Lab Tests, Consultations, Follow-Ups
Utilizing the "Walsh Approach" to Evaluate Mood and Behavior Disorders
Comprehensive Biotype Panel and Biotype Report
Second Opinion Physician, P.C., is a telemedicine/telehealth practice. It is maintained and managed by Dr. David Epstein, D.O., a functional medicine physician. He specializes in the Walsh Approach to manage mood and behavior disorders.
Typically, the initial Second Opinion Physician evaluation workup includes the Comprehensive Biotype Panel and Consultation. This lab work is referred to as the "Walsh Panel." It includes blood work from Lab Corp and urine pyrrole testing by DHA labs. Blood tests include whole blood histamine, homocysteine, copper, zinc, ceruloplasmin, vitamin D plus a CBC and Metabolic Panel. Dr Epstein will use this information, along with a patient-completed online questionnaire, to prepare a multi-page Biotype Report™. Following receipt of the Consultation with Report, the patient or responsible party has the option of scheduling a phone call to discuss any questions about the findings and plan.
Partial Lab Panels, Individual Tests and Follow-Up Assessments
The Comprehensive Walsh Panel includes various tests and smaller panels that can be ordered individually or as a whole, depending on budget and the need for retesting. There are five biotypes that Walsh-trained physicians evaluate based on lab results and patient history: undermethylation, overmethylation, pyroluria, copper overload, and toxic overload.
The Copper Overload Panel is a useful test for evaluating imbalances that can cause symptoms such as ADHD, anxiety, irritability, insomnia, and postpartum depression. It is important to address copper overload before addressing other imbalances, as the combination of copper overload with boosted methylation can temporarily worsen symptoms.
The pyrrole urine test is included in the initial Comprehensive Biotype Panel, but may not be necessary as the first test. It is used to determine the presence of pyroluria, which is a lifelong condition that can be improved with proper supplementation. The severity of zinc deficiency or copper overload is used to determine initial treatment for pyroluria. If there is a copper imbalance, the Pyrrole test can help determine the cause and indicate if there is likely to be a chronic vitamin B6 deficiency.
Other tests that may have recently been performed by the patient's primary care physician or psychiatrist include the vitamin D test, complete blood count (CBC), and metabolic panel. The CBC can help evaluate symptoms of undermethylation, overmethylation, and fatigue or chronic infection. These tests may not need to be redrawn if they have been conducted within the past 30-45 days when ordering a full panel Second Opinion Physician consultation.
To assess undermethylation and overmethylation, the whole blood histamine and homocysteine tests are used. These tests are available together as the Second Opinion Physician Methylation Panel and are evaluated together before considering supplements for methylation issues. An additional Methylation Panel by Doctors Data may be used when patients are taking antidepressants, but is only necessary when whole blood histamine results are unclear due to the use of antihistamine medications.
The MTHFR and COMT genetic tests may be helpful in deciding whether to supplement with methylated vitamins, but they are not used for evaluating methylation status according to the Walsh Approach. For more information on the role of MTHFR in determining the need for folic acid supplements, please see this article.
The Biotype Report is a summary of test results and client history that is reviewed by Dr Epstein. He makes professional recommendations and provides a list of supplements tailored to the patient's weight, existing medications, and past medical history. The report includes instructions on how to schedule the supplements, when to start taking them, and the recommended dosage. It also includes information on the patient's specific biotype according to the teachings of Dr William Walsh. This report is available for patients who have ordered labs through the Second Opinion Physician website. For tests performed by outside labs or clinics, there is an additional fee due to the extra time required to gather this information. Patients who provide their own Walsh Panel labs for evaluation can also order this Consultation which includes the Biotype Report.
*If currently stabilized on anti-depressant, anxiolytics or anti-psychotics, etc., are advised to continue taking the medications for six months, after starting the Walsh Protocol. At that time it is advised to work with the prescribing physician to supervise the reduction or discontinuation of such medications.
What to Expect - Test Ordering and Walsh Approach Consultation Reports
When ordering the full you will receive a confirmation of the order being processed. Then an email will be sent to you with instructions on fasting and supplements prior to lab testing. You will also receive a Lab Corp requisition in a pdf printable format. This can be taken to any Lab Corp drawing facility. Any test orders that do not include a consultation will include the pre-paid lab requisition and preparation instructions. Most orders are processed within 24 hours. Lab Corp results are complete within 3-4 working days. Consultation Reports are prepared within 1-2 days following the test results. A link will be sent to schedule a follow-up call to go over the results and answer any questions.
- All consultations will be confirmed by email with a link to a HIPAA-compliant, secure, online questionnaire and consent form.
- Pyrrole urine test kits are delivered to your mailing address directly from DHA Labs.
- All results are sent to Second Opinion Physician and will be forwarded to the patient, with or without a consultation.
- After taking supplements for 2-4 months, follow-up testing may be advisable. This info will be included in the Report. You may re-order tests online or else contact us with any questions.
- Follow up visits are recommended and vary on a case by case basis. Typically when labs are out of balance these may be re-tested after 2-4 months. This is useful when attempting to determine how well supplements have affected the blood chemistry or when considering adjusting supplement dosages.
- Second Opinion Physician will provide a form to you for your insurance, for possible reimburse for Lab Corp tests and doctor consultations. We do not accept assignment with insurance and cannot offer to transfer billing or provide refunds once the tests have been completed. If there is a chance your insurance will pay for your tests you order directly with Lab Corp, please address this in advance of ordering labs. We cannot provide a Diagnosis Code prior to the full evaluation with Biotype Report. Codes are typically required by insurance companies for lab reimbursements.
Dr Epstein will reply to emails regarding issues that come up relative to the labs, supplements and the consultation in general. This is typically provided at no charge. If the feedback requires an extended amount of time it may be best to order a 10 or 20 minute phone consultation.
Follow this link learn more about the Walsh Approach.
Feel free to contact us with any questions or to schedule a free, pre-consultation.
Walsh Approach Follow-Up Tests Considerations
Depending on results from initial tests, we like to retest only a few labs. If initial tests are out of normal range, follow-up tests may include one or more of the following: copper, ceruloplasmin, zinc, homocysteine and vitamin D.
- Pyrroles and histamine do not typically require re-testing.
- Retesting is helpful in determining which supplements to adjust.
- Zinc, copper and ceruloplasmin are often retested when patient has trouble with low zinc or elevated free copper and/or would like to begin on MT Promoter. It is also useful when attempting to lower your medications under the supervision of your primary care provider.
- Whole Blood Histamine does not change much with supplementation and unless the initial results are ambiguous due to concurrent medications, the test may be repeated when medications have been out of the system for 3-4 weeks.
- If your Dr Epstein suspects you are undermethylated but result interpretation is complicated by taking histamine lowering medications, he may recommend a different Methylation Panel.
- For persons who have a cardiovascular or stroke risk, it is advisable to wait on addressing undermethylation until homocysteine levels are brought down to a more normal level and periodically retest.
- CBC is retested when taking folates in an overmethylated person to monitor progress with red and white blood cell status.
General Functional Medicine Evaluations
Second Opinion Physician offers a broad range of tests provided by Lab Corp. Some may help with optimizing depression and anxiety therapy. Some, particularly useful labs include the Hashimoto's Thyroid Panel, CDSA Digestive Stool Analysis, Traumatic Brain Injury (TBI) Panel, Cognoscopy Panel for Memory and Dementia and the Hair Mineral Test.
Thyroid deficiency is a somewhat common underlying issue with mood disorders. A comprehensive stool analysis may indicate mood imbalance or nutrient deficiency is impacted by intestinal overgrowth of unhealthy bacteria, yeast or parasites. The hair mineral test can indicate if there are other metal imbalances, such as lead and mercury which can be another cause for copper overload and zinc deficiency. The TBI panel, as advanced by Mark Gordon, MD tests for sex hormones and other neuroprotective factors that may be impaired as a result of damage to the hypothalamus. The Cognoscopy Panel is Dale Bredesen, MD's full profile of markers, including APOE4 genetic test plus inflammation markers that can be corrected in persons with dementia, memory loss or as part of an overall strategy to monitor and optimize nutrients that play a significant role.