[GriffinValley]

Here is some basic information that may help assist in answering my question.I am a 41 yr old 5'7" 170lb Caucasian female. I was diagnosed with r/r MS in 1996,and Hep c in 2005{my hep c is well controlled and they believe stems from a blood transfusion} I have been in pain management for 13 months due to chronic pain from MS and other sources. I take a 75 mcg duragisic patch changed every 72 hrs,5mg/325 percocet 6x daily,10mg Flexiril 3x daily,1mg, clonazapam 3x daily . As well as 2000 UT vit D and a multi vit. I had a urine screen Aug 11th 2011 and received a call Sept. 29th 2011 that my screen was positive for alcohol. After thinking on it, I advised the nurse that yes I did have a glass of wine that night prior to the test as it was a special occasion at my Father's.I generally do not drink at all due to the hep c and the meds I take,I just didn't think of it that night,my fault. She advised me not to drink any more as my contract with the office forbids me to consume alcoholic beverages.I agreed and haven't had a drink since.The improvement the medication has made in my quality of life is far more important to me than any drink could ever be. I went from being almost completely bedridden ,to being able to function fairly well and I'm usually only down for the count about 2 days a week.
I had a screen on 3-16-2012. I was called 5-29-12 and told my screen was positive for alcohol. I advised the nurse I had not consumed any alcohol and requested the original sample be retested. That was impossible as the lab { Millennium labs},destroys samples after 30days as is their policy.I requested to come in at their earliest convenience for a random test or submit to another type of test and was refused.I was told I was being discharged from the practice..
The test results are as follows, LC MS/MS type of testing , specimen collected 3-16-12 8:51 am,received 3-19-12 8:32am,tested 3-19-12 12:10 pm ,completed 3-20-12 10:48 am. Tabulated results: ETG negative, cut toff 500ng, ETS 810ng cutoff 500ng, creatinine normalized 2810 micrograms of analyte per gram of creatinine.
I do not understand why the ETG is negative and the ETS positive since I had no notification of my test results until 75 days later { the office received the results on 3/20/12} I have no recollection of any food or other item { perfume,hair mousse,sanitizer isopropyl alcohol etc. etc. } that may have shown as a false positive. They had many instances to test me in the intermittent time as I go in monthly to pick up my prescriptions. My doctor, after much leg work on my disability lawyers side allowed me one more visit on 3/20/12 to finish up my disability determination forms.He was very helpful and easy to work with as always and only mentioned he played no part in my discharge that it is decided by a board. I have had very little success as of yet in finding a new pain management clinic as I seem to be red flagged as abusive to alcohol . I only have 2 1/2 weeks of meds left and am becoming increasingly anxious and plain stressed out which does not help my MS at all . Do I have any recourse as this seems to be a very negligent and irresponsible way to operate a practice. I offered several alternatives to remedy any doubts they should have had and was denied There are no other derogatory notes in my records .What would be the best course of action and what do you believe may have caused the test results. I did read a post on contacting the lab and other organizations. Should I request a time frame on getting their reply's back? Thank you for reading my lengthy post and I look forward to any thoughts and suggestions any one may have ,Thank you again.

[DrBill100]

EtS without detectable EtG is not an indication of alcohol consumption "When only one is present at concentrations below 5,000 ng/mL other sources of the metabolites must be considered." emphasis added.

And that is quoted directly from Millennium:

Correlation of Ethyl Glucuronide and Ethyl Sulfate

After reading that, you will see that this action is directly contradicted by the advice of the lab that performed the test. It is also most unusual to dispose of a positive sample in less than one year. 30 days is rule for negative samples.

I am currently working on a nearly identical matter brought in by a Medical Review Officer and will need additional info from you later tomorrow.

This is unfortunately not unusual when physicians place reliance on tests that they don't understand and particularly EtG/EtS testing.

It will probably be later tomorrow before I can get back to you.

NOTICE: Any person or entity that is subjected to or relies on EtG testing should read this Advisory issued by the US Department of Health and Human Services, September 2006 and remains in effect as of date of this posting. Copy available here > US DHHS Advisory

[GriffinValley]

EtS without detectable EtG is not an indication of alcohol consumption "When only one is present at concentrations below 5,000 ng/mL other sources of the metabolites must be considered." emphasis added.

And that is quoted directly from Millennium:

Correlation of Ethyl Glucuronide and Ethyl Sulfate

After reading that, you will see that this action is directly contradicted by the advice of the lab that performed the test. It is also most unusual to dispose of a positive sample in less than one year. 30 days is rule for negative samples.

I am currently working on a nearly identical matter brought in by a Medical Review Officer and will need additional info from you later tomorrow.

This is unfortunately not unusual when physicians place reliance on tests that they don't understand and particularly EtG/EtS testing.

It will probably be later tomorrow before I can get back to you.

NOTICE: Any person or entity that is subjected to or relies on EtG testing should read this Advisory issued by the US Department of Health and Human Services, September 2006 and remains in effect as of date of this posting. Copy available here > US DHHS Advisory

Thank you so much for your extraordinarily quick answer .I need to adjust an oversight on my part .My doctor last saw me on June 20th 2012 to finish my disability paperwork not March 20th 2012 as cited earlier. I look forward to answer,

[DrBill100]

Was just shutting down, but while you are here, it would be advisable to serve the lab with a certified letter advising that you want the subject sample held for re-test. Notwithstanding that your doctor advised it was discarded.

Also was any type of testing performed at the doctors office in relation to this test or at any time?

[GriffinValley]

Was just shutting down, but while you are here, it would be advisable to serve the lab with a certified letter advising that you want the subject sample held for re-test. Notwithstanding that your doctor advised it was discarded.

Also was any type of testing performed at the doctors office in relation to this test or at any time?

Thank you again,no testing was ever done at the doctor's office at any time. Even at my request they refused to allow me a retest,and to my knowledge {my knowledge being the answer from the nurse who answered the phone on May 30th} all testing is sent to Millennium labs ,they offer no in house testing.Which I frankly find odd because it is Eastern Virginia Medical School Pain Management , with Sentera Norfolk hospital at EVMS across the road every conceivable test possible is within 300yds of the office..
Should I request a time frame the sample be held or a written response sent back to me ?

[DrBill100]

Which I frankly find odd because it is Eastern Virginia Medical School Pain Management , with Sentera Norfolk hospital at EVMS across the road every conceivable test possible is within 300yds of the office..
Should I request a time frame the sample be held or a written response sent back to me ?

Not necessary. Be brief and specific. Attach copy of results for identification and send Certified, Return Receipt Requested. Send to attention: Laboratory Supervisor.

For my information, not in the correspondence, please list any medical condition that you are being treated for and the medications that you are currently taking.

I'll be tied up most of day but will review this evening.

For your protection, now and in the future please be careful not to post any information containing personal identifiers, i.e. name, address, etc.

[GriffinValley]

Not necessary. Be brief and specific. Attach copy of results for identification and send Certified, Return Receipt Requested. Send to attention: Laboratory Supervisor.

For my information, not in the correspondence, please list any medical condition that you are being treated for and the medications that you are currently taking.

I'll be tied up most of day but will review this evening.

For your protection, now and in the future please be careful not to post any information containing personal identifiers, i.e. name, address, etc.

I will send the letter this afternoon and again thank you for your help. As a note I just spoke with a young lady at the toxicology dept. of Millennium labs customer service at 1-877-451-3534 and asked her how long they store urine specimens for retesting in the case of a disputed result.Her reply was they need a certain amount of the specimen for testing{which I know is very minute amount around 10-12 drops I believe} and after 7-10 days the remaining amount is disposed of,which she followed up with sometimes are stored for 30 days. I rephrased and asked again and she still kept with 7to 10 to 30 days.
At any rate I will send the letter and await those results.
I have r/r MS diag. in 1996. I also have hep c diag. in 2005[well under control and am not taking any meds currently for that ,Pegatron has been suggested but due to various factors I have not as of yet pursed that course of treatment.
I am taking 75mcg Duragisic patches changed at 72 hrs,5mg/325 Percocet at 6x daily,10mg Flexiril 3x daily, and 1mg clonazapam 2x daily.Other meds and supplements include 400mg Ibuprofen for breakthrough pain or head aches etc. on occasional basis of about 6 or less doses monthly,2000 u of vit d daily, multi vit daily, fish oil daily, occasionally quinine in tonic water for muscle spasms.. That covers my current meds. Please let me know if I can give you any more information .I will check back around 7-8 pm est. My sincerest thanks.

[DrBill100]

Ran the medicines and found no possible interactions. That is to be expected and do to the delay in notice no longer relevant.

I spoke with the lab services division (HHS) this afternoon and determined that since this test was ordered by a physician it is classed as diagnostic and subject to regulation by their office. That means that they must investigate a complaint against the laboratory.

Will put together the elements of your complaint tomorrow and provide a list of those to contact, here is one resource that you should review in the meantime but don't take any action just yet.

CLIA Complaints

I hope you have taken the time to read the study from Millennium provided above. If not here it is again:

Correlation of EtG/EtS

[GriffinValley]

Ran the medicines and found no possible interactions. That is to be expected and do to the delay in notice no longer relevant.

I spoke with the lab services division (HHS) this afternoon and determined that since this test was ordered by a physician it is classed as diagnostic and subject to regulation by their office. That means that they must investigate a complaint against the laboratory.

Will put together the elements of your complaint tomorrow and provide a list of those to contact, here is one resource that you should review in the meantime but don't take any action just yet.

CLIA Complaints

I hope you have taken the time to read the study from Millennium provided above. If not here it is again:

Correlation of EtG/EtS

Yes I actually looked over it carefully several times and am rather dismayed at my Clinics either lack of knowledge or indifference to such an important piece of information. I am only hoping any other pain clinic will carefully review my test results as opposed to a precursory glance at "discharged due to UT results-positive for alcohol" which is in bold print across the top of my discharge letter.If you should need to see the test results or any other information you may useful please let me know as it is all scanned in and may be privately sent to you at your request. Thank you.

[GriffinValley]

Yes I actually looked over it carefully several times and am rather dismayed at my Clinics either lack of knowledge or indifference to such an important piece of information. I am only hoping any other pain clinic will carefully review my test results as opposed to a precursory glance at "discharged due to UT results-positive for alcohol" which is in bold print across the top of my discharge letter.If you should need to see the test results or any other information you may useful please let me know as it is all scanned in and may be privately sent to you at your request. Thank you.

In addition the letter to the lab to hold my specimen and request chain of custody is still needed as it will go out in tomorrows mail?

[DrBill100]

Currently awaiting a return call from Chemistry & Toxicology, FDA. There is great interest in this test just trying to determine which individual in which section is the key player. Sorry to keep you waiting.