Doctor and Patient

FAQs

Lab Tests have become a very important and powerful diagnostic tool for doctors – may it be risk assessment, confirming his clinical judgment, diagnosing infections, cancers, treatment follow up or effect of drugs or hormone imbalance etc. In short we all will need lab test some time or the other. In this web page, we have tried our best to give you correct general information. Some information may vary depending on the protocol followed by the laboratory you may visit.

Frequently Asked Questions (FAQs)

LAB TESTS

How do I prepare for Post-lunch (Post Prandial or PP) sugar test?


The post lunch sugar test is done at 2 hours of starting your regular lunch. For eg. If Mr. Koirala has started his lunch at 12.00 noon he needs to complete his blood collection at 2.00 pm. Mr. Koirala will be required to reach the lab at 1.35 pm, i.e. 25 minutes early to avoid registration delays. Also Mr. Koirala cannot have any food after finishing his lunch for 2 hours. He can have water and his medicines.




Fasting Dos and Don'ts


Stay hydrated and drink plenty of water. Take any medication that your doctor prescribed to you except for corticosteroids, estrogen or androgens, oral contraceptives, some diuretics, anti-psychotic medications including haloperidol, some antibiotics and niacin. Please consult your doctor for confirmation. Try and take early morning appointment for your test and after performing the blood draw for your test, you can take these prescribed medicine.
Do not smoke, drink any other liquid than water or exercise during your fast. Even chewing gum is off-. Any of these elements can adversely affect your test results.




How much time will it take at the Lab for me to perform my lab tests?


After completing your registration(15-20 minutes) it usually takes 20-40 minutes for completing your blood draw. But depending on your test requirements, the time may vary. In case you have additional post-lunch blood tests, you may have to come back to the lab. If you have additional ECG, X-ray and other imaging tests, the usual time taken may be 30 minutes to 2.5 hours. For health check-up you may usually spend upto 1-2 hour in the morning and 1-2 hour in the afternoon at the lab. For some tests like FNAC, 4D and health check-ups, a prior appointment is necessary.




How much time does it take to get test reports?


Usually for the common tests done, the test reports will be available on the same day evening. For special tests like microbiology cultures, many immunoassay tests, histopathology tests, etc. the reports will be available after longer durations.




When should do I get a Health-Check up done?


In general there is no recommended age for health check-up. Health check-up is recommended for all adults from age of 18 years onwards, at least annually. We also have 2 plans for kids and young adults. Most of the health check-ups today will include: Common blood tests like CBC, Blood sugar, Urine & Stool routine examination Preventive test check-up panels assessing risk of certain disease e.g. heart disease, cancer Assess general status of important organs like liver, kidney and thyroid gland Diabetes monitoring Radiology tests like X-ray chest/Sonography of abdomen and ECG check-up Check for nutritional deficiencies




Do Thyroid Profile and other hormonal tests require an preparation?


Hormone test do not require fasting. The baseline level for most of the hormones in the body is in the morning. Though majority of these tests can be done at any time, morning time is preferred. Some tests like Cortisol, Insulin, etc. may have to be done at the exact time prescribed by your doctor.




What tests do I need to undergo for Thyroid-related issues?


The common test for detecting thyroid gland problem is called Thyroid function test which includes

  • Free T3, Free T4 and TSH(Thyroid Stimulating Hormone) tests or
  • Total T3, Total T4 and TSH(Thyroid Stimulating Hormone) tests.
These tests can detect wether you have hypo-thyroidism(Slow working thyroid gland) or Hyper-thyroidism(Fast working thyroid gland). Also the Thyroid antibodies test is useful to rule out autoimmune thyroid problems.




What tests do I need for HIV?


In case you wish to screen yourself for HIV infection the usual screening test is called HIV sceening test.




Why are many doctors recommending Vitamin B12 & D tests these days?


  • Vitamin B12 is one of the important vitamins of the Vitamin B complex. It’s deficiency leads to Hematological or blood abnormalities and Neurogical (Nerves) abnormalities.
  • Vitamin D is not only important for bones but is now also been shown to take some part in autoimmune disease, heart disease, high blood pressure and diabetes.
  • In Nepal, India and other Asian countries, the deficiency of Vitamin B12 and Vitamin D is very common and widespread. Hence it is important for you to detect these deficiencies and take corrective steps.




How do I collect urine/stool for tests?


Clean plastic container for these tests are provided by the laboratory. It is always preferable to collect urine/stool samples in these containers rather than using home cleaned containers. For urine and stool culture test lab will provide special sterile containers.




When and how much urine do we collect for testing?


In case of urine routine and culture tests the best sample for testing is the morning urine sample. The urine is collected after cleaning private parts and allowing some initial urine to pass(Mid-Stream urine sample).In case you have symptoms of Urinary tract infection like fever, burning pain, increased frequency of urination- urine spot sample can also be collected for testing. 50 ml or more of urine should be collected for testing whenever possible. Test samples should be transported to the lab as soon as possible within one hour of collection.





CT SCAN

Will the CT Imaging Examination hurt?


No, CT imaging itself should cause no pain. CT imaging requires that the patient remain still during the examination. For some patients, keeping still for some time may be uncomfortable. The CT examination itself causes no bodily sensation. CT imaging examinations that require the patient to receive iodine contrast injection may cause slight, temporary discomfort while the intravenous needle is placed (see below section "do I need an injection?").




Is CT Imaging safe?


Yes, CT imaging is considered a safe examination. In general, the diagnostic benefit of a CT scan usually outweighs the risk of x-ray radiation exposure or injections of imaging contrast and use of sedatives during the scan. Patients should inform the radiologist or technologist if they have a history of allergies (especially to medications, previous iodine injections, or shellfish), diabetes, asthma, a heart condition, kidney problems, or thyroid conditions.




How long will CT examination take?


Depending on the type of exam you will receive, the length of the actual procedure will typically be between 10 minutes and 45 minutes. A few involved CT examinations take longer than 45 minutes. Also, many CT exams require the patient to hold their breath several times. This helps to eliminate blurring from the images, which can be caused by breathing or other patient motion. Please discuss specific questions about the duration of your CT imaging examination with the technologist before your exam.




Do I need a prescription to receive a CT examination?


Yes, your doctor must give you a referral (prescription) in order for you to receive a computed tomography (CT) imaging examination. However, certain basic screening examinations can be done without a prescription.




Can I move while I'm in the CT Scanner?


You should not move when you are on the CT table and the images are being acquired. It is important that you not move the body part being imaged, for example your head, until the entire CT exam is complete. CT exams of the chest and abdomen require the patient to hold their breath for a short period of time, for example, 10 to 25 seconds. This eliminates blurring in the image caused by breathing or other patient motion.




Can I bring a relative or friend with me, inside the CT Scan room?


No, CT uses x-ray and only the person being imaged should be in the CT scanner room during the examination.




Do I need a contrast injection for my CT Scan?


Not everyone needs an injection for CT imaging. When an contrast injection is needed, a pharmaceutical contrast agent made of iodine is used. This is only done when the radiologist and/or the referring physician have determined that it is necessary for diagnostic purposes. Iodine contrast is used to make specific organs, blood vessels or tissue types "stand out" with more image contrast in the resulting picture. This highlights the structure of the specific organs or vessel to better show the presence of disease or injury. The referring doctor provides the CT center with information about the patient's medical condition and the goal of the CT imaging procedure being ordered (for example, to diagnose cause of intense back pain). The decision to use or not to use an injection of CT contrast is made based on this information and the body part being examined.




Can my breast-feed after an injection of CT Contrast?


Typically, patients are instructed to wait for 24 hours after receiving the CT contrast injection before breast feeding again. Patients may wish to pump breast milk prior to the CT exam and store it for use during this 24-hour period. Always check with the radiologist and the imaging center for their specific recommendations.




Can I have a CT examination if I'm pregnant?


Pregnant woman should not have a CT exam or any x-ray examination, especially if the woman is in her first trimester (first of three-3 month periods of pregnancy). Depending on the condition, there may be other exams available, such as ultrasound, to help diagnose a medical condition. Pregnant women should always inform their imaging technologist or radiologist that they are pregnant, or may be pregnant.





MRI SCAN

Will the MRI scan hurt?


No – the MRI itself should cause no pain, it only requires that the patient remain still during the examination. For some patients, keeping still may be slightly uncomfortable. Sometimes patients may feel warmth in the area being imaged – this is normal. However, if this warmth becomes irritating or excessive, the patient should notify the imaging technologist as soon as possible. MRI exams which require the patient to receive Gadolinium contrast may cause slight, temporary discomfort while the intravenous needle is placed (see "Do I need an injection?").




How long will my scan take?


Depending on the type of exam you will receive, the length of the actual procedure will typically vary between 15 minutes and 45 minutes. More involved MRIs may take longer than 45 minutes. Some MRIs require the patient to hold their breath several times. This helps to eliminate blurring from the images, which can be caused by breathing or other patient motion. Please discuss specific questions about the duration of your MRI with the MR technologist before your exam.




Why does the MRI machine make that knocking sound?


The tapping or knocking noise heard during the MRI is created when "gradient coils" are switched on and off to measure the MR signal reflecting from the patient's body. The gradient coil is one of several internal parts of the MR system that you can not see. The gradient coil is made up of loops of wire which are embedded in a hard plastic tube. During the scanning process, an electric current is switched on and off through the gradient coil every few milliseconds. Because the switching is so rapid, the wires vibrate within the hard plastic and cause the knocking sound. This knocking is not harmful but the sound can be irritating to some patients. You will hear different knocking sounds during the MRI – this means that different types of "MR sequences" are being run to acquire different views and images of your body.




Will an MRI affect Dental fillings?


No – an MRI will not cause fillings in your teeth (if in proper condition) to dislodge or come out. The metal in most fillings is not affected by the MR system's magnetic field. However, fillings may cause some distortion of the images if you are having a scan of your neck, brain or facial area.




Can I have an MRI scan if I have braces?


Patients with braces may receive an MRI. However, if you have braces and need an MRI of your brain or facial area, the MR system may have difficulty "tuning" to your body. The MR tuning process is similar to tuning a radio to a specific frequency or radio station. This tuning process can be "confused" if the patient has metal in his or her body, particularly if the metal is in the area being imaged. Unfortunately, there is no way to know in advance how much distortion from braces may result on MRIs of the head, face or upper neck.




Do I have to go all the way inside the MRI scanner tunnel?


Yes – however, only the portion of the body that is being imaged must be positioned in the middle (end to end and side to side) of the MR system's tunnel or "all the way inside." For example, if a head study is being performed, the patients head must be positioned in the middle of the tunnel. For knee studies, the knee is positioned in the middle of the tunnel with the patients head facing the open end or possibly outside of the open end of the scanner (depending on the length of the magnet tunnel and the height of the patient). So-called "Open MR" systems do not have a tunnel design and may be more comfortable for some patients. Most MR systems use the cylindrical tunnel design; however, recent versions of the cylindrical MR systems have tunnels that are shorter and more comfortable than systems designed and manufactured previously. See 6 Ways to Stay Calm During MRI.




Do I need a prescription for an MRI scan?


Yes, your doctor must give you a referral (prescription) in order for you to receive an MRI.




Can I move when I'm inside the MRI tunnel?


You should not move when you are inside the tunnel or when you hear the knocking sound. For most MRIs, you may reposition your arms or scratch your face or body in between image acquisition (when the knocking has stopped). However, it is important that you refrain from moving the body part that's being imaged until the end of the exam. Note: An MRI of the chest and abdomen may require the patient to hold their breath for a short period of time (e.g., 10 to 25 seconds). This eliminates blurring in the image caused by breathing or other patient motion.




Can I bring a friend / relative inside the MRI scan room?


Only in neccessary conditions, you may bring a relative/friend inside the scan room. All people entering the MR scan room should be checked for metal in or on their body. This check may include the removal of:

  • Keys
  • Coins
  • Jewelry
  • Watches
  • Hairpins
  • Hairclips
  • Hearing aids
  • Wallets
  • Credit cards or ID cards with magnetic strips
From a medical and safety standpoint, if your companion is checked and cleared to enter the MR scan room, he or she may safely accompany you for the exam. Typically your companion will be seated in a chair next to the MR scanner, or they may stand next to the patient table during your exam.




Will I need to get an injection?


Not everyone needs an injection for their MRI. When an injection is needed, a pharmaceutical contrast agent called Gadolinium is administered to the patient. This is only done when the radiologist and/or the referring physician have determined that it is necessary for diagnostic purposes. Gadolinium contrast is used to make specific organs, blood vessels or tissue types "stand out" with more image contrast in the resulting picture. This highlights the structure of the specific organs or vessel to better show the presence of disease or injury. The referring doctor provides the MR center with information about the patient's medical condition and the goal of the MRI procedure being ordered (e.g., to diagnose cause of intense back pain). The decision to use or not to use an injection of contrast (Gadolinium) is made based on this information and the body part being examined.




How is the contrast injection given?


If an MRI does require the use of a Gadolinium injection, a small needle connected to an intravenous line is usually inserted into the patient's arm or hand. A special saline solution is first dripped in to keep the vein from clotting. Then a contrast agent called Gadolinium is administered through the intravenous line (typically about two-thirds into the exam). At the time of the injection, a patient may feel a cool sensation going up his or her arm. As with anything taken into the body, there is a very slight chance of an allergic reaction.




Can I breast-feed after an injection of contrast?


Yes. Only a tiny amount of the contrast agent gets into breast milk and the baby then absorbs only a small fraction of what they drink. Gadolinium is not a radioactive agent. The American Academy of Pediatrics states that Gadolinium is safe for breastfeeding mothers because the infant's dose is so small. We strongly recommend that you continue to breastfeed your baby after the scan, and not throw away any milk.




Can I have an MRI scan done if I'm pregnant?


This question is difficult to answer with a simple "yes" or "no." MRI (magnetic resonance imaging) is considered a safe exam. However, conclusive information showing how safe MRI is for pregnant women and the fetus is not yet available. MR imaging is generally not performed on women in the first twelve weeks of pregnancy (first trimester). Physicians typically do not perform MRI on pregnant women unless there are strong medical indications. Depending on the condition, there may be other exams available, such as ultrasound, to help diagnose a medical condition. If there is a strong medical reason for an MRI, your physician may consult with a radiologist to determine if MRI is the best course of action before proceeding. An abbreviated MRI exam may be performed, to reduce the time in the magnetic field, based on the recommendation of the referring physician and radiologist. Please consult with your physician for more specific information.





ULTRASOUND

What is an ultrasound?


An ultrasound scan uses sophisticated equipment to send sound waves into the body and captures the returning data to create images that are looked at and interpreted by a radiologist.




Is it the same as Video X-Ray?


There is no medical examination such as "Video X-Ray". It is only a misnomer (incorrect name) for an Ultrasound scan.




How does an ultrasound differ from an x-ray? Is it harmful?


Ultrasound uses sound waves, and no ionizing radiation, and has no known significant risks.




I am under age 30 and my doctor has ordered an ultrasound of my breast, shouldn’t I be getting a mammogram?


It is best to start with an ultrasound (no radiation) first. Women under the age of 30 also have very dense breasts, which makes mammography very difficult to interpret. If the radiologist feels as though a mammogram is necessary, we will then proceed with mammography.




Why does my bladder need to be full for a pelvic ultrasound?


A full bladder pushes the uterus in a position where we can see it better, and brightens up the entire pelvis so that we can adequately visualize the uterus and ovaries. It also moves the intestines and bowel out of the way.




I have heard that a transvaginal scan may be necessary, why?


Ultrasound uses sound waves to generate images of body parts. It is always best to get the sound transducer as close as possible to the part being imaged (ovaries and uterus) as possible to obtain the highly detailed images needed. You will never be forced into such an exam if you’re uncomfortable with this.




Is ultrasound better or worse than other modalities like CT?


Each modality images differently. Sometimes it is necessary to image with different modalities different ways for the best diagnosis. An ultrasound is what your doctor’s office has ordered at this time. Ultrasound is a very good, and very safe test. If additional imaging is needed, the radiologist will recommend it.





ENDOSCOPY

Can I brush my teeth before an Endoscopy?


Sure, as long as you don’t swallow anything for 6-8 hours before your procedure. We understand the compulsion to brush your teeth before a medical professional works in the vicinity of your mouth. It’s why you always want to brush your teeth before you have your semiannual dental checkup. If you feel the need to brush your teeth, go for it! Just be sure to spit!




What can I eat the day before an Endoscopy?


The day before your endoscopy, you should be able to eat whatever you want. However, you should have nothing to eat or drink for 6-8 hours before the procedure’s scheduled start time, depending on your doctor’s instructions.




What do I need to do before an Endoscopy?


Before you undergo an endoscopy, make sure to discuss your medical history and medications with your gastroenterologist. If you take any blood thinners (including aspirin) or medications for pain, diabetes, or blood pressure, you may need to stop taking your medicine for a period of time before your endoscopy. As mentioned above, you will need to refrain from eating for 6-8 hours before your procedure.




Will I be asleep during an Endoscopy?


No. You will be given a numbing solution or spray for your throat to make you more comfortable.




Are Endoscopy procedures painful?


Absolutely not. You will be given a numbing solution before the procedure. You shouldn’t be able to feel much during the procedure, and if you do feel something, you will be able to alert your doctor.





CT CARDIAC ANGIOGRAPHY

What is CT Cardiac Angiography Scan?


A computed tomography angiogram (CT angiogram) is a test that uses X-rays to provide detailed pictures of the heart and the blood vessels that go to the heart, lung, brain, kidneys, head, neck, legs, and arms. This test can show narrowed or blocked areas of a blood vessel. It can also show whether there is a bulge (aneurysm) or a buildup of fatty material called plaque in a blood vessel.




What are the benefits of CT Cardiac Angiography?


A CT angiogram is a less invasive test than a standard angiogram. A standard angiogram involves threading a thin tube called a catheter through an artery in your arm or leg up to the area being studied. But with a CT angiogram, no tubes are put in your body. If your doctor sees that one or more of your blood vessels are narrowed or blocked, you may need a standard angiogram anyway to double-check the abnormal results from the CT angiogram. This is more likely to happen if your doctor is considering surgery to treat the narrowing or blockage.




Why is a CT Cardiac Angiography done?


A CT angiogram is done to look for: A blood clot in the lungs (pulmonary embolism). A narrowing (stenosis) or blockage in the coronary arteries. This can occur when there is a buildup of fat (cholesterol) and calcium in the arteries. This buildup is called plaque. Heart problems, such as pericarditis (inflammation of the pericardial sac around the heart) and damage or injury to the heart valves. A bulge (aneurysm) or tear (dissection) in the aorta, which is a large blood vessel that carries blood from the heart to the rest of the body. A narrowing of arteries in the legs and in other parts of the body (peripheral arterial disease). An abnormal pattern of blood vessels that may be a sign of a tumor.




How to prepare for a CT Cardiac Angiography?


Talk to your doctor about all your health conditions before the test. For example, tell your doctor all of the medicines you take, if you are or might be pregnant, if you're allergic to any medicines, or if you take metformin. Tell your doctor if you get nervous in tight spaces. You may get a medicine to help you relax. If you think you'll get this medicine, be sure you have someone to take you home. You may be asked not to eat or drink anything for several hours before the test. Your doctor will let you know if there are certain foods or liquids you should avoid. If you are breastfeeding, you may want to pump enough breast milk before the test to get through 1 to 2 days of feeding. The radioactive tracer used in this test can get into your breast milk and is not good for the baby.




Does a CT Cardiac Angiogrpahy hurt?


The test will not cause pain, but some people feel nervous inside the CT scanner. If a medicine to help you relax (sedative) or dye is used, you may feel a quick sting or pinch when the IV is started. The dye may make you feel warm and flushed and give you a metallic taste in your mouth. Some people feel sick to their stomach or get a headache. Tell the technologist or your doctor how you are feeling.




What are the risks involved?


The chance of a CT angiogram causing a problem is small. There is a chance of an allergic reaction to the contrast material. Anytime you're exposed to radiation, there's a small chance of damage to cells or tissue. That's the case even with the low-level radioactive tracer used for this test. But the chance of damage is very low compared with the benefits of the test. If you breastfeed and are concerned about whether the dye used in this test is safe, talk to your doctor. Most experts believe that very little dye passes into breast milk and even less is passed on to the baby. But if you prefer, you can store some of your breast milk ahead of time and use it for a day or two after the test.





COLONOSCOPY

What is Colonoscopy?


A colonoscopy is an examination that enables your doctor to examine the lining of your colon (large intestine). The doctor will take a flexible tube about the size of a finger and slowly move it into the rectum and through the colon to look for signs of cancer or pre-cancerous lesions.




What are the symptoms of colon cancer?


Often, the early stages of colon cancer do not have symptoms. That is why preventive screening is very important. Every year, millions of adults help prevent the development of colon cancer by having a routine colonoscopy. During a colonoscopy, when doctors find pre-cancerous growths called “polyps,” they can easily remove the polyps – greatly lowering your risk of developing colon cancer. Symptoms can include rectal bleeding, anemia, a change in bowel habit, abdominal pain and weight loss, but these symptoms are common for other illnesses as well. When the symptoms are caused by cancer, the disease may be in a late stage.




Who is at risk of colon cancer?


Age is the No. 1 risk factor – more than 90% of colon cancer cases occur in people (men and women equally) age 50 and older. There are other risk factors:

  • Family history of colorectal cancer or adenomas (polyps)
  • Cigarette smoking – which can increase the risk of colon cancer death by 30% - 40%, possibly accounting for up to 12% of colon cancer fatalities
  • Obesity
  • Sedentary lifestyle
  • High-fat diet, especially one from mostly animal sources
  • Heavy alcohol intake
  • Ulcerative colitis or Crohn's colitis
  • Cancer of the uterus or ovaries before age 50
  • Past removal of the gall bladder
  • Past radiation therapy of the abdomen
  • Diabetes – which can increase the risk of developing colorectal cancer 30% - 40%




Who should be screened and when?


The American Cancer Society recommends that adults be screened for colon cancer beginning at age 50 – or even earlier if there is a family history of the disease.




Will I receive sedation for the exam?


You will receive “conscious sedation” for the exam, which means that an intravenous line is placed and medications are given intravenously. This is not general anesthesia, although almost all patients are comfortable during the procedure.




What do I need to do to prepare for a colonoscopy?


Preparation is a critically important part of the exam. If your bowel is not adequately cleaned out before the exam, the doctor will not be able to identify polyps, the pre-cancerous lesions. Before the procedure, you will have to take an oral laxative solution (called “a bowel prep” or “preparation”) to clean out your bowel. Specific prep instructions vary, but the prep usually begins 1 to 2 days before your procedure. Please read your prep instructions (given separately) to understand what you should do 1 day or 2 days before your colonoscopy.




I am menstruating. Can I still have a colonoscopy?


Yes, the procedure can still be performed while you have your period. Tampons can be worn if preferred by the patient.




Are there any complications or risks associated with having a colonoscopy?


In general, colonoscopy is a safe procedure. As with any medical procedure, however, there are some risks associated with the procedure and with the sedation used. You should contact your doctor if you feel severe abdominal pain, dizziness, fever, chills or rectal bleeding after the colonoscopy. Perforation and bleeding are two of the major complications associated with colonoscopy. Perforation is a tear through the wall of the bowel that may allow leakage of intestinal fluids. Perforations are generally treated with hospitalization, antibiotics, and possible surgery. There may be bleeding at the site of a biopsy or polyp removal. Most cases of bleeding stop without treatment or can be controlled at the time of the procedure. Rarely, blood transfusions or other treatments may be required to stop the bleeding. There also is a risk of having a reaction to a sedative given during the exam. In most cases, medications are available to counteract this reaction. Although complications after colonoscopy are rare, they can be serious and life-threatening. It is important for you to be aware of early signs that something might be wrong.




If I take medication, are there any risks?


In general, most medications do not interfere with this procedure. However, if you are on insulin, your dosage may need to be adjusted – or changed – for the preparation period and the day of the exam. Also, if you take anti-coagulant or blood-thinning medicines, they will have to be stopped (and be possibly started on a bridge medication) before the procedure to allow for biopsy and/or polyp removal. Ask your physician about adjusting your medication.




How long does the procedure take? How long will it take for me to recover?


The procedure itself usually takes from 15 to 60 minutes, but you should plan on spending 2 to 3 hours total to account for preparation, waiting and recovery time.