# CRP and ESR



## leemack (Nov 17, 2012)

Hello everyone.

My symptoms are chronic diarrhea (between 4 and 20 times a day), mucous, right lower quadrant pain and nausea, occasionally passing blood, for 2 years.
Also have eye pain and joint pain (in non weight bearing joints).

I'm obese and though I've lost 30 kg this year (due to not wanting to eat - eating = pain and diarrhea), my doc insists my CRP of 23 is to be expected as I'm obese and my ESR is only 13 - as such he doesn't think a colonscopy is warranted.

Any advice on this and on how to respond to him would be greatly appreciated.

Many thanks

Lee


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## LittleChloe (Nov 17, 2012)

No way!  Is your doc a gastroenterologist or a general practitioner? To what does he attribute the pain, diarrhea and weight loss and nausea? Have you been diagnosed with anything?


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## leemack (Nov 17, 2012)

LittleChloe said:


> No way!  Is your doc a gastroenterologist or a general practitioner? To what does he attribute the pain, diarrhea and weight loss and nausea? Have you been diagnosed with anything?


Hi and thanks for replying. My doctor thinks I have IBS - both my GP and GI. The GI reluctant gave me a sigmoidoscopy, which was performed by a nurse, but I think he was just covering his back on Rectal carcinoma as I also have coccyx pain (for no known reason).

I don't know how to argue my case for further investigations - my GP seems to think the GI is godlike and tells me he's never missed a diagnosis and has a 100% record. I'm skeptical.


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## StarGirrrrl (Nov 17, 2012)

Can you ask to see a different GI, or see a different GP and explain things?

I have hit that problem, after 6 years of consistent inflammation in blood, no cause found so they are now saying it's my weight.

In my mind it's quite simple, I do have a weight problem, a big one actually, but as I have symptoms and the inflammation has been found 2+2=4.

You know the symptoms are obviously being caused by the inflammation! Does being fat cause the passing of blood and getting up at 3am for the toilet?? Or considerable joint pain in my left shoulder/elbow/wrist?

Compound C3 and C4 are good inflammation markers, mine are huge while CRP is quite modest at 11-36.

Sorry I can't be more helpful.


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## xmdmom (Nov 17, 2012)

CRP increases with obesity and decreases with weight loss.  From what I can gather, the increase in CRP in obesity is usually not so high as 23.  One study found only 15% of obese men to have a crp level over 10, so your doctor shouldn't assume it's due to your weight.  See figure 1 http://www.nature.com/ijo/journal/v28/n5/pdf/0802609a.pdf


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## leemack (Nov 17, 2012)

StarGirrrrl said:


> Can you ask to see a different GI, or see a different GP and explain things?
> 
> I have hit that problem, after 6 years of consistent inflammation in blood, no cause found so they are now saying it's my weight.
> 
> ...


Hi, I really appreciate you replying. I feel bad that we are in a similar situation. I have also had difficulty getting an explanation for how joint pain in fingers, elbow, neck are caused by my weight. My CRP has been as low as 12 and was 23, 18 months ago, but I'm due to have more bloods done on 27th. My reasoning is that if I've lost 30kg, and my CRP goes up, then weight is NOT responsible for the increase. We'll see what the results are.

I've not heard of compound C3 and C4, I don't think these are on the list to be tested. I'll look those up. Thanks


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## leemack (Nov 17, 2012)

xmdmom said:


> CRP increases with obesity and decreases with weight loss.  From what I can gather, the increase in CRP in obesity is usually not so high as 23.  One study found only 15% of obese men to have a crp level over 10, so your doctor shouldn't assume it's due to your weight.  See figure 1 http://www.nature.com/ijo/journal/v28/n5/pdf/0802609a.pdf


Thanks . I was also thinking that if my weight hasn't increased, then CRP should be about the same, not increasing. I'll have a read of the journal article, I assume the same sort of figures apply to obese women as well. My experience with doctors is they assume everything is due to weight if we're obese .


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## Trysha (Nov 18, 2012)

Not everyone has increased CRP or ESR all the time and lab tests are not infallible either.
You do need proper investigation by a qualified GI specialist and should have a colonoscopy performed by an experienced gastroenterologist.
Refuse to have this done by a nurse----you are entitled to a qualified GI specialist  and don't accept anything less.Research the GI specialists and select a good one. If you are in London, St Marks Hospital is a very good place.
It is good you are having more blood work and hopefully this will include CBC, SED Rate CRP  Vit B12 iron levels etc.
Feel better soon
Trysha


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## xmdmom (Nov 18, 2012)

Leemack, the same is true of women. Below are some specifics: you don't need to read the articles just look at the table or figures.  Even if your CRP wasn't elevated, I would think an unintended 30 lb weight loss and chronic diarrhea should be further investigated.

A study of 83 obese women on a 12 week diet found average baseline CRP of 5.56 mg/L  falling to an average of 4.12 mg/L at the end of the study.
http://atvb.ahajournals.org/content/21/6/968.full  (See Table 2)

And http://jama.jamanetwork.com/article.aspx?articleid=196344 average Crp levels =3.2 mg/L for 60 obese women  (table1) and the highest CRP looks to be 19 or 20 (Figure 2)


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## leemack (Nov 18, 2012)

Trysha said:


> Not everyone has increased CRP or ESR all the time and lab tests are not infallible either.
> You do need proper investigation by a qualified GI specialist and should have a colonoscopy performed by an experienced gastroenterologist.
> Refuse to have this done by a nurse----you are entitled to a qualified GI specialist  and don't accept anything less.Research the GI specialists and select a good one. If you are in London, St Marks Hospital is a very good place.
> It is good you are having more blood work and hopefully this will include CBC, SED Rate CRP  Vit B12 iron levels etc.
> ...


Thank you, Trysha. I'll do as you say and insist on not having the colonoscopy done by a nurse (if I get to have one). I think the blood tests do include the things you've mentioned.


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## leemack (Nov 18, 2012)

xmdmom said:


> Leemack, the same is true of women. Below are some specifics: you don't need to read the articles just look at the table or figures.  Even if your CRP wasn't elevated, I would think an unintended 30 lb weight loss and chronic diarrhea should be further investigated.
> 
> A study of 83 obese women on a 12 week diet found average baseline CRP of 5.56 mg/L  falling to an average of 4.12 mg/L at the end of the study.
> http://atvb.ahajournals.org/content/21/6/968.full  (See Table 2)
> ...


Thank you, that is so helpful. I've noted those figures and will defiinately be using them in my next appt.


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