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CaliforniaMD
CaliforniaMD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 1495
Experience:  board certified neurologist
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Got bad news today. Bloodwork indicated elevated Aldolase

Customer Question

Got bad news today. Bloodwork indicated elevated Aldolase levels in blood. I had emg on left leg on aug 5 normal and emg on right leg on sept 15 normal. My neuro ordered a slew of new blood tests today and wants to repeat left leg emg. Everything I read about Aldolase seems like I am in bad shape. Are there any situations where Aldolase is raised that isn't serious? I haven't had any injury or trauma.
Submitted: 2 years ago.
Category: Neurology
Expert:  CaliforniaMD replied 2 years ago.

on what date was the blood test drawn?

do you work out?

Customer: replied 2 years ago.
Blood was drawn sept 12. I stopped working out a month ago except for doing pushups and walking.
Expert:  CaliforniaMD replied 2 years ago.

did you have a needle test during the EMG?
Customer: replied 2 years ago.
both times they did EMG/NCV. Tested 5-6 muscles in each leg by first doing the electric shock then sticking the muscles with needles and measuring the level of activity while muscle engaged and again when at rest.
Expert:  CaliforniaMD replied 2 years ago.

well, there is your trauma.

sticking needles in the muscles and moving them raises aldolase.

aldolase half life is TWO WEEKS.

your doctor should have instructed you to wait at least 2-4 weeks before you go for the blood tests and stop all exercise except walking.

exercise like push ups can also raise aldolase.

with vigorous exercise, women's CK for instance can go up to thousands.

along with all the multiple muscle needle trauma, no wonder your aldolase is up one week after the EMG.

you should relay this to your doc and have the muscle enzyme test repeated in a couple of weeks after your muscles heal and you limit your exercise to walking.


CaliforniaMD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 1495
Experience: board certified neurologist
CaliforniaMD and other Neurology Specialists are ready to help you
Customer: replied 2 years ago.
the emg was done on sept 15 and the bloodwork for aldolase was done on sept 12.
Expert:  CaliforniaMD replied 2 years ago.

but you had an EMG on aug 5.

do you have numbers? what was the level. what is the "normal" lab range?

i recall your CK was normal, right? was that also sept 12 or on a different day?

Customer: replied 2 years ago.

i had an emg/ncv on August 5. not sure what the numbers were, but i spoke to my neurologist yesterday and he said the numbers were all in the normal range the same as on sept 12. Today he said he wants to redo the left because of the increase in aldolase.

 

CPK, if that is CK, was normal. That was taken on Sept 9.

 

I had bloodwork for Aldolase on Sept 12

 

I had an emg/ncv on Sept 15

Expert:  CaliforniaMD replied 2 years ago.

it's all in the numbers -- how many times of high normal is the aldolase elevated.

i doubt doing the emg third time is going to add any new information.
it's just draining your wallet.

incidentally, your symptoms (tingling/burning) have nothing to do with a muscle disorder, they suggest neuropathy.

by the way, as we agreed before, this is not ALS.
Customer: replied 2 years ago.

Unfortunately i did not get the numbers for Aldolase, so i don't know how elevated it was.

 

I don't understand how my tingling and burning, which were my only symptoms for 6 weeks translated into this.

 

On our previous discussion, did i mention that one week ago, i experienced what my neurologist said was a panic attack? I had small muscle spasms all over my body while i laid in bed. I couldn't see them and they would stop when i stood up. My neuro said that they were likely anxiety and not fasciculations as they wouldn't stop when you stand and would be more stationary and would be like a work under my skin. i have gotten a few of these small muscle ticks or spasms since throughout my body. I had never had this before Sept 11.

 

Everything i read about raised aldolase levels says muscle disease/disorder. I ran 3 miles on Saturday. I also went to the gym Friday and rode the exercise bike for 15 minutes and worked out with weights for 30 minutes. This was after the aldolase test and was the first time i had done anything other than pushups and walking. my left knee is soar after doing the running Saturday.

 

I am worried about ALS though. I have a 6 year old son and wife so it is natural to fear the worst. With the anxiety angle, i'm not sure what is actually a symptom and what isn't?

 

 

Expert:  CaliforniaMD replied 2 years ago.

please don't feel offended about what i am going to say.

your statements strongly suggest hypochondriasis and generalized anxiety disorder.

if you had ALS, you could not run for 3 miles, do exercise bike for 15min and then lift wights for 30 min.

you said you stopped exercising but the truth is you do strenuous exercise and this elevates muscle enzymes.

your concerns and anxiety, as much as they cause you psychological distress, are unreasonable.

the tingling and burning in your feet and legs is probably from pounding your feet on the pavement or treadmill; this also happens with ellipticals even with best shoes.

you need to stop worrying excessively and devote this time to pampering yourself and spending quality time with your kid.


Customer: replied 2 years ago.

I see what you are saying and from the outside looking in, i would agree.

 

I didn't even have a GP this year. All of this started on July 14 and it has unraveled my life. It seems to be one thing after another. I didn't do any strenuous exercise the day of the Lab work for Aldolase, but did do a series of pushup regimens on both Saturday and Sunday before i did the blood work on Monday. I'm not sure if that would have impacted the results or not but i was pretty soar on Monday, the day i did the lab work.

Would that potentially skew the aldolase number?

 

I want to believe that i am fine and that i don't have ALS, but i keep getting having these things happen that make me start planning my funeral again. i can see the pyschosis in the whole situation, but can't overcome it. It is strange because i now can see how people become depressed when i never had any frame of reference. I'm not sure how to get back to living a normal life. I am a 37 year old CPA with a professional career, a wife with the same and a child. Lots to be thankful for but i can't seem to get past this. I hope you are right even though my knee hurts me now and i'm thinking-- ALS limb weakness, the beginning of the ende.

Expert:  CaliforniaMD replied 2 years ago.

honestly, i would look into pharmacological and behavioral help. this is clearly interfering with your life.

i looked at your 1st question on july 14 and you had some ulnar nerve issues and being a CPA, commonly resting your arm on the desk, etc. this is not unusual.

calf tingling was probably your sural nerve, unlikely anything to worry about.

all the muscle twitches are most likely benign fasciculations which are common in avid exercisers.

best wishes.
CaliforniaMD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 1495
Experience: board certified neurologist
CaliforniaMD and other Neurology Specialists are ready to help you
Customer: replied 2 years ago.
Aldolase was 13.5 with normal at 8.1
Expert:  CaliforniaMD replied 2 years ago.

ok, it's elevated.

the first step is to repeat the blood test.

since it doesn't sound like you have any symptoms suggesting muscle disease (nl CK, elevated aldolase can happen in certain immune myopathies), you also need to have your PCP make sure your liver is fine.

consider tests for hepatitis, liver function (ast, alt, ggt, ldh), etc.

normal CK and elevated aldolase usually means the muscle is OK.
Customer: replied 2 years ago.
Thanks. My leg is really bothering me today. I concede a part of that could be mental. I will take this list to my gp.
Expert:  CaliforniaMD replied 2 years ago.

i wouldn't call it partially mental/psychological. maybe you do have muscle strain.
if your calf and the back of the knee hurts, i'd consider venous and arterial studies to rule out a blood clot or arterial problem, respectively. again, unlikely, but just trying to cover all bases.




Customer: replied 2 years ago.
Some dull pain in calf today and knee. Knee has felt unstable but not impacted mobility. Knee began popping a lot when walking this past week.
Expert:  CaliforniaMD replied 2 years ago.

knee popping = wear and tear
CaliforniaMD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 1495
Experience: board certified neurologist
CaliforniaMD and other Neurology Specialists are ready to help you
Customer: replied 2 years ago.
Amen. 17 years of jogging. Thanks for your help. I'd like to keep you posted as you have been a good sounding board.
Expert:  CaliforniaMD replied 2 years ago.

even if you're petite, that's a lot of pounding on those poor joints.
elliptical is such a good alternative.

keep in touch and please don't worry too much.
Customer: replied 2 years ago.
Doc

Waiting on most bloodwork. ESR, CK, RPR and vitamin b12 came back normal. Waiting on andolase, ANA, mitochondria, anh rheumatoid factor.

I am concerned about my left leg as it is clearly compromised since I ran last Saturday. It feels less stable in the knee and the leg itself vs the right. I can still stand on one leg and do whatever, but to me it always feels weak and noticeably different. Had a good bit of burning sensation yesterday in both , which has been a constant. Any insight?
Expert:  CaliforniaMD replied 2 years ago.

with instability, one is always concerned about the joint.

you should consider seeing an orthopedist because it is beginning to sound like an ortho problem.

unfortunately, without being able to examine you, i don't know whether this burning is muscle fatigue or nerve-related.

with meniscal and ligament problems there is often burning pain because small articular nerve branches get pinched.
Customer: replied 2 years ago.
The leg felt stronger yesterday during the day, but today feels much weaker. Have you seen issues where the weakness or perceived weakness ebbed and flowed?

Doing the emg on the left leg Tuesday morning. That will be 53 days after same procedure done on that leg. What has your experience been with emgs done that close to each other?
Expert:  CaliforniaMD replied 2 years ago.


change in emg findings depends on what underlying pathophysiology present, if any.

let's wait till after your emg on tue. they should tell the preliminary findings right after the test.
Customer: replied 2 years ago.
Doc

Emg on left leg normal today. Neurologist did Another test on my left arm checking for some neuro muscular and it was normal. Got blood work back on Ana, mitochondria. RA, and Aldolase all normal. Aldolase came back at 3.8 this time. Doc said it may have been a lab error the first time? We are going to do it again next week to make sure. The 3.8 sample was done by mayo who he holds in higher esteem.

All that said, there is nothing to explain my leg symptoms. He said it could be the early stages of something nut CK, multiple emg, and other test are normal so far. Assuming Aldolase comes back normal again, we have nothing. He is also doing Ldh next week. I'm glad everything is normal but of course have no answers on my legs. Any other ideas?
Expert:  CaliforniaMD replied 2 years ago.
They ruled out anything neuro
You need to see ortho.
Customer: replied 2 years ago.
Can MS present in thoracic and not in brain and cervical?
Expert:  CaliforniaMD replied 2 years ago.

yes but you don't have symptoms that would suggest it.
Customer: replied 2 years ago.
What would the symptoms be?
Expert:  CaliforniaMD replied 2 years ago.

you don't have a thoracic cord lesion.

take care.

Customer: replied 2 years ago.

Doc

 

When i slightly flex my calf or thigh on both legs, i get what appear to be fasciculations as the muscle ripples. When i either flex further or relax, they disappear. My wife has these also in her thighs. What are the signficance of these muscle movements. I asked my neurologist about them and he said they weren't involuntary since you were contracting the muscle. What is your take?

Expert:  CaliforniaMD replied 2 years ago.

hi,

 

they are benign fasciculations and they happen in healthy people, esp. those who are into fitness.

 

there are no voluntary fasciculations.

Customer: replied 2 years ago.
Thanks doc. I have noticed these when I flex my calves in a certain way. My anxiety level has been high as a result. Still having muscle twitches all over body and tingling and burning in feet and lower legs.
Expert:  CaliforniaMD replied 2 years ago.


you got to work on controlling your anxiety and stop flexing your calves in a certain way.

this will only perpetuate your anxiety.

Customer: replied 2 years ago.
I'm trying to do that but more difficult than I imagined. I didn't even have a gp before 2011 so all of this health anxiety is new to me. My third Aldolase test came back normal as well as Ldh. Do you think anxiety could be the cause of my issues? My wife does. My neuro told me after the emg that he didn't have anything he knew to do. I don't know what reality is sometimes with all of this stuff. I am a CPA who is a director in a large corporation so it's not like I can't see things how others see them. I analyze things for a living. I'm just scared to lose my family.
Expert:  CaliforniaMD replied 2 years ago.

i know, all your tests were normal.

you need to find a psychiatrist and start treatment. looks like things are spinning out of control.

there is nothing wrong with you neurologically.

Customer: replied 2 years ago.
I agree I am out of control. Thanks for your advice. I always appreciate it. Have a pleasant evening.
Expert:  CaliforniaMD replied 2 years ago.

you're welcome.

you NEED outside help. instead of conquering it, you are getting worse.

don't wait.



Customer: replied 2 years ago.

HI Doc,

 

I have taken your advice and have an appointment with a shrink to discuss my issues. I agree i have issues that i can't tackle myself.

 

I have a question i need your help on. My dad died of multiple myeloma five years ago. This week, my neurologist ordered protein blood tests which hadn't been done to account for this as a possibility for my issues. THe test was monoclonal proteins and tested IgG, IgA, IgM, Kappa, and Lambda. THe results of the test were no m band protein identified, Immunofixation electrophoresis -no abnormal bands detected, and no evidence on monoclonal gammopathy. I also tested ESR which was normal.

 

Is there any other test that should have been done to rule out Multiple Myeloma? It seems like the protein test is a big indicator.

 

Thanks in advance and i am moving forward with getting help.

 

 

Expert:  CaliforniaMD replied 2 years ago.

with a normal IFE you're fine. MM is a disease of the elderly.

really glad to see you taking charge. you'll get through and over it.

Customer: replied 2 years ago.
what is IFE? My dad was 64 when he died of MM, so he was a bit older. Thanks again for your encouragement on the shrink. j
Expert:  CaliforniaMD replied 2 years ago.

average age of MM diagnosis is 68 in men but some indeed develop it a little sooner. there is no evidence for a hereditary basis of MM.

IFE = Immunofixation electrophoresis

you're welcome. take care :)

Customer: replied 2 years ago.
Doc

Started my treatment Monday. Taking it day to day. I have a new symptom I need help on. I am feeling my thigh muscle moving on the right but can neither see it nor can I feel it with my hand but I can feel it in the leg. What is this? A fascuc can be seen. It has been fpgoing on for an hour.

Thanks
Expert:  CaliforniaMD replied 2 years ago.

hi,

if it's moving and you can see it, it's fasciculations and/or twitch.
Customer: replied 2 years ago.
Hi doc. I am entering second full week after treatment began. Meds haven't really kicked In but I heard they take time. Four weeks ago Tuesday. I went to the Cleveland clinic for a second opinion. I took my emg, MRI. And lab results and met with two neurologist there on the 12 th of October. They ran five additional blood tests and did a skin biopsy looking for small fiber neurapathy. Got the results of the skin biopsy wednesday and I dont have sfn and all blood test were normal. I know you are saying I'm not surprised. I asked the neuro from clevelNd on wednesday about the symptoms I continue to have aches/pains in legs, burning, and muscle twitching. He like my neuro here said it was nothing serious. So I went out running this morning and did 2.5 miles. Made it through but my legs still don't feel right. I concede that we have done pretty much every test and the results objectively are all normal. Why do I still feel this way if everything is normal? Am I missing something other than more medication? I would think if something was killing me I wouldn't be able to do 2.5 miles but my brain only knows the way my body feels which is the same way it felt when I was going through the testing. Scared.
Expert:  CaliforniaMD replied 2 years ago.

anyone guy who can run for 2.5 miles is pretty healthy. it's normal to have some burning and aching when you work out so much. and you're not 20 anymore.
honestly, the only thing that is "killing" you is your anxiety.



Customer: replied 2 years ago.
Working on anxiety. Very tough. I havent been exercising much the last two months so can't blame any of my maladies on that. Twitching has increased but the docs don't seem concerned. Mostly in calves.
Customer: replied 2 years ago.
Doc

I saw my neurologist this morning because my muscle twitching in one spot had been popping up regularly for a day. He saw it and said it was a fasciculation and that it was either begnign or motor neuron disease. His words were now we wait. Is there anything I can do to assure myself that I don't have motor neuron disease? I don't have clinical weakness yet.

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