Most of my routine lab work is done through LabCorp. The following labs are included with your initial enrollment at no additional cost to you(*). This battery of tests will tell me a great deal about your health; it includes tests for diabetes, heart disease, thyroid function, inflammation, anemia, gout, kidney problems, liver problems, and electrolyte imbalances.
If you do not have known issues with diabetes or hypoglycemia then I recommend a 12 hour fast (i.e. nothing to eat or drink except water) before getting this battery of tests. If you do have diabetes–particularly if you use insulin or other medications that can cause hypoglycemia–then you do not need to fast beforehand.
- Complete Blood Count (CBC) with differential
- Comprehensive Metabolic Panel (CMP)
- Hemoglobin A1c
- Insulin (fasting)
- Magnesium, RBC
- Thyroid Stimulating Hormone (TSH)
- Uric Acid
- Lipid profile (cholesterol)
- High-sensitivity C-reactive protein (hsCRP)
- Vitamin D3 (25-OH Vitamin D3)
(*) As of October 2018 this list is under active revision and subject to change. Please confirm the labs to be included at the time of your enrollment.
In-office: In-office fingerstick glucose testing and urine dip-stick tests are complimentary.
Other Labs – Highly discounted prices
For patients who are willing to pay in advance, I am able to offer many labs at prices that are significantly below market rates. Patients wishing to have their insurance plans billed for labs may still do that.
For those paying for labs themselves, here’s an alphabetically-ordered Price Calculator to help you quickly figure out how much some of the more commonly ordered LabCorp labs will cost you. (Prices current as of October, 2018.)
If you’re less sure about what you might want to get, here’s a list of most of those same labs and their costs, along with a simple basic description.
$3.30 – Basic Metabolic Panel (BMP) – includes glucose, many electrolytes, and kidney function tests.
$4.20 – Comprehensive Metabolic Panel (CMP) – same as BMP but with addition of tests for liver function.
$26 – Basic pap smear lab fee. A pap smear is a test looking for the presence of abnormal cancerous or precancerous cells on the cervix. Under current guidelines, a pap smear is good for 3 years if results are normal with no recent history of an abnormal pap or high-risk HPV infection.
$45 – HPV / Human Papilloma Virus – adding this test to a basic pap smear increases the sensitivity for detection of disease by looking for the virus that causes cervical cancer. If this test is done and both the pap smear and HPV test come back normal then current guidelines suggest you won’t need another pap smear for 5 more years.
$3.75 – TSH / thyroid stimulating hormone – a pituitary hormone that reflects the brain’s desire for more thyroid hormones (T3 and T4) to be around. A higher TSH usually reflects increased demand for more hormone (i.e. a hypothyroid state).
$4.13 – Free T4 – the amount of unbound precursor to active thyroid hormone.
$4.13 – Free T3 – the amount of unbound active thyroid hormone.
$19.88 – Reverse T3 – an inactivated form of thyroid hormone that can be made from T4 instead of T3; this is commonly overproduced in response to inflammation, cortisol abnormalities, or other metabolic disturbances.
$5.25 – Antithyroglobulin antibody – used to detect and monitor autoimmune (Hashimoto’s) thyroiditis
$8 – Thyroid peroxidase (TPO) antibody – used to detect and monitor autoimmune (Hashimoto’s) thyroiditis.
$3 – CBC (complete blood count) with differential & platelets – shows the amounts and sizes of the various types of cells that make up blood.
$3 – Ferritin – best measure of iron stores but may also be elevated in inflammatory conditions
$3.60 – Iron & TIBC – measures of the amount of iron and the amount of available transferrin iron binding sites.
$10 – Vitamin B-12 & folate – critically important vitamins that may be deficient in anemia, fatigue, memory problems, or sensory neuropathy.
$22.35 – methylmalonic acid – a more accurate test for Vitamin B-12 deficiency; assesses tissue level B-12 deficiency, not just serum B-12 level.
Cardiovascular Disease Tests
Lipid panel (price is for subsequent tests; first is included with initial labs): $3.75
NMR Advanced Lipid Profile – a better lipid profile (cholesterol) test – it gives more detailed and accurate information. Recommended for higher-risk patients: $39.38
Apolipoprotein B (an essential marker that – together with a regular cholesterol test – more accurately predicts atherosclerosis risk): $7.30
Lipoprotein(a) – (a separate fraction of LDL cholesterol that can significantly increase risk for cardiac events): $9.50
high-sensitivity C-reactive protein (hsCRP) – a test for accurately detecting lower levels of C-reactive protein that may be suggestive of coronary artery disease (price is for subsequent tests; first is included with initial labs): $7
Hemoglobin A1c (price is for subsequent tests; first is included with initial labs): $3.38
Urine microalbumin (protein)/creatinine ratio (appropriate for those with history of diabetes or renal disease): $8
Testosterone, total (men): $6
Testosterone, free & total (men): $15
Testosterone, free & total (high-sensitivity, appropriate for women and hypogonadal men): $21.85
Follicle Stimulating Hormone (FSH): $4.50
Luteinizing Hormone (LH): $4.50
DHEA (a sex hormone precursor; low levels can also be a cause of low-functioning thyroid): $TBD
Lyme antibody (total) with reflex to Western Blot (chronic fatigue, chronic headaches, chronic joint pains – not useful for those previously diagnosed with Lyme disease): $16.25
Lyme Western Blot confirmatory testing (may not be useful for those previously diagnosed with Lyme): $23
Ovarian cancer (*) – see below
Prostate Screening Antigen (PSA): $5.25 (**); Total PSA with %free PSA (better for those with known history of elevated or borderline elevated PSA): $13.13
Uric Acid (price is for subsequent tests; first is included with initial labs): $2.50
Vitamin D level (price is for subsequent tests; first is included with initial labs): $13.75.
Magnesium, RBC: (Price is for subsequent tests, first is included with initial labs): $19.88 (***)
Although I am generally a proponent of genetic testing, I recognize that many people have concerns that somebody (whether themselves or others) might learn learn something about them that they would rather not have known. Although I will not attempt to address privacy concerns beyond noting that there are (currently) laws prohibiting health insurance companies and large employers from genetic discrimination, I strongly believe there can be significant benefits to having personal access to one’s own genetic information. In particular it’s important to know that genetic predispositions are not destiny: environmental factors are crucial in determining how likely we are to actually develop many major health problems. Potentially avoidable tragedies include such things as Alzheimer’s Disease, cancer, diabetes, heart disease, and Parkinson’s. (Yes, really!) In other cases genetic sequencing can help us make diagnoses of existing problems or identify which interventions are likely to work and which are likely to be ineffective (personalized medicine).
For most people who are interested I recommend getting their genome sequenced through 23andme.com. The 23andme Ancestry test actually includes the same SNP sequencing data as their more expensive Ancestry and Health test and is normally available for only $99, but is occasionally offered for less when they are running a special. Due to legal restrictions imposed by the FDA, the health reports offered by 23andme aren’t nearly as useful as the raw data files they also give you access to. You can use your raw 23andme data to obtain much more useful reports from third-party analysis services such as Genetic Genie, Livewello, or Promethease (among others).
Ancestry.com is another reasonable option for obtaining SNP data; the last time I checked I had the sense that it may be slightly inferior to 23andme for health-related information but slightly superior for genealogy.
For those particularly concerned about cancer, GetColor offers specialized DNA testing for 30 cancer-associated genes for $224. It should be noted that many of those genes may not be found with the limited “SNP-testing” approach of 23andme or Ancestry. By contrast those genes would be found with Whole Exome Sequencing (“WES”) or Whole Genome Sequencing (“WGS”). Whole Genome Sequencing (“WGS”) is the gold standard of genetic sequencing in most cases because it allows one to get effectively ALL of their DNA data; it’s still outside of the budget of many of my patients but has been coming down in price lately: As of this writing (July, 2018) WGS is available for $499 from Dante Labs,
(*) As of 2018, the marker tests for ovarian cancer screening (e.g. CA-125) are considered worthless by the FDA, the American College of Obstetricians and Gynecologists, and the US Preventive Services Task Force (among others). In the case of CA-125, for example, too many false positives occur, leading to an abundance of testing by ultrasound; an abnormality on ultrasound (which could also come from common things like ovarian cysts) then leads to a great number of exploratory surgeries–of which only about 1 in 20 will find a cancer.
Even ignoring all of the grief, worry, and extra surgeries caused by the huge numbers of false positives, it turns out there is no statistical difference in terms of the number of lives saved by testing for these markers. Unfortunately, by the time the CA-125 test turns positive, the cancer has generally already spread. Other markers (or panels of several markers) have not been shown to be any more effective.
Ovarian cancer is estimated to kill about 1 in 75 US women. Although the future holds some hope for the early detection of ovarian and other cancers (based on screening for oncogenic microRNA expression patterns), that technology has yet to arrive in physician offices. For now genetic screening (as discussed above) remains the most reasonable and effective means of identifying at-risk women.
(**) I do not necessarily recommend PSA testing, but I also do not necessarily recommend against obtaining it. It should be recognized that there are pros and cons associated with checking a PSA. It may be valuable for detecting prostate cancer at an early stage, but there is a great deal of controversy surrounding the wisdom of doing so, particularly for older men. This is because prostate cancer is usually a slow growing disease. Most men with prostate cancer will grow old and die from something else without ever knowing they have it– unless we test for it. Aggressive treatment of prostate cancer commonly results in undesirable side effects with only marginally increased odds of longer-term survival. (Please note the abundance of italicized weasel words, however; although the US Preventive Services Task Force recommends against the PSA for prostate cancer screening, different men have different priorities, so the choice is up to you.) If you have previously been treated for prostate cancer, then a high-sensitivity PSA is still recommended. For an informed perspective from a man treated for early prostate cancer that was detected by an elevated PSA, you might want to see this article from Men’s Health magazine.
(***) Due to inadequate consumption of green leafy vegetables, magnesium deficiency in Americans is now more common than not. It has many consequences, some of them fairly profound. There are two readily available tests to assess magnesium status: The cheap test (serum magnesium) is essentially worthless for most people most of the time as it generally shows a “normal” serum magnesium level even in people with a profound and symptomatic magnesium deficiency. The RBC magnesium test is better because instead of looking to see how much magnesium is floating around in between the blood cells, it measures how much magnesium is actually inside of the blood cells– which turns out to be a much better gauge of overall magnesium levels in our tissues.]