Instructions for Pre and Post Provacation

Before you do the tests please omit fish and shellfish from your diet for 1-2 weeks prior to collecting the urine specimen since they contain relatively high levels of mercury and arsenic. If your provocation test consists of oral medication DMSA, as a trial, ingest 2 capsules of DMSA provided in the trial dose packet. Wait 48 hours. If you have a significant reaction (severe gas, bloating, diarrhea, etc.), do not continue with the protocol and call the office. If you experience no significant reaction on the trial dose, continue with the following steps of the protocol.

Refrain from taking non-essential medications, dietary supplements and gandolinium-based contrast media (MRI) for 48 hours prior to and during specimen collection, unless otherwise instructed by your physician. Never discontinue prescription medications without first consulting your physician. Female patients should not collect urine during a menstrual period.

Pre Provacation (FMV/Random Collection) – Initial Assesment

1. Collect the first A.M. urine sample. Collect the urine into the specimen collection cup. If you urinate throughout the night, save the sample and combine it with the first A.M. urine. Pour the urine (or mixed urine sample) into the specimen vial by filling it up to the top of the label and then tighten the screw cap securely. Complete the label on the vial with the name and date of collection. Mark the vial as “PRE” sample. Leave the urine sample refrigerated at home (unless instructed otherwise). 2. When you come to the office to receive a provocation medication (oral and/or intravenous [IV]) you should be on an empty urinary bladder and empty stomach so Dr. Klimenko can administer the provocation medication (oral DMSA tablets). 3. In the collection information section of the requisition form (located in the upper right hand corner) fill in the date you finished the morning collection, your height & weight, and check “pre”.

Post Provacation (Timed Urine Collection < 24 hours) – After Initial Assesnment

After the administered medications (oral or/and IV) you will be collecting urine for the next 6 hours. Food should be withheld for 2 hours to ensure efficient absorption of the DMSA. You should consume 0.5-1 L of purified water right after administered oral or IV medications. Some patients may experience gas, bloating and/or loose stools with this protocol; such symptoms typically subside within 6 hours of dosing.

1. Empty your bladder before collection begins. Collect all urine up to and including the last urination of the prescribed time period, usually 6 hours. Collect urine during each urination into the specimen collection cup then pour it into the big collection container (clear or orange). Keep the container in a refrigerator until you are finished with your collection. 2. Upon completion of the collection hours, urinate one more time. Mix the urine by shaking the clear container for at least 30 seconds then pour the urine into the specimen vial. Do not squeeze the neck of the container or the cap might pop off. Fill up the vial up to the top of the label and then tighten the screw cap securely. Fill out the label on the vial with the name and date of collection. Mark the vial as “POST” sample. 3. In the collection information section of the requisition form (located in the upper right hand corner) fill in the date you finished the collection, your height & weight, and check the box marked “Timed” and fill in the number of hours you collected your sample (usually 6 hours). If the sample was collected after administration of provocation, check “post”.

To obtain the best results, Doctor’s Data recommends shipping specimens as soon as possible. If you cannot arrange shipping on the same day you finish the collection, such as over a weekend or holiday, refrigerate the specimen until you are ready to ship the test collection kit.

If you don’t have medical insurance, the cost of the test is $60 per specimen. If you submit 2 samples (pre and post urine) the cost is $120. If you do have medical insurance and want Doctor’s Data Laboratory to submit on your behalf for a payment you will pay co-payment of $110 per specimen. If you submit 2 samples (pre and post) the cost is $220. Therefore, it is for you to decide how you would like to proceed.