RE: Your valued opinons?'

[Guest guest]

Vern -

You do not describe what he is experiencing besides the heart beat in the ears.

A first degree heart block may be physiologic. It can occur in the conditioned athlete. It merely implies a delay in conduction within the heart. It may be a normal condition for this individual, especially with bradycardia. An MI would display significant Q waves in leads associated with the cardiac damage. There would also be some alteration in the ST segments depending on the acuteness of the infarction.

You do not mention when or why the blood chemistry was drawn. CPK (CK) will rise significantly following an MI. But it will move back to normal over the next few days. LDH will rise slower and return to normal slower. If there is a concern, fictionalization of the blood can be ordered to identify the origin of the elevation. SGOT (now more commonly reference as AST) will rise with cardiac injury, but the overall pattern does not suggest cardiac injury. All could be breakdown products from physical (muscle) activity.

By blood in the stool, I must assume that he sees red blood following elimination. While not absolute, fresh, free blood would suggest a bleeding source closer to the end of the colon. GI bleeding usually gives a tarring appearing stool. If it were a high GI bleed producing frank blood, one would expect anemia to be present on the blood count. Do we have a blood count and differential?

Do we know his blood pressure? Any history of hemorrhoids? What is his food intake? High protein? Low fiber?

Bleed in the GI tract should never be dismissed, but the presentation given would not suggest a GI cancer.

The lab work would suggest a slight increase in coronary risk with the slightly elevated cholesterol (total and LDL), but it is so close to the optimums that I would not be overly concerned about the risk if he is doing other risk lowering activities.

Given the bradycardia, the sensation of the heart beat in the ears, stress, the sometimes bloody stool, and the weight lifting, I would be inclined look closer at the possibility of hypertension and rule out hemorrhoids.

Tom Freedland

Tigard, OR

[Guest guest]

Tom:

Thank you for taking the time to post a comprehensive response, it is much appreciated.

As per your comments I am looking more at eliminating colon pathology more than an MI. He has no hypertension nor hemorrhoids and the lab has not post the CEA results yet.

I think it likely you are correct that the elevated CK, LDH, AST and such are indeed secondary to his weight training as his CRP was also within normal ranges though this also tends to point away from the colon path or any other systemic pathology going on....I'll wait for the CEA.

As I indicated been out of the internal disorders loop for a little while and your feedback is again much appreciated.

Vern

Re: "Your valued opinons?'

Vern -You do not describe what he is experiencing besides the heart beat in the ears. A first degree heart block may be physiologic. It can occur in the conditioned athlete. It merely implies a delay in conduction within the heart. It may be a normal condition for this individual, especially with bradycardia. An MI would display significant Q waves in leads associated with the cardiac damage. There would also be some alteration in the ST segments depending on the acuteness of the infarction.You do not mention when or why the blood chemistry was drawn. CPK (CK) will rise significantly following an MI. But it will move back to normal over the next few days. LDH will rise slower and return to normal slower. If there is a concern, fictionalization of the blood can be ordered to identify the origin of the elevation. SGOT (now more commonly reference as AST) will rise with cardiac injury, but the overall pattern does not suggest cardiac injury. All could be breakdown products from physical (muscle) activity.By blood in the stool, I must assume that he sees red blood following elimination. While not absolute, fresh, free blood would suggest a bleeding source closer to the end of the colon. GI bleeding usually gives a tarring appearing stool. If it were a high GI bleed producing frank blood, one would expect anemia to be present on the blood count. Do we have a blood count and differential?Do we know his blood pressure? Any history of hemorrhoids? What is his food intake? High protein? Low fiber?Bleed in the GI tract should never be dismissed, but the presentation given would not suggest a GI cancer.The lab work would suggest a slight increase in coronary risk with the slightly elevated cholesterol (total and LDL), but it is so close to the optimums that I would not be overly concerned about the risk if he is doing other risk lowering activities.Given the bradycardia, the sensation of the heart beat in the ears, stress, the sometimes bloody stool, and the weight lifting, I would be inclined look closer at the possibility of hypertension and rule out hemorrhoids.Tom FreedlandTigard, OR

[Guest guest]

-----Original Message-----From: Vern Saboe DC [mailto:vas@...]Sent: Monday, March 01, 2004 7:43 PMTFreedland@...; ACA-Members@...; Subject: Re: "Your valued opinons?'

Tom:

Thank you for taking the time to post a comprehensive response, it is much appreciated.

As per your comments I am looking more at eliminating colon pathology more than an MI. He has no hypertension nor hemorrhoids and the lab has not post the CEA results yet.

I think it likely you are correct that the elevated CK, LDH, AST and such are indeed secondary to his weight training as his CRP was also within normal ranges though this also tends to point away from the colon path or any other systemic pathology going on....I'll wait for the CEA.

As I indicated been out of the internal disorders loop for a little while and your feedback is again much appreciated.

Vern

Re: "Your valued opinons?'

Vern -You do not describe what he is experiencing besides the heart beat in the ears. A first degree heart block may be physiologic. It can occur in the conditioned athlete. It merely implies a delay in conduction within the heart. It may be a normal condition for this individual, especially with bradycardia. An MI would display significant Q waves in leads associated with the cardiac damage. There would also be some alteration in the ST segments depending on the acuteness of the infarction.You do not mention when or why the blood chemistry was drawn. CPK (CK) will rise significantly following an MI. But it will move back to normal over the next few days. LDH will rise slower and return to normal slower. If there is a concern, fictionalization of the blood can be ordered to identify the origin of the elevation. SGOT (now more commonly reference as AST) will rise with cardiac injury, but the overall pattern does not suggest cardiac injury. All could be breakdown products from physical (muscle) activity.By blood in the stool, I must assume that he sees red blood following elimination. While not absolute, fresh, free blood would suggest a bleeding source closer to the end of the colon. GI bleeding usually gives a tarring appearing stool. If it were a high GI bleed producing frank blood, one would expect anemia to be present on the blood count. Do we have a blood count and differential?Do we know his blood pressure? Any history of hemorrhoids? What is his food intake? High protein? Low fiber?Bleed in the GI tract should never be dismissed, but the presentation given would not suggest a GI cancer.The lab work would suggest a slight increase in coronary risk with the slightly elevated cholesterol (total and LDL), but it is so close to the optimums that I would not be overly concerned about the risk if he is doing other risk lowering activities.Given the bradycardia, the sensation of the heart beat in the ears, stress, the sometimes bloody stool, and the weight lifting, I would be inclined look closer at the possibility of hypertension and rule out hemorrhoids.Tom FreedlandTigard, OR OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

[Guest guest]

Vern, What will the CEA tell you ?

sharron fuchs dc

-----Original Message-----From: Vern Saboe DC [mailto:vas@...]Sent: Monday, March 01, 2004 7:43 PMTFreedland@...; ACA-Members@...; Subject: Re: "Your valued opinons?'

Tom:

Thank you for taking the time to post a comprehensive response, it is much appreciated.

As per your comments I am looking more at eliminating colon pathology more than an MI. He has no hypertension nor hemorrhoids and the lab has not post the CEA results yet.

I think it likely you are correct that the elevated CK, LDH, AST and such are indeed secondary to his weight training as his CRP was also within normal ranges though this also tends to point away from the colon path or any other systemic pathology going on....I'll wait for the CEA.

As I indicated been out of the internal disorders loop for a little while and your feedback is again much appreciated.

Vern

Re: "Your valued opinons?'

Vern -You do not describe what he is experiencing besides the heart beat in the ears. A first degree heart block may be physiologic. It can occur in the conditioned athlete. It merely implies a delay in conduction within the heart. It may be a normal condition for this individual, especially with bradycardia. An MI would display significant Q waves in leads associated with the cardiac damage. There would also be some alteration in the ST segments depending on the acuteness of the infarction.You do not mention when or why the blood chemistry was drawn. CPK (CK) will rise significantly following an MI. But it will move back to normal over the next few days. LDH will rise slower and return to normal slower. If there is a concern, fictionalization of the blood can be ordered to identify the origin of the elevation. SGOT (now more commonly reference as AST) will rise with cardiac injury, but the overall pattern does not suggest cardiac injury. All could be breakdown products from physical (muscle) activity.By blood in the stool, I must assume that he sees red blood following elimination. While not absolute, fresh, free blood would suggest a bleeding source closer to the end of the colon. GI bleeding usually gives a tarring appearing stool. If it were a high GI bleed producing frank blood, one would expect anemia to be present on the blood count. Do we have a blood count and differential?Do we know his blood pressure? Any history of hemorrhoids? What is his food intake? High protein? Low fiber?Bleed in the GI tract should never be dismissed, but the presentation given would not suggest a GI cancer.The lab work would suggest a slight increase in coronary risk with the slightly elevated cholesterol (total and LDL), but it is so close to the optimums that I would not be overly concerned about the risk if he is doing other risk lowering activities.Given the bradycardia, the sensation of the heart beat in the ears, stress, the sometimes bloody stool, and the weight lifting, I would be inclined look closer at the possibility of hypertension and rule out hemorrhoids.Tom FreedlandTigard, OR OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.