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  1. #1
    Registered User JimmyWolf's Avatar
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    Question Muscle/Kidney enzymes too high?

    I recently got blood test results back for my new doctor and he has told me that my muscle enzymes are 1.5 times higher than normal and that my kidney enzymes were a point higher than where they should be for me - my kidneys are being overworked trying to break down proteins, according to him (I'm a 29 yr old male btw).

    I've been working out at the gym for the past number of months. I had a good, hardcore trainer that helped me learn how to bulk up and cut. He was a firm believer in using protein shakes and supplements, but my doctor says I should stop using protein shakes + my nitric oxide supplements and should focus on getting all my protein through different foods. This would help bring my enzyme levels down to normal again.

    Does anyone out there know much about this? Should I really be worried about these enzyme readings and cut back? Or is it really normal for these enzymes to be high for people working out and my doctor just doesn't know it?
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    It really depends how high they are. FWIW there's no such thing as kidney "enzymes". You are probably referring to BUN/Creatinine. Having high muscles mass will raise Cr. A high protein diet can raise Cr. Cr is a measure of renal function, so naturally it is concerning if it is high. However if it is within reason and explainableby other causes, it is not so concerning.
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  3. #3
    Registered User 911medic's Avatar
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    Originally Posted by JimmyWolf View Post
    I recently got blood test results back for my new doctor and he has told me that my muscle enzymes are 1.5 times higher than normal and that my kidney enzymes were a point higher than where they should be for me - my kidneys are being overworked trying to break down proteins, according to him (I'm a 29 yr old male btw).

    I've been working out at the gym for the past number of months. I had a good, hardcore trainer that helped me learn how to bulk up and cut. He was a firm believer in using protein shakes and supplements, but my doctor says I should stop using protein shakes + my nitric oxide supplements and should focus on getting all my protein through different foods. This would help bring my enzyme levels down to normal again.

    Does anyone out there know much about this? Should I really be worried about these enzyme readings and cut back? Or is it really normal for these enzymes to be high for people working out and my doctor just doesn't know it?
    Are you taking Creatine? My dr told me that creatine supplementation would make some of my lab work LOOK like I might have a kidney problem, but there was no issue with it (I assume it has to do with the breakdown of creatine into (?) creatinine). He was glad I told him before he looked at the test results. I was fairly impressed with his knowledge of the supplements I was taking at the time.
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  4. #4
    Registered User US_Ranger's Avatar
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    When you're referring to kidney enzymes, are you referring to your CPK levels?

    There are numerous reasons your numbers could be high. By the way, I've been in for more blood tests in the last year than I can count (had near death experience because of over training which shut down my kidneys and almost my heart)

    1) Were you hydrated for your blood test? If not, your creatinine levels will usually be higher than normal giving a false impression of bad kidneys.

    2) How often do you train and what sort of training do you do? Everytime you hit the gym (especially with weights) you're going to elevate your AST and ALT levels (liver enzymes) It's a natural cycle of training and the more you train, the higher the levels will be. How long of a break did you have before your last blood test and the gym?

    3) Are you taking creatine? If so, you probably should stop, and in reality, you don't really need it anyway.

    4) How many grams of protein are you getting in everyday? The whole 2 grams per pound of bodyweight is a meathead statistic that is higher than it needs to be. You really shouldn't be going above ~1.5 and 1.0 isn't a bad goal.

    5) Do you have a genetic pre-disposition to kidney and liver problems? Talk to your family and see if this is a genetic problem.



    Figure those questions out and you should be able to see what the problem is.
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  5. #5
    Misc. OTO-HNS consult Dr. Horse's Avatar
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    Originally Posted by US_Ranger View Post
    When you're referring to kidney enzymes, are you referring to your CPK levels?
    CPK isn't a kidney enzyme. (maybe that's what you are implying)?


    1) Were you hydrated for your blood test? If not, your creatinine levels will usually be higher than normal giving a false impression of bad kidneys.
    You would have to be pretty significantly hypovolemic to have an elevation in creatinine. Before that you would see an increase in BUN. And even if dry enough to cause in increase in Cr, the BUN/Cr ratio would be telling of that cause.

    2) How often do you train and what sort of training do you do? Everytime you hit the gym (especially with weights) you're going to elevate your AST and ALT levels (liver enzymes) It's a natural cycle of training and the more you train, the higher the levels will be. How long of a break did you have before your last blood test and the gym?
    This is true only for AST, as it is not specific to the liver. ALT is, however, and is not in skeletal muslce.


    4) How many grams of protein are you getting in everyday? The whole 2 grams per pound of bodyweight is a meathead statistic that is higher than it needs to be. You really shouldn't be going above ~1.5 and 1.0 isn't a bad goal.
    True. 1gm/lb LBM is enough.

    Another thing to consider is medication and alcohol (with regards to the liver).
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  6. #6
    Registered User DomzyCuttin's Avatar
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    Originally Posted by Mr. Horse View Post
    It really depends how high they are. FWIW there's no such thing as kidney "enzymes". You are probably referring to BUN/Creatinine. Having high muscles mass will raise Cr. A high protein diet can raise Cr. Cr is a measure of renal function, so naturally it is concerning if it is high. However if it is within reason and explainableby other causes, it is not so concerning.
    I had 4 or 8 times the regular amount of CK (creatinine kinase) a year ago. Since then ive had blood tests, urine tests, and a variety of heart tests such as the holter monitor, echocardiogram, and the stress test and everything turned out fine. The high CK is due to muscle damage (so my doc told me) caused by working, BUT it can also be a sign of heart muscle damage, which is why it CAN be dangerous. Some biochemist student on this forum explained it and drew me a diagram and assured me that high CK is normal, and can even be in the thousands range right after strenous excersize. So OP, if that is what you are talking about, you are probably going to be fine.
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    Originally Posted by DomzyCuttin View Post
    I had 4 or 8 times the regular amount of CK (creatinine kinase) a year ago. Since then ive had blood tests, urine tests, and a variety of heart tests such as the holter monitor, echocardiogram, and the stress test and everything turned out fine. The high CK is due to muscle damage (so my doc told me) caused by working, BUT it can also be a sign of heart muscle damage, which is why it CAN be dangerous. Some biochemist student on this forum explained it and drew me a diagram and assured me that high CK is normal, and can even be in the thousands range right after strenous excersize. So OP, if that is what you are talking about, you are probably going to be fine.
    Your doctor should have figured that out before spending all that money on all those tests.
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  8. #8
    13S3A BlueFenix13S's Avatar
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    My liver enzymes have ALWAYS been high, even before I raised my protein intake. They hover in the "high normal" to "high" range dating back to when I was 14-15 years old or so. You may just naturally run high as well.
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  9. #9
    Registered User DomzyCuttin's Avatar
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    Originally Posted by Mr. Horse View Post
    Your doctor should have figured that out before spending all that money on all those tests.
    The tests were not relevant to the CK values. I refused to stop weight training for 2 weeks in order to get new tests. Stupid I know.. I was stubborn.

    The tests were done because I was half way through a cycle and wanted to see how my body reacted (thats the urine and blood test).

    The holter was given to me because I was getting a bad and long case of "holiday heart" (palpitations induced by alcohol) that I came down with from a month in europe. They persisted for a few months and finally I had a scheduled visit to the caridologist, but soon after the appointment was made I started taking a multi vitamin/mineral and the palpitations/other related symptoms stopped. I believe it was a magnesium deficiency that was causing the palpitations, since the alcohol probably left all my mineral levels very low.

    My doctor is very ignorant. She told me "you cant have heart problems at 19". She also refused to give me blood and urine tests because I had them done 6 months before and they were fine... But my mom intervened, so she wrote out the papers, I looked and barely anything was checked off. I told her I want to see my cholesterol and liver values aswell, so she agreed because my mom insisted. She fn googles my medical concerns infront of me, has NO knowledge of suplements at all, tells me protein is very bad for me, that the herbs I take such as hawthorn are bad (shes never even heard of it). I hate going to her, but thats what I get for having a Polish mother who wants a Polish doctor...
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  10. #10
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    normal doctors treat normal people.

    Normal in most areas that are in the industrialized world means, fat or at least skinny-fat, our of shape, with a bad to terrible diet.

    It does not include people that worry about calories, insulin response, people that work out heavily, or take supplements for ergogenic purposes, or even people that eat enough protein.

    Basically you need to consider that your doctor is going to have little to no training or education or even knowledge of things that are specific to you.
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  11. #11
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    Originally Posted by DomzyCuttin View Post
    I had 4 or 8 times the regular amount of CK (creatinine kinase) a year ago. Since then ive had blood tests, urine tests, and a variety of heart tests such as the holter monitor, echocardiogram, and the stress test and everything turned out fine. The high CK is due to muscle damage (so my doc told me) caused by working, BUT it can also be a sign of heart muscle damage, which is why it CAN be dangerous. Some biochemist student on this forum explained it and drew me a diagram and assured me that high CK is normal, and can even be in the thousands range right after strenous excersize. So OP, if that is what you are talking about, you are probably going to be fine.
    I ended up in the hospital last year (almost died) and when they took my CK levels, the number was 64,000. The chart maxed at 40,000 so they were a bit surprised. I think normal ranges are around 500 max?

    Anyway, yes, muscle damage is going to cause the higher levels and heart muscle damage is a possible scenario. I was given an EKG and it showed I was having a heart attack (even though I wasn't) just because my body was so wrecked.

    Even if your doctor, or someone else, says that elevated CK levels are fine, you should get a second opinion. It could be a bigger problem.
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    Originally Posted by Mr. Horse View Post
    CPK isn't a kidney enzyme. (maybe that's what you are implying)?




    You would have to be pretty significantly hypovolemic to have an elevation in creatinine. Before that you would see an increase in BUN. And even if dry enough to cause in increase in Cr, the BUN/Cr ratio would be telling of that cause.



    This is true only for AST, as it is not specific to the liver. ALT is, however, and is not in skeletal muslce.




    True. 1gm/lb LBM is enough.

    Another thing to consider is medication and alcohol (with regards to the liver).
    I understand cpk isn't an enzyme but I was referring to the fact it can show kidney function. Very elevated levels can be a precursor to rhabdomyolysis, which can lead to renal failure and possibly death.

    As for as dehydration and creatinine, I was told that even a moderate amount of dehydration could raise the test by .2 or so (enough to put someone over the normal limit) Maybe I'm thinking wrong though.

    Thanks for clearing up AST and ALT. I didn't know ALT wasn't in skeletal muscle.
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    Originally Posted by US_Ranger View Post
    I understand cpk isn't an enzyme but I was referring to the fact it can show kidney function. Very elevated levels can be a precursor to rhabdomyolysis, which can lead to renal failure and possibly death.
    You have it backwards. CPK IS an enzyme, but it is not a measure of kidney function. However, rhabdo can certainly lead to renal failure.

    As for as dehydration and creatinine, I was told that even a moderate amount of dehydration could raise the test by .2 or so (enough to put someone over the normal limit) Maybe I'm thinking wrong though.
    Actually, the kidney is amazing and can maintain a constant GFR at pretty widely varying perfusion pressures. It takes a pretty good amount of volume depletion (or other cause of pre-renal renal failure) to increase Cr.

    Thanks for clearing up AST and ALT. I didn't know ALT wasn't in skeletal muscle.
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    Registered User JimmyWolf's Avatar
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    Thanks for all the responses everyone! I got some better info about my blood test and will answer the questions given to me.

    For my Kidney, the doctor was actually talking about my urea level. It was just a little higher than it should have been. I've been trying to do the 1.5x or more bodyweight for protein per day but am bringing it down to 1x since people here seem to agree that is enough. I'm guessing the urea level had to do with my protein intake using protein shakes (plus natural foods).

    For my muscle, the doctor was referring to my CPK levels being way too high. I'm just guessing this has to do with my training. I forget if I muscle trained the day before the test but it may be likely. I try to do cardio at least 2x per week and weight train 3x a week. I try to tire out my muscle at every weight session I do: 2-3 exercises per muscle at 3-4 sets each.

    As for creatine, I've always stayed away from that stuff. Except for the time I tried Creatine Ethyl Ester pills for a few weeks. They sucked though, so I stopped using them a few months ago. No kidney or liver problems in my family that I know of.

    I'm wondering if this really is the case of a doctor just not knowing a lot about what people who really work out need. One concern was him telling me I should drop protein shakes period and stick with getting it from food instead, which would make it harder to make those daily protein goals we need.
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    can cause problems, but usally doesnt unless ur kidneys arent in tip top shape already
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  16. #16
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    A high CPK is not normal. A low CPK (300-500 range) is probably acceptable following a very strenuous workout. A moderate CPK (1,000-5,000) increases your risk of kidney damage.

    A high CPK (>6,000) significantly increases your risk of acute renal failure. 30% of all people with a CPK in this range will develop acute renal failure.

    As the CPK climbs even higher, you run the risk of your acute renal failure turning into chronic renal failure requiring dialysis.

    If your CPK continues to remain elevated, I would make sure your physician checks an aldolase level as well to ensure you don't have polymyositis.
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    What were your numbers?

    Assuming they weren't sky-high, I wouldn't worry about it, as they are easily explained by a high protein diet and heavy resistance training.
    No sir, I don't like it.
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    Originally Posted by southerndoc View Post
    A high CPK is not normal. A low CPK (300-500 range) is probably acceptable following a very strenuous workout. A moderate CPK (1,000-5,000) increases your risk of kidney damage.

    A high CPK (>6,000) significantly increases your risk of acute renal failure. 30% of all people with a CPK in this range will develop acute renal failure.

    As the CPK climbs even higher, you run the risk of your acute renal failure turning into chronic renal failure requiring dialysis.

    If your CPK continues to remain elevated, I would make sure your physician checks an aldolase level as well to ensure you don't have polymyositis.
    Lol, my CPK was at 63,000 when I was in the hospital.

    Where did you get these numbers by the way? I think they're off. I read, and was told by a doctor, that it's usually ~10% of people that will get acute renal failure with high CPK levels and it's usually when those numbers are REALLY high, not just >6,000. Rhabdomyalosis will develop in most cases before renal failure. As much as rhabdo sucks, it's a good way to shut down your body before your organs fail.
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    Originally Posted by US_Ranger View Post
    Lol, my CPK was at 63,000 when I was in the hospital.

    Where did you get these numbers by the way? I think they're off. I read, and was told by a doctor, that it's usually ~10% of people that will get acute renal failure with high CPK levels and it's usually when those numbers are REALLY high, not just >6,000. Rhabdomyalosis will develop in most cases before renal failure. As much as rhabdo sucks, it's a good way to shut down your body before your organs fail.
    From a chapter in Rosen's Emegency Medicine text. You can also find it online if you Google it.

    I think you are a bit confused. Rhabdomyolysis is when your CPK levels are >2 times normal from muscle breakdown. Acute renal failure occurs secondary to rhabdomyolysis when myoglobin clogs the glomerular membrane. It's actually myoglobinuria, not rhabdomyolysis that causes the renal failure, but for all purposes the two are closely related.

    Your physician just underestimated the numbers. Like you, I've also had rhabdo before (CPK of 17,000), and I didn't go into acute renal failure. The 30% doesn't mean everyone will -- 70% do not. However, the higher the number, the more likely you are to develop ARF.

    At 63,000, I'm surprised you didn't develop ARF. When I was rotating in the MICU, I admitted three patients with ARF secondary to rhabdo -- all of them requiring dialysis. One was on a statin and had a CPK of only 11,000, another was a drug abuser found lying down for a prolonged period of time who had a CPK of 92,000, and another was a crack cocaine abuser who was high on PCP, hyperthermic and running around the city naked for prolonged periods of time only to get in a fight with the cops later. His CPK was 220,000, and although his creatinine was normal on day 1, he ended up on dialysis by day 4.

    Not all ARF cases require dialysis, and the majority will recover enough kidney function to not require permanent dialysis. However, the 30% number is quoted extensively in the literature, and from my anecdotal experiences of seeing patients in the emergency department, it seems about right.
    Last edited by southerndoc; 04-05-2008 at 11:31 AM.
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    Originally Posted by southerndoc View Post
    From a chapter in Rosen's Emegency Medicine text. You can also find it online if you Google it.

    I think you are a bit confused. Rhabdomyolysis is when your CPK levels are >2 times normal from muscle breakdown. Acute renal failure occurs secondary to rhabdomyolysis when myoglobin clogs the glomerular membrane. It's actually myoglobinuria, not rhabdomyolysis that causes the renal failure, but for all purposes the two are closely related.

    Your physician just underestimated the numbers. Like you, I've also had rhabdo before (CPK of 17,000), and I didn't go into acute renal failure. The 30% doesn't mean everyone will -- 70% do not. However, the higher the number, the more likely you are to develop ARF.

    At 63,000, I'm surprised you didn't develop ARF. When I was rotating in the MICU, I admitted three patients with ARF secondary to rhabdo -- all of them requiring dialysis. One was on a statin and had a CPK of only 11,000, another was a drug abuser found lying down for a prolonged period of time who had a CPK of 92,000, and another was a crack cocaine abuser who was high on PCP, hyperthermic and running around the city naked for prolonged periods of time only to get in a fight with the cops later. His CPK was 220,000, and although his creatinine was normal on day 1, he ended up on dialysis by day 4.

    Not all ARF cases require dialysis, and the majority will recover enough kidney function to not require permanent dialysis. However, the 30% number is quoted extensively in the literature, and from my anecdotal experiences of seeing patients in the emergency department, it seems about right.
    Wow, I can't believe the drug user was over 200,000. I've never heard of anyone being that high (no pun) before.

    Well, I guess I stand corrected and you're correct about the numbers. I shouldn't really listen to physicians in the first place. I was actually discharged from the hospital about 3 hours after entry because the emergency room physician said I was just dehydrated. He didn't do any bloodwork or anything. I was paralyzed from the middle of my back down but the jackass didn't seem to care.

    I guess I'm pretty lucky if ~30% get ARF....especially with my numbers being pretty high. And yes, it seems a lot of people get rhabdo from statins. One of the many side effects people don't seem to know anything about.

    Also, I understand the myglobin clogging part. I actually had a lot of clogging going on. I finally flushed everything out but for the first 7-8 times I had to pee, my urine looked like dark coffee. I was hooked up to 2 bags of saline solution at once for a few days. I didn't know rhabdo was just from numbers though (>2 cpk levels) I thought you had to have more symptoms than just high numbers to develop it.

    Thanks for all the info, good stuff to know.
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    Originally Posted by US_Ranger View Post
    And yes, it seems a lot of people get rhabdo from statins. One of the many side effects people don't seem to know anything about.
    To be fair, rhabdo (and other forms of myositis) are in fact the most studied and most well known side effects of statins. There is gobs of data out there, and the numbers are actually VERY low. However, this is with statins alone; the risk of rhabdo goes way up when combined with fibrates. This is where you can get into trouble.
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    Originally Posted by US_Ranger View Post
    Well, I guess I stand corrected and you're correct about the numbers. I shouldn't really listen to physicians in the first place. I was actually discharged from the hospital about 3 hours after entry because the emergency room physician said I was just dehydrated. He didn't do any bloodwork or anything. I was paralyzed from the middle of my back down but the jackass didn't seem to care.
    Everyone criticizes the medical community for its faults, but rarely praises it when it gets things right.

    However, rhabdomyolysis isn't a reason for admission in most cases. I went home with mine. The key is hydration, and if the rhabdo is mild enough, that can be done at home.

    Regarding not checking labs on all patients, here is my philosophy on that: 95% of patients do not need labs checked. They are time consuming -- 90 minutes at the best hospitals, 3-4 hours at most hospitals. When there is a waiting room full of people, I can still check labs on every single patient "just in case" something is going on. This will cause the backlog of patients in the ED to get even worse. On a good day I will have 10% of my beds already taken by admitted patients waiting for a bed upstairs. On a typical day I will have 30%, and on a bad day as much as 80% of beds taken up.

    So when I'm down that number of beds, it makes patient turnover of upmost importance to minimize waiting times. Yes, there will still be waits, but those can be minimized as much as possible by eliminating unnecessary workups. Not only does it speed up patient care for everyone, but it also reduces healthcare costs. Labwork can easily run thousands of extra dollars.

    My philosophy is to order lab tests if I think something is wrong. I don't order them "just in case." If your exam was consistent with rhabdomyolysis, then I would have checked a CPK and creatinine. I would send electrolytes if you turned out to have rhabdomyolysis and needed it.

    Physicians need to go back to their roots and use clinical assessment to judge when to order labs and diagnostic tests. Unfortunately, in a busy ED where I might see 3-4 patients/hour, things can be tricky trying to spend time with patients when you're that busy. I saw 22 patients today in a 10-hour shift, including one patient in cardiac arrest (who paramedics could not intubate), a status epilepticus patient requiring intubation and anesthesia to control seizures, a septic patient requiring a central venous line and pressors to support his blood pressure, two lumbar punctures, and four laceration repairs. You can see that although I only averaged 2.2 patients/hour, the acuity was high, and if the time I spent with the critical patients was eliminated, then I was easily seeing 4 patients/hour.
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    Originally Posted by southerndoc View Post
    Everyone criticizes the medical community for its faults, but rarely praises it when it gets things right.
    You will quickly learn that most posters are anti-MD around here. You know how it is when something doesn't jive with one's belief system. "My doc said that the 650g of protein I eat a day is too much. He's an idiot like all other docs who are fed pharma propaganda and are trying to prolong disease, etc..."
    No sir, I don't like it.
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    Originally Posted by Mr. Horse View Post
    You will quickly learn that most posters are anti-MD around here. You know how it is when something doesn't jive with one's belief system. "My doc said that the 650g of protein I eat a day is too much. He's an idiot like all other docs who are fed pharma propaganda and are trying to prolong disease, etc..."
    Yep, unfortunately some people hate it when they hear things that goes against what they believe. Some people are anti-medicine and into "natural" treatments because they believe it's safer since it's natural. Rattlesnake venom and arsenic are natural, but they aren't safe.
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    ^^^^^

    Well, in MY defense and like I said earlier, I war paralyzed from the waist down. I went to the VA hospital the next day and they ordered labs for me. After getting the results, they threw an EKG on me and it showed what looked like a heart attack. They quickly got me into the emergency room.

    Yes, the medical world is criticized. I think it's legitimate in many cases. Why would you discharge someone from the hospital who is partially paralyzed and pissing blood? I guess that lab work just takes too much time though....especially at 2 in the morning. My mistake.
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    Originally Posted by US_Ranger View Post
    Yes, the medical world is criticized. I think it's legitimate in many cases. Why would you discharge someone from the hospital who is partially paralyzed and pissing blood? I guess that lab work just takes too much time though....especially at 2 in the morning. My mistake.
    I wasn't there when you were evaluated, so I don't know what your physical exam and exact complaints were. So I may or may not have checked labs. However, this sounds like an individual problem with one particular physician and not all physicians in general. I would suspect with your CPK being so high that you weren't really experiencing hematuria, but instead had tea colored urine from your myoglobinuria. (This actually reacts with a urine dipstick and will falsely report it as hematuria, but microanalysis will reveal no RBC's. The dipstick reacts because it detects heme, which is also part of myoglobin.)

    Just like I would never say all soldiers are heartless SOB's just because one soldier gets the bright idea to toss a puppy off a cliff.
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    Originally Posted by southerndoc View Post
    I wasn't there when you were evaluated, so I don't know what your physical exam and exact complaints were. So I may or may not have checked labs. However, this sounds like an individual problem with one particular physician and not all physicians in general. I would suspect with your CPK being so high that you weren't really experiencing hematuria, but instead had tea colored urine from your myoglobinuria. (This actually reacts with a urine dipstick and will falsely report it as hematuria, but microanalysis will reveal no RBC's. The dipstick reacts because it detects heme, which is also part of myoglobin.)

    Just like I would never say all soldiers are heartless SOB's just because one soldier gets the bright idea to toss a puppy off a cliff.
    You said rhabdo wasn't a case for admission in most cases. I agree. However, when someone can't walk and you discharge them and watch them CRAWL into a waiting car, maybe you should take the time for a blood test?

    And yes, I was pissing blood. I did a urine test and it came back as "moderate" (and this was over a day after I was initially taken to the hospital) Also, my urine wasn't tea colored, it was black like coffee.

    Yes, I have a problem with one specific physician. That was why I wrote what I wrote and that is why I think doctors should be a legitimate target of criticism when they fail to do their job. The doc at the VA hospital was on top of it and possibly stopped my kidneys from shutting down. I think he did a great job. However, why should I have to visit two hospitals to find this out?

    Also, your troop analogy isn't needed. If some solider in Iraq does something stupid or barbaric, he deserves whatever punishment he gets.
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    Originally Posted by US_Ranger View Post
    And yes, I was pissing blood. I did a urine test and it came back as "moderate" (and this was over a day after I was initially taken to the hospital) Also, my urine wasn't tea colored, it was black like coffee.
    This is exactly what I was saying before. Your physician was an idiot if he told you that you had hematuria because he failed to realize that a urine dipstick tests for HEME, not hemoglobin or red blood cells. Anything that contains heme -- red blood cells or myoglobin -- will react with the dipstick. When it was reported as "moderate," and with your symptoms, he must have failed to recognize that it was secondary to rhabdomyolysis. Had he sent the urine to the lab to have microanalysis performed he would have seen the lab report dipstick blood as "moderate" and RBC's as "0" which should have automatically prompted him to add a urine myoglobin and start aggressive fluid resuscitation until the urine myoglobin came back.

    Hematuria is never black. At most it's gross red (most of the time it's pink). Black (coca-cola) and tea colored urine is from myoglobinuria. Tea colored in more mild cases, and black urine in more severe cases (which are more prone to acute renal failure).

    You have every right to criticize one physician. However, I took your post saying you shouldn't listen to physicians to be a generalization instead of being targeted to one physician. Please don't hold the faults of incompetent physicians against those of us who actually know what we are doing. Even the best physicians make mistakes, but some out there haven't a clue, and if your physician saw moderate blood with coffee colored urine and 0 RBC's from the lab and still didn't put two and two together, then he/she is a lost cause. They wouldn't know rhabdomyolysis ever because I would say that this scenario is slapping them in the face multiple times with the diagnosis.
    Last edited by southerndoc; 04-06-2008 at 06:39 PM.
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    It's easy to criticize someone when you have NO UNDERASTANDING of what they do. This is a perfect example. You are mad because he sent you home "pissing blood", but as southerdoc has pointed out, you were NOT pissing blood. Your misunderstanding is making you mad, not reality. Kinda like the recent case about John Ritter's death. Lay people are up in arms saying "how can you make this mistake?", but don't understand what is really going on.
    No sir, I don't like it.
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