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Medical Speciality Question
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I am suddenly smelling like ammonia after an hour of exercise. I've been told that I smell like ammonia after races longer than half Ironman but I couldn't smell it myself. About 3 months ago I started noticing it and now that I am on the trainer I smell so bad like ammonia during a 1 hour ride that it is almost like someone has popped a wakeup ampule in the room. My diet is unchanged. In fact I started eating a few extra carbs when this started and that had no affect.

At the same time I started experiencing large muscle pain that was not resolved with NSAIDS and did not go away with time off, so I went to my GP. She checked my CPK and noticed it was at 250. This was with a week of no exercise. She told me that explains the muscle pain and the ammonia smell but doesn't tell her what is actually wrong. She has sent me to a rheumatologist. I made the appointment but now I'm wondering if this is the right specialist. It looks like they do arthritis and I doubt if that is the problem. The pain is not generally in joints, it is all over, and it has suddenly come up.

Not looking for a diagnosis, just wondering if I'm going to the right specialist.

Thanks in advance

"...the street finds its own uses for things"
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Re: Medical Speciality Question [AutomaticJack] [ In reply to ]
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Last edited by: OlderTryGuy: Dec 11, 17 10:41
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Re: Medical Speciality Question [OlderTryGuy] [ In reply to ]
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Checked with my husband, neurologist. Rhumatologist do deal with those kind of symtoms so that's problbay the best place to start-interesting case. Keep us posted if you don't mind
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Re: Medical Speciality Question [AutomaticJack] [ In reply to ]
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Well, if you were a board exam question, the answer would be McArdle's or CPT-II.

There are other things that cause muscle pain and hyperammonemia, but most of them either kill you as a young child or cause significant developmental delay.
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Re: Medical Speciality Question [frenchfried] [ In reply to ]
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Thanks

"...the street finds its own uses for things"
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Re: Medical Speciality Question [AndyPeterson] [ In reply to ]
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AndyPeterson wrote:
Well, if you were a board exam question, the answer would be McArdle's or CPT-II.

There are other things that cause muscle pain and hyperammonemia, but most of them either kill you as a young child or cause significant developmental delay.

Just looked both of those up. I'm hoping you would have failed your exam :)

However, the last time I was under general anesthesia I came out of it with muscle cramps and tremors. The Navy was worried enough about it that the follow up surgery was done with a spinal block and I now wear a medical alert bracelet. I never said anything about that to the GP - I didn't realize that dots might be connected, and the Navy never investigated, they just told me I'm sensitive to anesthesia. That was 30 years ago.

I guess I will find out next week.

"...the street finds its own uses for things"
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Re: Medical Speciality Question [frenchfried] [ In reply to ]
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frenchfried wrote:
Checked with my husband, neurologist. Rhumatologist do deal with those kind of symtoms so that's problbay the best place to start-interesting case. Keep us posted if you don't mind

The GP ran an entire series of blood work and called me Friday stating that my only abnormality was vitamin D levels. Apparently 30 is normal, above 25 is ok, and 11 (my reading) is completely out to lunch. She told me to take an over the counter supplement and go see the Rhumatologist.

To day I saw the Rhumatologist and he agreed with the Vitamin D as being why I'm sore but he is concerned as to why it is so low. Apparently the primary source of Vitamin D is from some process in the liver and he suspects that is not functioning correctly. So I'm scheduled for more tests on Thursday.

"...the street finds its own uses for things"
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Re: Medical Speciality Question [AutomaticJack] [ In reply to ]
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AutomaticJack wrote:
frenchfried wrote:
Checked with my husband, neurologist. Rhumatologist do deal with those kind of symtoms so that's problbay the best place to start-interesting case. Keep us posted if you don't mind


The GP ran an entire series of blood work and called me Friday stating that my only abnormality was vitamin D levels. Apparently 30 is normal, above 25 is ok, and 11 (my reading) is completely out to lunch. She told me to take an over the counter supplement and go see the Rhumatologist.

To day I saw the Rhumatologist and he agreed with the Vitamin D as being why I'm sore but he is concerned as to why it is so low. Apparently the primary source of Vitamin D is from some process in the liver and he suspects that is not functioning correctly. So I'm scheduled for more tests on Thursday.

Keep us updated if you are willing. I am always interested in pathology. Good reminder at the end of the year to use up any funds that you might have left if you are someone who loses the benefits at end of 2017. I do a proactive blood test, I only did 2 this year, but I would like to do a 3rd still. People would be surprised how often endurance athletes come up low in something like Vitamin D. If you are ever interested in seeing labs from someone under a large training load and stress you can always check out my report. This is the first one I published, but I will publish them all.


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Re: Medical Speciality Question [AutomaticJack] [ In reply to ]
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Vitamin D is manufactured by you skin from sunshine. That is not the only source. Not too uncommon at this time of year to have a low level especially if you spend most of you time inside. Where do you live? Are you outside much this time of year?

Life is full of froth and trouble, two things stand in stone
Kindness in another's troubles, courage in one's own
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Re: Medical Speciality Question [len] [ In reply to ]
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Long Island. I walk in to my office at about 6am every weekday, and leave about 5:30pm. I see the sun at lunch, if I'm not in a lunch meeting, but this is unchanged for over 15 years. Nothing new.

"...the street finds its own uses for things"
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Re: Medical Speciality Question [AutomaticJack] [ In reply to ]
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So what does smelling like ammonia mean? What is that a sign of? I encountered this once for a spell, but it was when I was lifting exclusively getting back into exercise and I would notice it. I never knew why, but eventually it went away. The timing was when I switched to more running and stopped with the crazy protein diet I had going on. Most likely coincidental, but a mystery.
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Re: Medical Speciality Question [AutomaticJack] [ In reply to ]
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The low D is a red herring. Everyone had low D. Seriously.

Ammonia smell in a workout usually means you are burning muscle. Carb deficiency to the point muscle is being sacrificed.

A simple view of things but easy to understand
https://www.google.com/...ia-article-1.2804757
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Re: Medical Speciality Question [AutomaticJack] [ In reply to ]
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I'm a rheumatologist and triathlete. And never posted before. Agree low Vit D can cause various ailments and might be blamed for variety of symptoms, muscle ache among them, and sometimes it is in fact the problem, and worth treating to see if it helps, but often is really just a red herring. Doubt it would cause these symptoms. And don't think anything in rheum field would explain. Agree w post above that protein deficiency could be causative. If any organic pathology to blame, would fall in realm of a neuromuscle specialist (subspecialty of neurology) - not rheum. Good luck!
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Re: Medical Speciality Question [doctorchris1979] [ In reply to ]
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So I was asked to keep everyone up to date.

I bounced around between doctors for a while and finally found a rheumatologist that is also a runner.

- Vitamin D is never a good indicator of anything and should be ignored if it is the only outlier.
- I'm an athlete in good shape so CPK is also a worthless indicator of a problem. He said is not unusual for long distance runner to have a CPK over 800.
- He then told me that he would bet that I have a problem in the lumbar region that is affecting nerves in the lower body. I told him my back didn't hurt and he told me that is not uncommon. A bunch of x-rays later and I have mild to moderate degenerative arthritis in L2 though L5.
- That was most like caused by what I did for a living from the age of 18 to 40. Now I'm going to pay for it.

Bottom line - Swimming, Biking, and Running are not going to make anything worse, and may actually help in the long run, and there is little that can be done. I now have a prescription for Naproxen when I need it. Go live life, or as the Corpsman used to tell us: Change your socks, take some Motrin, and Suck it up, Buttercup.

"...the street finds its own uses for things"
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Re: Medical Speciality Question [iamuwere] [ In reply to ]
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iamuwere wrote:
The low D is a red herring. Everyone had low D. Seriously.

Ammonia smell in a workout usually means you are burning muscle. Carb deficiency to the point muscle is being sacrificed.

THIS ^^^^


Vitamin D
https://jamanetwork.com/.../fullarticle/2667071
https://jamanetwork.com/.../fullarticle/2615260

Amonia smell
http://www.beginnertriathlete.com/...il.asp?articleid=326


Good to see you have some partial answers. Good luck in your training.
Last edited by: dtoce: Jan 12, 18 9:55
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Re: Medical Speciality Question [AutomaticJack] [ In reply to ]
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And your vitamin D deficiency in the winter likely isn't new either. Just likely no one has tested you for it until now. We used to give kids in Newfoundland cod liver oil in the winter for this problem. Tastes great!

Life is full of froth and trouble, two things stand in stone
Kindness in another's troubles, courage in one's own
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