> she's currently getting noticeably worse over a few weeks, including breathing, and we are doing what we can to expedite the diagnosis and hopeful treatment

Please pay attention to lactate levels in her blood work. Difficulties with breathing tell me that she may have episodes of lactic acidosis, actually I'm pretty sure she has given the other manifestations. This also means that she is B1 and/or B12 deficient.

Please note that the correct blood test for B1 deficiency is the test for transketolase activity which is rare and quite expensive. Not those quantitative B1 tests that show literally nothing. This may be a gotcha for lots of people with actual B1 deficiency but whose B1 quantitative levels are ok. This is a typical situation of concern for a condition known as mitochondrial dysfunction. The most widely-known cause of induced mitochondrial dysfunction is malnutrition, see Beriberi. Another common cause is the episodes of hypoxia or ischemia.

The B12 deficiency can be detected quite easily in the widely accessible blood work. It leads to anemia and may induce mitochondrial dysfunction as well.

Once mitochondrial dysfunction is induced there is no way out without the medical intervention.

Here is the framework of a treatment for a patient with induced mitochondrial dysfunction:

a) Slightly suppress the inflammation

b) Slightly anti-coagulate the blood

c) Fix the induced condition (osteoporosis)

d) Fix other induced conditions. Heart, liver are most-commonly affected, a close attention should be paid to them.

e) Gradually repair the damage of mitochondrial apparatus while reducing tissue hypoxia

All these actions should be undertaken in parallel, not one by one.

And here is a practical example of how I would treat her, for reference:

1. CoQ-10 60 mg + Alpha-lipoic acid 60 mg, should be taken at least 30 minutes before the first meal, daily.

2. Multivitamin*** + B1** (Thiamine Chloride, HCL) 250 mg + Benfotiamine 300 mg + Magnesium 100 mg + D3* 5000 I.U. + K2 MK7 100 mcg, right after the first meal, daily.

3. B3 (Nicothinamide Riboside or Nicothinamide) 100 mg, on an empty stomach between the first and second meals, daily.

4. Aspirin 300-500 mg or Ibuprofen 400 mg (but not both) right after the second meal, once in 2-4 days.

These medicals represent a so-called mitochondrial cocktail with an addition of NSAID.

Osteoporosis may require additional calcium supplementations.

Besides the medicals, the diet correction is obligatory. Lower the consumed sugar levels to less than 50 grams per day. Exclude the foods with glycemic index >= 50 from the everyday diet. There should be 3 meals: morning, day, evening. Do not overeat and do not be hungry. Prioritize quality fat products to hydrocarbonates (look at ketogenic diets for inspiration). Recommended everyday products: milk, eggs, meat, tomatoes, cucumbers, peppers, paprika, avocado, fatty fumed/salted fish (salmon, trout), black rice (not brown and not white!), barley porridge, cheese. Totally exclude tea and coffee. Avoid processed foods as they are poor in nutrients and may contain things like MSG which would cause neurotoxicity in patients with mitochondrial dysfunction.

Besides the medicals and diet, a life style corrections should be made. Everyday relaxed 45+ minutes walks are obligatory, but be sure that you have no bone pains in your feet. If you do, supplement with calcium and ensure that the specific pains go away before starting new physical activity sessions. Worries and responsibilities should be left behind. It is recommended to take at least 2 weeks sabbatical and devote it to the health.

Treatment progress control: after the first paradoxical reactions a patient should start to feel considerably better, and should continue to do that week after week. Sometimes there will be bitter regressions, but the overall course of treatment should be positive.

Blood work to pay attention to: lactic acid, transketolase, glucose, A1c, HOMA-IR, triglycerides, low-density lipoprotein (LDL), gamma-glutamyl transferase (GGT) and other hepatic markers. Be sure to exclude anemia. The closer the blood work to the norm, the better the person will feel.

* Periodically check the D3 levels in blood work to not become higher than normal, if it is then exclude D3 and K2 MK7.

** Therapeutical doses of B1 vitamin and vitamins in general may cause strong paradoxical reactions. Paradoxical reaction is when a patient perceives an imaginary worsening despite the fact that his condition is being improved. This means that the very first vitamin doses should be very small, just the tiniest pieces of a tablet, you can scrape them with a knife. Then the doses should be gradually increased to the recommended levels [1].

*** Multivitamin should contain Manganese. For example [2].

This protocol is for reference only and works better when it is adjusted to the conditions of a particular patient. The treatment takes months and sometimes years, depending on the age of the condition.

[1] https://www.hormonesmatter.com/refeeding-syndrome-thiamine-d...

[2] https://www.doppelherz.com/products/a-z-depot