How to get the most reliable laboratory results

[Palo Alto Jo]

Having spent 35 years working in laboratories in the U. S. I was I curious about the laboratory testing in Panama, and Boquete in particular.  I've used two laboratories in town, and spoken with my doctors about their concerns or recommendations.  The following are suggestions for those of you who are used to laboratories in the U. S., there are differences.

 

In the U.S. when you get your blood drawn, or drop off a specimen, you are asked to identify the labels they will place on your specimens.  Name, birthdate, ID number of some sort.  Then the date and time are written on the specimen.  This label is basically a UPC code.  With few exceptions, all analyzing equipment in the U. S. simply reads the barcode, sees what tests are ordered,  mechanically opens the tube, analyzes, then sends the results to a computer where a human reviews abnormal results and repeats any abnormals.  The technologists barely touch the tube other than to assure there is sufficient sample.  This is because of OSHA, who forced labs to reduce exposure to AIDS and hepatitis, etc.  Normal results are released with no review and go straight into the patient's record.  So, for most laboratory testing, it is extremely hard to get incorrect results, as long as you verify your OWN name.  Many of the procedures I'm describing here have been in use for the last 25 years.  I was a manager at LabCorp in Houston, we received over 50,000 test tubes each day.  We had to use these techniques or there would have been no way to type each name in before we even began the testing process.  Americans do a LOT of labs.

 

Now, I'll compare with Panama.   First, let me assure you, their equipment is relatively modern.  Equipment I used in smaller hospitals and labs.  Here, they simply do not add on the barcode readers, computer interfaces, automatic test tube openers, and other "safety" and convenience items .  The tests procedures are the same.  Glucoses are glucoses, the same chemical reagents as are used anywhere in the world.  So, why do you care?

It comes to two things I've observed.  No one asks your name, just scribble it on in light pencil or ink.  They also use test tubes here that do not allow for the blood specimens to have the luxury of sitting on the counter, untested, for more than an hour.  A glucose  that isn't tested within an hour will quickly degrade from very high, to normal or even low.  Other analytes, such as potassium will go higher the longer they sit.  I cannot confirm the tests here aren't run in a timely manner, but will tell you, my fasting blood sugar has been 105-110 for years.  Here, my glucose was reported 76, and surprisingly, that was nearly exactly the same value my husband got that day.  Our A1Cs were also identical, mine low for the first time in years.  

The problem, no doubt, our specimens were misidentified.  So, I recommend these three basic things you can do proactively.  Ask to confirm the names on your specimens before they leave your sight.  NEVER have your labs done on the same day as your relatives with the same last name, if you can avoid it.  Look at your results as soon as possible, the same day is best.  If anything looks odd for your history, ask them to repeat it, either with the old blood they saved in their refrigerator for 5 days, or ask to be redrawn and retested.  

The last advice, always drink plenty of water before going in for fasting blood tests.  Often they will tell you , nothing by mouth, when water is not only allowed it is necessary to find your veins easily.  Black coffee  and sugarless tea are also acceptable.

I hope to update this after visiting the laboratories located in the David hospitals.  They may be altogether different.  

Edited August 31, 2017 by Palo Alto Jo
Typo

[Bonnie]

This is great info, Jo. I look forward to the updates.

[Dottie Atwater]

Also check out Dixon Laboratorio in David. Excellent for humans, animals, agriculture. 777-0481.

[Palo Alto Jo]

Dottie I will do that!  Thank-you.  Interesting that they mix them in the same lab.  I started my career at a lab in Los Angeles where one of our clients was the L.A. Zoo.  Some of the critters normal values of certain analysts were so high we'd have to take apart the machines and  clean them before we could run another human specimen.  There was a lot of carryover.  I did learn the names of animals like "lesser kudo".  I give any lab willing to do both my sympathies, but someone needs to provide vet labs.  Cant wait to visit.  I'll add it to my to do list.

Edited August 31, 2017 by Palo Alto Jo
Typo

[Palo Alto Jo]

That was "lesser kudu"... Mistyped there.  I really did learn it.... 

[Dottie Atwater]

17 hours ago, Palo Alto Jo said:

Dottie I will do that!  Thank-you.  Interesting that they mix them in the same lab.  I started my career at a lab in Los Angeles where one of our clients was the L.A. Zoo.  Some of the critters normal values of certain analysts were so high we'd have to take apart the machines and  clean them before we could run another human specimen.  There was a lot of carryover.  I did learn the names of animals like "lesser kudo".  I give any lab willing to do both my sympathies, but someone needs to provide vet labs.  Cant wait to visit.  I'll add it to my to do list.

Talk to Manuel Dixon, the owner. A very sweet, gentle (bi-lingual) and knowledgeable man. I don't know that they necessarily "mix" anything. Manuel can answer your questions that I'm not even knowledgeable enough to ask. Also, they do quality testing every week, which "labs" in veterinary offices do not do. Dixon Laboratories is also expanding, and they will add a separate room for testing bio-hazard materials in which the personnel have to wear the bio-hazard suits. I've used this lab for a number of years and I'm very pleased. Their prices are also excellent. Tell him Dottie ("Mighty Mouse") sent you. (I don't get any "referral fee," it's just that Manuel and I like and respect each other and I send people to this competent lab whenever I can.)

[JudyS]

On 8/31/2017 at 11:44 AM, Palo Alto Jo said:

Having spent 35 years working in laboratories in the U. S. I was I curious about the laboratory testing in Panama, and Boquete in particular.  I've used two laboratories in town, and spoken with my doctors about their concerns or recommendations.  The following are suggestions for those of you who are used to laboratories in the U. S., there are differences.

 

In the U.S. when you get your blood drawn, or drop off a specimen, you are asked to identify the labels they will place on your specimens.  Name, birthdate, ID number of some sort.  Then the date and time are written on the specimen.  This label is basically a UPC code.  With few exceptions, all analyzing equipment in the U. S. simply reads the barcode, sees what tests are ordered,  mechanically opens the tube, analyzes, then sends the results to a computer where a human reviews abnormal results and repeats any abnormals.  The technologists barely touch the tube other than to assure there is sufficient sample.  This is because of OSHA, who forced labs to reduce exposure to AIDS and hepatitis, etc.  Normal results are released with no review and go straight into the patient's record.  So, for most laboratory testing, it is extremely hard to get incorrect results, as long as you verify your OWN name.  Many of the procedures I'm describing here have been in use for the last 25 years.  I was a manager at LabCorp in Houston, we received over 50,000 test tubes each day.  We had to use these techniques or there would have been no way to type each name in before we even began the testing process.  Americans do a LOT of labs.

 

Now, I'll compare with Panama.   First, let me assure you, their equipment is relatively modern.  Equipment I used in smaller hospitals and labs.  Here, they simply do not add on the barcode readers, computer interfaces, automatic test tube openers, and other "safety" and convenience items .  The tests procedures are the same.  Glucoses are glucoses, the same chemical reagents as are used anywhere in the world.  So, why do you care?

It comes to two things I've observed.  No one asks your name, just scribble it on in light pencil or ink.  They also use test tubes here that do not allow for the blood specimens to have the luxury of sitting on the counter, untested, for more than an hour.  A glucose  that isn't tested within an hour will quickly degrade from very high, to normal or even low.  Other analytes, such as potassium will go higher the longer they sit.  I cannot confirm the tests here aren't run in a timely manner, but will tell you, my fasting blood sugar has been 105-110 for years.  Here, my glucose was reported 76, and surprisingly, that was nearly exactly the same value my husband got that day.  Our A1Cs were also identical, mine low for the first time in years.  

The problem, no doubt, our specimens were misidentified.  So, I recommend these three basic things you can do proactively.  Ask to confirm the names on your specimens before they leave your sight.  NEVER have your labs done on the same day as your relatives with the same last name, if you can avoid it.  Look at your results as soon as possible, the same day is best.  If anything looks odd for your history, ask them to repeat it, either with the old blood they saved in their refrigerator for 5 days, or ask to be redrawn and retested.  

The last advice, always drink plenty of water before going in for fasting blood tests.  Often they will tell you , nothing by mouth, when water is not only allowed it is necessary to find your veins easily.  Black coffee  and sugarless tea are also acceptable.

I hope to update this after visiting the laboratories located in the David hospitals.  They may be altogether different.  

Thank you for the excellent information Jo.  One other thing to look at, if you can see the equipment, is if there is a calibration sticker on it.  Check the dates.  I once looked at one on a mammography machine a few years ago.  It did have a sticker, but it was dated 1996 and done in Miami.  They obviously got the machine used from Miami, but I wonder if they ever calibrated it themselves.  I have always wondered what kind of quality control, if any, they do here on their equipment.

[Palo Alto Jo]

Perhaps it will  make you feel a bit better if I explain how the manufacturers build in "stop analysis" if no maintenance or quality control specimens are run.  The machines stop and alarm and will not run until you perform maintenance  or if quality control (known valued specimens) are not within range.  It's extremely hard to bypass these built in parameters, and labs have no desire to turn out bad values.

 

 I'm sure many of the instruments here are refurbished ones from the U.S.  A new chemistry analyzer for a 200 bed hospital in the States costs approximately $500,000-700,000.  5 year old instruments in the U.S. are usually considered obsolete,  and traded in for a newer model.   Out of curiosity I looked for used instruments online.  Used $500,000 instruments are priced a found $15,000.  

 

Edited September 2, 2017 by Palo Alto Jo
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