Erythrocyte sedimentation rate

Blood culture is great.

Full blood count, ESR, CRP, looking for inflammatory markers.

Ooh, good shout.

Yeah, good shout for sure, dude.

What many people don't realize is that if you have even acute appropriate inflammation, like you sprained your ankle or you tweaked your back or you cut a toenail too close and now it's inflamed.

Any kind of inflammation, irritated pimple on your nose, any of these inflammatory things, even if it's an appropriate inflammation, is going to raise your blood sugar and definitely chronic inappropriate inflammation that you might check by having a CRP or an ESR or a homocysteine or a ferritin level.

If those are elevated because of chronic inappropriate inflammation, you're definitely going to have higher blood sugars until you fix that chronic inflammation.

But the take home message is even acute, sudden, appropriate inflammation from an injury is going to cause your blood sugar to go up.

So another issue that comes up when reading your paper is there was so much variability in when someone is able to get re-implanted.

Like, do you use ESR, CRP? Do you aspirate? Are you just looking at it clinically as if the wound's healed? There's really no definitive test there.

So based on the findings, what should people be using during either the antibiotic holiday or prior to re-implantation when they know they can go on to the second stage re-implantation?

Well, regarding the study, that was another huge limitation, right? Because that criteria for re-implantation, it was all over the place.

But to me, the most important thing is how the patient is doing in general.

Like, is their pain better? How the soft tissues and the skin look? And then there are some, I guess, indirect proxies of their overall health.

Is their albumin going up? Is the CRP going down? Not necessarily, again, being simplistic to say that ESR and the CRP have to be normal because some of these patients, they're never going to be normal.

I mean, you can see some trends and that has been reported in the literature.

So we look at things like the drive towards type 2 diabetes, the chronic sugar overload over time.

We look at things like markers in the blood like CRP and ESR, which, you know, weirdly, for instance, in someone who has a high amount of fat in their body, their inflammatory markers are higher.

This is just another sign of the chronic inflammation that's being driven.

So metabolic dysfunction at his heart is a driver for chronic inflammation.

Our lab values, again, we would expect to see in this patient, they would have high platelets.

We would expect to see our ESR and CRP elevated for inflammation.

And then they actually could have anemia.

So while the platelet count might be high, our hemoglobin and hematocrit may be lowered.

again, if they have a leaky valve, right, or they've got an inflammation, not necessarily a leaky valve, but if they've got inflammation around the valves of the heart and that can't, it's causing issues getting blood flow out to the lungs and the body, that's why you might see some of these other signs and symptoms around shortness of breath, chest pain, and dyspnea.

In terms of our labs and diagnostics, we're going to need an echocardiogram.

We would look at CRP and ESR markers to see if it's elevated.

We would look to see if there's an antistreptic titer.

There are different thresholds.

Usually, when people are talking about inflammation in kind of a clinical setting, some of the things that they will be looking for are C-reactive protein, sedimentation rate, or an ESR.

They can also look at a white blood cell count.

There are markers that kind of respond to inflammation like procalcitonin, haptoglobin, bibrinogen, ferritin, prealbumin.

And that's where some of the lab work comes in, right? And with lab work, we can also track inflammatory markers at the same time.

So we can say, okay, not only are you subjectively feeling better, but your HSCRP is down, your ESR has changed, your ANA is down.

And we can really track antibodies as well, which when we're talking about autoimmunity, that is one of the important things to track, looking at, are we having an effect on the antibodies produced for any given organ or system in the body? So in our clinic, a lot of times we use baseline blood testing as a first line marker.

And then we transition into some of the more advanced testing like ART to provide a baseline initial screening and identify what the priorities are.

It moves from the foundational question of, is there autoimmunity, to the deeper questions of what infections or toxins are hiding beneath the surface, deriving these processes.

And finally, to integrative insights, how is my gut ecosystem and my autonomic nervous system regulating my whole clinical picture? To recap that roadmap, layer one, we're looking at inflammation status.

So we're trying to determine, hey, is there any inflammatory processes going on? Is there a fire? And we're looking at HSCRP, ESR, ferritin, AG ratio.

And if there is, we want to see how the immune system is behaving, how the immune system is communicating.