Had Physical today - CRP through the roof

[Rambler]

I had my annual physical today. Blood work came back fine for the most part, total Cholesterol flat at 170, HDL up -to 60 now, triglycerides and LDL deep in normal range. Had the usual converstion about needing to exercise more, lose some weight, etc.

Two areas shocked me a little though: White cell count is 10% higher than high end of normal, and CRP (inflamation marker in blood test) was thru the roof (30x the mid point of normal). Doc said both might be related to the wrist pain I have had (since November, but much better now - I can live with it now whereas I couldn't sleep back in November because of the pain). Seems as though if it is getting better, the CRP level shouldn't be so high, especially if there was not ever any visible inflamation.

Anyone out there have experience with elevated CRP? ...combined with higher than normal white count? What caused it? How long did it take to normalize after an injury/illness? Pls help...Asian docs are not known for their openness about symptoms and problems...they like to know more than the patient and keep it that way. ...by the way, doc never did find (or tell me) what was wrong with the wrist...just gave is a shot and said come back if it still hurts.

Thanks

R

 

[Meadbh]

CRP = C Reactive Protein

Here are two links to read:

C-reactive protein - Wikipedia, the free encyclopedia

What Is CRP?

Bottom line: a high C reactive protein suggests that you might have some inflammation (which you already know you do). It's also associated with a whole variety of conditions including pregnancy. It's a very, very nonspecific test and doesn't provide any clues whatsoever as to the underlying cause. As you can read for yourself, if you happen to have elevated CRP you may be at risk for heart disease and diabetes, but so are millions of other people.

Elevated CRP is sometimes useful in my work when a patient presents with an illness that might, or might not, be a serious infection. If the CRP is low, we are reassured, and if it's high, we take the possibility of infection more seriously.

So this information, to me, simply suggests that you go on eating well, exercising and enjoying RE!

Don't worry, be happy!

 

[Rich_by_the_Bay]

Yet another example of why I do not bother checking CRP in otherwise low risk patients. Along with total body scans, unselected ultrasound "screenings," apolipoproteins, and a host of other "screening" tests which have not been shown to benefit patients and which cost a lot and can lead to secondary harm when they [-]create wild goose chases[/-] are "worked up." It's very important to be selective as to which patients receive which tests.

 

[Rambler]

Thanks Meadbh,

It can't be pregnancy...not that kinda guy...and fasting glucose was less than 100, and Hb1Ac was smack in the middle of normal with no substantive change over the past few years, so not diabetes or metabolic syndrome...yet. What has changed is that I am a lot fatter (15#) than last year, and the parts are beginning to get tired or wear out (tinnitus, wrist pain, ulcer, knee pain...all since last physical 13 months ago).

So, first things on the agenda: lose weight, exercise more, stop worrying so much, lose the stress, get back in shape, but, have the figure re-checked in 30 days (local doc's orders) just in case. Doc did tell me that if it does not subside, then we need to find the reason it is so high. If we know the reason, it can either be fixed or understood and lived with.

Again, thanks for the insight.

R

 

[Rambler]

Thanks RiT

I guess Meadbh's advice is very sound, eat right, exercise, and enjoy life (If I do that now then I will enjoy ER in a couple years).

Thanks

R

 

[Nords]

Pls help...Asian docs are not known for their openness about symptoms and problems...they like to know more than the patient and keep it that way. ...by the way, doc never did find (or tell me) what was wrong with the wrist...just gave is a shot and said come back if it still hurts.

Sounds like the best cure for your problems would be a new doctor.

Our local clinic (10 minutes away) gets a huge annual influx of med-school interns & residents. They're bright, enthusiastic, inquisitive, and quick to admit their ignorance. Sometimes a visit ends up more like a conference with one or two of them in the room plus their supervisor... and just listening to their conversations is far more informative than my own research, let alone entertaining.

I'm highly allergic to "I'm the doctor, I know what's best, and you'll do what I say".

 

[Meadbh]

Sounds like the best cure for your problems would be a new doctor.

I'm highly allergic to "I'm the doctor, I know what's best, and you'll do what I say".

You do have to wonder what value this test has added to your care. You've gotten all stressed now. The information about the test you got from us. You now know that you need to take care of yourself, but you knew that anyway. Having a repeat test is not going to add anything. So I fail to see how having a CRP done has helped you.

With doctors, as with any other professional, question everything!

 

[Walt34]

Yet another example of why I do not bother checking CRP in otherwise low risk patients. Along with total body scans, unselected ultrasound "screenings," apolipoproteins, and a host of other "screening" tests which have not been shown to benefit patients and which cost a lot and can lead to secondary harm when they [-]create wild goose chases[/-] are "worked up." It's very important to be selective as to which patients receive which tests.

Yeah we get that junk inserted into the newspaper here all the time. Bright-colored paper, with all the scare-mongering language without actually being threatening. They really skirt the edge of professionalism, it's obviously a money-making scheme.

 

[RetireeRobert]

Probably about 8 or 9 years ago on my bi-annual physical I asked my doc about the C-reactive protein test after having read somethin about it in some popular press somewhere. I wondered should I have that as part of my blood workup. I was thinking of it in terms of warning of potential heart system problems.

He said he was not comfortable with having the CRP blood test done. He said he was not convinced by the (then) current state of research, if one had an elevated level of CRP exactly what he should recommend to deal with the "supposed problem". In other words, I guess, he felt then the CRP test was just a test that often indicated a supposed "problem" for which there was no generally accepted or research proven "treatment solution".

I accepted what he said and haven't worried about it since. My new younger doc whom I just saw also did not get the CRP as part of my latest blood workup, so I guess it is still not a "mainstream" type test.

 

[Rambler]

tummy pain over siberia

I flew back to asia from Europe last weekend and my lower left belly started hurting somewhere over Siberia. It was so bad I thought it might be appendicitis, but it was way in the wrong spot. Went to the doc just to be sure, he tells me it is diverticulitis, and to go to a larger, well equipped hospital on monday. I did, and a little more poking and prodding (no scope, no barium) tells me again diverticulitis. Blood test saturday had very high WBC, but in the higher end of normal today. The CRP (seems part of every blood test they give me here) is now 14 (was 10 on feb 14th). Tot Chol, Triglycerides, HGL, LDL, liver function, glucose, etc normal, except sed rate and CRP. I wonder if the diverticulitis was already working itself up to a lather back in feb when I had the physical...thus the high CRP and slightly high whitw counts. But why would I not feel it, if it was already percolating away back in Feb? Maybe there are multiple inflammations going on that I'm not even aware of??

Doc wanted to hospitalize me, I offered the alternative of sleeping in my bed and eating my own soft and specially prepped food, but coming for whatever prodding and tests or IV treatments they want to do for the same three days he wanted me hospitalized. Doc relented and I came home (it is still painfull, but way less so than on friday, saturday or sunday). He agreed his approach was conservative (trying to sell an empty bed). I love docs for the care they provide, but around here, sometimes it is like they get a commission on a stay-over patient....I don't buy that. He did tell me to stay home for 3 or four days, which I will do, except for the annual s/h mtg, which I have to attend as chairperson.

R

 

[oma]

Its been several years since I've taken care of a patient with your ailment (I'm a nurse). I recall that the treatment was COMPLETE bowel rest and intravenous hydration. It usually resolved with rest in 2-3 days. I can't remember if endoscopy was performed - I think mostly XRays to assess the bowel lumen. I also believe we used IV antibiotics and H1 Histamine blockers (like Zantac). Perforated bowel is possibly a complication, if I remember correctly. Hope you start to feel better.

 

[calmloki]

I run very high CRP levels - given lots of varicosities and a leaky heart valve i got put on statins, which, while they lowered my cholesterol (frankly, i think daily oatmeal and regular exercise did more) did nothing for the CRP levels. I do think that boosting the number of oral hygenist visits and improving my oral health helped a fair amount. That said, over the last 5 years or so i can't say that i was able to predict increases or decreases in CRP level based on joint pain, oral health, enzyme treatment (for a while i thought, based on tests i paid for, Wobenzyme was a miracle cure, then i dropped it for a couple months and my level went down, so...), or anything. In my experience just a CRP blood test is pretty cheap - want to say like $20, not counting the blood draw. Whether it is of any value....

 

[Meadbh]

Rambler, I'm sorry you're sore! Obviously there was some inflammation going on after all. Diverticulosis is very common in people over 40, and simply means that there are little pouches in the wall of your colon. Probably 70% of people on this board have it. Well, you know the c**p that the colon contains, and once in a while, some of said c**p gets stuck in one of these little cul de sacs and things get a little inflamed. That's diverticulitis.

I'm not an expert on this as I'm a pediatrician and my patients are in the wrong age group to get it. Paging Dr Rich in Tampa......Dr. Rich to the Forum please!

Meanwhile, here are a few links (some with pictures):

Diverticulitis
MedlinePlus Medical Encyclopedia: Diverticulitis
Diverticulitis - Seniors' Health - C-Health
Canadian Society of Intestinal Research • Diverticular Disease
eMedicine - Diverticulitis : Article by Andrea Cooperman, MD

Hmm. I don't see any mention of CRP as a useful test in diverticulitis. As I said, it's nonspecific.

 

[Rich_by_the_Bay]

OK, OK. I had a dead battery in my pager. No, the dog ate it. Oh- wait - I don't have a dog. Anyhow...

This seems to be another in a series of cardiac risk predictors ordered and interpreted in a questionable way. CRP is produced by your liver when chemicals arising from inflammation are present in the blood. It's pretty sensitive, so that infections such as a little gingivitis can elevate it. As can atherosclerosis in the arteries. So, if you have lots of arterial plaques that are getting a little inflamed, you have a higher likelihood of having an elevated CRP.

There is some research (not proven in humans) that CRP itself can harm vessels, but mostly it's felt to be a marker. It can very a bit, so we usually average two readings a couple of weeks apart, if the first result is surprising.

CRP is associated with known risk factors like age, tobacco, obesity, blood pressure, type 2 diabetes, and sedentary lifestyle so it's usefulness as a risk factor is not so straight forward. In most careful studies it added little prognostic value to the more traditional risks. At best, it adds fractions of a percent to the risk estimate made without CRP. Using it did not, in the end, increase survival compared to those managed without it.

It's interesting that high levels (e.g. > 10) more often indicate some other major source of inflammation. It's levels in the 3-5 range that raise the most questions.

I don't order CRPs for my patients. When they get them anyway, I do a risk assessment (which I do anyway) and make shared decisions based on the whole picture. It's probable that CRP is a marker for athersclerosis but in the absence of other risk factors, an elevated CRP is much more likely to be due to other ailments. Like diverticulitis, gingivitis, etc.

One guy with a cholesterol in the 300s who refused treatment all but begged me to do a CRP. I made a deal with him that if it was elevated he would consider a statin, if normal he would continue to decline a statin. That was the only CRP I have ordered in a couple of years. It was about 4 or 5, and he's been on a statin since then, with a glucose in the 200 range as I recall.

See my signature line, kids.

 

[W2R]

One guy with a cholesterol in the 300s who refused treatment all but begged me to do a CRP. I made a deal with him that if it was elevated he would consider a statin, if normal he would continue to decline a statin. That was the only CRP I have ordered in a couple of years. It was about 4 or 5, and he's been on a statin since then, with a glucose in the 200 range as I recall.

Rich, you are making me feel so healthy in comparison!! I hope I never have cholesterol or glucose that bad.

 

[Buckeye]

A good test result for individuals with high CRP

JUPITER halted: Rosuvastatin significantly reduces cardiovascular morbidity and mortality

March 31, 2008

Michael O'Riordan
Chicago, IL - Rosuvastatin gained clinical traction today with the announcement that a large event-driven study was stopped early because the lipid-lowering agent was shown to be more beneficial than placebo in reducing cardiovascular morbidity and mortality [1].
The study is known as the Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER), a large, multinational, long-term, double-blind, placebo-controlled, randomized clinical trial designed to assess directly whether statin therapy (rosuvastatin 20 mg/day) should be given to apparently healthy individuals with low LDL-cholesterol levels but elevated C-reactive-protein (CRP) levels.
The halting of JUPITER was announced in the wake of the presentation of the disappointing results of the Effect of Combination Ezetimibe and High-Dose Simvastatin vs Simvastatin Alone on the Atherosclerotic Process in Patients with Heterozygous Familial Hypercholesterolemia (ENHANCE) study and an American College of Cardiology consensus panel that urged physicians to prescribe statin medications with proven clinical effectiveness. AstraZeneca issued a press release saying the independent data monitoring board observed "unequivocal evidence of a reduction in cardiovascular morbidity and mortality" among those treated with rosuvastatin compared with placebo.
In total, the trial included 15 000 males aged 50 years and older and females aged 60 years and older with no history of MI, stroke, or arterial revascularisation and LDL-cholesterol levels <130 mg/dL. Patients were considered at risk for coronary heart disease on the basis on their elevated CRP levels. The lead investigator of JUPITER is Dr Paul Ridker (Brigham and Women's Hospital, Boston, MA).
Dr Steven Nissen (Cleveland Clinic, OH), who conducted a study showing that intensive lipid lowering with rosuvastatin resulted in a significant regression of coronary atherosclerosis as measured by intravascular ultrasound (IVUS), said little is known about the stopping of JUPITER, but the results are good news for statins.
"Now, for every single statin, we have clinical-outcomes data," he told heartwire. "If that doesn't tell you that it's a class effect, then I don't know what does. In the wake of ENHANCE, it's obviously important, because if we're not going to use ezetimibe to get patients to low LDL levels we've got to use something, and potent statins certainly do work."
Dr Christie Ballantyne (Baylor College of Medicine, Houston, TX) said that the surrogate-outcomes data—the reduction in LDL-cholesterol levels, the effects of rosuvastatin on IVUS end points, as well as new data showing an effect of rosuvastatin on diameter stenoses as measured by quantitative coronary angiography—and the outcomes data are beginning to line up.

AstraZeneca sponsored the JUPITER study.

 

[Rambler]

Thanks all. It seems pretty certain that the high CRP and white cell levels were from the diverticulitits. The doc had cleared me to go on vacation last week, so long as I took it easy and did nothing strenuous. I sat in the shade while the girls enjoyed the sun and surf. All the while something was nagging the spot that had been so painful. Went to doc monday for follow-up. WBC were up again and CRP is flat but expected to increase. Doc ordered a CT, which showed that the mesentery membranes were now inflamed.

They put me in the hospital (writing this from my hospital bed...nothing better to do...), told me no food for 3-5 days, probably going to be here for about 7 days. I guess I can look at this optimistically, in that the elevated CRP does not appear to be from inflamed arteries.

R

 

[Martha]

So you get internet in the hospital bed? Cool! I guess. Good news that the inflammation appears to be a temporary problem and not due to something really bad.

 

[Rambler]

Yeah, I have a data card in the laptop, and they allow cell phones and data cards here as long as you are in a private room.

 

[W2R]

Thanks all. It seems pretty certain that the high CRP and white cell levels were from the diverticulitits. The doc had cleared me to go on vacation last week, so long as I took it easy and did nothing strenuous. I sat in the shade while the girls enjoyed the sun and surf. All the while something was nagging the spot that had been so painful. Went to doc monday for follow-up. WBC were up again and CRP is flat but expected to increase. Doc ordered a CT, which showed that the mesentery membranes were now inflamed.

They put me in the hospital (writing this from my hospital bed...nothing better to do...), told me no food for 3-5 days, probably going to be here for about 7 days. I guess I can look at this optimistically, in that the elevated CRP does not appear to be from inflamed arteries.

R

Rambler, I'm so sorry to hear that you are stuck in the hospital!! At least you have internet but still, hospitals are miserable places to be when you really would rather be elsewhere!

 

[Buckeye]

I hope you get out safely and soon. Hospitals are dangerous places! Good luck and get better.

 

[dumpster56]

I hope you get out safely and soon. Hospitals are dangerous places! Good luck and get better.

Oh man just what he needs to hear!

 

[Rambler]

They took me off food and onto IV only for 48 hrs or so, then added back little bits. I was feeling better, but the pain is starting to come back after the food.... To top that off, one of the veins for the IV wouldn't accept any more input so they moved it...the new spot seems to have become infected...moved again. New infection while on IV antibioticsstrange...
R

 

[W2R]

That does seem strange! At least you are in the right place to get the infection treated. Hang in there, and I hope you are able to eat some food without pain, soon.

 

[Meadbh]

Rambler, what you have on your IV site is called a Nosocomial Infection (something you picked up in the hospital) and unfortunately, it is not rare. I'll bet you are on IV antibiotics that will kill intestinal bugs like E. Coli (the ones causing the inflammation in your diverticuli). The infection at your IV site is probably associated with an organism (bug) that normally lives on skin, for example, staph epidermidis (epidermis = top skin layer). Most probably the antibiotics you have been on are not aimed at staph epidermidis.

Make sure your health care providers WASH THEIR HANDS or use alcohol based skin cleanser before touching or dressing that IV or replacing it. Make sure they disinfect the skin properly. Attention to cleanliness is particularly important at times when they are hanging your IV antibiotics.

Good luck!