The following labs are covered by your initiation fee. 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)
- Erythrocyte sedimentation rate
- Hemoglobin A1c
- Thyroid Stimulating Hormone (TSH)
- Uric Acid
- Lipid cascade profile (cholesterol) – if abnormality found, additional non-complimentary testing (NMR Lipoprofile and/or Direct-LDL measurement) will be automatically ordered to better assess cardiac risk. You will be responsible for this charge.
- High-sensitivity C-reactive protein (hsCRP)
- Iron and TIBC
Glucose: In-office fingerstick glucose testing (when appropriate) is 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.
The following 3 tests are highly recommended for screening, particularly for those with chronic health problems. Deficiency is very common and I would include these tests in the complimentary annual panel if I could afford to:
Vitamin D level (fatigue, abnormal calcium level, frequent falls): $25
Zinc (recommended for those with poor wound healing): $27
Magnesium, RBC: $34 [Magnesium deficiency is more common than not and 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. It generally shows a “normal” serum magnesium level, even in people with profound and symptomatic magnesium deficiency. The more expensive RBC magnesium test is somewhat better in that instead of looking to see how much magnesium is floating around in between the blood cells, it looks to see how much magnesium is actually inside of the blood cells. The most accurate magnesium test of all (tissue-level sampling) requires an actual tissue biopsy, which is a bit extreme for screening purposes and is not a service that I offer at this time.]
Basic pap smear fee is $25. (Good for 3 years, if results are clean and there is no recent history of abnormal pap or HPV.)
Pap + co-testing for high-risk Human Papilloma Virus (HPV) is $75 (Good for 5 years, if results are clean and there is no recent history of abnormal pap or HPV.)
Thyroid Tests (I do not recommend all of these tests for all patients with thyroid problems; prices are included here for illustrative purposes)
TSH (price is for subsequent tests; first is included with annual labs): $6
Free T4 (available amount of precursor to active thyroid hormone): $18
Free T3 (readily available amount of most active thyroid hormone): $19
Total T3 (total amount of most active thyroid hormone, includes bound/unavailable T3): $19
Total T4 (total amount of precursor to active thyroid hormone, includes bound/unavailable T3): $6
Reverse T3: (an “anti-hormone” that inhibits (blocks) active T3; it is commonly elevated in people with cortisol abnormalities): $72
Selenium, RBC (critically important trace element needed for proper thyroid function, needed to convert T4 to T3): $52
Iodine (second most important electrolyte in thyroid disorders, after selenium): $46
Antithyroglobulin antibody (used for testing for autoimmune thyroid problems): $31
Thyroid peroxidase (TPO) antibody (used for testing for autoimmune thyroid problems): $14
DHEA (a sex hormone precursor; low levels can be a cause of low-functioning thyroid): $19
Iron (anemia, fatigue): $4
Vitamin B-12 & folate (anemia, fatigue, memory problems, sensory neuropathy): $14
Ferritin (best measure of iron stores but may be falsely elevated in inflammatory conditions): $11
Total Iron Binding Capacity (TIBC): $10
Methylmalonic Acid (a much more accurate test for Vitamin B-12 deficiency; assesses tissue level B-12 deficiency, not just serum B-12 level): $73
Cardiovascular Disease Tests
Lipid panel (price is for subsequent tests; first is included with annual labs): $5
NMR Advanced Lipid Profile – a better lipid profile (cholesterol) test – it gives more detailed and accurate information. Recommended for higher-risk patients:: $45
Apolipoprotein B (an essential marker that – taken together with a regular cholesterol test – more accurately predicts atherosclerosis risk): $24
Lipoprotein(a) – (a separate fraction of LDL cholesterol that can significantly increase risk for cardiac events and stroke): $36
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: $18
Methylene Tetrahydrofolate Reductase (MTHFR) gene testing: $205
C-reactive protein/CRP (detects inflammation, appropriate for those with arthritis or other inflammatory conditions): $16
Genetic Testing for 30 different genes conferring higher risk for several types of hereditary cancers is offered through a company called GetColor for $224.
Insulin levels, (serial) following glucose challenge – (this is an advanced/non-traditional diabetes screen based on the work of Joseph Kraft, MD): price pending
Lyme antibody (chronic fatigue, chronic headaches, chronic joint pains – not useful for those previously diagnosed with Lyme disease): $45
Lyme Western Blot confirmatory testing (may not be useful for those previously diagnosed with Lyme): $120
Ovarian cancer (*) – see below
Prostate Screening Antigen (PSA): $8 (**); Total PSA with %free PSA (better for those with known history of elevated or borderline elevated PSA): $35
Testosterone level (fatigue, lack of libido, erectile dysfunction): $10
Urine microalbumin (protein)/creatinine ratio (appropriate for those with history of diabetes or renal disease): $16
(*) As of 2016, 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 that there is no statistical difference in terms of 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 near-future perhaps 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. In the meantime, one type of test stands out as being the only thing to offer any actual objective data that might enable some informed decisions to be made: genetic sequencing. As mentioned above, a company called GetColor is offering a battery of 30 genetic cancer screening tests for $224. Another company offering genetic screening for ovarian cancer is Ambrygen.
(**) 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.