Ordering Lab Tests, Assesments and Reports
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The Walsh Panel and Consultation by Second Opinion Physician
Walsh Panel Lab Testing, plus other Lab Tests, Panels and Evaluations.
On this site you may order all labs pertaining to the Walsh Panel or "sub-panels", plus the range of common tests offered by Lab Corp and functional lab companies.
Second Opinion Physician provides full and partial panels for new and repeat patient lab orders. Follow the bold links for pricing details.
For a full Walsh Panel test profile, the Comprehensive Biotype is the recommended. When this panel is ordered along with the corresponding Consultation option, Dr Epstein, D.O. will prepare a Biotype Assessment from the lab report and questionnaire. His services include a follow-up phone call to answer any questions you have about the report, supplement recommendations and follow-up plan.
Is it necessary to order all the tests in the Walsh Panel?
When on a budget, or for retesting previously-out-of-balance labs it is possible to order single tests within the Comprehensive Walsh Panel or smaller "sub-panels". Below are a listing of smaller panels and single items and purpose for testing.
- Copper Overload Panel - a good screen for anxiety, insomnia, irritability, PPD post-partum depression and imbalances caused by pyroluria. Doctors prefer to treat for elevated free copper before tackling methylation issues.
- Individually, or as in addition to the Copper Overload panel, it is good to include a Vitamin D, CBC and Metabolic profile. Vitamin D is important in serotonin receptor performance. CBC and Metabolic panels are useful screens for anemia, infections and inflammation as well as nutrient status, liver and kidney function. Typically they are required as a screen for most examinations. If you have had any of these tests drawn within the past 30-45 days they may not be necessary to redraw when ordering a Second Opinion Physician consultation.
- For assessing undermethylation and overmethylation, this site offers a simple Methylation Panel that includes whole blood histamine and homocysteine. These are evaluated simultaneously prior to supplementation for methylation issues. There is another Methylation Panel by Doctors Data used occasionally when patients are on anti-depressants, but when histamine is elevated while on such histamine-affecting-medicines, we can usually get by without doing the alternate panel for methylation by Doctors Data. This test is useful when the whole blood histamine test result is ambiguous due to anti-histamine medicines. While it may be helpful in deciding whether or not to supplement with methylated vitamins, we do not use MTHFR test for evaluating methylation status. For questions about MTHFR and the role it plays with determining need for folic acid supplements please see this article.
- Pyrrole urine test - while this is included in the initial Biotype panel, it is not always necessary as a first test. Whether or not pyrroles are elevated, the initial treatment for pyroluria is based on the degree of zinc deficiency or copper overload. If there is a copper imbalance, then a pyrrole test will be important to determine cause. Since pyroluria also determines Vitamin B6 status, an elevated free copper, followed by pyrrole lab is a good sequence for testing, to know if there is likely to be a chronic deficiency of zinc and B6 due to the pyroluria condition.
Other useful screening tests for depression and anxiety include TSH or a full thyroid panel and CDSA digestive stool analysis and a hair mineral test. Thyroid deficiency is a relatively common underlying issue with mood disorders. A comprehensive stool analysis can be used to help determine intestinal overgrowth of unhealthy bacteria, yeast or parasites. These are very common with depression, mood disorders, inflammation and nutrient deficiencies. 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 Biotype Report is a Consultation summary report that includes a review of the full panel of test results plus client history. Dr Epstein reviews each case and makes his professional recommendations in the detailed report. The patient is provided with a list of supplements, adjusted for weight, existing meds and past medical history. The report includes how to schedule supplements, when to start what and what is the target dosage recommended. It also includes pertinent details about your specific biotype, according to the teachings of Dr William Walsh PhD. For patients ordering a consultation for labs performed on the Second Opinion Physician website order this Biotype Report. For tests provide by outside labs or clinics, the fee is a bit higher due to the extra time involved in collecting this information. When providing your own Walsh Panel labs for evaluation, please select this Consultation and Biotype Report.
Here's what to expect:
A pre-paid requisition form will be emailed to you for blood to be drawn at Lab Corp. An email will accompany with instructions on fasting, and use of medications and supplements prior to testing. You will also receive this link to Lab Corp to find the nearest location.
- Urine test kit will arrive at your door from DHA for testing pyrroles.
- Your completed order and follow up email will include instructions and links for completing an online, encrypted questionnaire and telemedicine consent agreement.
- Labs results and Assessment and Plan will be sent to your email via an encyrpted server.
- If you selected Consult and Report, following receipt of your Assessment, a phone conversation will be scheduled between you and our Walsh Protocol doctor to discuss results.
- After taking supplements for 3-6 months, follow-up testing may be advisable. You may order online directly or else contact us with any questions.
- Second Opinion Physician will provide a form to you for your insurance, should they be prepared to reimburse for labs ordered through Lab Corp and for the consultation. We do not accept assignment with any insurance and cannot offer to transfer billing for insurance direct reimbursement to Lab after payment has been received. So if there is a chance your insurance will pay for your tests directly with Lab Corp, please address this in advance of ordering labs. Keep in mind, we cannot provide a Diagnosis Code prior to the full evaluation with Biotype Report. Codes are typically required by insurance companies for lab reimbursements.
- Follow up visits are recommended and may vary on a case by case basis. Typically when labs are out of balance these may be re-tested after 3-6 months. This is useful when attempting to determine how well supplements have affected the blood chemistry or when considering adjusting supplement dosages.
Dr Epstein will reply to emails regarding issues that come up relative to the labs, supplements and general concerns. This is typically at no charge. If the time required becomes extended you will be notified if the service requires additional fees.
We are looking forward to working with you!
If following an evaluation it is determined that there are other non-supplement supported issues that should be addressed, Dr Epstein will assist in locating a functional medicine physician in your area that is supportive of approach. Regarding medicines being taking at the time of testing: If one or more "biotypes" are found to be out of balance, clients are encouraged to stay on their current prescription regimen for up to six months while on the supplement protocol before attempting to discontinue medications. This is important to prevent a worsening of symptoms while on supplements. Second Opinion Physician does not manage prescriptions or assist with psychiatric medicine changes. This should be done with your local primary care provider or prescribing psychiatrist to properly monitor your condition during adjustments.
Follow Up Questions and Lab Services
Retesting, or not?
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.
- If histamine results are questionable because of taking antihistamine medicines, the test can be repeated when medications have been out of the system for 3-4 weeks.
- If your doctor suspects you may are undermethylated but result interpretation is complicated by taking histamine lowering medications, an alternate Methylation Panel may be ordered.
- 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.
- CBC is retested when replacing folates in an overmetylated person to monitor progress and ensure proper hemaglobin uptake and macrocytosis correction.