Starting with labs: Does Chris assess a fee for Cyrex Labs or just pass through the cost of the lab? Also, when standard labs CBC, CMP, etc., are ordered, do you assess a fee, as well? Do you order anything non-standard, as well? Trying to streamline the onboarding process, etc. This is all ordered after the first call, yes, so almost everyone is getting Cyrex Array 3, and then the following conversation re: gluten elimination.

Logistically, the way Chris works with patients is, initially, there is a 30-minute appointment generally with a nurse practitioner or maybe [with] a physician’s assistant, and it’s a 30-minute call and the questions are, what are your top five symptoms? What do you want us to focus on? What does your diet look like? And it’s just sort of a big picture overview, and then pretty much everyone gets a fairly standard set of testing. It includes a comprehensive blood panel through LabCorp, so Sandy, that’s where the CBC, the comprehensive metabolic profile, iron panel vitamin D, methylmalonic acid, folate, B12, homocysteine, C-reactive protein, all of these labs [are] pretty comprehensive. We order that right away, and for me, if patients don’t have a lot of money in their budget on testing (I totally get it [because] all these labs are expensive), the one test that I feel is absolutely essential is that comprehensive LabCorp panel. I do not want to miss impaired kidney function, liver function, anemia, [or] iron deficiency. Yes, we practice Functional and integrative medicine, but you have to remember that a lot of our patients aren’t necessarily seeing their conventional medical doctors, so we need to continue practicing medicine. To some extent, we need to cover all those basic pieces that we’ve learned in medical school; even though we’re all taking a functional approach, you cannot forget to look at those really basic pieces. To me, [the] LabCorp comprehensive panel or Quest, but just that standard blood panel is essential and needs to be done right away. You just can’t miss some things.

People also get a SIBO breath test, a stool test, a urine organic acids test, often the Precision Analytical Dutch hormone profile to look at sex hormones and adrenals, and we’ll get into the nuances of those tests as we move through the course.

Cyrex testing, PSI Rex testing, I would say 75 percent of patients who come to CCFM are already gluten-free, so there’s not really not a reason to run the Cyrex Array 3. It somebody’s still eating gluten, they’re kind of undecided, “Do I really want to take it out of my diet?” That’s when you run the Array 3 and you say, after you’ve adequately prepared for Array 3, then I want you to do the 30-day elimination diet before we meet, so you can schedule your case review appointment, which is going to be six to eight weeks after that initial phone call once we have all the test results back. Once you have that appointment scheduled, kind of count back 30 days and that’s when you’re going to start your Paleo elimination, grain-free, dairy-free, etc., diet.

And then you said, “Does Chris assess a fee for Cyrex labs or pass through the cost of the lab?” Basically, the patients, after the initial consult and after every appointment, receive an invoice that says here are the tests that were recommended and here’s how much they cost. It’ll be the cost of the lab, and then CCFM also adds, I believe, it’s [a] $100 administrative fee to every test kit that’s ordered, so patients are paying for the cost of the labs, for the time for the admins to order the labs, etc. That’s logistically how it works. [For the] initial consult, about five tests are ordered, so I think that’ll become very clear what tests we start with as we go through the course: [a] stool test, [an] organic acids hormone profile, and then that LabCorp panel.

I think we covered everything on that question. Awesome.