Thank you for your query at DoctorSpring.com
I understand your concern.
The thing is your blood parameters do not show anything suggestive of any active infection. But you still have mucus in the throat and that will only be there in cases of allergy/infection. So it will be prudent to take a course of antibiotics and do betadine gargling. The thorat issue should settle down. In absence of any enlarged lumph nodes, glandular fever does not seem likely and even monocytes are not enlarged. It just seems like a throat infection which needs to be treated.
Your uric acid is slightly elevated and that can be ignored. But your CK level is very high, indicating some ongoing muscle injury/ polymyositis. I will advise you to repeat the values after 7 days, just to confirm if there is any further injury.
For the time being do the following :
1) Betadine gargling 3-4 times a day.
2) Tab. Levofloxacin 500 mg twice daily for 5 days.
3) Tab. Neurobion Forte once daily at bed time for 5 days.
Let me know after the first 2 days of taking the medicine,
Patient replied :
My doctor told me that at 466 my CK levels were only slightly elevated and this could be due to my chiropractic treatment i have been receiving for a herniated disc or even muscle fatigue from my symptoms? He told me there was no need to re test for this? Can blood not show a throat infection/allergy? Just to add i have had two cortisone injections around 6 weeks ago into my lower back if that effects CK?
Now based on the additional history it can definitely be due to the muscle fatigue and the chiropractic treatment.
But i will still recommend you get it re-tested after a week or two because it is not mildly elevated. The values are pretty high, and such high values will definitely lead to further fatigue. Blood can show throat infection/ allergy ( mild elevation of leukocytes or eosinophils can be expected ) but in most cases it does not show, hence there is no point relying on blood parameters. The fact that there is mucus indicates infection and it is better if you take a course of antibiotics to treat it.
Patient replied :
I read somewhere that it can run into the thousands and the scale of 180-600 is only mildly elevated?
Can this ck level be causing all my symptoms? What can be done if it is still high in two weeks?
Why was my GP not concerned? He said it will not be related to feeling ill?
Yes what you read is true.
And why i asked you to get it rechecked is, if there is an ongoing muscle injury, next time the values can come in thousands too. So rather than waiting for it to get worse, it is logical to get it checked again. If the values stay the same, or comes down then no further intervention is required as per the CK is concerned.
Your GP is extremely confident that it is due to your chronic muscle fatigue, and i respect his opinion. But to be on the safer side, i will suggest you get it done again in 2 weeks time. For example when you have hepatitis, the ALT/AST levels initially will be only mildly elevated, but if you leave it, it will gradually become very high getting up to thousands. We should not wait for that to happen right?
In case its still high, we can check for other muscle related parameters such as myoglobin in your serum, and appropriate treatment for polymyositis can be started.
Patient replied :
Ok Thanks doctor. One more question. surely being only mildly elevated can make me feel as ill as i have been? Could cortisone injections be doing this as i am due one more? And if it is polymyositis what are my treatment options?
Yes if there is continuous ongoing muscle injury, it can make you feel quite sick. The values can literally jump very high in a matter of one day. No cortisone injection is not the reason, in fact it will reduce polymyositis if is the cause of your elevated CK.
See polymyositis is not that common and hence it is still early to call it that. But better to be safe and get it retested as i said earlier. May be it is just muscle fatigue. The repeat CK values will give a better picture. Muscular dystrophies can also be ruled out.
In case it is indeed due to muscle injury, immunosuppressants and corticosteroid injections will be helpful.
Continue the Levofloxacin too.