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Digestive Problems 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.

Specified Digestive Problems Testing:

• A. Comprehensive Stool Analysis

What is a Comprehensive Stool Analysis

The Comprehensive Stool may be used to assess digestive and absorptive functions, the presence of opportunistic pathogens and to monitor the efficacy of therapeutic remediation of GI disorders.

The   Comprehensive Stool Analysis (CSA) is a non-invasive diagnostic assessment that evaluates the status of beneficial and imbalanced commensal bacteria, pathogenic bacteria, yeast/fungus. Precise identification of pathogenic species and susceptibility testing greatly facilitates selection of the most appropriate pharmaceutical or natural treatment agent(s).

Indications and Contraindications

The Comprehensive Stool analysis is done to evaluate a person’s overall digestive health. Additionally, this test is necessary for patients who have conditions such as:

• Candidiasis
• Yeast infections, digestive parasites
• Viral, fungal and bacterial infection
• Colon cancer
• Chronic Fatigue
• Fibromyalgia
• Irritable Bowel Syndrome
• Leaky Gut Syndrome
• Various gastrointestinal problems
• Chronic diseases (mostly digestive)

How do you prepare for a Comprehensive Stool Analysis?

Inform your physician of any medications that you are taking. Certain medications must be avoided as this may alter the results of the stool analysis. In most cases, you may need to avoid taking medications 1-2 weeks prior to the scheduled testing.

You may need to follow a recommended 2 day diet prior to the test if you are being tested for blood in the stool. Be sure to follow the diet that is provided.

How does it feel? How long will it take?

Depending on what the stool is being tested for, you may need to collect a stool sample for 3-10 consecutive days, once a day. Collecting stool samples is painless, unless you are experiencing straining due to constipation. Pressure and a slight discomfort might be felt if stool is collected through a rectal swab.

Expected effects after the test:

There are no side effects after collecting stool samples.

Special instructions after the test:

Practice good hygiene every time stool is collected. Stool sample must be in placed in a tight sealed container and delivered to the laboratory as soon as sample has been collected. Thoroughly wash hands with soap and water right after collection as this may spread diseases.

Results:

EXAMINATION	NORMAL VALUE
Amount	100-200 g/d
Color	Brown
Consistency	Plastic, fiber and vegetable skins and seeds are usual
Size and shape	Formed
Gross blood	None
Mucus	None
Pus	None
Parasites	None
Fat	Colorless, 18% (neutral), fatty acids, crystals and soaps
Undigested food, meat fibers, starch, trypsin	None to very small amounts
Eggs and segments of parasites	None
Bacteria and viruses	None
Yeasts	None
Leukocytes	None
Water	Up to 75%
pH	Neutral to weak alkaline (pH 7.0-7.5
Occult blood	Negative
Urobilinogen	50-300 mg/24 hr
Porphyrins	Coproporphyrins: 611-1832 nmol/d Uroporphyrins: 12-48 nmol/d
Nitrogen	<2.5 g/24 hr
Apt test for swallowed blood	Negative in adults, positive in newborns
Trypsin	20-95 U/g
Osmolality, used with stool Na+K to calculate osmotic gap	200-250 mOsm
Sodium	5.8-9.8 mEq/24 hr
Chloride	2.5-3.9 mEq/24 hr
Potassium	15.7-20.7 mEq/24
Lipids (fatty acid)	0-6 g/24 hr
Carbohydrates	< 0.25 g/dL

The abnormal values that result from the Comprehensive Stool Analysis may indicate the presence of the following diseases:

• Pancreatitis, enteritis, celiac disease, cystic fibrosis, Crohn’s disease, Cystic fibrosis (abnormal levels of fat)
• Ileostomy (ésodium and chloride, ê potassium)
• Cholera (ésodium and chloride)
• Hemolytic anemia (éUrobilinogen)
• Liver disease, aplastic anemia, biliary obstruction (ê urobilinogen)
• Cystic fibrosis (é meat fiber)
• Chronic ulcerative colitis, localized abscesses, Shigellosis, E. coli diarrhea (positive in leukocytes)
• Candidiasis, Colitis, diarrhea (é pH)
• Carbohydrate and fat malabsorption (ê pH)
• Colon carcinoma, adenoma, gastric carcinoma, peptic ulcer, gastritis, Kaposi’s sarcoma, vasculitis, GI bleeding (positive presence of blood)
• Severe diarrhea, upper GI bleeding, lower GI bleeding, biliary obstruction (abnormal color of stools)

Notes:

Medications such as antibiotics and NSAIDs may cause inaccuracies in the results of CSA.

• B. Gastrointestinal and Lactose Breath Testing

What is a Breath Test?

The breath test is used measure elevated concentrations of hydrogen in the breath. It involves drinking a solution of sugar followed by blowing on a mouthpiece to check the breath for increased hydrogen and methane.

Indications and Contraindications

A breath test is done to patients who are experiencing gastrointestinal symptoms such as abdominal pains, bloating, flatulence, constipation and diarrhea which may be signs of chronic gastric inflammation and ulceration, small intestinal bacterial overgrowth, and lactose intolerance. This test is a simple, non-invasive procedure that may also lead to a specific course of treatment and relief for some patients experiencing the distress of irritable bowel syndrome.

A breath test is not recommended to patients who just had a colonoscopy, who are pregnant or have a heart and lung disease

How do you prepare for the Breath Test?

It is recommended that breath tests be given before antibiotic therapy is administered as to not unnecessarily dispense antibiotics.

For four weeks before the test:  avoid taking antibiotics and doing colon cleansing.

For one week before the test: avoid laxatives and stool softeners.

12 hours prior to the test:  do not eat or drink anything. Brush your teeth with little amount of water 2 hours before the test. Also avoid smoking, chewing gum and using mouthwash.

How does it feel? How long does it take?

The breath test is a painless and noninvasive procedure that will last for 2 to 4 hours, collecting breath samples every 15 minutes.  You will drink a sugar (fructose, lactose, lactulose, sucrose, etc.) solution with a normally tolerable taste. During the test, your breath will be collected by making you exhale through a bag.

Expected effects after the test

There are normally no side effects after the breath test. Effects such as bloating, pain and diarrhea indicate gastrointestinal problems.

Special instructions after the test

You may return to your normal activities and regular diet after the test. Follow your physician’s instructions if you are given any dietary restrictions.

Results

Normal Findings:  Hydrogen  and methane not present

Abnormal Findings: Production of hydrogen and methane

Fructose malabsorption:

Hydrogen- 20 parts per million over lowest preceding value

Methane- 12 parts per million over lowest preceding value

Hydrogen and Methane- 15 parts per million over lowest preceding value

Lactose malabsorption:

Hydrogen- 20 parts per million over lowest preceding value

Methane- 12 parts per million over lowest preceding value

Hydrogen and Methane- 15 parts per million over lowest preceding value

Small Bowel Bacteria Overgrowth:

Hydrogen and Methane- over 10-20 parts per million

Notes:

• The symptoms of irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth (SIBO) are very similar: abdominal pain, cramping, diarrhea, constipation and bloating.

• C.Upper Endoscopy

What is an Upper Endoscopy?

An upper endoscopy is a procedure that allows direct examination of the upper GI tract with a long lighted scope called an endoscope. The endoscope is inserted through the mouth and passes into the esophagus while the patient is sedated.

Indications and Contraindications

The upper endoscopy procedure is a test that is used to evaluate conditions such as:

• Gastro-oesophageal reflux disease (GORD)
• Abdominal pain
• Heart burn
• Swallowing disorders
• Dysphagia
• Ulcer symptoms or dyspepsia

Upper endoscopy is contraindicated to the following conditions:

• Severe upper GI tract bleeding
• Esophageal diverticula
• Recent upper GI tract surgery
• Rheumatic heart disease
• Endocarditis
• Patient has an artificial heart valve
• Pregnancy

How do you prepare for the Upper Endoscopy?

• Patient is restrained from eating starting midnight of the day of the endoscopy
• Remove dentures and eyewear before test
• Prepare for endoscopy by doing proper oral hygiene before the test
• Inform your physician of any medications that you are taking and follow instructions on how to take them at the day of the test

How does it feel? How long will it take?

The endoscopy will take approximately 30 minutes. The endoscope will be inserted gently through the mouth but you will be lightly sedated and anesthetized on the throat so you will not feel any pain. In some cases, test may be slightly uncomfortable. The endoscope will not interfere with your normal breathing.

Expected effects after the test:

You might experience temporary hoarseness or throat irritation after the endoscopy. This may be minimized by taking lozenges. Because you have been sedated for the procedure, you might experience drowsiness and dizziness after the test. Bloating, flatulence and belching are also some of the common effects of endoscopy.

Special instructions after the test:

If you have diabetes, bring your medication so you can take it after the procedure. You will need to rest and wait until the sedative wears off before you can leave the facility. Do not drive at least 8 hours after the endoscopy. Have an adult to drive you home after the test. Notify health care professional if complications such as bleeding, vomiting and severe stomach pains occur. Follow the instructions of your physician on when you can eat or drink after the test.

Results:

Results of the upper endoscopy are available shortly after the examination. If a biopsy has been performed, the results will be available approximately one week after the test. 

Normal Findings: Normal esophagus, stomach and duodenum. Smooth and color is normal. Absence of inflammation, ulcers, bleeding and abnormal growth.

Abnormal Findings:

• Ulcers and abnormal growths indicate peptic ulcer and tumors of the esophagus, stomach or duodenum
• Outpouching of the esophagus indicate esophageal diverticula
• Compressed lower esophagus indicates hiatal hernia
• Ulcers and tumors may be sources of upper GI tract bleeding
• Presence of peptic stricture and scarring
• Esophagitis
• Gastric ulcer

Notes:

Notify health care professional if you experience the following conditions after endoscopy:

• Vomiting of blood
• Black tarry stools
• Severe stomach pains
• Fever
• Colonoscopy .

What is a Colonoscopy?

A Colonoscopy is a procedure that involves the direct visualization of the rectum and the entire colon. In a colonoscopy, the doctor inserts a long, flexible, lighted tube linked to a computer and TV monitor into the anus.

Indications and Contraindications:

A colonoscopy is done to diagnose gastrointestinal problems in a patient. It is recommended to patients who are experiencing digestive complications such as blood in the stools, abdominal pains, inflammatory bowel disease, change in bowel habits, and diarrhea. A colonoscopy also screens for conditions such as colorectal cancer, ulcerative colitis and Crohn’s disease.

A colonoscopy should not be done to patients who have unstable medical conditions such as respiratory depression, hypotension, colon perforation, toxic megacolon, and profuse bleeding.

How do you prepare for a Colonoscopy?

Follow your doctor’s strict instructions on how to do an appropriate bowl preparation. A proper colon cleansing must be done before the colonoscopy. Commonly, patients have to perform a clear liquid diet with laxatives 24 hours before the examination. Do not consume solid foods, red foods and fluids, alcoholic beverages, aspirins, and iron medications. You may only take soft foods and water or clear juices. Four to six hours before the exam, you are required to fast and can only take clear and non-alcoholic liquids.

How does it feel? How long will it take?

A colonoscopy exam may take up to 15 minutes to 1 hour. You will be given intravenously a mild sedative so the procedure will be relatively painless. In some cases, you may feel abdominal cramping due to the air being pumped into the colon.

Expected effects after the test:

You may experience flatulence of gas pains due to the air pumped into the colon. In rare cases, your first bowel movement after the colonoscopy may be accompanied with small amounts blood.

Special instructions after the test:

It will take an hour or two before the sedatives wear off so have a responsible adult to drive you home after the exam. For the rest of the day, have ample rest and avoid driving, operating machineries and doing strenuous activities.

Since you have been fasting for the past 24 hours, bring a light snack to eat after the examination. Notify your physician if you develop fever, significant pain and GI bleeding

Results:

Normal Findings: Negative results- normal rectum and colon. No abnormalities are found.

Abnormal Findings: Positive Test Result- Presence of polyps, tumors, malformations, hemorrhoids, and inflammation

A positive result may indicate conditions such as:

• Colon cancer
• Colon polyps
• Inflammatory bowel disease such as: Ulcerative or Crohn’s disease
• Ischemic colitis
• Lower GI bleeding

Notes:

• Inadequate bowel preparation may result to stools obstructing the colonoscope.
• Red foods and fluids may be seen as blood in the colon, therefore producing inaccurate results

The Right Diagnosis and Treatment for Digestive Problems

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 Digestive Problems

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.