My bloodwork: 55 years old man

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    My bloodwork: 55 years old man


    Blood Pressure 104/78

    Cholesterol, total 178

    Triglycerides 54

    HDL 66
    VLDL 11
    LDL 101

    Serum Test 604 ng/dl
    Free Test (Direct) 12.8 pg/ml

    PSA 1.2

    TSH 1.585 uIU

    My doc says I am perfect. Being a newbie at this anti aging, the numbers look good but my libido is low. Any thoughts by you guys as to why?

    I was thinking maybe an anti estrogen because of my age?

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    Great numbers. My concern would be that by 55 we all have/had prostate cancer. The only question is how much. I would lower the estrogen with an AI, inversely raising your test and helping with the libido. I prefer Formastane, it helps me on all three fronts and only takes about 5 mins per application. I also use a Progesterone cream which helps a lot.
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    Quote Originally Posted by Dutchman View Post
    Great numbers. My concern would be that by 55 we all have/had prostate cancer. The only question is how much. I would lower the estrogen with an AI, inversely raising your test and helping with the libido. I prefer Formastane, it helps me on all three fronts and only takes about 5 mins per application. I also use a Progesterone cream which helps a lot.

    I was thinking of using formastane too. Why the progesterone? And where do you get it?
    •   
       

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    Quote Originally Posted by goshawk View Post
    Blood Pressure 104/78

    Cholesterol, total 178

    Triglycerides 54

    HDL 66
    VLDL 11
    LDL 101

    Serum Test 604 ng/dl
    Free Test (Direct) 12.8 pg/ml

    PSA 1.2

    TSH 1.585 uIU

    My doc says I am perfect. Being a newbie at this anti aging, the numbers look good but my libido is low. Any thoughts by you guys as to why?

    I was thinking maybe an anti estrogen because of my age?
    You have not provided enough information, posibly you have more tests, present it here.

    If you are 55yo who want to put some effort to figure out his health status, I can tell you my preferences.
    I am 67yo.

    Look at my post #44, for ideas, but short description:

    My list for blood test at Quest, blood drawn at Quest.

    At Genova Diagnostics:
    Estroessence
    and
    NutrEval

    Jan's BloodTest April13/2007
    ---------------------------------------------------------
    My blood test cost $3500
    but insurance covered everything except $6.

    I am waiting for the Genova tests to be processed by insurance. Genova takes care of insurance paperwork.
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    Need labs.
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    Quote Originally Posted by goshawk View Post
    Blood Pressure 104/78

    Cholesterol, total 178

    Triglycerides 54

    HDL 66
    VLDL 11
    LDL 101

    Serum Test 604 ng/dl
    Free Test (Direct) 12.8 pg/ml

    PSA 1.2

    TSH 1.585 uIU

    My doc says I am perfect. Being a newbie at this anti aging, the numbers look good but my libido is low. Any thoughts by you guys as to why?

    I was thinking maybe an anti estrogen because of my age?

    You don't know what your estrogen level is, and your contemplating taking an anti-E.

    As everybody said . . . more tests.
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    Quote Originally Posted by Kingston pt View Post
    Need labs.
    WBC 5.8
    RBC 5.07
    Hemoglobin 16.6
    crit 48.5
    MCV 96
    MCH 32.7
    MCHC 34.2
    RDW 12.8
    Platelets 223
    Nuetrophils 60
    Lymphs 31
    Monocytes 7
    EOS 1
    Basos 1

    Glucose 79
    BUN 19
    Creatinine 1.3
    Ratio 15
    sodium 140
    potassium 4.0
    Chloride 101
    CO2 27
    Calcium 9.4
    total protein 7.0
    Albumin 4.4
    globulin 2.6
    A/G ratio 1.7
    Bilirubin 0.9
    Phosphatase 57
    AST (SGOT) 39
    ALT (SGPT) 50


    I asked my doc to run the Crisler panel but he said not necessary if T is in normal range.
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    Quote Originally Posted by goshawk View Post
    WBC 5.8
    RBC 5.07
    Hemoglobin 16.6
    crit 48.5
    MCV 96
    MCH 32.7
    MCHC 34.2
    RDW 12.8
    Platelets 223
    Nuetrophils 60
    Lymphs 31
    Monocytes 7
    EOS 1
    Basos 1

    Glucose 79
    BUN 19
    Creatinine 1.3
    Ratio 15
    sodium 140
    potassium 4.0
    Chloride 101
    CO2 27
    Calcium 9.4
    total protein 7.0
    Albumin 4.4
    globulin 2.6
    A/G ratio 1.7
    Bilirubin 0.9
    Phosphatase 57
    AST (SGOT) 39
    ALT (SGPT) 50


    I asked my doc to run the Crisler panel but he said not necessary if T is in normal range.
    Insist on testing or change doc.

    Jan's BloodTest April13/2007

    Look for ideas on how to find a doctor, in my post #56.

    Usually endos are bad.
    Usually osteopaths are hopeful.
    No guarantee, have to interview (over phone first) either their staff or doctor.
    Post your ZIP, may get lucky, people may sugest doc for you.
    Mine is at 07410
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    Quote Originally Posted by JanSz View Post
    Insist on testing or change doc.

    Jan's BloodTest April13/2007

    Look for ideas on how to find a doctor, in my post #56.

    Usually endos are bad.
    Usually osteopaths are hopeful.
    No guarantee, have to interview (over phone first) either their staff or doctor.
    Post your ZIP, may get lucky, people may sugest doc for you.
    Mine is at 07410

    I saw your blood work Jan, amazingly comprehensive, but my question is: what can you do with all that info? In reading Dr Crisler's site, his standard armamentarium is T Gel, HCG, and anti estrogen.

    I doubt anyone/Doc will add T to my treatment, at over 600, I am likely a bit above normal for a 55 year old. My HPTA appears to be working pretty well, and as you have stated just adding HCG isn't likely to generate the response I need. That leaves an anti e as a possible.

    I am guessing I have enough T being generated, but my free T is a little low. What supps or meds would one take to get more free T and even better bioavailable T?

    My real issue is low libido and poor erectile response. I did not sleep well for a few months but I have found that Trazadone 100mg gives me 7-8 really deep hours of sleep. It also gives me rock hard nocturnal erections, like a teen ager, all night long. So the pumps and valves seem to work OK. I am not diabetic, I do not smoke, I probably have 12-15% body fat maybe less. I am 6', 185. Just for grins I went to a batting cage and I can catch up and crush a 80 MPH fastball, not all that useful in day to day but hand eye and reflex time is still really sharp. Ski double black diamonds, hike 14ers in the summer. I can hit the driver 280-320 pretty easy. I have noticed in the past year that my muscles just don't respond to lifting like they did just a year ago. Viagra, Cialis used to be just incredible for me but now they hardly work or its a real challenge.

    Whjat should I be looking at? Intuitively, I thought I might have high estrogen blocking the receptor for both arousal and muscle synthesis.
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    I am just 3 years younger than you. Me total test was about midrange. I had big problems with fatigue. Also problems with exericise recovery and erectile dysfunction.

    My free testosterone was significantly lower and my estradiol was very high (upper quartile).

    After ruling out the likely cause of the fatigue I elected a trial of testosterone and and an arotmatase inhibitor. My total test is upper limits of normal and estradiol levels are now lower quartile.

    I have had complete relief of the fatigue, post exercise recovery and erectile function is good.

    The issue of andropause is very new to the medical community in general and I understand the response of doc.

    Several thoughts:

    1) alway rule out the major diseases which may be the cause or contributing factor for your symptoms first. Dont just assume it testosterone or estrogen related.

    2)Always have a PSA and digital rectal exam as part of your work up and especially if you are considering hormone replacement.
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    Quote Originally Posted by goshawk View Post
    I saw your blood work Jan, amazingly comprehensive, but my question is: what can you do with all that info? In reading Dr Crisler's site, his standard armamentarium is T Gel, HCG, and anti estrogen.

    I doubt anyone/Doc will add T to my treatment, at over 600, I am likely a bit above normal for a 55 year old. My HPTA appears to be working pretty well, and as you have stated just adding HCG isn't likely to generate the response I need. That leaves an anti e as a possible.

    I am guessing I have enough T being generated, but my free T is a little low. What supps or meds would one take to get more free T and even better bioavailable T?

    My real issue is low libido and poor erectile response. I did not sleep well for a few months but I have found that Trazadone 100mg gives me 7-8 really deep hours of sleep. It also gives me rock hard nocturnal erections, like a teen ager, all night long. So the pumps and valves seem to work OK. I am not diabetic, I do not smoke, I probably have 12-15% body fat maybe less. I am 6', 185. Just for grins I went to a batting cage and I can catch up and crush a 80 MPH fastball, not all that useful in day to day but hand eye and reflex time is still really sharp. Ski double black diamonds, hike 14ers in the summer. I can hit the driver 280-320 pretty easy. I have noticed in the past year that my muscles just don't respond to lifting like they did just a year ago. Viagra, Cialis used to be just incredible for me but now they hardly work or its a real challenge.

    Whjat should I be looking at? Intuitively, I thought I might have high estrogen blocking the receptor for both arousal and muscle synthesis.
    Do not worry about dr John's tool box.
    Get the tests,
    Quest, blood, post results here, will discuss it.
    For sample way of posting look at my post #1 here
    Jan's BloodTest April13/2007

    Genova tests come with list of supplements, name, daily dose,
    no need for additional consultation.
    You may have anything wrong or defficient.
    Just tweak the close to 200 indicators that the tests check,
    you have a good chance at getting better.

    This is what I do.
    You do what suits you.
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    Quote Originally Posted by Diancecht View Post
    I am just 3 years younger than you. Me total test was about midrange. I had big problems with fatigue. Also problems with exericise recovery and erectile dysfunction.

    My free testosterone was significantly lower and my estradiol was very high (upper quartile).

    After ruling out the likely cause of the fatigue I elected a trial of testosterone and and an arotmatase inhibitor. My total test is upper limits of normal and estradiol levels are now lower quartile.

    I have had complete relief of the fatigue, post exercise recovery and erectile function is good.

    The issue of andropause is very new to the medical community in general and I understand the response of doc.

    Several thoughts:

    1) alway rule out the major diseases which may be the cause or contributing factor for your symptoms first. Dont just assume it testosterone or estrogen related.

    2)Always have a PSA and digital rectal exam as part of your work up and especially if you are considering hormone replacement.

    I get a *well man* check up yearly. No significant findings. My digital rectal was normal. My PSA one year ago was 1.1. Last week it was 1.2. Last year my total cholesterol was 206, it is now 178 due I guess to cutting out red meat and eating insanely (and boringly) healthy. I follow the glycemic index diet popularized by Joe Dillon and Michael Colgan MD.

    6 years ago I was in a horrific car crash, pronounced dead at the scene but then revived and life flighted to a 9 hour surgery, lost I believe 2-4 liters of blood. Fractured c1 vertebra but amazingly no paralysis. Took finesteride for about a year because I had 40% of my scalp denuded in the wreck but now I feel pretty good. I live in the Rocky Mountains at 8000 ft, 40 miles west of Denver.

    Try to stay active, last week in a blizzard I was fly fishing and almost lost 2 toes to frostbite, but damn the trout bite was hot that day.

    The night before the T test, I did not sleep a wink. I doubt my T at 11 am could have been lower. Do you think a Doc will add T to my system, knowing I am already at a very *acceptable* age related level?

    I can pay for the more comprehensive blood labs, but I self insure so its $3500 out of my wallet. What particular numbers are critical and how does one tweak them? For example, my free T is 12 which is lower range. How do I bump it to 18, for instance?

    I know DHT is important to erectile function, how do I boost that should I find it low? Or cortisol? How do you tweak ovewr 200 different stats?
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    Quote Originally Posted by goshawk View Post
    I get a *well man* check up yearly. No significant findings. My digital rectal was normal. My PSA one year ago was 1.1. Last week it was 1.2. Last year my total cholesterol was 206, it is now 178 due I guess to cutting out red meat and eating insanely (and boringly) healthy. I follow the glycemic index diet popularized by Joe Dillon and Michael Colgan MD.

    6 years ago I was in a horrific car crash, pronounced dead at the scene but then revived and life flighted to a 9 hour surgery, lost I believe 2-4 liters of blood. Fractured c1 vertebra but amazingly no paralysis. Took finesteride for about a year because I had 40% of my scalp denuded in the wreck but now I feel pretty good. I live in the Rocky Mountains at 8000 ft, 40 miles west of Denver.

    Try to stay active, last week in a blizzard I was fly fishing and almost lost 2 toes to frostbite, but damn the trout bite was hot that day.

    The night before the T test, I did not sleep a wink. I doubt my T at 11 am could have been lower. Do you think a Doc will add T to my system, knowing I am already at a very *acceptable* age related level?

    I can pay for the more comprehensive blood labs, but I self insure so its $3500 out of my wallet. What particular numbers are critical and how does one tweak them? For example, my free T is 12 which is lower range. How do I bump it to 18, for instance?

    I know DHT is important to erectile function, how do I boost that should I find it low? Or cortisol? How do you tweak ovewr 200 different stats?

    A high-cost shotgun test panel is not the only approach to testing. You have already had a lot of tests done. Since they are all in a healthy range, there seems to be no reason to repeat them unless a doc insists on it. The results you have posted indicate that you are fundementally very healthy.


    You need to test hormones and hormone-related molecules more thoroughly - Total T, free T and/or bioavailable T, DHT, SHBG, LH, FSH and prolactin. You also need to test for estradiol (E2). The E2 test should be an "ultrasensitive" assay.


    You need a better thyroid panel: TSH, Free T3 and free T4.

    You also need to assess your adrenal function: DHEAs, AT LEAST AM cortisol, preferably AM and PM cortisol, or a 24-hour urinary cortisol assay or possibly a salivary cortisol assay, althought there is some doubt over how reliable saliva tests are.

    Those are all I can think of at the moment. You can probably get the tests I have listed for about $1000.00 from a discount source.
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    Quote Originally Posted by cpeil2 View Post
    A high-cost shotgun test panel is not the only approach to testing. You have already had a lot of tests done. Since they are all in a healthy range, there seems to be no reason to repeat them unless a doc insists on it. The results you have posted indicate that you are fundementally very healthy.


    You need to test hormones and hormone-related molecules more thoroughly - Total T, free T and/or bioavailable T, DHT, SHBG, LH, FSH and prolactin. You also need to test for estradiol (E2). The E2 test should be an "ultrasensitive" assay.


    You need a better thyroid panel: TSH, Free T3 and free T4.

    You also need to assess your adrenal function: DHEAs, AT LEAST AM cortisol, preferably AM and PM cortisol, or a 24-hour urinary cortisol assay or possibly a salivary cortisol assay, althought there is some doubt over how reliable saliva tests are.

    Those are all I can think of at the moment. You can probably get the tests I have listed for about $1000.00 from a discount source.
    What discount source and can I just walk in and get a test? Or do I need a Drs order?
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    Quote Originally Posted by goshawk View Post
    I get a *well man* check up yearly. No significant findings. My digital rectal was normal. My PSA one year ago was 1.1. Last week it was 1.2. Last year my total cholesterol was 206, it is now 178 due I guess to cutting out red meat and eating insanely (and boringly) healthy. I follow the glycemic index diet popularized by Joe Dillon and Michael Colgan MD.

    6 years ago I was in a horrific car crash, pronounced dead at the scene but then revived and life flighted to a 9 hour surgery, lost I believe 2-4 liters of blood. Fractured c1 vertebra but amazingly no paralysis. Took finesteride for about a year because I had 40% of my scalp denuded in the wreck but now I feel pretty good. I live in the Rocky Mountains at 8000 ft, 40 miles west of Denver.

    Try to stay active, last week in a blizzard I was fly fishing and almost lost 2 toes to frostbite, but damn the trout bite was hot that day.

    The night before the T test, I did not sleep a wink. I doubt my T at 11 am could have been lower. Do you think a Doc will add T to my system, knowing I am already at a very *acceptable* age related level?

    I can pay for the more comprehensive blood labs, but I self insure so its $3500 out of my wallet. What particular numbers are critical and how does one tweak them? For example, my free T is 12 which is lower range. How do I bump it to 18, for instance?

    I know DHT is important to erectile function, how do I boost that should I find it low? Or cortisol? How do you tweak ovewr 200 different stats?
    Remember that accident.
    Some damage/injuries are slow to show up.

    If you want to cut on testing,
    do not test what have alredy been tested.
    remove all minerals and vitamins from my list,

    do the rest, Quest and Genova.

    if you want to cut on thyroid testing, do once
    the whole set then only
    FreeT3 and FreeT4

    if you want to cut on hormonal testing, do once the whole test then only

    Estradiol, Free, LC/MS/MS (36169X)
    Testosterone, Free, Bio/Total (LC/MS/MS)

    adjust yout T dose so BAT~575
    BAT- BioAvailableTestosterone
    adjust your FreeE2 (0.45 - 0.6)

    make additional adjustments looking at your EstroEssence results.
    ============================== =====================
    All letters and numbers on some Quest tests are important, otherwise you will end up with undesirable test.
    I e-mail my list to my doc, he prints it out on his office stationary, signs it.
    Important to get blood drawn at Quest.
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    Quote Originally Posted by JanSz View Post
    Remember that accident.
    Some damage/injuries are slow to show up.

    If you want to cut on testing,
    do not test what have alredy been tested.
    remove all minerals and vitamins from my list,

    do the rest, Quest and Genova.

    if you want to cut on thyroid testing, do once
    the whole set then only
    FreeT3 and FreeT4

    if you want to cut on hormonal testing, do once the whole test then only

    Estradiol, Free, LC/MS/MS (36169X)
    Testosterone, Free, Bio/Total (LC/MS/MS)

    adjust yout T dose so BAT~575
    BAT- BioAvailableTestosterone
    adjust your FreeE2 (0.45 - 0.6)

    make additional adjustments looking at your EstroEssence results.
    ============================== =====================
    All letters and numbers on some Quest tests are important, otherwise you will end up with undesirable test.
    I e-mail my list to my doc, he prints it out on his office stationary, signs it.
    Important to get blood drawn at Quest.
    Can I just walk into Quest and ask for this? I am a DDS so I guess I could order it myself if I needed, a little beyond my practice but...
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    Quote Originally Posted by goshawk View Post
    Can I just walk into Quest and ask for this? I am a DDS so I guess I could order it myself if I needed, a little beyond my practice but...
    DDS Doctor of Dental Surgery

    You are allowed to write scripts.
    Lucky b..d

    Go for it.

    also go to:
    myGDX Login

    open account at Genova Diagnostics.

    study the educational material that is there,
    just for doctors (not general public).

    Specially the top two there.

    Nutritional Testing (NutrEval & The ONE)
    EstroGenomics and Metabolism in Clinical Practice

    then the
    Interpretive Guides

    As a doc, see if you can get phone consultation with the big shots at Genova,
    that would be:
    Kathleen Thomsen MD (assume this is possible)
    Patric Hanaway MD (fat chance, he is the chief there)
    ------------------------------------------------------------------------------------
    Write you self a script to Quest.
    Go there 2-3PM, get the paperwork done first.
    Go there next day or so, 6:40AM
    They open at 7AM, you are going to be first.
    -------------------------------------------------------------------------------------
    Docs are not that great at anti-aging.
    Research is cutting edge.
    Lots of hype.
    Lots of money for a little of for nothing.
    Even the good ones, at least take long time, they always want to complete thier little project/research first.
    If you are simple case, always big if, you can do better on your own (with your own research).
    .
    .
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    Quote Originally Posted by goshawk View Post
    What discount source and can I just walk in and get a test? Or do I need a Drs order?
    Life Extension Foundation (LEF) or Direct Laboratory Services. With either organization, you just call the 800 number and tell them which tests you want. One of their docs actually orders the tests. They send you the request and you get the blood drawn at the nearest LabCorp location.

    LEF has two price levels - member and non-member. The $75.00 for becoming a member is worth it because you will save more than that the first time you order tests.

    Direct Labs is more expensive than LEF but they are for more efficient. I self-insure like you, and I pay the extra cost at Direct Labs so that I can have results back in a few days or a week instread of the 3-4 week turnaround from LEF.


    Some believe that Quest is more reliable than LabCorp, but Quest does not particpate in any direct access programs. Since you can order your own tests, you could probably just walk into any Quest location and order anything you want.

    It wouldn't surprise me if there were some sort of provider discount.
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    Quote Originally Posted by goshawk View Post
    I get a *well man* check up yearly. No significant findings. My digital rectal was normal. My PSA one year ago was 1.1. Last week it was 1.2. Last year my total cholesterol was 206, it is now 178 due I guess to cutting out red meat and eating insanely (and boringly) healthy. I follow the glycemic index diet popularized by Joe Dillon and Michael Colgan MD.

    6 years ago I was in a horrific car crash, pronounced dead at the scene but then revived and life flighted to a 9 hour surgery, lost I believe 2-4 liters of blood. Fractured c1 vertebra but amazingly no paralysis. Took finesteride for about a year because I had 40% of my scalp denuded in the wreck but now I feel pretty good. I live in the Rocky Mountains at 8000 ft, 40 miles west of Denver.

    Try to stay active, last week in a blizzard I was fly fishing and almost lost 2 toes to frostbite, but damn the trout bite was hot that day.

    The night before the T test, I did not sleep a wink. I doubt my T at 11 am could have been lower. Do you think a Doc will add T to my system, knowing I am already at a very *acceptable* age related level?

    I can pay for the more comprehensive blood labs, but I self insure so its $3500 out of my wallet. What particular numbers are critical and how does one tweak them? For example, my free T is 12 which is lower range. How do I bump it to 18, for instance?

    I know DHT is important to erectile function, how do I boost that should I find it low? Or cortisol? How do you tweak ovewr 200 different stats?
    Check you PM
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    You mention Finasteride. That is well known to really screw up a man's hormones (m)


    and then some. It often lowers DHT--often permanently and can disrupt many things. That may well be the source of many of your symptoms.
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    Quote Originally Posted by anyman View Post
    and then some. It often lowers DHT--often permanently and can disrupt many things. That may well be the source of many of your symptoms.
    Are there any clinical studies on this? I know Fin has been implicated in causing problems in about 2% of users. I take with a grain of salt any reports by balding men, especially younger balding men as to the sides and efficacy of hair loss meds. Those men are some of the most desperate, pitiful guys out there especially the younger ones. They report some of the most wildly anecdotal stuff you have ever heard as gospel.

    I get fatiqued but if the fish are biting or the powder is good I am the Eveready rabbit. I have really awful tinnitis and moderate hearing loss from listening to the drill for years but all in all I feel really good. I thought about it and if my sex drive is history, I can live with that but I see it as mostly a problem solving issue. Find the root cause and fix it.

    For personal reason I want the quickest band aid fix possible and then as time goes on, REALLY solve the problem.
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    Check this site.


    Quote Originally Posted by goshawk View Post
    Are there any clinical studies on this? I know Fin has been implicated in causing problems in about 2% of users. I take with a grain of salt any reports by balding men, especially younger balding men as to the sides and efficacy of hair loss meds. Those men are some of the most desperate, pitiful guys out there especially the younger ones. They report some of the most wildly anecdotal stuff you have ever heard as gospel.

    I get fatiqued but if the fish are biting or the powder is good I am the Eveready rabbit. I have really awful tinnitis and moderate hearing loss from listening to the drill for years but all in all I feel really good. I thought about it and if my sex drive is history, I can live with that but I see it as mostly a problem solving issue. Find the root cause and fix it.
    Check this site, for example:http://www.propeciahelp.com/forum/

    I have also heard from Dr John Crisler and Dr Eugene Shippen, 2 of the pioneers in this fields that they believe Finistaride can, in some people, cause irreversible issues. I believe that I may be one of the effected, although not nearly as bad as many are.
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    I asked my doc to run the Crisler panel but he said not necessary if T is in normal range.[/QUOTE]

    Take this with the qualifier that I have GREAT insurance. I tell my doctor what I want. I am the customer. I do him the favor of patronizing his practice so that he can afford his lifestyle.
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    Quote Originally Posted by Nemesis RR View Post
    I asked my doc to run the Crisler panel but he said not necessary if T is in normal range.
    Take this with the qualifier that I have GREAT insurance. I tell my doctor what I want. I am the customer. I do him the favor of patronizing his practice so that he can afford his lifestyle.[/QUOTE]

    I like your mind set.

    Post list of what you are testing and where.
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    edit
    Last edited by Diancecht; 12-30-2007 at 07:22 PM. Reason: he might take it wrongway
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    Quote Originally Posted by JanSz View Post
    Take this with the qualifier that I have GREAT insurance. I tell my doctor what I want. I am the customer. I do him the favor of patronizing his practice so that he can afford his lifestyle.
    I like your mind set.

    Post list of what you are testing and where.[/QUOTE]

    Among the normal profiles. Everything that Dr. John recommends every 4 months.

    My daughter recently had a medical condition and research pointed reasons to for a particular test. I asked the doctor to please run the test. The doc said it wasn't needed at this time. I said I wanted it as reference before any treatment occurred. Doc held firm. I offered to my research and that I could provide the literature and then told if the test wasn't ordered she would loose a patient. Test was ordered. The medical field in an honarable profession but we have to remember they are still running a business that would close without patronage.
  

  
 

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