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12-09-2017, 10:08 AM   #1
DanceMom
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Crp

I know CRP is an inflammatory marker. Just don't know if I should be concerned about A's results or not. Her CRP was 5.6 the morning before her appendectomy. We are one month post surgery and it is 14.3. Could this be normal after a surgery or is there something going on?
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A is 13

Diagnoses: Immune Dysfunction, Hypogammaglobulinemia, Asthma, Allergies

Treatment: Hizentra, Flovent, Zyrtec, Cellcept
12-09-2017, 10:45 AM   #2
Maya142
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We were told CRP can go up after surgery. I remember after my daughter's J tube surgery, her CRP was 13 (normal is 0-3 at our lab). Her GI wrote to say that was very common with surgery.

But in her case, her CRP continued to stay elevated for a year after that, so I'm pretty sure it was related to joint inflammation.

But surgery can definitely raise CRP.
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Mom of M (20)
diagnosed with Crohn's Disease at 16
Juvenile Idiopathic Arthritis at 12
Juvenile Ankylosing Spondylitis at 16

Mom of S (23)
dx with JIA at 14
Ankylosing Spondylitis at 18
12-09-2017, 01:34 PM   #3
DanceMom
Senior Member
We were told CRP can go up after surgery. I remember after my daughter's J tube surgery, her CRP was 13 (normal is 0-3 at our lab). Her GI wrote to say that was very common with surgery.

But in her case, her CRP continued to stay elevated for a year after that, so I'm pretty sure it was related to joint inflammation.

But surgery can definitely raise CRP.
How long would you expect it to stay elevated?
12-09-2017, 01:43 PM   #4
Maya142
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In my daughter's case, it was elevated 2-3 weeks after surgery and her GI said that was normal.

I don't know how long it is normally elevated for since hers stayed elevated because of active inflammation. It is actually STILL elevated more than 1 year later because of active arthritis.

Sorry - I hope someone will chime in with more helpful advice!!
12-09-2017, 02:03 PM   #5
my little penguin
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In all patients, CRP levels increased after surgery, reaching peak levels on the third day after hip arthroplasties (primary, 116 +/- 43 mg/l; revisions, 136 +/- 58 mg/l) and on the second day after knee arthroplasties (140 +/- 46 mg/l) and lumbar microdiskectomy (48 +/- 27 mg/l). C-reactive protein levels usually dropped to normal (less than 10 mg/l) within 21 days after surgery. No correlations were found between CRP response and the type of anesthesia, amount of bleeding, transfusion, operation time, administered drugs, age, or gender. Erythrocyte sedimentation rate increased to peak levels about five days after surgery, followed by a slow and irregular decrease. Still, 42 days after uncomplicated operations ESR often remained elevated. In conclusion, the level of CRP must be considered a better diagnostic aid for the early detection of postoperative infections than ESR. It can be assumed that the rapid decline in CRP after uncomplicated orthopedic surgery will be interrupted by a second rise or by a persisting elevated level if infectious complications occur.

From
https://www.ncbi.nlm.nih.gov/m/pubmed/1735220/


So per this 21 days after surgery
Which fits Maya142 2-3 weeks
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12-09-2017, 02:28 PM   #6
DanceMom
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It has been 4 weeks since her surgery. So maybe recheck in 2 weeks?
12-09-2017, 02:44 PM   #7
Maya142
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I would guess they will want to recheck.

She had a laparoscopic surgery, right? I would expect with a "smaller" surgery CRP would go down more quickly.

I know with my husband's many hip replacements, which are much more major surgeries, his CRP was REALLY high following surgery. With my daughter's abdominal surgery, which was an open surgery, not laparoscopic, it was high, but nothing like my husband's.

I would check with the surgeon or her GI.
12-09-2017, 05:02 PM   #8
DanceMom
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Surgery definitely doesn't care. I was not impressed with their after care at all. I will message GI.
12-09-2017, 10:28 PM   #9
crohnsinct
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When O had her hip surgery they told us her CRP could remain raised for 3 weeks and that her ESR would remain raised for over 40 days. The surgeon told us that the concern would be if her CRP went down and then had a second increase and that would point more to infection than the initial elevated rates.

How is she feeling?
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Daughter O dx 2/1/12 at age 12
Crohns & Remicade induced Psoriasis
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Previously used - Prednisone, Prevacid, Enteral Nutrition, Methotrexate oral and injections, Folic Acid, Probiotics, Cortofoam

Daughter T dx 1/2/15 at age 11
Vitaligo, Precoscious puberty & Crohn's
Remicade
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Previously used, Exclusive Enteral Nutrition, Methotrexate (injections and oral), Folic Acid, Entocort,IBD-AID Diet
12-10-2017, 07:52 AM   #10
DanceMom
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She feels like her abdomen is tight and a little sore. I've been told repeatedly that is normal and could last for months. She's back to dance, but doesn't feel that she's able to tumble or stretch her back much. Overall she isn't quite back to herself but she was off of her infusions for several weeks so that probably is a huge factor. She's lost some weight, but again I was told that was to be expected. I don't know what to think.
12-10-2017, 10:54 AM   #11
Maya142
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My daughter took about 6-8 weeks to recover completely from her abdominal surgery. She wasn't allowed to lift more than 10 lbs for 6 weeks.

Abdominal surgeries are tough - she had hip surgery this year and said it was MUCH easier to recover from than her J tube surgery.

So hopefully it will just take time.
12-10-2017, 12:28 PM   #12
DanceMom
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My daughter took about 6-8 weeks to recover completely from her abdominal surgery. She wasn't allowed to lift more than 10 lbs for 6 weeks.

Abdominal surgeries are tough - she had hip surgery this year and said it was MUCH easier to recover from than her J tube surgery.

So hopefully it will just take time.
Good to know. We were told no limitations after 2 weeks. She hasn't gone back to running yet (because I don't think she's ready) and is definitely limited at dance. This isn't what we were told to expect.
12-10-2017, 12:41 PM   #13
Maya142
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M had a bigger incision I think since it was an open surgery - a long one through her belly button. She also had two laparoscopic incisions (they had to see if the bowel was ok to place the tube before making the big incision) and then a fourth for the J tube.

I think the restrictions came from the big incision - the other three were tiny.

But honestly, what we have learned over the years is that every kid recovers at their own pace. M is very slow to recover. For example, with the hip surgery, some people are on crutches for 2 weeks, she was on crutches for 3.5 weeks.

We just know to expect her to recover more slowly now, in fact, we double the time the surgeon tells us .

A is still on Cellcept, right?? So that may slow healing too.
12-10-2017, 01:32 PM   #14
DanceMom
Senior Member
Yes, still on Cellcept. I'm waiting for her IgG results to come back. If they're low that could contribute to slow healing. If they're normal her Cellcept may need to be increased. She takes it to keep inflammation in check. It's a balancing act.
12-10-2017, 01:51 PM   #15
DanceMom
Senior Member
For a comparison, when your kids are in a flare what does their CRP look like? A's has always been normal until the last few months. Even with visible inflammation.
12-10-2017, 05:23 PM   #16
crohnsinct
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In the surgeon's defense, A is a complicated case so I am not so sure they would even know what to tell you to expect. BUT A is a complicated case and has immune deficiency so I would expect them to follow her a lot more closely post surgery and I would expect them to watch her numbers a lot more closely because isn't she at a higher risk of infection?

What units of measurement are they using to report her CRP? Were both tests from the same lab or at least using the same units of measurement?

We could all tell you our kids numbers when in a flare but that wouldn't be terribly useful because as we say all the time here, every kid is different. I know there are a lot of kids on here who are in a flare and their numbers are solidly within normal range BUT their parents know that it just isn't normal for them and where they sit when in remission is a lot lower.

O is currently 4 times higher than the upper limit for how they report CRP at her lab and she is in a flare. Not terrible get this kid to the hospital flare but enough to be going to the bathroom a lot, seeing occasional blood, have some level of fatigue, some pain and have the GI put her on steroids and change her Remi.
12-10-2017, 05:35 PM   #17
DanceMom
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Different labs, same unit of measurement - mg/L. Standard range for hospital lab is <1. Standard range for clinic lab is 0-2.9.
12-10-2017, 05:44 PM   #18
my little penguin
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If the range is different you canít compare them unfortunately

Just by the percentage of above normal maybe
But the numbers are not the same

Hope she feels better soon
12-10-2017, 05:46 PM   #19
crohnsinct
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OK reported as mg/L O is currently at 42. Her old GI doesn't start to really watch it until about a 10 and even then it will get you a retest in two weeks...take that as you will because we all know how I feel about how O's care was managed by old GI.

I just checked her old results. In "remission" O sits at about 1-1.5. Couple of times went up to 6-8 and only once was at .8.

Last edited by crohnsinct; 12-10-2017 at 05:59 PM. Reason: To add info
12-10-2017, 06:43 PM   #20
Maya142
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M's CRP has been elevated for over a year. Our lab's normal is between 0-3. Units are mg/L.
Her CRP has been anywhere from 8, 13, 19 to recently 34.

34 would be 10x the upper limit and that got both her GI and rheumatologist concerned.

Her GI did an FC which was less than 50, so we know it was inflammation in her joints and not her gut.

When she was on steroids, her CRP was down to <1.

Unfortunately, in the last 14 months, the only time her CRP has been normal was when she was on steroids .
12-11-2017, 09:19 PM   #21
kimmidwife
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I would definitely ask them to repeat it and keep an eye on her. I totally missed that she had her appendicts out. Hope she is doing better.
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Crohn's Dx'ed Sept 08
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