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SED LEVELS????


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My S/O had blood cultures done last week and the doctor called tuesday and told him his "sed" rates are 1/3 higher than they are suppose to be. His doctor said "just like before you had your surgery"

Has anyone had any experience with this? Does this mean his cancer is back? Hes been running fever again now for 2 to 3 weeks. With no apparent cause.

His family doctor order a PET Scan which he is having done today. It will be the first of the week before we know the results from this!! I'm scared of what they will find out!! This dang fever of his!! Its the reason they found his cancer to start with.. but it had gone away for over a month after his surgery!

I would have asked about this sooner, but we've had some bad power outages here in Ohio. Our power was out for 55 hours!! Thank God its back on now... Hope everyone else survived the storms!!

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Dear Rinksgal,

The "sed" rate you refer to is probably the erythrocyte (red blood cell-RBC) sedimentation rate or ESR. This is the rate at which red blood cells settle out in a tube of unclotted blood, expressed in millimeters per hour.Blood is collected in an anticoagulant an allowed to sediment in a glass calibrated column. At the end of one hour, the lab technician measures the distance the erythrocytes have fallen in the tube.

Elevated sedimentation rates are not specific for any disorder but indicate the presence of inflammation. Inflammation causes an alteration of the blood proteins which make the red blood cells aggregate, becoming heavier than normal.The speed with which they fall to the bottom of the tube corresponds to the degree of inflammation. Serial evaluations of the ESR are useful in monitoring the course of inflammatory activity and when performed with a white blood cell count can indicate infection.

Hope this helps...hang in there,

Lynn

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from the web ...

".....

Sedimentation Rate

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This test measures the rate at which red blood cells separate from plasma (the liquid part of blood) and fall to the bottom of a test tube to form a sediment.

High levels may indicate heart attack, rheumatic fever, giant cell arteritis, severe anemia, cancer relapse or other conditions.

Low levels may indicate congestive heart failure, sickle cell anemia or other conditions. "

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More info .... Like lynn said it is an indication of inflamation. It may or may not correlate with the cancer progressing. I did a search on pubmed and could not find much on it being used to monitor lung cancer. There was another article on pubmed that ESR could be useful if combined with platelet count, LDH and other measurements to detect cancer, but nothing about monitoring it.

Limited value of elevated erythrocyte sedimentation rate as an indicator of malignancy.

Monig H, Marquardt D, Arendt T, Kloehn S.

Department of General Internal Medicine, I Med. Klinik der KAU Kiel, University of Kiel, Schittenhelmstrasse 12, D-24105 Kiel, Germany. hmoenig@1med.uni-kiel.de

BACKGROUND: Patients with an elevated erythrocyte sedimentation rate (ESR) are often suspected of having malignant disease and are subjected to extensive investigations. Thus, the finding of an elevated ESR can result in considerable costs and might even be dangerous for the patient if invasive studies are ordered. OBJECTIVES: Our aims were to establish (i) the prevalence of malignant diseases in hospitalized patients and out-patients with elevated ESR; and (ii) the long-term incidence of malignant diseases in patients during 5 years after unsuccessful investigation for elevated ESR. METHODS: A cross-sectional survey was carried out in 128 patients admitted to the Department of General Internal Medicine, University of Kiel and in 94 out-patients under the care of a GP. A retrospective cohort study of 50 patients was also carried out by contacting GPs of patients discharged from hospital after unsuccessful investigation. RESULTS: In the hospitalized patients, the ESR was elevated in 53.1% (68/128) and was normal in 46.9% (60/128). Malignancy was found in 25.0% (17/68) of patients with elevated ESR and in 15% (9/60) of patients with normal ESR (P = 0.16). Of the out-patients, 94 patients with elevated ESR were investigated, of whom 8.5% (8/94) had malignancies (P = 0.004 compared with hospitalized patients). In the follow-up study of 50 patients who had been discharged with the diagnosis "elevated ESR of unknown origin", follow-up information was available from 38 individuals. Of these, 71.0% (27/38) had not developed signs or symptoms of any disease at the time of investigation. Malignant disease had developed in only 5.3% (2/38). CONCLUSION: The prevalence of malignancy in patients with elevated ESR is low, in both the clinical and the general practice setting. Elevation of ESR is not an early sign of malignant disease and does not justify extensive investigation in a patient who has no symptoms which are suggestive of a tumour.

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Thanks everyone for the information, I appreciate it!! It seems like everytime I have a question someone knows something about it on here! This site is such a big help!!!! I just wondered if everyones sed levels are high with the return of cancer? All of this is so confusing..................

Well he had the pet scan and I guess we'll know the results from that tomorrow!!!!! We figured it would be the first of the week. I Pray to God it doesn't show that his cancer has relapsed!! But to be honest I can't imagine what else has made his fever return, which is getting higher everyday. I wish his fever was from another cause!! But the doctor can't find any reason for his fever!!

I'm so dang scared to even learn what the results are!!!! Today I just feel like crying!!!!! I wish this would all just go away like some big nightmare!!!

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I hope it is not the cancer that is causing the fever. How long has it been since the surgery? Did they remove most of his medistinal lymph nodes or sample them?

What staging was done before the surgery (PET, medianoscopy, etc)

I am assuming the fever has been more than 3 weeks?

Take care

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I just read that cytokines like tumor necrosis factor (TNF) can cause inflamation and fever.

Also COX2 and EGFR (epidermal growth factor) causes inflamation and is expressed in tumor cells.

Could the doctor check for TNF-alpha and other cytokines like IL-6?

Maybe you could ask the Dr about a COX2- inhibitor and/or Iressa or Tarceva.

BTW, I lived in Dayton for 10 years (through high school).

----------------------------------------------------------------------------------

Lung Cancer. 2003 Jan;39(1):1-13. Related Articles, Links

Epidermal growth factor receptors and cyclooxygenase-2 in the pathogenesis of non-small cell lung cancer: potential targets for chemoprevention and systemic therapy.

Richardson CM, Sharma RA, Cox G, O'Byrne KJ.

Department of Oncology, University of Leicester, Osborne Building, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, LEI 5WW, Leicester, UK

The epidermal growth factor receptor (EGFR) is part of a family of plasma membrane receptor tyrosine kinases that control many important cellular functions, from growth and proliferation to cell death. Cyclooxygenase (COX)-2 is an enzyme which catalyses the conversion of arachidonic acid to prostagladins and thromboxane. It is induced by various inflammatory stimuli, including the pro-inflammatory cytokines, Interleukin (IL)-1beta, Tumour Necrosis Factor (TNF)-alpha and IL-2. Both EGFR and COX-2 are over-expressed in non-small cell lung cancer (NSCLC) and have been implicated in the early stages of tumourigenesis. This paper considers their roles in the development and progression of lung cancer, their potential interactions, and reviews the recent progress in cancer therapies that are directed toward these targets. An increasing body of evidence suggests that selective inhibitors of both EGFR and COX-2 are potential therapeutic agents for the treatment of NSCLC, in the adjuvant, metastatic and chemopreventative settings.

Cytokines in patients with lung cancer.

Matanic D, Beg-Zec Z, Stojanovic D, Matakoric N, Flego V, Milevoj-Ribic F.

Clinic for Internal Medicine, Pneumology Department, Clinical Hospital Centre Rijeka, Rijeka, Croatia. dubravkama@net.hr

Lung cancer is one of the most common malignant diseases and is amongst the leading causes of death. Cell-mediated immune response and cytokines could play an important role in antitumour immunity. The aim of the study was to evaluate the cytokines', tumour necrosis factor-alpha (TNF-alpha), interleukin-1beta (IL-1beta) and IL-6, releasing capacity in patients with lung carcinoma and benign lung disease. A group of 41 patients were tested for the production of TNF-alpha, IL-1beta and IL-6 in bronchoalveolar lavage (BAL) and blood. The levels of cytokines in the lung cancer patients were: (1) in BAL - IL-6, 173 +/- 85 pg/ml; TNF-alpha, 170 +/- 116 pg/ml; and IL-1beta, 473 +/- 440 pg/ml; (2) in the blood - IL-6, 197 +/- 53 pg/ml; TNF-alpha, 311 +/- 202 pg/ml; and IL-1beta, 915 +/- 239 pg/ml. Alveolar macrophages of the patients with a lung cancer secreted significantly more cytokines, IL-6 (P = 0.0004) and IL-1beta (P = 0.0047), than alveolar macrophages of the patients with a nonmalignant lung cancer. However, significantly lower levels of cytokine production by the BAL cells were found in patients with small cell lung cancer. This production decreased further in phase IV of nonsmall cell lung cancer.

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Hello Rinksgal - Winstead Churchill, who smoked cigars like a pot bellied stove but never got lung cancer, (geez!) said, "We have nothing to fear but fear itself." Well, your fear is well founded. Lung cancer is a dastardly monster who quietly hides - leering out from its dark cavern - basking in its own putrid stench. You've seen it raise its ugly, hideous head once...you KNOW what it can do...no wonder you're scared! Who isn't with your experience? Right now, you've got the "worry-watch," but soon, you'll know if you can breath a sigh of relief, or if you need to switch from the worry-watch to one of supportive, loving care, and since you've done that before...you know what to do...s/o is fortunate to have you. Let us know his CT results. I'll be busy on my knees for both of you as we wait to hear. Onward, Ellen Lilja

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John, he had his surgery May 20, 2003. They removed at least 4 of his lymph nodes. Before surgery, They found his tumor when they were trying to find a reason for his fever, they found this on a chest xray. They then ordered a catscan on his brain, chest and stomach area. Then since his surgery they ordered a bone scan. He was diagnosed with adenocaricnoma poorly differentialed. His tumor was 4.5 cm and they removed his right upper lobe with no recommendation for any other treatment. The oncoligist said there was a new study about follow up chemo, but he didn't reccomend it at that time.

My boyfriend just had a PET Scan done today. We are suppose to find out the results of that one tomorrow. His fever went away the 2nd day after surgery. and returned almost 3 weeks ago. aprox. a month after surgery. In one of the cat scans they did find a 7mm size place that they said they were gonna watch. They said they "think" its a cysts. But would watch it and if it grew then they would check it out. I've worried about this from the begining. I wish they could just check it. So maybe now with the pet scan it will show if it is a cysts or if it is the cancer metastasizing to somewhere else! God Help Us if it is!! We have both been moody and grumpy today. He's in such a bad mood, I really think its because of waiting for the test results to the pet scan. Not to mention hes tired of feeling bad all the time.

I can't even begin to imagine how all of you have handled dealing with yourself or someone you love having cancer and watching them go down heel. I told a good friend of mine today that I don't know if I'm strong enough to handle it. I'm afraid I will lose it totally if we get bad news tomorrow. I realize I'm worrying without having the results but I can't help it. I'm trying so hard not to get upset, but today I'm on the verge of losing it. I don't want to lose him!! Hes my whole life!!! Hes always been the strong one and I can't imagne me having to be, he's the one that takes care of everything including me!! I love him more than I thought I could love any man!! I thank all of you for your prayers and your responses even though I'm a little confused about TNF and all that other stuff. But I'm gonna do some research on the web about it. Thanks for the information.... My heart, thoughts and prayers are with all of you!!

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Infections can happen from the surgery. And it doesn't seem too long since his surgery. Could you get a 2nd opinion? Where is he being treated?

I would ask about a COX-2 inhibitor (celebrex). Aspirin is also a COX-2 inhibitor, but since he just came off surgery you have to be careful since it thins the blood and may cause complications. I would ask the doctor about trying to get the inflamation down possibly.

I hope this is no metastasis, but there is a clinical trial involving Thalidomide. Thalidomide may help with the TNF. TNF may be causing the inflammation and fever.

I'm not a dr, but these are things you may want to ask

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Thanks John for all your information. I will check all of this out. The doctor called a little bit ago and wants us to come to his office at 2:45 today to go over the test results with us. I'm scared, so dang scared!!!!!!!! Doctors don't have you come in unless its bad news!!! I'll let ya know what we find out.....

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Well his cancer is back in the lymph nodes in the center of his chest is the way the family doctor tells it. The reports says focus of abnormal uptake in the right side of the mediastinum consistent with malignant adenopathy... The computer analysis yields an SVU max of 10.4g/ml for the abnormaility indicating that it represents malignant adenopathy. Says there is a well defined nodular focus of abnormal activity noted in the right side of the mediastinum at the level of the aortic arch.

Any infor on all of this would be appreciated???

God Bless and Prayers to all of you!

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MAYBE HE HAD THE CANCER IN THE LYMPH NODES ALL ALONG. I KNOW THEY CHECKED 7 LYMPH NODES OF MY HUSBANDS DURING THE SURGERY AND FOUND MICROSCOPIC CANCER IN 5 OF THEM.

IT WASN'T A FEW MONTHS AND IT WAS IN HIS BRAIN, AND A FEW MONTHS AND IT WAS FOUND IN HIS BONES. I BELIEVE IT WAS AT BOTH PLACES BEFORE THE OPERATION. HE DID HAVE A PET BEFORE THE OPERATION BUT I KNOW IT DOESN'T SHOW ANYTHING IN THE BRAIN AND NOT SURE IF IT SHOWS THE BONE. I ASKED THE DR WHY THEY DIDN'T CHECK ALL THAT BEFORE THE OPERATION AND HIS ANSWER WAS WOULD IT HAVE CHANGED ANYTHING..... yES IT WOULD HAVE. MAYBE YOUR S/O HAD IT IN THE LYMPH NODES BUT THOSE ONES IT IS IN NOW WEREN'T THE ONES THAT WERE CHECKED. THAT IS IF ANY WERE CHECKED DURING THE SURGERY..... IT MAY NOT BE ANYTHING NEW. WHO REALLY KNOWS ANYTHING ABOUT ALL OF THIS. WE LEARN SOMETHING NEW EACH DAY AND EACH DR VISIT.....

PLUS, YOU SAID YOU COULD CRY. DO IT, IT WILL TAKE SOME PRESSURE OFF. SOMETIMES WE NEED A GOOD LONG CRY.....ITS BETTER THAN A THERAPIST AT THIS POINT......GOD BLESS.....

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