I get the usual tests and ekg, chest xray are ok. CBC shows little anemia but no infection....."ok, this must be the reason for fatigue but why chest pain?" He denys any bleeding and states he eats ok. More tests come back and looks like his liver is backing up! Hummm....maybe its hepatitis....ordered a hepatitis panel and asked if he used IV drugs or had high risk sex...no IV and no sex for 7 months. (OUCH!) Get his thyroid test back and "BINGO"...he's got a slow working thyroid. But why the anemia and chest pain? And for that matter....why the liver back up? Physical exam is all normal exept for the pale skin and big round red marks on his back. [I knew he saw an acupuncturist cause we do cupping to the back]. I ask, what did the acupuncturist give him and he said 3 bottles that he took for 2 weeks but he doesnt know the names. Also, he can't vocalize why he went all the way to downtown for this guy. [Did I say he has a hoarse voice also?]
So we have a 20 year old mexican-american, 6 months of chest pain, fatigue -and all worse in the last few days. Low thyroid, anemia, liver congestion and slow heart rate.
Final test comes back ...... he has full blown "rhabdomyolysis"! This is where the muscles of the body "denature" and start to leak into the blood stream...if gone unchecked the big proteins in the blood will block the kidney from filtering and kidneys shut down. (By the way his kidney test came back and yes he was in stage 2 failure.) Got the family to bring in the meds and here they are, scanned:
Looks like some back door manufacturer of traditional chinese medicine. Called my pharmacy friend, Clell Fowles out of Utah but it was late and still waiting for call back. In the mean time due to the muscle enzymes being the highest I've seen in a few years- (last time was with a patient who did the chicago marathon and got to 26 miles where he saw the finish line but then he woke up in the ICU 3 days later due to severe dehydration and hyperthermia -from not drinking enough during the course, leading to muscle breakdown). Only thing, in this guys case is that the thyroid issue and fatigue are explainable, maybe a little anemia also ......but massive tissue break down with backed up liver. Got to be from the herbs.....not necessarily from the specific component but from the "God only knows where this bottle is from" part. The "vitamin shoppe", "gnc", "walmart", "walgreens" and "target" are real cheap but one in four bottles acutally has the active ingredients it states. If quality control in the US stores is sometimes questionable...imagine a third world country importing their supplements to smaller stores. Work up is under way but I think the guy is out of the woods since he came in "early", (kidneys would have been shot by the morning). In summary he truely had a low thyroid state and anemia but unfortuatelywent to get treatment with acupunture (for that I applaud him) but happened to take herbs from a person that imports straight from the mainland (China) and stuff he took had a side effect. FDA can't regulate supplements so all those bottles really don't have to contain what the label says. Good established companies are always safer. Long standing herbal shops with active in the community herbalists are good. Especially if the company offers to fly distributors out to see where things are packaged. ........Buyer beware, over the counter supplements can kill!
