chronobiology 7

© 2011 Diagnos-Techs, Inc. All rights reserved. . www.diagnostechs.com � 1.800.878.3787

NEW BROCHURES FOR PROVIDERS AND PATIENTSFeaturing our new Food Intolerance Panel™ brochure

ChronoBiologyFebruary 2011 ▎ 7th Edition

LETTER

Why Choose Diagnos-Techs™?Ongoing Research and DevelopmentMichael Everitt, PhD

The Research and Development program at Diagnos-Techs™ is focused on testing that achieves and relates to wellness.

Currently, the laboratory measures hormone and

IgA antibody levels, examines stool samples and provides information about how the various measurements relate to the wellness of individuals. Diagnos-Techs™ maintains an ongoing program to investigate additional testing to improve the clinical support of this endeavor and is looking to expand the Adrenal Stress Index™ (ASI™) panel through the addition of more adrenal, hypothalamic and pituitary hormones. There is interest in the hormones related to body mass and nutrition such as the leptin

Lab NewsVITAMIN D TEST

COMING SOON!

Vitamin D is a fat-soluble vitamin that helps the body absorb calcium

and keep the right amount of calcium and phosphorus in the blood. Soon Diagnos-Techs™ will be offering a

Vitamin D Health Test to providers for their patients. For more information about Vitamin D, see page five.

A WORD FROM THE PRESIDENT…

Welcome to a new year and the 7th Edition of ChronoBiology Letter. In this issue, we present an interesting case study

featuring the Gastrointestinal Health Panel™ and ways to diagnose and treat abdominal distress.

Research suggests that vitamin D could play a role in the prevention and treatment of a number of conditions, such as type 1 and type 2 diabetes, hypertension, glucose intolerance and multiple sclerosis. Diagnos-Techs™ will soon be offering a vitamin D test to provide you with more ways to help your patients achieve wellness.

Thank you for choosing Diagnos-Techs™. We are committed to providing quality testing services to you and your patients to restore health and vitality.

Sincerely,

Elias Ilyia, PhDPresident, Diagnos-Techs™

• Cortisol x4• DHEA + DHEA(S)• Insulin x2• 17-OH Progesterone• Gluten Ab • Total Secretory IgA

• Stool culture for yeast• Chymotrypsin• Ova and parasites• Occult Blood• Bacterial stool pathogens• Fecal pH• Clostridium difficile Antigens• Total Intestinal SIgA• Tape Worm

• Giardia Antigen• Intestinal Lysozyme• Cryptosporidium Antigen• Alpha Anti-Chymotrypsin• Amoeba histolytica Ab• Gluten Intolerance Test• H. pylori Ab• Round Worm• Tissue Worm

• DHEA + DHEA(S) • Testosterone• Estrone• Estradiol• Estriol• Progesterone• LH• FSH

• DHEA + DHEA(S)• Androstenedione• Testosterone• Dihydrotestosterone• Estrone• Progesterone• LH• FSH

Adrenal Stress Index™

Expanded Gastrointestinal Health Panel™

Expanded Post Menopausal

Hormone Panel™

Expanded Male Hormone Panel™

GI-02 eMHPePostMASI

Flexi-Matrix™

“Build Your Own Panel”

• 17-OH Progesterone• Total Secretory IgA

• Ova and parasites• Fecal pH • Giardia Antigen

• Testosterone• Estrone• Estradiol

• Testosterone• Dihydrotestosterone

19110 66th Avenue South, Building G Kent, Washington 98032 USA

www.diagnostechs.com

LA B O R A T O R Y

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

THE LEADING LAB IN SALIVA TESTING SINCE 1989

DiagnosTechsTM

IN THIS EDITION

2 • Case Study Diagnosing Colitis Using Diagnos-Techs’™ GI Panel

4 • Educational Pathways 2011 Spring Conference Schedule Office Visits, On-line Meetings In-house Seminars with Dr. Dent

• Our Medical Advisors Meet Dr. Rafik Kamelman

5 • Lab News New Test–Vitamin D ASI Reminders/Discussion Points

6 • Tips from Customer Service

• Submitting Samples

• Clinical Pearls

7 • Resources for You Insurance Billing, Technical Services, Shipping, Contact Info

Back • Flexi-Matrix™ Panel Page “Build Your Own Panel”

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103411 13M 02/11 05_DTI/chrono#7

Flexi-Matrix™ test kits allow you to combine more than one panel, with the exception of BHP, FHP, eFHP, PeriM and ePeriM. When combining panels, be sure to include the individual tests listed under each of the panels. Flexi-Matrix™ customized test kits are the most economic way of customizing test panels and profiles to meet your clinical needs, saving you 20-70% off individual test fees.

Flexi-Matrix™

Customized Test Panels

n Choose 3 or more individual tests from the list shown on pages 4-6 of the Test and Fee Schedule. (Excludes DPD Bone Marker Test and CS3 Swab Culture for Yeast.) n Be sure to read detailed instructions and fill out the requisition form included in each collection kit. n You will always receive the lower price when your customized panel is identical to a standard panel.

Food Intolerance PanelTM

The Science of Laboratory Medicine

What We Test for and Why We Test it

Gluten intolerance

Gluten intolerance is a more common disorder than

previously reported in the scientific literature. Genetic

predisposition is common in individuals of northern European

descent (Celtic and Nordic) and in non-Caucasian and

Mediterranean ethnicities. Historically, the diagnosis relied on

invasive intestinal biopsy. A normal biopsy, however, does not

exclude the disease. With the advent of biochemical markers

(saliva SIgA) for gluten intolerance, several studies have

proven the presence of various forms of gluten intolerance in

12%-18% of the US and EU populations.

Cow’s milk intolerance vs. lactose intolerance

Cow’s milk intolerance is a specific genetically dictated

intolerance to the major milk protein known as casein. It is

defined as cow’s milk-(and cow’s milk-based dairy) induced

intestinal damage that is reversed by a cow’s milk-free

diet and returns with exposure. Milk intolerance is caused

by casein and other milk antigens/proteins in genetically

predisposed individuals. Casein triggers a toxic reaction in

the intestine that stimulates a gut-specific antibody called

secretory IgA, which we test for in saliva. In severe cases, the

problem is apparent at an early age (<3 years of age).

Casein is the substance in milk that

triggers a toxic reaction in the intestine of

those who are intolerant of cow’s milk.

Egg intolerance

Egg intolerance is defined as egg white-induced intestinal

damage that is reversed by an egg-free diet and returns

on challenge with eggs. It is an abnormal inflammatory

response to ovalbumin in genetically predisposed

individuals. Ovalbumin in chicken (and most other bird eggs)

can trigger a toxic reaction in the intestine that produces

secretory IgA antibodies, which we test for in saliva.

Soy Intolerance

It is defined as soy protein-induced intestinal damage that

is reversed by a soy-free diet and returns on challenge with

soy. It is an abnormal response to soy proteins in genetically

predisposed individuals. This is a problem that is on the

rise in the US. Soy protein is a relatively new food/food

additive in the US, and the long-term health effects for the

US population are not yet clear. However, if your saliva test

is positive, you may want to read food labels more carefully.

In severe cases, the problem is apparent at an early age (<3

years of age). In milder cases, patients may be completely

asymptomatic and may not become aware of the problem

until adulthood through objective testing using salivary

secretory IgA.

In conclusion…

Food intolerances are more common than publicly realized.

They may be treated following appropriate testing and

recognition which requires a single saliva sample.

www.diagnostechs.com • 1-800-878-3787

©2010 Diagnos-Techs, Inc. All rights reserved36310 5M 10/10 03_DTI/fip_patient

19110 66th Avenue South, Building G

Kent, Washington 98032

Major Accreditation

Diagnos-Techs is the only salivary-based lab that is

accredited by the Joint Commission and is committed

to providing its healthcare professional clients with lab

testing that is highly accurate, based on pure science and

designed to assist in restoring optimal health and promoting overall

wellness for patients.

Licensure and Proficiencies

Also accredited and licensed by the State of Washington (License

No. MTS-0327), subject to the Clinical Laboratory Improvement

Act of 2003 (CLIA-2003) certification. Our Federal CLIA Number

is 50D0630141. External proficiency testing obtained from the

College of American Pathologists, American Proficiency Institute

and American Association of BioAnalysts.

continued on page 5

Providers may order up to 50 complimentary patient brochures.

Here's how:

❶Phone 1-800-878-3787

❷Fax 253-398-2449

❸Email [email protected]

❹Download ready-to-print brochures by clicking the ”client tools“ tab after logging in on our web site at www.diagnostechs.com

Did You Know?The Advantages of Saliva Testing:Non-Invasive • No blood draw needed

Convenient • Specimens easily collected at home

Precise • Tissue level measurement of biologically active fraction of steroid hormone• Convenient multiple sample collection• Samples stable for several weeks

Online Meetings & Office Visits with our Medical Advisors

Online meetings offer an overview of our test panels and sample reports to familiarize clients with how to use them with an opportunity to ask questions.

Office visits provide local clients the opportunity to receive information on testing and how to further integrate our lab into their practice.

To schedule an appointment, please email Tomomi at [email protected].


ChronoBiologyLETTER February 2011 ▎ 7th Edition

How to Reach UsBusiness Hours 7:30am–5:00pm Pacific Standard Time (PST) Monday through Friday, except major holidays

Corporate Address 19110 66th Avenue S., Building G Kent, WA 98032 USA

Customer Service p 800-878-3787 f 425-656-2871

p 425-251-0596

Shipping p 800-878-3787 f 253-398-2449

Technical Services p 800-878-3787 f 425-251-0637

Lab Address Sample Processing 6620 S. 192nd Place, Building J-106 Kent, WA 98032 USA

Monday-Saturday USPS Deliveries P.O. Box 389662 Tukwila, WA 98138-9662 USA

Visit Diagnos-Techs™

Onlinewww.diagnostechs.com

2 7

Technical Services

Tips for SuccessnWe must have at least two forms of written patient ID, name and date of birth on all vials and order forms to process samples.

n Patients should not contact the lab for treatment related questions. Please advise patients to consult with you if they have any treatment related questions pertaining to collection. Medical support is available for provider questions about drug interactions at 1-800-878-3787.

n Review patient medication list. This will help your patients to understand what to avoid before taking our tests.

n Have your account number or accession number ready before you call.

n Share this newsletter with authorized staff. This information will help employees who call on your behalf.

n Sign up to access results online. Call Customer Service for password, 1-800-878-3787.

DIAGNOS-TECHS™ RESOURCES FOR YOU ▼

Contact Us

Shipping

Billing

Courtesy Service FROM OUR TEAM OF INSURANCE SPECIALISTS

Our dedicated team of Insurance Specialists is trained to assist you with any insurance-related questions you may have. We prevent payment processing challenges by helping you and your patients navigate through the maze of test codes and fees.

As a courtesy, we will submit claims to most insurance companies at our clients’ and patients’ requests. In addition, we are able to bill Insurance carriers for all referring doctors, nurse practitioners and registered nurses. We are able to advise you on which services are billable. Although we are a non-contracted provider with all insurance companies (with the exception of Medicare), most insurance carriers offer coverage on our services and are billable. Depending on a patient’s benefit plan, insurance companies usually cover our tests at the maximum allowable rates so that our patients will have no out-of-pocket expenses.

Patient Insurance DisclaimerDiagnos-Techs™, Inc. is a non-contracted

provider with all insurance companies.

Please verify your out-of-network benefits

including out-of-network deductibles

and co-insurances by contacting your

insurance carrier. Diagnos-Techs™,

Inc. will bill your insurance at the

retail price per line item. If deductibles

and/or co-insurances are applied,

Diagnos-Techs™, Inc. is obligated in the

state of Washington to collect by law.

Free Return Shipping on returned domestic test kitsSTORAGE & MAILING INSTRUCTIONS FOR ALL SPECIMENSn Ship samples on the same day as last sample collection (preferred).n If not, refrigerate samples and ship within 3 days. No ice bags are required during shipping.n Write the patient’s name and address on the outside of box.n Include all samples, test form, and if applicable, a check or a copy of the front and back of insurance card together inside the supplied box. Please be sure to seal the box with clear tape before shipping. • US Domestic: Deliver completed test kit box to any Post Office (not mailbox). Return shipping to Diagnos-Techs™ is PRE-PAID. Kits are delivered to our P.O. Box by USPS Monday–Saturday. • International: Delivery charges still apply. International deliveries should be addressed to the physical address only, which is located to the right. Do not address to the PO Box. Deliveries can be made Monday through Friday via a private courier of your choice.

INTERNATIONAL COURIER SHIPPING

Diagnos-Techs™, Inc.Sample Processing

6620 S. 192nd Pl., #J-106Kent, WA 98032 p 425-251-0596

Diagnosing Colitis Using Diagnos-Techs™ Gastrointestinal Health Panel™

Kamal Henein, MD Raymond Dent, ND

Test Name Result / NotesCode Reference Values/Key

09-GI-02Accession: Continue Results For: NO NAME, NO NAMEDiagnos-Techs, Inc.

1) Prolonged gut transit time > 96 hrs. 2) Deficiency in SIgA production due to reducedIgA immunocytes count. 3) Elevated cortisol/DHEA ratio.For cortisol/DHEA refer to ASI.

9MB3 Normal: <6 mg% dry wtBord. Elevated: 6-8 Elevated: >8

Intestinal Lysozyme (Stool)

Elevated lysozyme indicates an ongoing colonic inflamation.The literature indicates that certain nonpathogen mediated colonic inflammation can beameleorated by retention enemas of mixed short chain fatty acid solutions.

190MB4 Normal: <60 mg% dry wtBorderline Elev.: 60-100 Mild/Distal Colitis: 100-180 *Colonic Inflammation: >180 *

Alpha Anti-Chymotrypsin (Stool)

* Applicable with elevated lysozyme; small intestine irritation with normal lysozyme.

14FG1 Normal: >9 U/10gLow: 4-9 Abnormally Low: <4

Chymotrypsin (Stool)

Chymotrypsin is a marker enzyme for pancreatic exocrine output.

NegativeFG4 Normal: Negative.Occult Blood (Stool)6.8FG5 Normal: 5-8.5Fecal pHPositiveFI1 Normal: Negative.Milk (Casein) Ab. SIgA (Saliva)NegativeFI2 Normal: Negative.Soy (Protein) Ab. SIgA (Saliva)NegativeFI3 Normal: Negative.Egg (Albumin) Ab. SIgA (Saliva)30 PositiveFI4 Borderline: 13-15 U/ml

Positive: >15 U/mlGliadin Ab, SIgA (Saliva)

Gliadins are polypeptides found in wheat, rye, oat, barley, and other grain glutens, andare toxic to the intestinal mucosa in susceptible individuals.Healthy adults and children may have a positive antigliadin test because of subclinicalgliadin intolerance. Some of their symptoms include mild enteritis, occasional loosestools, fat intolerance, marginal vitamin and mineral status, fatigue, or acceleratedosteoporosis.Scan. J. Gastroenterol. 29:248(1994).

Not detectedASC Normal Result: Not detectedRoundworm (Ascaris lumbricoides)SIgA (Saliva)

Not detectedT-SOL Normal Result: Not detectedTapeworm (T.solium) SIgA (Saliva)Not detectedTRIC Normal Result: Not detectedTrichinella spiralis SIgA (Saliva)

Not Provided To The Lab.Diagnosis Code:

COURTESY INTERPRETATION of test and technical support are available upon request, to Physicians Only.

Please Note: All examples of patient treatment or therapy are for illustrative and/or educational purpose. Use this report in contextof the clinical picture and patient history before initiating hormone or other therapies or recommendations.

2 Copyright DTI 1991 - 2010©

01/01/2009

Diagnos-Techs, Inc.Clinical & Research Laboratory

Completed: 08/12/200909-GI-02Received :

Accession #

PO BOX 389662, Tukwila, WA 98138-0662

CLIA License # 50D0630141Tel: (425) 251-0596

Results For:.6620 S 192ND PL # J-104

KENT WA 98032USA Tel: 425-251-0596 Fax: 425-251-9520

DIAGNOS-TECHS, INC.

Not Provided

Patient's Tel:

Reported : 12/21/2010

01/01/2009Specimen Collected:

Age:NO NAME NO NAME

Gender:


GI-02 Expanded GI PanelNo yeast isolatedCS1 +1=Trace +2=Light +3=Moderate

+4=Abundant +5=ConfluentStool Cu. Fungi, Isol. & I.D.

No ova or parasitesGP2 Ova & Parasites, x3 (Stool)Moderate mixed Gram negative rods/flora.Moderate mixed Gram positive rods/flora.

Pathogens/Bacterial Overgrowth Detected:---------------------------------------------------------Klebsiella/Enterobacter/Serratia Group. -ModerateAlpha Hemolytic Streptococcus - ModerateGamma Hemolytic Streptococcus - Rare

Other Findings:---------------------Non pathogenic E. coli - Rare

GP3 Expected Findings:- Moderate to abundant growth of mixed Gram (+) & (-) flora- No pathogens should be detected.

Bacterial Stool Cu.

In general, early disturbances in microfloral balance may be reflected in the nonexpected and selective overgrowth of microbial species that are usually non dominant.

Please note: As of February 2005, GP3 report has been made more comprehensive toreflect all observed findings + isolates.GP3 test performed by Lab.Corp. of America, Seattle WA or PPL Lab., LynnwoodWA.

NegativeGP3CD Normal: NegativeC. Difficile: Toxins A & B (Stool)Testing Toxins A+B yields 99% sensitivity; single toxin test yields 83%.

NegativeGP4 Normal: NegativeGiardia Antigen (Stool)NegativeGP5 Normal: NegativeCryptosporidium Antigen (Stool)NegativeGP6S Normal: NegativeToxoplasma Ab, SIgA (Saliva)Not detectedGP7S Normal: Not detectedAmeba histolytica Ab, SIgA (Saliva)<3GP8S Negative: < 3 U/ml

Borderline: 3-5.5 U/mlPositive: >5.5 U/ml

Helicobacter pylori Ab, IgG (Saliva)

250MB2 Low: <400 mg% dry wtNormal: 400-880 Elevated: >880

Total Intestinal SIgA (Stool)

Depressed SIgA may be due to :


Figure 1

For 11 months a 56 year old woman has been complaining of diarrhea and abdominal pain. Her bowel movements occur five to six times a day and are watery, non-bloody and not foul smelling. The diarrhea is intermittent and sometimes interferes with her sleep–leaving her feeling weak, tired and sleepy during the day. She also complains of joint pain and mild abdominal pain that is not relieved by her bowel movements.

Her medical history is positive for hypothyroidism for which she takes Synthroid 50 mcg/day, and hypertension treated with Atenolol 50 mg/day. She also takes Omeprozole 20 mg for heartburn, Ibuprofen 200 mg twice a day for her joint pain and Celexa 20 mg/day for depression. She has no known drug allergies. She is married with two children, holds an office job, drinks filtered municipal water, does not smoke and drinks one to two beers a week. She has not travelled recently and has had no wilderness exposure.

Physical examination reveals a middle-aged woman who appears mildly underweight, in moderate discomfort, but in no significant distress. Her abdominal examination shows no distention and was soft with no rebound tenderness. She has hypoactive bowel sounds and peri-umbilical tenderness to palpitation.

Otherwise, her examination was unremarkable.

Pertinent laboratory findings included:

LABSWBC 11,500 mm 6,300-10,800 mL

Hematocrit 38% 37-48%

Sodium 136 mEq/L 135-145 mEq/L

Potassium 3.8 mEq/L 3.5-5.0 mEq/L

Chloride 97 mEq/L 98-106 mEq/L

Bicarbonate 19 mEq/L 18-23 mEq/L

Serum Lab Results

A colonoscopic examination found a macroscopically normal colonic epithelium, with the exception of diffuse patchy erethema.

A Diagnos-Techs™ Expanded Gastrointestinal Panel™ (GI-02) was ordered, which generated the following results: (see Figure 1)

The findings (elevated alpha antichymotrypsin, elevated lysozymes, low intestinal SIgA, anti-gliadin antibodies elevated at 30, positive

MB2 Total Intestinal SIgA (Stool) 250 Low: <400 mg% dry wt Normal: 400-880 Elevated: >880

Diagnos-Techs™ Expanded Gastrointestinal Panel™ (GI-02) Report

FI1 Milk (Caseiin Ab, SIgA (Saliva) Positive Normal: Negative

MB4 Alpha Anti-Chymotrypsin (Stool) 190 Normal: <60 mg% dry wt Bord. Elevated: 60-100 Mild/Distal Colitis: 100-180* Colonic Inflammation: >180*

GP3 Bacterial Stool Cu. Moderate mixed Gram negative rods/flora. Moderate mixed Gram positive rods/flora

Pathogens/Bacterial Overgrowth Detected:

Klebsiella/Enterobacter/Serratia Group–Moderate Alpha Hemolytic Strepococcus–Moderate Gamma Hemoytic Streptococcus–Rare

Other Findings:

Non pathogenic E. Coli–Rare

Expected Findings:

-Moderate to abundant growth of mixed Gram (+) & (-) flora

-No pathogens should be detected

Reference Ranges

FI4 Gliadin Ab, SIgA (Saliva) 30 Positive Normal Result: Not detected Normal Result: Not detected

MB3 INtestinal Lysozyme (Stool) 9 Normal: <60 mg% dry wt Bord. Elevated: 6-8 Elevated: >8


GI

ASI


Clinical Pearls INFORMATION TO BUILD ON

6 3

WHEN YOU CALL…please have your account number available .

REQUEST A PRICE LIST

Please note, we do not quote patient pricing over the phone. If your office needs a current price list, call 1-800-878-3787 to request a price list be e-mailed, faxed or mailed to your office.

Issue #7 Chronobiology Letter is published quarterly by Diagnos-Techs™ Laboratory, Inc. in Kent, WA, USA, as an educational resource for our health care clients. The information in this newsletter is not to be construed as medical advice.

Diagnos-Techs™, Inc. 19110 66th Ave. S, Bldg. G, Kent, WA 98032 USA

� Printed on recycled paper.

© 2011 by Diagnos-Techs™, Inc. All rights reserved.

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DOWNLOAD A PRICELIST

Our current price list is

now available to download as a PDF file. Visit

us online at www.diagnostechs.com

and go to Providers and click on Provider Login. Then login with your account number and click on Client Tools, where you can download and print the price list.

Tips from Customer Service

A D R E N A L S T R E S S I N D E X

G A S T R O I N T E S T I N A L H E A LT H

Guidelines for SUBMITTING Samples SIgA to casein and bacterial dysbiosis) led to the diagnosis of non-specific colitis. She was advised to avoid eating gluten and dairy products and to discontinue the use of Ibuprofen. A course of probiotics, digestive enzymes, natural anti-inflammatory supplements, (e.g. Boswellia) and vitamin B12, led to the normalization of alpha-antichymo-trypsin and lysozymes, evidenced on the follow-up test. Her diarrhea and abdominal pain improved within days after initiating therapy, and her joint pain resolved over a period of about two weeks.

Follow up testing was completed three months post-treatment. The results showed that the inflammatory markers had all normalized, the intestinal SIgA was trending toward normal and the anti-gliadin antibodies had decreased to six (negative).

DISCUSSIONDiagnosing and treating abdominal distress in its various forms can prove to be a challenge to the clinician. In evaluating the case under consideration, important elements of the patient’s clinical presentation and history are noteworthy. An absence of travel out of the United States would weigh in favor of a non-parasitic infection as would the absence of positive findings on the GI-02 panel relating to multicellular and monocellular infectious organisms. No clinical signs of an acute abdomen were noted, and serology did not demonstrate definitive evidence of acute infection. Electrolyte derangement was broadly present, consistent with the history of diarrhea. Mild metabolic acidosis was also a factor evidenced by the depressed bicarbonate readings. The lack of occult blood and offensive odor also weighed in

favor of a non-infectious pathology. The inflammatory markers measured on the GI-02 panel demonstrated elevated anti-alpha chymotrypsin and intestinal lysozyme. These findings are consistent with accelerated degradation of both colonic and small intestinal epithelium. The mildly elevated anti-gliadin antibody levels (via salivary IgA) are consistent with early stage immune responses to gluten. The damaged enteric mucosa is a possible result of long-term Ibuprofen exposure. Compromised levels of intestinal SIgA levels were consistent with a non-infectious etiology as well as deranged mucosal integrity secondary to long-term NSAID use.

A noteworthy relationship regarding the abatement of the patient’s joint pain is the systemic inflammatory condition possibly induced by exposure to gluten and casein. Both of these antigens tested positive on the GI-02 panel and may have been underlying triggers of her arthritic symptoms.

Diarrheal diseases are common in older populations. At any one point in time, ~9% of an older out-patient population will experience diarrhea. Recent studies suggest that microscopic colitis (MC) is the cause of chronic diarrhea in 10-30% of older patients investigated with an endoscopically normal appearing colon. Although there are different causes for chronic diarrhea, MC is increasingly recognized as a major diagnostic entity in older individuals.

Microscopic colitis is bowel inflammation that is only visible using

a microscope. It is a less severe type of inflammatory bowel disease with normal endoscopic appearance of the colon and a comparatively benign course that is not associated with malignant transformation.

For unknown reasons, the incidence of microscopic colitis increases in the elderly. This is more common in women, with a female to male ratio reaching 7.9 to 1 in certain subtypes of microscopic colitis. Autoimmune diseases, particularly thyroid and/or celiac disease, are associated with this type of colitis. In a recent epidemiological study of 164 patients with MC, 11.0% had a prior diagnosis of hypothyroidism.(1) Other studies have supported that celiac disease is found in up to 23% of patients with microscopic colitis.(2,3) There is also a link between the use of several medications and microscopic colitis. A recent study showed that those with microscopic colitis more commonly consumed NSAIDs, SSRIs and beta-blockers.(4)

Pre-collection:

When filling out forms:

Lab Code

Laboratory Test Name*

Test

Fee

CPT CodesTest D

escription for Billing

ICD.9.CM

Gastrointestinal–Infectious Diseases Tests | Stool

CS1Stool Culture, yeast a

nd fungi

(Brown A vial x 1)

$36

87102

87106

Culture, stool, fu

ngi

islolation

Culture, stool, fu

ngi ID

112.85

536.8

564.1

528.00

462112.0

691.0

569.42

Candidal enteritis

Digestive tract irritation

Irritable colon, spastic or mucus

Inflammation, mouth

Inflammation, pharynx

Oral (or throat) candida

Rash–diaper

Rectal pain

GP3Stool culture, bacteria & flora

(Brown A vial x 1)

$4487045 & 87046

Culture bacteria, stool

009.0

009.2

009.1

Colitis, infectious

Diarrhea, infectious

Gastroenteritis,

infectious

GP3CdClostrid

ium difficile Toxins A&B

(Brown B vial x 1)

$42

87324Immunoassay Clostrid

ium

Toxin

008.45

009.0

Clostridium difficile, colitis

Colitis, infectious

Gastrointestinal–GI Functional Markers Tests | Stool

FG1Chymotrypsin

(Brown A vial x 1) $35

84490Trypsin, feces, quant.

578.1

783.21

579.8

579.4

787.3

564.00

536.8

536.8

579.8

Blood in stool

Abnormal weight loss

Decreased tolerance to fats

Fatty stool, pancreatic

indigestion

Flatulence, gas or bloating

Constipation, unspecified

Gastric irrita

tion

Hypermotility, ie. reduced transit

Intestinal malabsorption

FG4Occult Blood


82270Occult Blood, feces

FG5Fecal pH


83986pH test, st

ool

MB2Total Intestinal SIgA

(Brown A vial x 1)$42

83883Nephelometry,

Immune globulin A

279.01 Selective IgA

Immunodeficiency

MB3Intestinal Lysozyme


85549Lysozyme (muramidase)

inflammation marker

558.3

009.0

556.0

009.2

564.1

Colitis, allergic

Colitis, infectious

Ulcerative enterocolitis


Irritable bowel syndrome

MB4Intestinal Alpha Anti-C

hymotrypsin

(Brown A vial x 1)

$4283883 (83883-91

in panels)

Nephelometry, Alpha

Anti-Chymotrypson

Lab Code


Test

Fee

CPT CodesTest D


ICD.9.CM

Adrenal & Stress Hormone Tests | Saliva

CORTCortiso

l – 6am-8am (Blue H vial x 1) $39

82530Cortiso

l, Free

CORTCortiso

l – 11am-1pm (Blue H vial x 1) $39

82530Cortiso

l, Free

CORTCortiso

l – 4pm-5pm (Blue H vial x 1) $39

82530Cortiso

l, Free

CORTCortiso

l – 10pm-Midnight (Blue H vial x 1)$39

82530Cortiso

l, Free

DHEADHEA & DHEA-S pooled value

(Blue H vial x 2)

$50

82626DHEA

704.1 Hirsutism

P17-OH17-OH Progesterone (Blue H vial x 1) $46

8349817-Hydroxyprogesterone

255.2 Congenital adrenal

hyperplasia

Metabolism Module Tests | Saliva

ISNInsulin(Fasting) (Blue H vial x 1) $30

83525Insulin, Total

250.0

251.1

251.2

Diabetes

Hyperinsulinism

Spontaneous hyperinsulinism

ISN Insulin (Non-Fasting) (Blue H vial x 1) $30

83525Insulin, Total

250.0

251.1

251.2

Diabetes

Hyperinsulinism


Food Intolerance & Immunity Tests | Saliva

FI-1Cow’s m

ilk (Casein) Ab, SIgA

(Blue HC vial x 1)

$33

83516Casein Antibody

579.0

995.67

995.68

995.69

Celiac Disease

Hypersensitivity, milk products

Hypersensitivity, egg products

Hypersensitivity due to other

specified food

FI-2Soy protein Ab, SIgA

(Blue HC vial x 1) $33

83516Soy Antibody

FI-3Egg (Albumin) Ab, SIgA (Blue HC vial x 1) $33

83516Egg Albumin Antibody

FI-4Gluten (Gliadin) Ab, SIgA (Blue HC vial x 1) $33

83516Gluten (Gliadin) Antibody

MB2-STotal Salivary SIgA

(Blue H vial x 1) $42

83883Nephelometry, Secretory


immunodeficiency

Gastrointestinal–Parasitic & GI Diseases I Tests | Saliva

GP6-SToxoplasma gondii–Ab, SIgA

(Blue H vial x 1)

$42

86777Tosoplasma Antibody

130.7

006.1

536.8

535.40

787.1

127.0

123.0

123.1

728.11

124

Toxoplasmosis

Chronic ameba

Gastric irrita

tion

Gastritic

Heartburn

Ascaris lumbricoides infection

Taenia solium (Intestinal form)

Taenia solium (Larval form)

Myositis

Trichinosis

GP7-SAmoeba histolytica–Ab, SIgA

(Blue H vial x 1)

$42

86753Amoeba histolytica

Antibody

GP8-SHelicobacter pylori Ab, IgG

(Blue H vial x 1)

$42

86677Helicobacter pylori

Antibody

ASCAscaris (R

oundworm) Ab, SIgA

(Blue H vial x 1)

$42

86682Ascaris A

ntibody

T-SOLTaenia solium (Tapeworm) Ab, SIgA

(Blue H vial x 1)

$42

86318Taenia solium Antibody

TRICTrichinella (Tiss

ue Worm) Ab, SIgA

(Blue HC vial x 1)

$42

86784Trichinella Antibody

Gastrointestinal–Parasitic & GI Diseases II Tests | Stool

GP1Ova & parasites

(Brown B vial x 1) $44

87177

87209

O & P, smear,

concentrate & ID. Stain

009.3

136.8

Diarrhea of parasitic origin

Intestinal Blastocystis

GP2Ova & parasites


87177 ( x 3 )

87209 ( x 3 )

O & P, smear,


009.3

136.8



GP4Giardia Antigen


87328Immunoassay, Giardia

antigen

007.1Intestinal Giardiasis

GP5Cryptosporidium Antigen (Brown B vial x 1) $33

87328 (87328-91

in panels)

Immunoassay,

Cryptosporidium antigen

007.4Cryptosporidiosis

* NOT for Insurance Billing

TEST & FEE SCHEDULE

2010

Lab Code


Test

Fee

CPT CodesTest D


ICD.9.CM

Hormone Panels | Saliva

PostM Post Menopause

Hormone Panel™ (Blue H vial x 1)

Includes:

$99

626.0

610.1

625.3

617.9

Amenorrhea/ovarian

dysfunction

Cystic breast, chronic

Dysmenorrhea

Endometriosis

DHEA DHEA & DHEA-S

$50

82626DHEA & DHEA-S

TTF Testosterone

$44

84402Testosterone

E1 Estrone

$44

82679Estro

ne

E2 Estradiol

$44

82670Estra

diol

E3 Estriol

$44

82677Estrio

l

P1 Progesterone

$44

84144Progesterone

ePostM

Expanded Post

Menopause Hormone

Panel™

(Green F/L vial x 1)

Includes all PostM™ tests plus:

$112

All PostM codes

above plus:

255.2

704.1

256.0

Female masculinization

Hirsutism

Hyperestrogen

FSH Follicle Stimulating Hormone

$44

83001Follicle Stimulating

Hormone

LH Luteinizing Hormone

$44

83002Luteinizing Hormone

PeriMPeri Menopause


2 saliva samples sent together.

Get the 6 hormones in PostM™

done on each.

$120 82679, 82679-91

82670, 82670-91

82677, 82677-91

84144, 84144-91

82626, 82626-91

84402, 84402-91

Estrone

Estradiol

Estriol

Progesterone

DHEA

Testosterone

256.31

626.9

627.2

Hypo-ovarianism/premature

menopause

Menstrual disorder

Menopausal symptoms

ePeriMExpanded Peri Menopause

Hormone Panel™(Green F/L vial x 2)


Get the 8 hormones in the

ePostM™ done on each.

$180 All PeriM codes

above plus:

83002

83001

Luteinizing Hormone

Follicle Stimulating

Hormone

278.00

784.0

626.9

627.2

253.4

628.0

Obesity, unspecified

Headache

Disorders of menstruation

Menopausal symptoms

Pituitary disorders

Infertility

FHP Cycling Female

Hormone Panel™(Blue FHP vial x 11)

Mapping of cycle with 11 samples.

Panel Includes:

$200

256.4

627.9

625.4

626.6

627.2

Ovarian cysts

Postmenopausal disorder

Premenstrual tension

Spotting, Intermenstrual

Menopausal symptoms

DHEA DHEA & DHEA-S pooled value $50

82626DHEA–billed once

TTF Testosterone pooled value

$44

84402Testosterone (fre

e)–

billed once

E2 Estradiol ( x 11 )

$44each

82670-91

84144-91

Estradiol

} Luteal

Progesterone Phases

P1 Progesterone ( x 11 )

$44each

82670

84144

Estradiol

} Follicular

Progesterone Phases

eFHP Expanded Cycling

Female Hormone

Panel™

(Blue eFHP vial x 11)


Panel includes all FHP™ tests plus:

$270

All FHP codes

above plus:

628.0

253.4

278.00

259.9

Infertility

Pituitary disorders


Endocrine disorder, unspecified

FSH Follicle Stimulating Hormone ( x 5 )$44each


Hormone

LH Luteinizing Hormone ( x 5 )

$44each



xxxxx 5M 03/10 03_DTI/feesched

Diagnos-Techs, Inc. 800.878.3787 www.diagnostechs.com • Page 5

©2010 Diagnos-Techs, Inc. All rights reserved.

34110 10M 03/10 03_DTI/feesched

Diagnos-Techs, Inc. 19110 66th Avenue South, Building G, Kent WA 98032 800.878.3787 www.diagnostechs.com • Page 1

L A B O R A T OR

Y

CLI N

I CA L &

R E S E AR C H

The leading lab in Saliva TeSTing Since 1989

DiagnosT

echsTM

Prices Effective June 1, 2010

W I T H C P T C O D E S

Flexi-Matrix™ allows you to combine more than one panel, with the

exception of BHP, FHP, eFHP, PeriM and ePeriM. When combining

panels, be sure to include the individual tests listed under each of

the panels you are combining. Flexi-Matrix™ customized test panels

are the most economic way of customizing test panels and profiles

to meet your clinical needs, saving you a 20-70% volume discount

off individual test fees.

Flexi-Matrix

™




Note: Diagnos-Techs, Inc. also offers several standard pre-defined test panels at very reasonable fees. Flexi-Matrix™ cannot be used for the DPD Bone Marker Test,

CS3 Swab Culture for Yeast, FHP, eFHP, PeriM or ePeriM Panels.

Flexi-Matrix™ Test Fees

Any 3–5 tests

$95

Any 6–9 tests

$132

Any 10–15 tests

$180

Any 16–20 tests

$240

Any 21–25 tests

$295

Over 25 Tests

$295

+ $12 for each additional

marked test; max 32 tests**

**Pending sufficient amount of samples to run all of the tests

Must use Flexi-Matrix™ saliva, stool or combination test kit.

n Choose 3 or more individual tests from the list shown on pages 4-6 of this Test and Fee Schedule.

(Excludes DPD Bone Marker Test and CS3 Swab Culture for Yeast.)

n Be sure to read detailed instructions and fill o

ut the requisition form included in each collection kit.

n You will always receive the lower price when your customized panel is identical to a standard panel.

REFERENCES1. Incidence rates and risk factors: a population-based study. Clin Gastroenterology Hepatol (2008) 6:35-40

2. Koskela RM, Niemela SE, Karttunen TJ, Lehtola JK. Clinical characteristics of collagenous and lymphocytic colitis. Scand J Gastroenterology (2004) 39:837-45

3. Olesen M, Eriksson S, Bohr J, et al. Lymphocytic colitis: a retrospective clinical study of 199 Williams JJ, Kaplan GG, Makhija S, et al. Microscopic colitis-defining Swedish

4. Fernandez-Banares F, Esteve M, Espinosa JC, et al. Drug consumption and the risk of microscopic colitis. Am J Gastroen terology (2007) 102:324-30

nPatient’s should not exercise for at least three hours prior to each sample collection for the Adrenal Stress Index Panel.

nIt is the provider’s decision whether or not to have the patient do the challenge meal. Patients may collect the non- fasting insulin following a challenge meal. The challenge meal* listed on the ASI form is a suggestion. *Gluten Free alternatives to the challenge meal include gluten free oatmeal and gluten free cornflakes.

nMark either the GI-1 or the GI-02 on the GI Health Panel test form. Please do not mark both panels as the GI-02 is our most comprehensive stool and saliva panel and includes all of the tests offered in the GI-1.

nWhen ordering tests on the Flexible Test Matrix, it is not necessary to mark both the GP1 and GP2 as the GP1 Ova and Parasites test is run from one fecal B vial, the GP2 is run from two B vials and therefore includes the GP1.

✓

✓

✓

✓

“Microscopic colitis is bowel inflammation that is only visible using a microscope.”

. www.diagnostechs.com � 1.800.878.3787

ASI

-Adr

enal

Str

ess

Inde

x

© 2011 Diagnos-Techs™, Inc. All rights reserved.

Educational Pathways

Diagnos-Techs™ offers several educational pathways to support our provider clients in their patient care. Office Visits, Online Meetings, and Courtesy In-House Seminars are available

for you to enhance your practice and stay informed.

ChronoBiologyLETTER

Raymond Dent, ND, was awarded his doctorate in Naturopathic Medicine from John Bastyr College of Naturopathic Medicine in Seattle, WA in 1982. He has practiced both privately and with teams of holistically-oriented medical doctors and labs over the past 28 years. Dr. Dent has taught courses at Bastyr University,

authored articles on alternative and integrated health care and appeared on television and radio broadcasts. Dr. Dent’s practice is broad in scope and utilizes therapeutic nutrition, homeopathy, botanical medicine as well as innovative procedural approaches incorporating radio-frequency and galvanic therapy for in-office treatment of cosmetic skin conditions.

COURTESY IN-HOUSE SEMINARS Diagnos-Techs™ Begins 2011 Series of Courtesy In-House SeminarsThe Role of Adrenal Dynamics in Functional Medicine is a comprehensive educational seminar designed to help clinicians integrate adrenal medicine into his or her practice. The seminars will be presented by Dr. Raymond Dent and are scheduled for February 25 and March 25 respectively. Please arrive by 9:00am to register; the seminar is being held from 9:30am to 3:00pm. To reserve a seat, please call Jessica at 1-800-878-3787. Space is limited.

February 2011 ▎ 7th Edition

54

Dr. Dent

MEDICAL SUPPORT Diagnos-Techs’™ team of medical advisors is available to assist our licensed healthcare professional clients by answering questions about our laboratory tests and assisting in interpretation or consultation of test results. There is no additional fee to receive this service. Our medical support team consists of MDs, NDs and a PhD offering a combined 100+ years of medical experience. To speak to medical support call 1-800-878-3787.

Vitamin D Test

Coming Soon!Some facts about Vitamin D:• Vitamin D is a fat-soluble vitamin that exists in two main forms: D2 (ergocalciferol) & D3 (cholecalciferol)

• Since vitamin D can be synthesized endogenously and because individuals with adequate

Diagnos-Techs™

Lab News

DR. RAYMOND DENT

family of hormones. There is a strong interest in measurement of vitamins and minerals as they relate to coenzymes and cofactors in maintaining optimum nutritional status.

Expansion of testing for infectious disease and parasites is an ongoing process both in the measurement of antigens/antibodies via ELISA

Why Choose Diagnos-Techs™?Ongoing Research and Development

continued from page 1

IMPORTANT!Read This before proceeding with your test!

The following requirements must be met or your test

will not be processed. Write your name & date of birth on both

the front of requisition form and on all vials. Write the date you

collected your last sample on the front of the form.

➊

➋

▼▼

38510 11/10 180M 05_DTI/important

HELPING YOU TO HELP YOUR PATIENTSNew Reminders in Test Kit Boxes

These slips started going out in test kit boxes in November highlighting two very important reminders for patients to ensure that their tests get processed as quickly as possible.

exposure to sunlight do not require

dietary supplementation, vitamin D and its metabolites

are considered hormones and hormone precursors rather

than vitamins.

• Besides its well-known role in regulating body levels of calcium and phosphorus, and in bone mineralization, it has become clear that receptors for vitamin D are expressed in a wide range of cells and tissues that do not play a role in mineral ion homeostasis.

Rafik Kamelman, MD, graduated from Cairo University Medical School in 1997. He practiced medicine and general surgery for three years before joining Diagnos-Techs™ in 2001. Dr. Rafik has been a medical consultant for the past two years, advising Diagnos-Techs™ clients and interpreting test results. Prior to that,

Dr. Rafik spent seven years in the lab overseeing all the tests, assays and specimen processing.

Dr. Rafik

DR. RAFIK KAMELMAN

(Enzyme-Linked ImmunoSorbent Assay) testing and advances in microscopic analyses. The family of food intolerance tests will be expanded to include more dietary antigens from the environment including cereals, meats, fruits and vegetables. Additional efforts address early detection of disease and failing health due to aging and genetic disposition. We will continue with our efforts to monitor patient health using simple patient directed tests.

�

DISCUSSION POINTSADRENAL STRESS INDEX INSTRUCTIONSPleaseremindyourpatientsto:

✓ write their name & date of birth on all vials & on the front of the requisition form. We are unable to process tests received without this information.

✓ collect all samples on a single day following schedule on requisition form starting with the morning sample & ending with the midnight sample.

✓ discontinue use of sublingual drops, troches & pellet hormones the night before collection. For 3-5 days prior to collection swallow them with water.

✓avoid using antacids, bismuth medications or mouth wash the night before collection.

✓avoid chocolate, onions, garlic & cruciferous vegetables on day of

collection. Less than 1 tablespoon is OK. Avoid coffee, tea or other

caffeinated beverages on that day.

✓ eat 50 grams or 200 calories of carbohydrates 60-90 minutes prior

to noon collection, at the providers discretion.

✓avoid eating or drinking anything except water for 60 minutes prior to each collection as well as to avoid brushing their teeth or smoking 60 minutes before each collection.

✓ rinse mouth thoroughly with cold water 3-5 minutes prior to each collection.

✓hold cotton roll under the tongue until fully saturated. This can take anywhere from 5-20 minutes or more depending on the patient. To assist in saliva production, your patient can chew a piece of colorless & sugarless gum a couple minutes prior to their collection.

✓return the cotton to the vial, recap it, place it in the zip lock bag with the absorbent orange shipping pad, and refrigerate each sample until mailing. Mail all samples & paperwork together inside the supplied box within three days of collection.

name a

nd

date o

f birt

h!

Meet Our Medical Advisors

The Role of Adrenal

Dynamics in Functional Medicine

Presented byRaymond Dent, ND

This Seminar will:▶ help you, the Clinician, integrate adrenal medicine into your practice▶ review circadian biorhythms and chronobiology▶ show the benefits/limitations of adrenal diagnostic modalities▶ highlight adrenal physiology, biochemistry and hormone effects▶ assess diagnosis and treatment of hypothalamic-pituitary-adrenal-axis disorders▶ provide a workshop highlighting case studies and diagnostic data

Courtesy Seminars


2 0 11 Series

● ACA's National Chiropractic Legislative Conference (NCLC) February 12-15, 2011 American College of Chiropractic Washington DC

● The Robert Fishman Institute presents “Think Outside the Box” , The Next Generation Continues/2011 Conference February 19-20, 2011 Nova Southeastern University Fort Lauderdale, FL

● Integrative Healthcare Syposium 2011 March 4-6, 2011 • Hilton, New York, NY

● California Naturopathic Doctors Assoc. (CNDA) Spring Conference March 26-27, 2011 • Berkeley, CA

● Health Biz Expo April 9, 2011 National College of Natural Medicine Portland, OR

● 19th Annual World Congress on Anti-Aging Medicine April 7-9, 2011 American Academy of Anti-Aging Medicine (A4M) • Orlando, FL

● iMOSAIC Conference April 8-9, 2011 • Minneapolis, MN

● The Institute for Functional Medicine 18th International Symposium April 28-30, 2011 • Bellevue, WA

● ACOG 59th Annual Clinical Meeting April 30-May 4, 2011 American College of Obstetricians and Gynecologists • Washington DC

Diagnos-Techs™ will be exhibiting at the following conferences. If you are attending any of these conferences, please visit our booth. We look forward to meeting you in person.

Diagnos-Techs™ On the Road


GI

ASI


Clinical Pearls INFORMATION TO BUILD ON

6 3

WHEN YOU CALL…please have your account number available .

REQUEST A PRICE LIST

Please note, we do not quote patient pricing over the phone. If your office needs a current price list, call 1-800-878-3787 to request a price list be e-mailed, faxed or mailed to your office.

Issue #7 Chronobiology Letter is published quarterly by Diagnos-Techs™ Laboratory, Inc. in Kent, WA, USA, as an educational resource for our health care clients. The information in this newsletter is not to be construed as medical advice.

Diagnos-Techs™, Inc. 19110 66th Ave. S, Bldg. G, Kent, WA 98032 USA

� Printed on recycled paper.

© 2011 by Diagnos-Techs™, Inc. All rights reserved.

LA B O R A T O R Y

CL I



DiagnosTechsTM

DOWNLOAD A PRICELIST

Our current price list is

now available to download as a PDF file. Visit

us online at www.diagnostechs.com

and go to Providers and click on Provider Login. Then login with your account number and click on Client Tools, where you can download and print the price list.

Tips from Customer Service

A D R E N A L S T R E S S I N D E X

G A S T R O I N T E S T I N A L H E A LT H

Guidelines for SUBMITTING Samples SIgA to casein and bacterial dysbiosis) led to the diagnosis of non-specific colitis. She was advised to avoid eating gluten and dairy products and to discontinue the use of Ibuprofen. A course of probiotics, digestive enzymes, natural anti-inflammatory supplements, (e.g. Boswellia) and vitamin B12, led to the normalization of alpha-antichymo-trypsin and lysozymes, evidenced on the follow-up test. Her diarrhea and abdominal pain improved within days after initiating therapy, and her joint pain resolved over a period of about two weeks.

Follow up testing was completed three months post-treatment. The results showed that the inflammatory markers had all normalized, the intestinal SIgA was trending toward normal and the anti-gliadin antibodies had decreased to six (negative).

DISCUSSIONDiagnosing and treating abdominal distress in its various forms can prove to be a challenge to the clinician. In evaluating the case under consideration, important elements of the patient’s clinical presentation and history are noteworthy. An absence of travel out of the United States would weigh in favor of a non-parasitic infection as would the absence of positive findings on the GI-02 panel relating to multicellular and monocellular infectious organisms. No clinical signs of an acute abdomen were noted, and serology did not demonstrate definitive evidence of acute infection. Electrolyte derangement was broadly present, consistent with the history of diarrhea. Mild metabolic acidosis was also a factor evidenced by the depressed bicarbonate readings. The lack of occult blood and offensive odor also weighed in

favor of a non-infectious pathology. The inflammatory markers measured on the GI-02 panel demonstrated elevated anti-alpha chymotrypsin and intestinal lysozyme. These findings are consistent with accelerated degradation of both colonic and small intestinal epithelium. The mildly elevated anti-gliadin antibody levels (via salivary IgA) are consistent with early stage immune responses to gluten. The damaged enteric mucosa is a possible result of long-term Ibuprofen exposure. Compromised levels of intestinal SIgA levels were consistent with a non-infectious etiology as well as deranged mucosal integrity secondary to long-term NSAID use.

A noteworthy relationship regarding the abatement of the patient’s joint pain is the systemic inflammatory condition possibly induced by exposure to gluten and casein. Both of these antigens tested positive on the GI-02 panel and may have been underlying triggers of her arthritic symptoms.

Diarrheal diseases are common in older populations. At any one point in time, ~9% of an older out-patient population will experience diarrhea. Recent studies suggest that microscopic colitis (MC) is the cause of chronic diarrhea in 10-30% of older patients investigated with an endoscopically normal appearing colon. Although there are different causes for chronic diarrhea, MC is increasingly recognized as a major diagnostic entity in older individuals.

Microscopic colitis is bowel inflammation that is only visible using

a microscope. It is a less severe type of inflammatory bowel disease with normal endoscopic appearance of the colon and a comparatively benign course that is not associated with malignant transformation.

For unknown reasons, the incidence of microscopic colitis increases in the elderly. This is more common in women, with a female to male ratio reaching 7.9 to 1 in certain subtypes of microscopic colitis. Autoimmune diseases, particularly thyroid and/or celiac disease, are associated with this type of colitis. In a recent epidemiological study of 164 patients with MC, 11.0% had a prior diagnosis of hypothyroidism.(1) Other studies have supported that celiac disease is found in up to 23% of patients with microscopic colitis.(2,3) There is also a link between the use of several medications and microscopic colitis. A recent study showed that those with microscopic colitis more commonly consumed NSAIDs, SSRIs and beta-blockers.(4)

Pre-collection:

When filling out forms:

Lab Code


Test

Fee

CPT CodesTest D


ICD.9.CM

Gastrointestinal–Infectious Diseases Tests | Stool

CS1Stool Culture, yeast a

nd fungi

(Brown A vial x 1)

$36

87102

87106

Culture, stool, fu

ngi

islolation

Culture, stool, fu

ngi ID

112.85

536.8

564.1

528.00

462112.0

691.0

569.42

Candidal enteritis

Digestive tract irritation

Irritable colon, spastic or mucus

Inflammation, mouth

Inflammation, pharynx

Oral (or throat) candida

Rash–diaper

Rectal pain

GP3Stool culture, bacteria & flora

(Brown A vial x 1)

$4487045 & 87046

Culture bacteria, stool

009.0

009.2

009.1

Colitis, infectious


Gastroenteritis,

infectious

GP3CdClostrid

ium difficile Toxins A&B

(Brown B vial x 1)

$42

87324Immunoassay Clostrid

ium

Toxin

008.45

009.0

Clostridium difficile, colitis

Colitis, infectious

Gastrointestinal–GI Functional Markers Tests | Stool

FG1Chymotrypsin


84490Trypsin, feces, quant.

578.1

783.21

579.8

579.4

787.3

564.00

536.8

536.8

579.8

Blood in stool

Abnormal weight loss

Decreased tolerance to fats

Fatty stool, pancreatic

indigestion

Flatulence, gas or bloating

Constipation, unspecified

Gastric irrita

tion

Hypermotility, ie. reduced transit

Intestinal malabsorption

FG4Occult Blood


82270Occult Blood, feces

FG5Fecal pH


83986pH test, st

ool

MB2Total Intestinal SIgA

(Brown A vial x 1)$42

83883Nephelometry,

Immune globulin A


Immunodeficiency

MB3Intestinal Lysozyme


85549Lysozyme (muramidase)

inflammation marker

558.3

009.0

556.0

009.2

564.1

Colitis, allergic

Colitis, infectious

Ulcerative enterocolitis


Irritable bowel syndrome

MB4Intestinal Alpha Anti-C

hymotrypsin

(Brown A vial x 1)

$4283883 (83883-91

in panels)

Nephelometry, Alpha

Anti-Chymotrypson

Lab Code


Test

Fee

CPT CodesTest D


ICD.9.CM

Adrenal & Stress Hormone Tests | Saliva

CORTCortiso

l – 6am-8am (Blue H vial x 1) $39

82530Cortiso

l, Free

CORTCortiso

l – 11am-1pm (Blue H vial x 1) $39

82530Cortiso

l, Free

CORTCortiso

l – 4pm-5pm (Blue H vial x 1) $39

82530Cortiso

l, Free

CORTCortiso

l – 10pm-Midnight (Blue H vial x 1)$39

82530Cortiso

l, Free

DHEADHEA & DHEA-S pooled value

(Blue H vial x 2)

$50

82626DHEA

704.1 Hirsutism

P17-OH17-OH Progesterone (Blue H vial x 1) $46

8349817-Hydroxyprogesterone

255.2 Congenital adrenal

hyperplasia

Metabolism Module Tests | Saliva

ISNInsulin(Fasting) (Blue H vial x 1) $30

83525Insulin, Total

250.0

251.1

251.2

Diabetes

Hyperinsulinism


ISN Insulin (Non-Fasting) (Blue H vial x 1) $30

83525Insulin, Total

250.0

251.1

251.2

Diabetes

Hyperinsulinism


Food Intolerance & Immunity Tests | Saliva

FI-1Cow’s m

ilk (Casein) Ab, SIgA

(Blue HC vial x 1)

$33

83516Casein Antibody

579.0

995.67

995.68

995.69

Celiac Disease

Hypersensitivity, milk products

Hypersensitivity, egg products

Hypersensitivity due to other

specified food

FI-2Soy protein Ab, SIgA

(Blue HC vial x 1) $33

83516Soy Antibody

FI-3Egg (Albumin) Ab, SIgA (Blue HC vial x 1) $33

83516Egg Albumin Antibody

FI-4Gluten (Gliadin) Ab, SIgA (Blue HC vial x 1) $33

83516Gluten (Gliadin) Antibody

MB2-STotal Salivary SIgA

(Blue H vial x 1) $42

83883Nephelometry, Secretory


immunodeficiency

Gastrointestinal–Parasitic & GI Diseases I Tests | Saliva

GP6-SToxoplasma gondii–Ab, SIgA

(Blue H vial x 1)

$42

86777Tosoplasma Antibody

130.7

006.1

536.8

535.40

787.1

127.0

123.0

123.1

728.11

124

Toxoplasmosis

Chronic ameba

Gastric irrita

tion

Gastritic

Heartburn

Ascaris lumbricoides infection

Taenia solium (Intestinal form)

Taenia solium (Larval form)

Myositis

Trichinosis

GP7-SAmoeba histolytica–Ab, SIgA

(Blue H vial x 1)

$42

86753Amoeba histolytica

Antibody

GP8-SHelicobacter pylori Ab, IgG

(Blue H vial x 1)

$42

86677Helicobacter pylori

Antibody

ASCAscaris (R

oundworm) Ab, SIgA

(Blue H vial x 1)

$42

86682Ascaris A

ntibody

T-SOLTaenia solium (Tapeworm) Ab, SIgA

(Blue H vial x 1)

$42

86318Taenia solium Antibody

TRICTrichinella (Tiss

ue Worm) Ab, SIgA

(Blue HC vial x 1)

$42

86784Trichinella Antibody

Gastrointestinal–Parasitic & GI Diseases II Tests | Stool

GP1Ova & parasites


87177

87209

O & P, smear,


009.3

136.8



GP2Ova & parasites


87177 ( x 3 )

87209 ( x 3 )

O & P, smear,


009.3

136.8



GP4Giardia Antigen


87328Immunoassay, Giardia

antigen

007.1Intestinal Giardiasis

GP5Cryptosporidium Antigen (Brown B vial x 1) $33

87328 (87328-91

in panels)

Immunoassay,

Cryptosporidium antigen

007.4Cryptosporidiosis


TEST & FEE SCHEDULE

2010

Lab Code


Test

Fee

CPT CodesTest D


ICD.9.CM

Hormone Panels | Saliva

PostM Post Menopause


Includes:

$99

626.0

610.1

625.3

617.9

Amenorrhea/ovarian

dysfunction

Cystic breast, chronic

Dysmenorrhea

Endometriosis

DHEA DHEA & DHEA-S

$50

82626DHEA & DHEA-S

TTF Testosterone

$44

84402Testosterone

E1 Estrone

$44

82679Estro

ne

E2 Estradiol

$44

82670Estra

diol

E3 Estriol

$44

82677Estrio

l

P1 Progesterone

$44

84144Progesterone

ePostM

Expanded Post

Menopause Hormone

Panel™

(Green F/L vial x 1)

Includes all PostM™ tests plus:

$112

All PostM codes

above plus:

255.2

704.1

256.0

Female masculinization

Hirsutism

Hyperestrogen

FSH Follicle Stimulating Hormone

$44


Hormone

LH Luteinizing Hormone

$44


PeriMPeri Menopause



Get the 6 hormones in PostM™

done on each.

$120 82679, 82679-91

82670, 82670-91

82677, 82677-91

84144, 84144-91

82626, 82626-91

84402, 84402-91

Estrone

Estradiol

Estriol

Progesterone

DHEA

Testosterone

256.31

626.9

627.2

Hypo-ovarianism/premature

menopause

Menstrual disorder

Menopausal symptoms

ePeriMExpanded Peri Menopause

Hormone Panel™(Green F/L vial x 2)


Get the 8 hormones in the

ePostM™ done on each.

$180 All PeriM codes

above plus:

83002

83001

Luteinizing Hormone

Follicle Stimulating

Hormone

278.00

784.0

626.9

627.2

253.4

628.0


Headache

Disorders of menstruation

Menopausal symptoms

Pituitary disorders

Infertility

FHP Cycling Female

Hormone Panel™(Blue FHP vial x 11)


Panel Includes:

$200

256.4

627.9

625.4

626.6

627.2

Ovarian cysts

Postmenopausal disorder

Premenstrual tension

Spotting, Intermenstrual

Menopausal symptoms

DHEA DHEA & DHEA-S pooled value $50

82626DHEA–billed once

TTF Testosterone pooled value

$44

84402Testosterone (fre

e)–

billed once

E2 Estradiol ( x 11 )

$44each

82670-91

84144-91

Estradiol

} Luteal

Progesterone Phases

P1 Progesterone ( x 11 )

$44each

82670

84144

Estradiol

} Follicular

Progesterone Phases

eFHP Expanded Cycling

Female Hormone

Panel™

(Blue eFHP vial x 11)


Panel includes all FHP™ tests plus:

$270

All FHP codes

above plus:

628.0

253.4

278.00

259.9

Infertility

Pituitary disorders


Endocrine disorder, unspecified

FSH Follicle Stimulating Hormone ( x 5 )$44each


Hormone

LH Luteinizing Hormone ( x 5 )

$44each



xxxxx 5M 03/10 03_DTI/feesched

Diagnos-Techs, Inc. 800.878.3787 www.diagnostechs.com • Page 5

©2010 Diagnos-Techs, Inc. All rights reserved.

34110 10M 03/10 03_DTI/feesched


L A B O R A T OR

Y

CLI N

I CA L &

R E S E AR C H

The leading lab in Saliva TeSTing Since 1989

DiagnosT

echsTM


W I T H C P T C O D E S

Flexi-Matrix™ allows you to combine more than one panel, with the

exception of BHP, FHP, eFHP, PeriM and ePeriM. When combining

panels, be sure to include the individual tests listed under each of

the panels you are combining. Flexi-Matrix™ customized test panels

are the most economic way of customizing test panels and profiles

to meet your clinical needs, saving you a 20-70% volume discount

off individual test fees.

Flexi-Matrix

™



Diagnos-Techs, Inc. 19110 66th Avenue South, Building G, Kent WA 98032 800.878.3787 www.diagnostechs.com •

Note: Diagnos-Techs, Inc. also offers several standard pre-defined test panels at very reasonable fees. Flexi-Matrix™ cannot be used for the DPD Bone Marker Test,

CS3 Swab Culture for Yeast, FHP, eFHP, PeriM or ePeriM Panels.

Flexi-Matrix™ Test Fees

Any 3–5 tests

$95

Any 6–9 tests

$132

Any 10–15 tests

$180

Any 16–20 tests

$240

Any 21–25 tests

$295

Over 25 Tests

$295

+ $12 for each additional

marked test; max 32 tests**

**Pending sufficient amount of samples to run all of the tests

Must use Flexi-Matrix™ saliva, stool or combination test kit.

n Choose 3 or more individual tests from the list shown on pages 4-6 of this Test and Fee Schedule.

(Excludes DPD Bone Marker Test and CS3 Swab Culture for Yeast.)

n Be sure to read detailed instructions and fill o

ut the requisition form included in each collection kit.

n You will always receive the lower price when your customized panel is identical to a standard panel.

REFERENCES1. Incidence rates and risk factors: a population-based study. Clin Gastroenterology Hepatol (2008) 6:35-40

2. Koskela RM, Niemela SE, Karttunen TJ, Lehtola JK. Clinical characteristics of collagenous and lymphocytic colitis. Scand J Gastroenterology (2004) 39:837-45

3. Olesen M, Eriksson S, Bohr J, et al. Lymphocytic colitis: a retrospective clinical study of 199 Williams JJ, Kaplan GG, Makhija S, et al. Microscopic colitis-defining Swedish

4. Fernandez-Banares F, Esteve M, Espinosa JC, et al. Drug consumption and the risk of microscopic colitis. Am J Gastroen terology (2007) 102:324-30

nPatient’s should not exercise for at least three hours prior to each sample collection for the Adrenal Stress Index Panel.

nIt is the provider’s decision whether or not to have the patient do the challenge meal. Patients may collect the non- fasting insulin following a challenge meal. The challenge meal* listed on the ASI form is a suggestion. *Gluten Free alternatives to the challenge meal include gluten free oatmeal and gluten free cornflakes.

nMark either the GI-1 or the GI-02 on the GI Health Panel test form. Please do not mark both panels as the GI-02 is our most comprehensive stool and saliva panel and includes all of the tests offered in the GI-1.

nWhen ordering tests on the Flexible Test Matrix, it is not necessary to mark both the GP1 and GP2 as the GP1 Ova and Parasites test is run from one fecal B vial, the GP2 is run from two B vials and therefore includes the GP1.

✓

✓

✓

✓

“Microscopic colitis is bowel inflammation that is only visible using a microscope.”



How to Reach UsBusiness Hours 7:30am–5:00pm Pacific Standard Time (PST) Monday through Friday, except major holidays

Corporate Address 19110 66th Avenue S., Building G Kent, WA 98032 USA

Customer Service p 800-878-3787 f 425-656-2871

p 425-251-0596

Shipping p 800-878-3787 f 253-398-2449

Technical Services p 800-878-3787 f 425-251-0637

Lab Address Sample Processing 6620 S. 192nd Place, Building J-106 Kent, WA 98032 USA

Monday-Saturday USPS Deliveries P.O. Box 389662 Tukwila, WA 98138-9662 USA

Visit Diagnos-Techs™

Onlinewww.diagnostechs.com

2 7

Technical Services

Tips for SuccessnWe must have at least two forms of written patient ID, name and date of birth on all vials and order forms to process samples.

n Patients should not contact the lab for treatment related questions. Please advise patients to consult with you if they have any treatment related questions pertaining to collection. Medical support is available for provider questions about drug interactions at 1-800-878-3787.

n Review patient medication list. This will help your patients to understand what to avoid before taking our tests.

n Have your account number or accession number ready before you call.

n Share this newsletter with authorized staff. This information will help employees who call on your behalf.

n Sign up to access results online. Call Customer Service for password, 1-800-878-3787.

DIAGNOS-TECHS™ RESOURCES FOR YOU ▼

Contact Us

Shipping

Billing

Courtesy Service FROM OUR TEAM OF INSURANCE SPECIALISTS

Our dedicated team of Insurance Specialists is trained to assist you with any insurance-related questions you may have. We prevent payment processing challenges by helping you and your patients navigate through the maze of test codes and fees.

As a courtesy, we will submit claims to most insurance companies at our clients’ and patients’ requests. In addition, we are able to bill Insurance carriers for all referring doctors, nurse practitioners and registered nurses. We are able to advise you on which services are billable. Although we are a non-contracted provider with all insurance companies (with the exception of Medicare), most insurance carriers offer coverage on our services and are billable. Depending on a patient’s benefit plan, insurance companies usually cover our tests at the maximum allowable rates so that our patients will have no out-of-pocket expenses.

Patient Insurance DisclaimerDiagnos-Techs™, Inc. is a non-contracted

provider with all insurance companies.

Please verify your out-of-network benefits

including out-of-network deductibles

and co-insurances by contacting your

insurance carrier. Diagnos-Techs™,

Inc. will bill your insurance at the

retail price per line item. If deductibles

and/or co-insurances are applied,

Diagnos-Techs™, Inc. is obligated in the

state of Washington to collect by law.

Free Return Shipping on returned domestic test kitsSTORAGE & MAILING INSTRUCTIONS FOR ALL SPECIMENSn Ship samples on the same day as last sample collection (preferred).n If not, refrigerate samples and ship within 3 days. No ice bags are required during shipping.n Write the patient’s name and address on the outside of box.n Include all samples, test form, and if applicable, a check or a copy of the front and back of insurance card together inside the supplied box. Please be sure to seal the box with clear tape before shipping. • US Domestic: Deliver completed test kit box to any Post Office (not mailbox). Return shipping to Diagnos-Techs™ is PRE-PAID. Kits are delivered to our P.O. Box by USPS Monday–Saturday. • International: Delivery charges still apply. International deliveries should be addressed to the physical address only, which is located to the right. Do not address to the PO Box. Deliveries can be made Monday through Friday via a private courier of your choice.

INTERNATIONAL COURIER SHIPPING

Diagnos-Techs™, Inc.Sample Processing

6620 S. 192nd Pl., #J-106Kent, WA 98032 p 425-251-0596

Diagnosing Colitis Using Diagnos-Techs™ Gastrointestinal Health Panel™

Kamal Henein, MD Raymond Dent, ND


09-GI-02Accession: Continue Results For: NO NAME, NO NAMEDiagnos-Techs, Inc.

1) Prolonged gut transit time > 96 hrs. 2) Deficiency in SIgA production due to reducedIgA immunocytes count. 3) Elevated cortisol/DHEA ratio.For cortisol/DHEA refer to ASI.

9MB3 Normal: <6 mg% dry wtBord. Elevated: 6-8 Elevated: >8

Intestinal Lysozyme (Stool)

Elevated lysozyme indicates an ongoing colonic inflamation.The literature indicates that certain nonpathogen mediated colonic inflammation can beameleorated by retention enemas of mixed short chain fatty acid solutions.

190MB4 Normal: <60 mg% dry wtBorderline Elev.: 60-100 Mild/Distal Colitis: 100-180 *Colonic Inflammation: >180 *

Alpha Anti-Chymotrypsin (Stool)

* Applicable with elevated lysozyme; small intestine irritation with normal lysozyme.

14FG1 Normal: >9 U/10gLow: 4-9 Abnormally Low: <4

Chymotrypsin (Stool)

Chymotrypsin is a marker enzyme for pancreatic exocrine output.

NegativeFG4 Normal: Negative.Occult Blood (Stool)6.8FG5 Normal: 5-8.5Fecal pHPositiveFI1 Normal: Negative.Milk (Casein) Ab. SIgA (Saliva)NegativeFI2 Normal: Negative.Soy (Protein) Ab. SIgA (Saliva)NegativeFI3 Normal: Negative.Egg (Albumin) Ab. SIgA (Saliva)30 PositiveFI4 Borderline: 13-15 U/ml

Positive: >15 U/mlGliadin Ab, SIgA (Saliva)

Gliadins are polypeptides found in wheat, rye, oat, barley, and other grain glutens, andare toxic to the intestinal mucosa in susceptible individuals.Healthy adults and children may have a positive antigliadin test because of subclinicalgliadin intolerance. Some of their symptoms include mild enteritis, occasional loosestools, fat intolerance, marginal vitamin and mineral status, fatigue, or acceleratedosteoporosis.Scan. J. Gastroenterol. 29:248(1994).

Not detectedASC Normal Result: Not detectedRoundworm (Ascaris lumbricoides)SIgA (Saliva)

Not detectedT-SOL Normal Result: Not detectedTapeworm (T.solium) SIgA (Saliva)Not detectedTRIC Normal Result: Not detectedTrichinella spiralis SIgA (Saliva)

Not Provided To The Lab.Diagnosis Code:

COURTESY INTERPRETATION of test and technical support are available upon request, to Physicians Only.

Please Note: All examples of patient treatment or therapy are for illustrative and/or educational purpose. Use this report in contextof the clinical picture and patient history before initiating hormone or other therapies or recommendations.


01/01/2009

Diagnos-Techs, Inc.Clinical & Research Laboratory

Completed: 08/12/200909-GI-02Received :

Accession #

PO BOX 389662, Tukwila, WA 98138-0662

CLIA License # 50D0630141Tel: (425) 251-0596

Results For:.6620 S 192ND PL # J-104

KENT WA 98032USA Tel: 425-251-0596 Fax: 425-251-9520

DIAGNOS-TECHS, INC.

Not Provided

Patient's Tel:

Reported : 12/21/2010

01/01/2009Specimen Collected:

Age:NO NAME NO NAME

Gender:


GI-02 Expanded GI PanelNo yeast isolatedCS1 +1=Trace +2=Light +3=Moderate

+4=Abundant +5=ConfluentStool Cu. Fungi, Isol. & I.D.

No ova or parasitesGP2 Ova & Parasites, x3 (Stool)Moderate mixed Gram negative rods/flora.Moderate mixed Gram positive rods/flora.

Pathogens/Bacterial Overgrowth Detected:---------------------------------------------------------Klebsiella/Enterobacter/Serratia Group. -ModerateAlpha Hemolytic Streptococcus - ModerateGamma Hemolytic Streptococcus - Rare

Other Findings:---------------------Non pathogenic E. coli - Rare

GP3 Expected Findings:- Moderate to abundant growth of mixed Gram (+) & (-) flora- No pathogens should be detected.

Bacterial Stool Cu.

In general, early disturbances in microfloral balance may be reflected in the nonexpected and selective overgrowth of microbial species that are usually non dominant.

Please note: As of February 2005, GP3 report has been made more comprehensive toreflect all observed findings + isolates.GP3 test performed by Lab.Corp. of America, Seattle WA or PPL Lab., LynnwoodWA.

NegativeGP3CD Normal: NegativeC. Difficile: Toxins A & B (Stool)Testing Toxins A+B yields 99% sensitivity; single toxin test yields 83%.

NegativeGP4 Normal: NegativeGiardia Antigen (Stool)NegativeGP5 Normal: NegativeCryptosporidium Antigen (Stool)NegativeGP6S Normal: NegativeToxoplasma Ab, SIgA (Saliva)Not detectedGP7S Normal: Not detectedAmeba histolytica Ab, SIgA (Saliva)<3GP8S Negative: < 3 U/ml

Borderline: 3-5.5 U/mlPositive: >5.5 U/ml

Helicobacter pylori Ab, IgG (Saliva)

250MB2 Low: <400 mg% dry wtNormal: 400-880 Elevated: >880

Total Intestinal SIgA (Stool)

Depressed SIgA may be due to :


Figure 1

For 11 months a 56 year old woman has been complaining of diarrhea and abdominal pain. Her bowel movements occur five to six times a day and are watery, non-bloody and not foul smelling. The diarrhea is intermittent and sometimes interferes with her sleep–leaving her feeling weak, tired and sleepy during the day. She also complains of joint pain and mild abdominal pain that is not relieved by her bowel movements.

Her medical history is positive for hypothyroidism for which she takes Synthroid 50 mcg/day, and hypertension treated with Atenolol 50 mg/day. She also takes Omeprozole 20 mg for heartburn, Ibuprofen 200 mg twice a day for her joint pain and Celexa 20 mg/day for depression. She has no known drug allergies. She is married with two children, holds an office job, drinks filtered municipal water, does not smoke and drinks one to two beers a week. She has not travelled recently and has had no wilderness exposure.

Physical examination reveals a middle-aged woman who appears mildly underweight, in moderate discomfort, but in no significant distress. Her abdominal examination shows no distention and was soft with no rebound tenderness. She has hypoactive bowel sounds and peri-umbilical tenderness to palpitation.

Otherwise, her examination was unremarkable.

Pertinent laboratory findings included:

LABSWBC 11,500 mm 6,300-10,800 mL

Hematocrit 38% 37-48%

Sodium 136 mEq/L 135-145 mEq/L

Potassium 3.8 mEq/L 3.5-5.0 mEq/L

Chloride 97 mEq/L 98-106 mEq/L

Bicarbonate 19 mEq/L 18-23 mEq/L

Serum Lab Results

A colonoscopic examination found a macroscopically normal colonic epithelium, with the exception of diffuse patchy erethema.

A Diagnos-Techs™ Expanded Gastrointestinal Panel™ (GI-02) was ordered, which generated the following results: (see Figure 1)

The findings (elevated alpha antichymotrypsin, elevated lysozymes, low intestinal SIgA, anti-gliadin antibodies elevated at 30, positive

MB2 Total Intestinal SIgA (Stool) 250 Low: <400 mg% dry wt Normal: 400-880 Elevated: >880

Diagnos-Techs™ Expanded Gastrointestinal Panel™ (GI-02) Report

FI1 Milk (Caseiin Ab, SIgA (Saliva) Positive Normal: Negative

MB4 Alpha Anti-Chymotrypsin (Stool) 190 Normal: <60 mg% dry wt Bord. Elevated: 60-100 Mild/Distal Colitis: 100-180* Colonic Inflammation: >180*

GP3 Bacterial Stool Cu. Moderate mixed Gram negative rods/flora. Moderate mixed Gram positive rods/flora

Pathogens/Bacterial Overgrowth Detected:

Klebsiella/Enterobacter/Serratia Group–Moderate Alpha Hemolytic Strepococcus–Moderate Gamma Hemoytic Streptococcus–Rare

Other Findings:

Non pathogenic E. Coli–Rare

Expected Findings:

-Moderate to abundant growth of mixed Gram (+) & (-) flora

-No pathogens should be detected

Reference Ranges

FI4 Gliadin Ab, SIgA (Saliva) 30 Positive Normal Result: Not detected Normal Result: Not detected

MB3 INtestinal Lysozyme (Stool) 9 Normal: <60 mg% dry wt Bord. Elevated: 6-8 Elevated: >8


NEW BROCHURES FOR PROVIDERS AND PATIENTSFeaturing our new Food Intolerance Panel™ brochure

ChronoBiologyFebruary 2011 ▎ 7th Edition

LETTER

Why Choose Diagnos-Techs™?Ongoing Research and DevelopmentMichael Everitt, PhD

The Research and Development program at Diagnos-Techs™ is focused on testing that achieves and relates to wellness.

Currently, the laboratory measures hormone and

IgA antibody levels, examines stool samples and provides information about how the various measurements relate to the wellness of individuals. Diagnos-Techs™ maintains an ongoing program to investigate additional testing to improve the clinical support of this endeavor and is looking to expand the Adrenal Stress Index™ (ASI™) panel through the addition of more adrenal, hypothalamic and pituitary hormones. There is interest in the hormones related to body mass and nutrition such as the leptin

Lab NewsVITAMIN D TEST

COMING SOON!

Vitamin D is a fat-soluble vitamin that helps the body absorb calcium

and keep the right amount of calcium and phosphorus in the blood. Soon Diagnos-Techs™ will be offering a

Vitamin D Health Test to providers for their patients. For more information about Vitamin D, see page five.

A WORD FROM THE PRESIDENT…

Welcome to a new year and the 7th Edition of ChronoBiology Letter. In this issue, we present an interesting case study

featuring the Gastrointestinal Health Panel™ and ways to diagnose and treat abdominal distress.

Research suggests that vitamin D could play a role in the prevention and treatment of a number of conditions, such as type 1 and type 2 diabetes, hypertension, glucose intolerance and multiple sclerosis. Diagnos-Techs™ will soon be offering a vitamin D test to provide you with more ways to help your patients achieve wellness.

Thank you for choosing Diagnos-Techs™. We are committed to providing quality testing services to you and your patients to restore health and vitality.

Sincerely,

Elias Ilyia, PhDPresident, Diagnos-Techs™

• Cortisol x4• DHEA + DHEA(S)• Insulin x2• 17-OH Progesterone• Gluten Ab • Total Secretory IgA

• Stool culture for yeast• Chymotrypsin• Ova and parasites• Occult Blood• Bacterial stool pathogens• Fecal pH• Clostridium difficile Antigens• Total Intestinal SIgA• Tape Worm

• Giardia Antigen• Intestinal Lysozyme• Cryptosporidium Antigen• Alpha Anti-Chymotrypsin• Amoeba histolytica Ab• Gluten Intolerance Test• H. pylori Ab• Round Worm• Tissue Worm

• DHEA + DHEA(S) • Testosterone• Estrone• Estradiol• Estriol• Progesterone• LH• FSH

• DHEA + DHEA(S)• Androstenedione• Testosterone• Dihydrotestosterone• Estrone• Progesterone• LH• FSH

Adrenal Stress Index™

Expanded Gastrointestinal Health Panel™

Expanded Post Menopausal

Hormone Panel™

Expanded Male Hormone Panel™

GI-02 eMHPePostMASI

Flexi-Matrix™

“Build Your Own Panel”

• 17-OH Progesterone• Total Secretory IgA

• Ova and parasites• Fecal pH • Giardia Antigen

• Testosterone• Estrone• Estradiol

• Testosterone• Dihydrotestosterone

19110 66th Avenue South, Building G Kent, Washington 98032 USA


LA B O R A T O R Y

CL I



DiagnosTechsTM

IN THIS EDITION

2 • Case Study Diagnosing Colitis Using Diagnos-Techs’™ GI Panel

4 • Educational Pathways 2011 Spring Conference Schedule Office Visits, On-line Meetings In-house Seminars with Dr. Dent

• Our Medical Advisors Meet Dr. Rafik Kamelman

5 • Lab News New Test–Vitamin D ASI Reminders/Discussion Points

6 • Tips from Customer Service

• Submitting Samples

• Clinical Pearls

7 • Resources for You Insurance Billing, Technical Services, Shipping, Contact Info

Back • Flexi-Matrix™ Panel Page “Build Your Own Panel”

LA B O R A T O R Y

CL I



DiagnosTechsTM

103411 13M 02/11 05_DTI/chrono#7

Flexi-Matrix™ test kits allow you to combine more than one panel, with the exception of BHP, FHP, eFHP, PeriM and ePeriM. When combining panels, be sure to include the individual tests listed under each of the panels. Flexi-Matrix™ customized test kits are the most economic way of customizing test panels and profiles to meet your clinical needs, saving you 20-70% off individual test fees.

Flexi-Matrix™


n Choose 3 or more individual tests from the list shown on pages 4-6 of the Test and Fee Schedule. (Excludes DPD Bone Marker Test and CS3 Swab Culture for Yeast.) n Be sure to read detailed instructions and fill out the requisition form included in each collection kit. n You will always receive the lower price when your customized panel is identical to a standard panel.

Food Intolerance PanelTM

The Science of Laboratory Medicine

What We Test for and Why We Test it

Gluten intolerance

Gluten intolerance is a more common disorder than

previously reported in the scientific literature. Genetic

predisposition is common in individuals of northern European

descent (Celtic and Nordic) and in non-Caucasian and

Mediterranean ethnicities. Historically, the diagnosis relied on

invasive intestinal biopsy. A normal biopsy, however, does not

exclude the disease. With the advent of biochemical markers

(saliva SIgA) for gluten intolerance, several studies have

proven the presence of various forms of gluten intolerance in

12%-18% of the US and EU populations.

Cow’s milk intolerance vs. lactose intolerance

Cow’s milk intolerance is a specific genetically dictated

intolerance to the major milk protein known as casein. It is

defined as cow’s milk-(and cow’s milk-based dairy) induced

intestinal damage that is reversed by a cow’s milk-free

diet and returns with exposure. Milk intolerance is caused

by casein and other milk antigens/proteins in genetically

predisposed individuals. Casein triggers a toxic reaction in

the intestine that stimulates a gut-specific antibody called

secretory IgA, which we test for in saliva. In severe cases, the

problem is apparent at an early age (<3 years of age).

Casein is the substance in milk that

triggers a toxic reaction in the intestine of

those who are intolerant of cow’s milk.

Egg intolerance

Egg intolerance is defined as egg white-induced intestinal

damage that is reversed by an egg-free diet and returns

on challenge with eggs. It is an abnormal inflammatory

response to ovalbumin in genetically predisposed

individuals. Ovalbumin in chicken (and most other bird eggs)

can trigger a toxic reaction in the intestine that produces

secretory IgA antibodies, which we test for in saliva.

Soy Intolerance

It is defined as soy protein-induced intestinal damage that

is reversed by a soy-free diet and returns on challenge with

soy. It is an abnormal response to soy proteins in genetically

predisposed individuals. This is a problem that is on the

rise in the US. Soy protein is a relatively new food/food

additive in the US, and the long-term health effects for the

US population are not yet clear. However, if your saliva test

is positive, you may want to read food labels more carefully.

In severe cases, the problem is apparent at an early age (<3

years of age). In milder cases, patients may be completely

asymptomatic and may not become aware of the problem

until adulthood through objective testing using salivary

secretory IgA.

In conclusion…

Food intolerances are more common than publicly realized.

They may be treated following appropriate testing and

recognition which requires a single saliva sample.

www.diagnostechs.com • 1-800-878-3787

©2010 Diagnos-Techs, Inc. All rights reserved36310 5M 10/10 03_DTI/fip_patient

19110 66th Avenue South, Building G

Kent, Washington 98032

Major Accreditation

Diagnos-Techs is the only salivary-based lab that is

accredited by the Joint Commission and is committed

to providing its healthcare professional clients with lab

testing that is highly accurate, based on pure science and

designed to assist in restoring optimal health and promoting overall

wellness for patients.

Licensure and Proficiencies

Also accredited and licensed by the State of Washington (License

No. MTS-0327), subject to the Clinical Laboratory Improvement

Act of 2003 (CLIA-2003) certification. Our Federal CLIA Number

is 50D0630141. External proficiency testing obtained from the

College of American Pathologists, American Proficiency Institute

and American Association of BioAnalysts.

continued on page 5

Providers may order up to 50 complimentary patient brochures.

Here's how:

❶Phone 1-800-878-3787

❷Fax 253-398-2449

❸Email [email protected]

❹Download ready-to-print brochures by clicking the ”client tools“ tab after logging in on our web site at www.diagnostechs.com

Did You Know?The Advantages of Saliva Testing:Non-Invasive • No blood draw needed

Convenient • Specimens easily collected at home

Precise • Tissue level measurement of biologically active fraction of steroid hormone• Convenient multiple sample collection• Samples stable for several weeks

Online Meetings & Office Visits with our Medical Advisors

Online meetings offer an overview of our test panels and sample reports to familiarize clients with how to use them with an opportunity to ask questions.

Office visits provide local clients the opportunity to receive information on testing and how to further integrate our lab into their practice.

To schedule an appointment, please email Tomomi at [email protected].

chronobiology 7

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