Medical mystery

Ever hear of Rhabdomyolysis?

Me neither, not until the condition landed me back in the hospital nearly two weeks ago.

Rhabdomyolysis: It sounds like some disease that members of Dr. Gregory House's diagnostic team would throw out in one of their brainstorming sessions. They have a patient in the ER, with a set of benign but baffling symptoms and a notable medical history. "Patient presents with episodes of light-headedness and vertigo, similar to episodes in October that involved brachycardia, an abnormally slow heart rate that briefly fell to zero and caused patient to lose consciousness." 

After the patient (me) had a series of sudden fainting episodes one Sunday in October, the patient underwent surgery to have a pacemaker implanted in her chest. The pacemaker now kicks in whenever the heart rate drops below 65.

I have been feeling good with the pacemaker,finding myself with increased energy throughout the day and more stamina when I exercise. On the morning of Saturday, April 28, I went to a regular class at my gym -- a mix of cardio and strength training.  I was feeling a little tired that morning -- I thought from a lack of sleep -- but the workout picked me up. But then that afternoon,  I started to suddenly feel this sensation of the blood rushing out of my head and of the world collapsing in on me. It happened three times, once while I was standing at the kitchen counter and cutting up some chicken for dinner. Each time, I got myself to a place where I was sitting or lying down, and waited for the sensation to pass. I didn't lose consciousness. 

My husband and I wondered if the pacemaker was acting up -- or not -- so we decided to go to John Muir Medical Center's Emergency Room, where I underwent various tests, including an EKG, which didn't show anything unusual.  A representative of St. Jude's, the manufacturer of my pacemaker, also came by and checked out the device. It was working properly; my heart rate was beating reliably. 

The staff sent me home. 

Then on Sunday afternoon, after my husband and I had returned from a walk around Mount Diablo,  we received a call from the ER doctor who had seen me the night before. He had some alarming news: my CPK levels were extremely high. "CPK," I thought, "California Pizza Kitchen? "

No, Creatine phosphokinase, he explained. It is an enzyme (see model above)  found mainly in the heart, brain, and skeletal muscle. High levels of it in the blood indicate a breakdown of muscle tissue somewhere in the body. The normal range for CPK levels in the blood is is 60 to 250. Mine was 6,000. According to the Medline Plus, people usually have high levels if they have had:

• Brain injury or stroke
• Convulsions 
• Delirium tremens
• Dermatomyositis or polymyositis
• Electric shock
• Heart attack
• Inflammation of the heart muscle (myocarditis)
• Lung tissue death (pulmonary infarction)
• Muscular dystrophies
• Myopathy

With my pacemaker, the doctors were of course concerned that I had suffered a heart attack. But the ER doctor was also worried that this muscle breakdown --Rhabdomyolysis -- releases a protein called myoglobin into the bloodstream. Too much myoglobin in the system can cause kidney damage. Whatever the cause of my "rhabdo," the doctor wanted back me in the hospital immediately, receiving IV fluids to flush out the bad proteins and to save me from kidney damage.

So, back to John Muir I went. I was admitted to a nice, quiet private room on the third floor, where I spent the night hooked up to an IV drip.  Another blood test showed that the muscle tissue breaking down in my body didn't come from my heart -- so no heart attack, no heart damage.

But that left what? The doctors were baffled. I had not been super drunk and going through alcohol withdrawal on Saturday. I hadn't been in any kind of accident and suffered muscle damage. I had been exercising Saturday morning, but nothing out of the ordinary and elevated CPK levels from exercise are usually associated with an athlete who has just run a marathon or done super-heavy weight lifting.

My CPK levels fell to 2100 by Monday, April 30, and I was sent home with orders to see my primary care physician and cardiologist, undergo more blood work, and stay well hydrated.

One possible explanation? Simple dehydration. Maybe I had not been drinking enough water. Actually, I had been thinking in recent weeks that I wasn't drinking enough.

But when I told my son I might have "dehydration,"  he gave me a skeptical look and started teasing me. He hinted that I had a celebrity train wreck diagnosis. He had certainly heard of enough celebrities checking into the hospital for what their publicists euphemistically called  "dehydration" or "exhaustion." I assured him that, no, I am not in the throes of a chemical addiction.

This week, I've seen both my primary care physician and cardiologist. "This is strange," my cardiologist said. Other than those dizzy spells and my elevated CPK levels, I am asymptomatic. I feel fine. The cardiologist asked if I had been out foraging for mushrooms and eating them. No, I said. Had I been sick with the flu or some other virus? Again, no. My primary care doctor noted I didn't have any weird rashes that might indicate an auto-immune disorder. Still, she wants to do more blood work to check for that and to see if anything is wacky with my thyroid.

So, we'll see. It has certainly been an interesting year, health-wise.