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Family Medicine (Expert Forum)
Extremely High SedRate
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
Questions in the Family Medicine forum are answered by Dr. J.M. Keyes. Topics covered include general health issues, adolescence, babies, child health, eating disorders, fitness, immunizations and vaccines, infectious diseases, medical tests and procedures, and senior health.
Extremely High SedRate
by jcmiyake, Apr 12, 2004 12:00AM
About a month ago, I went to my doctor complaining of a pain in the mid to upper right quadrant of my abdomen. The first doctor thought perhaps I had an ovarian cyst, so he sent me to get a pelvic ultrasound.
I asked the technician to check out the area I was complaining about (not my ovaries, by the way). After telling me that all my other organs looked fine (kidneys, bladder) she told me that I have a fatty liver.
I also had a round of blood tests, my liver enzymes were slightly elevated. There is blood in my urine (only shows up in the tests, not visible to the eye).
The next doctor made me get an abdominal CT scan and more blood tests.
CT scan results read: severely fatty liver. Everything else: negative. Second set of blood tests, Hep B & C negative, Iron tets all in the normal range. My sed rate is EXTREMELY high. ESR/Sed Rate 135 mm/hr.
The doctor then sent me to see a gastroenterologist: he thought I might have Crohn's. I had a colonoscopy last week (that was fun). My colon is healthy, no sign of any inflammation. Next on the list is a liver biopsy and then I'm supposed to see a Rhuematologist to rule out Lupus. I don't have any unusual bone or joint pain and no rashes.
My question is this... could there be anything that the doctors are missing?
Every doctor I see, I ask if it's possible I may have appendicitis. My grandmother had appendicitis a few years ago, her appendix was "tucked inside" so it wasn't seen in her CT scans or ultrasounds, but only found during exploratory surgery.
With my sed rate at 135, should I continue all of these tests or just forget about it? I've read some conflicting information about high sed rates online. Some sites say that anything over 100 is a sign that there is a serious infection or inflammation, some sites say that it could mean nothing at all.
It's been over a month now, I'm still in pain, I've seen a different doctor every other week and had lots of fruitless tests. I'm getting very frustrated and would really appreciate any insight you have!
I asked the technician to check out the area I was complaining about (not my ovaries, by the way). After telling me that all my other organs looked fine (kidneys, bladder) she told me that I have a fatty liver.
I also had a round of blood tests, my liver enzymes were slightly elevated. There is blood in my urine (only shows up in the tests, not visible to the eye).
The next doctor made me get an abdominal CT scan and more blood tests.
CT scan results read: severely fatty liver. Everything else: negative. Second set of blood tests, Hep B & C negative, Iron tets all in the normal range. My sed rate is EXTREMELY high. ESR/Sed Rate 135 mm/hr.
The doctor then sent me to see a gastroenterologist: he thought I might have Crohn's. I had a colonoscopy last week (that was fun). My colon is healthy, no sign of any inflammation. Next on the list is a liver biopsy and then I'm supposed to see a Rhuematologist to rule out Lupus. I don't have any unusual bone or joint pain and no rashes.
My question is this... could there be anything that the doctors are missing?
Every doctor I see, I ask if it's possible I may have appendicitis. My grandmother had appendicitis a few years ago, her appendix was "tucked inside" so it wasn't seen in her CT scans or ultrasounds, but only found during exploratory surgery.
With my sed rate at 135, should I continue all of these tests or just forget about it? I've read some conflicting information about high sed rates online. Some sites say that anything over 100 is a sign that there is a serious infection or inflammation, some sites say that it could mean nothing at all.
It's been over a month now, I'm still in pain, I've seen a different doctor every other week and had lots of fruitless tests. I'm getting very frustrated and would really appreciate any insight you have!
Doctor's Answer
by Kevin Pho, MD, Apr 13, 2004 12:00AM
, Apr 13, 2004 12:00AM
A sedimentation rate is very non-specific. Many inflammatory disorders - including rheumatological diseases or infection - can raise it. By itself, it isn't that useful - it has to be used in conjunction with other tests. A rheumatology evaluation is a reasonable next step to further evaluate this.
Regarding appendicitis - the CT scan is a fairly sensitive test. The sensitivity if this test for appendicitis is 95-98 percent (i.e. if you do have it, the test would be positive 95-98 percent of the time). If it is negative, it is unlikely that appendicitis is present.
Regarding the fatty liver. I would consider stopping alcohol if you do drink. The liver biopsy is a reasonable next step for further evaluation.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
Regarding appendicitis - the CT scan is a fairly sensitive test. The sensitivity if this test for appendicitis is 95-98 percent (i.e. if you do have it, the test would be positive 95-98 percent of the time). If it is negative, it is unlikely that appendicitis is present.
Regarding the fatty liver. I would consider stopping alcohol if you do drink. The liver biopsy is a reasonable next step for further evaluation.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
