LP report, I'm not seeing o-bands mentioned. So confused!

[lovemy6monkeys]

At the top of the lab report for "ordered tests" it has this exactly: GLUCOSE, CSF, DESCRIPTION, CSF, REQ SIGNATURE, PROTEIN, CSF, CSF ANALYSIS, PROTEIN ELECT.

Then the results:
CHEMISTRY
GENERAL CHESMISTRY
TP- 6.8
FLUIDS and STOOL
Appearance, CSF- clear
Color, CSF- colorless
Nucl cells, CSF- 5
RBC, CSF- 0
Comments, CSF- see below
(then this note/comment)
CSF differential not preformed. Nucleated cell count is within the normal range. Cytospin slide is available for review. Call XXX to request a differential if clinically indicated.
(the the results continue)
Description, CSF- clear
Protein, CSF- 26
Glucose, CSF- 63

GRAM STAIN
0 PMN's/ low power field
no organisms seen

AEROBIC CULTURE
no growth

From what I've read here, it sounds like other LP reports specifically say o-bands on them. Mine does not. Does this mean my doctor did not order the o-band test? I'm very confused!

In other news, I saw my PCP for the chest pressure and eye pain. He ran and EKG which came out fine. He wants me to get a chest x-ray tomorrow, but he said that he thinks it is either another piece of the MS possibility, or there is something that causes the upper chest muscles to spasm and it could be that. he told me the name, but I forgot it LOL He checked my ears (since the eye pain will sometimes radiate to my ear and upper jaw) and they were clear. He felt my sinuses and they were fine. He said I have had enough "pictures" of my brain lately that he can rule out a mass or tumor causing the problem. So, he said, again, that he thinks it is possibly MS related, and since my neuro is actually a neuro- ophthamologist he asked if I was comfortable waiting until my appointment on the 4th with my neuro. I am ok with waiting. No real answers, but at least I'll have the issues on my record and heart or lung issues will be ruled out for the pressure problem.

Thanks for reading! And thanks for any thoughts you might have about the LP results!
~Jess

[RedFlame]

It's so darn hard to wait for so long.  Just remember no matter what is says or doesn't say, it isn't 'definitive' for anything, it's a tool.  I know how hard it is.  

We are waiting with you!    Red

[Tiredofbeingnumb]

I agree with Quix and everyone who says that the test was probably referred to an outside lab. I know that even with getting the LP done at the hospital, not every test under the sun is done at the hospital. I used to work in a lab at a 600+bed hospital, and I know for a fact that we did not perform the O-band test. We did, however, perform the cytology, chemistry, and microbiology tests that you referred to in your post. Even big hospital labs don't perform every single test.

A lot of these specialized tests are extremely expensive to run (even more common tests are expensive) and just don't make financial sense to most institutions to perform. If they only run a handful of these tests, at several hundred or even thousand dollars a pop, they will lose money.

To get more technical, it isn't even JUST about running patient samples, but also about running quality control, maintaining the instruments used to run the tests...this can add up to a huge expense. For most places it is much more financially sound to send the test to a reference lab.

As far as the time it takes to get the result...it depends on where the reference lab is located. If you live in or around a large city, you are more likely to have a major reference lab nearby. The quicker your specimen gets there, the sooner they can get started on running the test. I work at a reference lab that is outside a city, but we only do certain tests. We are not the "main hub" lab. So, if we get a specimen for a test we do not perform, it will then get sent on to the main lab, which, incidentally, is in a different state than us. That is my thinking on why it will take several weeks to get an O-band result. Not because it takes that long to run the test, but because it takes time to travel to that particular lab, run the test, and then send the results back to the dr. Oh, another thought, a particular test may be run only 1 day a week. So, if your sample gets there on a Tuesday, but that particular test is only run on a Monday, it wil be a week before your sample is even run. I know this was how it was in the hospital that I worked with certain tests, it may be similar in a reference lab.

Hospital labs are designed to put out the "STAT" results. I believe that most of the results in your list would be considered STAT, or what we call critical values. I know that where I worked, in Microbiology, we had a turnaround time of 1 hour to report the gram stain on spinal fluid. Meaning, from the time the CSF was sent to the lab, the results need to be reported an hour from that time. Spinal fluid was one type of specimen where we stopped what we were doing to run the tests on the CSF. Checking for O-bands, while critical for us in the aiding of the diagnosis, doesn't really fall into life or death results, so they can afford to send it out. Also, obtaining spinal fluid isn't like drawing blood, it is a medical procedure, so if they get a good amount, they are going to go ahead and order any and all of the tests that they can, to save themselves from having to do another LP.

I hope this information helps. I would call the office and just get confirmation that the test was ordered.

[twopack]

I was just thinking that the same day blood draw is a good indication that the right test panel was ordered.  I don't see IGG levels on your report either.  Here's hoping the remainder of the results are still to come.

I looked up my own results.  The stated run date for most of it is six days after the draw.  I don't know how long it then took for the report to find it's way to the office.  There were four pages of results.  I will say that I have had some other tests/scans done recently and the reports never made it to my patient files (perhaps not even to the office).  

Please ask the office to specifically check with the lab and see if all the results are back.  Hearing nothing doesn't mean normal or complete.  Maybe no one but you is looking for anything else.  This is a job that belongs to office staff anyway so I don't see a point in waiting for the doc or your appointment date.  

I think I hear some resignation in your responses Jess.  I'm not surprised with the journey you've been on the last several months.  It's exhausting in every way when you have to champion your own cause every inch along the way.  Please don't lose your resolve now.  Your doc has been attentive and caring.  You have tried to be patient. In the end, waiting usually just begets more waiting.  It would be so nice to have actual information at the appointment.

Mary

[lovemy6monkeys]

Mary,

They did draw blood. I do know that all the testing was done right at the hospital I had the LP done at. Ahhh, well. I guess I'll just be patient and wait till the 4th to find out what was going on.

Thanks everyone!
~Jess

[twopack]

Jess, did they draw blood on the day of your LP?  That would also have to be checked for O bands.

Mary

[sllowe]

hey Jess,

I'm 2nd and 3rding (is that even a durn word?) that it's probably just the preliminary results and more will follow.   But, to be certain - first call the Dr. and ask if all the results are in. I'd not wait until the 4th and this is why....

Dr. office can then check your file and call the lab to find out. If for some reason the lab says - Yup, that's all that was ordered!   Dr. can ask the lab to check fluid for o-bands. If the lab has enough CSF to run the test, they will.   They typically keep fluid on hand for a little while - not long though, so it's short window of opportunity, and it's then contingent on if there are extra viles of fluid for testing.

Do let us know what you decide!
ttys,
shell

[RedFlame]

WOW,  He's right Jess, it's possible that the O-band study hasn't even come in yet!!!

Red

[Mike_Shuswap]

Hi Jess.

I think Quix might be on to something.

After my LP, I had an appt with my GP to get the results. He was away, and his replacement was a retired Dr who was very abrupt, almost rude. She told me my LP was perfectly normal, no O bands.

She didn't want me to read the report myself and wouldn't give me a copy (no problem, I figured I'd wait and get it from my regular GP when  he got back)

I made another appt to get some other results from upcomming tests, and to get a copy of my neg LP test.

At the end of that appt I mentioned the replacement Dr's demeaner and asked for copies of all tests, including the LP.

He pulled it out and said "yes, you tested pos for O bands as you know".....WHAT!!

Turns out the O band test is done by a differant lab that took a bit longer than the other tests. The grumpy replacement Dr didn't know this.

Sorry, I know I'm rambling on here. I just figured it was important for you to know what happened to me is possibly happening to you right now. (minus the grumpy doc)

good luck

Mike

[RedFlame]

Hi Jess,  

The 'plot' continues to thicken doesn't it?  I'm not a doctor but the results you mention don't sound like he did a complete panel.  

There was a sentence at the top of mine where the differentials were reported.  I had 4 vials that were all for different things that were specified in the order.  There was a Lyme Titer, protein glucose type of stuff, VDRI which I found out meant neuro syphilis type venereal disease (gee thanks I thought), SLE, 2 Herpes virus, csf study, o-bands etc.

Did you get to see your order?  Do you know how many vials were taken?  Surely he wouldn't mess up on that---one can hope since it's not easily re-done.  

I would call and let them know exactly what you want to know.  Can you make an appt. soon with your PCP to at least discuss the report?

What is really good about your doctor is that he is pushing for early intervention to help stop the progression.  This is a hopeful sign.  I have heard that early in the disease the numbers in your CSF can change.  

I'm sorry this continues to be so confusing and hoping you get treatment soon

((((Hugs))))

[lovemy6monkeys]

Quix,

Thanks for the reply!

I'm thought of something last night (as I was hiding under the covers at 3am while my husband tried to get a bat out of our bedroom LOL Oh, the joys of country living!). Do you think maybe my doctor didn't order the o-band test? Are there MS mimics that can be ruled out by testing CSF? My neuro said he was 70% sure I have MS.

I'm going to pin my neuro down and make him explain things to me when I see him on the 4th.  My medical transcript from the end of May (when I went in for leg paresthesia & was started on my second round of IV steroids) he said I was showing Classic MS symptoms, that my symptoms were localized in my dorsal columns of the spinal cord which can be "incredibly difficult to vocalize on MRI" and he was concerned that untreated it might "progress to a permanent pain syndrome or even disability" He then said for me to come back in 2 weeks with my husband to discuss treatment options. (this is all in my records!)

But, 2 weeks later, he decided I needed the LP done.

I hate this! I hate that I was told this is MS and was given the expectation of starting DMD and then that was taken away. I hate that I did not have the courage to ask why he changed his mind about starting treatment.

I'm sorry to be asking so many questions :-(
~Jess

[Quixotic1]

You can call the lab or ask your doc..  Often the O-Bands are sent out to special labs and wouldn't always be mentioned on the report you have.  It is possible they are still being tested.  I hope so.  The LP isn't something you want to mess up the orders on.


Quix