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Forum Name: Hematology Topics

Question: Young male adult athlete slight high RBC Series, A/G ratio


 JOELCOQUI - Sat Aug 30, 2008 10:25 am

I am a physically fit male future minor/major league prospect in college. This is very important to me and we have exhausted all other options. Here are my CBC OUT OF RANGE: WBC 5.4 RBC 5.18 HEMOGLOBIN 15.7 HEMOCRIT 46.5 T3 UPTAKE 37 EPSTEIN-BARR VCA IGG 4.31 EBV NUCLEAR AG 5.00 POTASSIUM 3.3 A/G RATIO 2.2
1 month ago, I fell ill playing ball. I started trembling, sweating, weak legs, got lightheaded and felt like passing out. I had trouble focusing. Since then I have seen several specialists and found nothing. In the clinical environment, my blood pressure is high 150/90 - At home it is 128/80. I went to kidney specialist, had doplar...all negative except for slight elevated BP 132/85 (taken several times during visit -there is the clinical environment). CT of head is negative. Lyme disease titer negative. I don't recall ever having mononucleosis. My pediatrician just put me on Augmentin in case I have a sinus infection with strep throat (awaiting those results). I am not on any steriods. I just have an occasional drink of an all natural protein shake. It has been over a month. I still have these waves of nausea, pressure behind the eyes and in my head, lightheaded and weak at the legs. This is not constant though. I can go a few hours span of feeling fine. I am a little concerned because this is jeopardizing my future as we started playing again. Do you have any suggestive blood tests or work ups? Thank you.
 John Kenyon, CNA - Mon Sep 08, 2008 12:47 am

User avatar Hello -

Most of your labs are either normal or very close, so probably don't reflect the cause of your complaint. However, the potassium (K) is on the low side, which could very well explain the leg weakness and trembling, while your other symptoms do sound suggestive of a sinus infection, which should have no relation to the low K, which is my primary concern. Where is it going? Do you manage to stay properly hydrated? Electrolyte imbalance is often the cause of generalized musclular weakness (and cramping).

Do you, by any chance, have a fondness for licorice? This is something which, as silly as it sounds, needs to be ruled out early on, as over-indulgence in licorice can cause potassium loss with consequent muscle weakness or even flaccid paralysis in extreme cases. Of course there are other causes of low K, not always obvious. Eliminating licorice is just to get the oddball thing out of the way.

As for the EBV and not recalling having had mono, this is not at all unusual and the ups and downs of it are not usually a major problem, although of course there can be flareups which include marked fatigue and lassitude. I don't think this is likely to be a major problem, but it is something to keep in mind.

Again, I think the single most remarkable finding (seemingly overlooked by your doctor) is the low K level. It could reflect something as simple as a diet deficient in potassium, and of course it's not low enough to cause profound or life-threatening problems, but the fact it is not normal is odd and ought to be explored, especially since muscle strength and function depend so heavily upon it.

I hope this is helpful to you. Please follow up with us as needed.
 JOELCOQUI - Sun Sep 21, 2008 7:39 pm

Thank you. I also had an EEG and MRI of the brain and all is normal. I am still having dizzy spells which makes it hard to play the game. Its on and off. The MD ordered a catecholamine 24 urine to check my adrenaline gland for any growth or abnomality. My top number BP fluctuates from around 138 to 120 lateley on my home monitor. I do not eat licorice and I just started taking a potassium supplement. What else can you think of? Thank you.
 JOELCOQUI - Sun Sep 21, 2008 7:41 pm

Thank you. I also had an EEG and MRI of the brain and all is normal. I am still having dizzy spells which makes it hard to play the game. Its on and off. The MD ordered a catecholamine 24 urine to check my adrenaline gland for any growth or abnomality, but I am never home that long to do it. My top number BP fluctuates from around 138 to 120 lateley on my home monitor. I do not eat licorice and I just started taking a potassium supplement. What else can you think of? Thank you.
 JOELCOQUI - Sun Sep 21, 2008 7:44 pm

Thank you. I also had an EEG and MRI of the brain and all is normal. I am still having dizzy spells which makes it hard to play the game. Its on and off. The MD ordered a catecholamine 24 urine to check my adrenaline gland for any growth or abnomality but I am not home enough time to do it. My top number BP fluctuates from around 138 to 120 lateley on my home monitor. I do not eat licorice and I just started taking a potassium supplement. What else can you think of? Thank you.
 John Kenyon, CNA - Tue Sep 23, 2008 10:56 am

User avatar You're welcome. Your blood pressure seems to be staying within reasonable bounds, if a tiny bit on the high side. The 24-hour urine test is somethng worth making the time for, since it can evaluate whether or not you suffer from an unusual sort of adrenal tumor called pheochromocytoma. These tumors can actually occur in other parts of the body than the adrenal glands themselves, and they secrete adrenaline of their own, which can not only account for blood pressure increases, but also nervousness and an increase in resting heart rate. This still wouldn't explain the dizziness, however, which may well be a separate issue and should be investigated on its own. Since your blood pressure never seems to be low, it's probably not faintness you're feeling, but vertigo, usually a product of an inner ear disturbance. This should be explored. The potassium supplement should help with the loss of that salt, which is important, but dizziness can be, as you've found, a very disruptive thing too, even when it's not dangerous. Checking for vertigo would be very important, or at least treating for it symptomatically with somethng like meclizine.

Best of luck to you. Keep in touch here.
 JOELCOQUI - Mon Nov 10, 2008 10:31 am

Negative for pheochromocytoma. MRI negative. The headaches are sometimes waking me up at night. It feels like pressure around the temples and forehead. Its on top of my head as well. It just feels like pressure on my brain. I just took my BP and its 148/90. High. My BP goes up and down. What else do you think? The pediatrician says it may be a sinus infection.....but for 3 months?? I already went thru a does of antibiotics in case it was. Please help.
 John Kenyon, CNA - Mon Nov 10, 2008 11:41 am

User avatar Hi there -

Well, those test results are good news, but at some point we sometimes wish something would show up just so we could have something to hang the symptoms on. The sinus infection theory is still very viable, especially if it is a deep sinus or a walled-off infection. Antibiotics may well do the trick in that case, but sometimes need to be rotated, and yes, those infections, even with treatment, can be incredibly long-lasting, stubborn and recurrent. That may just be the culprit.

Thanks for following up, and please keep us updated.
 JOELCOQUI - Wed Nov 12, 2008 8:10 am

Whats your opinion on the flucuating blood pressure? I don't know if Im getting more stressed out about this but it has been staying high. 140/90. My pulse rate is around 88. I have a second opinion appointment next week. Do you think I should stop working out with my team. I don't want my coach to think there is something wrong when it could be as simple as a medication fix. Thanks again. T
 John Kenyon, CNA - Thu Nov 13, 2008 9:43 pm

User avatar Hi -

The BP elevation is just at the point where we like to follow it, with an eye toward treating medically if it continues to creep up consistently. The number you quote here is considered the upper end of "normal", and while it's not, in itself, any reason to stop working out, do be sure you keep your appointment, as your doctor will likely want to follow this and may even decide to begin treating it now, rather than waiting. It's not bad, it's just not quite where we like to see it. Currently the trend is toward wanting to see it no higher than 120/80, but there can be enough fluctuation during the course of a day, that your doctor may just want to keep an eye on this. Not yet a "dangerous" level. Maybe a treatable one.
 JOELCOQUI - Tue Feb 03, 2009 9:28 am

It has been a while and all my tests are shown to be negative. There are added symptoms now and don't know in what topic I should post. My BP goes up and down (to normal) within a 5 minute check. I get flushed and flashes of profuse sweat for no reason. This happens a few times a week. I notice after an evening of having a few social cocktails, the next morning my heart races irregularly and my bp is high. The last reading I got was 150/85 with an irregular pulse. I went for a jog for 10 minutes on this freezing morning and I felt better. bp went down. My headaches are every day and I am just dealing with them. Neurologist said MRI is totally normal. I know my symptoms are all over the place and don't know where to turn now. I am trying to phase out my pediatrician ...Im going on 20 years old this year. She does suggest seeing a cardiologist. Please think this one out and help. I still work out but not as often as I used to. I am definitely in shape. Thank you.
 John Kenyon, CNA - Wed Feb 04, 2009 9:23 pm

User avatar At this point your pediatrician is right, this is now a job for a cardiologist to evaluate. You may be given a 24 hour monitor to wear to see what sort of irregularity your heart is trying to pull. It's also the right time to make the transition from pediatrician to GP or internist. Since your BP is still fluctuating and is creeping up, it seems, I'd definitely say it's time for a cardiological consult. This may be a big help. I certainly hope so. Let us know how things go.
 JOELCOQUI - Thu Aug 13, 2009 11:50 pm

I am keeping in touch as you asked and don't know if this is the right forum. My last visit was with the endocrinologist with all tests negative. I am tired and feed up with no one having an answer to my high blood pressure. I still get the sweats and shakes on occasion. I just don't get it,,,maybe my stress hormone because I am a little stressed now.
 JOELCOQUI - Fri Aug 14, 2009 7:54 am

I failed to say, I saw a cardiologist also. He referred me to an endo. BP 150/90
 JOELCOQUI - Thu Sep 03, 2009 7:12 am

OK, No reply yet but I want to fill you in and still need advice. Endo dr. found my cortisol levels to be very high -Cortisol free urine 95.7 the serum AM cortisol was 29.5 the renin activity 4.28 the aldosterone lc/ms/ms is 6 and in range. He is suspecting cushings disease even though i don't have most of the symptoms...no moon face, no diabetes, no buffalo hump on my back, not gaining weight. Is it possible that my heavy working out everyday made my cortisol levels real high. Would that account for the high alderstone and renin also? The endo MD finds it interesting and having me repeat the 24 hr urine (which I know is routine). I don't really want to be his guinea pig being that most of his dealings are diabetes cases. Do you have any ideas? I am very stressed now. I do usually get worked up over small things but this is big and now Im a real mess.
 JOELCOQUI - Wed Sep 16, 2009 8:17 am

I brought myself to E/R with bad palpitations as I woke up and hit the baseball field. I was admitted because my rate would not go down with beta blocker and flecanide. I eventually did 24 hrs. later and was then released to follow up with cardio and says nothing is wrong. The hospital insisted on doing another 24hr urine for catacholamines, etc. for Pheocromocytoma check but my regular urologist says its a waste and I do not have that. So what gives...still have occasional hot flashes and body tremors. My BP is under control now from the meds. Please help.
 John Kenyon, CNA - Fri Sep 25, 2009 11:18 pm

User avatar Hi there and apologies for the delay in response, but was due to circumstances beyond my control. This latest finding is very interesting and, while not something one would think of right off or even halfway through, it could explain a lot. Your idea about the possibility of something like Cushing's being caused by heavy workouts is interesting and might bear further investigation, but there's no baseline support for such a theory at present. However, pheochromocytoma is not ruled out until the test has been done, and I'm not sure why your urologist is certain you don't have this, when there is clearly something going on. This should be ruled out as well as Cushing's or something similar. The elevated cortisol is being caused by something, and of course it could be related to an increase in serum adrenaline as well, all of which are suspects in your symptoms. I can well understand your frustration, but you may be close to a resolution now, and someone needs to order that 24-hour urine test. I'd push for that, ask him to just humor you, and if it's negative there's really nothing lost. The cortisol elevation also needs to be followed.

As I said, you may be getting close to a resolution. While there's not enough as yet to call this one thing or another, there are now some strong clues. Good luck to you and please follow up with us. I should be able to reply in a timely manner for the forseeable future. Good luck!
 JOELCOQUI - Wed Jan 20, 2010 9:12 am

I was put on BP meds from my cardio dr. that barely lower my pressure. All follow ups with endo shows negative. All the MDs I saw said its a rare case that I have flucuating high blood pressure. Someone suggested I may have a form of Dysautonomia or POTS?? Should the cardio dr. have picked that up??. He was voted as one of the best Drs according to Castle Connelly reports.
 JOELCOQUI - Fri Jul 09, 2010 8:24 am

Please help. I was admitted from the ER for going into A-Fib again. Different hospital. They don't know whats wrong except I have to be on 50 mg. metoprolol for the rest of my life???? and carry around Flecinide in my pocket just in case???? Why me at age 20?

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