Could a plumber’s work environment be the source of his muscle pain? An unconventional test provides the answer.

Mr. L, a 57-year-old plumber with a two-year history of myalgia, presented to our clinic after being examined by a number of different providers. His chief complaint was long-standing cramps in his lower extremities. Over the past two years, he had also experienced episodes of diffuse tightness and heaviness in the muscles of both his upper and lower extremities and in his abdomen. These symptoms were generally precipitated by strenuous physical activity. Relief had been obtained after 24 hours of rest. At other times, he had no significant muscle discomfort or fatigue. He had no inflammatory joint complaints or symptoms consistent with polymyalgia rheumatica or giant-cell arteritis. None of his symptoms were suggestive of vasculitis or autoimmune connective tissue disease. Mr. L did have a history of valvular heart disease related to a past episode of rheumatic fever.

Mr. L’s severe muscle cramping had significantly altered his work as a plumber. The heaviness and tightness usually began in his leg, hamstring, or quadriceps muscles and then radiated down to his toes, up through his abdomen, and into his arms and fingers.

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This usually began in the morning following a long day of work, but occasionally, it happened in the evening as well. Mr. L reported no joint pain, swelling, redness, rashes, headaches, fever, or weight loss. Over the past several years, he had missed a considerable amount of work because of the cramping. The pain had become severe enough for Mr. L to consider filing for disability. However, he had noticed slight improvement in his symptoms after he began taking calcium, magnesium, and vitamin D supplements.

Examination and tests

On examination, Mr. L appeared well-developed and in no acute distress. His height was 175.4 cm and his weight was 106.2 kg for a calculated BMI of 35. His physical exam was normal except for a grade 2/6 systolic ejection murmur heard at the right upper sternal border and a 3/5 holosystolic murmur heard at the base and radiating to the apex. His joints showed no synovitis in either upper or lower extremities. Range of motion of all joints was within functional limits. The neurologic exam showed appropriate gait for age as well as normal upper and lower proximal and distal strength.

Lab results showed a C-reactive protein level of <0.03 mg/L. Electrolytes, uric acid, blood urea nitrogen, creatinine, and rheumatoid factor were all within normal limits. In addition to low calcium levels, his vitamin D2 and D3 results indicated mild-to-moderate deficiency.

The patient’s social history revealed longtime employment as a plumber. Since plumbers are exposed to heavy metals during welding and construction, a hair analysis was ordered to rule out heavy-metal poisoning. In addition to the muscle pain reported by our patient, exposure to heavy metals can cause fatigue, hypertension, cardiovascular disease, cancer, and diabetes. Fortunately, our patient reported none of these other symptoms.


The use of tissue rather than blood analysis for heavy-metal exposure has come under criticism by some, but it is important to note that the effects of heavy metals are seen at the tissue level, not in the blood. Moreover, the Environmental Protection Agency has approved tissue mineral analysis for detecting heavy-metal poisoning since routine blood tests cannot detect chronic exposure to these substances.

While some toxic metals are eliminated, those that remain are stored in fatty tissues, joints, hair, and skin. In addition, some toxic metals will replace vital minerals, thus allowing toxic metals to work as a substitute when the body is deficient in vital minerals. Exposure to heavy metals can affect the sodium/potassium levels or the stress ratio, which is a window to adrenal function. If the sodium and potassium levels are inverted—meaning the potassium levels are higher than the sodium levels—the body is in a state of chronic degeneration and cannot eliminate toxic metals. Individuals with an inverse ratio also tend to have low blood sugar, exhaustion, decreased immunity, poor digestion, allergic reactions, and adrenal fatigue.

Mr. L’s initial hair analysis was high in lead (1.086 mg%), cadmium (0.040 mg%), aluminum (3.49 mg%), nickel (0.059 mg%), selenium (0.631 mg%), manganese (0.114 mg%), and copper (7.9 mg%). Nutritional therapy was started to include vitamin D (800 IU) for calcium absorption and calcium lactate (a very absorbable form of calcium and magnesium produced by a natural fermentation process) four tablets three times daily. Appropriate levels of calcium intake prevent absorption of lead by the skeletal system.

Mr. L’s inverse sodium/potassium ratio (0.64; normal 2.50) indicated severe adrenal fatigue. For adrenal support, he was given two adrenal (desiccated) tablets daily for two months. After completion of this initial therapy, he was started on six tablets daily of Drenamine, a product especially formulated to help maintain the healthy functioning of the adrenal glands. Drenamine supplies rich sources of vital nutrients combined with bovine adrenal tissue proteins.

The final component of Mr. L’s therapy was ChelaCo, a combination of hawthorn, milk thistle, garlic, and calcium. Herbs are used to make heavy metals more soluble and play a role in reducing GI absorption. Specifically, milk thistle, garlic, and hawthorn can encourage mobilization and excretion of heavy metals. Garlic is an antagonizer for lead, cadmium, and organic mercury. In one study, garlic was given to workers exposed to high levels of lead, and after one to three month, signs of chronic toxicity decreased by 83% (J Ethnopharmacol. 1986;15:121-132). Milk thistle can strongly bind heavy metals while mobilizing excretion of those metals.

The patient returned for follow-up two weeks later and reported his cramping had lessened. After one month, the cramping had disappeared. A repeat hair analysis done after the completion of four months of therapy revealed elimination of toxic metals: lead 0.327 mg%, cadmium 0.028 mg%, aluminum 2.26 mg%, copper 2.1 mg%, manganese 0.062 mg%, and selenium 0.112 mg%. His sodium/potassium ratio remained low (1.04) but was greatly improved. The patient was instructed to continue taking the supplements until his next follow-up hair analysis four months later.

Lessons Learned

This patient was seen by a number of providers for treatment of myalgia, but no underlying cause was established until toxic metals were found on hair analysis, which may be considered controversial by some health-care providers. In this case, however, hair analysis established the findings that enabled the diagnosis to be made. The recommended nutritional/herbal therapy worked to resolve the patient’s myalgia. Allopathic medicine should be open to working with alternative providers for the benefit of the patient. After all, everyone is working toward the same goal, and sharing expertise helps all parties involved.

Ms. Sauser is a family nurse practitioner and owner of the Complementary Care Center in Atlantic, Iowa.