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High CRP; Gallbladder Stone and More
Hi @Bernadette_Abraham @Daniel
I need your review, guidance and feedback for my uncle who has been going through some medical problems back at home country.
In summary:
– He had a lot of stomach pain, loose stools, vomiting etc. to start with. He was unable to eat or hold his food or medications in for a long time. Lost a lot of weight as well.
– The ultrasound indicated gallbladder stone with a size of 17mm.
– The blood test dated 28th April indicated high CRP.
– He refused any other medical treatment or investigation at hospitals and insisted on staying at home and use his antibiotics with a focus to prepare for gallbladder surgery only.
– He was convinced yesterday; and was admitted to a hospital to re-check the levels in blood, have serum and antibiotics directly via blood to better manage the current issues and speed up the recovery process. Also, run some further tests.
– The blood test 6th May dated is attached here. The CRP levels seem to have come down.
– The doctors refused to operate on him due to what they have seen in results or in the absence of full investigation.
– Based on the latest test results, the doctors suspected something else is potentially at play in addition to the gallbladder stone. If I am not wrong, a blood marker indicates potential cysts, tumours? ?The doctors suggested screening; however, my uncle who is at the moment quite a stubborn man refusing any further investigation. He is of the opinion that his main issue is the gallbladder stone, and the focus must be gallbladder surgery only; all other examinations are nothing but waste of his time. Unfortunately, he is not taking all these medical problems physiologically well. It has been draining for everyone around him.
I have promised him that I would share these results with you both and seek your interpretation of the tests; positive or negative. And also, your suggestions moving forward. He is luckily ok to seek another view on his condition at the moment.
We believe, he is scared to know more or do not want to go through lengthy medical examinations and opt the easiest way possible, which he thinks is a gallbladder surgery.
I am fully aware it would be hard to draw any conclusion without further investigation; however, would appreciate it if you can share your initial review, thoughts and recommendations to your best ability. The results are not in English; but I assume you would be fine with that.
Many thanks
Regards
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16 Replies
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Hi @DXB – thank you for sharing all of the details and his lab results. I was able to make out the markers even though they weren’t in English.
I’m glad that he’s open to getting a second opinion.The good news like you mentioned is that his CRP levels have come down significantly, which shows that the antibiotics and IV fluids helped reduce the infection/inflammation.
However, the doctors are right to want to investigate further because there are a few red flags that shouldn’t be ignored. His white blood cell count is still quite high, which means that his immune system is still likely fighting off an ongoing infection or inflammation. His hemoglobin has dropped even more, so the anemia is getting worse, and his albumin levels are low. Both of these suggest poor nutritional status that could slow down healing. His sodium is also low, which could be affecting his energy and mood.
And as you pointed out, his CA 19-9 marker is slightly elevated, which can sometimes indicate issues in the pancreas or bile ducts. This doesn’t necessarily mean cancer, but it does justify further screening, just to be sure. And operating while he’s still in a compromised state could lead to complications.
Now from a functional perspective, there were a few other markers of note:
-His fasting glucose and HbA1C are suboptimal. An HbA1C between 5.7% and 5.9% often indicates pre-diabetes. Ideally, it should be <5.3% so blood sugar regulation is definitely something to take seriously. This can impact liver/gallbladder health so from a root cause perspective, addressing blood sugar should be a key priority.
How is his diet? Does she consume a lot of sweets and flour based products (i.e. croissant, bread, pasta, crackers, muffins, etc)? How is his stress level normally?
-His T3 marker is also clinically low. This means he’s having trouble converting T4 to T3, which is nutrient dependent (iron, vitamin A, zinc, selenium) but also hormone dependent. Any kind of infection/inflammation and poor liver health will affect it as well.
If you take a look at our “Gallstones” handout in our Symptom Dictionary, you’ll see that insulin resistance and hypothyroid function are two primary drivers for the development of gallstones, which can explain his predicament.
And while CA 19-9 is usually used as a tumor marker to monitor certain types of cancer, particularly pancreatic cancer, there are however also other benign conditions that can elevate this marker and are worth investigating:
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Liver Dysfunction: Hepatitis, cirrhosis, or other liver disorders (MRI can rule this out)
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Gallbladder Issues: Cholecystitis or gallstones (Ultra sound and MRI can rule these out)
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Pancreatitis: Inflammation of the pancreas, which can occur due to various reasons, including infections, trauma, or genetic conditions. (MRI can rule this out)
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Cystic Fibrosis: A genetic disorder that affects the exocrine glands, including the pancreas. If he has respiratory or gastrointestinal symptoms, screening for cystic fibrosis might be warranted.
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Biliary Obstruction: Any blockage in the bile ducts (ultrasound/MRI can rule this out)
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Inflammatory Bowel Disease: If he has gastrointestinal symptoms such as abdominal pain, diarrhea, or weight loss, evaluating for Crohn’s disease or ulcerative colitis could be beneficial (does he have any digestive complaints?)
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General Infections or Inflammation: since his CRP has come down, he might want to remeasure with the more sensitive inflammation marker (hs-CRP). Ideally we want it to be <1. Given the high WBC and high neutrophils, it’s likely that he’s still fighting an infection/inflammation, and this alone can be driving up the CA 19-9 marker.
But given the insulin resistance and suboptimal GGT (liver function), taking a closer look at his liver and pancreas would be warranted. A simple MRI/ultrasound can rule this out. It would help rule out a lot that isn’t cancer related – so you can reassure him.
I completely understand why he’s hesitant, but without a proper scan to rule out anything more serious, it could actually put him at more risk during or after surgery.
Maybe you could gently explain it to him like this: The scan isn’t to look for bad news, it’s to make sure nothing is missed and to make the surgery safer. If it’s really just the gallbladder, this will confirm it and give everyone peace of mind to proceed with the surgery.
But hopefully he’ll still be willing to work on blood sugar/thyroid and liver health, because even if the gallbladder is removed, it doesn’t fix the reason why it became diseased in the first place.
I hope this is helpful, and gives you more to share with him.
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Thanks so much for the comprehensive feedback Bernadette. Much appreciated
He is diabetic, I forgot to mention that. I can’t say he is great with his diet. And as you pointed out, it could be the underlying reason to this all.
Quick question, he had an abdominal ultrasound which had indicated the issues with gallbladder stone. The liver was found normal. I cannot see comments on pancreas.
The doctors had suggested performing comprehensive MRI, which triggered a massive push back and he left the hospital afterwards.
Do you think that an ultrasound is sufficient? I see MRI is noted in your response to rule out the potential reasons. I guess it is probably the safest way of investigating the matter
I will pass on your feedback to him. I am sure he will value your comments and advice
I may come back here with more updates and test results, as it progresses
Thanks so so much again
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@DXB yes, an MRI is the best way to go if you can convince him. And again, explain to him that it’s not necessarily to find out bad news, but to confirm if it’s in fact safe to proceed for surgery.
We’re here when you need us. I know how difficult it can be to deal with a family member who refuses care. Best of luck with your uncle’s next steps…
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Thanks so much Bernadette
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Thanks so much Bernadette
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Hi again @Bernadette_Abraham
So, my uncle has decided to give himself a month before any medical treatment at the hospital. He is feeling quite down, so he decided to give himself sometime to lift up his spirit again. In the meantime, do you think the following supplements are ok to give to him to support his recovery:
– B12 (In drop form for better absorption)
– Methyl folate
– Magnesium glycinate (Nighttime before sleep)
– Inositol (Nighttime before sleep)
– Proflora – Soil based probiotics (Nighttime before sleep)
The gut and brain axis are so clear at the moment as I fear his stomach problems are leading to some sort of depression. Supplements to facilitate a deep resting sleep along with some good bacteria to support his gut are my initial thoughts. I was also thinking a good B complex as well, but thought less is probably better now for him.
Could you please let me know how you would feel about these supplements?
Thanks so much again for your help.
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Hi @DXB can you clarify what type of treatment he’ll be getting please in a month. Will there be any form of surgery or simply more imaging?
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Hi @Bernadette_Abraham . Unfortunately he has made an executive decision for himself that he would be at home finishing his antibiotics and resting only.
I missed before – you had asked whether he has any issues with digestion; he seems to be fine handling his food.
He says he is not in a state of mind to get into an MRI machine or do more investigations.
So after 1 month, he wants to do the gallbladder surgery only.
Our hands tied here unfortunately, all I can offer now is to support his system and recovery as much as possible.
He lost a lot of weight, still not strong. Hence I suggested the supplements above in the meantime. Hoping to visit him in a month and will try to influence him for more tests.
<font face=”inherit”>Could you please let me know your thoughts on the supplements, if you can. I know there is lack of</font><font face=”inherit”> information about his current health. </font>
Thanks again
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@DXB please take a look at our Preparing for Surgery protocol for ways to support the body before and after surgery.
I would be careful giving him B vitamins at this stage because it might push liver detox which currently is compromised due to state of his gallbladder. It could make him feel worse.
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Thanks Bernadette. Will check this out
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Hi @Bernadette_Abraham; I have managed to visit my uncle and convinced him to have the tomography. I am copying below the translation of the report. Unfortunately, there seems to be a long list of issues. His problems had started with having Covid a few months ago and he had really struggled at the time with his lungs and breathing. I can see in the report there are so many other medical issues, but do you think the water accumulation at lungs and heart are a result of covid?
That would be appreciated if you can share your overall view of the report. What would be the next step in your view? I have also attached the latest blood test, which is not so comprehensive though.
Many thanks.
Here’s the translation of the medical findings you provided:
1. *Bilateral widespread pleural effusion*: There is fluid accumulation in both lungs, which could be associated with conditions such as infection, heart failure, or malignancy.
2. *Subsegmental atelectatic changes in the lower lobe of the left lung*: There are signs of lung collapse due to airway obstruction in the lower lobe of the left lung.
3. *Air cysts in the anterior and middle segments of the lower lobe of the right lung*: There are air-filled cystic structures in specific areas of the right lung.
4. *Pericardial effusion*: Fluid accumulation around the heart.
5. *Widespread edema in the abdominal wall at the abdominopelvic level*: There is swelling in the abdominal wall, which could suggest fluid retention or other underlying conditions.
6. *Hepatomegaly*: Enlargement of the liver, which can be due to various causes such as liver disease or congestion.
7. *Cholelithiasis*: Presence of gallstones in the gallbladder.
8. *Hyperplastic changes in both adrenal glands*: There are changes in the adrenal glands that indicate an increase in cell number, which may need further evaluation.
9. *Small amount of urine in the bladder*: There was a small volume of urine observed in the bladder, and thickening of the bladder wall was noted medially and laterally. Correlation with a full bladder via sonography is recommended.
10. *Diffuse thickening of the wall and narrowing of the lumen in the sigmoid colon*: There are changes in the sigmoid colon that may suggest inflammatory or obstructive processes.
11. *Multiple diverticula in the sigmoid colon*: Presence of small pouches in the sigmoid colon, which can be associated with diverticulitis.
12. *Rare calcified atheromatous plaques in the abdominal aorta wall and iliac arteries*: There are a few calcified plaques in the arteries, indicating early atherosclerosis.
These findings suggest a range of potential health issues that may require further investigation and management. It’s crucial to consult a healthcare professional for a detailed assessment and appropriate treatment.
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Hi @DXB — I’m glad that your uncle agreed to move forward with the tomography despite how reluctant he was initially. What is his current sentiment about additional investigations after receiving this report?
Below is a summary of the findings to hopefully give you a direction of what to consider next given the complexity of his case with the many systems being affected, which no doubt can feel overwhelming and scary.
1. Pleural and pericardial effusions (fluid around lungs and heart): these can absolutely be linked to a past viral infection like Covid, especially if it hit him hard. That said, fluid build-up can also be a result of heart failure, kidney issues, or malignancy, so these should not be ignored or simply blamed on Covid especially that it’s been a few months ago and he’s still retaining fluid. This definitely requires further attention as a priority.
2. Collapsed area in the lung (atelectasis) and air cysts: these are also not unusual after a respiratory illness, especially in older adults or those with underlying health conditions, but the cysts should be monitored over time.
3. Liver enlargement (hepatomegaly) + abdominal wall edema: these together again can point to either congestion from heart strain, liver dysfunction, or low albumin/protein levels, which matches with his earlier labs showing low albumin. So again, something like an echo would be warranted for the heart.
4. Gallstones and colon changes (diverticula, thickening): these are more localized issues that may be causing some of his digestive symptoms if any. The colon thickening may be inflammation (colitis), but it’s hard to say without further tests. Not necessarily a priority to surgery clearance.
5. Adrenal hyperplasia: this is something that needs to be looked at with hormone levels. On its own, it doesn’t say much, but it could explain energy/fatigue issues if it’s functional.
So what to do next?
Before any surgery, he’ll need to get pre-op clearance to make sure his heart, lungs and liver can handle the stress of an operation.
Given the fluid around his heart, an echo is definitely warranted, along with a repeat blood panel to check liver/kidney function, inflammatory markers and albumin since these were flagged in his previous results. What did his doctor recommend as the next step based on these findings?
I know additional testing is probably not what your uncle wants to hear, but from a medical standpoint, these other findings can’t be ignored and the doctor surely won’t operate without full clearance, so it’s justified.
With that said, I just want to honor you for the support and attention you’ve been giving your uncle. We’re here for you as well. Please do share any updates or questions as they come.
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Hi @Bernadette_Abraham Thanks so much for your kind words and extending your support. Much appreciated.
We had an early access to the report on the weekend; so I was able to share with you ahead of his visit to doctors.
As you can imagine, as soon as the doctors saw the report on Monday morning, my uncle ended up getting admitted to the hospital due to the criticality of his situation. He had an emergency consultation with a lung and heart specialist and underwent a series of tests including an echo as you had predicted. They concluded that there is heart failure; however, the reason for that needs further investigation.
The blood test on Monday also revealed he caught pneumonia; so the doctors were contemplating which intensive care unit he needs to be admitted to; respiratory or heart.
He is currently at the respiratory division getting treatment for both pneumonia and heart failure. The doctors have flushed his system with a medication through urine in response to extreme water retention in particular around his heart and lungs.
I have attached his latest blood test which shows various red flags. The other Xray report translation is as below. Thanks so much again for your help.
Technique: The scan was performed from the thoracic inlet to the diaphragm, using mediastinal and parenchymal windows, without contrast material, in axial slices of 1 mm thickness.
Findings:
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Trachea and mediastinum are midline.
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Heart appears normal in size.
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No pericardial effusion (no fluid around the heart).
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Major vascular structures: Aorta diameter is within normal limits.
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No pathological-sized lymphadenopathy (LAP) in the mediastinum.
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Lung parenchyma: right upper lobe, there are consolidated areas with air bronchograms, suggestive of alveolar filling (often seen in pneumonia).right lower lobe (basal medial segment) and left lower lobe (basal segments), there are areas of alveolar infiltration and atelectasis (partial lung collapse or reduced air content).
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Pleural effusion (fluid around the lungs):
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Right side: 6 cm thick
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Left side: 9 cm thick These are <strong data-start=significant fluid accumulations.
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Bony structures within the scan range are normal.
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Trachea and mediastinum are midline.
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Heart size is normal.
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No pericardial effusion.
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Aorta is of normal diameter.
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No pathological lymph nodes in the mediastinum.
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Consolidated areas with air bronchograms are seen in the right upper lobe.
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Alveolar infiltration and atelectasis observed in both lower lobes.
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Bilateral pleural effusion: 6 cm on the right, 9 cm on the left.
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Bony structures appear normal.
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This reply was modified 2 weeks, 2 days ago by DXB.
Conclusion and Recommendations:
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Hi @DXB – thank you so much for the update. I can only imagine how intense and emotional the past few days have been for you and your family.
I’m relieved your uncle is finally receiving proper medical care and is being closely monitored. When there’s an emergency, I’m grateful for the advancements in modern medicine. And this is exactly where conventional medicine shines – handling acute, life-threatening emergencies.
I’m glad they acted quickly once they received the report, especially to address the fluid buildup and support his heart. And with the pneumonia now being treated in the respiratory unit, he’s clearly in the right place.
Please take comfort knowing he’s surrounded by professionals who manage these kinds of cases every day. Once he stabilizes, there may be opportunities to support his recovery more holistically, but for now, medical intervention is absolutely the priority and trust that he’ll get better.
Sending you strength, and wishing your uncle steady healing. We’re here whenever you need us. 
Totally agree Bernadette. Thanks so much again for your continuous support
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This reply was modified 2 weeks, 1 day ago by DXB.
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