Guest guest Posted July 27, 2005 Report Share Posted July 27, 2005 If it were me, I'd first get help from a friend or family member. You should have a witness, and someone to make sure you don't get too ill to function and for moral support. This nephrologist has to be reminded a human being is a complete organism with historical data, and not a lab test machine. Second, you and/or your helper have a good medical advocacy lawyer standing by with complaints and press releases at the ready, emphasizing the risk depending upon how long your BP has been high (i.e. LVH, etc). Third, I would tell the doctor directly the name of your lawyer, and to expect a call if he doesn't read the article and act on it now. In 60 minutes. If he balks, the lawyer should file for an injunction against the doctor, and complaints with his board, state licensing authority, medical or science editor(s) in the press, etc. as once. That day. I only recommend the lawyer so as not to threaten without him/her. It is part of the legal custom to do this, but don't wait for any lawyer who says they'll take longer than one day. Go right to the doctor once you speak to the lawyer, not telling him the lawyer is going to take " x " days to be ready. If someone won't get the doc on the phone for medical reasons, tell them it involves his state license, and is urgent. My dad is an ALJ who has taken or suspended many doctor licenses in one hour. Call you state hearing office or licensing authority and ask for immediate advocacy if you have any trouble. Now (again if it were myself) if spiro had lowered my BP, I would reintroduce it, at 50 mg increments each day or half day, depending upon BP-results. Don't settle for anything higher than 120/80. Be prepared to feel unfamiliarly dizzy, especially upon sudden standing up from long sitting or prone positions. Get your K tested daily to make sure it doesn't go too high. I would immediately use the DASH diet in Dr T 's easy book as well. Together, they worked actually too well for me at first. I had to tweak the levels of spiro and dietary sodium to fit my own results (118 / 70). Just a few thoughts, Dave On Jul 27, 2005, at 5:50 PM, bayabas76 wrote: > > Take my article to your Dr and let him >> read it. Keep us posted on the effects of Sprior. Capto will not > work in >> PA alone. > > I did give him a copy of your article and asked him to study it in > relation to my case. Sadly, he was hesitant in accepting it and I would > not be surprised if he did not read it at all. > > My bp is high and I am sweating as I am writing this. I dont feel well. > Should I just take Spiro on my own? This doc has pulled me off Spiro > three days ago. I am considering taking 100mg Spiro on my own, any comments? My K level is now 3.6. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 28, 2005 Report Share Posted July 28, 2005 In a message dated 7/27/05 10:17:43 PM, dave@... writes: Get your K tested daily to make sure it doesn't go too high. I would immediately use the DASH diet in Dr T 's easy book as well. T Any GOOD book store can get this for you in 2 or 3 days. May your pressure be low! Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD, FACP, FACC, FAHS Clinical Professor of Medicine and Epidemiology Director, Hypertension Diagnosis and Treatment Center Board Certified in Internal Medicine, Geriatrics and Hypertension Published over 220 scientific papers, book chapters and 220 abstracts in the area of high blood pressure epidemiology, physiology, endocrinology measurement, treatment and how to detect curable causes. Listed in Best Doctors in America Specializing in Difficult to Control High Blood Pressure and the History and Physiology of High Blood pressure in the African Diaspora Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 28, 2005 Report Share Posted July 28, 2005 UCSF, and that's her teacher talking. What is unstated is the unrecognized cases, and her practice's diabetes focus. Dave On Jul 28, 2005, at 2:46 PM, lowerbp2@... wrote: > > In a message dated 7/28/05 3:28:23 PM, dave@... writes: > > >> She >> referred me to her professor, who said " she's seen, what maybe 2 >> cases >> in her career? " > > > I dont know any good Endocrinologist who has seen only 2 cases of PA. > My guess is that they saw many but did not recognize them. Where did > she train? > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 29, 2005 Report Share Posted July 29, 2005 In a message dated 7/28/05 8:36:16 PM, dave@... writes: UCSF, and that's her teacher talking. What is unstated is the unrecognized cases, and her practice's diabetes focus. Dave Her teacher must not taught her a good broad course in Endocrinology or she must not have gone on Enodcine rounds or to endocrine or HTN clinic at UCSF where they have seen hundreds of cases of PA. It would be intersting to find out why she did not see any in her training. May your pressure be low! Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD, FACP, FACC, FAHS Clinical Professor of Medicine and Epidemiology Director, Hypertension Diagnosis and Treatment Center Board Certified in Internal Medicine, Geriatrics and Hypertension Published over 220 scientific papers, book chapters and 220 abstracts in the area of high blood pressure epidemiology, physiology, endocrinology measurement, treatment and how to detect curable causes. Listed in Best Doctors in America Specializing in Difficult to Control High Blood Pressure and the History and Physiology of High Blood pressure in the African Diaspora Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 29, 2005 Report Share Posted July 29, 2005 In a message dated 7/29/05 12:34:21 PM, farahbar@... writes: Somehow I am not surprised. I was at Stanford and none of the doctors there suspected PA. Even when my husband and I asked the professor himself who was a hyptertention specialist if I was tested for PA said that there was no need for it because that was so rare and refused to test me despite the high bp, LVH, and low K. Professor of what? May your pressure be low! Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD, FACP, FACC, FAHS Clinical Professor of Medicine and Epidemiology Director, Hypertension Diagnosis and Treatment Center Board Certified in Internal Medicine, Geriatrics and Hypertension Published over 220 scientific papers, book chapters and 220 abstracts in the area of high blood pressure epidemiology, physiology, endocrinology measurement, treatment and how to detect curable causes. Listed in Best Doctors in America Specializing in Difficult to Control High Blood Pressure and the History and Physiology of High Blood pressure in the African Diaspora Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 29, 2005 Report Share Posted July 29, 2005 Somehow I am not surprised. I was at Stanford and none of the doctors there suspected PA. Even when my husband and I asked the professor himself who was a hyptertention specialist if I was tested for PA said that there was no need for it because that was so rare and refused to test me despite the high bp, LVH, and low K.lowerbp2@... wrote: In a message dated 7/28/05 8:36:16 PM, dave@... writes: UCSF, and that's her teacher talking. What is unstated is theunrecognized cases, and her practice's diabetes focus.DaveHer teacher must not taught her a good broad course in Endocrinology or she must not have gone on Enodcine rounds or to endocrine or HTN clinic at UCSF where they have seen hundreds of cases of PA. It would be intersting to find out why she did not see any in her training.May your pressure be low!Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD, FACP, FACC, FAHSClinical Professor of Medicine and EpidemiologyDirector, Hypertension Diagnosis and Treatment CenterBoard Certified in Internal Medicine, Geriatrics and HypertensionPublished over 220 scientific papers, book chapters and 220 abstracts in the area of high blood pressure epidemiology, physiology, endocrinology measurement, treatment and how to detect curable causes.Listed in Best Doctors in AmericaSpecializing in Difficult to Control High Blood Pressure and the History and Physiology of High Blood pressure in the African Diaspora Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 29, 2005 Report Share Posted July 29, 2005 Hypertension with special emphasis on refractory cases, problems of antihypertensive pharmacology - In fact he mentioned that he has seen few cases of pa not 100 but few and I didnt' fit the criteria. (dont' know what the criteria is, are we supposed to have visual marks to identify us as PA patients? I assume high bp of 250/150 and low K wasn't enough criteria for testinglowerbp2@... wrote: In a message dated 7/29/05 12:34:21 PM, farahbar@... writes: Somehow I am not surprised. I was at Stanford and none of the doctors there suspected PA. Even when my husband and I asked the professor himself who was a hyptertention specialist if I was tested for PA said that there was no need for it because that was so rare and refused to test me despite the high bp, LVH, and low K.Professor of what?May your pressure be low!Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD, FACP, FACC, FAHSClinical Professor of Medicine and EpidemiologyDirector, Hypertension Diagnosis and Treatment CenterBoard Certified in Internal Medicine, Geriatrics and HypertensionPublished over 220 scientific papers, book chapters and 220 abstracts in the area of high blood pressure epidemiology, physiology, endocrinology measurement, treatment and how to detect curable causes.Listed in Best Doctors in AmericaSpecializing in Difficult to Control High Blood Pressure and the History and Physiology of High Blood pressure in the African Diaspora Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 29, 2005 Report Share Posted July 29, 2005 This happened to me over and over. UC and their whole system seemed to think this way. The County hospitals, lauded for their association with the UC campuses had the " PA is so rare " water coolers. They also seemed to have " AVS is too expensive and dangerous " coffee-mugs. Sometimes I think the hospital CEO's hand out leaflets urging everyone to forget about it, and simply cut out adrenal glands ONLY if you see a tumor on a scan, raving about the benefits of " non-invasive " surgery. Laporoscopy : the latest flavor of the decade. Then, keep your fingers crossed for a few months thereafter. This is precisely what was done to me. A crapshoot in the back room, with unseen vultures circling overhead. I am constantly amazed (although no longer surprised) when new people arrive in these groups saying " I showed a tumor on my CT scan, and am being advised about laporoscopy. " Then, everyone starts taking to them about the other causes, odds of surgical success with and without AVS study, low Na diet, spiro, GRA, etc. Then, they go back to their doctors, with varied responses. All seem to receive " what? that is so rare " input. As a researcher in speech conventions, I have discovered that common talk or " discourse " can define entire subjects where science could (or should) be applied to find out what really happens over the large field of cases, no matter what the outcome. In this one, science has defined it, at least in part, but costs, fashions or gossip seem to blot it out. Maybe it is rare, even with the unrecognised cases, which we see all the time. Until someone does some broad sample screening, with some longitudinal tracking, science won't accept it as common. Of course, " since it is so rare, " we cannot get the grants for THAT kind of research. Too broad. Catch-22. The AMA and AHA are ratcheting their incidence estimates upward to 10% of the HTN population from 1-2% previously. You'd think that would be known to these practitioners, if nothing else. But apparently not. Last January's TIME cover story, called PA " the most under-recognised cause of hypertension, " citing large sample screens in Italy that indicated 1/4 of HTN patients may have it, with half of the antihypertensive medication-resistant ones showing positive on their aldo/renin/low K blood & urine work and spiro/low salt diet tests. The lawyers are stating to perk up too, I found. They are trying to decide, one malpractice specialist told me, whether to go after the professional associations, hospitals, HMO's, universities, pharmaceutical companies or individual doctors. ;^0 Dave On Jul 29, 2005, at 10:32 AM, Farah Rahbar wrote: > Somehow I am not surprised. I was at Stanford and none of the doctors > there suspected PA. Even when my husband and I asked the professor > himself who was a hyptertention specialist if I was tested for PA said > that there was no need for it because that was so rare and refused to > test me despite the high bp, LVH, and low K. > > lowerbp2@... wrote: >> In a message dated 7/28/05 8:36:16 PM, dave@... writes: >> >> >>> UCSF, and that's her teacher talking. What is unstated is the >>> unrecognized cases, and her practice's diabetes focus. >>> >>> Dave >> >> Her teacher must not taught her a good broad course in Endocrinology >> or she must not have gone on Enodcine rounds or to endocrine or HTN >> clinic at UCSF where they have seen hundreds of cases of PA. It >> would be intersting to find out why she did not see any in her >> training. >> >> >> >> May your pressure be low! >> >> Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD, FACP, FACC, FAHS >> Clinical Professor of Medicine and Epidemiology >> Director, Hypertension Diagnosis and Treatment Center >> Board Certified in Internal Medicine, Geriatrics and Hypertension >> >> Published over 220 scientific papers, book chapters and 220 abstracts >> in the area of high blood pressure epidemiology, physiology, >> endocrinology measurement, treatment and how to detect curable >> causes. >> Listed in Best Doctors in America >> Specializing in Difficult to Control High Blood Pressure and the >> History and Physiology of High Blood pressure in the African Diaspora Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 29, 2005 Report Share Posted July 29, 2005 In a message dated 7/29/05 2:50:39 PM, farahbar@... writes: Hypertension with special emphasis on refractory cases, problems of antihypertensive pharmacology - In fact he mentioned that he has seen few cases of pa not 100 but few and I didnt' fit the criteria. (dont' know what the criteria is, are we supposed to have visual marks to identify us as PA patients? I assume high bp of 250/150 and low K wasn't enough criteria for testing Severe HTN and low K-think of primary or secondary HTN. Dont need nuttin else to test for it. Today even severe HTN is enough asit has been for me for 30+ years. May your pressure be low! Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD, FACP, FACC, FAHS Clinical Professor of Medicine and Epidemiology Director, Hypertension Diagnosis and Treatment Center Board Certified in Internal Medicine, Geriatrics and Hypertension Published over 220 scientific papers, book chapters and 220 abstracts in the area of high blood pressure epidemiology, physiology, endocrinology measurement, treatment and how to detect curable causes. Listed in Best Doctors in America Specializing in Difficult to Control High Blood Pressure and the History and Physiology of High Blood pressure in the African Diaspora Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 29, 2005 Report Share Posted July 29, 2005 In a message dated 7/29/05 3:59:18 PM, dave@... writes: individual doctors. It comes down to the individual Dr. I think. They all learned about PA in Medical School at least if they graduated after 1955!. It has been in every BP guideline ever published. So it is common knowledge and all Drs should be aware of it. After all the most common reason to visit a Dr today for a chroinc disease is for HTN. If you aint a good HTN Dr you are not a good Dr. May your pressure be low! Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD, FACP, FACC, FAHS Clinical Professor of Medicine and Epidemiology Director, Hypertension Diagnosis and Treatment Center Board Certified in Internal Medicine, Geriatrics and Hypertension Published over 220 scientific papers, book chapters and 220 abstracts in the area of high blood pressure epidemiology, physiology, endocrinology measurement, treatment and how to detect curable causes. Listed in Best Doctors in America Specializing in Difficult to Control High Blood Pressure and the History and Physiology of High Blood pressure in the African Diaspora Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 30, 2005 Report Share Posted July 30, 2005 In a message dated 7/30/05 1:40:20 PM, wbongianni@... writes: If you would do something, start a fund to research PA. A blood marker like the PSA screen would be a good first start. Wayne We have excellent tests already. It is called a good clinical history and Physicla Exam and an accurate BP and K and renin and aldo. Pretty simple. May your pressure be low! Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD, FACP, FACC, FAHS Clinical Professor of Medicine and Epidemiology Director, Hypertension Diagnosis and Treatment Center Board Certified in Internal Medicine, Geriatrics and Hypertension Published over 220 scientific papers, book chapters and 220 abstracts in the area of high blood pressure epidemiology, physiology, endocrinology measurement, treatment and how to detect curable causes. Listed in Best Doctors in America Specializing in Difficult to Control High Blood Pressure and the History and Physiology of High Blood pressure in the African Diaspora Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 14, 2005 Report Share Posted August 14, 2005 Again, if the BP is not controlled with the usual drugs the standard of practice has been to find out why which includes measuring renin and aldo and this has been the standard for over 30 years. Recommend you read JNC 7 and take a copy to your Drs. In a message dated 7/31/05 11:02:05 AM, wbongianni@... writes: > We have excellent tests already. It is called a good clinical history and > Physicla Exam and an accurate BP and K and renin and aldo. Pretty simple. I respectfully disagree. Most people do not have a good clinical history. They may get a BP check at work and told to follow it up. How many do? If they do, the HTN will be treated with HTLZ, and they'll be sent home. How many will buy a pressure cuff? How many will keep a daily record? PA will only become obvious when potassium starts to drop significantly. In my case this last took 20 after diagnosis with HTN. And I got an annual physical. Even after my primary was convinced I had PA, it took another 6 months to convince my endrocrinologist(does this sound like a common theme), and only after Intraveinous sampling-an expensive and dangerous proceedure. Most men died with prostatic cancer. With digital detection, prostate cancer is the second leading cancer killer in men. With the PSA, men are going on to get biopsys earlier, and they are getting treated earlier. I would be willing to bet we will see this cancer go down in the list in the following 5-10 years. Wayne May your pressure be low! Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD, FACP, FACC, FAHS Clinical Professor of Medicine and Epidemiology Director, Hypertension Diagnosis and Treatment Center Board Certified in Internal Medicine, Geriatrics and Hypertension Published over 220 scientific papers, book chapters and 220 abstracts in the area of high blood pressure epidemiology, physiology, endocrinology measurement, treatment and how to detect curable causes. Listed in Best Doctors in America Specializing in Difficult to Control High Blood Pressure and the History and Physiology of High Blood pressure in the African Diaspora Quote Link to comment Share on other sites More sharing options...
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