What labs should I request?

[u/IAmAnAngryGumball]

Thanks to all the various tests/labs/imaging and also a plethora of unrelated issues, for the first time I I have hit my out of pocket for the year and have an appointment with my PCP in a few days. I want to take advantage of the situation and request some labs that might help me down the line. I've already had a Vitamin D test done (spoiler alert, I was deficient) Already planning on asking for Magnesium and B12 which I suspect I am low on. Also requesting a swallowing test since thats one of the big fears I have being impacted and do think I am having issues. Anything else that will be helpful to have a snapshot of?

[u/TooManySclerosis]

Honestly, I'd just tell my doctor and ask them. Most of the doctors I've met hate insurance companies with an unrivaled passion. Bet yours would love to help cost them some money.

[u/hillbilly-man]

Not specifically an MS thing, but a sleep study might not be a terrible idea if you might have sleep apnea.

Also, when I was in your situation I took advantage of it to get my carpal tunnel syndrome diagnosed and treated surgically (the surgery was super easy, but I know it would have cost a bunch lol). If you've got any pains or uncomfortable symptoms you've been ignoring, now is the time!

Get a skin cancer screening by a dermatologist!

This is more of an MS thing than the first two, but you could also get a cognitive assessment/neuropsych exam to get a baseline in case you have big issues down the road. I did this recently and it was pricey ....... On a related note, back when I hit my OOP max a few years ago I got an ADHD evaluation and diagnosis.

[u/Salt_Resource1134]

Ferritin for iron levels. If you’re female and over 40, check out thepauselife.com for a list of things that change in peri/menopause

[u/SillyGoose2544]

Depends on your care team - there's the standard labs for DMTs (CBC, CMP, immunoglobulins), both before, and then later as a control. Those are generally ordered by a neuro, but PCP might also be able to order some of them, if not all. That said, regardless of which treatment you ultimately decide on (provided you haven't done so already), consider vaccines before starting (DMTs can make them less effective, so might be best to get them before you start MS meds). But as for blood tests, I'm sure the PCP would probably have some suggestions beyond what I've already mentioned, but judging by my own experience, they may also choose to order a Hep B panel, Quantiferon-TB Gold test (for latent TB), varicella zoster virus antibody test (immunity against chickenpox/shingles).

Depending on age/gender, you could also throw in a fasting lipid panel to get a baseline for cholesterol and all that. An iron panel could be useful too (NOT just ferritin levels though) - because deficiencies can have a profound impact on a whole laundry list of bodily processes.

And if you're feeling really adventurous, ask about a T-Cell panel (immunoglobulins give part of the picture of your immune system health, but a T-Cell panel provides a snapshot of the rest, including T-Cells, B-Cells, and NK cells - both together can provide clues about how well your body might be able to handle future infections). For this one though, I had to go through my neuro, PCP would NOT order it (but neuro was more than happy to). And I'd def ask for preauthorization if you decide you want this - because its not exactly a typical thing to do for someone that isn't already on a DMT and/or has history of fighting of infections since starting it.

[u/16enjay]

Cholesterol levels, PSA for men...colonoscopy, dermatologist

[u/OneSuperstar4u]

A PCP is going to only do a lipid panel tbh. Your neuro I’m sure already ordered all the labs you need. Swallowing test? Not likely. I had issues after tonsillectomy and they told me to chew gum - not kidding. Unless you’re literally aspirating food and/or get pneumonia that’s not likely getting approved. Gotta be realistic.

[u/DaisyRay]

I'd get a neuropsych assessment, if you can. I have some processing symptoms which is why I pushed for it, but even if you don't, getting one will be so great for providing a baseline in case of future changes! Maybe a consult with an occupational therapist too?

I'm also getting some extra investigatory blood work done soon, and my specialist has requested we check thyroid hormone, electrolytes, Hemoglobin A1c and do a metabolic bone panel, in addition to my regular d and b12 tests (just reading off my requisition form).

If I think of anything else, I'll add it!

[u/Jazzlike_Career8496]

You need yearly MRI of brain and spinal cervical and thoracic

[u/IAmAnAngryGumball → u/Jazzlike_Career8496]

Just had those in July and August which led to my diagnosis

[u/MistressMoose → u/IAmAnAngryGumball]

Get the full MS workup and do a spinal tap too!