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Lab Requisition

Dear Lab,

Please do these tests on this patient and mail a copy of the results to the patient and to the doctor listed below. If you are for some reason not able to send a copy of the lab results to the patient, please let the patient know this and ask the patient to have the labs done elsewhere.

Thank you,


Jacob Teitelbaum, M.D.

Patient SSN:
Doctor


Symptoms: (check all you've ever had--the more you check, the more likely it is your insurance will pay for the test)
01. Fatigue
02. Abdominal Pain/Gas
03. Diarrhea
04. Constipation
05. Anemia (ever had)
06. Sinusitis
07. Hypoglycemia
08. Rashes
09. Low Thyroid (Hypothyroid)
10. Overactive Thyroid (Hyperthyroid)
11. Joint Pains/Arthritis
12. Muscle Aches/Pains
13. Confusion/Poor Memory
14. Numbness or Tingling in Fingers or Toes (Paresthesias)
15. Increased Thirst
16. Decreased Libido (Sex Drive)
17. Infertillity
18. Abnormal Body Hair Growth
19. Low Blood Pressure
20. High Blood Pressure
21. Increased Urination
22. Dizziness
23. Allergies

Symptoms for Females Only:
24. Irregular Periods
25. Hysterectomy
26. No Periods
27. Nipple Discharge (Galactorrhea)


Section 1 includes the most important labs. Section 2 labs are quite helpful but not critical. Section 3 labs are sometimes (but not usually) helpful. If you have insurance, the price negotiated by your insurance company is usually much lower even if you haven't met your deductible.



Lab Tests

Section 1- Very Important Lab Tests

#

Description

1.


CBC (i.e. blood count) with differential. Looks for anemia and other blood problems.

2.

ESR (sed rate) or sedimentation rate. Looks for inflammatory causes of fatigue and pain.

3.

Chemistry panel (checks 12 to 20 different basic chemistries - CRITICAL to check for diabetes, kidney, liver, electrolyte disorders and other common problems. Include at least sodium, K+, magnesium, BUN, CREAT, SGOT, SFPT, calcium and glucose.

4.

Free T4 (not a T4 Index.) The most important Thyroid test -- checks the actual active hormone level. Much better than Thyroid "index" tests in CFIDS/FMS patients.

5.

Vitamin B12 Level. Checks for low B12. (Don't do if on B12 shots.)

6.

Iron (Fe) percent Saturation - iron (Fe) & TIBC. Checks for low iron (mix of 2 tests).

7.

DHEA-S (DHEA - Sulphate; NOT a DHEA level). A regular DHEA test is usually not reliable. If you have any decreased libido or abnormal hair growth or loss, please note these under "symptoms" above so your insurance company is more likely to pay for the test.

8.

Cortrosyn Stimulation Test. Must be begun by 8:30 a.m. Checks adrenal function. This requires an injection and most labs don't know how to do it. A hospital or hormone specialist's (endocrinologist) lab is your best bet ($150). LAB--IF YOU CAN'T DO A COTROSYN STIMULATION TEST, DO A MORNING CORTISOL INSTEAD ($87). This is not as reliable but gives useful information. Either test MUST be drawn before 9 a.m.

9.

TSH - Another Thyroid test. Helpful, but not reliable in CFS/FMS.


Section 2 - These Labs Can Be Very Helpful If They Are Affordable





Description

10.

Free Testosterone - Must be the Free Testosterone level. A simple "Testosterone" test or "Total Testosterone" test is not adequate unless the result is below the normal range. (Please be SURE normal values are reported based on the patient's age!)
Critical for males & helpful for females. If you have any decreased libido or abnormal hair growth (or loss) please note these under diagnoses above, so your insurance company is more likely to pay for the test.

11.

Stool Test - For ova & parasites. Do this only at GSML Labs (800-572-4762) or The Pathology Center (480-777-1078) -- both by mail. Most other labs will ruin the test and give you a totally useless negative result even if you have parasites. TO THE LAB - IF YOU ARE NOT ONE OF THE ABOVE 2 LABS, WE DO NOT AUTHORIZE YOU TO DO THE O&P.

12.

Urine Analysis

13.

Estradiol Level - For females only- Indicator of Estrogen adequacy (do blood test around mid-cycle or anytime if no periods). Do not do this test if you are taking birth control pills - the results will not be accurate.

14.

HgbA1C (Glycosylated Hemoglobin) - Screens for Diabetes. Although not accepted to be used in this way, it may be very rough, yet quite useful indicator of low blood sugar (& low adrenal function).

15.

FSH - For females only - Indicator of Estrogen adequacy (do blood test around mid-cycle). Do not do this test if you are taking birth control pills - the results will not be accurate.



Section 3 - These Labs Are Helpful In Some Cases - But Are Less Critical Than The Others



Description

16.

Ferritin - A more sensitive indicator of iron levels - not useful without " percent Saturation " test above.

17.

IgE - Looks for evidence of allergies (does not check for specific allergies).

18.

Somatomedin C - A screening test for growth hormone deficiency which is very common in FMS (and may be treated with natural supplements).

19.

Stool Test for Clostridium Difficile - Can be done at any lab. Especially important if diarrhea is a major problem.

20.

Antimicrosomal Antibodies - They sometimes help in detecting subtle yet important Thyroid dysfunction.

21.

Total T3 - (NOT a T3RU). Checks the other (T3) Thyroid hormone. A T3 RU is fairly useless.

22.

Prolactin - A hormone that's sometimes elevated in CFIDS. Especially important to do if you have any nipple discharge.

23.

LH - For females only - Indicator of Estrogen adequacy (do blood test around mid-cycle). Do not do this test if you are taking birth control pills - the results will not be accurate.

24.

Lyme Titre (by PCR testing) - If you have had tick bite(s) and live in areas where Lyme's disease is seen (e.g., Eastern U.S.). Especially if you had a ring-like rash after a tick bite.

25.

Antinuclear Antibody (ANA) - Do if you have red, swollen, inflamed joints (as opposed to simply joint pain with joints looking normal) and/or an ESR (sed rate) test over 25.

26.

Antithyroglobulin Antibodies- They sometimes help in detecting subtle yet important Thyroid dysfunction.

27.

Latex Fixation (Rheumatoid Factor) - Checks for Rheumatoid Arthritis. Do if you have red, swollen, inflamed joints (as opposed to simply joint pain with joints looking normal) and/or ESR (sed rate) test over 25.

28.

PSA-prostate specific antigen (screens for prostate cancer)

29.

Hepatitis A antibody

30.

Hepatitis B antibody

31.

Hepatitis C RNA quantitative - extended range


*price varies dramatically from lab to lab and is usually much lower if you have insurance




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Some information on this site is from the book From Fatigued to Fantastic! Third Edition by Jacob Teitelbaum MD, copyright 2007 by Jacob Teitelbaum MD. Used by permission of Avery Publishing, an imprint of Penguin Group (USA) Inc.