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Health: Four Tests For Chronic Inflammation

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These are four of the most common tests for inflammation:

  • Erythrocyte sedimentation rate (sed rate or ESR). This test measures how fast red blood cells settle to the bottom of a vertical tube of blood. When inflammation is present the red blood cells fall faster, as higher amounts of proteins in the blood make those cells clump together. While ranges vary by lab, a normal result is typically 20 mm/hr or less, while a value over 100 mm/hr is quite high.
  • C-reactive protein (CRP). This protein made in the liver tends to rise when inflammation is present. A normal value is less than 3 mg/L. A value over 3 mg/L is often used to identify an increased risk of cardiovascular disease, but bodywide inflammation can make CRP rise to 100 mg/L or more.
  • Ferritin. This is a blood protein that reflects the amount of iron stored in the body. It’s most often ordered to evaluate whether an anemic person is iron-deficient, in which case ferritin levels are low. Or, if there is too much iron in the body, ferritin levels may be high. But ferritin levels also rise when inflammation is present. Normal results vary by lab and tend to be a bit higher in men, but a typical normal range is 20 to 200 mcg/L.
  • Fibrinogen. While this protein is most commonly measured to evaluate the status of the blood clotting system, its levels tend to rise when inflammation is present. A normal fibrinogen level is 200 to 400 mg/dL.

Commentary:

Inflammation is an essential, evolutionarily conserved mechanism that our bodies have developed for excluding infections, toxins, and damaged or cancerous cells.

Acute inflammation in response to infections is almost always beneficial, except where it is disproportionate to the danger that it fights; the common cold is  probably innocuous, but we develop symptoms from our bodies’ response. Covid has been found to incite disproportionately severe inflammation, which can lead to severe disease, and the need for corticosteroids.

Chronic inflammation is a different animal, and is usually undesirable. Sometimes it is due to an infection, such as tuberculosis, which won’t go away. Sometimes the bodies immune system develops a disordered communication system, and fights its own cells, called auto immunity.

Chronic inflammation can also be caused by obesity, chronic stress, cigarette smoking, alcohol in excess, and cancer, which can also be CAUSED BY chronic inflammation.

Chronic inflammation is also associated with Alzheimer’s, heart disease, rheumatoid arthritis, and type two diabetes. Asthma is a chronic inflammatory disease of the airways. IBD, inflammatory bowel disease, is a chronic inflammatory disease of the intestinal tract.

The symptoms of chronic inflammation very widely depending on the area involved. Abdominal pain, chest pain, joint pain, skin rashes, fatigue, and fever are some of the symptoms.

You can reduce your likelihood of chronic inflammation by maintaining normal weight, having regular exercise, eating a diet rich in natural vegetables and fruits (antioxidants),  avoiding alcohol and cigarette smoke, and by reducing or handling your stress.

—Dr. C.

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In The Lab, Medicine, Men's Health, Women's Health

IN THE LAB: TESTS FOR AND DIAGNOSING “aNEMIA”

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I should have known something was wrong.

I was getting short of breath with a third of a 45-minute exercise I had done for years, but I rationalized it away. I reasoned that I hadn’t been sleeping well, I am getting old. And my heart isn’t working as well because of the Atrial Fibrillation.

Physicians have a big armamentarium of excuses they can generate, and besides it is their Karma to GIVE Medical care rather than to RECEIVE it.

The AHA moment came when I bumped my leg, and peeled back some skin. My skin is old and fragile, and I’m always tearing it in small areas.

This time, I got to see the blood run all the way down my leg like a drop of grape juice, not the thick blood I’m used to. If anything, my blood should be thicker, more viscous, since my average Hemoglobin is 16 gm., on the high side of normal.

I got my blood drawn, and ordered a CBC and a ferritin. The CBC shows the Hemoglobin level, and a number of other measurements bearing on anemia, and the ferritin gives a measure of IRON STORES.

I can’t remember the first time my ferritin was ordered, or why, but it has for years been borderline, just barely in the normal range, dipping down as low as 18, and rising as high as 35.

Since a common cause of low iron stores with a good diet is colon cancer, I had about 3 colonoscopies to rule out cancer over a period of 6 years; lucky me.

At least they were all negative, and without polyps.

This time the ferritin was 12, well into the abnormal range, and the Hemoglobin was 8.6 gm. little more than half my usual.

I had been fibrillating for 5 months, and been on 5 mg. Eliquis ( an anticoagulant/blood thinner) for the same period. Having a recent normal colonoscopy, the most likely diagnosis was AVMs (arteriovenous malformations) of the small bowel, with bleeding accelerated by the Eliquis,

Since small bowel surgery contraindicated a diagnostic videocapsule, this diagnosis would have to remain an assumption.

I reduced the Eliquis by 25%, calculated my blood loss rate and started 2 capsules of feosol alternating with 3 capsules daily. Over a period of 4 months, my Hemoglobin came back up to 15 gm., and my ferritin came up to 50. I am due another test as soon as I get enough nerve to brave the Covid and go to the lab.

This story is a good illustration of treating one illness, and thereby creating another in this world awash with medication. How much better it is to stay as healthy as possible.

However, I am becoming increasingly aware of the fact that Health is not often the top priority in most peoples lives.

As an illustration, I refer to todays’ Sunday New York Times, which reviewed 2 books on walking, one written to praise its’ health benefits. To quote the reviewer, “

The issue with ‘ in praise of walking’ is Mr. O’Mara’s assumption that how good an activity may be for us is the most essential measure of its worth”. Praising health raises an issue?

Personally, my main exercise is walking, and I do it expressly for health. That doesn’t mean that I don”t enjoy walking and have other motivations. I would not be walking as FAST, however, it it were not so healthy.

–Dr.C.