CRP ESR levels

[Willowcat05]

Hi,

Just had Jacks blood results back from doctors his crp level is at 38 and esr is at 39.Dont understand why they are raised when he is having no symptoms he looks good and is full of energy doesn't have any cold either Spoke to his IBD nurse she says just to keep an eye on him incase it is the start of a flair coming oh how I hate this disease so much it just lies lurking then hits with a bang.


Waiting on an appointment with surgeon

Meds
Azathioprine 50mg
Ferrous sulphate 2x 200mg
Centrum multi vit

 

[Brian'sMom]

I hear ya...the silent disease sometimes I hope its just a fluke. Have they been normal and this the first lab that came back this way? Just curious, when were his last labs?

 

[Willowcat05]

Hi Brian's mom,

His last tests were done in June they came back normal because he had been on een for 8wks prior to having them done also he had scopes in April which showed his right side of his colon and ileum need to be removed due to scarring this seems to be holding him back from growing he is very small for his age and only weights 34kg hoping that surgery will be soon and we will have a reprieve of this illness for a short time.

 

[Sascot]

That's a shame about the CRP/ESR. I hope he doesn't start flaring! Do you know which surgeon you are seeing? We saw Mr Walker on Wednesday - I really like him alot!

 

[Willowcat05]

Sorry Sascot We are seen by D Barcley one of the GI's at Yorkhill but have not been told which surgeon.How long did it take to get your appointment?

 

[Tesscorm]

Hi Willowcat,

My son's CRP/ESR levels did rise as well once he finished the exclusive period of enteral nutrition. FWIW, he stayed on supplemental EN (so 1/2 the daily dose, 5 nights per week - he had his thru NG tube) for another 18 months. The increased levels of CRP/ESR did not result in a flare as he remained in clinical remission throughout this period (his crp and esr fluctuated with each lab); it seems the supplemental EN helped 'maintain' a certain level of crohns activity but was not strong enough to eliminate all inflammation (hence, we had to add remicade).

I have no studies to back this up but I do believe the nutrition my son received while on EN played a part in helping his body 'maintain' his clinical remission status??? (FYI, my son was taking in 1500 calories/night of an elemental formula.)

As your son is already on aza, it may be worth considering supplemental EN to see if could be the boost he needs to maintain remission with aza??? The nutritional benefit is always good so no real downside (other than compliancy ).

Hope all stays 'well' until you are able to see the GI/surgeon. :ghug:

 

[Sascot]

This was a return appointment after his check up in February. I believe it's usually Mr Walker or Mr Haddock that look after the GI kids. You could phone Dr Barclay's secretary and check which one then phone the surgeon's secretary and see how much longer you will have to wait. (I tend to nag them until they finally give me an appointment :lol. If the secretary has your mobile number, then she may be able to offer a cancellation.

 

[Patricia56]

I think the nurse may have been premature in telling you that increased CrP and ESR signalled a flare. They certainly might but they could also signal an oncoming viral infection that is in the early phase of the infection where he would have few if any symptoms.

I hope this is the case although our kids tend to get worse colds that last longer and may cause a flare because of the similarity of the tissues in the respiratory tract and those in the gut.

I would not expect surgical removal of scar tissue to improve his nutritional status - on the contrary. If he has stricturing then I suppose it might be affecting his absorption in the small intestine but that doesn't really make sense to me. I would think a stricture would slow down the passage of food increasing the likelihood that maximum nutrition was absorbed.

As I understand it from my son's doctors, poor nutritional status is due to inflammation in the small intestines or scar tissue that is preventing part of the small intestine from absorbing nutrition.

Removing scar tissue that isn't absorbing nutrition can't improve nutrition.

If they are removing inflamed tissue would seem to have the same result.

I'm not saying he shouldn't have the surgery. I'm just not sure you will see any magical improvement in his nutritional/growth status as a result unless they are removing inflamed tissues. Just getting rid of the inflammation should improve things but I'm not sure how much. Maybe others who've had this surgery can chime in on whether they saw growth or not.

I second the continuation of supplemental nutrition or even a return to EEN if he had growth while on it. Catch up growth requires a substantial increase in calories. I believe you have to increase it to above what is normal for his expected size - and that's a whole lot of calories. You should be supplementing his regular diet with high calorie items as much as possible. Cream and butter, protein shakes, etc.

If you haven't been referred to a nutritionist then I would ask for that ASAP.

Finally, different parts of the small intestine absorb different nutrients. The TI is the main place that B vitamins are absorbed for example. So depending on the part they will remove he may need permanent supplementation.

If you're not already doing vitamin/trace mineral supplementation then I would talk with the doctor or nutritionist about this. If he is anemic it is very important to treat that so that his brain and body develop normally.

 

[Willowcat05]

This was a return appointment after his check up in February. I believe it's usually Mr Walker or Mr Haddock that look after the GI kids. You could phone Dr Barclay's secretary and check which one then phone the surgeon's secretary and see how much longer you will have to wait. (I tend to nag them until they finally give me an appointment :lol. If the secretary has your mobile number, then she may be able to offer a cancellation.

Thanks Sascot I will give Dr Barcley's secetary a phone and see which surgeon it is.