ESR

1. As a medical student, everytime i went back to my hometown for holiday, it does not mean that i can run from medicine. I do feel like i want to run away for a week from medicine but i just can't.

2. even in holiday, there are family member who would ask me some question regarding their sign and symptoms and it is more difficult than the exam question where your answer would be rejected if it is false, but with your family, no one will say you are wrong. You are always right. But what if you are wrong? I guess i am liar if i answer it wrong. I'l like committing a sin.

3. So i try to answer the best that i could. For every symptoms, i would go for the simplest diagnosis that i can make. For example, if someone ask me about headache, i would say it may be due to stress, maybe migraine, and so on before getting to meningitis or encephalitis, tumor and everything. I don't want to make them afraid.

4. So it is like exam huh..! I would be ready for everything. Ask me a question, vague answer followed by " must go and consult a doctor" would be my usual answer. This is important, i don't want to make a diagnosis at this point. Go and see real doctor would be my advice to everyone because people really need to see doctor if they are sick and not only rely to this young final year medical student who are struggling hard to pass exam.

5. However, the funny thing happen today when my auntie came to my house. I was ready for the question... and the question is " My ESR is high, what should and should not eat?"

WHATTTT????? ESR HIGH? IS THAT A SYMPTOMS? OR IS IT A DISEASE? NO IT IS A LAB TEST RESULTS?

In what world people would go and ask you about ESR increase? How do they know?

6. This is the evidence of advancing health screening program that organized by private sector who want to scoop money from the people. Measure ESR, show it to be increase and make people spend thousand ringgit for supplement what would not cure the ESR. How do we cure high ESR actually? Do we have some kind of insulin for that? haha.

7. Well, ESR is raised when they are inflammation in our body cause by infection, notably tuberculosis in my endemic area for tuberculosis or athritis. Any inflammation. Name any other inflammation condition...SLE, RA, Gout...etc..everything can cause ESR to be increased. But is it significant? I guess another lab test is CRP which also give us idea regarding on going inflammation in our body.

8. So do we routinely check for ESR? no. We don't. Without any diagnosis to be confirmed, we can't simply order ESR. It is an indicator for another disease.

9. So why do those private hospital or clinic check their patient (without any sign and symptoms) ESR level? Simple, money lah. Who will not be afraid if there is abnormal result in their blood investigation? Everyone will. So more opportunity to make their patient spend more money to buy thing.

10. Sometimes it is good to do routine check up. We may have a disease that we did not realize for a very long time. But, the bad thing is, it also can cause hypochondriasis (google yourself!).

What important is, doctors should educate their patient regarding anything that they found to be abnormal in every investigation they made. Discuss and explain transparently everything that the patient need to know. Do not show abnormal result and left patient wondering like that and further more ask patient to buy supplement product from you.

High ESR does not always reflect a problem. if you did not have any pain, no fever, nothing, then nothing should be done other than having a healthy diet, good exercise and a very wide smile and a good laugh everyday.