Guest guest Posted July 3, 2004 Report Share Posted July 3, 2004 Dear Pam, Maybe, just maybe, your BP equipment at home is registering very differently from the office equipment. I suggest that during your next visit that you take your BP " stuff " along with you and when their office equipment is used then use yours. This will give you some idea about any differences that might occur. Also remind the doctor about the " White Coat syndrome " . Which means that patients often have a higher BP when they have to go to the doctor's office than when they are in more comfortable surroundings. Something, you must accept is that a specialist usually just sees what they specialize in. That might explain the difference between doctors. When I started out with my hyperaldosteronism, a neurologist thought that my strange readings were the result of brain tumor. The Urologist told me that the same readings we the result of a constriction of the vein in the Kidney. And so it went, I think even the Janitor got involved and thought I needed work therapy to resolve my problems <))). I finally found an internist that specialized in anything that goes on in the abdomen. He explained all this to me and then proceeded to take all of the information (not everybody's opinion) and made a conclusion that I had an adenoma. Which he then proceeded to prove through other tests. I'm not a doctor, but I empathize with your situation. Doctors, get very upset when you imply that you think ther're wrong. (something about the legality of it all) I would recommend that you first check your BP cuff with the Doctor's. And then gather the test results, not the opinions since it might bias further treatment. And find a General Practitioner, or an internist. Explain to them that you are presenting the test results you've had so far and ask if they could take a more systemic view of those tests and see if that might help. --- Pamela s <spirlhelix@...> wrote: > Hi, Dr. Grim and All, > > Maybe some of you can relate to my problem. I am very > thankful to be getting low readings on 100 mg > Aldactone, 10 mg lisinopril, 160 mg Diovan, and 30 mg > Isosorbide mononitrate every day. > > My blood pressure is so low that typically, I don't > even get a reading using my home monitor. When I > recently saw my nephrologist, my BP was 115/48--yes, > that is 48 diastolic! Low, low. I'm sometimes a > little lightheaded or often slightly flattened (that's > what I call it when I can't get out of bed with low > blood pressure). I followed his advice and cut back > on Lisinopril, which used to be 20 mg daily. > > My big problem is my heart failure specialist. She's > gotten it into her head, because I adamantly refuse BP > meds that give me side effects no matter how high or > low my blood pressure reads, that I am " cooking " my > home numbers, and nothing will persuade her otherwise; > especially when my blood pressure when last in her > office was 158/111, or thereabouts. I had suspected > that she did not believe my home numbers, but I > recently got my hands on some correspondence between > her and my internist, and my suspicions are confirmed. > She told him point blank that she did not believe my > home numbers, and he apparently has done nothing to > change her mind on this point. > > It also does not help my case that I was not able to > get a good washout of Spironolactone to do a > conclusive test of the aldo:renin ratio. To her, an > inconclusive test is just that: inconclusive. Even > though my blood pressure shoots into stroke ranges > after a week and a half off spironolactone. > > She wanted to get a 24-hour monitor and see what my > blood pressure does during the day; I was very > agreeable to this idea, but then I was told that her > office no longer has access to one, and does not have > any immediate plans to gain access to one. So here I > am with a heart failure specialist who does not > believe me, and will probably continue to think I am > discarding my medications and that my blood pressure > in the office is indicative of what it is at home, and > who is likely to reccomend more medication, not less. > Meanwhile, my nephrologist is perfectly happy with my > blood pressure and wants me to taper off some of my > meds. > > I wonder if anyone has any ideas about how to get > these diverging treatment plans from different > specialists into the same ball park. So far, my > internist seems rather indifferent and acts like it's > not his problem to get some common understanding going > between my specialists. To tell the truth, I think he > tends to support my heart failure specialist rather > than my nephrologist, even though I've been seeing the > nephrologist far longer than either the internist or > the heart failure specialist and the nephrologist is > the only one who knows everything about my case. > > Perhaps I should just suggest the heart failure > specialist hospitalize me for a few days so my blood > pressure and medications can be properly monitored. > But she would probably still find some reason to > disbelieve me. I don't know what else to suggest. > > I wouldn't care so much, except she is supposed to be > the most highly regarded heart failure specialist in > the city, and I doubt I'll be able to find another > heart failure specialist who will believe my word > against hers. > > Any ideas? Dr. Grim, is there some literature that > points to the excessive variability of blood pressure > readings in hyperaldosteronism? Or would you be > willing to correspond with her and share some of your > expertise? > > Help! > > Warmly, > > Pam > > ===== > " I'd rather learn from one bird how to sing, than to > teach ten thousand stars how not to dance. " > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 5, 2004 Report Share Posted July 5, 2004 You need to find a specialist in Hypertension that has a lot of experience with primary aldosteronism to help figure out what is best for you. The heart failure Dr does not seem like this person. Where do you live-I forgot. CE GrimMD In a message dated 7/3/2004 4:07:18 PM Eastern Daylight Time, Pamela s <spirlhelix@...> writes: >Hi, Dr. Grim and All, > >Maybe some of you can relate to my problem. I am very >thankful to be getting low readings on 100 mg >Aldactone, 10 mg lisinopril, 160 mg Diovan, and 30 mg >Isosorbide mononitrate every day. > >My blood pressure is so low that typically, I don't >even get a reading using my home monitor. When I >recently saw my nephrologist, my BP was 115/48--yes, >that is 48 diastolic! Low, low. I'm sometimes a >little lightheaded or often slightly flattened (that's >what I call it when I can't get out of bed with low >blood pressure). I followed his advice and cut back >on Lisinopril, which used to be 20 mg daily. > >My big problem is my heart failure specialist. She's >gotten it into her head, because I adamantly refuse BP >meds that give me side effects no matter how high or >low my blood pressure reads, that I am " cooking " my >home numbers, and nothing will persuade her otherwise; >especially when my blood pressure when last in her >office was 158/111, or thereabouts. I had suspected >that she did not believe my home numbers, but I >recently got my hands on some correspondence between >her and my internist, and my suspicions are confirmed. > She told him point blank that she did not believe my >home numbers, and he apparently has done nothing to >change her mind on this point. > >It also does not help my case that I was not able to >get a good washout of Spironolactone to do a >conclusive test of the aldo:renin ratio. To her, an >inconclusive test is just that: inconclusive. Even >though my blood pressure shoots into stroke ranges >after a week and a half off spironolactone. > >She wanted to get a 24-hour monitor and see what my >blood pressure does during the day; I was very >agreeable to this idea, but then I was told that her >office no longer has access to one, and does not have >any immediate plans to gain access to one. So here I >am with a heart failure specialist who does not >believe me, and will probably continue to think I am >discarding my medications and that my blood pressure >in the office is indicative of what it is at home, and >who is likely to reccomend more medication, not less. >Meanwhile, my nephrologist is perfectly happy with my >blood pressure and wants me to taper off some of my >meds. > >I wonder if anyone has any ideas about how to get >these diverging treatment plans from different >specialists into the same ball park. So far, my >internist seems rather indifferent and acts like it's >not his problem to get some common understanding going >between my specialists. To tell the truth, I think he >tends to support my heart failure specialist rather >than my nephrologist, even though I've been seeing the >nephrologist far longer than either the internist or >the heart failure specialist and the nephrologist is >the only one who knows everything about my case. > >Perhaps I should just suggest the heart failure >specialist hospitalize me for a few days so my blood >pressure and medications can be properly monitored. >But she would probably still find some reason to >disbelieve me. I don't know what else to suggest. > >I wouldn't care so much, except she is supposed to be >the most highly regarded heart failure specialist in >the city, and I doubt I'll be able to find another >heart failure specialist who will believe my word >against hers. > >Any ideas? Dr. Grim, is there some literature that >points to the excessive variability of blood pressure >readings in hyperaldosteronism? Or would you be >willing to correspond with her and share some of your >expertise? > >Help! > >Warmly, > >Pam > >===== > " I'd rather learn from one bird how to sing, than to teach ten thousand stars how not to dance. " > >__________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 5, 2004 Report Share Posted July 5, 2004 PS I trust someone is taking your pressure with a mercury manometer and has recently had their hearing tested. In a message dated 7/3/2004 4:07:18 PM Eastern Daylight Time, Pamela s <spirlhelix@...> writes: >Hi, Dr. Grim and All, > >Maybe some of you can relate to my problem. I am very >thankful to be getting low readings on 100 mg >Aldactone, 10 mg lisinopril, 160 mg Diovan, and 30 mg >Isosorbide mononitrate every day. > >My blood pressure is so low that typically, I don't >even get a reading using my home monitor. When I >recently saw my nephrologist, my BP was 115/48--yes, >that is 48 diastolic! Low, low. I'm sometimes a >little lightheaded or often slightly flattened (that's >what I call it when I can't get out of bed with low >blood pressure). I followed his advice and cut back >on Lisinopril, which used to be 20 mg daily. > >My big problem is my heart failure specialist. She's >gotten it into her head, because I adamantly refuse BP >meds that give me side effects no matter how high or >low my blood pressure reads, that I am " cooking " my >home numbers, and nothing will persuade her otherwise; >especially when my blood pressure when last in her >office was 158/111, or thereabouts. I had suspected >that she did not believe my home numbers, but I >recently got my hands on some correspondence between >her and my internist, and my suspicions are confirmed. > She told him point blank that she did not believe my >home numbers, and he apparently has done nothing to >change her mind on this point. > >It also does not help my case that I was not able to >get a good washout of Spironolactone to do a >conclusive test of the aldo:renin ratio. To her, an >inconclusive test is just that: inconclusive. Even >though my blood pressure shoots into stroke ranges >after a week and a half off spironolactone. > >She wanted to get a 24-hour monitor and see what my >blood pressure does during the day; I was very >agreeable to this idea, but then I was told that her >office no longer has access to one, and does not have >any immediate plans to gain access to one. So here I >am with a heart failure specialist who does not >believe me, and will probably continue to think I am >discarding my medications and that my blood pressure >in the office is indicative of what it is at home, and >who is likely to reccomend more medication, not less. >Meanwhile, my nephrologist is perfectly happy with my >blood pressure and wants me to taper off some of my >meds. > >I wonder if anyone has any ideas about how to get >these diverging treatment plans from different >specialists into the same ball park. So far, my >internist seems rather indifferent and acts like it's >not his problem to get some common understanding going >between my specialists. To tell the truth, I think he >tends to support my heart failure specialist rather >than my nephrologist, even though I've been seeing the >nephrologist far longer than either the internist or >the heart failure specialist and the nephrologist is >the only one who knows everything about my case. > >Perhaps I should just suggest the heart failure >specialist hospitalize me for a few days so my blood >pressure and medications can be properly monitored. >But she would probably still find some reason to >disbelieve me. I don't know what else to suggest. > >I wouldn't care so much, except she is supposed to be >the most highly regarded heart failure specialist in >the city, and I doubt I'll be able to find another >heart failure specialist who will believe my word >against hers. > >Any ideas? Dr. Grim, is there some literature that >points to the excessive variability of blood pressure >readings in hyperaldosteronism? Or would you be >willing to correspond with her and share some of your >expertise? > >Help! > >Warmly, > >Pam > >===== > " I'd rather learn from one bird how to sing, than to teach ten thousand stars how not to dance. " > >__________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 5, 2004 Report Share Posted July 5, 2004 Dr Grim, Thanks for your response. I live in Cincinnati, Ohio. I have had my hearing tested; it's fine. My home monitor is not a mercury one, but I keep bringing it with me when I go to the doctor's office, and there it registers very much the same as the doctor's. Several people in the doctor's office will take my blood pressure with similar results, so I suppose the hearing factor can be ruled out. At my nephrologist's office, my blood pressure using a mercury sphygmomanometer was 115/48. It was 116/65 at my internist's office. It just jumps up around my heart failure specialist, who makes me nervous because she is so skeptical. Any ideas are welcome. Warmly, Pam --- lowerbp2@... wrote: > PS I trust someone is taking your pressure with a > mercury manometer and has recently had their hearing > tested. > > > In a message dated 7/3/2004 4:07:18 PM Eastern > Daylight Time, Pamela s > <spirlhelix@...> writes: > > >Hi, Dr. Grim and All, > > > >Maybe some of you can relate to my problem. I am > very > >thankful to be getting low readings on 100 mg > >Aldactone, 10 mg lisinopril, 160 mg Diovan, and 30 > mg > >Isosorbide mononitrate every day. > > > >My blood pressure is so low that typically, I don't > >even get a reading using my home monitor. When I > >recently saw my nephrologist, my BP was > 115/48--yes, > >that is 48 diastolic! Low, low. I'm sometimes a > >little lightheaded or often slightly flattened > (that's > >what I call it when I can't get out of bed with low > >blood pressure). I followed his advice and cut > back > >on Lisinopril, which used to be 20 mg daily. > > > >My big problem is my heart failure specialist. > She's > >gotten it into her head, because I adamantly refuse > BP > >meds that give me side effects no matter how high > or > >low my blood pressure reads, that I am " cooking " my > >home numbers, and nothing will persuade her > otherwise; > >especially when my blood pressure when last in her > >office was 158/111, or thereabouts. I had > suspected > >that she did not believe my home numbers, but I > >recently got my hands on some correspondence > between > >her and my internist, and my suspicions are > confirmed. > > She told him point blank that she did not believe > my > >home numbers, and he apparently has done nothing to > >change her mind on this point. > > > >It also does not help my case that I was not able > to > >get a good washout of Spironolactone to do a > >conclusive test of the aldo:renin ratio. To her, > an > >inconclusive test is just that: inconclusive. Even > >though my blood pressure shoots into stroke ranges > >after a week and a half off spironolactone. > > > >She wanted to get a 24-hour monitor and see what my > >blood pressure does during the day; I was very > >agreeable to this idea, but then I was told that > her > >office no longer has access to one, and does not > have > >any immediate plans to gain access to one. So here > I > >am with a heart failure specialist who does not > >believe me, and will probably continue to think I > am > >discarding my medications and that my blood > pressure > >in the office is indicative of what it is at home, > and > >who is likely to reccomend more medication, not > less. > >Meanwhile, my nephrologist is perfectly happy with > my > >blood pressure and wants me to taper off some of my > >meds. > > > >I wonder if anyone has any ideas about how to get > >these diverging treatment plans from different > >specialists into the same ball park. So far, my > >internist seems rather indifferent and acts like > it's > >not his problem to get some common understanding > going > >between my specialists. To tell the truth, I think > he > >tends to support my heart failure specialist rather > >than my nephrologist, even though I've been seeing > the > >nephrologist far longer than either the internist > or > >the heart failure specialist and the nephrologist > is > >the only one who knows everything about my case. > > > >Perhaps I should just suggest the heart failure > >specialist hospitalize me for a few days so my > blood > >pressure and medications can be properly monitored. > > >But she would probably still find some reason to > >disbelieve me. I don't know what else to suggest. > > > >I wouldn't care so much, except she is supposed to > be > >the most highly regarded heart failure specialist > in > >the city, and I doubt I'll be able to find another > >heart failure specialist who will believe my word > >against hers. > > > >Any ideas? Dr. Grim, is there some literature that > >points to the excessive variability of blood > pressure > >readings in hyperaldosteronism? Or would you be > >willing to correspond with her and share some of > your > >expertise? > > > >Help! > > > >Warmly, > > > >Pam > > > >===== > > " I'd rather learn from one bird how to sing, than > to teach ten thousand stars how not to dance. " > > > >__________________________________________________ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 5, 2004 Report Share Posted July 5, 2004 Pam, My perspective is that it really is not worth it for you to be seeing a specialist who is the cause of so much stress in your life. Everyone else except this specialist agrees with your BP readings. Those sound like pretty good odds to me that your BP readings at home are in the right and she is out of line. With all the health problems that you are working so hard to deal with, you do not need another stressor in the form of a specialist who is parental to you and does not believe you. Find yourself another specialist. I live in Cincinnati and see a cardiologist for my mitral valve defect, his name is Dr Shea, and he is at offices next to Bethesda North hospital. I can highly recommend him, if you decide to try someone else. Jim > Dr Grim, > > Thanks for your response. I live in Cincinnati, Ohio. > I have had my hearing tested; it's fine. My home > monitor is not a mercury one, but I keep bringing it > with me when I go to the doctor's office, and there it > registers very much the same as the doctor's. Several > people in the doctor's office will take my blood > pressure with similar results, so I suppose the > hearing factor can be ruled out. > > At my nephrologist's office, my blood pressure using a > mercury sphygmomanometer was 115/48. It was 116/65 at > my internist's office. It just jumps up around my > heart failure specialist, who makes me nervous because > she is so skeptical. > > Any ideas are welcome. > > Warmly, > > Pam > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 5, 2004 Report Share Posted July 5, 2004 In general Cardiologists are not specialist in Hypertension and even less so in primary aldosteronism. CE Grim MD In a message dated 7/5/2004 9:20:47 AM Eastern Daylight Time, " Royden Forsythe " <rjf_at_fts@...> writes: >Pam, > >My perspective is that it really is not worth it for you to be seeing >a specialist who is the cause of so much stress in your life. >Everyone else except this specialist agrees with your BP readings. >Those sound like pretty good odds to me that your BP readings at home >are in the right and she is out of line. With all the health problems >that you are working so hard to deal with, you do not need another >stressor in the form of a specialist who is parental to you and does >not believe you. Find yourself another specialist. I live in >Cincinnati and see a cardiologist for my mitral valve defect, his name >is Dr Shea, and he is at offices next to Bethesda North >hospital. I can highly recommend him, if you decide to try someone else. > >Jim > > >> Dr Grim, >> >> Thanks for your response. I live in Cincinnati, Ohio. >> I have had my hearing tested; it's fine. My home >> monitor is not a mercury one, but I keep bringing it >> with me when I go to the doctor's office, and there it >> registers very much the same as the doctor's. Several >> people in the doctor's office will take my blood >> pressure with similar results, so I suppose the >> hearing factor can be ruled out. >> >> At my nephrologist's office, my blood pressure using a >> mercury sphygmomanometer was 115/48. It was 116/65 at >> my internist's office. It just jumps up around my >> heart failure specialist, who makes me nervous because >> she is so skeptical. >> >> Any ideas are welcome. >> >> Warmly, >> >> Pam >> > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 5, 2004 Report Share Posted July 5, 2004 I think I have previously recommmende Dr. Gordon Guthrie in Lexingon, KY as the most knowledable person in the area I know-or Dr. Myron Weinberger in Indiananpolis. In a message dated 7/5/2004 4:09:37 AM Eastern Daylight Time, Pamela s <spirlhelix@...> writes: >Dr Grim, > >Thanks for your response. I live in Cincinnati, Ohio. > I have had my hearing tested; it's fine. My home >monitor is not a mercury one, but I keep bringing it >with me when I go to the doctor's office, and there it >registers very much the same as the doctor's. Several >people in the doctor's office will take my blood >pressure with similar results, so I suppose the >hearing factor can be ruled out. > >At my nephrologist's office, my blood pressure using a >mercury sphygmomanometer was 115/48. It was 116/65 at >my internist's office. It just jumps up around my >heart failure specialist, who makes me nervous because >she is so skeptical. > >Any ideas are welcome. > >Warmly, > >Pam > > >--- lowerbp2@... wrote: >> PS I trust someone is taking your pressure with a >> mercury manometer and has recently had their hearing >> tested. >> >> >> In a message dated 7/3/2004 4:07:18 PM Eastern >> Daylight Time, Pamela s >> <spirlhelix@...> writes: >> >> >Hi, Dr. Grim and All, >> > >> >Maybe some of you can relate to my problem. I am >> very >> >thankful to be getting low readings on 100 mg >> >Aldactone, 10 mg lisinopril, 160 mg Diovan, and 30 >> mg >> >Isosorbide mononitrate every day. >> > >> >My blood pressure is so low that typically, I don't >> >even get a reading using my home monitor. When I >> >recently saw my nephrologist, my BP was >> 115/48--yes, >> >that is 48 diastolic! Low, low. I'm sometimes a >> >little lightheaded or often slightly flattened >> (that's >> >what I call it when I can't get out of bed with low >> >blood pressure). I followed his advice and cut >> back >> >on Lisinopril, which used to be 20 mg daily. >> > >> >My big problem is my heart failure specialist. >> She's >> >gotten it into her head, because I adamantly refuse >> BP >> >meds that give me side effects no matter how high >> or >> >low my blood pressure reads, that I am " cooking " my >> >home numbers, and nothing will persuade her >> otherwise; >> >especially when my blood pressure when last in her >> >office was 158/111, or thereabouts. I had >> suspected >> >that she did not believe my home numbers, but I >> >recently got my hands on some correspondence >> between >> >her and my internist, and my suspicions are >> confirmed. >> > She told him point blank that she did not believe >> my >> >home numbers, and he apparently has done nothing to >> >change her mind on this point. >> > >> >It also does not help my case that I was not able >> to >> >get a good washout of Spironolactone to do a >> >conclusive test of the aldo:renin ratio. To her, >> an >> >inconclusive test is just that: inconclusive. Even >> >though my blood pressure shoots into stroke ranges >> >after a week and a half off spironolactone. >> > >> >She wanted to get a 24-hour monitor and see what my >> >blood pressure does during the day; I was very >> >agreeable to this idea, but then I was told that >> her >> >office no longer has access to one, and does not >> have >> >any immediate plans to gain access to one. So here >> I >> >am with a heart failure specialist who does not >> >believe me, and will probably continue to think I >> am >> >discarding my medications and that my blood >> pressure >> >in the office is indicative of what it is at home, >> and >> >who is likely to reccomend more medication, not >> less. >> >Meanwhile, my nephrologist is perfectly happy with >> my >> >blood pressure and wants me to taper off some of my >> >meds. >> > >> >I wonder if anyone has any ideas about how to get >> >these diverging treatment plans from different >> >specialists into the same ball park. So far, my >> >internist seems rather indifferent and acts like >> it's >> >not his problem to get some common understanding >> going >> >between my specialists. To tell the truth, I think >> he >> >tends to support my heart failure specialist rather >> >than my nephrologist, even though I've been seeing >> the >> >nephrologist far longer than either the internist >> or >> >the heart failure specialist and the nephrologist >> is >> >the only one who knows everything about my case. >> > >> >Perhaps I should just suggest the heart failure >> >specialist hospitalize me for a few days so my >> blood >> >pressure and medications can be properly monitored. >> >> >But she would probably still find some reason to >> >disbelieve me. I don't know what else to suggest. >> > >> >I wouldn't care so much, except she is supposed to >> be >> >the most highly regarded heart failure specialist >> in >> >the city, and I doubt I'll be able to find another >> >heart failure specialist who will believe my word >> >against hers. >> > >> >Any ideas? Dr. Grim, is there some literature that >> >points to the excessive variability of blood >> pressure >> >readings in hyperaldosteronism? Or would you be >> >willing to correspond with her and share some of >> your >> >expertise? >> > >> >Help! >> > >> >Warmly, >> > >> >Pam >> > >> >===== >> > " I'd rather learn from one bird how to sing, than >> to teach ten thousand stars how not to dance. " >> > >> >__________________________________________________ >> > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 5, 2004 Report Share Posted July 5, 2004 Pam, I am glad you are calming down. Doctors can drive us crazy sometimes! Your choices here sound healthy to me and I support you in them. Bringing your readings from the other offices is a great idea, and if she is still not convinced from other doctors' data regarding you, then it sounds like she is a control freak who is not going to believe you. I'm sorry you are going through this and I hope you find resolution soon! Jim > Jim, > > Thanks for your ideas. I'm starting to calm down > about it a little bit; I have an appointment coming up > with her on the 12th. I think I will bring in copies > of my other doctors' office notes about my blood > pressure readings in their offices in lieu of a list > of home readings. I will not offer to show her any > home readings, because she appears to question their > validity. I also found a decent medical article on > hyperaldosteronism and blood pressure that I will > present for her perusal. > > And if my blood pressure is high while in her office, > I will tell her that I am beginning to be suspicious > of readings taken in her office, as they are > inexplicably higher than readings taken in other > doctors' offices. I will note that, since my regieme > has not changed in any other way, apparently meeting > with her makes me inordinately nervous--and perhaps it > would be best for me to be attended by doctors who > don't have this effect on me. > > That puts the ball in her court, so to speak. I will > see what she has to say in response to that. > > Warmly, > > Pam > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 5, 2004 Report Share Posted July 5, 2004 Pam, I am glad you are calming down. Doctors can drive us crazy sometimes! Your choices here sound healthy to me and I support you in them. Bringing your readings from the other offices is a great idea, and if she is still not convinced from other doctors' data regarding you, then it sounds like she is a control freak who is not going to believe you. I'm sorry you are going through this and I hope you find resolution soon! Jim > Jim, > > Thanks for your ideas. I'm starting to calm down > about it a little bit; I have an appointment coming up > with her on the 12th. I think I will bring in copies > of my other doctors' office notes about my blood > pressure readings in their offices in lieu of a list > of home readings. I will not offer to show her any > home readings, because she appears to question their > validity. I also found a decent medical article on > hyperaldosteronism and blood pressure that I will > present for her perusal. > > And if my blood pressure is high while in her office, > I will tell her that I am beginning to be suspicious > of readings taken in her office, as they are > inexplicably higher than readings taken in other > doctors' offices. I will note that, since my regieme > has not changed in any other way, apparently meeting > with her makes me inordinately nervous--and perhaps it > would be best for me to be attended by doctors who > don't have this effect on me. > > That puts the ball in her court, so to speak. I will > see what she has to say in response to that. > > Warmly, > > Pam > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 6, 2004 Report Share Posted July 6, 2004 YOu need to reminde her that Lisinopril and Diovan do not work in pateints with PA to lower the BP but Sprio and Inspra does. The Imdur may or may not work. Your heart failure is almost certainly related to your PA. You treat heart failure by treating the cause. The cause is the PA and long standing low K. My guess is that the CHF is mostly reversed by now with your excellent BP control on Spiro. Keep up the good work. I also remind you and others that unless there is excess salt in the diet, aldosterone does not cause high blood pressure and heart and kidney damage. DASHing is an important part of the treatment. May your pressure be low! Clarence E. Grim, BS, MS, MD, FACP, FACC Professor of Medicine and Epidemiology Board Certified in Internal Medicine, Geriatrics and Hypertension Focusing on difficult to control high blood pressure and high cholesterol especially in the African Diaspora “Of all the forms of injustice, inequality in health is the most shocking and inhumanâ€: Dr. Luther King, Jr. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 6, 2004 Report Share Posted July 6, 2004 Dr Grim, That sounds contrary to what I've learned so far about hyperaldosteronism. What I understand is that the excess of aldosterone in the bloodsteam causes the body to retain sodium and dump potassium. So even if you are eating a low-sodium diet, you will still have higher sodium levels in your blood and therefore elevated blood pressure. I have always heard the only way to treat it is by blocking the aldosterone via Spiro or Inspra, or by surgery. I realize that a low-sodium diet also greatly helps, because it keeps another factor in check that causes HTN, so I do not want to imply that diet has no affect, to the contrary, I agree with you about the need to be on a low-salt diet. But is that sufficient when excess amounts of aldosterone are floating around in your blood, telling your system to retain sodium? Jim > I also remind you and others that unless there is excess salt in the diet, > aldosterone does not cause high blood pressure and heart and kidney damage. > DASHing is an important part of the treatment. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 7, 2004 Report Share Posted July 7, 2004 It is not possible to cause high blood pressure in man or animals by giving only aldosteorne-you must also give a high salt diet. The problem is that to lower the BP when it has been up for some time will likely take a radical diet approach to get the sodium low enoght---like the rice fruit diet at ricediet.com But you could also try the DASH14 day challenge diet to see if that is all you need. It will certainly help. Work with your health care team and see if they would be willign to work with you on this--if you think you can do the diet. If drugs are working well you may just sit tight. May your pressure be low! Clarence E. Grim, BS, MS, MD, FACP, FACC Professor of Medicine and Epidemiology Board Certified in Internal Medicine, Geriatrics and Hypertension Focusing on difficult to control high blood pressure and high cholesterol especially in the African Diaspora “Of all the forms of injustice, inequality in health is the most shocking and inhumanâ€: Dr. Luther King, Jr. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 8, 2004 Report Share Posted July 8, 2004 Thanks for the explanation, Dr Grim. I've been on a low-salt diet since my HTN developed, which was before I discovered I had PA. I've also been on a low-fat, low-sweets diet for some time. The main difference between my diet and the DASH diet is that I am pretty strongly lactose intolerant, so I have soy milk and soy yogurt instead of regular dairy. This means my proportions of food from the nuts/seeds/beans food group in the diet goes way up. Do you know if eating soy affects HTN? If other healthy foods like this are substituted in the DASH diet, does it negate the helpful affects for lowering BP (i.e. does the diet have to be in the exact proportions of food types prescribed)? Jim > It is not possible to cause high blood pressure in man or animals by giving > only aldosteorne-you must also give a high salt diet. > > The problem is that to lower the BP when it has been up for some time will > likely take a radical diet approach to get the sodium low enoght---like the rice > fruit diet at ricediet.com > > But you could also try the DASH14 day challenge diet to see if that is all > you need. It will certainly help. > > Work with your health care team and see if they would be willign to work with > you on this--if you think you can do the diet. > > If drugs are working well you may just sit tight. > > > > May your pressure be low! > > Clarence E. Grim, BS, MS, MD, FACP, FACC > Professor of Medicine and Epidemiology > Board Certified in Internal Medicine, Geriatrics and Hypertension > Focusing on difficult to control high blood pressure and high cholesterol > especially in the African Diaspora > > > > “Of all the forms of injustice, inequality in health is the most shocking and > inhumanâ€: > Dr. Luther King, Jr. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 8, 2004 Report Share Posted July 8, 2004 My only concern would be the sodium in the Soy. I would shoot for the 1500 mg per day goal at least of the low sodium DASH. To eleminate all meds you may need to go lower and only trial and erro will determine what your level of sodium intake it takes to get your BP to gaol without medications. The rice diet is 250 mg. which is very difficult to do. So you need to weigh: can I do it and is it worth it? In a message dated 7/8/2004 7:52:22 AM Eastern Daylight Time, " Royden Forsythe " <rjf_at_fts@...> writes: >Thanks for the explanation, Dr Grim.  I've been on a low-salt diet >since my HTN developed, which was before I discovered I had PA. I've >also been on a low-fat, low-sweets diet for some time.  The main >difference between my diet and the DASH diet is that I am pretty >strongly lactose intolerant, so I have soy milk and soy yogurt instead >of regular dairy.  This means my proportions of food from the >nuts/seeds/beans food group in the diet goes way up.  Do you know if >eating soy affects HTN?  If other healthy foods like this are >substituted in the DASH diet, does it negate the helpful affects for >lowering BP (i.e. does the diet have to be in the exact proportions of >food types prescribed)? > >Jim > > >> It is not possible to cause high blood pressure in man or animals by >giving >> only aldosteorne-you must also give a high salt diet. >> >> The problem is that to lower the BP when it has been up for some >time will >> likely take a radical diet approach to get the sodium low >enoght---like the rice >> fruit diet at ricediet.com >> >> But you could also try the DASH14 day challenge diet to see if that >is all >> you need.  It will certainly help. >> >> Work with your health care team and see if they would be willign to >work with >> you on this--if you think you can do the diet. >> >> If drugs are working well you may just sit tight. >> >> >> >> May your pressure be low! >> >> Clarence E. Grim, BS, MS, MD, FACP, FACC >> Professor of Medicine and Epidemiology >> Board Certified in Internal Medicine, Geriatrics and Hypertension >> Focusing on difficult to control high blood pressure and high >cholesterol >> especially in the African Diaspora >> >> >> >> “Of all the forms of injustice, inequality in health is the most >shocking and >> inhumanâ€Â: >> Dr. Luther King, Jr. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 8, 2004 Report Share Posted July 8, 2004 PS: The only way to be certain how much sodium you are taking in is to have your Dr. order a 24 hour urine for sodium, K and creatinine content. This will tell you how much sodium you have eaten on the average over the last few days. In a message dated 7/8/2004 7:52:22 AM Eastern Daylight Time, " Royden Forsythe " <rjf_at_fts@...> writes: >Thanks for the explanation, Dr Grim.  I've been on a low-salt diet >since my HTN developed, which was before I discovered I had PA. I've >also been on a low-fat, low-sweets diet for some time.  The main >difference between my diet and the DASH diet is that I am pretty >strongly lactose intolerant, so I have soy milk and soy yogurt instead >of regular dairy.  This means my proportions of food from the >nuts/seeds/beans food group in the diet goes way up.  Do you know if >eating soy affects HTN?  If other healthy foods like this are >substituted in the DASH diet, does it negate the helpful affects for >lowering BP (i.e. does the diet have to be in the exact proportions of >food types prescribed)? > >Jim > > >> It is not possible to cause high blood pressure in man or animals by >giving >> only aldosteorne-you must also give a high salt diet. >> >> The problem is that to lower the BP when it has been up for some >time will >> likely take a radical diet approach to get the sodium low >enoght---like the rice >> fruit diet at ricediet.com >> >> But you could also try the DASH14 day challenge diet to see if that >is all >> you need.  It will certainly help. >> >> Work with your health care team and see if they would be willign to >work with >> you on this--if you think you can do the diet. >> >> If drugs are working well you may just sit tight. >> >> >> >> May your pressure be low! >> >> Clarence E. Grim, BS, MS, MD, FACP, FACC >> Professor of Medicine and Epidemiology >> Board Certified in Internal Medicine, Geriatrics and Hypertension >> Focusing on difficult to control high blood pressure and high >cholesterol >> especially in the African Diaspora >> >> >> >> “Of all the forms of injustice, inequality in health is the most >shocking and >> inhumanâ€Â: >> Dr. Luther King, Jr. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 8, 2004 Report Share Posted July 8, 2004 Soybeans by themselves are naturally low in sodium (8 to 10 mg per cup), its just the processing of them that you have to watch out for. Soy milk (Silk brand) is 120mg per cup, rather high, and soy yogurt (Whole Soy brand) is 20mg per cup, which is better. 2000 mg daily is what I've been aiming for, but I'm going to try for the 1500 mg now. I understand why monitoring with a doctor is important when trying to adjust via diet, especially if you go way low on the sodium because then the meds are overcompensating. I think I can tell when my sodium swings up or down because of the way I feel - if its up I notice a difference in thirstyness and fatigue/muscle ache. Perhaps going to a clinic like RiceDiet or getting more direct interaction from my doctors in adjusting my diet would be good to get sodium and HTN down. I've asked the library to get me the RiceDiet book. Thanks for the help. Jim > My only concern would be the sodium in the Soy. > > I would shoot for the 1500 mg per day goal at least of the low sodium DASH. > > To eleminate all meds you may need to go lower and only trial and erro will determine what your level of sodium intake it takes to get your BP to gaol without medications. > > The rice diet is 250 mg. which is very difficult to do. So you need to weigh: can I do it and is it worth it? > Quote Link to comment Share on other sites More sharing options...
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