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Dr. SH
Dr. SH, Board Certified Physician
Category: Medical
Satisfied Customers: 8765
Experience:  Doctor of Medicine
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I have had muscle pain for a year, particularly in my legs,

Resolved Question:

I have had muscle pain for a year, particularly in my legs, in April 2013 I had full blood tests and my CK total was 500. In May 2014 I was wrongly prescribed Zocor which I took for 10 days and also wrongly prescribed Metformin which I took for 2 weeks. I felt worse after this and the muscle pain has continued. In January 2014 I had full blood tests done and was found to have an elevated CK-MM total at 1,275 without explanation, LDH value was 328. I recently had a biopsy taken from my leg as the doctor suspected myopathy. The tests were done overseas and the results were inconclusive. I have been told I have to wait 4 months after the biopsy which was done in April to re-test CK total. Last ECG and EMG for muscle function were both normal. I do sometimes experience a burning rash across my face cheeks. Tests for Lupus also came back negative. I do not drink alcohol or take any other medication. I am struggling to get a clear explanation of my problem and really need some advice.
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. SH replied 2 years ago.

Dr. Shahzad MD :

Hi there. Thank you for your question. I will be helping you out with your queries

Dr. Shahzad MD :

Have you had your vitamin D levels checked?

Dr. Shahzad MD :

Please let me know.

Customer:

Hello - no I did not, but I have been taking Vitamin D supplements regularly

Dr. Shahzad MD :

I think that you should have a vitamin D test done to make sure its normal even though you are taking the vitamin D supplements regularly.

Dr. Shahzad MD :

Have you had your thyroid function checked?

Dr. Shahzad MD :

T3, T4 and TSH?

Customer:

Would the vitamin D levels affect the CK totals and muscles so much?

Customer:

Thyroid function was checked and is normal

Dr. Shahzad MD :

Yes low levels of vitamin D can cause myositis and high levels of muscle enzymes. Even though your level of 1275 is high but its not as high as you think.

Dr. Shahzad MD :

Its only mildly high.

Dr. Shahzad MD :

Levels in the thousands is something that is considered very high.

Customer:

I thought that the CK was very high as the range given for the blood rest was up to 300

Customer:

Is the test for Vitamin D just a standard blood test?

Dr. Shahzad MD :

Yes its a standard blood test.

Dr. Shahzad MD :

Done all over the world.

Dr. Shahzad MD :

Vitamin D deficiency is very common.

Dr. Shahzad MD :

Have you had your calcium levels checked as well?

Customer:

I

Test Results
Full Size Image

Customer:

I have just sent you my recent test and biopsy results, can you explain what they show other than high CK?

Customer:

I have not had calcium levels checked

Dr. Shahzad MD :

Please wait a moment

Dr. Shahzad MD :

When these levels were raised were you already on some kind of statins?

Dr. Shahzad MD :

or not?

Dr. Shahzad MD :

I think that you should have vitamin D and calcium along with phosphorus levels checked.

Dr. Shahzad MD :

statins = cholesterol medications like zocor.

Customer:

No statins initially, they were prescribed in May 2013 after my initial CK test which was at only 500 in April 2013

Customer:

I am just checking regarding the calcium test, I have had so many done that I am not sure

Customer:

But both drugs were prescribed when not actually needed, in the Philippines

Customer:

I did not have calcium levels checked

Dr. Shahzad MD :

You should have:
Calcium
Phosphate
Vitamin D levels
You should also be on all unnecessary medications because those are one of the most common causes of such elevation of muscle enzymes and symptoms like what you are having.

Dr. Shahzad MD :

I think that at the present moment you need to wait and get the CPK repeated after a few months to see how it goes and now your symptoms go. Plus I would recommend doing these tests that I mentioned in the meantime.

Customer:

All medications were stopped after 2 weeks and that was a year ago and I understand that those could not have caused permanent damage, is that correct?

Customer:

What would you determine to be really elevated CK totals?

Customer:

Should I not worry about these at the level they are?

Dr. Shahzad MD :

The really high levels are over 10,000

Dr. Shahzad MD :

Levels of over 1000 are high but not very high.

Dr. Shahzad MD :

They can be said to be mild to moderately high.

Dr. Shahzad MD :

Are you with me?

Customer:

Yes I understand, it's just getting very frustrating with the information I am being given being so conflicting and unfortunately a lot of the tests have been done in countries where the medical care is not so good

Customer:

Can you please confirm that the drugs I was prescribed should not have caused any permanent damage?

Dr. Shahzad MD :

i understand

Dr. Shahzad MD :

yes the damage is temporary in the vast majority of cases.

Dr. Shahzad MD :

I mean if its due to medications

Dr. Shahzad MD :

anymore questions?

Customer:

Could I just ask, if the tests for calcium etc etc come back OK, what would you suggest next?

Dr. Shahzad MD :

If calcium, vitamin D and phosphate come back normal, I would just wait for another CPK test to know how everything is going.

Customer:

Could you tell me what you would consider to be 'normal' CK levels? There is a lot of conflicting information out there

Customer:

i.e. what is the range

Dr. Shahzad MD :

Your CPK level at 500 was only very slightly elevated so if its dropping and comes down to this level or around this level I would be satisfied.

Customer:

But since then it has been around 1300 so that is a considerable change, during that time and since then nothing has changed in my personally including diet, lifestyle etc and that is why it is confusing

Customer:

So for a year now the levels have been elevated

Dr. Shahzad MD :

I understand that its frustrating.

Dr. Shahzad MD :

Have you had any antibody tests done?

Dr. Shahzad MD :

Like ANA, and antibodies against various muscle fibers?

Dr. Shahzad MD :

Have you been to a rheumatologist?

Customer:

I don't think so and I have not seen a rheumatologist, I was hoping to find one here

Dr. Shahzad MD :

there must be one around you somewhere.

Dr. Shahzad MD :

You should ask your doctor to refer you to one.

Dr. Shahzad MD :

I think that the person best equipped to manage you would be a rheumatologist as far as I am concerned.

Customer:

If only it were that simple! As noted I am in a country where the healthcare is very poor

Customer:

Can you note the tests that you would recommend

Customer:

Sorry I had ANA test, it was normal

Dr. Shahzad MD :

I think that first of all you should have:
Calcium
Phosphate
Vitamin D and then we will proceed from there.

Customer:

OK, did you see that I noted that I did have an ANA test and it was normal

Dr. Shahzad MD :

Yes

Dr. Shahzad MD :

There are many other antibody tests that also need to be done.

Customer:

What would you suggest?

Dr. Shahzad MD :

I would name a few antibody tests that should be done.

Dr. Shahzad MD :

Anti Jo 1 antibody.

Dr. Shahzad MD :

Anti Mi 2 antibody.

Dr. Shahzad MD :

anti-aminoacyl-tRNA synthetases

Dr. Shahzad MD :

Anti-SRP

Dr. Shahzad MD :

these are the main antibody tests

Dr. Shahzad MD :

ANA has already been done and was okay

Dr. Shahzad MD :

So that does not need to be repeated

Dr. Shahzad MD :

I would also like to do ESR and CRP tests done if you have not had those done already

Customer:

What are the last 2 for?

Dr. Shahzad MD :

To look for inflammation

Dr. Shahzad MD :

If there is inflammation anywhere in the body e.g. in the muscles these are supposed to be raised.

Dr. Shahzad MD :

In myositis they are usually raised.

Customer:

But I already had a biopsy done on my leg, the results of which is what I sent you - something else is needed?

Dr. Shahzad MD :

Sometimes inflammation is patchy.

Dr. Shahzad MD :

Meaning that the biopsy may not have hit a representative area.

Dr. Shahzad MD :

So even in cases where there is inflammation a negative biopsy still does not definitively rule out myositis.

Dr. Shahzad MD :

Sometimes MRI of the muscles are helpful in showing the inflamed areas of the muscles.

Customer:

What do the 2 tests you mention involve?

Dr. Shahzad MD :

MRI is like an x ray

Dr. Shahzad MD :

specialized x ray

Customer:

I know, sorry I meant the ESR and the CPR

Customer:

I presume they are just blood tests also?

Customer:

I am somewhat confused how to proceed now as you started with suggesting some tests for deficiencies and now we are talking about MRIs etc

Dr. Shahzad MD :

Blood tests

Customer:

Did the discussion end?

Dr. Shahzad MD :

all are blood tests

Dr. Shahzad MD :

we will go step by step

Dr. Shahzad MD :

First do the calcium, phosphate and vitamin D and if those are normal then we will proceed to the next step

Dr. Shahzad MD :

You need a good doctor who understands you and who you can follow up with.

Customer:

Is there a rheumatologist on this site?

Dr. Shahzad MD :

No

Dr. Shahzad MD :

Let me know if you have more questions.

Customer:

For now, no - thanks

Dr. Shahzad MD :

You are most welcome
Take care
Wish you all the best.
Please do rate me for my services before you leave by clicking on one of the smilies below. I hope I provided excellent services.
Tip/bonus is always appreciated.
Goodbye :)

Dr. Shahzad MD :

Please do remember to follow up with me on your test results.
Do not forget to rate me before you leave as that is the only way I am credited here.
Thank you.

Dr. SH, Board Certified Physician
Category: Medical
Satisfied Customers: 8765
Experience: Doctor of Medicine
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