An Evaluation for CFS and FMS and others…
A CFS Evaluation
Medical evaluations are often referred to as “workups.” A workup
starts with a complete history and physical examination, ideally. Practically,
however, one does what is expedient. The order in which the lab tests are done
depends upon the judgment of the examiner, but this is usually arbitrary. Some
doctors order no tests at all, and some order a standard battery for all their
chronic fatigue patients.
The lab evaluation starts with the traditional lab tests. (See the
section under “Lab Tests”) These are usually negative, but they are inexpensive
and rule out many serious illnesses. Next I would get a series of tests done by
a hand picked specialty lab. I’ll use Great Smokies as an example because my
experience with them has been better than with any other lab. Their telephone
number is 800-522-4762. Order free kits by calling this number. A kit is the
collection of implements needed to do the test. They have 3 prices for each test
(except in New York). The first price is the price if they bill insurance and
have to wait to get their money, and take the risk of getting paid. The second
price is the cash price to the patient. The third price is the cash price to the
doctor. New York does not allow multiple pricing. It is very expensive for an
office to bill insurance and take the risk of getting paid. Obviously a patient
need not get all of these tests, and the deciding party could pick and choose as
is appropriate.
Comprehensive Digestive Stool Analysis 3 day, purge $374 $285 $206
Intestinal Permeability $86 $65 $47
Food Allergy profile $340 $250 $110
Elemental Hair Analysis $125 $46 $42
Amino Acid Analysis $350 $250 $200
Adrenocortex Stress Profile, complete, saliva $150 $108 $75
Comprehensive Detoxification Profile $139 $127 $118
MetaMetrix Medical Laboratory, 5000 Peachtree Industrial Blvd.,
Norcross, GA 30071 Tel: 770-446-5483 or 800-221-4640: They have 2 prices: The
insurance price and the cash price (Except in New York). MetaMetrix does not
bill Medicare
Fractionated porphyrin profile #94 $178 $89
Organic acid metabolite panel-urine #91 $349 $155
Since I have not mentioned this last test elsewhere, I will do so
here. This test measures 39 separate bi-products of metabolism in the urine. It
can tell how effectively the cell is producing energy as well as the efficiency
of many other physiologic functions. The test can pinpoint certain vitamin and
nutritional deficiencies and is therefore quite practical as well as useful in
validating diagnoses.
I have no need or desire to profit from the practice of medicine. I
also want to avoid any liability. I would like to see that proper laboratory
testing is made available to people who need them in an ethical manner. Many
patients have no physician in their area who performs or understands these
tests. Many patients belong to HMO’s who might not approve these tests. My
impression is that about 95+% of patients are effectively blocked from obtaining
these tests.
There are many CFS organizations with RN’s and other medical
personnel who are eager to help. I would be willing to order tests, if in doing
so it could be legally established that I was not creating a doctor-patient
relationship and was released from all liability. This might be a
self-contradictory statement. (Although I have some mixed feelings about this, I
believe that a patient should have the right to obtain laboratory tests without
a doctor’s prescription, with the disclaimer that the patient assumes the risk
of misinterpretation.) I think that CFS organizations could explore the legal
and practical ramifications of implementing a testing program.
Test results from Great Smokies and many of the better labs are
printed out with color graphs that make them easy to read. You may not
understand all of the biochemistry involved (most doctors don’t anyway), but you
can see if you are in the green zone or the red zone and how far. The best labs
employ physicians who know the tests backward and forwards and can explain them
to their professional clients. It may be possible for R.N.’s to be an interface
between the lab M.D.’s and the patient with the appropriate disclaimer. The
R.N.’s could become educated about the tests with the help of me, the lab
manual, and the free lab consultants.
It is an understatement that many people are concerned about the
quality of medical care. We have to be creative. I recently got a flu shot in a
supermarket. The person administering the shot was neither a doctor or a nurse.
A flu shot is an invasive procedure, carrying a minimal risk. I’m not
complaining. I think it was a good thing. A lab test carries NO risk. So it just
makes good sense that given the present direction that medicine is taking, that
a laboratory testing program could be carried out in a professional, cost
effective, manner such that everybody would have access to them. Furthermore, as
these tests are ordered more frequently, the price will continue to drop. Less
than 1% of the people needing these tests are getting them. Imagine what the
price would be if I approached a lab on behalf of an organization and negotiated
a price for 10,000 tests!
The Goldstein protocol is like a lab test. Please read the Goldstein
section. Imagine that an organization bought those medications wholesale, in
quantity, under proper supervision, and made up kits with one pill of a kind in
each kit, and provided the kits by mail to patients for a reasonable donation.
The patient then takes each pill, in the convenience of his home, a couple of
days apart. When you go to Dr. Goldstein’s office you are given several things
in a single visit and it is hard to tell what medicine is doing what. A kit
could be provided to a patient for a very reasonable price or donation. The
patient would have more flexibility in dosage. He could start with a microdose
to test for sensitivity first. I have always advocated this for patients because
many are sensitive to certain drugs. Starting with a whole pill that you are
sensitive to can lead to a very unpleasant day. Again the legal ramifications of
doing this would have to be explored.
It bothers me that some organizations are spending a huge amount of
energy in unproductive directions. Its not their fault. It’s just that no one
has come up with anything better.
I would welcome your personal contribution to this collection of information.
E-mail David A. Hall, M.D. for more info. My E-mail address is
cfsdoc@…
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