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Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Medical
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Experience:  14 years experience in the field of Family Practice
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Curious about a mixture of testing I am having completed. I am currently seeing a Rheum D

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Curious about a mixture of testing I am having completed. I am currently seeing a Rheum Doc and have been having muscle fatigue symptoms after working out. It makes me so fatigued I can barely get through the day. My CK is elevated at 1681 (range26-174), my aldolase at 9.2(range0-7.6), my albumin at 5.3(range3.4-4.8), my AST(GOT) at 61(range4-37), and my monocytes at 10.3(range1.7-9.3). Ive had chest xrays which were normal, normal bone scan, normal EMG, and all other normal lab values. This comes and goes, some days I feel great and others I feel like crap (especially after exercise). I have always been active, I exercise daily (I am active duty military and have been for 8 years, I've never experienced soreness like this in my life). It started 3 years ago and has astronomically worsened. I get to where I am so tired I can't think straight and feel "foggy". I had a behavioral health work up as well to rule out any Chronic Fatigue Syndrome. I just don't know what to do and th
Submitted: 1 year ago.
Category: Medical
Expert:  Anthony Bray, MD replied 1 year ago.
Hello!
The very high CK levels indicate muscle breakdown. This could be an inflammatory / autoimmune disease of muscle tissue....polymyositis or dermatomyositis would be diagnostic possibilities.
Heavy exercise can cause transient elevations of CK but your values seem too high for just that.
You being active duty may mean that you have to do your best to stay in shape but I would keep exercise as moderate as possible until a better handle was gained on your condition.
The slight elevated AST is only mildly elevated on this one liver enzyme. It being under 100 may indicate little significance ...so the liver enzyme is only mildly elevated...it could be part of a more general inflammatory process.
I don't think that CFS fits as that is condition of chronic fatigue without other clear explanation. The source of your muscle inflammation is the source of your aches and fatigue.
I would ALSO have concern that you may have some subtype of muscular
dystrophy.
Your condition should also be reviewed in light of any medications that you may have been taking. Muscle inflammation is potential side effect of certain medications.
Drink plenty of water !! Too much muscle breakdown may also risk your kidney function....
I hope that this information is helpful. Let me know if you have further questions or discussion. I will be happy to get back with you.
If my answers have been helpful and to your satisfaction then please remember to leave positive feedback. THank you and Best Regards,
Anthony Bray MD
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again---
So far my top suspect for your case would be polymyositis (and related autoimmune disease)
See article>>>>
http://www.medicinenet.com/script/main/mobileart.asp.articlekey=454&page=1
I hope that this will be helpful for you.
Again let me know if you have further questions or discussion. Updates on your condition are welcome on this thread. Best Regards!
Anthony Bray MD
Expert:  DrRussMD replied 1 year ago.
Hello
Thank you for requesting me.
You weakness distribution does not fit the typical pattern for polymyositis.
You have not described difficulty with girdle muscles specifically [eg: getting out of a chair].
The best course at this point would be a muscle biopsy after first having an EMG/NCS which would also give relatively non invasive information.
OK, so that is an initial answer….
Please use reply to expert if you have further questions. When you are ready, please click a positive rating [hopefully excellent]. If you forgot something, come back. I am here daily.
Customer: replied 1 year ago.
I did have an EMG conducted as well, it came back normal. Almost everything but my labs are normal. I forgot to place in there that I had a positive ANA (but it changes with my CK levels...if my CK is good then my ANA is good). They're ruling out polymyositis, however, my CK changes frequently. The most pain I have is in my hips and shoulders, secondary to that would be biceps and quads. The doctor says that if my next CK comes back normal that there is nothing wrong but that she'll submit me for the muscle biopsy and MRIs (which I had one on my thigh which was normal previously). I am just curious if there any other differentials to rule out or if we are missing something. If everything continues to come back normal, am I just being a wuss and this is normal following exercise? That seems to be the direction they're going. I am fit and active and have never had issues like this following exercise prior. It began VERY gradually until it caused enough discomfort and pain that I went to see someone.
Expert:  DrRussMD replied 1 year ago.
There is an entire spectrum of fibromyalgia and myofascial pain disorders...which are not progress and can be treated by backing off on the exercise, doing a graduated program with physical therapy, etc.
What they have not mentioned is myopathy related to medications [steroids].
Also hereditary [not likely].
Thyroid disease
magnesium deficiency.......check and make sure your serum is at least 2.5 or higher.
Supplement if not.
please click a positive rating [hopefully excellent]. If you forgot something, come back. I am here daily.
Customer: replied 1 year ago.
They found a mild vitamin D deficiency. That's about it, and it was still WNL. Thyroid-normal, and I am not on any meds except the once weekly vitamin D meds. I believe fibromyalgia was ruled out already.
Expert:  DrRussMD replied 1 year ago.
Ruling out fibro does not rule out myofascial pain syndrome, on the same spectrum.
I would suggest you see a physical medicine and rehabilitation specialist, a type of MD well trained in this.
Vitamin D can be supplemented at 10,000 units a day.
Check the magnesium, if you are D deficient you are very likely to be mag deficient.
Check a celiac panel, anti gliadin antibody, and HLA DQ 2,8 to rule out gluten problems.
That's about it.
please click a positive rating [hopefully excellent]. If you forgot something, come back. I am here daily.
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again--
Vitamin D deficiency is the most common nutritional deficiency. This would be related to your calcium metabolism.Vitamin D deficiency would not cause so much breakdown of muscle tissue and elevation of CK.Fibromylagia may cause muscle pain but that condition would also not cause the elevated CK...
I Hope that this is helpful. Let me know if you have further questions.Best Regards!
Anthony Bray MD

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