonally in her ears. She does not fit the signs for Liver Yin Deficiency-- GI is great at all times.
I was going to start with XCHT, but still feel unsettled about the damp heat component. Being that she is nearly 16 years old and that season is mostly over, should I just suck it up and see if she is alive to get an exacerbation next summer? I have advised them to change her diet to a minimal amount of processed food, plus cooling proteins for fresh component. Maybe that will be enough?
Thoughts anyone?