RE: Re: MD & prealbumin

[Guest guest]

or... you can " just " give them a copy of one of Pam Charney's et al studies.

Merav Levi, RD, MS, CDNA dietitian, not the food police.

http://www.linkedin.com/in/meravlevi

" Life is not measured by the number of breath you take, but by the moments that

take your breath away. " - Carlin " People don't forget the truth, they just

become better in lying " (Revolutionary Road)

To: rd-usa

From: catiapb@...

Date: Sat, 23 Apr 2011 11:28:43 +0000

Subject: Re: MD & prealbumin

C reactive protein is a marker of inflammation either it is the

patients knees or the ulcer. Any kind of inflammatory process leads to a drop in

negative response acute phase proteins like prealbumin. ESR is not always

elevated with inflammatory processes it is a test with very low sensitivity and

specificity, in asymptomatic persons doesn't even appear elevated. I had several

surgical patients with CRP of around 300 and ESR in normal rates.

With suborn doctors, I usually use the approach of starting the sentence " as you

know... " , then I throw them the guidelines or latest researches to explain what

I want to do. Never got a negative response using that approach.

>

> > I am in need of RD clinical judgement ammunition as to communicate

effectively w an MD R/E interpreting prealbumin levels.

> > I am monitoring a SNF resident w IV sacral. Fro 1/11 to 3/11, wt increased

(desired), wound healing, eating well, family aware of importance of protein,

adequate kcals, fluids for wound healing support. Diet: NAS, arginaid, MVI, Vit

C, ZNSO4, Procel 1 scoop TID (15 gm pro). March labs: all WNL chem 7, alb and

prealbumin.

> > In April, new labs freaked out the MD: ESR sed rate 95, normal range 0-30, C

reactive pro 142.8 normal range 0.0-1.0. prealbumin 16, now < NL.

> > MD wants more pro. I communicated that the prealbumin is not a tool for

diagnosing adequacy of protein intake, and that the drop in prealbumin is likely

related to the inflamation response evident by the elevated C reactive pro.

> > He wrote....

> > " There was concern regarding markly elevated CRP. With the overall improved

appearance and reduction in size of the ulcer do not believe the elevated CRP is

related to inflammatory process of the ulcer and the elevated CRP maybe due to

other inflammatory processes as the patient is experiencing inflammation in both

knees. The elevated CRP could also be erroneous as there is no concomitant and

elevation of the ESR. (actually, the ESR is >NL). " Protein supplement ProCel is

not high protein (5 gm/scoop). Increase procel 2 scoops 4 x day (40 gm pro), in

addition to Arginaid and repeat prealbumin in 5-7 days to determine response. "

> > Ugh.

> > I need a reference in hand prior to calling this doctor to discuss.

> > What script would you use, knowing I will likely have 60 seconds of his

time.

> > Thanks for your help.

> O MS,RD,LD

>