AST and ALT are liver function tests, looking for signs of liver inflammation. A good thing to check if lipitor is causing muscle inflammation, as it can cause liver inflammation too. If present, this tends to normalize quickly after the medication is removed.
If a doc is sending someone to a rheumatologist, I’d expect to see an ESR (erythrocyte sedimentation rate) and CRP (c-reactive protein) among the lab tests.
No idea what 272ry is. I’ve enough trouble deciphering what I meant with my own handwriting…
Odd that that wasn’t on the first test. I’ve been off lipitor for days now, and my muscle inflammation is pretty much gone, I’d expect my liver would also have normalized.
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Hmm, I have sheet lab right here, I’d guess you mean “CRP-Routine (inflamation)”, not “CRP-Ultrasens (Cardiac)”; maybe I should check that box? I don’t see an ESR on the checkboxes, and I don’t think I can replicate my doc’s handwriting and add that myself, so that’s right out.
Might take a little longer. And I don’t worry much about the levels unless they’re over 4 x top normal readings, like in the 200’s. I wouldn’t check the liver functions intially just due to complaints of muscle pain, but if elevated CPK resulted, I then would probably check liver functions.
I’d not alter the order sheet; you could end up getting stuck with the lab bill. Some of those tests are pricey!
Oh, one final comment: If an ANA is positive, it’s always good to know at what titer it is positive, and what pattern. Titers of 1:40 or less are not real meaningful in most cases, and when they are, it takes a rheumatologist to figure out what it all means. Titers of 1:80 or higher may tend to have more significance.
You have to wonder, though, if some numbnutz has tried that – “wow, I should probably have a metabolic panel, too! And maybe this other one here…” and they check like 10 items and give that to the lab.
Okay, I’ll see if I can get that out of the doctor; the lab results I got were not what the lab sent but what the doctor’s minions printed out from their system. It may be pre-digested and leaves out the titer, or the lab just didn’t send that information. I’ll ask.
Hey, Qadgop, one more thing – unbeknownst to me, my family doc prescribed me Flexeril (muscle relaxant), 10mg, take 1/2 to 1 pill before bed; it just showed up in my mailbox from our mail-order pharmacy. My doctor had mentioned maybe prescribing an MR, but she didn’t give me a prescription sheet when I was leaving, so I figured she changed her mind. If my muscle aches are gone, do I need this? Does it have theraputic value aside from muscle aches, or is it just for treating my achy-breaky symptoms? I’ll probably take it for a couple of nights in any case, since she’s my doctor and you aren’t , but I’m curious to get your opinion.
I don’t much use muscle relaxers, except for acute muscle spasms, & then only for short term use. I feel they have no credible use outside of helping break a muscle spasm. I consider them some of the most over-prescribed drugs on the planet. They are very popular medications among those who abuse drugs, especially when they can’t get their drug of choice, as they tend to induce sleep as a side-effect.
Those are my general thoughts on the topic of muscle relaxers. I am not applying them to your specific situation because you’re not my patient.
AST (SGOT) 24, normal 0-40
ALT (SGPT) 29, normal 0-55
CK 193, normal 24-204
So liver function is normal, and CK has come down 49 points, obviously from discontinuing Lipitor. FYI to Qadgop, I also got back the real lab results from LabCorp for my initial test, and the ANA titer is not documented. Strangely, the second test did not check ANA, so I don’t know if Lipitor was affecting that as well, and if its changed.
I’m starting to wonder if I should bother with the rheumatologist, based solely on that ANA reading. For some people (see velvetjones earlier), a whacked ANA is their normal. OTOH, I’d really like to know if there’s anything up with my joint pain, which is pretty bad sometimes.
I have an appointment with a rheumatologist in San Jose on 5/21. I’m trying to get into the rheumatologist in Gilroy; they have no appointments available, but will call me if something opens up.
FWIW, I feel a lot better now that I’m not taking Lipitor: a lot of body aches have gotten a lot better, esp my forearms, but also legs and back. Sometimes I felt like I’d been kicked by mule down a flight of stairs.
I’d like to say thanks to all the contributor to this thread – I feel a lot more knowledgable and a lot calmer about this issue than I had when I posted the OP last week. Thank you!!!
I’d reccomend going. I see a rheumotologist for my lupus, and it’s not really that big of a deal. You may get some good feedback from him, and even if you don’t, all you lose is a few hours.
Just was hoping I could bump this and that people are still reading!
My D.O. recommended I go to a Rheumatologist. I went to him because my right knee has been bugging me for awhile now (hurts a bunch especially when I sit on my duff and get up, but after walking around a bit will stop hurting. I can’t sit-kneel anymore without a lot of pain either). He gave me a cortisone shot, which helped for 3 weeks but then the pain slowly came back. And my left knee is starting to hurt, too.
My factor test was negative but my Sed Rate was 35 and my C Reactive Protein was 3.10. He still is concerned it could be RA due to that, my left knee hurting, family history (my grandma (maternal side) had RA and her mother did as well) along with being of Northern/Eastern European descent (and extremely pale to prove it ;)).
He also mentioned off-handedly (because it’s more of a ‘zebra’ than a ‘horse’) Ehler-Danlos Syndrome, because of my apparently extreme flexibility, the joint pain and he had me stretch my neck skin (apparently was stretchier than normal). He wants me to see a Rheumatologist first, but it’s funny because I read the Wikipedia page on EDS, see the drawings at the top and say, “hey, I can do all of those!”
Anyway, so I’m rather scared and I guess just wanted some replies while I wait around for the doc.
I’ve seen people go further than that. I work in a medical lab and more than once I have seen requests forms written in two different sets of handwriting, where all the tests in the 2nd style are weird esoteric tests that we do maybe once a year or pretty much never. Obviously these patients don’t realise that the first thing we do when we see something like that is ring the doctor whose name is on the form and have a quick chat about why they are asking for all these unusual tests. The answer is usually along the lines of “oh no, I only requested some standard tests…hmmm…the patient did come in here with a list of tests he/she had looked up on the internet…what’s that you say, it’s in different handwriting? Ah, I see, I’ll speak to the patient and let them know not to do that again.”
I was diagnosed about 2 1/2 years ago with RA. Never had a pain or sick day in my life. I was 62 at the time. My grandmother had it. Never had pain that hurt that much.
Went to the specialist, they put me on two meds, and I’ve been 100% pain free until two months ago. RA came back, won’t go away. They’re gonna switch me to Humira. This isn’t first choice because of cost. I’ll tell you in three weeks if it works.
It just weirds me out because I’m 26, dangit. Why am I going through this now? I knew that later in life I’d be in pain because of my joints (extremely flexible, shoulders and hips can go out of their sockets pretty easily, knees and elbows hyperextend, etc.). I figured I’d have longer than this before I’d notice this crap.
So I finally saw a rheumatologist, and she diagnosed psoriatic arthritis, pending a dermatologist agreeing that I have psoriasis. The diagnosis code is 714.9.
She said they get pretty aggressive with treatment, and preventing damage to the joints is the priority. She said Methotrexate (a former cancer chemo treatment) and biologics are used for treatment, as well as regular anti-inflammatories such as Aleve/Naproxen. So, I’m off to the dermatologist soon to see what that next doctor makes of all this. The rheumatologist also said that if its not psoriatic arthritis, then lupus is another candidate. But she seemed pretty sure that this is psoriatic arthritis.
I’m still googling to figure out what this all means. Anyone here have psoriatic arthritis ?
ETA: I see Diogenes has this as well, per his post above. Sorry to hear that.
Per my posts above: I was finally approved for Enbrel a week ago. I give myself a very simple shot once a week. I was suffering horribly the last month waiting to be approved. Within hours of getting the shot, my pain lessened, and was totally in remission within 12 hours. Miracle drugs.
Wow, that’s awesome, samclem, especially after you went for weeks in pain, to have a magic bullet just take care of it, poof! I hope that drug keeps working well for you. My rheumatologist mentioned Enbril and Humira as possible drugs for me as well, so we’ll see if that bullet works on my issues, too.
I love my TNF inhibitor. When I started Remicade, Enbrel had stopped working for me. I had immediate results - walked in the office stiff and sore (Remicade is a 2-hour IV infusion) and walked out feeling about 500% measurably better. Definitely a miracle, for me - this is what keeps me functional, able to work at my job, and able to enjoy my life.
Most insurance companies will not approve a patient for Enbrel, Humira, or Remicade until they have ‘trialed’ less expensive things like methotrexate first and have had no benefit from them. The process can be long, especially since methotrexate particularly can take months to show results. (It never did a thing for me except upset my stomach. It’s of questionable benefit in AS anyhow, but it still has to be tried for the approval process.)
As an estimate on cost - I pay $700 for each Remicade infusion I receive (including the associated labwork), and that’s AFTER my insurance pays at 85%. Enbrel and Humira are somewhat cheaper. All of these medications have ‘loyalty’ or discount programs you can enroll in to cover part of the cost, and it’s well worth it.
Replace Enbrel, Humira, Remicade with any costly treatment, and that’s what insurance would do for every case. My housekeeper has been on chemo for about a year and a half because the insurance won’t approve an operation to remove her tumor directly. She’ll do a several week round, the cancer is still there after but not growing as far as they know, and they’ll order another round of chemo. Month after month, rolling the dice that the tumor won’t spread to other parts of her body.
Months? Holy moley, that must be frustrating as heck.
Wow, that’s like $4700 per treatment, total. I can see where insurance would balk. How often must you get Remicade treatment?
How does that work? Are you basically ‘buying’ futures in the drug treatment, so the lab/mfr can expect regular payments over some months? That’s pretty cool if it works that way.
I don’t see an ESR on the checkboxes, and I don’t think I can replicate my doc’s handwriting and add that myself, so that’s right out. 
