I have one more doubt, my wife has her appendix removed. can that result in a high esr value of about 40mm/hr?

Appendicitis.: Well, if the ESR was drawn BEFORE the appendix was removed for appendicitis, then its elevation would make sense. But if the ESR was drawn AFTER the appendix was removed, especially if drawn several weeks after removal, then I'd presume there's another reason for the ESR elevation. Only if drawn immediately after removal could it make sense in that context.