42 year old engineering professor who runs marathons has 3-4 months of numbness in his hands and feet. The lateral fingers and toes become numb. He complains of an intermittent vice like pain in his legs if he sits with the legs dependent. He has had intermittent CPK's with values between 300 and 2000. Examination was normal. Nerve conductions were completely normal as were EMG's. The tentative diagnosis is hyper CKemia.
The patient was offered the option of muscle biopsy which can make a definitive diagnosis in about 18 % of cases. Ultimately, he should not exercise aggressively.
Suggestion was made to take high dose Naproxen sodium before exercising. Any other thoughts? How important is muscle biopsy in the this case?
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