ESR

[karools16]

What is considered a satisfactory ESR? My neurologist likes it under 25. My GP, who knows very little about GCA, says under 40. I had an ESR last week, as I had a tender hairline and mildish headaches on 3 mg Pred.I also asked him how much I could increase the steroids to, for a 6 week chest infection. I got no results, and when I asked a nurse, at a routine appt, she said the reply was satisfactory, which is of no help to me. I am disillusioned with the medics, at present, as after 7 weeks, my Respiratory Consultant has still not given me the test results, for water on the lungs. The headaches have now gone.

[PMRpro Ambassador]

It's an historical thing. When the ESR test was first developed someone came up with a calculation for what was an acceptable level for your ESR at a given age.

They had done thousands and thousands of tests in many apparently healthy people of all ages - and found that at birth it is zero and then increases with age. It was assumed that this was a normal thing and so the calculation was used for many years to decide whether an ESR level was OK for the particular patient. To do it for women you added 10 to your age and divided the result by 2 and for men you just divided age by 2. So at 20 an ESR of 10-15 was fine. By age 55 the range was 25 to 35 or thereabouts and if it was heading for 40 that was felt to be borderline. In more recent years they have realised that the ESR is, at best, a VERY variable figure! A cold will raise it, even pregnancy will raise it, and it is only a very vague indicator that something is going on. And as we age - then there are all sorts of "inflammatory things" happening that will raise the ESR and not always be obvious so these figures are probably increased for that reason. In a perfectly healthy person the ESR should be more like the 25 your neurologist likes than the 40 your GP is happy with.

I don't know how much you know about statistics - but there is a very famous thing called the "bell-shaped curve". To get it you measure something in thousands and thousands of cases - and plot a graph. The largest number will be about the middle, as you go out both ways to the extremes there will be fewer and fewer. At the end you take the range of numbers that make up 95% of the total population - and the top and bottom 2.5% are regarded as outliers or abnormal.

Even in older adults there will be some whose personal normal level is in these corners - my ESR is 4, at its highest it crept up to 7. There are some people whose personal normal is over 30. Everyone is a bit different. It's biology!

What is most significant for anyone whose ESR behaves as expected - not like mine - is the trend. If it is high when you are diagnosed as having some inflammatory illness and then it falls with treatment it is worth looking at it again to make sure you aren't relapsing. But it is always the symptoms and the patient that is important - the figures are not reliable because in some people they don't rise, in others they don't rise when still taking any pred, in others they shoot up. The numbers are just a guide, nothing more, but if they rise over a period of weeks, there is probably something wrong.

[Hidden in reply to PMRpro]

Wow... thanks for the information

[DorsetLady PMRGCAuk volunteer]

Good question, and as PMRpro says varies from person to person.

I've just had this discussion with my GP - about a month after pains started was tested for PMR, at that time was told ESR was satisfactory so couldn't be PMR. Later found out it was 30 - this was 6 years ago when it was worked out on age as PMRpro described, so should have been around 35.

Eighteen months later on diagnosis (loss of right eye) it was 68. Despite high levels of Pred at start it's rarely been in single figures, mainly in teens. It did rise to 30s and 40s in 2013 but that was due to stress, late hubby diagnosed with liver cancer, in and out of hospital plus bereavement.

Between the levels of 13mg doŵn to 1mg it was late teens. From 1mg to zero it's been 22 or 23 (over last 4 to 5 months).

As I have OA and am 69 yrs old with no GCA PMR type aches and pain, WE have decided that this is probably my "norm".

I must admit I'm lucky in that my present GP is sensible, and has been around the block long enough not to be too rigid on numbers. As he says how can a reading of 7.9 be ok, but a reading of 8 ring alarm bells - you need all the facts, not just a set of numbers.

When you ask for the results, don't be fobbed off by the answer 'satisfactory' that means nothing - ask for the actual reading, then, over time, you will have a better idea of what is your norm. But you must be aware that lots of things can affect your ESR, it's not just PMR. Plus of course, if it continues to increase month on month you need to find out why.

[karools16 in reply to DorsetLady]

Thanks DorsetLady.Yesterday my chiropodist said I should ring the Dr, not even his secretary, and ask for a print-out of the results of the bloods taken. I used to have regular ESR bloods taken, but it seems to have fallen away. When I see my Neuro. in Dec, he will not be satisfied with a 'satisfactory' verdict.

[DorsetLady PMRGCAuk volunteer in reply to karools16]

I always get my bloods done at GP surgery, and always asked what the figure was, not the GPs comments, they're always very non committal, unless it's really bad! and I've kept a note, for my own benefit really. I changed GPs a couple of years ago, and he's let me reduce in my own way, having a blood test every 2 or 3 months just to monitor things. If the receptionist gets a bit angsty about giving me the figures I always say I need them to know what dose of Pred to take. Never been refused.

You shouldn't have any problem getting a printout, just be a little firm, but polite, if you need to!

[karools16 in reply to DorsetLady]

Yes, I used to keep a monthly record of the ESR, mainly for the Neuro.I changed to a new Dr(new to the surgery as well) in Feb.It's really been a case of the pot calling the kettle black, as the GP said I should be firm with the Consultant/Secretary in getting results and then he doesn't either!

[DorsetLady PMRGCAuk volunteer in reply to karools16]

Yep. That sounds about right!

My hubby used to say - If you want something done, do it yourself!

[maria40 in reply to DorsetLady]

Yes, I do exactly the same having got my previous GP now sadly retired to put a note on my screen to say that I could have a print out of the results.

[karools16 in reply to maria40]

maria40, isn't it a shame that the patient has to ask the doctor for a print out, and that results aren't just given?

[PMRpro Ambassador in reply to karools16]

Here in Italy we are encouraged to collect our own results from the lab - and if we say we want them when the blood sample is taken at the hospital we will be charged the full cost if we don't collect them! The same applies to x-rays and scans of all sorts and the hospital will burn you a DVD for the grand sum of 5 euros.

[karools16 in reply to PMRpro]

I am so fed-up with it all, that, if I could afford it, I would go privately. Having said that, it's only this year and with 2 new doctors, that I have had non-results. On the whole, I think the NHS is marvellous, problems and all. Coming from S.African state hospitals,is like night and day.

[piglette]

My ESR has been between 57 and 58 for over a year. My GP says it is stable! I asked my rheumatologist about the high reading and she said it was nothing to worry about and just shrugged. She said it goes up with age, I am not that old!

[DevonMichael]

When I had my blood test during the afternoon for ESR to check if I had GCA. I got a telephone call from a doctor at 930pm in the evening, clearly concerned, to relay that the reading was a 124. Because that meant nothing to me and to understand the context of what was high, he did say they are concerned with anything over 10.

Glad your headaches have gone.

[karools16 in reply to DevonMichael]

Gosh, DevonMichael. doc concerned if ESR over 10! Have never got down to that in 10 years!

[DevonMichael in reply to karools16]

Interesting! I have only the one ESR experience so far but hope to get some follow up in October so may have some new number to compare!

[PMRpro Ambassador in reply to DevonMichael]

Heavens - he must worry a lot unnecessarily about most of his patients then! Under 15 for men and under 20 for women is accepted as absolutely fine by most experts.

[violetsnowdrop]

One of the practice GPs recently 12/9 asked me to repeat a blood test because ESR was 56, which was considered too high. The repeated test came back with a similar result. Tests carried out at the local hospital 21/9 whilst being treated for what transpired to be a major sinus blockage/infection showed ESR 60 : CRP 14. At GP practice 22/9 day looked at historical records --ESR level has been around 50-55 for the last 10 years!

[karools16 in reply to violetsnowdrop]

Hello violetsnowdrop. Our ESR levels show that 1 size doesn't fit all, which some doctors would have us believe!

[karools16]

For some very unknown reason, I cannot see the full post, by HeronNS, nor reply to it. Sorry, but all other posts come through ok, but, have tried repeatedly.....don't know what problem is?

Karools16

[HeronNS in reply to karools16]

? Karools, I do have a habit of writing replies and then deleting them, sometimes before I post, rarely afterwards. Maybe I did that yesterday and you saw the notification after I posted but just before I deleted ? Why ? I write too d... much and I know it, but sometimes just need to express something even if no one reads it.

[karools16 in reply to HeronNS]

HeronNS glad I have seen your post now.Oh Yes, I know the feeling when you just need to have a liitle rant/need some TLC, and you get it here.