Re: CK blood test


"Sharon Hope" <shope@xxxxxxxx> wrote in message
news:wfWdnZYbd_P96VTfRVn-tQ@xxxxxxxxxxxxxx
>
> "Bill" <xxx@xxxxx> wrote in message
> news:MZ7ye.153$LK5.85@xxxxxxxxxxxxxxxxxxxxxxxxxxxxx
>>
>> "Sharon Hope" <shope@xxxxxxxx> wrote in message
>> news:uuudndUjpebdUFXfRVn-2g@xxxxxxxxxxxxxx
>>>
>>> "Bill" <xxx@xxxxx> wrote in message
>>> news:3N2ye.194$Xp6.75@xxxxxxxxxxxxxxxxxxxxxxxxxxxxx
>>>>
>>>> "Sharon Hope" <shope@xxxxxxxx> wrote in message
>>>> news:xJWdnd-d1M3hNFXfRVn-2g@xxxxxxxxxxxxxx
>>>>>
>>>>> "Bill" <xxx@xxxxx> wrote in message
>>>>> news:EN%xe.152$Xp6.1@xxxxxxxxxxxxxxxxxxxxxxxxxxxxx
>>>>>>
>>>>>> "Sharon Hope" <shope@xxxxxxxx> wrote in message
>>>>>> news:W9idnfLmY7EBHlXfRVn-pg@xxxxxxxxxxxxxx
>>>>>>>
>>>>>>> "Robert" <Robertitsme@xxxxxxxxxxx> wrote in message
>>>>>>> news:FOednZk6qqRJz1XfRVn-qQ@xxxxxxxxxx
>>>>>>>> http://jnnp.bmjjournals.com/cgi/content/full/68/6/750
>>>>>>>>
>>>>>>>> http://www.gpnotebook.co.uk/cache/-415956920.htm
>>>>>>>>
>>>>>>>> Being a doctor is hard and not as straight forward as some would have
>>>>>>>> you
>>>>>>>> believe.
>>>>>>>>
>>>>>>>> Statins are contra indicated in hypothyroidism which is what I
>>>>>>>> presume you
>>>>>>>> have based on your Super sensitive TSH which is low. Thyroid meds are
>>>>>>>> based
>>>>>>>> on TSH levels. Too low then meds are cut back and too high then meds
>>>>>>>> are
>>>>>>>> increased.
>>>>>>>> Thyroid impacts metabolism. You know how people go on diets and they
>>>>>>>> say to
>>>>>>>> lose fat and not muscle? Muscle metabolism is involved in thyroid
>>>>>>>> disorders
>>>>>>>> as reflected by the CK or CPK which stands for creatine
>>>>>>>> phosphokinase. It is
>>>>>>>> an enzyme that is involved with high energy phosphorulation coupling
>>>>>>>> reactions. ATP is the energy source of preference for aerobic use
>>>>>>>> while
>>>>>>>> creatine phosphate is the preferred source for anaerobic function.
>>>>>>>>
>>>>>>>> There are three different enzymes that we can test for. The one of
>>>>>>>> use
>>>>>>>> clinically is the CKMB fraction that is derived from heart generally
>>>>>>>> and is
>>>>>>>> used to check for heart attacks. The CKMM fraction is from
>>>>>>>> conventional
>>>>>>>> muscle and the CKBB fraction from brain.
>>>>>>>>
>>>>>>>> There are many, many reasons for CK elevations, from regular exercise
>>>>>>>> to
>>>>>>>> more severe disease.
>>>>>>>>
>>>>>>>> To blame everything on statins is just as dangerous and not blaming
>>>>>>>> anything
>>>>>>>> on statins.
>>>>>>>>
>>>>>>>>
>>>>>>>
>>>>>>> Yes, the doctors are supposed to look for "horses, not zebras" in
>>>>>>> identifying the cause of a problem.
>>>>>>>
>>>>>>> In this case, the doctor should first ask, did you participate in an
>>>>>>> ultra-marathon race immediately before the blood test?
>>>>>>>
>>>>>>> If not, the "horse" approach would be to ask:
>>>>>>>
>>>>>>> Is this patient taking a drug that has a known adverse effect of
>>>>>>> muscle damage as identified by elevated CK? Yes? A statin? Then the
>>>>>>> most likely cause is the statin.
>>>>>>>
>>>>>>
>>>>>>
>>>>>> I don't know if that is true or not true. What do you base that on? Do
>>>>>> you know what % of people who are not on statins normally have high CK
>>>>>> levels? Thanks.
>>>>>>
>>>>>
>>>>> We know the "norms" from the CK Lab report.
>>>>>
>>>>
>>>> That's not the point or addressing the question I asked. The question I'm
>>>> trying to get an answer to is: If you took a random cross section of the
>>>> population of non statin takers what is the liklihood that a person would
>>>> show a high level of CK on this test. Or, to put it another way, what is
>>>> the probability of a false positive on this test? Your claim that the
>>>> most likely cause is a statin requires the false positive rate to be low.
>>>>
>>>
>>> I don't take random cross sections of anything. I work full time plus to
>>> keep the family afloat, because one wage earner is now disabled from
>>> statin adverse effects.
>>>
>>
>> Which has no relevance to anything being discussed here.
>
> The relevance is that you should ask an expert.
>
>>
>>> The most logical place to look for a sudden symptom that corresponds to
>>> the most common known adverse effects of the drug the patient is taking is
>>> that drug. This is not surprising.
>>>
>>> No rates of false positives are required at all. Once one cause is
>>> eliminated, others are visited. Are you asking if a CK reading itself is
>>> likely to be a false positive? If that were common, I would expect that
>>> there would be a series of measurements made, or the measurement would not
>>> be considered useful at all. Apparently doctors are encouraged to use it
>>> with statin patients and with myopathy, so draw your own conclusions.
>>>
>>> I am no an expert on anything medical, and would expect you to ask an
>>> expert your question.
>>>
>>
>> You claimed:
>>
>> " Is this patient taking a drug that has a known adverse effect of muscle
>> damage as identified by elevated CK? Yes? A statin? Then the most
>> likely cause is the statin."
>>
>> I am asking you to support YOUR claim. Why could not the most likely cause
>> be a false positive due to something else?
>>
>
> Horses, not zebras. Obviously if the patient is taking a known myotoxic and
> neurotoxic substance, that would be the first place to look.
>

What you said was the most likely cause was statins. You have yet to support
that. For your statement to be true the number of false positives must be low.
And you have yet to show that it is.

>>
>>> My comments spring from the observation that, despite the fact that the
>>> most common adverse effects from statin drugs are well documented as
>>> muscle damage, cognitive damage and nerve damage, many doctors faced with
>>> that constellation of symptoms in a statin patient refuse to consider the
>>> drug while they chase other possible or imagined causes, while all the
>>> while the drug adverse effects are worsening and becoming more
>>> debilitating and disabling.
>>>
>>>
>>
>> Which has nothing to do with the question which is why could not the most
>> most likely source be a false positive due to something else?
>>
>
> Assuming a false positive from an established test is simply denial.
>

Now you are making no sense. The rate of false positives is what it is as
determined over time. One does not assume it.

> The same kind of denial that is common among heart attack patients who
> rationalize the chest pain with difficulty breathing to be indigestion.
>
> Assuming a false positive in an overt symptom is denial.
>

This has nothing to do with a decision on the part of the patient. It has to
do with the reliability of the test. You are trying to avoid the question.

>>>>> If a drug is prescribed that has the adverse effects the patient is
>>>>> presenting, regardless of the drug is a statin, that is the most likely
>>>>> cause to investigate first. This per a presentation on Medical Ethics
>>>>> at UCSD.
>>>>>
>>>>> Diagnosis can be challenging when it is an obscure but documented
>>>>> adverse effect, and when it is an adverse effect of more than one drug
>>>>> the patient is taking.
>>>>>
>>>>> In the case of statins, muscle pain and muscle damage with and without
>>>>> elevated CK is the most common adverse effect. No mystery in muscle
>>>>> pain with elevated CK while on statins or after statins.
>>>>>
>>>>>>
>>>>>>> If no statin has been taken, and no other myotoxin, look for the next
>>>>>>> most likely cause of the elevated CK.
>>>>>>>
>>>>>>>
>>>>>>> If, by the way, the statin was discontinued due to muscle pain, expect
>>>>>>> the muscle pain and damage to continue for months to years before
>>>>>>> subsiding.
>>>>>>
>>>>>> Just the opposite is true. From
>>>>>>
>>>>>> http://medicine.ucsd.edu/SES/adverse_effects.htm
>>>>>>
>>>>>> "Although symptoms usually resolve on stopping the drug, for a
>>>>>> proportion of those who have contacted us, muscle symptoms - pain or
>>>>>> weakness - or peripheral neuropathy may persist when the drugs are
>>>>>> discontinued."
>>>>>>
>>>>>
>>>>> This is not binary, there is a range of recovery experiences.
>>>>>
>>>>
>>>> I did not say it was. You claimed:
>>>>
>>>>
>>>>>>> If, by the way, the statin was discontinued due to muscle pain, expect
>>>>>>> the muscle pain and damage to continue for months to years before
>>>>>>> subsiding.
>>>>
>>>> According to the what I cited. One should not "expect the muscle pain and
>>>> damage to continue for months to years before subsiding." And there are
>>>> many more references that say the muscle pains typically resolve upon
>>>> discontinuing the statins.
>>>>
>>>> Therefore you were absolutely wrong.
>>>>
>>>
>>> Not so. You cited a website by the same researcher I cited. Knowledge is
>>> gained over time.
>>>
>>>
>>
>> The fact that I cited the same website was to show that even people you
>> trust disagree with with you. What does "Knowledge is gained over time"
>> have to do with anything. Again why should one
>>
>
> It means that new information has been published subsequently.
>


And I would expect the web site to be the most recent.


>> "expect the muscle pain and damage to continue for months to years before
>> subsiding"
>>
>>
>
> Because it has been documented.
>

Which you refuse to provide.


>>
>>>>> In my husband's case, the CK continued to elevate, ramping up to the
>>>>> threshold of rhabdo, for 12 full months off the statin before leveling
>>>>> off and starting to subside.
>>>>>
>>>>
>>>> I did not say it could not happen in an individual case.
>>>
>>> I say it did indeed happen in this individual's case. And, I have
>>> observed it myself, and I have the documented evidence.
>>>
>>
>>
>> So what? I agree with this. That fact that you have documented it has no
>> relevance to this discussion.
>>
>
> The discussion is "does this happen" and the documentation is evidence that
> "yes, this does happen."
>
> Clearly relevant.
>

I have already agreed to this a you keep bring it up. The question is what a
typical person should expect.

>>>>
>>>>> Dr. Golomb, whose website you cite, presented at the International
>>>>> Coenzyme Q10 Association conference this spring, and gave statistics on
>>>>> the ranges (in months) of time (with a plus-or-minus factor of
>>>>> additional montns) for two categories:
>>>>>
>>>>> 1) Time to start of recovery
>>>>>
>>>>> 2) Time to recover in full (or to the degree of recovery possible)
>>>>>
>>>>> These tables included the three most common statin adverse effects:
>>>>>
>>>>> a) Muscle Damage
>>>>> b) Cognitive Damage
>>>>> c) Nerve Damage
>>>>>
>>>>> In addition, she presented these numbers for the number of statin
>>>>> exposures. i,e,, if a patient suffered an adverse effect on one statin,
>>>>> halted the statin, recovered, then was started on a second statin. Also,
>>>>> the same for a halt, recovery, then prescription for a third statin.
>>>>>
>>>>> Further, Dr. Golomb set the likelihood of experiencing the same adverse
>>>>> effect on the second statin, if the statin is at the same effective
>>>>> dosage in the 90-95% range.
>>>>>
>>>>
>>>> None of which is relevent to the question.
>>>
>>> Obviously, if the time before there is any recovery at all from statin
>>> muscle damage is measured in MONTHS, that would be precisely relevant to
>>> the question of how long it typically takes for muscle pain begins to
>>> lessen. (that is after discontinuing the statin, of course)
>>>
>>
>> I will accept that if you present evidence of it - not your recollection of
>> it. It is not consitent with her website which says that "symptoms usually
>> resolve upon stopping the drug" This does not imply to most people months
>> or years. (Unless you mean 0 to 2 months and 0 years) Otherwise please
>> provide some evidence of your claim that I can see. What is a typical time
>> for resolution of symptoms?
>>
>
> You should have attended her presentation, as I did. Unless and until she
> publishes the findings in print, I will have the knowledge of what she
> presented, as will all the other attendees, but you will not.
>

You have your recollection, which I do not trust. And you have not even
elaborated on what your recollection is. You just said she talked about these
points. You gave no details on what she said. Or on what it was based on. Your
interpretation is contridicted by her own web site and by

"Many of the myopathic patients had felt markedly improved when they stopped
their statin therapy for two weeks before entry into the trial. "

from

http://www.impostertrial.com/physician.htm

So what we have is your source from your recollection for which you can
provide absoultely no support, no details about what exactly was said, and no
details on the underpinings for what said. And this is coupled with your
admitted biases. It is further contridicted by your source's website and
another website which you trust. Why should anyone accept what you say?


>>> Oftentimes, not always, CK elevation correlates to muscle pain.
>>>
>>> This, again, is the START of recovery, there is another entire chart, also
>>> measured in MONTHS (plus-or-minus some number of MONTHS) before the muscle
>>> pain resolves.
>>>
>>> If that is not relevant to the question, you didn't ask clearly enough.
>>>
>>>
>>>>
>>>>>>
>>>>>>
>>>>>>
>>>>>>
>>>>>>>CK elevation can continue to climb for a full year before leveling off
>>>>>>>and then subsiding.
>>>>>>>
>>>>>>> In some cases, the statin muscle damage exists without the elevated
>>>>>>> CK.
>>>>>>>
>>>>>>> In many cases, some level of statin-induced muscle dysfunction is
>>>>>>> permanent.
>>>>>>>
>>>>>>
>>>>>> I don't think there has been any documented case of permanent muscle
>>>>>> damage without elevated CK levels. Do you have any evidence that such
>>>>>> cases exist?
>>>>>>
>>>>>
>>>>> That was the previous paragraph, the statement "In many cases, some
>>>>> level of statin-induced muscle dysfunction is permanent" was
>>>>> independent. No, I have not seen the breakdown of the cases of
>>>>> permanent muscle damage with vs without elevated CK. The answer to this
>>>>> would be in one of the many statin adverse effects studies awaiting
>>>>> publication.
>>>>>
>>>>
>>>> Such a case may or may not exist in studies awaiting publication. But I
>>>> have been though some of the previous studies and have not found one. I
>>>> don't think you can cite one either.
>>>>
>>>> Do you know about when the adverse effects studies will be published?
>>>
>>> When the journal editorial board is ready to publish a study that might
>>> not please their statin pharmco advertizers.
>>>
>>
>> What do you mean by that?
>
> Obvious. No explanation is necessary.


You believe all journals are anti-statin so therefore the studies will never
get published?

Bill
>>
>> Bill
>>
>>>>
>>>> Bill
>>>>
>>>>>> Bill
>>>>>>
>>>>>>>> "Ben" <organ@xxxxxxxx> wrote in message
>>>>>>>> news:da9db30o1c@xxxxxxxxxxxxxxxxxxxxx
>>>>>>>>> Hi Everyone
>>>>>>>>>
>>>>>>>>> I had full blood work done a few weeks ago and most of the result
>>>>>>>>> was very
>>>>>>>>> good. Especially the cholesterol. but two readings were out of the
>>>>>>>>> normal
>>>>>>>>> limits. And that is STSH 0.08, that is for the thyroid. which is not
>>>>>>>> working
>>>>>>>>> well due that I am on Amiodarone and also the CK 390. Now the
>>>>>>>>> cardiologist
>>>>>>>>> reduce my thyroid medication, but said nothing about the CK.
>>>>>>>>> My question is, are the two related, what is CK reading anyway?
>>>>>>>>> Your input would be appreciated
>>>>>>>>> Ben
>>>>>>>>>
>>>>>>>>>
>>>>>>>>>
>>>>>>>>
>>>>>>>>
>>>>>>>
>>>>>>>
>>>>>>
>>>>>>
>>>>>
>>>>>
>>>>
>>>>
>>>
>>>
>>
>>
>
>


.

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