Brief Answer:
Diagnosis of disease and treatment

Detailed Answer:
Hi XXXXXXX thanks for asking from HCM.

I can understand your worry. You are having symptoms of muscular fatigue, weakness along with respiratory and cardiac complaints. It could be

: Muscular dystrophy
As you are 47 years old, few muscular dystrophies affect in 40-45 years age group like
Distal muscular dystrophy, Myotonica dystrophy, Limb girdle and Oculopharyngeal.
All these dystrophies are slowly progressive disease. There symptoms vary slightly. Main symptom is muscle weakness, early tiredness, acquiring chest infections due to respiratory muscle weakness. Area of muscle involvement varies in each type.

You can suspect it if
-You notice that while doing work your muscles get fatigued easily
- Weak cough
- Thinning of calves/biceps/forearm without any change in diet or any known illness
- Repeated chest infection
- Muscle fasciculations which are flickering movements noticed on muscles without its use. It can also occur normally in case of fatigue/lack of sleep/stress or anxiety
- Oculpharyngeal dystrophy mainly involves muscles of throat and oral cavity. Symptoms are difficulty in swallowing liquids/regurgiation/aspiration of food in chest/weak cough.
- In Myotonic Dystrophy, muscles relax late after contraction.

Your investigations were negative 2,1/2 years back. You can repeat few investigations to rule it out
: EMG of involved muscles
: If doubt, muscle biopsy
: MRI spine and brain and nerve conduction velocity (NCV) to rule out nervous system cause
: Chest X ray to know about chest infiltration
: ECG and ECHO of heart to know about stress, any impending heart failure


: Another cause is Anxiety panic disorder stress related. It can be suspected if other organic causes have been ruled out. The reason behind anxiety could be stress due to suspicion of dangerous disease. You can have all mentioned symptoms due to it.

To confirm it, kindly consult a "Psychiatrist". It can be treated by anti anxiety medication like Benzodiazepines, counselling and behavioural therapy.

There is one symptom which needs more evaluation and that is
Pain radiating from elbow to hand with tingling, more pain on lifting weight.
It could be due to cervical disc disease. It can be diagnosed by MRI cervical spine and involvement of nerve root can be further confirmed by NCV of suspected nerve root (C6,C7).

Meanwhile you should
: Avoid lifting weight
: Avoid neck flexion
: Avoid use of pillow while lying supine
: I am not advising any medication till diagnosis is confirmed.

Hope it will help you. Still in doubt, kindly let me know, I would be happy to help.

Thanks, take care.

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Brief Answer:
Diagnosis of disease and treatment

Detailed Answer:
Hi, welcome back.

It is good that your EMG was normal and it was negative 6 months ago only.
Regarding raised CK level, it could be elevated due to

: Muscle injury
: Strenuous exercise
: Polymyositis
: Muscle dystrophy
: Drug induced muscle damage
: Even intramuscular injection
: Neuromuscular disease etc.

I have mentioned all these causes to tell you that raised CK value could be due to any of above condition. Decreasing value is suggesting that it was some temporary damage or rise which got controlled on itself. Myopathies or myositis lead to persistent rise in CK value and very high values.

There is another CK which is CK-MB. It is specific for heart disease.
I have briefed you about normal CK level and its conditions, not CK-MB.

My advise is to get complete evaluation and relate your findings with conditions which were mentioned in previous answer. It will help in reaching unto some conclusion.

Hope it will help you. Thanks, take care.

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