Aa
Lumbar Punctures and Meds
Does anyone know if there are medications that could change the results of a LP? For example are there meds that can increase the level of Albumin in the CSF or the total protein count of the CSF? Thanks
Your comments about VA practices are noted and I do think I have some understanding. I suspect there is some ‘conflict of interest’ involved when the VA is diagnosing diseases with the potential for high treatment costs and long-term disability benefits. Like the SSA, the VA has tight budgets it must function within. I suppose it is easier to deny benefits by failing to diagnosis than it is to diagnosis early and try to deny benefits later. I’m not saying it’s the right way or the best way. It’s just the way it is. Government benefit plans don’t always have the option to ‘drop’ people needing expensive care after diagnosis like private employers and insurance carriers.
Unfortunately, I doubt more funding will be available in the near future to cover the medical needs of older vets since there has been a steady stream of battlefield injured soldiers coming home with chronic health needs for quite some time. In fact, it has been acknowledged in recent years that large numbers of combat veterans have been discharged with unrecognized and untreated closed head injury as a result of non-penetrating explosive percussion. These injuries inflict no visible wound but scar the brain with damage that can last a lifetime. Please, it isn’t that your husband isn’t important. There are just so many needs to serve.
I am a veteran myself and I’m married to one. Like most United States military personnel we learned early on in our service careers that sacrifice would be a closer companion to us than benefit. We accepted that until, well past the half-way mark to retirement, we decided our growing family might be better suited to the challenge vs. reward system of civilian life.
We were fortunate to return to civilian life without service connected disability. I’m relieved we’ve managed to remain employable and haven’t added to the burden of the VA system. We used military health care while on active duty. I haven’t used VA services but I do know a little something about how it works. I hope you won’t hold my personal experience naïveté with the VA health care model against me.
All of us need to keep in mind that active duty and veteran health care systems are the longest standing examples of what US government administrated health care looks like. When it is good it is very, very good. When it is bad, it is horrid.
I’m not saying any of this is right. It’s a statement of truth as I see it and have lived it. Many of us face limitations and difficulties as we search to name that which challenges our health. Then face them again as we search for solutions to live better and fuller lives despite specific diagnoses. That’s why we gather to support one another here in the forum community.
I apologize for going on like this. I don’t mean to minimize your particular struggle and hope I haven’t discouraged you from sharing in the future. I’m just remembering the many times I’ve felt like I followed the rules and did the ‘right’ things but somebody else got my promised reward anyway. I think I’ll work on changing my focus….. to thoughts of how the best things in life aren’t things, how I wasn’t created to live forever anyway and how nobody ever promised me I’d be active and feeling good every day of my life…. until that last day rolls in. It is as it is and I’ll try to enjoy every bit I can.
Unfortunately, I doubt more funding will be available in the near future to cover the medical needs of older vets since there has been a steady stream of battlefield injured soldiers coming home with chronic health needs for quite some time. In fact, it has been acknowledged in recent years that large numbers of combat veterans have been discharged with unrecognized and untreated closed head injury as a result of non-penetrating explosive percussion. These injuries inflict no visible wound but scar the brain with damage that can last a lifetime. Please, it isn’t that your husband isn’t important. There are just so many needs to serve.
I am a veteran myself and I’m married to one. Like most United States military personnel we learned early on in our service careers that sacrifice would be a closer companion to us than benefit. We accepted that until, well past the half-way mark to retirement, we decided our growing family might be better suited to the challenge vs. reward system of civilian life.
We were fortunate to return to civilian life without service connected disability. I’m relieved we’ve managed to remain employable and haven’t added to the burden of the VA system. We used military health care while on active duty. I haven’t used VA services but I do know a little something about how it works. I hope you won’t hold my personal experience naïveté with the VA health care model against me.
All of us need to keep in mind that active duty and veteran health care systems are the longest standing examples of what US government administrated health care looks like. When it is good it is very, very good. When it is bad, it is horrid.
I’m not saying any of this is right. It’s a statement of truth as I see it and have lived it. Many of us face limitations and difficulties as we search to name that which challenges our health. Then face them again as we search for solutions to live better and fuller lives despite specific diagnoses. That’s why we gather to support one another here in the forum community.
I apologize for going on like this. I don’t mean to minimize your particular struggle and hope I haven’t discouraged you from sharing in the future. I’m just remembering the many times I’ve felt like I followed the rules and did the ‘right’ things but somebody else got my promised reward anyway. I think I’ll work on changing my focus….. to thoughts of how the best things in life aren’t things, how I wasn’t created to live forever anyway and how nobody ever promised me I’d be active and feeling good every day of my life…. until that last day rolls in. It is as it is and I’ll try to enjoy every bit I can.
The formula to calculate the IgG index looks like this:
CSF IgG X serum albumin / serum IgG X CSF albumin
Multiply CSF IgG by serum albumin (A)
Multiply serum IgG by CSF albumin (B)
Divide result of (B) into result of (A) for IgG Index
As you can see, a change in ANY component of the equation will alter the end result and therefore the index. If your husband’s medicine is increasing his CSF albumin I would think his serum albumin would be elevated as well. An artificial change in either may be reason enough to argue for an exception to VA protocol and approval to use the electrophoresis type of testing at an outside lab.
The IgG index indicates the origin of the IgG that is found in the CSF sample. A high index indicates the CSF proteins were indeed produced in the CNS and therefore can be used as a marker for CNS inflammatory disease (MS among others). I don’t know how the reported index would translate into a specific number of equivalent O-bands (and actually doubt it does).
It isn’t completely archaic or unreasonable to use the index. There are a couple of reasons I’m not too surprised the VA has stuck with it rather than changing over to the newer electrophoresis type of testing. I still hope you took a look at the Health Page about o-band detection though. It really helps in understanding things.
You’ll find this statement right at the top of the Health Page. “There is STILL no recommendation in the world of MS Diagnosis that a positive LP for O-bands should be included in the requirements for diagnosis.” That didn’t change with the 2010 version of the McDonald criteria either.
Some doctors (mine included) don’t require a LP at all for MS diagnosis. When they do order it, it is to rule out other possible causes of symptoms. You may not want to fret too much about the VA not offering the updated test. Some here have had a negative o-band result used against them in the search for a diagnosis. At any rate, the MS diagnosis is supposed to be based on a combination of physical exam findings; patient reported symptoms and results from a variety of laboratory, electrical and radiological testing. No single result can confirm or refute.
I do hope your husband receives the care he needs without too much unnecessary struggle. He is fortunate to have you at his side advocating.
CSF IgG X serum albumin / serum IgG X CSF albumin
Multiply CSF IgG by serum albumin (A)
Multiply serum IgG by CSF albumin (B)
Divide result of (B) into result of (A) for IgG Index
As you can see, a change in ANY component of the equation will alter the end result and therefore the index. If your husband’s medicine is increasing his CSF albumin I would think his serum albumin would be elevated as well. An artificial change in either may be reason enough to argue for an exception to VA protocol and approval to use the electrophoresis type of testing at an outside lab.
The IgG index indicates the origin of the IgG that is found in the CSF sample. A high index indicates the CSF proteins were indeed produced in the CNS and therefore can be used as a marker for CNS inflammatory disease (MS among others). I don’t know how the reported index would translate into a specific number of equivalent O-bands (and actually doubt it does).
It isn’t completely archaic or unreasonable to use the index. There are a couple of reasons I’m not too surprised the VA has stuck with it rather than changing over to the newer electrophoresis type of testing. I still hope you took a look at the Health Page about o-band detection though. It really helps in understanding things.
You’ll find this statement right at the top of the Health Page. “There is STILL no recommendation in the world of MS Diagnosis that a positive LP for O-bands should be included in the requirements for diagnosis.” That didn’t change with the 2010 version of the McDonald criteria either.
Some doctors (mine included) don’t require a LP at all for MS diagnosis. When they do order it, it is to rule out other possible causes of symptoms. You may not want to fret too much about the VA not offering the updated test. Some here have had a negative o-band result used against them in the search for a diagnosis. At any rate, the MS diagnosis is supposed to be based on a combination of physical exam findings; patient reported symptoms and results from a variety of laboratory, electrical and radiological testing. No single result can confirm or refute.
I do hope your husband receives the care he needs without too much unnecessary struggle. He is fortunate to have you at his side advocating.
thank you twopack, but from the research I have done it truely is a math calculation that gives o-band results, esp if you are stuck with the VA doing the diagnose. If you don't use the VA or have a family member within the VA you may not understand such a blanket statement. The VA uses the IgG Index as the math calculation to rule on O-bands. (NCEMI eTools has a calculator online you can use which shows o-band results that happens to match what the VA gave us exactly) One of my husbands meds is know for increasing Albumin and protein, this med is at 110mg per day. I know it can effect serum/plasm results but have no clue if it can also effect the CSF results because his CSF Albumin is high, I'm thinking it changes the o-band results, even with the Albumin high he has one o-band, if the CSF Albumin had been in the normal range it would have shown 2 o-bands. I thought this was an interesting question, that noone seems to have an answer for. I do thank each and everyone of you for helping me find an answer.
I hope this will still be useful to you.... or someone down the line.
Drugs can cross the blood brain barrier but they usually need to be taken in higher doses or by intravenous infusion to reach high enough concentrations to treat anything ‘on the other side’.
For example, baclofen works in the spinal cord to control spasticity. It gets there by crossing the BBB but only when we take enough of it over the course of a day to maintain high enough blood concentrations to 'push' it through. However, dosing is usually limited to about 80mg/day to limit the experience of significant side effects.
If higher doses are needed to control spasticity a baclofen pump is sometimes used to deliver the drug directly into the CSF surrounding the spinal cord. A shorter route = a much smaller dose to achieve superior relief with fewer side effects. (Don’t get too excited though - intrathecal baclofen dosing has its very own list of pitfalls and perils.)
Anyway, I doubt there is much any of us could be taking on a regular basis that reaches high concentration in the CSF. Besides, most of the things a doc is looking for when doing a lumbar puncture are either not changed by medications or significantly different than usual blood testing.
There are no math calculations I'm aware of to calculate o-bands - at least Quix and sllowe made it sound easier than that in the Health Page. Have you taken a look at it?
http://www.medhelp.org/health_pages/Multiple-Sclerosis/Can-you-Diagnose-MS-with-an-LP-that-is-Negative-for-O-bands/show/142?cid=36
Drugs can cross the blood brain barrier but they usually need to be taken in higher doses or by intravenous infusion to reach high enough concentrations to treat anything ‘on the other side’.
For example, baclofen works in the spinal cord to control spasticity. It gets there by crossing the BBB but only when we take enough of it over the course of a day to maintain high enough blood concentrations to 'push' it through. However, dosing is usually limited to about 80mg/day to limit the experience of significant side effects.
If higher doses are needed to control spasticity a baclofen pump is sometimes used to deliver the drug directly into the CSF surrounding the spinal cord. A shorter route = a much smaller dose to achieve superior relief with fewer side effects. (Don’t get too excited though - intrathecal baclofen dosing has its very own list of pitfalls and perils.)
Anyway, I doubt there is much any of us could be taking on a regular basis that reaches high concentration in the CSF. Besides, most of the things a doc is looking for when doing a lumbar puncture are either not changed by medications or significantly different than usual blood testing.
There are no math calculations I'm aware of to calculate o-bands - at least Quix and sllowe made it sound easier than that in the Health Page. Have you taken a look at it?
http://www.medhelp.org/health_pages/Multiple-Sclerosis/Can-you-Diagnose-MS-with-an-LP-that-is-Negative-for-O-bands/show/142?cid=36
The answer I got from the lab wasn't very helpful but this is what she said:
It would be best to give a list of medications to the laboratory that is performing the testing. For each test they perform, they have a list of drugs that may interfere with the test results. I do not know of any off the top of my head that interfere with the testing for MS in spinal fluid.
It would be best to give a list of medications to the laboratory that is performing the testing. For each test they perform, they have a list of drugs that may interfere with the test results. I do not know of any off the top of my head that interfere with the testing for MS in spinal fluid.
Thank you for the idea Lulu, I have sent them the question and if they answer it I will let post it here.
the labtestsonline folks are willing to take questions and are very good with giving understandable answers. You might go there and send them your question .... and if you get an answer, please let us know, ok?
Initially - because I am not the scientist here - I was thinking the drugs wouldn't cross the blood brain barrier, but then I got started thinking about the tx for meningitis and those antibiotics have to get into the CSF somehow.
I'm guessing that in the lab they are able to sort out everything that appears in a sample, but that's just a guess. Not to be gross, but think about a urine sample - there are lots of contaminants in there but they are still able to see what they need to ..... the same must be true about CSF.
Initially - because I am not the scientist here - I was thinking the drugs wouldn't cross the blood brain barrier, but then I got started thinking about the tx for meningitis and those antibiotics have to get into the CSF somehow.
I'm guessing that in the lab they are able to sort out everything that appears in a sample, but that's just a guess. Not to be gross, but think about a urine sample - there are lots of contaminants in there but they are still able to see what they need to ..... the same must be true about CSF.
thanks Lulu,
I need all the help I can get. I can't find much about it either. I know there are meds that can give false reading for plasma/serum levels such as antipsychotic, antiepilepsy, and opiates, but no info on CSF interference.
That being said, one would think that Igg Index etc could have false negative readings because those meds I've listed raise the levels of proteins and/or IgG in serum in people taking any of those meds. Or am I just not understanding the math involved in the labs used to calculate o-bands?
I need all the help I can get. I can't find much about it either. I know there are meds that can give false reading for plasma/serum levels such as antipsychotic, antiepilepsy, and opiates, but no info on CSF interference.
That being said, one would think that Igg Index etc could have false negative readings because those meds I've listed raise the levels of proteins and/or IgG in serum in people taking any of those meds. Or am I just not understanding the math involved in the labs used to calculate o-bands?
some things about changes in serum -
http://www.answers.com/topic/protein-electrophoresis
info about the test, itself-
http://labtestsonline.org/understanding/analytes/csf/tab/test
interesting question and I find very little about that .... I'll keep looking
http://www.answers.com/topic/protein-electrophoresis
info about the test, itself-
http://labtestsonline.org/understanding/analytes/csf/tab/test
interesting question and I find very little about that .... I'll keep looking
some things about changes in serum -
http://www.answers.com/topic/protein-electrophoresis
interesting question and I find very little about that .... I'll keep looking
http://www.answers.com/topic/protein-electrophoresis
interesting question and I find very little about that .... I'll keep looking
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