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Aging and Longevity Testing Overview

In order to gauge your current state of health, our clinic will often request copies of your last two years of medical testing and will often recommend further testing as needed.  Our clinic does request some testing that is and not commonly performed in more "mainstream" medical clinics.  24-hour heavy metal testing with provoking agent, neurotransmitter analysis, food sensitivity testing, comprehensive stool testing and Candida antigen testing are commonly recommended by our medical staff.   Some of these are discussed in detail in the links in this section.

What to Expect on Your First Visit:

First office visits typically last 45-60 minutes.  Your doctor will review your intake form with you and gather a detailed medical history.  A partial physical exam is usually performed and medical records are often requested from your primary care physician and/or other doctors.  Specialty laboratory testing may be recommended.  Most clients are offered an initial protocol consisting of nutritional supplementation, dietary and life style recommendations.

First Visit: Blood Test

To assess and identify kidney, liver, blood sugar and other key factors such as blood cholesterols. The results are explained to the patient, giving him/her a fuller understanding of the blood chemistry, so that they may take control.

Patients are required to fast for 14 hours before the test. Water may be drunk freely, but not tea, coffee, juices or other beverages. Appointments are normally arranged for mid-morning so that food and drink can be consumed up to 8pm the previous evening. On the day of the appointment, any prescribed medication should be taken with water as normal.

Patients are recommended to bring food to eat after the blood sample has been taken. Diabetics should advise the clinic, and separate arrangements will be made.

First Visit: Urine Analysis

To establish exactly how the kidneys are functioning. Patients are required to collect urine over a period of 24 hours. This should be as near the date of the blood test as possible, but must not include the 14 hours fasting period prior to the appointment.

A recommended timetable is that the first urine of the day should be excluded, than all subsequent urine for the next 24 hours collected in clean plastic containers. (If collection starts at 8am, this process must be followed until 8am the following day.) Eg. Appointment 10am Friday, fasting commences Thursday 8pm. Urine collection starts Wednesday 8am. until Thursday 8am.

Containers should be clearly labeled with the patient’s names and brought to the clinic at the time of their appointment.

First Visit: Resting ECG for Doctors Report

The electrocardiograph (ECG) determines the condition of the heart and measures its actions and the pulse. The doctor in charge reports any findings in his medical notes.

Specific Aging and Longevity Testing:

Part of the protocol for Aging and Longevity can involve having you undertake comprehensive blood, stool and urine testing and a complete physical exam. Depending upon your age and medical condition, you may also be sent for tests such as EKG & exercise tolerance tests, prostate, testicular and pelvic ultrasound tests, colonoscopies, mammograms, bone density testing, and others.

1. Complete Blood Cell Count

What is a Complete Blood Cell Count?

A complete blood cell (CBC) count is a series of blood tests that provides extensive information about the hemotologic system and other organ systems. It measures the number of the red blood cells (RBC), white blood cells (WBC), hemoglobin, hematocrit, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and platelets in the body.

Indications and Contraindications

A complete blood count is routinely done during medical and physical exams to assess a number of diseases and conditions. It is useful in determining conditions such as:

• Anemia
• Dehydration
• Arthritis, Rheumatoid arthritis
• Blood diseases (Leukemia)
• Kidney diseases
• Infections

How do you prepare for a Complete Blood Cell Count?

No special preparation such as fasting or sedation is required before the test.  However, it is recommended that you avoid eating foods that are high in fat prior to getting tested. Notify your physician if you are taking medications as it may be necessary for you to stop taking them before the test.

How does it feel? How long will it take?

The blood sample is taken from a vein in your arm. An elastic band is wrapped around your upper arm. It may feel tight. You may feel nothing at all from the needle while your blood is being drawn, or you may feel a quick sting or pinch depending on your sensitivity to pain. Drawing a blood sample for the complete blood cell (CBC) count will only last for a few minutes.

Expected effects after the test:

Normally, there are no major effects after the test. In most cases, patients may feel a little sore and slight bleeding may occur on the needle site. Bruising or swelling may also occur. 

Special instructions after the test:

After drawing blood, cover the needle site with a clean and dry bandage. If advised by the health care professional, apply pressure or warm compress on the area several times a day to minimize swelling and bruising.

Results:

Normal Findings

Test	Normal Value	Interpretation
RBC (red blood cell)	1.5-5.3 million/mm3	High values of RBC occurs in conditions such as renal disease, extrarenal tumors, cardiovascular disease, pulmonary disease, alveolar hypoventilation, carboxyhemoglobin, dehydration Low values of RBC occurs in conditions such as autoimmune diseases (rheumatoid arthritis), anemia, hemorrhage, bone marrow failure, hemolysis, leukemia , malnutrition, multiple myeloma, Addison’s disease
Hemoglobin	13.0-18.0 grams/100 mL	Same as RBC result
Hematocrit	37-49% (men), 36-46% (women)	Same as RBC result
Platelet count	150,000-400,000/mm3	Increase in the number of platelets occurs in conditions such as iron-deficiency anemia, hemolytic anemia Hodgkin’s disease, renal failure, acute infections, inflammatory diseases, asphyxiation, splenectomy, primary thrombosis, granulocytic leukemia, rheumatoid arthritis, SLE Decrease in the number of platelets occurs in viral and bacterial infections, cancer chemotherapy, HIV infection, eclampsia, renal insufficiency, alcohol toxicity, congestive heart failure, congenital heart disease
WBC (White Blood Cell)	4,500-11,500/mm3	High values of WBC occurs in conditions such as infections, inflammations, physical and emotional stress, lupus, tuberculosis, rheumatoid arthritis, malnutrition, leukemia, tissue injury, uremia Low values of WBC occurs in conditions such as viral infections, bone marrow disorders, malaria, AIDS, lupus, Cushing’s syndrome
Mean corpuscular volume (MCV)	82-98 fL	Low values of MCV occurs in conditions such as iron-deficiency anemia, anemia of chronic disease, Shahidi-Nathan-Diamond Syndrome High values of MCV occurs in conditions such as vitamin B12 deficiency, folate deficiency pernicious anemia, lymphoma, celiac disease, chronic pancreatic disease, hyperthyroidism
Mean corpuscular hemoglobin (MCH)	26-34 pg/cell	High values of MCH occur with macrocytic anemia. Low values of MCH occur with microcytic anemia
Mean corpuscular hemoglobin concentration (MCHC)	32-36 g/dL	Low values of MCHC occur in conditions such as hypochromic anemia. High values of MCHC occur in conditions such as spherocytosis and in newborns.

2. Comprehensive Metabolic Panel

What is a Comprehensive Metabolic Panel (CMP)?

A comprehensive metabolic panel is a blood test that measures your sugar level, electrolyte and fluid balance, kidney function, and liver function. This panel also measures the blood levels of sodium, potassium, calcium, chloride, carbon dioxide, glucose, blood urea nitrogen, creatinine, protein, albumin, bilirubin, and liver enzymes.  A CMP evaluates your liver, kidneys, blood proteins, blood sugar, and organ functions.

Indications and Contraindications:

The Comprehensive Metabolic Panel is ordered as a part of a routine medical examination. Your doctor may order a comprehensive metabolic panel as part of a regular health examination. Your doctor may use this test to check on a medical condition, such as high blood pressure, or to help diagnose a medical condition, such as diabetes.

How do you prepare for the complete cholesterol testing?

The patient is required to fast for 9 to 12 hours and only water may be taken leading up to the test. This is to obtain a more accurate result. Coffee, tea, and other beverages such as alcohol or pop soda should be avoided within 24 hours before the testing. If you are taking contraceptive pills, the doctor may advise you to stop taking drugs a few days before the test as this may affect the test results.

How does it feel? How long will it take?

The CMP is a painless procedure that usually lasts for a few minutes, about three minutes or less. Some patients may feel a slight stinging pain while the needle is being inserted to draw blood. After the test, a small amount of throbbing might occur on the needle site.

Expected effects after the test:

Normally, there are no major effects after the test. In most cases, patients may feel a little sore and slight bleeding may occur on the needle site. Bruising or swelling may also occur.

Special instructions after the test:

After drawing blood, cover the needle site with a pressure wrap or a bandage. Because patients fast leading up to the test, it is recommended to bring a light snack to eat after the test in case you become hungry. You may return to your normal activities and regular diet after the test.

Results:

Test	Normal Findings	Implications
Ammonia	Adults- 15-56 µg/dl; Children- 36-85 µg/dl	Increased levels of ammonia indicate the following conditions: Liver disease, cirrhosis, GI Hemorrhage, renal disease
Bilirubin	Total- 0.3-1.0 mg/dl	Bilirubin elevations indicate: Jaundice, congestive heart failure, hemolytic anemias, hemorrhagic pulmonary tracts
Blood Urea Nitrogen (BUN)	Adults- 6-20 mg/dL; Elderly (>60 yrs)- 8-26 mg/dL; Children- 5-18 mg/dL	Increased BUN levels indicate the following: impaired renal function, chronic renal disease, urinary tract obstruction, GI tract hemorrhage, diabetes mellitus Decrease BUN levels indicate: liver failure, malnutrition, celiac disease, acromegaly
Albumin	Adult- 3.5-4.8 g/dL; Children- 2.9-5.5 g/dL	Increased albumin indicates dehydration Decreased albumin indicate: Acute and chronic inflammation and infections, cirrhosis, liver disease, nephritic syndrome, crohn’s disease, burns, heart failure, thyroid disease
Sodium	Adult- 136–145 mEq/L; Children- 138–145 mEq/L	Increased levels indicate: dehydration caused by severe vomiting or diarrhea, Cushing's syndrome, kidney disease or injury, diabetic ketoacidosis, diabetes insipidus, (hyperaldosteronism). Decreased levels indicate: sweating, burns, severe vomiting or diarrhea, psychogenic polydipsia,  poor nutrition, underactive adrenal glands or thyroid gland, >heart failure, kidney disease, cirrhosis, cystic fibrosis
Potassium	Adults- 3.5–5.0 mEq/L; Children- 3.4–4.7 mEq/L; Infants- 4.1–5.3 mEq/L;  Newborn- 3.9–5.9 mEq/L	Increased levels indicate: damage or injury to the kidneys, severe burns, crushing injuries, heart attack, and diabetic ketoacidosis. Decreased levels indicate: hyperaldosteronism, severe burns, cystic fibrosis, alcoholism, Cushing's syndrome, dehydration, malnutrition, vomiting, diarrhea and certain kidney diseases, such as Bartter's syndrome.
Creatinine	Adult male- 0.9-1.9 mg/dL; Adult female- 0.6-1.1 mg/dL; Children- 0.5-1.0 mg/dL; BUN/creatinine ratio: 10:1 to 20:1	Increase levels indicate: impaired renal function, chronic nephritis, obstruction of the urinary tract, congestive heart failure, shock, hyperthyroidism, gigantism, dehydration Decreased levels indicate: severe liver disease, inadequate dietary protein
Calcium	Adult- 9.0–10.5 mg/dL; Children- 7.6–10.8 mg/dL	Increased levels indicate: hyperparathyroidism, kidney disease, tuberculosis, or cancer that has spread to the bones, eating a diet with too much vitamin D, vitamin A, or calcium, dehydration, >sarcoidosis, chronic liver or kidney problems,Paget's disease, and Addison's disease. Decreased levels indicate: hypoparathyroidism, malabsorption syndrome, bone problems, kidney disease, acute pancreatitis
Chloride	Adults- 98–106 mEq/L; Children- 90–110 mEq/L; Newborn- 96–106 mEq/L	Increased levels indicate: anemia, dehydration, kidney disease Decreased levels indicate: >cushing’s syndrome, diabetic ketoacidosis heart failure, kidney failure
Carbon Dioxide	Adults- 23–29mmol/L; Children- 20–28 mmol/L	Increased levels indicate: respiratory acidosis,  chronic obstructive pulmonary disease (COPD), emphysema, and pneumonia, cushing's syndrome, Conn's syndrome, and alcoholism. Decreased levels indicate: pneumonia, cirrhosis, liver failure, or hyperventilation, diabetes, kidney or heart failure, aspirin overdose, shock, frequent diarrhea, dehydration
Glucose	70–99 mg/dL	Increased levels indicate: diabetes, heart attack, stroke, Cushing's syndrome Decreased levels indicate:  insulinoma, addison's disease, hypothyroidism, cirrhosis, kidney failure, anorexia.

3. Total Cholesterol Testing

What is Total Cholesterol testing?

A total cholesterol test is a series of blood tests that measures the bad and good cholesterol and triglycerides in the blood. The purpose of this test is to detect the patient’s risk for coronary heart disease, heart failure or stroke.

Indications and Contraindications

A total cholesterol test should be done to patients who have a history of heart disease, high cholesterol, and diabetes. This test is also important if you are on a high-cholesterol diet and are overweight.

This test should not be done on patients that have acute illness, heart disease, stress or are pregnant.

How do you prepare for the complete cholesterol testing?

The patient is required to fast for 9 to 12 hours and only water may be taken leading up to the test. This is to obtain a more accurate result. Coffee, tea, and other beverages such as alcohol or pop soda should be avoided within 24 hours before the testing. If you are taking contraceptive pills, the doctor may advise you to stop taking drugs a few days before the test as this may affect the test results.

How does it feel? How long will it take?

The total cholesterol test is a painless procedure that usually lasts for a few minutes, about three minutes or less. Some patients may feel a slight stinging pain while the needle is being inserted in the veins of the arm to draw blood. After the test, a small amount of throbbing might occur on the needle site.

Expected effects after the test:

There are no major effects after the test. In most cases, patients may feel a little sore and slight bleeding may occur on the needle site. Bruising or swelling may occur.

Special instructions after the test:

After drawing blood, cover the needle site with a pressure wrap or a bandage. Because patients fast leading up to the test, it is recommended to bring a light snack to eat after the test in case you become hungry. You may return to your normal activities and regular diet after the test.

Results:

• Normal/ Desirable: under 200 mg/dl
• Moderate/ Borderline: 200- 239 mg/dl
• High/ High Risk: above 240 mg/dl
• A high cholesterol value may be related to pregnancy, hypertension, myocardial infarction, atherosclerosis, high-cholesterol diet, enzyme deficiencies, hypothyroidism and diabetes.
• A low cholesterol value may be related to malabsorption, malnutrition, hyperthyroidism, cholesterol-decreasing medication, liver disease, sepsis and stress.

Notes:

Patients with high levels of cholesterol are recommended to adopt a low-cholesterol diet by avoiding foods high in saturated fat such as animal fats, dairy products, processed meats, and deep-fried foods. Increase intake of fruits and vegetables is highly advised. Engage in a healthy lifestyle by exercising, avoiding alcohol and smoking.

 

 

4. DEXA Bone Density Test

What is the DEXA Bone Density Test?

A DEXA (Dual-Energy X-Ray Absorptiometry) bone density test is the most reliable way to determine if you have osteoporosis or low bone mass. This DEXA scan is a safe, painless and quick test that can measure bone strength and predict fracture risk before you develop osteoporosis so effective preventive therapy can be started. Bone density tests are also used to monitor the response to particular medications.

Vertebral compression fractures often occur without significant pain and are an additional sign of osteoporosis. Multiple studies confirm that up to 75% of compression fractures of the spine are present without pain. The same DEXA equipment used for bone density testing can obtain a picture of the middle and lower spine to allow a radiologist to evaluate your spine for compression fractures. The presence of a vertebral compression fracture further increases the risk of suffering an additional osteoporosis related fracture and is therefore an important piece of clinical information which can allow your physician to better treat the condition.

This is done with x-ray technology; this involves minimal radiation, is accurate and can be used to follow up treatment. We utilize Hologic DEXA equipment for both DEXA bone density and vertebral fracture assessment. A DEXA scan is considered to be the gold standard for diagnosing and monitoring bone loss. There is the risk of x-ray exposure; however, it is well below the level that causes adverse affects.

Indications and Contraindications

• The DEXA bone density test may be considered for people with the following conditions (Indications for DEXA bone density test):
• Family history of osteoporosis
• Endocrinopathies
• Post menopausal women
• Type 1 diabetes 
• Anorexia
• Multiple myeloma
• GI malabsorption
• Chronic renal and liver disease
• Have a history of fracture
• Rheumatoid arthritis
• Thyroid disease (hyperparathyroidism, hyperthyroidism)
• Crohn’s disease
• Celiac disease
• Irritable bowel syndrome

The DEXA Bone Density Testing is contraindicated to patients who have the following conditions:

• Pregnancy
• Presence of barium in the body
• Fractural deformities
• Radiopaque implants

How do you prepare for the DEXA Bone Density Test?

There is no need for fasting or sedation for the DEXA Bone Density Test. Wear loose, comfortable clothing, preferably without zippers, buttons, or any metal, to the exam.

Do not schedule this exam within one week after having an exam that uses barium or oral/intravenous contrast material (such as an MRI or CT scan). Stop taking calcium supplements 24 hours before the scheduled test.

Arrive 15 minutes prior to your scheduled time in order to complete a medical history questionnaire that is important for the DEXA interpretation. The technologist will ask you questions regarding your medical history and measure your height. You will need to remove all jewelry, hair accessories, glasses, and other metal objects as they may interfere will the exam. Once the exam is complete, your technologist will counsel you on National Osteoporosis Foundation preventative measures.

How does it feel? How long will it take?

The DEXA scan is a safe, painless and quick test. It is a noninvasive way to measure bone strength and predict fracture risk before you develop osteoporosis so effective preventive therapy can be started. This procedure will take approximately 15 minutes.

Expected effects after the test:

There is the risk of x-ray exposure; however, it is well below the level that causes adverse affects.

Special instructions after the test:

You will not receive your results the day of the exam from the technologist who performs the exam. You will however, receive a letter with the results written in lay language when you meet with your physician who ordered the test.  You can return to your normal activities immediately after your bone density study.

Interpretation of Results:

The test results will be in the form of a T-score and a Z-score

• Normal: Bone mass density less than 1.0 standard deviation below normal
• Osteopenia: Bone mass density value at 1.0-2.5 standard deviation below normal
• Osteoporosis: Bone mass density value greater than 2.5 standard deviation below normal

Notes:

Both men and women can take steps from a young age to prevent osteoporosis by ensuring they:

Have a healthy and varied diet with plenty of fresh fruit, vegetables and whole grains

• Eat calcium rich foods
• Absorb enough Vitamin D
• Avoid smoking
• Limit alcohol consumption
• Limit caffeine
• Do regular weight bearing and strength training activities.

The Right Diagnosis and Treatment Aging and Longevity

Once the comprehensive review is completed for each patient, our doctors and our team of medical professionals will evaluate your diagnosis. At this point, our doctors will spend one on one time with you to interpret and explain your results. Together you will explore your goals and discuss your treatment plan options. These treatment plans can be implemented using multiple modalities such as medications, hormones, diet, supplements, behavior and lifestyle changes, and alternative therapies. Our doctors will prescribe a preventative and comprehensive treatment plan that is tailored to your needs and fits into your lifestyle.

Patients Medical’s  Personal Approach to Aging and Longevity

Our doctors and our team at Patients Medical will regularly monitor your progress and track the effectiveness of your program making adjustments if necessary. Our goal is to support you and advise you every step of the way.

We work in conjunction with your existing doctors. Any gaps between specialists are filled to ensure we support your overall health and well-being. While we treat serious medical conditions such as Alzheimer’s, Diabetes, Parkinson’s, Multiple Sclerosis, anxiety, depression, and heart disease; the primary objective of our staff is prevention and early detection of disease.

We are located at: Patients Medical PC, 800 Second Avenue, Suite 900 (Between 42nd & 43rd Street), Manhattan, NYC, New York, NY 10017.