Enjoyable video thanks, Viral. Love the animations/drawings, and it's a nice clinical summary. Couple of queries about investigations - were the set you quoted for the 'reassuring story (bad at the beginning of the day) but insist on having some tests' or the 'get worse through the day but no obvious pointer to a specific physical cause'? Leading on from that, what's ESR to look for? I've worked in places were it's a tightly controlled test, in some places only to be requested by ophthalmologists to look for GCA. Is CRP always an acceptable alternative?
Tim R Hey Tim :) thanks for watching. 1 - the source for 'worse as you do stuff' being more worrying than 'better as you do stuff' is a BMJ Learning module (learning.bmj.com/content/files/tiredalltime.pdf, page 7) 2 - The recommendation for just those 4 blood tests originated from the Dutch College of GPs in that guide we all keep on our shelves - 'Algemene principes en uitvoering in eigen beheer'. The VAMPIRE trial ( bjgp.org/content/59/561/e93 ) then compared using just those 4 against using lots of others for investigating fatigue and found restricting to these 4 was just as good. As to why the Dutch GPs went for ESR over CRP, I'm not sure. I guess it could be for hunting down causes like PMR/SLE, which classically raise ESR more than CRP. Or perhaps to help spot myeloma/lymphoma. Probably unrelated but something I discovered whilst looking into this question - apparently chronic fatigue syndrome's most common blood work abnormality is a ridiculously low ESR, to the extent that even a normal ESR, let alone a raised one, suggests another diagnosis.
