Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Suggest Treatment For Symptoms Of Severe Muscle Cramps, Nausea, Itchiness, And Kidney Pain When CK Is Mildly Elevated
Question: Hello, I am a 23 year old male. My CK levels was consistently mild for the last three times it was checked. The first time it was at 600 U/L with symptoms including sever muscle cramps, nausea, itchiness, and kidney pain. During this time I was in China and don't remember doing anything to cause this to happen. A few months later I returned to the US and went to the ER. The doctor checked my CK levels again and it was at 292 U/L, symptoms decreased. He wasn't sure what caused my CK levels to increase like that and felt that it may have been something in China that caused the increase. I got my CK levels rechecked for a third time a few weeks back and it went up to 466 U/L. The doctors also ordered a ESR, ANA, CBC, CMP, and C reactive protein, all normal. My doctor then referred me to a rheumatologist with suspicions of myopathy. My Rheumatologist didn't find any clinical weakness in his evaluation. He has since rechecked my CK, Aldolase and many other test and asked me to come back in 4 weeks. I am going to be honest with you, I am a bit concerned and the reason is because of my current symptoms. I have noticed when I raise my left arm I have muscle twitching in my shoulder. I also have some weakness. I can't tell if the weakness that I am feeling in the left arm is real ( I can lift things and work out), but I am sure I do have the twitching when I raise that same arm. This weakness is for sure not clinical, but this along with my CK being mildly elevated has sparked a reasonable amount of anxiety. I have trouble breathing and it seems to be effecting my sleep. At times it feels as though i am not getting enough air. Occasionally I can feel the kidney pain and muscle cramps like I felt when in China (but not as bad).
My mild CK levels and my left arm are the two things that are concerning me. What is you opinion on this?
Second, putting aside my symptoms for a second, If you where viewing my CK levels fluctuating like this, what would be the cause? Would you be concerned?
Now knowing everything I have told you, what would be the best course of action? Do you think this is myopathy or any other disease?
My doctor also performed a thyroid stimulating hormone (TSH) test and that was also normal. Just recently we have tested for PTH, aldolase, sjogren AB, anti-jo-1, and cortisol urine levels. That was two weeks ago and I have not received a call from my doctors office. To be honest I am concerned because a lot of my symptoms are overlapping with ALS/MD. I have a few questions that I was hoping you could help me with.
My mild CK levels and my left arm are the two things that are concerning me. What is you opinion on this?
Second, putting aside my symptoms for a second, If you where viewing my CK levels fluctuating like this, what would be the cause? Would you be concerned?
My mild CK levels and my left arm are the two things that are concerning me. What is you opinion on this?
Second, putting aside my symptoms for a second, If you where viewing my CK levels fluctuating like this, what would be the cause? Would you be concerned?
Now knowing everything I have told you, what would be the best course of action? Do you think this is myopathy or any other disease?
My doctor also performed a thyroid stimulating hormone (TSH) test and that was also normal. Just recently we have tested for PTH, aldolase, sjogren AB, anti-jo-1, and cortisol urine levels. That was two weeks ago and I have not received a call from my doctors office. To be honest I am concerned because a lot of my symptoms are overlapping with ALS/MD. I have a few questions that I was hoping you could help me with.
My mild CK levels and my left arm are the two things that are concerning me. What is you opinion on this?
Second, putting aside my symptoms for a second, If you where viewing my CK levels fluctuating like this, what would be the cause? Would you be concerned?
Brief Answer:
Elevated CK levels
Detailed Answer:
Hello. Many thanks for your question.
CK (Creatine Kinase) of the MUSCLE variety (MM) in males is considered normal up to 300 U/L In females the limits of upper normal are around 200. Therefore, the value of 466 only represents about a 33% increase in the upper limit of normal which on the 2nd draw was below the original value of 600. Taken together with the fact that all standard and very sensitive markers of inflammation such as CRP, ESR, and ANA I would not necessarily be overly concerned on the mild elevation. Be that as it may I do not disagree and think it was a good move to have a rheumatologist give an opinion. Good news from that exam was that he did not detect significant muscle weakness...nor were CK elevations all that notable to EXPECT muscle weakness.
If you are performing heavy duty activities such as working out, lifting weights, etc. and not noticing true blue muscle weakness then, I would not put much emphasis on perceived weakness doing lesser activities nor twitching since anxiety and stress can cause muscle twitching and can be seen normally in all individuals. Difficulty with breathing is more likely a manifestation of stress and anxiety as these muscles would be extremely hard pressed the FIRST muscles affected in some type of myopathy when in virtually every form of myopathy we know of...respiratory function is never significantly affected until the later and even latest stages of evolution.....therefore, a little "chill" will go a long way to help you sleep more comfortably right about now.
I believe that it is a good thought that something in China may have triggered the original elevation in your CK....though if you say there was no real muscle trauma, infection, medication/illicit drug use that could've produced those numbers then, it may be difficult to track the agent down unless some additional medical findings become apparent or you can recall additional details of your travels to China. For example, was there any episodes of diarrhea, fever, did you get vaccinations for malaria/other communicable diseases before traveling? Those sorts of things can and do cause CK elevations. Drinking lots of fluids especially water will bring CK down under those circumstances.
Again, to reiterate, I am not concerned about the CK elevations that you have demonstrated. They are not nearly high enough in both NUMERIC VALUE nor in escalation factor to be concerned for significant or important pathological processes as I explained above.
In a 25 year old otherwise healthy with mild CPK elevations in the absence of inflammatory markers, ALS/MND would be the last thing I'd place on a differential diagnosis list....and in fact, any concern regarding this should be discarded immediately since this is absolutely not the way ALS presents either clinically or by laboratory expression.
This query has utilized a total of 57 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Elevated CK levels
Detailed Answer:
Hello. Many thanks for your question.
CK (Creatine Kinase) of the MUSCLE variety (MM) in males is considered normal up to 300 U/L In females the limits of upper normal are around 200. Therefore, the value of 466 only represents about a 33% increase in the upper limit of normal which on the 2nd draw was below the original value of 600. Taken together with the fact that all standard and very sensitive markers of inflammation such as CRP, ESR, and ANA I would not necessarily be overly concerned on the mild elevation. Be that as it may I do not disagree and think it was a good move to have a rheumatologist give an opinion. Good news from that exam was that he did not detect significant muscle weakness...nor were CK elevations all that notable to EXPECT muscle weakness.
If you are performing heavy duty activities such as working out, lifting weights, etc. and not noticing true blue muscle weakness then, I would not put much emphasis on perceived weakness doing lesser activities nor twitching since anxiety and stress can cause muscle twitching and can be seen normally in all individuals. Difficulty with breathing is more likely a manifestation of stress and anxiety as these muscles would be extremely hard pressed the FIRST muscles affected in some type of myopathy when in virtually every form of myopathy we know of...respiratory function is never significantly affected until the later and even latest stages of evolution.....therefore, a little "chill" will go a long way to help you sleep more comfortably right about now.
I believe that it is a good thought that something in China may have triggered the original elevation in your CK....though if you say there was no real muscle trauma, infection, medication/illicit drug use that could've produced those numbers then, it may be difficult to track the agent down unless some additional medical findings become apparent or you can recall additional details of your travels to China. For example, was there any episodes of diarrhea, fever, did you get vaccinations for malaria/other communicable diseases before traveling? Those sorts of things can and do cause CK elevations. Drinking lots of fluids especially water will bring CK down under those circumstances.
Again, to reiterate, I am not concerned about the CK elevations that you have demonstrated. They are not nearly high enough in both NUMERIC VALUE nor in escalation factor to be concerned for significant or important pathological processes as I explained above.
In a 25 year old otherwise healthy with mild CPK elevations in the absence of inflammatory markers, ALS/MND would be the last thing I'd place on a differential diagnosis list....and in fact, any concern regarding this should be discarded immediately since this is absolutely not the way ALS presents either clinically or by laboratory expression.
This query has utilized a total of 57 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Doctor,
Thanks for the detailed reply. In your opinion, what do you think this can be then? I usually do a lot of research for the sake of learning but I know that this can backfire when trying to self diagnose. That is why your opinion is greatly valued.
I do know that sometimes I have muscle twitching all around. But the twitching that I have when raising my arm doesn't seem to make sense. For example, if I stand up and put both my hands on top of my head, I can feel cramping/twitching in my left shoulder. But if I am laying down on the bed and do the same thing, no twitching. It seems as though with slight activity from the shoulder muscle (or force of gravity), twitching is presented. What could be the cause for this?
I also forgot to mention that I have weakness in my right leg when waking up. I noticed it when I got up from my low resting bed. It seems as though something internal is building up while I sleep and the moment I wake up and move I feel the weakness. My walking is way off and the sensation lasted for approximately one minute. What could be the cause of this?
And lastly, what do you suggest from here on out? I am trying to move on from this yet it seems hard. There are things happening now since being back from China that has not happened before I left. I hope to figure this out soon.
Thanks for the detailed reply. In your opinion, what do you think this can be then? I usually do a lot of research for the sake of learning but I know that this can backfire when trying to self diagnose. That is why your opinion is greatly valued.
I do know that sometimes I have muscle twitching all around. But the twitching that I have when raising my arm doesn't seem to make sense. For example, if I stand up and put both my hands on top of my head, I can feel cramping/twitching in my left shoulder. But if I am laying down on the bed and do the same thing, no twitching. It seems as though with slight activity from the shoulder muscle (or force of gravity), twitching is presented. What could be the cause for this?
I also forgot to mention that I have weakness in my right leg when waking up. I noticed it when I got up from my low resting bed. It seems as though something internal is building up while I sleep and the moment I wake up and move I feel the weakness. My walking is way off and the sensation lasted for approximately one minute. What could be the cause of this?
And lastly, what do you suggest from here on out? I am trying to move on from this yet it seems hard. There are things happening now since being back from China that has not happened before I left. I hope to figure this out soon.
Brief Answer:
CK rise after trip to China likely NOT indicative of muscle disease
Detailed Answer:
I've read your questions wishing to know "what" this could be, however, need to ask you to recall what I stated in the beginning of the last response.
I will repeat those statements for your convenience in which several questions were posed that could point to REASONS why the CK may have elevated in China....if in fact, that's where the initial insult started.
"I believe that it is a good thought that something in China may have triggered the original elevation in your CK....though if you say there was no real muscle trauma, infection, medication/illicit drug use that could've produced those numbers then, it may be difficult to track the agent down unless some additional medical findings become apparent or you can recall additional details of your travels to China. For example, was there any episodes of diarrhea, fever, did you get vaccinations for malaria/other communicable diseases before traveling? Those sorts of things can and do cause CK elevations. Drinking lots of fluids especially water will bring CK down under those circumstances.
Again, to reiterate, I am not concerned about the CK elevations that you have demonstrated. They are not nearly high enough in both NUMERIC VALUE nor in escalation factor to be concerned for significant or important pathological processes as I explained above."
Also, I understand your concerns for muscle disease being present of the MOTOR NEURON type such as ALS, however, as both I and another consultant have stated your AGE and overall presentation coupled with the fact that another physician who examined you could not find any definite muscle weakness strongly speak AGAINST those diagnoses.
However, if you feel you are in fact weak in muscle strength or that the twitchings have some clinical meaning associated with the CK elevations then, I would suggest an evaluation by a neurologist (Neuromuscular specialist) at this point in order to look at you for that type of problem. I understand your points about the shoulder girdle right leg weakness that you feel may be present and have no immediate explanation for that since I've not had the opportunity to examine you. These would be questions for the NEUROLOGY EXAMINER to answer for you....or test out using other methods, however, it seems to me that your CK levels are trending downward...and this is a good thing.
I agree that doing a bit of investigation on the internet is not only tempting....but when done judiciously by non-medical folks can be quite educating and even helpful when trying to assess problems. However, in my opinion, the vast majority of medical information which is available to EVERYONE is highly mis-interpretable, and almost never applies since medicine is the study of human ailment in the context of the whole person which is proper history, evolution, PHYSICAL EXAMINATION, and then, diagnostics.
If one tries to find the answer (sometimes a needle in the haystack" by only considering isolated symptoms or isolated blood or other tests....one usually gets misled down a path that leads only to unnecessary anxiety and fear.
My suggestion going forward is to continue documenting those things you find "off" from China, sitting down calmly and carefully thinking whether any of what you are feeling could've possibly happened before the CHINA TRIP, and to recall anything that you might've experienced such as transient loose bowels, diarrhea, etc. that could've occurred which you passed off. I would drink generous amounts of fluids (water and juices mostly), and consider seeing a NEUROMUSCULAR SPECIALIST if indeed you believe there to be muscle weakness that was otherwise missed by the last doctor who examined you.
Of course, you've also mentioned that other lab tests have been obtained that may be pending so you need to get those results and have them properly interpreted by the appropriate specialist in order to rule out things that may still be under suspicion from a rheumatological point of view.
I continue to place MOTOR NEURON DISEASE/ALS in the basement of possibilities at this point and believe they shall likely remain there even following future workups! That's a good thing.
Once again, if I've provided useful and helpful information to your questions could you do me the favor of CLOSING the query and including positive feedback with a 5 STAR rating? Again, many thanks for submitting your inquiry and please let me know how things turn out. If you are having trouble getting a timely appointment with a neurologist or neuromuscular specialist in your area I would pleased to see you in my office which is in the XXXXXXX OH part of the country depending on your ability to travel a bit to see doctors. We also have a plethora of specialists with whom I've connected in the event your problem requires other input.
Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.
This query has utilized a total of 90 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
CK rise after trip to China likely NOT indicative of muscle disease
Detailed Answer:
I've read your questions wishing to know "what" this could be, however, need to ask you to recall what I stated in the beginning of the last response.
I will repeat those statements for your convenience in which several questions were posed that could point to REASONS why the CK may have elevated in China....if in fact, that's where the initial insult started.
"I believe that it is a good thought that something in China may have triggered the original elevation in your CK....though if you say there was no real muscle trauma, infection, medication/illicit drug use that could've produced those numbers then, it may be difficult to track the agent down unless some additional medical findings become apparent or you can recall additional details of your travels to China. For example, was there any episodes of diarrhea, fever, did you get vaccinations for malaria/other communicable diseases before traveling? Those sorts of things can and do cause CK elevations. Drinking lots of fluids especially water will bring CK down under those circumstances.
Again, to reiterate, I am not concerned about the CK elevations that you have demonstrated. They are not nearly high enough in both NUMERIC VALUE nor in escalation factor to be concerned for significant or important pathological processes as I explained above."
Also, I understand your concerns for muscle disease being present of the MOTOR NEURON type such as ALS, however, as both I and another consultant have stated your AGE and overall presentation coupled with the fact that another physician who examined you could not find any definite muscle weakness strongly speak AGAINST those diagnoses.
However, if you feel you are in fact weak in muscle strength or that the twitchings have some clinical meaning associated with the CK elevations then, I would suggest an evaluation by a neurologist (Neuromuscular specialist) at this point in order to look at you for that type of problem. I understand your points about the shoulder girdle right leg weakness that you feel may be present and have no immediate explanation for that since I've not had the opportunity to examine you. These would be questions for the NEUROLOGY EXAMINER to answer for you....or test out using other methods, however, it seems to me that your CK levels are trending downward...and this is a good thing.
I agree that doing a bit of investigation on the internet is not only tempting....but when done judiciously by non-medical folks can be quite educating and even helpful when trying to assess problems. However, in my opinion, the vast majority of medical information which is available to EVERYONE is highly mis-interpretable, and almost never applies since medicine is the study of human ailment in the context of the whole person which is proper history, evolution, PHYSICAL EXAMINATION, and then, diagnostics.
If one tries to find the answer (sometimes a needle in the haystack" by only considering isolated symptoms or isolated blood or other tests....one usually gets misled down a path that leads only to unnecessary anxiety and fear.
My suggestion going forward is to continue documenting those things you find "off" from China, sitting down calmly and carefully thinking whether any of what you are feeling could've possibly happened before the CHINA TRIP, and to recall anything that you might've experienced such as transient loose bowels, diarrhea, etc. that could've occurred which you passed off. I would drink generous amounts of fluids (water and juices mostly), and consider seeing a NEUROMUSCULAR SPECIALIST if indeed you believe there to be muscle weakness that was otherwise missed by the last doctor who examined you.
Of course, you've also mentioned that other lab tests have been obtained that may be pending so you need to get those results and have them properly interpreted by the appropriate specialist in order to rule out things that may still be under suspicion from a rheumatological point of view.
I continue to place MOTOR NEURON DISEASE/ALS in the basement of possibilities at this point and believe they shall likely remain there even following future workups! That's a good thing.
Once again, if I've provided useful and helpful information to your questions could you do me the favor of CLOSING the query and including positive feedback with a 5 STAR rating? Again, many thanks for submitting your inquiry and please let me know how things turn out. If you are having trouble getting a timely appointment with a neurologist or neuromuscular specialist in your area I would pleased to see you in my office which is in the XXXXXXX OH part of the country depending on your ability to travel a bit to see doctors. We also have a plethora of specialists with whom I've connected in the event your problem requires other input.
Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.
This query has utilized a total of 90 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello again,
I recently got my results from the rheumatologist and my CK levels are back down to 291 U/L. All the other tests that where performed to possibly indicate a muscle tissue disorder came back normal. It seems to me that my baseline is at around 290 since that always seems to be where it ends up. My PCP and rheumatologist have conflicting information on whether that is my normal CK level.
I did take some time to think of everything that has happened before and during the trip. I do have a family history of high blood pressure and my doctors always mention it being high when I have regular check ups. Though I didn't have anything suspicious enough back then to spark any concern in them. During the trip however, I remember going to the cardio doctor in China and given spironolactone and hydrochlorothiazide (since it was a Chinese version not sure how credible they where) for my high blood pressure. I tried it for a few days and a week later is when I noticed my itchiness, nausea, kidney pain. Went to the hospital and was told that I may have acute renal failure since the Creatinine and creatine kinase levels where high (CK 600 and Creatinine was 430) and I was getting most of the symptoms of renal failure. Stopped taking the diuretics but had a few more episodes of kidney pain and nausea. A month later is when I returned to the states with my levels down to 292. As I stated before, the symptoms are not as bad but still present. Ex: the muscle cramps in China was sudden and painful. I would be sitting on the bus when all of a sudden my abs started to cramp. My current muscle cramps are more wide spread. Sometimes the fingers, the abs, the legs, and of course when I raise my arm. It seems that whatever has happened has left a mark which is why I am concerned. This is where things get difficult. As you stated, it may be hard to figure out the cause of this rise in CK and the symptoms. My two initial thoughts where the air pollution or the medicine I was taking. But since I stopped taking the meds and am currently not in China, it is hard to figure out which one was the cause. But I guess it doesn't matter since I am trying to move on.
Since my rheumatologist has ruled out any muscle tissue disorder, the only thing left is to decide if it is necessary to see a neurologist. You mentioned the inflammatory markers. All of them came back normal (still waiting for CCP but assuming that is fine). Does the absence of elevated inflammatory markers leads you to believe I don't need to see a Neurologist or is that just to rule out a muscle tissue disorder?
Is there any correlation between neurological disorders and air pollution, medications, etc?
Thank you for your time.
I recently got my results from the rheumatologist and my CK levels are back down to 291 U/L. All the other tests that where performed to possibly indicate a muscle tissue disorder came back normal. It seems to me that my baseline is at around 290 since that always seems to be where it ends up. My PCP and rheumatologist have conflicting information on whether that is my normal CK level.
I did take some time to think of everything that has happened before and during the trip. I do have a family history of high blood pressure and my doctors always mention it being high when I have regular check ups. Though I didn't have anything suspicious enough back then to spark any concern in them. During the trip however, I remember going to the cardio doctor in China and given spironolactone and hydrochlorothiazide (since it was a Chinese version not sure how credible they where) for my high blood pressure. I tried it for a few days and a week later is when I noticed my itchiness, nausea, kidney pain. Went to the hospital and was told that I may have acute renal failure since the Creatinine and creatine kinase levels where high (CK 600 and Creatinine was 430) and I was getting most of the symptoms of renal failure. Stopped taking the diuretics but had a few more episodes of kidney pain and nausea. A month later is when I returned to the states with my levels down to 292. As I stated before, the symptoms are not as bad but still present. Ex: the muscle cramps in China was sudden and painful. I would be sitting on the bus when all of a sudden my abs started to cramp. My current muscle cramps are more wide spread. Sometimes the fingers, the abs, the legs, and of course when I raise my arm. It seems that whatever has happened has left a mark which is why I am concerned. This is where things get difficult. As you stated, it may be hard to figure out the cause of this rise in CK and the symptoms. My two initial thoughts where the air pollution or the medicine I was taking. But since I stopped taking the meds and am currently not in China, it is hard to figure out which one was the cause. But I guess it doesn't matter since I am trying to move on.
Since my rheumatologist has ruled out any muscle tissue disorder, the only thing left is to decide if it is necessary to see a neurologist. You mentioned the inflammatory markers. All of them came back normal (still waiting for CCP but assuming that is fine). Does the absence of elevated inflammatory markers leads you to believe I don't need to see a Neurologist or is that just to rule out a muscle tissue disorder?
Is there any correlation between neurological disorders and air pollution, medications, etc?
Thank you for your time.
Brief Answer:
I see no need to for a neurological consult BUT here's a number:
Detailed Answer:
Thank you for your follow up concerns.
I am glad to hear that your CK levels are back down to the 290 level. That is well within normal limits in my books and usually to drive levels to their ultimate nadirs (lowest levels) one only need hydrate with a generous quantity of water over a 24-48 hr. period so that urine becomes clear and then, check levels. In the absence of muscle disease or inflammation (which appears to be the case for you) the CK levels obtained after such rigorous hydration should be your resting levels of this enzyme. At that point you can use that value as the "TIE- BREAKER" to tell whether your PCP or rheumatologist are right in saying that 290 is your resting baseline or not. Frankly, CK levels can vary dramatically during the day and at night and especially after heavy physical activity. It actually changes as frequently and as much as a person's blood pressure since the concentration in blood represents the sum total/average of liberated enzymes that are "leaking" out of muscle tissue that is normally metabolizing and undergoing wear and tear phenomenon. There's always going to be a baseline amount of CK in the bloodstream.
Therefore, based on that fact and coupled with the rheumatologist who has given you a thorough workup by laboratory as well as examination means and found no significant or compelling evidence for muscle disease (and actually....a maximum of 600-700 is actually QUITE LOW by "muscle disease" standards. Those types of numbers are more consistent with a transient and clinically trivial circumstance which now appears to be resolving on its own without any specific measures.
I do not believe that your description to this point of your physical parameters warrants a visit to the neurologist since they will likely only want to see the laboratories that have already been obtained and do a brief examination. My belief is they will find no muscle weakness of a neuro or myopathic type and therefore, no real neurological diagnosis is possible in your case.
I believe what happened to you was a fully biochemical/metabolic sequence of events that involved a process of acute inflammation due to unknown etiology (underlying cause). I have never heard of any published or otherwise reported cases of air pollution causing acute phase reactant elevations (CK). Such elevations (as I've explained before) are more due to either transient infection, metabolic disturbances that somehow IRRITATE muscle fibers, acute DEHYDRATION/LOSS OF WEIGHT, medication side effects, or acute physical activity/exertion. Generally, these events have a lead time of 24-72 hrs. before enzyme elevations become apparent. However self limited and benign cases of CK elevations almost always subside from a few days to few weeks and also by simple hydration and proper diet.
I am equally as BENIGNLY excited about the theory that anything "permanent" has occurred because of the relatively low levels of CK elevations seen in your case. Most elevations that are significant get up at least in the several thousand if not tens of thousands of units ranges and do not quickly come down at all. They go on to cause many other organ system problems which are typically taken care of in the hospital (not as an outpatient as in your case) due to tyhe threat of organ/system shutdown.
None of this has happened therefore, I would not dwell on other things since the cause of this episode will likely remain a mystery. The most important thing is that your numbers are to normal and the lab tests to date have all been normal as well suggesting that there is NO ACTIVE INFLAMMATION going on in the body.
I did mention medications as being a COMMON CULPRIT of CK elevations. I would not be a bit surprised if the herbal/homeopathic medication you took in China were the cause....wouldn't be the first time something like this has happened. But by the same token, your taking that medication was transient and so I wouldn't expect any long term or permanent sequelae to have occurred.
Therefore, I would not dwell or allow the topic to run away with your imagination so to speak. If you are going to be dead-set on getting a neurological examination done then, maybe I will throw this out as a possibility which is to consider scheduling yourself to see me in my office in XXXXXX. I say this since I am certain that by this point I will have much more knowledge about your overall situation then, anybody you may be going to on a 2nd opinion basis. I am capable of having the office schedule you in less than 1 weekI would have ready access within 24-48 hrs. to perform any number of ancillary tests such as EMG/NCV studies, LP punctures, and/or MRI's, etc. if necessary.
However, please let me be clear. I truly don't believe that additional testing is necessary at this point in time. I truly don't believe that seeing more specialists are necessary at this time, and I truly believe (based upon all the available data and description of your physical status) that this was a transient and quite benign episode of CK elevation that likely happen to a slightly lesser or even greater extent in virtually all human beings at some point in their lives between infancy and the elderly state. All the same, my office can make very expeditious arrangements to get you seen and tested as necessary in a matter of days if you so choose. If you'd like more information on having an in office full consultation for a neurological examination including a discussion and review of all events leading up to when you felt most out of sorts
Many thanks for submitting your inquiry and please let me know how things turn out. We also have a plethora of specialists with whom I've connected in the event your problem requires other input.
This query has utilized a total of 117 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
I see no need to for a neurological consult BUT here's a number:
Detailed Answer:
Thank you for your follow up concerns.
I am glad to hear that your CK levels are back down to the 290 level. That is well within normal limits in my books and usually to drive levels to their ultimate nadirs (lowest levels) one only need hydrate with a generous quantity of water over a 24-48 hr. period so that urine becomes clear and then, check levels. In the absence of muscle disease or inflammation (which appears to be the case for you) the CK levels obtained after such rigorous hydration should be your resting levels of this enzyme. At that point you can use that value as the "TIE- BREAKER" to tell whether your PCP or rheumatologist are right in saying that 290 is your resting baseline or not. Frankly, CK levels can vary dramatically during the day and at night and especially after heavy physical activity. It actually changes as frequently and as much as a person's blood pressure since the concentration in blood represents the sum total/average of liberated enzymes that are "leaking" out of muscle tissue that is normally metabolizing and undergoing wear and tear phenomenon. There's always going to be a baseline amount of CK in the bloodstream.
Therefore, based on that fact and coupled with the rheumatologist who has given you a thorough workup by laboratory as well as examination means and found no significant or compelling evidence for muscle disease (and actually....a maximum of 600-700 is actually QUITE LOW by "muscle disease" standards. Those types of numbers are more consistent with a transient and clinically trivial circumstance which now appears to be resolving on its own without any specific measures.
I do not believe that your description to this point of your physical parameters warrants a visit to the neurologist since they will likely only want to see the laboratories that have already been obtained and do a brief examination. My belief is they will find no muscle weakness of a neuro or myopathic type and therefore, no real neurological diagnosis is possible in your case.
I believe what happened to you was a fully biochemical/metabolic sequence of events that involved a process of acute inflammation due to unknown etiology (underlying cause). I have never heard of any published or otherwise reported cases of air pollution causing acute phase reactant elevations (CK). Such elevations (as I've explained before) are more due to either transient infection, metabolic disturbances that somehow IRRITATE muscle fibers, acute DEHYDRATION/LOSS OF WEIGHT, medication side effects, or acute physical activity/exertion. Generally, these events have a lead time of 24-72 hrs. before enzyme elevations become apparent. However self limited and benign cases of CK elevations almost always subside from a few days to few weeks and also by simple hydration and proper diet.
I am equally as BENIGNLY excited about the theory that anything "permanent" has occurred because of the relatively low levels of CK elevations seen in your case. Most elevations that are significant get up at least in the several thousand if not tens of thousands of units ranges and do not quickly come down at all. They go on to cause many other organ system problems which are typically taken care of in the hospital (not as an outpatient as in your case) due to tyhe threat of organ/system shutdown.
None of this has happened therefore, I would not dwell on other things since the cause of this episode will likely remain a mystery. The most important thing is that your numbers are to normal and the lab tests to date have all been normal as well suggesting that there is NO ACTIVE INFLAMMATION going on in the body.
I did mention medications as being a COMMON CULPRIT of CK elevations. I would not be a bit surprised if the herbal/homeopathic medication you took in China were the cause....wouldn't be the first time something like this has happened. But by the same token, your taking that medication was transient and so I wouldn't expect any long term or permanent sequelae to have occurred.
Therefore, I would not dwell or allow the topic to run away with your imagination so to speak. If you are going to be dead-set on getting a neurological examination done then, maybe I will throw this out as a possibility which is to consider scheduling yourself to see me in my office in XXXXXX. I say this since I am certain that by this point I will have much more knowledge about your overall situation then, anybody you may be going to on a 2nd opinion basis. I am capable of having the office schedule you in less than 1 weekI would have ready access within 24-48 hrs. to perform any number of ancillary tests such as EMG/NCV studies, LP punctures, and/or MRI's, etc. if necessary.
However, please let me be clear. I truly don't believe that additional testing is necessary at this point in time. I truly don't believe that seeing more specialists are necessary at this time, and I truly believe (based upon all the available data and description of your physical status) that this was a transient and quite benign episode of CK elevation that likely happen to a slightly lesser or even greater extent in virtually all human beings at some point in their lives between infancy and the elderly state. All the same, my office can make very expeditious arrangements to get you seen and tested as necessary in a matter of days if you so choose. If you'd like more information on having an in office full consultation for a neurological examination including a discussion and review of all events leading up to when you felt most out of sorts
Many thanks for submitting your inquiry and please let me know how things turn out. We also have a plethora of specialists with whom I've connected in the event your problem requires other input.
This query has utilized a total of 117 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for your detailed reply and the invitation to your office.
Ok so the last thing to talk about then would be the symptoms. I want to know in your honest opinion if this is anything to be concerned about from a neurological standpoint. I do understand that symptoms can and will vary from person to person. I will try and be as detailed as possible with everything.
As you know I am having breathing problems. At night I feel as though I am not getting enough air which keeps me awake (sometimes wakes me up during the night). A bit of history, I do have very large turbinates in my nose since I was a child (larger now more than ever before). In the past, when I would get a cold they would completely block my nasal passage and I wouldn't be able to breath through the nose, hence mouth breathing, but that was only when I had a cold and I would never be woken up at night. It's blocked all the time now and am not sure why. Anyways, I noticed that when I breath through my nose at night I can sense (during sleep) that something isn't right. But I don't switch to mouth breathing, so I wake up. It is like my body does not know to make that switch. I am having consistent burping/belching. Not sure if it is GERD/LPR because a lot of the times I wake up in the morning burping and belching without eating or drinking. These problems are during the day as well. Sometimes I would be really short of breath while running on a treadmill. I was told I have mild gastritis (endoscopy) but my gastroenterologist doesn't think it has anything to do with my breathing problems. I have had an echocardiogram and a pulmonary function test, both normal. I am honestly not sure whether it has anything to do with my diaphragm with all the muscle problems I am experiencing.
I am getting muscle twitches/cramps all over. I have had twitching in the past before but this seems a bit different. The twitching/cramps can happen when I am active or at rest. For example, I would be watching a movie and all of a sudden I feel a muscle in my leg twitch or my my whole finger twitch. Furthermore, I could be stretching or moving when all of a sudden I would get a cramp in a muscle group. Now as stated before, it is not as bad as when I was in china but it is still present.
Last thing of note is the weakness, right leg and left arm. If you asked me to do a push I could with no problem. If you asked me to stand on my toes I could no problem. That is what makes this strange because I can still feel it. It wouldn't do too much good talking about this since it wouldn't be considered clinical weakness. But still any thoughts would be appreciated.
I apologize if I repeated anything. I want to make sure you have enough information.
P.S. If there are any questions you have for me to better understand anything, please let me know.
Ok so the last thing to talk about then would be the symptoms. I want to know in your honest opinion if this is anything to be concerned about from a neurological standpoint. I do understand that symptoms can and will vary from person to person. I will try and be as detailed as possible with everything.
As you know I am having breathing problems. At night I feel as though I am not getting enough air which keeps me awake (sometimes wakes me up during the night). A bit of history, I do have very large turbinates in my nose since I was a child (larger now more than ever before). In the past, when I would get a cold they would completely block my nasal passage and I wouldn't be able to breath through the nose, hence mouth breathing, but that was only when I had a cold and I would never be woken up at night. It's blocked all the time now and am not sure why. Anyways, I noticed that when I breath through my nose at night I can sense (during sleep) that something isn't right. But I don't switch to mouth breathing, so I wake up. It is like my body does not know to make that switch. I am having consistent burping/belching. Not sure if it is GERD/LPR because a lot of the times I wake up in the morning burping and belching without eating or drinking. These problems are during the day as well. Sometimes I would be really short of breath while running on a treadmill. I was told I have mild gastritis (endoscopy) but my gastroenterologist doesn't think it has anything to do with my breathing problems. I have had an echocardiogram and a pulmonary function test, both normal. I am honestly not sure whether it has anything to do with my diaphragm with all the muscle problems I am experiencing.
I am getting muscle twitches/cramps all over. I have had twitching in the past before but this seems a bit different. The twitching/cramps can happen when I am active or at rest. For example, I would be watching a movie and all of a sudden I feel a muscle in my leg twitch or my my whole finger twitch. Furthermore, I could be stretching or moving when all of a sudden I would get a cramp in a muscle group. Now as stated before, it is not as bad as when I was in china but it is still present.
Last thing of note is the weakness, right leg and left arm. If you asked me to do a push I could with no problem. If you asked me to stand on my toes I could no problem. That is what makes this strange because I can still feel it. It wouldn't do too much good talking about this since it wouldn't be considered clinical weakness. But still any thoughts would be appreciated.
I apologize if I repeated anything. I want to make sure you have enough information.
P.S. If there are any questions you have for me to better understand anything, please let me know.
Brief Answer:
Please feel free to reread above descriptions
Detailed Answer:
Your additional questions and commentary about the "symptoms" would only result in my boring you once again with the exact same responses which are detailed above. None of your presentation, in my opinion, as a neurologist require the attention of a neurologist nor testing for neurological sequelae. Please see above.
I believe that your condition was one of a transient biochemical/metabolic nature (again as stated above) which will be very difficult to pinpoint since all parameters appear to have returned to baseline by your report. In addition, there are no indicators of either acute or chronic inflammation therefore, as things stand I HONESTLY believe that you have recovered from the brunt of whatever it was that stimulated your system to behave by spilling a LITTLE bit of muscle enzyme into your bloodstream. However, the gates have closed and clinically you are assessed as normal.
The invitation remains open to you to visit us in XXXXXXX if you would like to confirm the findings of the rheumatologist or anybody else who has examined you, however, I think that would be overkill and costly on your part. I believe you would be benefited greatly by not dwelling any further on what's going on at this point...not even twitching muscles if they happen to occur since that phenomenon can also occur in people without elevations in CK and unless there are other neurological signs or symptoms of significance happening....we never treat such occurrences since it would suppose we knew exactly what the underlying cause is....though somehow we are virtually certain after a point in time that such muscle twitching is totally benign.
"Feeling" weak and BEING weak are 2 separate things with the former being a purely SUBJECTIVE and individual feeling while the latter is something that a 3rd party observer can verify and even quantify. I believe if you get with someone who can help you sort through the issues of anxiety and stress that you've been placed under by virtue of having gone through these last few months.....you may find that your perceptions may actually start leveling out and you will feel much better.
Once again, if I've provided useful and helpful information to your questions could you do me the favor of CLOSING the query and including positive feedback with a 5 STAR rating? Again, many thanks for submitting your concerns and please let me know how things turn out. Do let me know if you'd like to make a trip to XXXXXX and I will gladly have the staff contact you for a rapid response appointment....however, quite frankly, I don't think an examination will add much more information to what we already know....but all the same, I am happy to give you a full revision and neurological assessment.
This query has utilized a total of 135 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Please feel free to reread above descriptions
Detailed Answer:
Your additional questions and commentary about the "symptoms" would only result in my boring you once again with the exact same responses which are detailed above. None of your presentation, in my opinion, as a neurologist require the attention of a neurologist nor testing for neurological sequelae. Please see above.
I believe that your condition was one of a transient biochemical/metabolic nature (again as stated above) which will be very difficult to pinpoint since all parameters appear to have returned to baseline by your report. In addition, there are no indicators of either acute or chronic inflammation therefore, as things stand I HONESTLY believe that you have recovered from the brunt of whatever it was that stimulated your system to behave by spilling a LITTLE bit of muscle enzyme into your bloodstream. However, the gates have closed and clinically you are assessed as normal.
The invitation remains open to you to visit us in XXXXXXX if you would like to confirm the findings of the rheumatologist or anybody else who has examined you, however, I think that would be overkill and costly on your part. I believe you would be benefited greatly by not dwelling any further on what's going on at this point...not even twitching muscles if they happen to occur since that phenomenon can also occur in people without elevations in CK and unless there are other neurological signs or symptoms of significance happening....we never treat such occurrences since it would suppose we knew exactly what the underlying cause is....though somehow we are virtually certain after a point in time that such muscle twitching is totally benign.
"Feeling" weak and BEING weak are 2 separate things with the former being a purely SUBJECTIVE and individual feeling while the latter is something that a 3rd party observer can verify and even quantify. I believe if you get with someone who can help you sort through the issues of anxiety and stress that you've been placed under by virtue of having gone through these last few months.....you may find that your perceptions may actually start leveling out and you will feel much better.
Once again, if I've provided useful and helpful information to your questions could you do me the favor of CLOSING the query and including positive feedback with a 5 STAR rating? Again, many thanks for submitting your concerns and please let me know how things turn out. Do let me know if you'd like to make a trip to XXXXXX and I will gladly have the staff contact you for a rapid response appointment....however, quite frankly, I don't think an examination will add much more information to what we already know....but all the same, I am happy to give you a full revision and neurological assessment.
This query has utilized a total of 135 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
