Where and when can I get the tests done?

You may have your tests completed at any Kaiser Permanente laboratory in Northern California. The results will automatically be forwarded to me.

There are four locations in the Greater Southern Alameda Area where you can have your tests done:

CAMPUS	LOCATION	MON - FRI	SAT - SUN
Union City Laboratory	3557 Whipple Road, Union City Building B, 1st Floor	8:00 AM - 5:30 PM	CLOSED
Hayward Laboratory	27400 Hesperian Blvd, Hayward, Basement of Main Clinic Building	7:00 AM - 7:00 PM	7:00 AM - 12:00 Noon
Sleepy Hollow Medical Office Building	One block north of Hayward Hospital, 1st Floor	9:00 AM - 5:00 PM	CLOSED
Fremont Laboratory	39400 Paseo Padre Parkway, Fremont 2nd Floor	7:00 AM - 7:00 PM	7:00 AM - 12:00 Noon

NOTE: Since July 28, 2008, the Union City Building B laboratory closes 30 minutes earlier on weekdays, at 5:30 pm, instead of 6:00 pm.

Why do I need laboratory tests?

There are several reasons why it is important to have me perform certain laboratory blood tests. Blood tests can identify some medical conditions (such as thyroid hormone problems) that can show up as a psychiatric condition (such as depression, anxiety, or mania). Blood tests are sometimes obtained at the start of treatment with a medication, so that we have "baseline" or "starting" tests to compare with future tests.

In these tests, a soft rubber strap is tied around your upper arm to make the viens in your arm stand out. The "blood drawning technician," also called a phlebotomist, will then clean the area with an alcohol swab and use a small needle attached to a thin rubber tube to withdraw blood from one of the viens into one or more vials. After the blood is collected, the phlebotomist removes the rubber strap, slides out the needle, and secures a small gauze dressing over the site with paper tape. Afterwards, applying several (5-10) minutes of mild, steady pressure to that area of your arm is all you need to do.

There are some medications (including the older antidepressants, also known as "TCA"s or tricyclic antidepressants) for which an electrocardiogram ("EKG" or "ECG") may be checked before starting or near the begining of starting the medication. In that type of test, sticky, gel coated pads are attached in a line aross your chest, reaching around your left side, and also at your wrists and ankle. Wires are attached to these pads and connected to a sensitive recording device that prints out the electrocardiogram. This allows me to get a very detailed measurement of exactly how your heart is beating and whether the use of certain medications are safe for you. When you are done, a few wipes with a facial tissue to clean the gel away are all that you need before you put your shirt or blouse back on and pull up your socks.

Certain medications require routine monitoring while you use them, in order to measure how much of the medicine your body is getting, and to catch hidden side effects before they become a problem. These type of tests are often done more frequently at the beginning of treatment with certain medications, and then at a different frequency later on.

If you take LITHIUM, you will need to have your blood tested no less than once every six months. Tests may include:

• Lithium level (at between 10 and 12 hours after your last dose)
• Thyroid test: Thyroid Stimulating Hormone "TSH" level (because lithium might weaken the thyroid gland in some people)
• Kidney tests: Blood Urea Nitrogen "BUN" and Creatinine levels, and Glomerular Filtration Rate (GFR) (because lithium can sometimes cause kidney difficulties)

If you take VALPROIC ACID (generic Depakene or brand name Depakote) or CARBAMAZEPINE (brand name Tegretol), you will need to have your blood tested no less than once every six months. Tests may include:

• valproic acid or carbamazepine level (at between 10 and 12 hours after your last dose)
• Complete Blood cell count "CBC" (because these medicines sometimes lower the amount of white blood cells or platelets)
• Liver tests: AST and ALT (because these medicines sometime cause the liver irritation)

If you take CLOZAPINE (brand name Clozaril), you will need to have your blood tested every week. After a certain period of time, some patients are allowed to have the testing every two weeks. This medicine can, in rare cases, cause a reaction in which your bone marrow shuts down and you stop making white blood cells, which will almost always result in death if the medication is not stopped right away. This testing can allow us to possibly detect this before it's too late and take the steps needed (such as stopping the clozapine) to stop or reverse the damage. You will only be allowed to pick up a one-week or two-week supply of this medication if your blood test shows that you have enough white blood cells. If the amount of a certain type of white blood cell drops below a certain critial amount, the medication must be stopped forever.

If you take any of the antipsychotic medications, including but not limited to QUETIAPINE (Seroquel), RISPERIDONE (Risperdal), OLANZAPINE (Zyprexa), ARIPIPRAZOLE (Abilify), ZIPRASIDONE (Geodon), CLOZAPINE (Clozaril), HALOPERIDOL (Haldol), FLUPHENAZINE (Prolixin), or CHLORPROMAZINE (Thorazine), you should have fasting blood sugar levels checked near the start of treatment, and then either intermittently, or sooner if you show clinic signs of elevated blood sugar such as increased thirst and urination. If elevated blood sugar is detected, treatment to lower blood sugar can be started, or the medication can be switched from one of the above to another. These tests are done more frequently at the start of treatment, but eventually are done about every 1 to 2 years if there is no other indication of high blood sugar. Fasting cholesterol tests are often done in conjuction with fasting glucose tests.

In order to have fasting tests obtained properly, you must not have anything to eat or drink (expect plain water) for at least 12 hours before having your blood drawn in the morning.