Guest guest Posted May 26, 2003 Report Share Posted May 26, 2003 It is one of our weird flukes of medicine. They always knew it was a problem to bleed to much (lack of clotting), but it never occured to them that it could be a problem to have too much clotting. So they took the normal range all the way to zero. Also Sed is usually not used to determine clotting problems, more sophisticated measures are used. The way sed rates are usually used is that a high sed rate is associated with autoimmune diseases and other things I don't remember. So that is what they are typically looking for when they do that test. It turned out that everyone who has hypercoagulation also had very low sed rates. Mine were always 0-2 since I have been sick which is all the data I have, I hypercoagulate easily, and have genetic causes for it in my family. A low sed rate means that the blood takes forever to settle out. In reality those low numbers are not " normal " . A normal person will not have sed rates that low. But it wasn't until they started studying people with CFS that they noticed this correlation. Thanks, Doris ----- Original Message ----- From: winsomme I was wondering if someone could illuminate something that has confused me for some time. over time, i have often read about a low sed rate in CFS being indicative of hypercoagulation. i have always had low sed rates when they were taken (between 0 and 3), but i always wondered why that would indicate a problem. i believe the reference range for a Sed Rate is 0-15, so how can anybody have a low sed rate when the ref range starts at 0? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 26, 2003 Report Share Posted May 26, 2003 Bill, Reference ranges are almost worthless. Sometimes they call it “normal range”. In pharmacy school, profs kept calling various health problems “normal” and one day I asked how that could be. The prof replied that “normal” means the norm or average. And the average American has health problems! This explains in part while doctors may tell you it’s normal, when you complain of fatigue, PMS, pain, or whatever. And we think “normal means the ideal, healthy state, to which we want to return. For example, since the average American is somewhat anemic, the reference range on your lab results shows anemic as “normal”. To compound matters, the labs don’t use the whole population’s results for their reference ranges, they use only the population consisting of people they’ve tested. Which is mostly sick people. While everybody may get a CBC (complete blood count), so that some non-anemic people are included, other tests are done only on those who are suspected of having unhealthy levels for that test. I almost used the words “abnormal results”. Even if a high percentage of testees have unhealthy results, they are all counted in the pool that determines what the “normal’ is. Then, a very wide part of the resulting bell curve, is counted in the reference, or “normal” range. Only the most extreme results are left out. For your sed rate results, 0-3 is in the low end of “normal’, but science has shown it to be unhealthy. Hope this helps. Barb ESR/Sed Rate I was wondering if someone could illuminate something that has confused me for some time. over time, i have often read about a low sed rate in CFS being indicative of hypercoagulation. i have always had low sed rates when they were taken (between 0 and 3), but i always wondered why that would indicate a problem. i believe the reference range for a Sed Rate is 0-15, so how can anybody have a low sed rate when the ref range starts at 0? any thoughts would be appreciated. thanks bill Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 26, 2003 Report Share Posted May 26, 2003 thanks for your posts. i guess i'm not so worried about the reference range, but the idea of a " low sed rate. " could somebody point me to some literature as to what makes a low sed rate abnormal. it is my understanding that if you are hypercoaguable you would have a " high " sed rate. and that technically there is no such thing as a low sed rate because " 0 " is normal. i totally understand that reference ranges aren't always the best measure, but when the range tells you that there is no " LOW " side, then what is the reasoning behind suggesting that it is abnormal? anyway, these are just some questions circulating around in my head. thanks bill > Bill, > Reference ranges are almost worthless. Sometimes they call it " normal > range " . In pharmacy school, profs kept calling various health problems > " normal " and one day I asked how that could be. The prof replied that > " normal " means the norm or average. And the average American has health > problems! > This explains in part while doctors may tell you it's normal, when you > complain of fatigue, PMS, pain, or whatever. And we think " normal means the > ideal, healthy state, to which we want to return. > For example, since the average American is somewhat anemic, the > reference range on your lab results shows anemic as " normal " . To compound > matters, the labs don't use the whole population's results for their > reference ranges, they use only the population consisting of people they've > tested. Which is mostly sick people. While everybody may get a CBC > (complete blood count), so that some non-anemic people are included, other > tests are done only on those who are suspected of having unhealthy levels > for that test. I almost used the words " abnormal results " . Even if a high > percentage of testees have unhealthy results, they are all counted in the > pool that determines what the " normal' is. > Then, a very wide part of the resulting bell curve, is counted in the > reference, or " normal " range. Only the most extreme results are left out. > For your sed rate results, 0-3 is in the low end of " normal', but > science has shown it to be unhealthy. > Hope this helps. > > Barb > > > ESR/Sed Rate > > I was wondering if someone could illuminate something that has > confused me for some time. > > over time, i have often read about a low sed rate in CFS being > indicative of hypercoagulation. i have always had low sed rates when > they were taken (between 0 and 3), but i always wondered why that > would indicate a problem. > > i believe the reference range for a Sed Rate is 0-15, so how can > anybody have a low sed rate when the ref range starts at 0? > > any thoughts would be appreciated. > > thanks > bill > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 27, 2003 Report Share Posted May 27, 2003 Try www.hemex.com The reasoning is empirical. People with low sed rates also are found to have excess fibrin (hypercoagulation). When treated, the sed rates come up. I don't believe you are correct that hypercoagaguable would be a high sed rate. It is the opposite. Sed rate is how fast the blood settles. If you have thick blood it does not settle fast. As I said before, high sed rate is usually associated with autoimmune problems such as lupus, although I don't know why those types of illnesses cause that. A 0 sed rate means the blood doesn't settle out, so I don't see how anyone could think that " 0 " is normal. " Normal " is probably something like 5-10. But they took the range down to 0 because they didn't know it was a problem. Thanks, Doris ----- Original Message ----- From: winsomme thanks for your posts. i guess i'm not so worried about the reference range, but the idea of a " low sed rate. " could somebody point me to some literature as to what makes a low sed rate abnormal. it is my understanding that if you are hypercoaguable you would have a " high " sed rate. and that technically there is no such thing as a low sed rate because " 0 " is normal. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 27, 2003 Report Share Posted May 27, 2003 Bill, what I’m saying is that the medical definition of “normal” is less than worthless. Forget normal/abnormal. Go for the science, and think healthy/unhealthy. If you keep leaning on the fact that the lab said it’s normal, you’re stuck. Barb ESR/Sed Rate > > I was wondering if someone could illuminate something that has > confused me for some time. > > over time, i have often read about a low sed rate in CFS being > indicative of hypercoagulation. i have always had low sed rates when > they were taken (between 0 and 3), but i always wondered why that > would indicate a problem. > > i believe the reference range for a Sed Rate is 0-15, so how can > anybody have a low sed rate when the ref range starts at 0? > > any thoughts would be appreciated. > > thanks > bill > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 27, 2003 Report Share Posted May 27, 2003 I think my question is getting confused here. i am trying to figure out why a sed rate of " 0 " is considered unhealthy and why medicine does not acknowledge this.... normal, abnormal, healthy, unhealthy. whatever the terminology, i'm trying to figure out the reasoning. as my understanding of the test goes, an ESR is done to check for signs of inflamation. a " high " ESR indicates the presence of inflamation. the idea of hypercoagulation, as i understand it, is that due to immune system activation there is a build up of fibrin in the blood. thus, i would think that the ESR should be high when the blood is in a hypercoaguable state. but that's not what i'm reallly confused about. what i really want to know is why a low sed rate is considered bad, and what the arguement is by mainstream medicine as to why a low sed rate is not bad. thanks bill > Try www.hemex.com > The reasoning is empirical. People with low sed rates also are found to have excess fibrin (hypercoagulation). When treated, the sed rates come up. I don't believe you are correct that hypercoagaguable would be a high sed rate. It is the opposite. Sed rate is how fast the blood settles. If you have thick blood it does not settle fast. As I said before, high sed rate is usually associated with autoimmune problems such as lupus, although I don't know why those types of illnesses cause that. > > A 0 sed rate means the blood doesn't settle out, so I don't see how anyone could think that " 0 " is normal. " Normal " is probably something like 5-10. But they took the range down to 0 because they didn't know it was a problem. > Thanks, > Doris > ----- Original Message ----- > From: winsomme > > thanks for your posts. i guess i'm not so worried about the reference > range, but the idea of a " low sed rate. " could somebody point me to > some literature as to what makes a low sed rate abnormal. > > it is my understanding that if you are hypercoaguable you would have > a " high " sed rate. and that technically there is no such thing as a > low sed rate because " 0 " is normal. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 27, 2003 Report Share Posted May 27, 2003 Bill - I went through this some time ago, here is what I remember and found... ESR is used as a measure of inflammation based on the fact that some proteins produced by inflammation cause the red cells to clump together (in nice neat little stacks of discs) more than normal. Because they are clumped they tend to fall out of suspension and drop to the bottom. The faster they drop, the higher the " sedimentation Rate " . So the reasoning is - higher sed rate means they are more clumped which means that more of this inflammatory protein must be present which means that there is inflammation. This is the normal way of looking at it. However there are some things that stop sedimentation, and lead to low ESRs as a result. Firstly, extra thick blood. This I think is the main reason PWCs score a low sed rate. THis is Berg's theory, there is a quote below. It is also shown in the second quote as " hyperviscosity " . A second reason is if the red cells are distorted and not in their normal nice disk shape. In this case, they are unable to clump in the neat stacks becasue they don't fit together, so they don't clump as much and thus they don't sediment as fast. Here are two references that tell you a bit about the subject generally, google has plenty more under CFS ESR. http://www.aafp.org/afp/991001ap/1443.html http://www.fpnotebook.com/HEM113.htm here's a quote from Berg... We are writing a new journal article addressing the Normal Range of Sed Rates (ESRs). <5 test values are indicative of a hypercoagulable state. The only time this is not true is a cancer called Multiple Myeloma where there is a lot of extra protein producced by the cancer cells. In either case, because of the Soluble Fibrin or extra proteins, the RBCs cannot settle out of the plasma and thus you have rates of 0-4. The lower the Sed Rate, the more SFM and the more hypercoagulable the patient is and from http://www.aafp.org/afp/991001ap/1443.html A decreased ESR is associated with a number of blood diseases in which red blood cells have an irregular or smaller shape that causes slower settling.1,3 In patients with polycythemia, too many red blood cells decrease the compactness of the rouleau network and artifactually lower the ESR. An extreme elevation of the white blood cell count as observed in chronic lymphocytic leukemia has also been reported to lower the ESR.1,5 ypofibrinogenemia, hypergammaglobulinemia associated with dysproteinemia, and ******************hyperviscosity***************** may each cause a marked decrease in the ESR. Although it has been reported that drug therapy with aspirin or other nonsteroidal anti-inflammatory agents may decrease the ESR, this has been disputed.2,3 Cheers, n At 07:40 27/05/03, you wrote: >thanks for your posts. i guess i'm not so worried about the reference >range, but the idea of a " low sed rate. " could somebody point me to >some literature as to what makes a low sed rate abnormal. > >it is my understanding that if you are hypercoaguable you would have >a " high " sed rate. and that technically there is no such thing as a >low sed rate because " 0 " is normal. > >i totally understand that reference ranges aren't always the best >measure, but when the range tells you that there is no " LOW " side, >then what is the reasoning behind suggesting that it is abnormal? > >anyway, these are just some questions circulating around in my head. > >thanks >bill > > > > > > > > > Bill, > > Reference ranges are almost worthless. Sometimes they call >it " normal > > range " . In pharmacy school, profs kept calling various health >problems > > " normal " and one day I asked how that could be. The prof replied >that > > " normal " means the norm or average. And the average American has >health > > problems! > > This explains in part while doctors may tell you it's normal, >when you > > complain of fatigue, PMS, pain, or whatever. And we think " normal >means the > > ideal, healthy state, to which we want to return. > > For example, since the average American is somewhat anemic, the > > reference range on your lab results shows anemic as " normal " . To >compound > > matters, the labs don't use the whole population's results for their > > reference ranges, they use only the population consisting of people >they've > > tested. Which is mostly sick people. While everybody may get a CBC > > (complete blood count), so that some non-anemic people are >included, other > > tests are done only on those who are suspected of having unhealthy >levels > > for that test. I almost used the words " abnormal results " . Even >if a high > > percentage of testees have unhealthy results, they are all counted >in the > > pool that determines what the " normal' is. > > Then, a very wide part of the resulting bell curve, is counted >in the > > reference, or " normal " range. Only the most extreme results are >left out. > > For your sed rate results, 0-3 is in the low end of " normal', >but > > science has shown it to be unhealthy. > > Hope this helps. > > > > Barb > > > > > > ESR/Sed Rate > > > > I was wondering if someone could illuminate something that has > > confused me for some time. > > > > over time, i have often read about a low sed rate in CFS being > > indicative of hypercoagulation. i have always had low sed rates when > > they were taken (between 0 and 3), but i always wondered why that > > would indicate a problem. > > > > i believe the reference range for a Sed Rate is 0-15, so how can > > anybody have a low sed rate when the ref range starts at 0? > > > > any thoughts would be appreciated. > > > > thanks > > bill > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 27, 2003 Report Share Posted May 27, 2003 Bill, The erythrocyte sedimentation test is a very old test. You're right, a high value of the ESR indicates inflammation. Normally red blood cells repel each other electrostatically because of their common zeta potential. Anything that helps to cancel the zeta potential out will assist the red blood cells in clumping together and in forming rouleaux, which are like stacks of poker chips. When the red cells are joined together, it decreases their effective surface-to-volume ratio, and thus increases their weight- to-drag ratio. They are thus able to fall out of suspension in the viscous medium of plasma faster. This is what happens in inflammation states and in certain diseases. Thus, a high ESR has traditionally been an indicator of inflammation or these other diseases. In the case of hypercoagulation, what happens is that the fibrinogen, which normally would increase the ESR if present in excess because of its effect on cancelling the zeta potential, is joined together to produce fibrin fibers. These larger fibers act as mechanical barriers and impede the settling of red blood cells, producing a lower ESR. As I understand it this is something that was discovered rather recently by Berg. It isn't yet accepted by the conventional medical community, and probably won't be unless someone who is " properly placed " in the medical establishment publishes a statistally significant double-blind paper studying it in one of the respected journals, and it is verified by a second study, etc. Berg is a guy with a master's degree who runs a private lab in Phoenix, Arizona. The alternative practitioners pay attention to him, and he sponsors a booth at their conferences and gives talks. But to get it into medical textbooks to be taught at medical schools, the information has to have a more sophisticated pedigree than that. It needs to come from s Hopkins, or Mayo Clinic or UC San Francisco, or Duke or etc. There may not be much incentive for the drug companies, who fund most biomedical research, to fund such a study. There probably aren't big profits in selling heparin, because it's a natural substance and thus can't be patented to achieve a monopoly position, as is normally done with pharmaceuticals. So I think that's the nitty-gritty behind this situation. Rich > > Try www.hemex.com > > The reasoning is empirical. People with low sed rates also are > found to have excess fibrin (hypercoagulation). When treated, the > sed rates come up. I don't believe you are correct that > hypercoagaguable would be a high sed rate. It is the opposite. Sed > rate is how fast the blood settles. If you have thick blood it does > not settle fast. As I said before, high sed rate is usually > associated with autoimmune problems such as lupus, although I don't > know why those types of illnesses cause that. > > > > A 0 sed rate means the blood doesn't settle out, so I don't see how > anyone could think that " 0 " is normal. " Normal " is probably > something like 5-10. But they took the range down to 0 because they > didn't know it was a problem. > > Thanks, > > Doris > > ----- Original Message ----- > > From: winsomme > > > > thanks for your posts. i guess i'm not so worried about the > reference > > range, but the idea of a " low sed rate. " could somebody point me > to > > some literature as to what makes a low sed rate abnormal. > > > > it is my understanding that if you are hypercoaguable you would > have > > a " high " sed rate. and that technically there is no such thing as > a > > low sed rate because " 0 " is normal. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 27, 2003 Report Share Posted May 27, 2003 thanks for the info. the reason i was posting this question is my most recent sed rate was " 0 " , but my ISAC from HEMEX was all normal. thanks bill > > > > Rich, > > > > Does this then resemble what Les Sipsoms work describes about the 'clumping' blood cells that are not able to get through the capilaries? > > That 'should' read Les Simpson....shouldn't type when I'm this tired....sigh... > > Marcia Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 27, 2003 Report Share Posted May 27, 2003 Bill, I think that's interesting. Have you had your blood examined by live blood dark field microscopy? It might be possible to actually see what's in the blood that is preventing settling of the red cells. Rich > thanks for the info. > > the reason i was posting this question is my most recent sed rate > was " 0 " , but my ISAC from HEMEX was all normal. > > thanks > bill Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 27, 2003 Report Share Posted May 27, 2003 > Anything that helps to cancel the > zeta potential out will assist the red blood cells in clumping > together and in forming rouleaux, which are like stacks of poker > chips. When the red cells are joined together, it decreases their > effective surface-to-volume ratio, and thus increases their weight- > to-drag ratio. They are thus able to fall out of suspension in the > viscous medium of plasma faster. This is what happens in > inflammation states and in certain diseases. Thus, a high ESR has > traditionally been an indicator of inflammation or these other > diseases. Rich, Does this then resemble what Les Sipsoms work describes about the 'clumping' blood cells that are not able to get through the capilaries? I don't know if they did SED rates on me in my early years since CFS hadn't been invented yet, but the last 4 or so yrs my SED rate is now high. Marcia Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 27, 2003 Report Share Posted May 27, 2003 Marcia, Les doesn't really directly observe " clumping. " What he does is to examine the shapes of individual red blood cells that have been " fixed " with glutaraldehyde so that their shapes are " frozen " and don't change during shipment to his lab in New Zealand. He finds that there are more abnormally shaped red cells in people with CFS than in normal, healthy people, particularly more " flat " cells, which have flat sides, without the usual dimples. He infers that these abnormally shaped red cells would have difficulty in travelling through the smaller diameter capillaries, and thus would not be able to deliver oxygen as well as normal cells. As n said in his post about this, abnormally shaped red cells can't " clump " together to form rouleaux as readily as normal cells, so having abnormally shaped red cells slows down their sedimentation and gives a lower ESR. I don't think Les has done a correlation of ESR with percentage of flat cells, but that would be interesting to see. My impression is that Les pretty much sticks with examining red cells with his scanning electron microscope and reporting the results. He doesn't wander too far afield from this activity, for example by trying to understand the biochemistry of what's going on and offering hypotheses to explain his observations. He leaves that to others. Rich > Rich, > > Does this then resemble what Les Simpson's work describes about the 'clumping' blood cells that are not able to get through the capilaries? > > I don't know if they did SED rates on me in my early years since CFS hadn't been invented yet, but the last 4 or so yrs my SED rate is now high. > > Marcia Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 27, 2003 Report Share Posted May 27, 2003 > Rich, > > Does this then resemble what Les Sipsoms work describes about the 'clumping' blood cells that are not able to get through the capilaries? That 'should' read Les Simpson....shouldn't type when I'm this tired....sigh... Marcia Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 27, 2003 Report Share Posted May 27, 2003 Hi Marcia, The little I know of Les Simpson's findings is that red blood cells are misshapen and his hypothesis is that they cannot easily flow through the capillaries or that they may have reduced oxygen carrying capacity. The bi-concave shape of the RBC does aid in its ability to carry oxygen so this does make sense. If blood volume is reduced due to loss of water. The blood would be more hypertonic than normal. The website below shows what a red blood cell looks like in a hypertonic solution (scroll down toward the bottom of the page and clik on the photo of the RBC in a hypertonic solution as seen through a microscope. http://cwx.prenhall.com/bookbind/pubbooks/hillchem3/medialib/media_por tfolio/12.html I sometimes wonder if this could not account for the misshapen red blood cells found by Dr. Simpson, but he being a Dr. I would imagine that he would know about the effects of the solution upon the cell. I would like to know more about what he is finding. Anyway, take a look, its pretty interesting. All the best, Jim > > > > Anything that helps to cancel the > > zeta potential out will assist the red blood cells in clumping > > together and in forming rouleaux, which are like stacks of poker > > chips. When the red cells are joined together, it decreases their > > effective surface-to-volume ratio, and thus increases their weight- > > to-drag ratio. They are thus able to fall out of suspension in the > > viscous medium of plasma faster. This is what happens in > > inflammation states and in certain diseases. Thus, a high ESR has > > traditionally been an indicator of inflammation or these other > > diseases. > > Rich, > > Does this then resemble what Les Sipsoms work describes about the 'clumping' blood cells that are not able to get through the capilaries? > > I don't know if they did SED rates on me in my early years since CFS hadn't been invented yet, but the last 4 or so yrs my SED rate is now high. > > Marcia Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 27, 2003 Report Share Posted May 27, 2003 Jim, That really is a pretty picture, but the blood in PWCs is usually not found to be hypertonic, and that type of cell shape is not what Les predominately sees. Blood chemistry panels usually show the electrolytes and proteins to be in the normal ranges in PWCs. It's important to keep in mind that the concentration of each of these solutes is controlled, and when the blood plasma volume decreases by excessive urination, for example, the separate control systems continue to control the concentrations of the major electrolytes. Rich > > > > > > > Anything that helps to cancel the > > > zeta potential out will assist the red blood cells in clumping > > > together and in forming rouleaux, which are like stacks of poker > > > chips. When the red cells are joined together, it decreases their > > > effective surface-to-volume ratio, and thus increases their > weight- > > > to-drag ratio. They are thus able to fall out of suspension in > the > > > viscous medium of plasma faster. This is what happens in > > > inflammation states and in certain diseases. Thus, a high ESR has > > > traditionally been an indicator of inflammation or these other > > > diseases. > > > > Rich, > > > > Does this then resemble what Les Sipsoms work describes about > the 'clumping' blood cells that are not able to get through the > capilaries? > > > > I don't know if they did SED rates on me in my early years since > CFS hadn't been invented yet, but the last 4 or so yrs my SED rate is > now high. > > > > Marcia Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 27, 2003 Report Share Posted May 27, 2003 Rich, Thanks for the further explanation. I'm sure that the hypertonic solution that produced the cell structure deformations in that picture was much more hypertonic than would be found in blood. Per info in the " Cell Physiology Sourcebook " an acidic pH in the cell could possibly affect the cytoskeletal structure of the cell. Another possibility that I've thought about is that when constructing the RBC maybe their was not sufficient resources to build it properly. But with the tight controls that the body has on everything I doubt that that may be the case. It would probably not build the RBC until all required ingredients were available. All the best, Jim > Jim, > > That really is a pretty picture, but the blood in PWCs is usually > not found to be hypertonic, and that type of cell shape is not what > Les predominately sees. Blood chemistry panels usually show the > electrolytes and proteins to be in the normal ranges in PWCs. It's > important to keep in mind that the concentration of each of these > solutes is controlled, and when the blood plasma volume decreases by > excessive urination, for example, the separate control systems > continue to control the concentrations of the major electrolytes. > > Rich > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 27, 2003 Report Share Posted May 27, 2003 I went to bed last night and i was still wrestling with this topic. here's my quandry: what is it about this test (ESR) that it does not have a low level? Forget about CFS for a second. just think about this test by itself, with no diagnosis attatched to it. there must be some reason (whether it is right or not) to think that a Sed Rate of " 0 " or " 1 " is healthy. it's not a complicated test, right? what would a hematologist say if you asked them to explain what a Sed Rate of " 0 " means? the reason i'm harping on this is because one of the things we are looking for are markers that can demonstrate that PWC's have a physiological problem. and if a large portion of us have a sed rate <4, and a sed rate of <4 is bad, then wouldn't a portion of our problem be picked up right away. An ESR was one of the first tests i had done four years ago. There must be some reason that science does not recognize that a low sed rate is bad. i'm not saying that it is accurate, but they must have a reason. forget about CFS for a second, just think about the the sed rate test. a low sed rate means (according to Berg et al) that the RBC's are not moving properly through the blood, right? So, what is the counter arguement? just think back to that first DR appt you had, and think what it would have like if the DR said, " Your sed rate is LOW. I'm not sure what is causing it to be low, but it is LOW none-the-less. " thanks bill > > Jim, > > > > That really is a pretty picture, but the blood in PWCs is usually > > not found to be hypertonic, and that type of cell shape is not what > > Les predominately sees. Blood chemistry panels usually show the > > electrolytes and proteins to be in the normal ranges in PWCs. It's > > important to keep in mind that the concentration of each of these > > solutes is controlled, and when the blood plasma volume decreases > by > > excessive urination, for example, the separate control systems > > continue to control the concentrations of the major electrolytes. > > > > Rich > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 27, 2003 Report Share Posted May 27, 2003 and correct me if i'm wrong, but in order to demontstrate this fact (low sed rate in CFS), wouldn't you just have to take a group of PWC's and a group of healthy controls and show that healthy people don't have low sed rates and PWC's do....? i mean the idea that if you have a low sed rate, you won't feel well should be really easy to demonstrate. > > > Jim, > > > > > > That really is a pretty picture, but the blood in PWCs is usually > > > not found to be hypertonic, and that type of cell shape is not > what > > > Les predominately sees. Blood chemistry panels usually show the > > > electrolytes and proteins to be in the normal ranges in PWCs. > It's > > > important to keep in mind that the concentration of each of these > > > solutes is controlled, and when the blood plasma volume decreases > > by > > > excessive urination, for example, the separate control systems > > > continue to control the concentrations of the major electrolytes. > > > > > > Rich > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 27, 2003 Report Share Posted May 27, 2003 > i mean the idea that if you have a low sed rate, you won't feel well > should be really easy to demonstrate. This is true about low blood pressure too. Its obviously low, but back in the late 70's when I first became ill (before CFS was a recognized illness) my BP was 90/50. My Dr. just said, well, if it stays like that you should live forever !(meaning, how lucky for me, no high BP). I just grumped 'You call this living????'. Then he admitted it would probably not be associated with a lot of energy! Thats as far as it ever went. Over the years it did go up, unhelped by him. I think the avg. dr. just doesn't 'think' sometimes. Marcia Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 28, 2003 Report Share Posted May 28, 2003 Bill, I can imagine that it might be a bit chagrining to have a zero sed rate with normal coagulation tests, and not know what that means. As I understand it, the red blood cells in the plasma act like a colloid. In a colloid, a particulate solid is suspended within a liquid. The particles have a higher density than the liquid, so that by Archimedes principle they would settle to the bottom, with their rate of settling determined by the balance between the force of gravity, determined by the density difference, and the drag force due to the viscosity of the liquid. However, in a colloid, the particles are small enough that the electrostatic forces that are always present become significant compared to the gravitational force. The electrostatic forces arise from the fact that the quantum mechanically determined electron affinity is different for each substance, and when two substances are placed in contact, there is a net transfer of electrons from the one with the lower affinity to the one with the higher affinity, until the resulting electrostatic force balances the force due to the difference in affinity. Then the net current ceases, and there is a residual net charge, setting up what's called the zeta potential. The result of this is that the colloidal particles all reach the same zeta potential, if they are composed of the same substance. The are thus charged with the same polarity, and since like charges repel, they repel each other. If these electrostatic forces are sufficiently strong, they can overbalance the gravitational force, and the colloid will remain in suspension. This is called a stable colloid. In the case of the red blood cells, they become negatively charged relative to the plasma. There are proteins in the plasma that are unsymmetrical and carry electrical charges as well. These can have dipoles, which consist of a positive and a negative charge separated by some distance on the molecule. These dipoles will orient in the electrostatic field of the red blood cells, and in doing so will tend to cancel out the field. If this is sufficiently effective, the red cells will not only be able to fall out of the plasma under the action of gravity, but they will also be able to join together, bound by shorter-range Van der Waals forces, and stack together, forming rouleaux. These forces don't come into play unless the particles are able to get close together, i.e., unless the forces arising from the zeta potential are sufficiently decreased. If the red cells stack together, they decrease their effective surface to volume ratio. They can thus fall out more rapidly under the force of gravity, because the drag force will be minimized. So the effect of the protein dipoles is two-fold: first, it destabilized the colloid and allows the red blood cells to fall out of the plasma, and second, it allows them to aggregate and thus to drop out faster, producing a high sed rate. These are two separate issues. As I understand it, when a person has a hypercoagulation problem, the fibrinogen, which would normally act to increase the sed rate by helping to cancel out the zeta potential, actually binds together to form larger fibrin fibers, and these act as mechanical barriers to the sedimentation of the red cells. This thus produces a low sed rate, but not a zero sed rate. In order to have a truly zero sed rate, it means that the zeta potential is not sufficiently cancelled out, and the red blood cells are thus repelling each other enough to preserve a stable colloid. They thus remain in suspension indefinitely. What could cause this? I think that one possibility is that there is a deficiency of proteins in the blood that would normally balance the zeta potential. Have you had your blood proteins measured, i.e., globulins and albumin? I think you are also asking why doctors haven't paid any attention to low sed rates, or zero sed rates in the past. I think it's just a matter of the significance of this not having been understood until Berg pointed it out a few years ago, and the difficulty in getting something new tested, published, and accepted as medical doctrine by the huge medical establishment. In principle you are right that it shouldn't be too difficult to test this idea. However, this takes someone with the right credentials and stature in the scientific community, funding, motivation and great care to make sure it is done in a convincing and statistally significant way, and factors that may confound the interpretation must be thought out and compensated for. It really is a lot of work to do a scientific experiment in a way that will convince the (rightly) critical scientific community of something new. Believe me, I worked in scientific research for nearly 40 years, and I have some feeling for this, having been involved in a lot of scientific debates over the interpretation of experiments. It may seem very simple, but it isn't. There are actually lots of things in medicine that are not well proven for many of these same reasons, but are used anyway. A few years ago the medical establishment started emphasizing the concept of " evidence-based medicine " to try to counter this problem, but it has revealed that there are many things that are done that aren't based on documented evidence. They have just been " grandfathered in " by experience and long practice. The sed rate test is one of these very old lab tests that continues to be used, even though it isn't always well understood on a " first principles " basis. I hope this helps. Rich > > > > Jim, > > > > > > > > That really is a pretty picture, but the blood in PWCs is > usually > > > > not found to be hypertonic, and that type of cell shape is not > > what > > > > Les predominately sees. Blood chemistry panels usually show > the > > > > electrolytes and proteins to be in the normal ranges in PWCs. > > It's > > > > important to keep in mind that the concentration of each of > these > > > > solutes is controlled, and when the blood plasma volume > decreases > > > by > > > > excessive urination, for example, the separate control systems > > > > continue to control the concentrations of the major > electrolytes. > > > > > > > > Rich > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 28, 2003 Report Share Posted May 28, 2003 Bill, I have a sed rate of around 10 or 12, but have two genetic coagulation defects and an abnormal ISAC panel. When I stop my heparin for more than a few days or so, I can definitely tell the difference. So I wonder why my sed rate isn't low like most pwc's. Any ideas, Rich? Donna in NC Re: ESR/Sed Rate > thanks for the info. > > the reason i was posting this question is my most recent sed rate was " 0 " , but my ISAC from HEMEX was all normal. > > thanks > bill Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 28, 2003 Report Share Posted May 28, 2003 Donna, Take a look at my message #21812 to Bill. My guess is that you have some proteins in your blood that are cancelling the zeta potential of the red blood cells and overwhelming the mechanical barrier effect of the fibrin molecules. I think we should keep in mind that Berg has not said that a low sed rate is an unequivocal sign that there is hypercoagulation, or that a high sed rate is an unequivocal sign that there is no hypercoagulation. I have a copy of the slides he used at the recent OHM meeting in San Francisco, and one of them says, " Sed Rates < 5 are indicative of a hypercoag state. " He has always said that to really be sure, you have to take the types of tests that he offers. Rich > Bill, > I have a sed rate of around 10 or 12, but have two genetic coagulation > defects and an abnormal ISAC panel. When I stop my heparin for more than a > few days or so, I can definitely tell the difference. So I wonder why my sed > rate isn't low like most pwc's. Any ideas, Rich? > > Donna in NC > > Re: ESR/Sed Rate > > > > thanks for the info. > > > > the reason i was posting this question is my most recent sed rate was " 0 " > , but my ISAC from HEMEX was all normal. > > > > thanks > > bill Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 28, 2003 Report Share Posted May 28, 2003 rich thanks for posting so much info on this topic. i'm not so much frustrated by my DR's interpretation of the ESR, but as to why the reference range is for the test is 0-15 (0-20, i have seen it that too). To me, that means that when they developed the test, for some reason they determined that you can be healthy and have a sed rate of " 0 " what we seem to be saying here is that you can't have a sed rate of " 0 " and be healthy because with a sed rate of 0, your RBC's are not settling properly. i can see why interpreting the cause of a low sed rate would be complicated, but i can't see why recognizing that a Sed rate of " 0 " is unhealthy is.... At some point the developers of this test or those who set up guidelines for the test looked at it and said that a sed rate of " 0 " is healthy. and i'm just trying to figure out what that rationale is.... thanks bill > > > > > Jim, > > > > > > > > > > That really is a pretty picture, but the blood in PWCs is > > usually > > > > > not found to be hypertonic, and that type of cell shape is > not > > > what > > > > > Les predominately sees. Blood chemistry panels usually show > > the > > > > > electrolytes and proteins to be in the normal ranges in > PWCs. > > > It's > > > > > important to keep in mind that the concentration of each of > > these > > > > > solutes is controlled, and when the blood plasma volume > > decreases > > > > by > > > > > excessive urination, for example, the separate control > systems > > > > > continue to control the concentrations of the major > > electrolytes. > > > > > > > > > > Rich > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 28, 2003 Report Share Posted May 28, 2003 Donna, Sorry, I meant message #58212. Can I blame it on brain fog? Rich > > Bill, > > I have a sed rate of around 10 or 12, but have two genetic > coagulation > > defects and an abnormal ISAC panel. When I stop my heparin for > more than a > > few days or so, I can definitely tell the difference. So I wonder > why my sed > > rate isn't low like most pwc's. Any ideas, Rich? > > > > Donna in NC > > > > Re: ESR/Sed Rate > > > > > > > thanks for the info. > > > > > > the reason i was posting this question is my most recent sed > rate was " 0 " > > , but my ISAC from HEMEX was all normal. > > > > > > thanks > > > bill Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 28, 2003 Report Share Posted May 28, 2003 Bill, In principle, I don't think it's necessary for red blood cells to settle out of standing blood in order for them to do their job of transporting oxygen to the other cells of the body. After all, in the body, you want them to stay mixed with plasma so they can be transported around the circulatory system by it. So I don't see an intrinsic reason why a person could not be healthy while having a zero sed rate. It's just that most people's red cells do settle out at some rate, and Berg has noticed that there is a fairly good correlation between having a sed rate less than 5 and being hypercoagulated. He has also mentioned that having cold hands and feet all the time is suggestive of hypercoagulation. But these aren't 100% one-to-one correspondences, just indicators that it might be worthwhile to test for hypercoagulation. Rich > rich > > thanks for posting so much info on this topic. > > i'm not so much frustrated by my DR's interpretation of the ESR, but > as to why the reference range is for the test is 0-15 (0-20, i have > seen it that too). > > To me, that means that when they developed the test, for some reason > they determined that you can be healthy and have a sed rate of " 0 " > > what we seem to be saying here is that you can't have a sed rate > of " 0 " and be healthy because with a sed rate of 0, your RBC's are > not settling properly. > > i can see why interpreting the cause of a low sed rate would be > complicated, but i can't see why recognizing that a Sed rate of " 0 " > is unhealthy is.... > > > At some point the developers of this test or those who set up > guidelines for the test looked at it and said that a sed rate of " 0 " > is healthy. > > and i'm just trying to figure out what that rationale is.... > > thanks > bill Quote Link to comment Share on other sites More sharing options...
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