>Sending Test Kits, Poop Smugglers No More!

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Growing our own vegetables

Doing biomedical tests are important as well as expensive. There are many ways we can economise. Many of us now face the task of sending test kits of urine and stool samples for our children’s treatment. We either send the test kits to the labs directly or to our overseas doctor. Whenever possible, always send the test samples directly to the testing speciality lab,rather than to the middle-men lab as is the case in certain Asian countries. Thus avoiding the price mark-up and the samples are fresh and gets to the appropriate labs faster. Otherwise you end up sending the urine and stool to for example, to the Singapore clinic or Jakarta lab, which takes 2 days, then the clinic or local lab then sends it out to the appropriate labs in the USA or Europe which takes another 3-5 days depending on weekends. Which means the turnaround time for your child’s precious urine or stool takes roughly 1 week to get there. Remember, there’s a small period of time which the samples are still viable, otherwise the samples would have deteriorated or rejected by the lab.

So, either you get the full complete test kit from your doctor which includes the collection vials, requisition form and customs declaration forms. Or you email your doctor to request from the lab eg. Doctor’s Data Inc to courier the test kit directly to you, this is easily done. My doctor has done this for me several times, it saves me a trip to Singapore just to pick up a test kit. DDI will email you for confirmation as well as request for your credit card details to charge you for the delivery cost one way. This costs you US$20 per test kit.

If your doctor is reluctant to do this for you, please find a sympathetic local doctor to help you order the test kit, otherwise contact DDI or their local agent (there is one in Singapore for the region) directly to ask for their assistance, they may be able to find a way to help you. Once you receive the kit, read the instructions on how to collect the samples and shipping information carefully. When in doubt, contact your doctor or the lab directly for further clarification. Then you fill in the test sample, fill in the form and courier it back to DDI.

However, in the case of the French lab Phillipe Auguste Laboratoire which is highly respected for their urine prophyrin test as well as their Organic Acid Test (OAT), you can contact them directly on their website to request for them to send you their test kit directly to you. They do not require a doctor to order them, a parent can order it themself. After you fill in the test kit, fill in the appropriate requisition form the details needed such as name of your managing physician/doctor and your credit card details. This is the same for Great Plains Lab, you can contact them directly and order the test kits yourself. They generally require a physician’s approval for US patients, however contact them for assistance for international patients.

For Philippe Auguste Laboratoire, please send the package by registered post only, not courier or poslaju. This is due to French customs restrictions. By post can take 1-2 weeks to arrive, however you can always check by email with the lab directly if they have received your shipment. Always make a copy of your requisition form so that you can provide the order or test kit number etc. Another way to check if they have received it is to check your credit card statement, the lab will only charge your credit card once they have received and are processing your test kit.

When filling in any test requisition form, please include your email address so that you too will get a copy of the test result, otherwise they will send it only to your doctor. And if your doctor is super busy, he or she may not have time to email the results to you. The turnaround time for the results to come back once receiving the test kit will vary. Depending on certain labs or tests, it’s usually 2-5 working days, it may even take up to 2 weeks. Especially when testing for clostridia or candida, it might take more time to culture. Even over the Christmas holidays, I found that they processed my test results quickly and efficiently. However, keep in touch with the lab to find out if your test results are ready, don’t wait too long idly by. I know parents who had to wait 2-3 months for their test results, when they finally received it from their doctor, they found out on the report date that the test was completed months back. So, be proactive and contact the lab yourself. We pay a lot of money for these tests and the consults, so I expect to get my test results on time. Time doesn’t wait for anyone, so even if you contact the doctor and they say that the test report hasn’t come back yet, if you think it’s an unreasonable amount of time, please contact the lab yourself. Take charge, don’t let others slow you and your child’s treatment down unnecessarily.

Hard at work washing windows

For test samples sent to DDI, it requires ice packs, I would suggest including extra ice packs, more than just the small one they provide in the test kit. They cater to mostly US patients, which only takes 1 day delivery, plus their weather is quite cool compared to us in South East Asia. Thus I always include 2-3 large ice packs whenever sending to DDI. For samples to be sent to the French lab, they do not require ice packs at all.

For urine and stool samples to be sent to the USA, please use Fedex. Many Malaysian parents have discovered that Fedex are the best choice. They are used to sending biological non-hazardous materials ie. Urine and stool samples to medical labs overseas. Please contact Fedex directly www.fedex.com/my/  for Malaysian families to request for pick-up as well as delivery slips and packaging materials.  You do not need to register with Fedex or open an account with them. Say goodbye to poop smuggling!

The complete test kits by the labs contains requisition forms and customs declaration forms, so if possible make extra copies of the customs declaration forms for Fedex and for yourself just in case. We have found that other courier companies in Malaysia will refuse such shipments. Many parents have wasted their time calling UPS, DHL, PosLaju and other courier companies, only to be rejected. In the meantime, the clock is ticking because we worry about the viability and freshness of the urine and stool. However with Fedex, we get no issues at all.

Apart from urine sent to the French lab, time is of the essence when you courier out your test kit to the US labs. It usually takes 3-4 days for Fedex to deliver from Malaysia to the USA. Therefor, consider what day you are sending the package off. If you send it off by Fedex to the US lab on Monday, chances are, it will arrive on Thursday, even with any complications or customs delay, it will reach by Friday. If you ship it off from Malaysia on a Friday for example,
courier companies will still ship it over the weekend so your package will arrive at the lab perhaps on Monday or Tuesday. However I prefer not to ship out a package to the USA on Wednesdays and Thursdays. Chances are, it will arrive and cleared by Customs on a Saturday or Sunday. So it will remain in the Fedex storage facility in the US over the weekend as they only do deliveries Monday-Friday. Also take note of public holidays in the US, in case the day your package is schedule to arrive on a holiday, thus meaning another day’s delivery delay, your stool and urine sample sitting in a hot warehouse with an already melted ice pack.

With hair samples, there’s not much issue. Blood spot tests are easy to do ourselves at home and will not raise too much issues with Fedex or customs. However, for tests that require blood or plasma serum samples, this will be discussed in another article.

Even if you don’t have a Fedex account, they will still accept it. You will have to pay yourself for the Fedex courier cost for international patients. The labs usually provide a pre-paid Fedex shipping docket, but that only applies to USA deliveries,. However, they are super efficient and doesn’t give you any hassles about sending non-hazardous biological materials unlike other courier companies. When you call for pickup, they usually arrive within the day to your house or office, they will ask the location you are shipping to and the estimated weight of the package. They will give you the estimate cost, however the pickup guy will weigh it when he arrives at your place and give you the exact cost. So you can then pay him in cash.

To make the tests cheaper, you can opt to omit the “recommendation” pages at the end especially for the OATS and Food Intolerance IgG. Most of those recommendations are usually not beneficial plus costs you additional money. We just need the test result and the analysis. The supplement recommendation in the OATs are to me unnecessary and inaccurate as it is based purely on that 1 test, rather than the overall biochemistry of your child. If your doctor or biomedical practitioner rely too much on the supplement recommendation at the back or base your child’s treatment protocol solely based on the OATs supplement recommendation report, then I would be wary. Because a trained and experienced biomed clinician wouldn’t depend too much on it, most experienced biomed doctors don’t even request for it for their patients as they find it a waste of money for the family. The IgG food Intolerance test also have an option to include the Dietary Recommendation, which to me is unnecessary and an extra waste of money. What is important is the test results of the reactive foods itself, we don’t need to pay extra money for a meal planner which is usually based on a typical American kid’s diet anyway.

Before you order your own test kits, please verify with your own Biomed doctor first the exact name of the test required, which labs he prefers and then reconfirm that the test kit you are going to order is the exact same thing. Otherwise you just might end up doing the wrong test and lose a lot of money and time. Remember, there are many stool tests or urine OATs test, you need to choose which one in the list is the one recommended or requested by your doctor.

Earning pocket money by mowing Atok’s lawn

Now that we know there are many options on how to obtain our own test kits at more affordable prices, doesn’t mean that you should start doing random testing by ordering other types of tests other than recommended by your doctor. Financial constraints are always a concern, I believe the bulk of our budget should always go towards appropriate foods, supplements and treatment consults. Remember, tests are just a guideline. The overal treatment plan should be based on patient history, your child’s unique medical issues and your own parental observation. An experienced biomed doctor will only recommend you to do specific tests that he or she feels are necessary based on your child. Most importantly, the doctor should know what to do with the results and how to treat the issues as laid out in the test results. Otherwise you end up with a bunch of useless expensive tests and no way to go forward.

We find that in certain countries in Asia, overseas biomedical tests are imposed with huge taxes or markups, some to a ridiculous extent. Recently, I was quoted US$500 per child for a particular test via a middle-man lab. I went home, did my research and found out that I can order the test kit myself from the actual testing lab and that it will only cost me US$80! Ridiculous right?? Especially the fact that I’m paying for 2 daughters’ biomedical treatment, every cent counts. If I didn’t have my own initiative, I would have lost US$840, what a rip off!

Therefor we should take the initiative to find other cost saving measures. If your doctor or the local labs are not able to help you source cheaper options, then please join the KL Biomed forum at http://health.groups.yahoo.com/group/klbiomed/ . There are many experienced Asian parents who are very proactive and resourceful. We can all learn a lot from each other and find ways to economise.

In the US, it is customary for patients to submit the samples directly to the labs themselves and pay for the cost of the test directly to the labs, at the exact price with no additional markups. In the US, the patients even source their own supplements. For speciality compounded supplements, their doctors will send the prescription to the compounding pharmacy, and the parents deal directly with the pharmacy for delivery, cost, payment and other issues. In Asia, we are used to having the doctor spoon feed us everything from providing test kits to selling supplements. Yes it does make for convenience and I am grateful to doctors who have made things easy for me and my kids. I’m all for convenience but not when I’m being taken advantage of and paying 600% mark-up. Even with the additional delivery charges, I am still better off.

If you are on a tight budget as many of us Autism parents are, be proactive in finding other means to reduce your cost. In South East Asia, it is unfortunate that biomedical treatments are considered to be Autism treatments only for the rich. I hope to see that in the near future, biomed will be more and more affordable and accessible for all children with Autism, ADHD and related disorders. Treating Autistic children’s underlying medical conditions should be affordable and available for every child, not just for the rich.

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