<s>[INST] Hello, my mother is 63 years old and has a raised ESR of 33 and now 36. She has high blood pressure and has been on medication for about two years or more. She has had lower back pain for many years and now has some occasional wrist pain. However, all blood tests including antinuclear antibody, rheumatoid factor, and blood count are normal except a low neutrophil count. Otherwise, she feels fine and has no infection. However, she has vitamin D deficiency. She had H.pylori some years ago which was treated and has had problems after eating - she felt discomfort after even very small meals. The GP gave her antacid tablets which seemed to help a bit but I am not convinced that it was acidity. I have looked up various sources that show raised ESR, low neutrophils and osteoporosis equals multiple myeloma or other cancers of the colon or breast. In light of the raised ESR of 36, vitamin D deficiency and low neutrophils, what could be wrong? Thank you [/INST] thank you for the question Mild osteoporosis is managed on calcium and vitamin D supplemts..have dexa-bone mineral density measured for current status. Rabeprazole D for acidity.Ostovit DM twice a day for 1 month for back and wrist.ESR may be raised in mild inflammation of joints also low neutrophils may be due to mild disease condition, do not worry ahe will be alright </s>