Chronobiology 9

L & R E S C A E A I R I N C L H C

DiagnosTechsTM ChronoBiologyLETTER L A Y THE LEADING LAB IN SALIVA TESTING SINCE 1989 B R O R A T O 19110 66th Avenue South, Building G August 2011 ▎ 9th Edition Kent, Washington 98032 USA www.diagnostechs.com

O ™ Chronobiology Director of NT LE Diagnos-Techs I R D A N O Clinical & Research Laboratory ™ C and Diagnos-Techs Test Panels

O E F September 2011 Quar ter ly Newslet ter Medical

P L National Health Observances The title of A N E HIGHLIGHTS IN THIS EDITION Support Sept 13 your regular • National Celiac Disease 2 • Hormones in Cosmetics John White, MD, CM Awareness Day Inadvertent Transdermal newsletter from Progesterone Intake Diagnos-Techs™ Sept 24 fter more than five years as one ® • Family Health & Fitness Day 4 • Educational Pathways is “Chronobiology of the medical consultants at Sept 28 -In-house Seminars Letter”. Central A -Office Visits & Phone Consultations Diagnos-Techs™, I have the distinct • National Women’s Health to this concept & Fitness Day™ -DTI On the Road privilege to be appointed Director of is the ability of September is also… • Specimen Delays–Just Chill! Medical Support. In this role, I will Diagnos-Techs™ • National Alcohol & Drug Addiction • Applicability of the FHP continue to build upon our already Awareness Month to not only provide outstanding department, to initiate • Prostate Cancer Awareness Month 5 • Lab News accurate scientific -eFHP Improvements updates and adjustments in our test results for your patients • Hormone Supplementation instructions and reporting of results, and but also provide these data over time • Elevated DHEA/S Levels to be a channel for the comments of our in order to depict their variations and clientele. In the latter regard, please call 6 • Billing Assistance vagaries throughout a particular periodic -DTI’s Test & Fee Schedule me at our general number, 800.878.3787 I-MAT EX R cycle. This is easily accomplished L IX 7 • Resources for You with your suggestions. F -Insurance Billing due to the unique nature of saliva -Technical Services I received an MD, CM degree from C testing. Multiple, potentially traumatic

S ™ U -Shipping & Contact Info McGill University, spent two years active L ™ venipunctures are avoided, and testing S E Customized Test Panels Flexi-Matrix Flexi-Matrix ™ T N “Build Your Own Panel” Back • Flexi-Matrix Panel duty with the US Continued on page 6 O A - is completely private. M P Page “Build Your Own Panel” I Z E D • Insulin x2 Continued on page 5 Flexi-Matrix™ test kits allow you to order individualized test combinations, with the exception of BHP™, FHP™, • Gluten Ab • Chymotrypsin

eFHP™, PeriM™ and ePeriM™ panels. When combining panels, be sure to include the individual tests listed ™ This summer you will see a new and improved face of Diagnos-Techs on the • Tape Worm Diagnos-Techs Launches under each of the panels. Flexi-Matrix™ customized test kits may be the most economic way of customizing • Round Worm World Wide Web. Some exciting features include new provider locator, user friendly provider login page, UPS Returns on the Web, easy-to-access reports, test panels and profiles to meet your clinical needs, possibly saving you 20-70% off individual test fees. • Estriol New Website and much more! Please check out the site at www.diagnostechs.com. n Choose 3 or more individual tests from the list shown on pages 4-6 of the Test and Fee Schedule. • Progesterone • FSH

(Excludes DPD Bone Marker Test and CS3 Swab Culture for Yeast.) • Androstenedione n Be sure to read detailed instructions and fill out the requisition form included in each collection kit. • Estrone n You will always receive the lower price when your customized panel is identical to a standard panel. New Test Kit Boxes and Easy Shipping with UPS! iagnos-Techswww.diagnostechs.com ™ announces new, larger test kit boxes and a partnership with UPS (United Parcel Service) enabling us

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The Leading Lab in Saliva Testing Since 1989 ChronoBiology LETTER August 2011 ▎ 9th Edition DIAGNOS-TECHS ™ RESOURCES FOR YOU ▼

Technical Hormones Billing Customer Service Contacts U …90-95% of all the  submitted creams… Courtesy Service Tips for Success How to Reach Us FROM OUR TEAM OF in Cosmetics tested positive for n po Sign u t access results online. Business Hours Inadvertent Transdermal Progesterone Intake INSURANCE SPECIALISTS Call Customer Service for 7:30am–5:00pm progesterone. Our dedicated team of Insurance password, 1-800-878-3787. Pacific Standard Time (PST) John White, MD, CM “ n We must have at least two forms Monday through Friday, Specialists is trained to assist you except major holidays with insurance-related questions. of written patient ID, name In this issue, we highlight an all too we offered anonymous testing of hormonal balance, but also proper We avoid payment processing and fdate o birth on all vials and Corporate Address order forms to process samples. th frequent finding noted in the results suspect face creams for our clients. therapeutic judgement. challenges by helping you and 19110 66 Avenue S., Building G your patients navigate the maze of n Kent, WA 98032 USA of the Female Hormone™ and ASI™ We were not surprised to find that Patients should not contact the Face creams and shampoos are test codes and fees. lab with test related questions. Panels. Figure 1 is an actual Cycling 90%-95% of all the submitted ” Customer Service classified legally as cosmetics, and As a courtesy, we will submit Please advise patients to consult Female Hormone Panel™ result we creams, lotions, etc. tested positive p 800-878-3787 f 425-656-2871 as such, are not under the close claims to most insurance with you if they have any questions p 425-251-0596 recently processed. At first glance, the for progesterone. In addition, we pertaining to collection. Medical purview of the FDA. Not only can companies at our clients’ and Accounting graphed results might suggest a fairly found considerable contaminating support is available for provider manufacturers add progesterone to patients’ requests. In addition, f 425-264-0612 normal picture. Be alert, however, that estrogens and androgens. Faced we are able to bill insurance questions about results or their products (up to 4%) but they are email [email protected] for each separate test the computer with the futility of this testing, it has carriers for all referring doctors, treatment suggestions at not required to list it on their labels. 1-800-878-3787. Shipping may reset the plotting values on the been discontinued. The patients we nurse practitioners and registered Be highly suspect of any product nurses. We are able to advise you n p 800-878-3787 f 253-398-2449 estradiol and/or progesterone axes to tested were likely dosed unwittingly Review patient medication list. touted as “anti-wrinkle,” “anti-aging,” on which services are billable. This will help your patients to Technical Services accommodate the values measured. In with progesterone (non-bioidentical)Diagnos-Techs, Inc. Clinical & Research“rejuvenating” Laboratory or “our own special Although we are a non-contracted understand what to avoid before p 800-878-3787 f 425-251-0637 the table of actual values that appears contained within creams or shampoosPO BOX 389662, Tukwila, WA 98138-0662 Tel: (425) 251-0596 provider with all insurance taking our tests. We do not discuss formula.” One prominent face cream Lab Address above the graph, note the excessively and for long periods of time. SuchCLIA License # 50D0630141 companies (with the exception of medications directly with patients. producer actually acknowledgedReceived : 12/31/2010 adding Sample Processing Accession # 10-eFHP 01/04/2011 elevated progesterone levels in figure extra progesterone exposure prejudices Completed: Medicare), most insurance carriers nd 01/04/2011 n Have your account number or 6620 S. 192 Place, Building J-106 progesterone (“nature’sReported own anti-wrinkle : offer coverage on our services 1 (green shaded area) throughout accurateDIAGNOS-TECHS, baseline results, INC. and not Results For: accession number ready before Kent, WA 98032 USA . substance”)FEMALE on PATIENTits website; it was rapidly and are billable. Depending on a both the follicular and luteal phases. only confuses the body’s essential you call. 6620 S 192ND PL # J-104 taken down.Age: 35 ContinuedGender: on nextFemale page patient’s benefit plan, insurance Compare to the normal ranges n Tips for saliva production. KENT WA 98032 Patient's Tel: companies usually cover our tests Please visit us online at USA Tel: 425-251-0596 Fax: 425-251-9520 12/20/2010 located below the patient values. Expanded Female Hormone Panel Specimen Collected: Figure 1 at the maximum allowable rates so In order to produce enough www.diagnostechs.com The patient was not taking any there are no out-of-pocket expenses. saliva, suggest to your patients to eFHP Expanded Female Hormone Panel chew dental grade paraffin wax. www.facebook.com/diagnostechs prescribed supplementary hormones. Day of Cycle Day 2 5 8 10 12 14 18 20 24 Patient Insurance Disclaimer ™ Careful inquiry by her practitioner Estradiol pg/ml 28 28 31 37 40 28 37 25 33 Diagnos-Techs , Inc. is a non-contracted provider Progesterone pg/ml 140 93 125 315 748 828 1026 501 213 with all insurance companies. Please verify your out-of-network benefits (including out-of-network revealed she was an avid user of a Start 11/27/2010 Phase Estradiol Progesterone deductibles and co-insurances) by contacting Cycle End 12/20/2010 Follicular 2 - 10 pg/ml 20 - 100 pg/ml “rejuvenating” face cream. Ranges your insurance carrier. Diagnos-Techs™, Inc. will Information Length 23 Preovulatory 7 - 25 pg/ml bill your insurance at the retail price per line item. Shipping Our lab has noted such elevated Average 24 Luteal 3 - 16 pg/ml 65 - 500 pg/ml If deductibles and/or co-insurances are applied, progesterone values for a number Estradiol Axis Progesterone Axis Diagnos-Techs™, Inc. is obligated by law in the State of Washington to collect. Free UPS Return Shipping on returned domestic test kits of years. Several STORAGE & MAILING INSTRUCTIONS FOR ALL SPECIMENS HIPAA Compliance years ago, n Ship samples on the same day as last sample collection (preferred). INTERNATIONAL The Health Insurance Portability and n If not possible, refrigerate samples and ship within 3 days. COURIER SHIPPING Accountability Act of 1996 (HIPAA) requires ™ No ice bags are required during shipping. Diagnos-Techs , Inc. us to protect and maintain the privacy of our Sample Processing n Write the patient’s name and address on the outside of box. patients’ identifiable health information. The 6620 S. 192nd Pl., #J-106 n standards are meant to improve the efficiency Include all samples, test form and, if applicable, a check or a copy of the Kent, WA 98032 and effectiveness of the nation's health care front and back of insurance card together inside the supplied box. Please p 425-251-0596 system. We are committed to implementing be sure to seal the box with clear tape before shipping. Progesterone Estradiol Day of Cycle appropriate administrative, technical and • US Domestic: Deliver completed test kit box to any UPS location. www.UPS.com/dropoff physical safeguards to protect the privacy Test Return shipping to Diagnos-Techs™ is PRE-PAID. Kits will arrive within three days of shipment. Description Result Ref Values of Protected Health Information. For more DHEA Dehydroepiandrosterone 10 Normal Adults (M/F): 3-10 ng/ml information, go to www.diagnostechs.com • International: Delivery charges still apply. International deliveries should be addressed to the and click About Us/Notice of HIPAA physical address only, which is located to the right. Dot no address to the PO Box. Deliveries can TTF Free Testosterone 68 Elevated Borderline: 6-9 pg/ml Normal: 10-38 pg/ml Privacy Practices. be made Monday through Friday via a private courier of your choice.

Serum levels of progesterone may is the result of inadvertent intake or regarding face cream use or other Director of Medical Support Why Choose Diagnos-Techs™? Continued from front page not reflect salivary levels when of inadequate natural or bioidentical source, of progesterone; if present, the progesterone creams are applied; progesterone to maintain a normal product should be stopped and testing High Quality …I am pleased to typically salivary values more truly estradiol/progesterone balance. The performed at least six to eight weeks Laboratory Service reflect the tissue levels.(2, 3) This high progesterone levels probably later. This advice applies equally for have a second career at discrepancy may be due to variance reflect the presence of isomers of peri- and post-menopausal testing. iagnos-Techs™ maintains superior in transport by the body of different natural progesterone that are not test quality by using a daily program A woman with proper progesterone D Diagnos-Techs. products. Although most substances recognized by the body as truly natural of comprehensive quality assurance. All supplementation should not need any Coast Guard (US Public Health Service) are carried in the blood stream, long and, hence, do not maintain the proper quantitative results are obtained from test “ progesterone-containing face creams. and thereafter qualified in General chain lipids are transported preferen- estradiol/progesterone balance. runs which are in compliance with industry Pure moisturizers (e.g. cetaphil) or, Surgery, and Cardiovascular and Thoracic tially by the lymphatics. Progesterone standard testing protocols from the Clinical generally, baby moisturizers, lotions, Surgery at the McGill University Teaching itself is lipophilic, as is any cream base Laboratory Standards Institute (CLSI), World Adama Trimnell, DVM, PhD, uses …elevated progesterone shampoos are probably safe. The an immunoflourescent microscope Hospitals. I further qualified” in Pediatric containing it. Thus, lymphatic transport Health Organization (WHO)* and similar to detect antigens for the GI Health cosmetic industry probably is not Surgery at Johns Hopkins, spent ten years increases progesterone content in levels have also been noted organizations. A minimum of two control Panel in the DTI Lab. adding progesterone to baby on staff there, and finished my academic the tissue fluid and, consequently, in materials are included with each run. Each and every result is reviewed by in women prescribed products yet! career as a Professor of Pediatric Surgery salivary measurements. Progesterone supervisory personnel to provide accurate results for initial tests as well as at various institutions. I am proud to gels, on the other hand, are water progesterone cream… Because it usually is impossible to highly precise results in follow-up tests, ensuring the highest standard of “ have over 175 peer reviewed scientific soluble and may possibly achieve gauge the extent of progesterone stores clinical management. publications as primary or coauthor. After serum progesterone levels comparable This patient’s elevated estradiol in a patient’s body after transdermal * WHO is the World Health Organization that sets international standards for various to saliva values.(2) may have some contribution from use, the progesterone values reported parameters in medical practice. World Health Organization (WHO) has designated The Joint retiring in Seattle near my children and Commission and Joint Commission International (JCI) as the world’s first WHO Collaborating grandchildren, I am pleased to have a her relatively high DHEA (possible by Diagnos-Techs™ constitute those Center dedicated solely to patient safety. Such elevated progesterone levels second career at Diagnos-Techs™. exogenous intake), which, in turn, measured in the laboratory. The have also been noted in women ” may be a contributor to her elevated ranges provided are not adjusted for Our Medical Support Department prescribed progesterone cream, or • ICD-9 & CPT Codes testosterone. Inquiry should be made, any outside factors. Diagnos-Techs™ BILLING ASSISTANCE consists of a blend of fine medical who use various over-the-counter as well, regarding topical testosterone believes that it is incumbent upon the Many providers have a of the office visit by supplying the and naturopathic physicians who are progesterone creams. Moreover, we use by a male partner resulting in practitioner to interpret the basic data cash-only practice and patient with the appropriate ICD-9 ready to assist our clientele with expert have observed higher salivary levels passive transfer. provided vis-à-vis the clinical picture advise their patients with and CPT codes for the tests ordered. interpretation of the sophisticated tests when progesterone cream is used than presented by the patient, without any insurance to file their own individual These are provided to each office on and panels we provide and occasionally when progesterone is administered Appropriate therapy in this case consists form of interpretive modification of the Lab Code

Laboratory Test Nam of stopping any progesterone creams, insurance claims. The Insurance Billing the three-page foldout entitled Test with guidelines toward appropriate orally or sublingually. This may be AdrenalCORT & Stress Hormone Testse* | Saliva Cortisol Test Fee ranges by our laboratory. – 6am-8am CORT CPT Codes Cortisol ™ – 11am-1pm (Blue H vial x 1) prescribed or inadvertent, or properly DepartmentCORT at Diagnos-TechsTest Description fo stands and Fee Schedule 2010 sent out by Cortisol therapy. Inasmuch as we have no doctor/ due to the intrinsic lipophilic property $39 – (Blue H vial x 1) CORT 4pm-5pm r Billing Cortisol 82530 $39 – DHEA 10pm-Midnight (Blue H vial x 1) Cortisol, Free DHEA & DHEA-S poole 82530 $39 ICD.9.CM P17-OH (Blue H vial x 1) Cortisol, Free ™. adjusting over-prescribed oral or by to provide assistance.82530 In addition, Diagnos-Techs It is also available 17-OH Progesterone d value $39 patient relationship with those tested, of the cream base and, possibly, the (Blue H vial x 2) 82530 Cortisol, Free Metabolism Module Tests | Saliva $50 Lab Code (Blue H vial x 1) 82626 Cortisol, Free ISN REFERENCES the provider’sInsulin(Fasting) office$46 DHEAcan often help Gastrointestinal–InfectiousLaboratory Test Name Diseases Tests | Stool transmucosal progesterone. Inasmuch 83498 for download and printing at our have not taken a history or performed progesterone itself, which causes LabISN Code (Blue H vial x 1) 17-Hydroxyprogeste CS1 * Insulin (Non-Fasting) 704.1 Stool Culture, yeast and Test $30 Hirsutism Fee 1. Ilyia, EF; McClure, D; Farhat, rone CPT Codes (Blue H vial x 1) 83525 Food Intolerance & Immunity Tests | Saliva 255.2 fungi Test Description for Billing Insulin, Total Congenital adrenal as it can take months to rid the body of their patients with insurance at the time website,(Brown A vial x 1) www.diagnostechs.com. $30 hyperplasia $36 a physical exam, and are generally FI-1 a variable amount of the applied Cow’s milk (Casein) 83525 Laboratory Test Name* 87102 MY. Long Term Effects of Topical 250.0 GP3 FI-2 Insulin, Total Stool culture, bacteria & 87106 Culture, stool, fungi Soy protein Ab, SIgA Ab, SIgA 251.1 Diabetes islolation ICD.9.CM 251.2 (Blue HC vial x 1) Hyperinsulinism Culture, stool, fungi ID FI-3 Spontaneous hyperinsu GP3Cd Gastrointestinal–InfectiousEgg (Albumin) Ab, SI $33 Diseases floraTests | Stool its subcutaneously stored progesterone, 250.0 Clostridium difﬁcile Toxi 112.8 (Blue HC vial x 1) 5 not licensed to practice in a client’s 83516 251.1 Diabetes 536.8 Candidal enteritis progesterone to sequester in fat cells FI-4 (Brown A vial x 1) Progesterone Cream Application: $44 Gluten (Gliadin) Ab, SIg 251.2 Hyperinsulinism 564.1 Digestive tract irritatio gA $33 linism Gastrointestinal–GI Functional Markers Tests87045 | Stool & 87046 MB2-S (Blue HC vial x 1) Casein Antibody Spontaneous hyper ns A&B 528.00 Irritable colon, spastic 83516 462 Inflammation, mout Total Salivary SIgA (Brown B vial x 1) TEST & FEE SCHEDULE A (Blue HC vial x 1) $33 FG1 $42 Culture bacteria, stool 112.0 Inflammation, phary n insulinism Chymotrypsin 691.0 or mucus Gastrointestinal–Parasitic & GI Diseases I Tests | 83516Saliva Soy Antibody 579.0 Test Oral (or throat) ca 2010 Lab Code & R E $33 87324 569.42 Rash–diaper h any oral or transmucosal bioidentical L S 995.67 A Case Study. Intl J Pharm A E (Blue H vial x 1) Celiac Disease FG4 Rectal pain nx WITH CPT particular state, we can not provide 83516 Egg Albumin Antibod 995.68 Occult Blood Immunoassay Clos ndida under the skin. Not only is the actual GP6-S C A Hypersensitivity, milk p 009.0 CODES I R (Brown A vial x 1) Prices Effective June 1, 2010 NToxoplasma gondii–Ab $42 995.69 Hypersensitivity, egg Fee Toxin 009.2 Colitis, infectious I CS1 C FG5 009.1 Gluten (Gliadin) Antibo Hypersensitivity due to Fecal pH $35 Diarrhea, infectious L H 83883 y tridium GP7-S specified food roducts (Brown A vial x 1) CPT CodesGastroenteritis, infec Lab Code 84490 008.45 C Amoeba histolytica–A , SIgA Nephelometry, Secreto products $10 009.0 Clostridium difﬁcile, colitis Compounding (1998) dy other Laboratory Test Name*GP8-S (Blue H vial x 1) (Brown A vial x 1) Trypsin, feces, qua Colitis, infectious tious Laboratory Test Name* progesterone replacement program $42 TM 82270 L Helicobacter pylori Ab b, SIgA MB2 I C A & R specific treatment recommen- N E $11 I S amount of progesterone reaching ry Total Intestinal SIgA L 86777 C E 279.01 Occult Blood, fecesnt. A (Blue H vial x 1) PostM R C ASC $42 Selective IgA 83986 578.1 Hormone H

Ascaris (Roundworm) Tosoplasma Antibody MB3 Test , IgG Test DescriptionPost Menopause for Billing immunodeficiency 783.21 Gastrointestinal–Infectious Diseases86753 Tests | Stool Intestinal Lysozyme pH test, stool Blood in stool Fee (Brown A vial x 1 Panels | Saliva 579.8 Abnormal weight loss Hormone Panel™ CPT Codes L T-SOL (Blue H vial x 1) A $42 B DiagnosTechs Amoeba histolytica ) 579.4 Decreased tolerance Includes: O Taenia solium (Tapeworm Ab, SIgA MB4 $42 R A T O R Y 2. Stanczyk, FZ; Paulon, RJ; Subiz, Antibody 130.7 Intestinal Alpha Anti Fatty stool, pancreatic Test Description for Billin The leading lab in Saliva Te must be administered gradually up to 86677 (Brown A vial x 1) DHEA (Blue H vial x 1) DiagnosTechs006.1 83883 787.3 indigestion DHEA & DHEA-S dations. If requested, we Toxoplasmosis (Blue H vial x 1) $99 TM the blood stream unpredictable, but, TRIC $42 564.00 Trichinella (Tissue Wor ) Ab, SIgA Helicobacter pylori 536.8 Chronic ameba $42 Flatulence, gas or blo to fats L -Chymotrypsin Nephelometry, 536.8 TTF ST Y THE86682 LEADING Antibody LAB IN535.40 SALIVAGastric irritation TESTING SINCE 1989 Constipation, unsp Testosterone g ing Since 1989 A (Blue H vial x 1) Test 85549 Immune globulin A 536.8 Gastric irritation Gastrointestinal–Parasitic & GI DiseasesR $42 II Tests | Stool 787.1 Gastritic B m) Ab, SIgA O Ascaris Antibody (Brown A vial x 1) 579.8 Hypermotility, ie. reducating E1 O R A T 127.0 Heartburn $42 Lysozyme (muramida ecified Estrone R. Percutaneous Administration 86318 123.0 83883 (83883-91 Intestinal malabsorption ICD.9.CM (Blue HC vial x 1) Ascaris lumbricoides inf inflammation marke 279.01 E2 $50 GP1 $42 123.1 Taenia solium (Intest in panels) Selective IgA Estradiol the full dose to maintain appropriate CS1 Ova & parasites FeeTaenia solium Ant ed transit 82626 728.11 Taenia solium (Larval form Nephelometry, Alph se) Immunodeficiency $44 626.0 are pleased, however, E3 if discontinued, it may take several 86784 GP2 124CPTMyositis Codesection Anti-Chymotrypson r 558.3 Estriol DHEA & DHEA-S Amenorrh Ova & parasites ibody inal form) 009.0 $44 84402 610.1 Trichinella Antibody Trichinosis Flexi-Matrix Colitis, allergic P1 dysfunctionea/ovarian (Brown B vial x 1) Customized Test Panels 87102a 556.0 Colitis, infectious Progesterone 625.3 Cystic breast, chronic of Progesterone: Blood Levels eP 82679 Testosterone Issue #9 Chronobiology Letter) is published 009.2 Ulcerative enterocolit ost $44 617.9 GP4 Dysmenorrhea $44 Flexi-Matrix™ allows you to combine more than one panel, with the 564.1 M Giardia Antigen (Brown B vial x 3) ™ Diarrhea, infectious Expanded Post Estrone Endometr Irritable bowel syndrom 82670 ICD.9.CM 87177 $44 Menopause Hormone iosis progesterone balance in the body. A GP5 87209 exception of BHP, FHP, eFHP, PeriM and ePeriM. When combining is Cryptosporidium Antigen $68 82677 Estradiol to suggest appropriate O & P, smear, Test Description for Billing Panel™ months to leech entirely out of the fat (Brown B vial x 1) 87177 ( x 3 ) $44 quarterly by Diagnos-Techs™ concentrate & ID. Sta Laboratory, Inc. 87209 ( x 3 ) panels, be sure to include the individual tests listed under each of e Includes all PostM™ tests Estriol and Endometreal Protection. Culture, stool,$112 84144 $33 O & P, smear, FSH Follicle Stimulating (Green F/L vial x 1) (Brown B vial x 1) concentrate & ID. S the panels you are combining. Flexi-Matrix™ customized test panels Must use Flexi-Matrix™ sa Progesterone 87328 in 009.3

$33 136.8 Diarrhea of parasit LH plus: Hormone (1) ™ ©2010 Diagnos-Techs, Inc. All rights reserved. in Kent, 87328WA, (87328-91 USAImmunoassay, Giardia as an educational resourceare Luteinizing Hormone 009.3 Intestinal Blastocystis the most economic way of customizing test panels and profiles liva, stool or combination te All PostM codes repeat Female Hormone Panel is antigen tain Flexi-Matrix PeriM in panels) 136.8 therapeutic pathways. GP3 Diarrhea of parasitic icorig origin to meet your clinical needs, saving you a 20-70% volume discount above plus: stores beneath the skin. Menopause (2005) 12:232-237 Immunoassay, Any 3–5 tests Peri Menopause $44 Intestinal Blastocystis 87106™ fungi Stool culture, bacteria & flora 255.2 Cryptosporidium antigen 007.1 Test Fees st kit. Hormone Panel™ off individual test fees. Any 6–9 tests 83001 704.1 for our health care clients.Intestinal Giardiasis The content in this 2 saliva samples sent Female masculinizatio in $44 Diagnos-Techs, Inc. 800.878.3787 Follicle Stimulating 256.0 Hirsutism 007.4 Any 10–15 tests Get the 6 hormones $95 done on each. 83002 Hormone Hyperestrogen Cryptosporidiosis (Blue H vial x 2) $120 n n Any 16–20 tests ePeriM together. 82679, 82679-91 recommended three to four menstrual Choose 3 or more Luteinizing Hormone 87102 $132 in PostM™ 82670, 82670-91 Candidal enteritis newsletter is for informational purposes only Any 21–25 tests ICD.9.CMExpanded Peri Menopause www.diagnostechs.com isolation 3. O’Leary, P; Feddema, P; (Excludes DPD Bone Marker Test and CS3 Swab Culture for Yeast.) $180 Hormone Panel™ 82677, 82677-91 Estrone individual tests from the list shown on pages 4-6 84144, 84144-91 Estradiol On behalf of our entire n 2 saliva samples sent t Be sure to read 82626, 82626-91 Estriol • Over 25 Tests $240 Get the 8 hormones in t Digestive tract irritation Note as well in figure 1 (blue Page 5 84402, 84402-91 Progesterone and is not to be construed as medicaln advice. $295 ePostM™ done on (Green F/L vial x 2) $180 256.31 DHEA GP3Cd 34110xxxxx 10M 5M 03/10 03/10 03_DTI/feesched03_DTI/feesched You will always receive detailed the instructions lower price and fill out the requisition form included in each collection kit. ogether. Culture, stool,**Pending sufficient amount FHP Testosterone Hypo-ovarianism/pre cycles or months later, once the new Chan, K; et al. Salivary, But All PeriM codes + $12 for each$295 additional Culture,Cycling Female each. stool,he 626.9 menopause Irritable colon, spastic or mucus marked test; max 32 above plus: 627.2 Clostridium difficile Toxins A&BNote Hormone Panel™ Menstrual disorder mature : Diagnos-Techs, Inc. also offers several standard pre-defined of this Test and Fee Schedule.of samples to run all of the te Mapping of cycle wi Menopausal symptoms Medical Support Department, I (Brown A vial x 1) $44 83002 tests** CS3 Swab Culture for Yeast, FHP, Panel Includes: 83001 shaded area) that, despite very high DHEA (Blue FHP vial x 11) Luteinizing Hormone Inflammation, mouth when your customized panel is identical to a standard panel. $200 278.00 Diagnos-Techs™, Inc. Prices Effective June 1, 2010sts DHEA & DHEA-S poole th 11 samples. Follicle Stimulating Not Serum or Urinary Levels GP3 87106 fungi 87045 & 87046 Hormone 784.0 Obesity, unspecified TTF replacement program has been established. fungi ID 626.9 Stool culture, bacteria & flora Diagnos-Techs, Inc. 19110eFHP, 66 PeriM or ePeriM Panels. Testosterone pooled va Headache d value 627.2 Disorders of menstruaInflammation, pharynx th 112.8 253.4 test panels at very reasonable fees. Flexi-Matrix™ cannot be used for the DPD Bone Marker Test, E2 Menopausal sympto Estradiol ( x 11 ) 628.0 Pituitary disorders pledge that we will continue to 19110 66 Avenue S. th lue $50 CLEAR Avenue South, Building G, Kent WA 98032 800.878.3787 5 Infertility tion progesterone values, this patient has 256.4 ms of Progesterone Are Elevated 82626 536.8 CandidalP1 enteritis$44 Oral (or throat) candida Gastrointestinal–GI Functional Markers Tests | Stool 627.9 islolation Progesterone ( x 11 Ovarian 84402 DHEA– 625.4 Postmenocysts billed once Building G CultureeFHP $44 626.6 Premenst pausal disorder ) Testosterone (free)– each 627.2 Spotting rual tensionRash–diaper 564.1 DigestiveExpanded Cycling tract irritation82670-91 $42 billed once Menopaus, Intermenstrual provide the outstanding support (Brown B vial x 1) Female Hormone 84144-91 As a corollary to the above discussion, After Topical Application of www.diagnostechs.com $44 Estradiol al symptoms elevated estradiol in both follicular GP3Cd Panel™ each Culture, stool, 82670 Progesterone Kent, WA 98032 USA 528.00 IrritableMapping of cycle with 1colon, spastic or mucus Rectal pain $270 84144 Luteal • Page 6 Panel includes all FHP™ te Estradiol } Phases Clostridium difficile Toxins A&B 87324 FSH (Blue eFHP vial x 11) FG1 Follicle Stimulating H Progesterone Phases (Brown A vial x 1) $44 1 samples. Follicular Progesterone Cream to Pre- and Chymotrypsin 462 Inflammation, mouth } 009.0 sts plus: you deserve and to improve LH All FHP codes if a valid and accurate assessment of Luteinizing Hormone ormone 87045 & 87046 fungi ID above plus: and luteal phases of her cycle. In the FPO ( x 5 ) 628.0 Colitis, infectious Printed on recycled paper. 112.0 Inflammation,Diagnos-Techs, Inc. 19110( x 665 ) $44 pharynx 009.2 each 253.4 Infertil Immunoassay83001 ity Post-Menopausal Women. Clin * NOT for Insurance Bil 278.00 Pituitar $44 AREA Follicle Stimulating 259.9 Obesity,y disorders th each Diarrhea, infectious Avenue South, Building G,83002 Kent WA 98032 800.878.3787 Endocrin whatever and whenever 691.0 Oral (or throat) candida Hormone 009.1 unspecified a woman’s hormone status is desired, Gastrointestinal–GI Functional Markers Tests | Stool Billingling FG4 e disorder, unspecified face of no known estradiol intake, her ©Occult 2011 by BloodDiagnos-Techs™, Inc. (Brown All rights CultureA vial reserved. x 1) 569.42 Rash–diaper Luteinizing Hormone Gastroenteritis, infectious Endocrin (2005) 53:615-620 (Brown B vial x 1) $42 008.45 $35 Rectal pain www.diagnostechs.com necessary. inquiry should be made prior to testing Clostridium difficile, colitis estrogen dominance state most likely FG1 FG5 87324 009.0 • Page 1 Chymotrypsin Fecal pH (Brown A vial x 1) 84490009.0 Colitis, infectious 6 © 2011 Diagnos-Techs, Inc.Immunoassay All rights$10 reserved. 009.2 Colitis, infectious www.diagnostechs.com 1.800.878.3787 3 FG4 009.1 Trypsin,Diarrhea, feces,infectious Occult Blood (Brown A vial x 1) (Brown A vial x 1) 82270 Gastroenteritis, infectious $35 $11 008.45 FG5 009.0 OccultClostridium Blood, difficile, colitis578.1 Fecal pH MB2(Brown A vialTotal x 1) Intestinal 84490SIgA 83986 783.21 Blood in stool Colitis, infectious Abnormal weight loss $10 579.8 Trypsin, feces, pH test, stool 579.4 Decreased tolerance to fats (Brown A vial x 1) MB3 Intestinal Lysozyme82270 (Brown A vial x 1 Fatty stool, pancreatic $11 ) $42 578.1 787.3 indigestion Occult Blood, Flatulence, gas or bloating MB2 Total Intestinal SIgA 83986 83883 783.21 Blood in stool 564.00 MB4 Intestinal Alpha Anti-Chymotrypsin (Brown A vial x 1) 579.8 Abnormal weight loss 536.8 Constipation, unspecified pH test,$42 stool 579.4 Nephelometry,Decreased tolerance to 536.8fats Gastric irritation (Brown A vial x 1 579.8 Hypermotility, ie. reduced transit MB3 Intestinal Lysozyme 85549 Fatty stool, pancreatic ) 787.3 indigestion Intestinal malabsorption $42 279.01 (Brown A vial x 1) $42 564.00LysozymeFlatulence, gas or bloating MB4 (Brown A vial x 1) 83883 83883 (83883-91 Selective IgA Intestinal Alpha Anti-Chymotrypsin 536.8 Constipation, unspecified Immunodeficiency $42 Nephelometry,in panels)536.8 Gastric irritation 558.3 85549 579.8 Nephelometry,Hypermotility, ie. reduced 009.0 transit Colitis, allergic Intestinal malabsorption 279.01 556.0 Colitis, infectious (Brown A vial x 1) $42 Lysozyme Ulcerative enterocolitis 83883 (83883-91 Selective IgA 009.2 Immunodeficiency 564.1 Diarrhea, infectious in panels) 558.3 Irritable bowel syndrome Nephelometry, 009.0 Colitis, allergic 556.0 Colitis, infectious 009.2 Ulcerative enterocolitis 564.1 Diarrhea, infectious Irritable bowel syndrome

ChronoBiologyLETTER August 2011 ▎ 9th Edition

Chronobiology with intermittent estrogen surges (and Continued from front page Hormone Educational Pathways @ Diagnos-Techs™ possibly, estrogen dominance) and Chronobiology may be women with premenstrual syndrome. Supplementation MEDICAL SUPPORT iagnos-Techs™ offers several educational pathways to thought of as the study Of course, follow-up testing with any Diagnos-Techs’™ team of medical advisors support our provider clients in their patient care. Courtesy of the biology of the & Salivary Hormone Testing is available to assist our licensed health D of our panels after treatment provides In-House Seminars, Office Visits body over time through When saliva testing is used to care professional clients by answering the perfect opportunity to track over analysis of specific assess the status of a patient taking questions about our laboratory tests and and Telephone Consultations are time a patients problems and therapy. changes and aberrations of hormones, avoid ingesting or applying assisting with interpretation of test results. available for you to enhance your Diagnos-Techs™ prides itself not only selected hormones, chemistries, etc. the hormones on the day of the There is no additional fee to receive practice and stay informed. See in the accuracy of its findings but also The father of this important approach test until the collection is finished. this service. Our medical support team the capability to observe the temporal info at left and below for details. to biologic testing is Dr. Franz Halberg, Moreover, with sublingual or buccal consists of MDs and NDs offering over 100 variations of these findings to better a scientist from Minnesota who (transmucosal) hormone replacement, years of medical experience. To speak to Seminars scheduled for Fall 2011 understand your patient. medical support call 1-800-878-3787. emphasized the importance of for three days prior to testing the Resuming in September, Diagnos-Techs™ examining periodic (cyclic) phenomena product should be swallowed with will offer comprehensive educational in living organisms. TELEPHONE CONSULTATIONS ™ a glass of water, in order to avoid & OFFICE VISITS seminars designed to help clinicians integrate hormone assessment into their Diagnos-Techs Many of the diagnostic panels contamination of the saliva. Any dose with our Medical Advisors practice. Our next two seminars are scheduled for September 23 and October 28. offered by Diagnos-Techs™ are on the evening prior to testing should Telephone Consultations offer an Keep checking our website for more information, www.diagnostechs.com. designed specifically to reflect the Lab News be avoided. On the day of testing, overview of our test panels and reports to chronobiology of the particular areas Announcing Improvement the usual transmucosal route can be familiarize clients with how to use them, studied. The Adrenal Stress Index™ in the Expanded Female resumed–after the saliva collection and offer an opportunity to ask questions. SPECIMEN DELAYS? ™ ™ Applicability of the (ASI™) panel was the initial study Hormone Panel (eFHP ) is finished. Office Visits provide local clients the Just Chill! offered by Diagnos-Techs™ (starting in The Expanded Female Hormone opportunity to receive information on Cycling Female 1989) and was designed specifically to ™ ™ testing and how to further integrate our If a slight delay ™ ™ Panel (eFHP ) adds evaluations Hormone Panel (FHP ) assess the changes and perturbations Elevated lab into their practice. To schedule an in returning a of the pituitary hormones, follicle The eleven-vial Cycling Female Hormone of the circadian cortisol rhythm appointment, please email Jessica at completed kit to the stimulating hormone (FSH) and DHEA/DHEAS Levels Panel™ (FHP™) should not be ordered throughout the day. Additionally, [email protected]. lab is anticipated, the lutenizing hormone (LH), to the Diagnos-Techs™ has noticed more for a woman who is not cycling in a it assays fasting and random (or specimens can be kept regular FHP™ for cycling women. elevated DHEA/S levels than in prior normal fashion. Hormonal birth control post-prandial) insulin results. Most frozen or refrigerated up to Currently, five assessments of each years. The laboratory has checked its is designed to prevent ovulation and, notably, the chronobiology of estradiol three days until transported– hormone are reported, centered controls repeatedly, and all values thereby, obvert a normal luteal phase rise and progesterone during a woman’s with the exception of stool around the estimated time of are in order. Consequently, we urge of progesterone from a corpus luteum. menstrual cycle are captured in the specimens. Freezing can kill bacteria ovulation. These assessments are you to search painstakingly for This creates an abnormal cycle. To check Cycling Female Hormone Panel™ and fungi and vitiate their effective valuable adjuncts in assessing a exogenous sources in your patients. ™ the adequacy of hormonal birth control, (FHP™) offered by Diagnos-Techs™. Diagnos-Techs culturing–an important part of the GI woman’s cycle for fertility and With increasing frequency, it appears a single-vial sample in mid-luteal phase Collecting saliva every two to three Health Panel™. If a delay in transpor- ovulation. Considering variations that DHEA/S is being added to various using the Post Menopausal Panel™ days (at the same time of day) in tation is expected, stool specimens can in the timing of ovulation and the proprietary products. We are aware On the Road (PostM™) will suffice to confirm the lack one of the eleven vials (frozen upon be kept temporarily in a refrigerator length the cycles exist, they may of the presence of DHEA/S in some Conferences & Tradeshows of progesterone elevation from a collection) can provide a clear If you are attending either of the events (cooled but not frozen). For optimal not be covered by or included in cosmetics such as facial toners and corpus luteum. picture of woman’s essential cycling listed below, please visit our booth. We reception and handling by the lab, the current five reported hormone moisturizers. It can also be found in look forward to meeting you in person! hormonal pattern. In its expanded send completed kits via UPS Monday values, Diagnos-Techs™ will soon specialized tonics or power drinks form (eFHP™), five FSH and LH values through Friday. increase the number of values of designed to “pep up” patients. For ● Catholic Medical Assoc.— Oct. 6-8, 2011 (soon to increase to seven), measured 80th Annual Educational Conference FSH and LH reported to the seven practitioners, if a patient has been around the time of ovulation, provide Phoenix, AZ • http://tinyurl.com/3lxqbnt middle values. This improvement will prescribed DHEA/S and is coming important information regarding ● A4M— December 8-10, 2011 DID YOU KNOW? provide a broader coverage of FSH back with elevated levels, consider the vital pituitary influence over 19th Annual World Congress on✓✓ ✓ and LH values to further elucidate adjusting the dosage. Anti-Aging Medicine & Biomedical✓✓ ✓ DR. FRANZ HALBERG of the University of Minnesota, ovulation. This panel is helpful Technologies • Las Vegas, NV any vagaries encountered in a who coined the word circadian, is widely considered the for women with fertility concerns, http://tinyurl.com/3zyp7ed woman’s cycle. “father of American chronobiology.” symptomatic perimenopausal women

O ™ Chronobiology Director of NT LE Diagnos-Techs I R D A N O Clinical & Research Laboratory ™ C and Diagnos-Techs Test Panels

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