How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask Lisa, MSN, FNP-BC, CCRN Your Own Ques...

Lisa, MSN, FNP-BC, CCRN
Lisa, MSN, FNP-BC, CCRN, Nurse Practitioner
Category: Health
Satisfied Customers: 890
Experience:  Board Certified Family Nurse Practitioner
18529113
Type Your Health Question Here...
Lisa, MSN, FNP-BC, CCRN is online now
A new question is answered every 9 seconds

I have had an elevated CPK (over 500) for over 2 years now.

Customer Question

I have had an elevated CPK (over 500) for over 2 years now. I had been on statins for several years but was taken off that therapy for suspicion of my high CPK and muscle pain. I have seen two rheumalologists and have returned to my internist for an anwer to my pain. The pain used to be just in the major muscles of both my legs but seems to have now progressed to many other muscles, especially after exercise. I am a 57 YO male with high cholesterol(now untreated) and hypertension treated with 10mg./day of ramipril. I also have BPH and am taking 0.4mg of Flomax/day. I have been tested for Fibromyalgia, MS, Lupus, RA, and parasitic infections. I also received an EMG but there was no definitive result. My muscle strength was very good although the pain is starting to get to me now. I have a physical job and it is starting to affect my performance. I used to run 3-5 miles at least three times a week. I ran 2miles for each of the last two days and my legs and feet are in much pa
Submitted: 4 years ago.
Category: Health
Expert:  Lisa, MSN, FNP-BC, CCRN replied 4 years ago.

Hello;

 

Thank you for writing in today. I want to provide you with the best possible informations, so I do have a few questions. When exactly did you stop the statin medication? Do you know any trends in your readings over the last two years? For example, were you previously > 1000 and have dropped down, or have you been relatively stable around 500? Have you had any improvement in the last 2 years, even if marginal? Have you had a muscle biopsy? Have you taken any CoQ-10 supplement? When was the last time you had your thyroid level checked? Any other abnormal labs? When did you start the Ramipril and the Flomax? Do you take any other medications or supplements not mentioned? Any other medical conditions or past medical history, such as heart attack, not mentioned? Do you drink alcohol? Have you ever abstained from your running for a few weeks before your CPK labs? Please let me know. Lisa

Customer: replied 4 years ago.
Stopped statins for over a year.CPK-from 295 to about 750. For the most part it hovers between 400 and 575 while I exercised,ie. running, doubles racquetball and paddleball. Muscle biopsy was generally ruled out by two rheumatologists and my internist as probably not likely to bear any fruit and I was told that it would be quite painful. I take 240mg./day of CO Q-10/day. I used to take 360mg. but I dropped the dosage about two months ago since i realized that I was no longer taking a statin and I thought that the extra pill was unnecessary. I'm not sure if my Thyroid level was checked, but I seem to have a faint memory of it.Liver enzymes would occasinally hover around the upper limits, particularly during the summer when I might tend to consume more alcohol than usual. Typically 2 glasses of wine per day, and 2-3 mixed drinks per day on weekends. Abnormal labs- occasional high glucose. usually around 95 but as high as 135. Had recent glucose test and it was OK. Stopped Crestor 9/24/08. Started ramipril at least 4 years ago. Started Flomax( unsure) about three years ago. I have abstained from running for a month before a CPK test with only a little improvement. No remarkable history. Vitamins-C, B-12 Nicin 2500mg., E 800IU,Folic Acid, Multi, co Q-10 240mg.,claritin 10mg.,fish oil 1700mg.,zinc,flaxseed oil 8000 mg.,and 1-2 Napraxen sodiums a day for pain.
Expert:  Lisa, MSN, FNP-BC, CCRN replied 4 years ago.

Hello;

 

Thank you for responding to the questions. The information is helpful, and I will make a few points regarding the information; however, I do have a couple more questions. Have they evaluated the CPK isoenzymes, particularly your CPK-MM, CPK-MB, or CPK-BB? I assume these elevations are of CPK-MB; however, I do want to make certain. Also, were you taking the high dose niacin with your Crestor? Please let me know. Lisa.

Expert:  Lisa, MSN, FNP-BC, CCRN replied 4 years ago.
The cardiac person in me acidentally typed CPK-MB; however, I meant CPK-MM (muscle).
Customer: replied 4 years ago.
Lisa,
I neglected to mention that I have a herniated disk, L5-S1 I believe. I mentioneed this to the technician performing my EMG and only after I did, he checked that region for any abnormality. I was told that there is probably a contributing factor to my pain. Why then is my CPK level so high if there is nerve impingement? I have also been had an STD panel done and they are all negative including HIV and hepatitis. I only started the high dose after My cardiologist took me off of crestor 2,000mg a day. Six months ago my internist increased it to 3,000mg. a day but Just last week I reduced it by 500mg. in the morning because my stomach was not tolerating it too well during the day. The CPK enzymes were never, to my knowledge ever broken down except for one time awhile bacck in the beginning to determine that there was no heart specific problem. By the way my annual thallium stress tests have all been normal. I am scheduled for one again tomorrow.
Expert:  Lisa, MSN, FNP-BC, CCRN replied 4 years ago.
Thank you for answering all of the questions. I know questions can be a hassle; however, information is particularly helpful in these types of situations. After reading over everything, this is an interesting case. At this point a definitive answer may be difficult, particularly since there are significant limitations, due to the internet format; however, I think I may be able to offer you some possible suggestions. If anything, the information may help you feel more informed and maybe help you direct additional follow up. It will take me a few minutes to write this all up. Don't worry. I haven't gone anywhere. Lisa
Customer: replied 4 years ago.
Lisa,
I need to go to bed now since I have to be up at 4:30 AM EST. Can we continue this tomorrow and how do I do that.
Lou
Expert:  Lisa, MSN, FNP-BC, CCRN replied 4 years ago.

Lou,

 

Sorry this is taking so long. I want to make sure I'm not missing any of the points I want to mention. I'm almost done; however, go get some sleep. I will post. When you long back in tomorrow, you will have access to this thread, and you'll be able to see everything in the morning. Have a good night. Lisa

Customer: replied 4 years ago.
Thanks.
Lou
Expert:  Lisa, MSN, FNP-BC, CCRN replied 4 years ago.

Well, I this may actually be a combination of issues. First of all, if not done recently, you should have your thyroid function tested. Thyroid imbalance can cause some of the same symptoms. In addition, I wasn't surprised to hear about your herniated disc. The way you describe your pain made me suspect something such as a disc herniation or musculoskeletal injury. Given your history of activity, you may actually have an underlying issue. At any rate, if not already done by the neurologist, you may want to consult your providers about more comprehensive diagnostics, such as MRI or CT scans. Also, you could consider consulting a sports medicine specialist. I think it would be particularly important to comprehensively evaluate this disc issue. I think it will be necessary to effectively treat your pain. Since you had a history of statins and an elevated CPK level, it sounds like more time has been spent evaluating for autoimmune and medication side effects. I just want to make sure that the disc herniation has been comprehensively evaluated and other possible sports injuries have been considered. Now, as for the elevated CPK levels, the good news is that they are mildly elevated. However, ideally, you would have had a more progressive decline in your numbers since stopping the statin. Since there is still not a reasonable explanation for your elevated CPK levels, I would have to recommend discussing further evaluation. This would mean looking at the CPK more closely, specifically the isoenzymes. Also, a muscle biopsy may be considered. I do understand why your providers would recommend deferring the biopsy, since you have a mild elevation; however, if it continues to persist and you continue to have discomfort much longer, you may want to reopen that discussion. Also, for what it's worth, muscle biopsies do not have to be very painful experiences. If you have an experienced provider, local anesthetic is used and the whole procedure is done relatively easily and painlessly. Usually, there is some muscle stiffness or tenderness afterward, but it can be reduced with Tylenol and ice. Anyway, there is a possibility that I do want to mention regarding the CPK levels. I'm curious about your high dose niacin levels. I have known high dose niacin to cause some CPK elevation in patients. This is common when mixed with a statin; however, it can also happen with high-dose niacin when used alone, but it is rare. Also, high dose niacin, although, again, rare, can cause some myalgia (muscle pain). Obviously, we can't substitute as a provider, given the online format; therefore, I would have to recommend you discuss any changes with your provider; however, with this being said, I wonder if a drug holiday, particularly the niacin, may result in some improvement. I realize that you have high cholesterol; however, since you continue to have an elevated CPK level, it may be reasonable to abstain from the high dose niacin for a few weeks and to monitor for an improvement in the CPK. Perhaps the statin initially caused the elevated CPK level; however, although rare, high-dose niacin may be causing the CPK to remain elevated. In addition, high dose niacin may be contributing to your glucose elevations and increased liver function enzymes. However, some of your other supplements can also be contributing to this. At this point, in addition to limiting the niacin, you may want to consider limiting your over the counter supplement usage. It's actually not recommended to take many supplements, particularly high doses, when taking niacin, unless directed by a doctor. You may want to consider limiting everything except your Flomax, ramipril, Claritin, multi-vitamin, fish Oil, CoQ-10, and Flaxseed. I would recommend continuing the CoQ-10 because it actually helps replace the enzyme that is commonly depleted from the muscles when statins are used. If you limit these supplements short term, you may find your CPK level, liver enzymes, and glucose improved. If you are taking a complete multivitamin and have a healthy diet, most people do not generally need separate supplements. (If you are taking B12 due to pernicious anemia, this should be continued.) Also, I do want to caution that drinking alcohol and taking high dose niacin can cause additional irritation to the liver. This may be a long shot. In addition, you may have another underlying issue, such as injury or issue related to the herniated disc; however, I still think this is worth considering or exploring. If your stress test comes back clear tomorrow, your provider may be willing to allow a short term hold on the niacin (and maybe consider limiting the supplements) to see if your labs improve. Again, the myalgia (muscle pain) and elevated CPK is not too common, but it can happen; however, not all providers will be receptive to entertaining the consideration, but I wanted to mention it to you. I wish I could provide you with a more definitive answer, but I hope this helps. If you have any additional questions, concerns, or need me to clarify any of this information, please let me know. Lisa

Lisa, MSN, FNP-BC, CCRN, Nurse Practitioner
Category: Health
Satisfied Customers: 890
Experience: Board Certified Family Nurse Practitioner
Lisa, MSN, FNP-BC, CCRN and 3 other Health Specialists are ready to help you
Expert:  Lisa, MSN, FNP-BC, CCRN replied 4 years ago.
I was able to read your feedback, and I noticed your question about a neurologist. If you haven't been seen by a neurologist, I definitely think a consult is reasonable. It is possible that you did have an EMG done, without a neurology consult, and, if this is the case, you may want to talk with your provider about getting a referral. If you ever have additional question and want to contact me, when you post your question, you can put my name in the posting to request that I answer the question. You will always have access to this threaded discussion, so you will always be able to access my name. I hope this helps. Also, I hope you get some relief soon. Take care. Lisa

Edited by Lisa, MSN, FNP-BC, CCRN on 12/10/2009 at 5:34 AM EST
Customer: replied 4 years ago.
It seems as though you never received the $50.00 bonus that I allocated for you according to my AMEX statement. There was a security freeze on my account temporarily and I corrected it ASAP. You should be able to reaccess it if you did not receive your bonus. If you cannot receive the bonus, please let me know how I can get it to you.
Lou Perniciaro
Expert:  Lisa, MSN, FNP-BC, CCRN replied 4 years ago.

Lou,

 

Thank you for the bonus. That was very generous. I'm glad I could help. I'll forward this to the department that handles billing, and they can clear it up. If you ever have any other questions, please let me know. Take care. Lisa

Customer: replied 4 years ago.
You are very welcome. It was the least I could do since you put so much effort into your advice. I just scheduled a TSH ,Free T4 , and an Isoenzyme CPK as per your advice. Would you like to be informed of my results? Since you seemed so intrigued by my case, I thought that you may be interested in any diagnosis that may arise from my investigation. Please let me know. Otherwise, I will not take up anymore of your ntime. Thanks so much again for your determination.
Lou
Expert:  Lisa, MSN, FNP-BC, CCRN replied 4 years ago.
Yes, if you want to follow up, I would really be interested in the results. Take care. Lisa

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
< Last | Next >
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
  • I have been dealing with an extremely serious health crisis for over three years, and one your physicians asked me more questions, gave me more answers and encouragement than a dozen different doctors who have been treating me!! Janet V Phoenix, AZ
 
 
 

Meet The Experts:

 
 
 
  • Nurse Milli, RN

    Nurse (RN)

    Satisfied Customers:

    4043
    20 years experience in many areas of Nursing. Both Hospital and Private Practice experience.
< Last | Next >
  • http://ww2.justanswer.com/uploads/NU/nursescare4u/2013-3-31_03429_JApic.64x64.jpg Nurse Milli, RN's Avatar

    Nurse Milli, RN

    Nurse (RN)

    Satisfied Customers:

    4043
    20 years experience in many areas of Nursing. Both Hospital and Private Practice experience.
  • http://ww2.justanswer.com/uploads/agketch/2008-7-14_184046_drketchresized.jpg Dr. Ketch's Avatar

    Dr. Ketch

    Doctor

    Satisfied Customers:

    102
    Medical Degree, Former Assistant Professor at School of Medicine at Yale University
  • http://ww2.justanswer.com/uploads/FA/FamilyPhysician/2013-8-31_191624_JA550x500Photo.64x64.jpg Family Physician's Avatar

    Family Physician

    Doctor (MD)

    Satisfied Customers:

    5622
    Emergency Medicine and Family Practice for over 26 years
  • http://ww2.justanswer.com/uploads/drphophalia/2007-08-23_095626_dr._arun_phophalia.jpg Dr. Arun Phophalia's Avatar

    Dr. Arun Phophalia

    Doctor (MD)

    Satisfied Customers:

    17025
    MBBS, MS (General Surgery), Fellowship in Sports Medicine
  • http://ww2.justanswer.com/uploads/VA/VANP/2012-6-6_235535_Skye2.64x64.jpg A. Schuyler, NP's Avatar

    A. Schuyler, NP

    Nurse Practitioner

    Satisfied Customers:

    12170
    Board Certified NP, MS, RN. Private practice & hospitalist
  • http://ww2.justanswer.com/uploads/TA/tazechip/2012-6-7_135230_drpic.64x64.png Dr. Chip's Avatar

    Dr. Chip

    Doctor (MD)

    Satisfied Customers:

    10029
    Over 20 yrs of Family Practice
  • http://ww2.justanswer.com/uploads/neurosurg/2009-10-06_120923_profile.jpg Dr. Mark's Avatar

    Dr. Mark

    Doctor (MD)

    Satisfied Customers:

    6234
    U.S. Physician/Surgeon in Neurosurgery