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Posted: Thu Aug 12th, 2004 05:07 |
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D-METABOLITES TESTS
You may post your D-metabolites results in 'Help with understanding D-metabolites tests' for analysis. First, please read carefully 'How to post your D-metabolites tests results'.
Apart from the symptoms or diagnosis being indicative, the way to find out if the Marshall Protocol may be applicable to any person or their disease is to test the D Metabolites.
The D METABOLITES consist of two tests
1,25 dihydroxyvitamin -D
25 hydroxyvitamin - D
Please make sure that both tests are ordered, not just the commonly done 25-D. Be sure the sample for the very sensitive 1,25-D assay is sent to the performing lab frozen. You may need to remind the technician at the drawing (satellite) lab to freeze the sample for shipping.
Note: Some Quest drawing labs have inaccurate information in their printed manuals. There has been no change in the need to freeze the 1,25-D sample for transport.
To facilitate correct handling of the blood sample for 1,25-D and to avoid your having to tell the drawing lab how to do their job, you can ask your doctor to sign and staple the following instructions to the lab order:
-Please perform the following Vitamin D tests: 1,25-D and 25-D.
-Please ensure that collection staff arrange for centrifuging and freezing of the 1,25D sample. (only)
-The sample should be allowed to settle and clot at room temperature for at least 30 minutes (but no more than two hours) and then centrifuged. Do not hold on dry ice prior to centrifuging.
-After centrifuging, freeze at between -2 and -10 C.
-The sample must be transported on dry ice in order to remain frozen until it reaches the testing lab.
Labs
For information about which labs to use to ensure that the sample for the 1,25-D test is frozen, see this post.
We do not recommend using Labcorp for your D metabolites tests. Their results have proven unreliable even when the sample was shipped to them frozen. This may be due to a policy of allowing the frozen sample to thaw in the refrigerator before they run the test. These are expensive tests and you would be taking a chance on their accuracy by using Labcorp. If that is your only option, we can tell if the test is accurate only when the result of the 1,25-D is elevated. If it is low, we cannot know if it's a lab error or a true result.
Note: 1,25D levels are very minute. 1 p gm/ml is one millionth part of one millionth part ( pico is 10 raised to the -12 power) and the pathology to measure such levels is extremely sensitive to correct handling. For every gm of Vitamin D taken in barely one part in 1000 ends up as the double hydroxylated 1,25-D.
Diagnostic ICD codes for payment
The best disease codes for 1,25-D and 25-D testing are those for osteoporosis. All sarcoidosis patients are at risk for osteopenia or osteoporosis and most patients with other inflammatory diseases complain of fatigue.
We have had no reports of insurance or Medicare refusing to pay for these tests when these codes are used:
733.00 Osteoporosis, unspecified
733.90 Osteopenia
135 Sarcoidosis
275.40 Unspecified disorders of calcium metabolism
275.42 Hypercalcemia
278.4 Hypervitaminosis D
780.9 Fatigue
CPT codes are as follows:
--Vitamin D (1,25): 82652
--Vitamin D (25OH): 82306
If your doctor (or HMO) believes that the tests cannot be justified, point out that:
-the FDA has approved 1,25-dihydroxyvitamin D for testing kidney function.
-these tests are also approved for investigation of the risk of osteporosis.
-anyone who has been on prednisone is at risk of osteoporosis.
For 1,25-D test data, see:
Marquette General Health System
It is not necessary to fast for these blood tests. The D-metabolites tests can be done whether or not the patient has been avoiding ingested Vitamin D or sun/lights. This information is taken into consideration when assessing the test results. One very small (7 patients), 1982 study demonstrated that the serum concentration of 1,25-D fluctuated with the menstrual cycle. Levels of 1,25-D were shown to be dramatically higher near ovulation in women not on the pill. The higher the level, the more persuasive the evidence will be for your doctor. Therefore, you may wish to have your blood drawn as close to midcycle (day 15) as you can.
OTHER INFLAMMATORY MARKERS
ACE or angiotensin-converting enzyme
"Elevated ACE indicates the same as the 1,25-D and therefore adds nothing to the interpretation, except an increased level of confidence. On the other hand, if ACE is normal (as so many are), the ACE gives a decreased level of confidence. Nevertheless, if cost is not a factor, I always like to see as much data as I can." Dr. Trevor Marshall, PhD
C Reactive Protein are inflammatory markers which, if elevated, return to baseline along with Triglycerides, Alkaline Phosphatase and 1,25D as the MP does its job. These markers typically start to drop after about 6-12 months.
SED rate will (hopefully) go way up in the early stages of the Marshall Protocol indicating that bacteria are being killed, and the body's immune system is dealing with them. Later on (at 12 months or so) the SED rate will remain closer to normal, as fewer organisms are being killed. Eventually it returns to baseline.
Optional tests which may be helpful if affordable
A Complement C3a assay and Soluble Interleukin 2 Receptor (sIL2R) may also be used to measure inflammatory activity. They can help to confirm possible errors in the 1,25-D assay or to confirm that inflammation is not so widespread but it is usually not necessary to do these tests.
Coverage of IL2R will vary by insurance company. Here is a paper showing it as an effective diagnostic tool for sarcoidosis, so Doc might take the position that he is trying to rule out sarcoidosis:
http://tinyurl.com/3uywe
1. The D-metabolites can be done nonfasting but it wouldn't hurt to fast. Either way is fine.
2. No food restrictions. Avoiding ingested Vitamin D is recommended as a change in your eating pattern to help you recover your health. It will not change the D-metabolites results unless you've been diligently avoiding Vitamin D for months. We do need to know when you post if you have been supplementing so we can take that into account for the assessment.
3. The test for 25-D is done routinely at many labs and does not require special handling. When the 1,25-D is sent out, the same blood specimen is probably used for both tests and they can both be frozen. Freezing preserves the specimen and will not harm it even if it isn't necessary. Last edited on Thu Oct 23rd, 2008 07:15 by
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Posted: Wed Oct 27th, 2004 03:02 |
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HOW TO INTERPRET THE SIGNIFICANCE OF THE INITIAL D-METABOLITE LEVELS
Post your lab results in the 'Help with understanding D-metabolites tests' thread for an interpretation of your results. You are welcome to read the summary below, but it is important to realize that what appears to be a normal level may not be a healthy level. Please post your results at the website for a careful evaluation.
Consider the whole picture
When assessing the D-levels, one must evaluate and compare the two measurements, 25-D, the precursor and 1,25-D, the active metabolite. The clinical picture must be considered also.
Lab ranges
D-metabolites results that are within normal lab ranges may still be abnormal because high levels are not used to diagnose any illness. Therefore, lab ranges are determined without considering that a large percentage of patients getting these tests are ill with undiagnosed Th1 inflammation, thus skewing the 1,25-D range upward. The Merck Manual 1,25-D range of 20-45 pg/ml is a more reliable indicator of the 1,25-D normal range. 25-D ranges are skewed high by dietary supplementation.
Explanation of normal lab ranges, Merck Manual's normal range for 1,25-D and explanation of sigma high is here.
If necessary, convert metric results using this formula:
1,25D (pmol/L) - divide pmol/L by 2.4 to get it in pg/ml
25D (nmol/L) - divide nmol/L by 2.5 to get it in ng/ml
D ratio
It was previously thought that a low 25-D indicated a rapid conversion of this pre-hormone to 1,25-D. Dr. Marshall's recent research found that high levels of 1,25-D inhibit the conversion of vitamin D into 25-D. Thus, the D ratio (ratio of 25-D to 1,25-D) is not a sufficient indicator of vitamin D dysregulation, especially when 25-D levels rise above 15 ng/ml. Moderators will base assessment on their knowledge of the complete metabolism.
Now that we know more about the molecular activity of vitamin D metabolism, the D ratio carries less significance. Pre-MP, it is an adequate clinical guesstimate of Th1 inflammation (but an inadequate scientific analysis) if it is able to be interpreted accurately. The D ratio has no value after the MP has begun.
To determine the D-ratio, divide 1,25-D pg/ml by 25-D ng/ml.
Classic results of dysregulated Vitamin D metabolism
When the 1,25-D is quite high and the 25-D is quite low, you will see a classic picture of dysregulated D-metabolism caused by Th1 inflammatory disease. A D-ratio that is higher then 2 is a sign of inflammation. A normal ratio in a healthy person is between 0.75 to 1.75. There may be situations where the ratio may appear to be normal and yet there is still inflammation in the body. For example, someone who has supplemented with Vitamin D will skew their D ratio downward by creating an artificially high 25-D.
High 25-D
A 25-D that is within the normal range may be too high for a patient with Th1 inflammation.
Vitamin D supplementation can increase levels of 25-D high enough to actually shut down the inflammatory production of 1,25-D. When the concentration of 25-D rises above about 25 ng/ml it displaces 1,25-D from the active site in the VDR (Vitamin D Receptor), deactivating the VDR and reducing the body's ability to mount a Th1 immune response.
The actual values at which this happens vary from person to person, and from infection to infection. Therefore, high 25-D does not lead to high 1,25-D. There is no direct relationship, as 1,25-D is driven by an independent set of parameters other than any dependence on 25-D. Thus a very high 25-D may indicate a suppressed level of 1,25-D.
A high level (above 25 ng/ml) is a sign that the patient is supplementing or ingesting foods high in vitamin D. This level needs to be reduced so there is less 'fuel' for the inflammation. The patient will need to take a close look at everything s/he ingests for the source/s of Vitamin D and agree to diligently avoid them. Because vitamin D is converted into 25-D and stored in body fat for several months, it will take 2 months to halve and another two months to halve again down to a reasonable value. It is desirable for the D-25 level to be 12 ng/ml or lower.
Average 25-D
Intracellular bacterial infection causes elevated 1,25-D, while viral infections cause 1,25-D to drop very low. Concurrent CWD intracellular bacterial and viral infections may, therefore, result in a 1,25-D that is in the average range. The depression of 1,25-D by the viral infection offsets the rise caused by the Th1 inflammation. This can be confirmed by viral testing if necessary. It should be suspected when the clinical picture indicates Th1 inflammation but the D tests results are equivocal.
Low 25-D
A 'deficient' 25-D (less than 20ng/ml) in conjunction with a normal or, especially, with a high 1,25-D is telltale. In a person with inflammatory symptoms, this suggests a high level of 1,25-D because high 1,25-D inhibits the conversion of vitamin D into 25-D resulting in a low level of 25-D, particularly if this person has been supplementing with Vitamin D. If the 1,25-D happens to be low, this is a clue that the 1,25-D result is inaccurate due to mishandling of the sample.
25-D results that are below the normal lab range do not automatically indicate the need for supplementation of this inert precursor as most physicians believe. There is no direct correlation between the level of 25-D and 1,25-D in persons with inflammatory disease. Inert 25-D can be extremely low and no supplementation is needed if the active metabolite is sufficiently high as is the case with Th1 inflammation.
Low 1,25-D
Initial levels below 25 pg/ml suggest no Th1 inflammation. But if symptoms indicate Th1 inflammation, this result is more likely a false low caused by mishandling of the blood sample. Blood samples for this delicate assay must be sent frozen and kept frozen until the test is run.
If the Benicar blockade was already in place or there has been a significant reduction in sunlight exposure when the sample was drawn, the level will be lower.
If the patients inflammation is in tissues that are poorly perfused by blood (nerves, joints, skin), the serum sample will not be an accurate reflection of what is going at the paracrine level.
Use of immunosuppressants, especially prednisone will lower the 1,25-D by 25-40%.
Measured lower levels of 1,25-D may also be a sign that the immunosupression of 25-D is in play.
Extremely low levels (below 15pg/ml) suggest a severe viral infection such as AIDS or hepatitis. Considering the clinical picture will help you decide if this is a false low. Your doctor should be able to rule out these diseases if that is a concern.
A lower 1,25-D assay than expected (based on the clinical picture), provided the assay comes from a reliable source and has been verified, coupled with an obvious Th1 presentation, is a good indication of secondary fungal or viral infection.
"The reduction of 1,25-D generation observed when the body is challenged by serious viral infections is part of the body trying to adapt the immune response to prioritize the most dangerous challenges. 1,25-D docking into the VDR controls innate immunity. It controls IL2, TLR2, TLR4 and most of the Th1 innate immunity pathway."
..Trevor..
High 1,25 D
High values are always reliable. If a sample is mishandled by the lab, the value will decay to a lower value. Therefore, as long as the result is high, it can be regarded as reliable.
The Danish 1,25-D population data, which is the largest study and the most reliable we have, found that the mean value for 1,25-D in a normal population was 29 pg/ml with a standard deviation of 9.5. By plugging a value of (42-29)/9.5 = 1.37 as z into an online statistical calculator you can find the percent of the population that would have a lower value.
Levels above 15 pg/ml, while not high, do indicate a dominant Th1 immune system response versus an immune system response to a viral infection. Levels above 30 pg/ml suggest systemic inflammation. If the 1,25-D exceeds the Merck maximum of 45 pg/ml, it indicates that the patient is in the top 2 percent of the population and at risk of skeletal wasting due to osteoclast stimulation by the 1,25-D.
Many of labs list ridiculous ranges for 1,25-D. The Merck manual reports the maximum value for 1,25-D is 45 pg/ml.
Extremely high 1,25 D
Levels above 60 pg/ml indicate well-perfused inflammation, where the inflamed tissue is close to the bloodstream. Usually that means lung or heart involvement. Dr. Marshall tells physicians that anybody with a 1,25-D over 80pg/ml is at risk of a cardiac Herxheimer reaction. Therefore, the doctor needs to be very sure to give enough 40mg Benicar tablets to be able to increase to q4hr dosing if the patient experiences chest pain, bradycardia or other cardiac arrhythmia due to an immune system reaction.
Make sure you get a copy of the raw data results. It is not good enough to be told if your levels are "normal" or not. You need the actual data numbers to understand what the data actually means when you later discuss the results with your doctor. File the results away, they may come in useful later on.
When you have your test results see How to post your D-metabolites test results. You dont need to have a diagnosis....the D tests are sufficient along with your symptoms and history.
Dr. Marshall's papers regarding the D-ratios:
http://clinmed.netprints.org/cgi/content/full/2002080004
http://bmj.bmjjournals.com/cgi/eletters/326/7379/12/b#55641
http://www.chestjournal.org/cgi/eletters/123/1/18
Therapeutic probe. (click here)
If blood tests do not show classic results or do not strongly suggest Th1 inflammation, this does not necessarily rule out D-mediated inflammatory disease. If the clinical presentation warrants, starting the Marshall Protocol could be a good diagnostic tool used as a therapeutic probe. If the expected response occurs, a presumptive diagnosis can be made. In other words, if Benicar causes the expected the neurological-type adjustment symptoms and minocycline provokes a Herxheimer reaction, this is proof positive of occult microbes and that the Marshall Protocol is the appropriate treatment. See Therapeutic probe.
See What is a therapeutic probe?
How often should I test D levels? What are the target numbers?
For background information, see:
Vitamin D Tutorial (Calciferol and Calcitriol)
____________________
*We can help you understand chronic disease, but only your physician is licensed to give you medical care *
Always consult your physician before commencing or changing any treatment he/she has prescribed for you
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Posted: Wed Dec 1st, 2004 00:59 |
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Handling of blood for D-metabolites tests - 2004 Letter from Quest Diagnostics explaining how they handle the specimens.
Dear Sue:
Thank you for your website inquiry dated October 22, 2004. I will do my best to address your questions about specimen handling at Quest Diagnostics.
1. Exactly what should the doctor write on the lab request to make sure that the lab technician understands what to do?
Below is a list of the most common ways to request this test:
1,25 DIHYDROXYCHOLECALCIFEROL
1,25 DIHYDROXYVITAMIN D
1,25 HCC
1,25 OH-D
1,25 VITAMIN D
CALCIFEROL
CALCITROL
DIHYDROXYCHOLECALCIFEROL
Any of the above should be recognized by the phlebotomist and the proper specimen collection and handling performed.
2. How much blood should be drawn to end up with 3 ml of serum?
On average (depending upon the patient's hematocrit), you would need to draw twice the amount of blood than the serum needed. So for 3 ml of serum, we would generally draw one 7ml red top tube.
3. What source should the technician use to find out what to do with the specimen?
The laboratory Directory of Services. This is a document of specimen handling protocol published by the performing laboratory.
4. Will the specimen be unusable if it is not centrifuged before it clots? How soon after the blood is drawn must it be centrifuged?
The specimen MUST clot PRIOR to centrifuging. We recommend that the specimen sit for at least 30 minutes prior to centrifuging, in order to obtain the optimum amount of serum, and assure a clean separation of the clot and the serum.
5. Should the blood be kept at room temperature or refrigerated while it is waiting to be centrifuged?
The specimen can remain at room temperature while waiting to be centrifuged. But in no case should the specimen sit beyond 3 hours at room temperature.
6. Is it acceptable for a satellite lab to draw the blood and then transport it to a larger hospital lab for centrifuging and freezing?
This would not be our practice. A satellite lab should centrifuge and freeze the specimen prior to transport.
7. If whole blood is transported on dry ice before it is centrifuged, will the dry ice freeze the blood?
Yes, definitely, Will that make it unusable? Yes. The specimen must be spun and poured off prior to freezing; otherwise the red cells will lyse and make the specimen unusable.
8. What temperature should the specimen be frozen to? Does this require a special freezer? If so, do most labs have such a freezer?
The specimen is stable up to 3 days refrigerated, and up to 1 year frozen. Most labs and physician offices have refrigerator/freezers which freeze anywhere from -2 to -10 degrees. This is certainly adequate for this sample.
9. How long should a specimen be in a freezer before it is given to a Quest courier?
Presumably the same day it is drawn, to expedite testing, but the specimen is stable for up to one year if frozen. (Is there such a thing as a Quest courier?) Yes! Many, many of them. You can commonly see them driving in white cars or vans with the Quest Diagnostics logo on the side.
10. What happens if the specimen is removed from the freezer too soon and is transported on dry ice? Will the dry ice continue to freeze it?
This is a very common, and recommended practice. Most couriers carry dry ice in order to maintain specimens in the frozen condition while enroute to the testing laboratory.
11. When the Quest courier picks up the 1,25 D specimen, where does he take it?
To the local main laboratory for additional processing, and preparation for transport. We have 24 major laboratories across the US. This testing is then forwarded to the esoteric testing centers, generally by air, the same evening it is picked up.
12. Is the 1,25 D tested at several different sites in the U.S.?
This is a test performed by Quest Diagnostics Nichols Institute, our esoteric testing centers located in Chantilly, VA and San Juan Capistrano, CA. Is it done every day? It is setup 6 days a week, in the evenings.
13. What percentage does Quest reject because of hemolysis, lipemia, received thawed, room temperature or refrigerated?
We do not have this information readily available. Each main laboratory would reject the specimen due to hemolysis or lipemia prior to forwarding it to the esoteric testing center. If you need to have the reject rate for the specimens received at Nichols, I would have to contact each of those departments to obtain.
14. What does "Performing Lab" mean?
This is the actual testing laboratory, in our case it would be Quest Diagnostics Nichols Institute.
15. Who gives the reference ranges-Quest or the local lab or hospital?
It is the responsibility of the testing (or "performing lab") to maintain and report reference ranges. If the local hospital refers this test to us, then it is their responsibility to report the result using our reference range. If the local hospital performs the test themselves, then it is their responsibility to maintain and report their own reference ranges.
16. What does "Field 25" mean on your information sheet? (below)
I cannot determine what you are referring to??
17. Can the specimen be kept at room temperature for three hours and then refrigerated for three days and THEN frozen?
Yes, but that is the limit of the stability of the specimen.
18. Ideally, how soon after collection should the specimen be frozen?
Within 3 hours, but up to 72 hours if the specimen is refrigerated.
I hope this helps you and the others interested in Vitamin D testing. I would be interested in knowing the web address of the internet discussion group, in order to pass it along to our testing scientists. If you have additional technical questions, we would be happy to address them.
Thank you for supporting Quest Diagnostics!
Regards,
Elaine Phillips
National Director, Branch Operations
Office: 253-851-8749
Cell: 253-225-2187
Home office address: 3916 Rosedale Street
Gig Harbor, WA 98335
If you look up the serum 1,25-dihydroxyvitamin D test at the Quest website, you can read Quest's instructions to reject samples that are received thawed or refrigerated and not frozen.
===================================
Labs may keep samples refrigerated for days
If you read Elaine Phillip's detailed report on QUEST lab in the US, you will see that the results may be valid up to 72 hours IF refrigerated but not frozen.
When I had my blood drawn in Las Vegas, NV to have it shipped to California for testing - about 5 hrs by car they assured me the blood would be FROZEN.
Does it matter, maybe not IF they indeed get it there and then test it right away.
The problem really is, once it gets to the lab UNFROZEN will it sit in a fridge for several more days?
We have heard in the US that they don't run the test until they get a shelf full of blood samples.
This would mean you better have that sample frozen. Hope this helps. ~Paula
=================================
Drawing labs may not have correct information
Not all lab testing procedures are specified explicitly, but freezing the 1,25-D sample for transport is truly fundamental. It's not fair to blame a drawing lab for failing to freeze the sample when there would appear to be nothing explicit out there which authoritatively suggests otherwise.
There is little external confirmation to be found about the need to freeze the serum sample for the 1,25-D. The following info may be used as supporting documentation if needed:
UK-based Supra-Regional Assay Service, the main testing lab located in Manshester, states: "Ensure the sample remains frozen during transport."
Elaine Phillips, the National Director of Branch Operations states in personal correspondence: "The specimen can remain at room temperature while waiting to be centrifuged. But in no case should the specimen sit beyond 3 hours at room temperature." ~paulalbert
.....................................................................................
http://tinyurl.com/2syc9w
Quest says that the sample will be degraded if left for more than:
3 hours at room temperature
72 hours refrigerated
one year if frozen
Quest will refuse to accept a sample received at room temperature. That's why their results are so consistently reliable
..Trevor..
____________________
*We can help you understand chronic disease, but only your physician is licensed to give you medical care *
Always consult your physician before commencing or changing any treatment he/she has prescribed for you
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Meg Mangin R.N.
Former Team Member
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Posted: Fri Feb 18th, 2005 14:07 |
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Frequently asked questions about testing:
Policy regarding posting lab test results
How often should I test D levels? What are the target numbers?
Which diagnostic tests do I need?
What do my lab tests mean?
My sodium is low. What should I do?
My potassium is elevated. What should I do?
My doctor says I’m anemic. What should I do?
My white count is low. What should I do?
My kidney function tests are worse since I started the MP. What should I do?
My cholesterol and/or triglycerides are very high. Will the MP help?
Why has my ACE gone up since I started the MP?
What tests do I need to monitor my progress on the MP?
Why can't CWD bacteria be detected with tests?
____________________
Nothing contained in this site is or should be considered, or used as a substitute for, medical advice, diagnosis or treatment by your physician.
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Aussie Barb
Research Team
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Posted: Thu May 12th, 2005 02:03 |
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(filelink)
Reliable labs
Your local blood lab will draw blood for the tests. Unless, you go to one of the few labs that actually runs the tests, the blood sample will be sent out to a specialized lab. Ask your local drawing lab which test lab it will be sent to.
We do not recommend using Labcorp for your D metabolites tests. They do not insist that the sample be frozen for shipping and their results have proven unreliable even when the sample was shipped to them frozen. This may be due to a policy of allowing the frozen sample to thaw in the refrigerator before they run the test. These are expensive tests and you would be taking a chance on their accuracy by using Labcorp. If that is your only option, we can tell if the test is accurate only when the result of the 1,25-D is elevated. If it is low, we cannot know if it's a lab error or a true result. Please ask your doctor to designate a different lab.
Quest
To find a quest lab located near you:
http://tinyurl.com/9uou6
If you should experience technical difficulties in locating a center you can also access the Patient Service Center Locator by dialing 800-377-8448"
Mayo
Here is the Mayo Medical labs home page.
Specialty Labs in Santa Monica
Here is their website.
For test information, call 1-800-421-4449.
Labs around the world
Here is the link to Quest, where you can search for local labs. Find an International Location.
France
Laboratoire LCL, Paris. France. (http://www.groupelcd.com)
Sweden
Here is a Lab in Sweden that can measure 1,25-D
UK
Here is a Lab in the UK that can measure 1,25-D
drawn at my local hospital, tested at Manchester Supra-Regional Assay Service (SAS) Centre
SAS 25D/1,25D assay page:
cost (NHS would not fund) - £100 (GBP)
SAS protocol includes freezing and I also spoke to the lab technician to confirm. ~Nikolai
"Depends where you live and whether your doc would be happy taking the blood for you. There are several lab's in the London area, and a lab in Manchester. You could get a BUPA hospital to take the blood, but it needs to be frozen before sending to the lab. The logistics are awkward and it is expensive which is why I never bothered." ~Jobell
Any Nuffield Hospital can do the tests you require. Simply get a letter from your GP requesting which tests SPECIFICALLY and be prepared to part with almost £200. They are not available on the NHS. ~Rainbowcatcher
Holland
It has to be send to lab Stein in Valkenburg) in Holland. ~Ben
Australia
Vitamin D testing in Melbourne, Australia (click here)
Central Sydney Laboratory (for ACT Pathology)
I have followed through on QML and their handling procedures and are satisfied with them. All 1,25D tests in Queensland (and northern NSW) go to the Central Pathology Lab at Royal Brisbane Hospital. In MP posts a couple of years ago, a Brisbane man had both these tests done at QML and then Sulli and Nick and there was only a tiny variation. So I believe that both labs handle the tests correctly. ~Moxie
Sydney Concord Hospital
Canada
A lab in Canada that can do the 1,25-D and 25-D tests is "Laboratoire Médical Biron" in Quebec, (514)866-6146 or 1-800-463-7374. The 25-D test costs approx $85ca and 1,25-D approx $115ca.
Here's a lab that performs the tests and follows the procedures recommended here at MP.com:
Gamma-Dynacare Medical Laboratories has several client centers in Ontario, Quebec, and Saskatchewan. Find their locations HERE. Read about their test procedures HERE (click on V and find the vitamin D tests). I went for my tests there today. The technician was very helpful in answering my questions. Their standard procedure for the 1,25D test is to allow the sample to clot before spinning, and then to freeze for shipment, which is exactly what we want. The Vit D tests are shipped to their lab in London, Ontario. Most results are received in 3-5 business days. These tests ARE covered by Ontario health insurance (OHIP). If you are not covered by any insurance plan, the tests cost $51.70 each (CND).
For US patients interested, Gamma-Dynacare has service centers in Kingston and Windsor, Ontario, which are both near US/Canada border crossings (New York and Michigan). I'm not sure if there are any regulations against crossing the border for a blood test.
One side note: If your doc is testing you for Sarcoidosis and requests an ACE test, check to see if it is covered under your insurance first. It is NOT covered by OHIP (cost is $35), and is not a very reliable indicator of Sarc anyway. ~Alison
6-22-07 I just wanted to re-butt my previous statements. Gamma-Dynacare didn't turn out to produce reliable results with regard to 1,25D. A better lab in Ontario, BC and Quebec is LifeLabs. The Ontario health plan (OHIP) covers both D-tests.~Alison
Check with other members
Private messaging other members may bring you some information about local labs. To find other members who live near you:
a. Click on your screen name and select “View Profile”
b. Click on the information in the “Location” field. If you click on the city, you will get a list of people who live in that city. If you click on the state, you will get a list of people who live in that state. If you click on country, you will get a list of people who live in that country.
HOW TO FIND OTHER MEMBERS IN YOUR AREA
Please fill out your profiles if you want people to be able to find you!
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Barb: Dx Inflammatory Disease Endocrine Imbalance 2003| Depression| 24+ years not Dx| MP Aug04| ABC of MP| MP Search|
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Meg Mangin R.N.
Former Team Member
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Posted: Thu Jun 2nd, 2005 04:51 |
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filelink
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Nothing contained in this site is or should be considered, or used as a substitute for, medical advice, diagnosis or treatment by your physician.
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Meg Mangin R.N.
Former Team Member
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Posted: Fri Apr 14th, 2006 21:13 |
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The value of testing cytokines
Most of the cytokines are not testable in the circulation, or, if they are, their values are meaningless. That is why the CFS practitioners are endlessly arguing over some sort of supposed Th1/Th2 imbalance - truth is they can't measure what they are talking about, and therefore conjecture continues to build upon conjecture.
The prototypical Th1 cytokine is Interferon-gamma, which has to be sampled from the inflamed tissue. Luckily it catalyzes the production of 1,25-D in the infected cells by a factor as high as 30 times. So 1,25-D can be measured as a proxy for Interferon-gamma's presence.
..Trevor..
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Nothing contained in this site is or should be considered, or used as a substitute for, medical advice, diagnosis or treatment by your physician.
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Meg Mangin R.N.
Former Team Member
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Posted: Fri Aug 11th, 2006 22:33 |
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(filelink)
Last edited on Wed Feb 7th, 2007 05:25 by Meg Mangin R.N.
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Nothing contained in this site is or should be considered, or used as a substitute for, medical advice, diagnosis or treatment by your physician.
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Belinda
Former Team Member
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Posted: Wed Nov 1st, 2006 00:54 |
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(filelink)
Quest confirms 1,25-D sample still needs to be frozen for shipment
I had a conversation today with Elaine Phillips at Quest. She verified Quest's advice regarding specimens collected for the 1,25-dihydroxyvitamin D test is unchanged: the specimen is stable 3 hours at room temperature, or 3 days refrigerated, or one year frozen.
Most local Quest labs DO NOT run the 1,25-D test. Quest transports nearly all 1,25-D testing to their laboratory in San Juan Capistrano, California. The Teterboro, NJ lab does run 1,25-D tests for the immediately surrounding area. That means that MOST specimens are transported to California, requiring that they be frozen shortly after the blood draw to ensure quality readings.
We informed Ms. Phillips that Quest's online lab instructions regarding transport temperatures for the 1,25-D tests was either lacking information or included erroneous information relative to the following local Quest labs:
- Sacramento, CA
- Lenexa, KS
- Baltimore, MD
- Teterboro, NJ
- Las Vegas, NV
- Syossett, NY
- Portland, OR
- Erie, PA
- Pittsburg, PA
Ms. Phillips is going to work to get this online information corrected to specify that the specimen must be FROZEN for transport (except for locations close to the labs doing the test) and that specimens received thawed or at room temperature will be rejected.
Meanwhile, many physician offices will be consulting Quest's printed lab guidelines. Once the online guides are corrected, the printed guidebooks will eventually be corrected.
FYI: Until corrections are in place:
If your physician's office consults one of the local Quest labs listed above or the printed guide, they may get incorrect information regarding preparation of the specimen for transport.
It is my understanding that the medical provider's office staff should call and request dry ice for shipment prior to specimen pickup via laboratory dispatch.
Belinda
Belinda verified that Quest has not changed their requirement for 1,25-D serum to be frozen during transit.
Belinda also has identifed that United Health Care ended their contract with Quest in 2006, and that means 1,25-D tests may be an insurance issue to remember and deal with in 2007.
[FILE LINK HERE]
Takeaway:
You do need to have 1,25-D tested, but not nearly as often as 25-D.
[FILE LINK HERE]
When you do get your 1,25-D tested, insist that Quest do it.
Quest may be more pricy or a problem with insurance if you have United Health Care coverage, so you don't want that test botched because some technician got a bad info set from Quest and is following that. Take the information from Belinda and Quest when you go to have the test done, and insist that the instructions are followed.
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Meg Mangin R.N.
Former Team Member
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Posted: Sat Nov 4th, 2006 15:00 |
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(filelink)
Quest labs verifies low 25-D in Th1 inflammation
From the Quest Diagnostics Lab manual online.
http://tinyurl.com/y84t7v
Under the 25-D test interpretation, they write, "In diseases that increase vitamin D metabolism such as obesity and sarcoidosis, blood levels of 25D are often decreased..."
.....................................
The widespread supplementation of Vitamin D into the food supply makes analysis of 25-D data problematic. The many variations in diagnosis related to symptoms makes comparison of 25-D between disease groups imprecise and irrelevant.
You will find details regarding D tests above.
The quote from Quest labs is a gem because they are inadvertantly recognizing the relevance of low 25-D to disease even if they don't understand why.
Most of our members with a variety of diseases have elevated 1,25-D.
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Nothing contained in this site is or should be considered, or used as a substitute for, medical advice, diagnosis or treatment by your physician.
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Meg Mangin R.N.
Former Team Member
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Posted: Fri Jul 27th, 2007 20:07 |
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[filelink]
Measurement of D2 and D3
D2 (ergocalciferol) isn't usually added to dietary sources.
D3 (cholecalciferol) is a chemical added to food as a vitamin D supplement.
Both are forms of 25-D and both are measured when a 25-D test is done.
Mayo and Quest labs now show these two values (D2 and D3) separately in the 25-D test results.
Quest is assigning the values of these numbers to certain factors in an apparent attempt to determine vitamin D supplement compliance. Their report states:
"Measurement of 25-OH2 is an indicator of compliance with supplements. Levels >4 ng/mL suggest compliance." However, we usually see levels of D2 less than 4ng/ml even when massive supplementation is reported.
Quest also states "25-OHD3 indicates endogenous production." We often see this level high when supplementation is reported.
Because most of the results of serum D2 we have seen do not correlate with vitamin D supplement intake, we believe breaking down the 25-D measurement into D2 and D3 has no practical application.
Please refer to these tests in your reports as simply 25-D.
All forms of Vitamin D should be considered when trying to achieve the desired goal of maintaining the total 25-D at 12ng/ml or lower. See Stores of D gradually drop
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Nothing contained in this site is or should be considered, or used as a substitute for, medical advice, diagnosis or treatment by your physician.
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Meg Mangin R.N.
Former Team Member
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Posted: Fri Jul 27th, 2007 20:10 |
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[filelink]
Variations inherent in 25-D test results
I spoke with a doctor with Quest Labs and he told me that near the top and bottom end of the range for 25D there is quite a bit of variability/error due to laboratory methodology -- one is limited by the inherent sensitivity of the testing method.
In other words, if they do repeat tests for 25D taken from a single blood sample, they would get a certain amount of variation in their test results among the various 25D determinations using their laboratory methods. So, especially at low levels, near the bottom end of the range, even if it were to change by 3 ng/ml, for example, one could not be sure that it had really changed at all, since there is quite a lot of variation due to the nature of the lab test, especially near the limits of its range.
If the level increases or decreases by a few ng/ml according to the test results, in actuality, one would not know if that was a real increase/decrease or if the change was an artefact of the limited sensitivity of the test. One can really only rely on fairly large changes as being meaningful. One should not over interprete (or worry too much) about small changes, especially at the lower limits of the tests range which MPers are striving for.
With the 1,25D levels he told me the Coefficient of Variation (CV) was around 25% (the standard deviation divided by the mean in % terms) and this was similar across its entire range.
~Joyce Waterhouse, PhD
____________________
Nothing contained in this site is or should be considered, or used as a substitute for, medical advice, diagnosis or treatment by your physician.
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