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FLU-LIKE MUSCLE pain, COLD on dieting for FATTY LIVER.

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Generally, I am healthy. I was diagnosed last July 7, with mild fatty liver. I responded with fish diet and oatmeal and lost 5 kilos in 1 month time. On my 6th week of dieting, I feel like Im having some flu-like muscles pains. I feel cold in the external environment but I have no fever, no rash, no cough, no colds. Sometimes my eyes are burning and mouth is warm (feels like having a flu except that I have no fever). I have seen a cardiologist, endocrinologist, opthalmologist, rheumatologist (gave me a dx of fibromylagia) and my lab tests are normal except for my total CK which is 422 to 273 to 203 taken on 2 weeks interval. I was given pregabalin by my rheumatologist. I still have those flu-like muscle pains. What's wrong with me?


Category: Rheumatologist

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Category: Internal Medicine Specialist
 27 Doctors Online

Thank you for your query at
I understand your concern.
CK as a test, by itself is very non specific as it can be elevated in a range of disorders. But in absence of any other deranged lab tests, it mostly points towards, post-viral fibromyalgia as has been rightly diagnosed by your rheumatologist. Mostly viral infections won't have fever, fever starts when there is super imposed bacterial infections. So it is possible that your muscle pains ( myalgia ) started due to the viral infection and it got widespread ( fibromyalgia ) .
CPK is high, it may also be due to exercise and rapid loss of weight sometimes contaminant in protein supplement called tryptophan can cause this symptoms. Excessive intake of fish oil can cause vitamin E and A toxicity.
Please get VIT D3 levels if it is possible.

Can you tell me where exactly is the pain? Is it more in the lower back? Or is it just through out?
Also do you have any joint pains?
Since the CK level is coming down by itself, it shows you're recovering and no such intervention is required. If the pain is bad, you can take Tab. Ibuprofen ( Advil ) 400 mg twice a day after food.
I can assure you, there is nothing to worry about. Post viral neuritis ( nerve pain ) and myalgia ( muscle pain ) is common and the recovery is spontaneous.

Feel free to discuss further,

Patient replied :

Thank you for your response. Next question would be this. I started feeling the muscle pains last August 27 and I still have the symptoms until now. The pain is all throughout. Sometimes it is hard to pinpoint because it comes and goes on different areas for the entire day. Although they are manageable, I was thinking if this is viral, this should be self-limiting correct? How long can this last? My ionized calcium is also low as I have sent you the picture of that. My doctor ordered me to take TUMS every after meals 3 times a day. I can tell that I am improving daily. Also, this feeling of coldness (when I touch something metal, I can feel the coldness of the object as if I'm having a flu), what is this? Is this all related?
For now, what should I do? I am given with Pregabalin 50mg as Neuropathic Pain Reliever.

I am happy that you have been put on calcium medicine however the absorption of calcium is highly dependent on VIT D availability. There are quite a few possibilities, since you're recovering mostly it is due to a post viral recovery, and that is a good sign, that you're getting better every day.
As of now i will advise you to get your Vitamin D level checked too.
Pain can be also due to muscle strain especially psoas and quadratus lumborum strain. it can be because of enthesitis due to spondyloarthritis. But these possibilities will only come into picture if you don't recover may be in another couple of weeks. Muscle pain can be due to vit b12 deficiency also. ZINC Magnesium, sodium and potassium all are linked to muscle health deficiency of any of these can cause pain. Continue taking the TUMS and the Pregbalin. We will take things one at a time. Get your vitamin d levels evaluated and attach the reports when you can,
Kind Regards.

Patient replied :

Thank you very much. I have seen a neurologist yesterday and she confirmed that the pain I am feeling is not related to muscle but peripheral nerve pain. So she prescribed on the TUMS, Pregabalin and Vit B complex (Polynerve). Next week, I will have my CK and Calcium rechecked. Now that the pain is not muscle, what could be the cause of the pain? As I recalled, my C-reactive protein, my ANA and ESR are normal. What is this that I am feeling? Could anxiety be a cause to this one? My family is prone to anxiety as well.

Dear Sir,
It is good that you had meeting with Neurologist, after examination he would have concluded about muscle versus nerves issue. He has started you on medicines. Please continue, but in my setting the investigation are carried out before I label someone with fibromyalgia. I had enlisted them, for two reasons- once a person has been labeled fibromyalgia, a disease of exclusion the investigations comes to sudden end.
So if you have treatable condition and wrongly labelled as fibromyalgia a golden opportunity is lost. However a neurologist opinion who has examined would be the best opinion.
Yes anxiety can cause pain. so for anxiety management you can get a few sessions of cognitive behavior therapy by a psychologist/psychiatrist would be a great idea.
Hope this was helpful,

Dr. Bimlesh Dhar Pandey
Category: Internal Medicine Specialist
Senior Residency: Rhematology, All India Institute of Medical Schiences, New Delhi, 2009
Post Graduate, Junior Residency: MD (Internal Medicine), Rajendra Institute of Medical Sciences, Jharkhand, 2006
Residency: Physiology, Institute of Medical Science, Banaras Hindu University, Varanasi, 2003
Internship: Government Medical College, Trichur, 2001
Medical School: MBBS, Calicut University, 2001
Dr. Bimlesh Dhar Pandey and 4 other Medical Specialists are ready to help you

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