Re: Effects of Increase on Inspra

September 18, 2006

50 of Inspra is a very small dose depening on your size and

aldo excess. Many will need 200 or even more. Should have

max effect by 2 weeks or so. Assume you are also DASHing.

If you read my article and take it to your Dr you will not BB and ACES

and ARBS and CCBs may not work very will if at all in PA. Were you ever

on Spiro

May your pressure be low!

CE Grim MD

Clinical Professor of Internal Medicine

Professor of Epidemiology

Board Certified in Internal Medicine, Geriatrics and Hypertension

Effects of Increase on Inspra

Hello Dr. Grim -- wondering how soon I should be feeling the effects

of an increase in the effects of increasing my Inspra dose? I

Increased the Toprol 50mg 2x a day on 9/1 and the Inspra 50 mg 2x day

on 9/8. So far it has had no effect. my BP is not dangerously high,

just moderately (145/100). Is it too soon to tell? I am also on

Verapamil 180SA mg & Maxzide 12.5 mg & potassium 20 meq 2xday.

Thanks...Kim in MN.

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September 18, 2006

>

> 50 of Inspra is a very small dose depening on your size and aldo

excess. Many will need 200 or even more. Should have max effect by 2

weeks or so. Assume you are also DASHing.

>

> If you read my article and take it to your Dr you will not BB and

ACES and ARBS and CCBs may not work very will if at all in PA. Were

you ever on Spiro

>

>Dr. Grim -- Thanks for the quick reply -- my weight is 138#, I am

5'4 " . I am currently having daily nausea and losing weight because I

cannot eat much. seeing a Gastro on wed for this...Am also being

referred to an Endo on Tues by my primary...I also have been having

'bone pain' in my thigh, is this a symptom of PA? I just had my aldo

and renin ck'd and aldo was up and renin down, but primary didn't give

me #'s, sorry, she just fax'd the report down to the Endo so I will

have to wait and get them when I see him in the Cities tomorrow. I was

on Spiro once years ago when 1st diagnosed with Htn, don't remember

why they took me off it...I took your article in with me to my primary

and mentioned your recommendation re/meds but she wanted to get me

stabalizied 1st before making any changes she said...if that makes

sense..and yes i have been Dashing since my visit to the Mayo in March

of 2006. Thanks again, Kim in MN.

September 18, 2006

In a message dated 9/18/06 6:47:44 AM, cornerstone@... writes:

I also have been having

'bone pain' in my thigh, is this a symptom of PA? I

Depends on if it is related to low K or not. Pains can be mostly in muscles. How do you know it is in the bone and not the muscle. What brings it on or makes it better.

May your pressure be low!

C.E. Grim, B.S., M.S., M.D.

Specializing in Difficult to Control High Blood Pressure

and the Physiology and History of Survival During

Hard Times and Heart Disease today.

September 20, 2006

>

> In a message dated 9/18/06 6:47:44 AM, cornerstone@... writes:

>

> > I also have been having

> > 'bone pain' in my thigh, is this a symptom of PA? I

> >

>

> Depends on if it is related to low K or not. Pains can be mostly in

> muscles. How do you know it is in the bone and not the muscle.

What brings it on

> or makes it better.

My potassium is now controlled/within normal ranges and i am still

having the pain, it is a constant ache that is with me all the time. i

feel it is in the 'bone' not the muscle because when i push on it

that's what it feels like...nothing makes it better...this is not a

severe pain, like a 5 or a 6 on the pain scale...falls around the

center of my upper thigh...

maybe something totally unrelated? my internist says let her know what

is going on with this again in 6 wks when i see her again...maybe get

some pictures done...

good news, my bp is finally responding to the increase in inspra (up

to 100mg). But, Saw an endo (who really seems to know what he is

doing, i think!!) yesterday in the Cities, a 3-1/2 drive for me, and

he ordered some tests done because he said that the tests that i had

done were not 'definitive' enough for PA. so now i have to go off the

inspra for 5 weeks...take the labs and then go to see him a week later

with the results...

kim in MN

>

September 20, 2006

Kim

What labs did you show him? going off inspra for labs does not sound right

though I dont know for sure. I did a 24hr aldosterone test on sprio it showed

the over the limit. Potassium being low sure made my bones acke until my K was

up a little above mid range. What did this dr. suggest you do in the mean time

to keep you K up? if he wants you to stop inspra for 5 weeks. Sounds dreadful

ita

> > In a message dated 9/18/06 6:47:44 AM, cornerstone@ writes: I also have been

having

'bone pain' in my thigh, is this a symptom of PA? I

Depends on if it is related to low K or not. Pains can be mostly in muscles.

How do you know it is in the bone and not the muscle.

What brings it on or makes it betterMy potassium is now controlled/within normal

ranges and i am still

> having the pain, it is a constant ache that is with me all the time. i

> feel it is in the 'bone' not the muscle because when i push on it

> that's what it feels like...nothing makes it better...this is not a

> severe pain, like a 5 or a 6 on the pain scale...falls around the

> center of my upper thigh...

>

> maybe something totally unrelated? my internist says let her know what

> is going on with this again in 6 wks when i see her again...maybe get

> some pictures done...

>

> good news, my bp is finally responding to the increase in inspra (up

> to 100mg). But, Saw an endo (who really seems to know what he is

> doing, i think!!) yesterday in the Cities, a 3-1/2 drive for me, and

> he ordered some tests done because he said that the tests that i had

> done were not 'definitive' enough for PA. so now i have to go off the

> inspra for 5 weeks...take the labs and then go to see him a week later

> with the results...

>

> kim in MN

> >

>

September 20, 2006

BE sure to take my article to him. You may have early PA not advanced.

In a message dated 9/20/06 1:00:09 PM, meling333@... writes:

Kim

What labs did you show him? going off inspra for labs does not sound right though I dont know for sure. I did a 24hr aldosterone test on sprio it showed the over the limit. Potassium being low sure made my bones acke until my K was up a little above mid range. What did this dr. suggest you do in the mean time to keep you K up? if he wants you to stop inspra for 5 weeks. Sounds dreadful

ita

> > In a message dated 9/18/06 6:47:44 AM, cornerstone@ writes: I also have been having

'bone pain' in my thigh, is this a symptom of PA? I

Depends on if it is related to low K or not. Pains can be mostly in muscles. How do you know it is in the bone and not the muscle.

What brings it on or makes it betterMy potassium is now controlled/within normal ranges and i am still

> having the pain, it is a constant ache that is with me all the time. i

> feel it is in the 'bone' not the muscle because when i push on it

> that's what it feels like...nothing makes it better...this is not a

> severe pain, like a 5 or a 6 on the pain scale...falls around the

> center of my upper thigh...

>

> maybe something totally unrelated? my internist says let her know what

> is going on with this again in 6 wks when i see her again...maybe get

> some pictures done...

>

> good news, my bp is finally responding to the increase in inspra (up

> to 100mg). But, Saw an endo (who really seems to know what he is

> doing, i think!!) yesterday in the Cities, a 3-1/2 drive for me, and

> he ordered some tests done because he said that the tests that i had

> done were not 'definitive' enough for PA. so now i have to go off the

> inspra for 5 weeks...take the labs and then go to see him a week later

> with the results...

>

> kim in MN

May your pressure be low!

C.E. Grim, B.S., M.S., M.D.

Specializing in Difficult to Control High Blood Pressure

and the Physiology and History of Survival During

Hard Times and Heart Disease today.

September 20, 2006

In a message dated 9/20/06 8:10:41 AM, cornerstone@... writes:

good news, my BP is finally responding to the increase in Inspra (up

to 100 mg). But, Saw an endo (who really seems to know what he is

doing, i think!!) yesterday in the Cities, a 3-1/2 drive for me, and

he ordered some tests done because he said that the tests that i had

done were not 'definitive' enough for PA. so now i have to go off the

inspra for 5 weeks...take the labs and then go to see him a week later

with the results...

My approach is to see if BP and K normalizes on Spiro or Inspra. This is a reasonable test of the role of spiro on the BP. If it does it is a good prediction of the results of surgery. Then if you have problems on Spiro or Inspra go on to AVS.

May your pressure be low!

C.E. Grim, B.S., M.S., M.D.

Specializing in Difficult to Control High Blood Pressure

and the Physiology and History of Survival During

Hard Times and Heart Disease today.

September 21, 2006

In a message dated 9/21/06 6:54:14 PM, meling333@... writes:

Hi Kim

Im in Pilot Hill 1 hr from Sacramento and 1 1/2hr from Tahoe. Have you had your DHEA and Testosterone tested their made from the same layer as aldosterone.

Test is made in the Reticularis and and aldo in Glomerulosa

DHEA does not really tell you much about adrenal problems and testosterone is mostly made in ovaries in women esp post menopause.

Here is a good review.

http://www.femalesexualdysfunctiononline.org/meetings/asrm-menopause/buster/presentation_text.cfm?cme_activityid=99 & showmenu=1

May your pressure be low!

C.E. Grim, B.S., M.S., M.D.

Specializing in Difficult to Control High Blood Pressure

and the Physiology and History of Survival During

Hard Times and Heart Disease today.

September 21, 2006

>

> Kim

> What labs did you show him? going off inspra for labs does not sound

right though I dont know for sure. I did a 24hr aldosterone test on

sprio it showed the over the limit. Potassium being low sure made my

bones acke until my K was up a little above mid range. What did this

dr. suggest you do in the mean time to keep you K up? if he wants you

to stop inspra for 5 weeks. Sounds dreadful

> ita

>

> --- Hi ita! The labs he was talking about are aldo serum (36.5),

cortisol(21.6) & renin plasma (.37). He (the Endo) said that because I

was on Inspra when the blood was drawn the test was invalid. So that

is why he wants me off it for 5 weeks and then he is running a full

renal panel, creatinine clearance, 24 hr aldo, 24 hr cortisol & the

cortisol/renin/aldo. I am currently on a cocktail of other BP meds as

well as a potassium supplement and get tested frequently for my k

levels cuz they are rather pesky. the day after i went off my inspra

my BP was up, tho. I have a call into my internist, gonna talk to her

about possibly increasing my other diuretic..or? Didn't get a chance

to talk to her today cuz was in hosp getting an indoscopy done

(yuck)-- been nauseated and losing weight...they found some bleeding

and 'spots of irritation' & took samples for biopsy, won't know more

till monday -- oh the joys of rural living!! anyway, thanks for the

post and your concern...you're in Calif, right? Or in Tahoe? I was

raised in Southern Cal...but am a MN gal now! (go Twins!) Thanks again

ita...

Kim

> > >

> >

>

September 21, 2006

Hi Kim

Im in Pilot Hill 1 hr from Sacramento and 1 1/2hr from Tahoe. Have you had your

DHEA and Testosterone tested their made from the same layer as aldosterone. Mine

are elevated as well as aldosterone. I wonder if that is really true, being on

inspra makes your tests of aldo invalad. hmmmm Good luck on your 5 weeks of

inspra. Do you have a adenoma? ita

hyperaldosteronism , " kimsstay " <cornerstone@...> wrote:

>

> > Kim

> > What labs did you show him? going off inspra for labs does not sound

> right though I dont know for sure. I did a 24hr aldosterone test on

> sprio it showed the over the limit. Potassium being low sure made my bones

acke until my K was up a little above mid range. What did this

> dr. suggest you do in the mean time to keep you K up? if he wants you

Hi ita! The labs he was talking about are aldo serum (36.5),

> cortisol(21.6) & renin plasma (.37). He (the Endo) said that because I was on

Inspra when the blood was drawn the test was invalid. So that is why he wants me

off it for 5 weeks and then he is running a full renal panel, creatinine

clearance, 24 hr aldo, 24 hr cortisol & the

> cortisol/renin/aldo. I am currently on a cocktail of other BP meds as well as

a potassium supplement and get tested frequently for my k levels cuz they are

rather pesky. the day after i went off my inspra

my BP was up, tho. I have a call into my internist, gonna talk to her about

possibly increasing my other diuretic..or? Didn't get a chance to talk to her

today cuz was in hosp getting an indoscopy done

> (yuck)-- been nauseated and losing weight...they found some bleeding and

'spots of irritation' & took samples for biopsy, won't know more till monday --

oh the joys of rural living!! anyway, thanks for the

post and your concern...you're in Calif, right? Or in Tahoe? I was raised in

Southern Cal...but am a MN gal now! (go Twins!) Thanks again

> ita...

> Kim

September 21, 2006

In a message dated 9/21/06 4:09:55 PM, cornerstone@... writes:

I did a 24hr aldosterone test on

spiro it showed the over the limit.

Spiro may increase urine aldo as it increase renin. But data from Mayo clinic says it does not make much difference.

The labs he was talking about are aldo serum (36.5), cortisol(21. co & renin plasma (.37).

This is PA if spiro or Inspra was messing it up then renin would be up as well. It is not===but then again you need the normal range for that lab.

May your pressure be low!

C.E. Grim, B.S., M.S., M.D.

Specializing in Difficult to Control High Blood Pressure

and the Physiology and History of Survival During

Hard Times and Heart Disease today.

September 22, 2006

Just do a Google search on for the web site.

May your pressure be low!

C.E. Grim, B.S., M.S., M.D.

Specializing in Difficult to Control High Blood Pressure

and the Physiology and History of Survival During

Hard Times and Heart Disease today.

September 22, 2006

>

Hi ita

Sounds like you are in a great part of Cal...they have not been able

to see anything on CT scans, no adenoma...which is why they want to do

venous sampling, but he wants to get 'definitive' diagnosis not

'suggestive' diagnosis 1st before putting me thru that...makes sense,

right? had my free testosterone checked prior to hysterectomy and it

was almost too low to register...not sure about DHEA...

how are things going for you lately?

kim

>

September 22, 2006

>

> In a message dated 9/21/06 6:54:14 PM, meling333@... writes:

>

> > Hi Kim

> > Im in Pilot Hill 1 hr from Sacramento and 1 1/2hr from Tahoe. Have

you had

> > your DHEA and Testosterone tested their made from the same layer as

> > aldosterone.

> >

> Test is made in the Reticularis and and aldo in Glomerulosa

>

> DHEA does not really tell you much about adrenal problems and

testosterone is

> mostly made in ovaries in women esp post menopause.

>

> Here is a good review.

>

http://www.femalesexualdysfunctiononline.org/meetings/asrm-menopause/buster/pr

> esentation_text.cfm?cme_activityid=99 & showmenu=1

>

Dr. Grim, I can't open that file, get the standard error message...I

no longer have my ovaries because of total hysterectomy and in fact

had been 'limping along' with only one due to a surgery many years

ago, don't our bodies compensate and make the testosterone elsewhere?

would be interested in reading the article...thanks, kim in mn

>

September 22, 2006

Kim

I was sickly with blood pressure in 04, sellling in 05 my adenoma showed up in

06. I attempted AVS in july didnt work out at all. I dont know if I could ever

go through AVS again and just take my chances and have the adenoma cut out. My

symptoms seem to be getting worse as the adenoma was showed up in Jan 06 it was

not there in 05 now it is 1.5cm I need another ct of it and bet its bigger now

which would make since as labs are getting higher. Its a beautiful place in

Nortern calif. I cant wait to swim the rivers again, roller skate,ride horse and

run about and have fun in the summer. Last 2 summers have been a drag. Where are

you having AVS done?

ita

hyperaldosteronism , " kimsstay " <cornerstone@> wrote:

> >

Hi ita

Sounds like you are in a great part of Cal...they have not been able to see

anything on CT scans, no adenoma...which is why they want to do venous sampling,

but he wants to get 'definitive' diagnosis not'suggestive' diagnosis 1st before

putting me thru that...makes sense,

right? had my free testosterone checked prior to hysterectomy and it was almost

too low to register...not sure about DHEA...how are things going for you lately?

> kim

> >

>

September 23, 2006

>

> Kim

>

> Kim

> I was sickly with blood pressure in 04, sellling in 05 my adenoma

showed up in 06. I attempted AVS in july didnt work out at all. I dont

know if I could ever go through AVS again and just take my chances and

have the adenoma cut out. My symptoms seem to be getting worse as the

adenoma was showed up in Jan 06 it was not there in 05 now it is 1.5cm

I need another ct of it and bet its bigger now which would make since

as labs are getting higher. Its a beautiful place in Nortern calif. I

cant wait to swim the rivers again, roller skate,ride horse and run

about and have fun in the summer. Last 2 summers have been a drag.

Where are you having AVS done?

> ita

> Hey ita

I love Northern Cal, I was there visiting my little bro 2 years ago in

Somes Bar (was in the northern tip of the state), he has since moved

to Washington State. My Dad and another bro still live in Southern Cal

where i grew up, I was there last fall for a visit. I know what you

mean about missing out on all the fun stuff...I live in a very

beautiful area of Minnesota, where there are more lakes, trees &

eagles than people!! and haven't been able to get out and enjoy myself

the last two years (summer or winter -- I enjoy winter sports, too)

cuz of this stupid illness. it sucks. Anyway, my Endo is down by the

cities, but he was trained at Mayo, so I am not sure where he will

want to do the AVS at? Not even sure who will would be doing it...we

haven't gotten that far in our disscussion yet, want to see the

results of the tests 1st...What did you mean by your procedure 'not

working out'?

I was very interested in Dr. Grim's comments about the results of my

recent test and that the renin would be elevated as well if the Inspra

was skewing the results. After reading Dr. Grim's article, it kinda

makes sense that the disease progresses...I don't like to take a 'wait

and see' attitude...as far as I am concerned if you wait and see, it

is just gonna get worse and do more damage to your body than it

already has!! I mean when I had a MRI done of my brain (I have chronic

daily Headaches/migraine) there were all these little white spots &

when I asked about them I was told they were because of my

'uncontrolled bp' -- and that they also sometimes see them in the

beginnings of alzheimers... wonderful!! also have the thickenings of

the left ventricle cuz of the darned bp...so yea, i don't want to have

it any longer than i have to. I am so sorry you are having to deal

with feeling worse lately...that really is awful. I hope things go

better for you soon!

kim

September 23, 2006

Kim

That good your have a dr trained at Mayo that should be a plus I hope. I sure

have doubts about Endos in Sacramento as 5 of them in the last year kept coming

up with nothing but the most they would do is push a pencil. All the labs that

proved my elevated aldo were my idea after meeting Dr. GRim. My AVS was a flop

as the dr. could never find the right vein and then he puchured the vein and all

was quickly stoped.The leak didnt show up on the ultra sound as those veins are

not under alot of pressure and it clotted up quickly. Maybe if the dr. had

showed up for our meeting the day before so I could tell him about my 2 kidneys

on the right side things might have been different. But who knows. I was messed

up for a week in bed with alot of pain unable to eat and could hardly keep

fluids in me. I lost 10lbs in 6 days. I should have never been sent home in that

shape and I have never heard from the quack that ordered the AVS. It hard to get

a good adrenal vein sampler. I sure wish there was another way to know what is

going on with adrenals besides AVS. When you find out where you going I would be

interested in knowing. I dont think I really am feeling worse lately just sick

and tired of being in this body I am better on spiro. I still dont have a dr.

and refuse to see the last 2 Endos that told me I am exhausting the Endo dept

and to take my symptoms somewhere and get them sorted out as there is nothing

wrong with me Endo wise. CAn you amagine being told that?

I was so sick and sitting there with low K as they didnt even bother to get

their labs they ordered. I got those labs through primary care 4 days later. Its

like missing out on life being sickly with Conns.

I dont know about my heart as no one has checked it out yet. I guess something

to do next.

ita

> > Hey ita

> I love Northern Cal, I was there visiting my little bro 2 years ago in

> Somes Bar (was in the northern tip of the state), he has since moved

> to Washington State. My Dad and another bro still live in Southern Cal

> where i grew up, I was there last fall for a visit. I know what you

> mean about missing out on all the fun stuff...I live in a very

> beautiful area of Minnesota, where there are more lakes, trees &

> eagles than people!! and haven't been able to get out and enjoy myself

> the last two years (summer or winter -- I enjoy winter sports, too)

> cuz of this stupid illness. it sucks. Anyway, my Endo is down by the

> cities, but he was trained at Mayo, so I am not sure where he will

> want to do the AVS at? Not even sure who will would be doing it...we

> haven't gotten that far in our disscussion yet, want to see the

> results of the tests 1st...What did you mean by your procedure 'not

> working out'?

>

> I was very interested in Dr. Grim's comments about the results of my

> recent test and that the renin would be elevated as well if the Inspra

> was skewing the results. After reading Dr. Grim's article, it kinda

> makes sense that the disease progresses...I don't like to take a 'wait

> and see' attitude...as far as I am concerned if you wait and see, it

> is just gonna get worse and do more damage to your body than it

> already has!! I mean when I had a MRI done of my brain (I have chronic

> daily Headaches/migraine) there were all these little white spots &

> when I asked about them I was told they were because of my

> 'uncontrolled bp' -- and that they also sometimes see them in the

> beginnings of alzheimers... wonderful!! also have the thickenings of

> the left ventricle cuz of the darned bp...so yea, i don't want to have

> it any longer than i have to. I am so sorry you are having to deal

> with feeling worse lately...that really is awful. I hope things go

> better for you soon!

> kim

>

September 23, 2006

Kim

What test determins this thickenings of the left ventricle? Does it have any

thing to do with swelling? Someone I know on interferon tx had white spots in

their head After her tx was over her white spots went away. How odd but nice.

ita

also have the thickenings of

> the left ventricle cuz of the darned bp...so yea, i don't want > kim

>

September 23, 2006

Left

ventricle thickening occurs when the heart has to work harder. The

test they do to see that is an echocardiogram, which is an ultrasound

of the heart. They can tell from that if the wall has thickened or

not. I have a bad mitral valve so they have to check for this for me,

which is why I know about the left ventricle thickening, it can happen

to me from that as well as from BP.

Jim

meling333 wrote on 9/23/2006 2:58 PM:

Kim

What test determins this thickenings of the left ventricle? Does it

have any thing to do with swelling? Someone I know on interferon tx had

white spots in their head After her tx was over her white spots went

away. How odd but nice.

ita

also have the thickenings of

> the left ventricle cuz of the darned bp...so yea, i don't want

> kim

>

September 24, 2006

>

> Kim

> What test determins this thickenings of the left ventricle? Does it

have any thing to do with swelling? Someone I know on interferon tx

had white spots in their head After her tx was over her white spots

went away. How odd but nice.

> ita

>

> also have the thickenings of

> > the left ventricle cuz of the darned bp...so yea, i don't want > kim

> >

>Hey ita,

It was an ultrasound and doppler, actually ordered due to severe pvc's

with lightheaded spells when my potassium when south and suspected PFO

(I do have one) -- lot of good it did me to find that out as they

won't do anything about it for migraine relief, only if you have a

stroke 1st, then they will close up the hole, a little like closing

the barn door once the cows get loose, but what do I know, right? My

pvc's are still happening by the way -- even tho my potassium is now

in the normal range due to the supplements i am taking (i am getting

it checked now once a week cuz i am off the inspra). annoying but

benign, so they tell me. Do you get them? Another weird symptom i just

developed is facial numbness -- around the bridge of my nose and top

teeth, and sometimes left cheek. Also get numb fingers and toes. My

nose will kinda hurt as well, like someone punched me there...maybe

this is totally unrelated to the PA and more related to my

headaches/migraines...who knows!!

kim

October 2, 2006

In a message dated 9/23/06 12:51:38 PM, meling333@... writes:

Kim

That good your have a dr trained at Mayo that should be a plus I hope. I sure have doubts about Endos in Sacramento as 5 of them in the last year kept coming up with nothing but the most they would do is push a pencil. All the labs that proved my elevated aldo were my idea after meeting Dr. GRim. My AVS was a flop as the dr. could never find the right vein and then he puchured the vein and all was quickly stoped.The leak didnt show up on the ultra sound as those veins are not under alot of pressure and it clotted up quickly. Maybe if the dr. had showed up for our meeting the day before so I could tell him about my 2 kidneys on the right side things might have been different. But who knows. I was messed up for a week in bed with alot of pain unable to eat and could hardly keep fluids in me. I lost 10lbs in 6 days.

This is one of the reasons I dont do AVS until I am convinced it is needed.

It is not risk free.

I should have never been sent home in that shape and I have never heard from the quack that ordered the AVS. It hard to get a good adrenal vein sampler. I sure wish there was another way to know what is going on with adrenals besides AVS. When you find out where you going I would be interested in knowing. I dont think I really am feeling worse lately just sick and tired of being in this body I am better on spiro. I still dont have a dr. and refuse to see the last 2 Endos that told me I am exhausting the Endo dept and to take my symptoms somewhere and get them sorted out as there is nothing wrong with me Endo wise. CAn you amagine being told that?

I was so sick and sitting there with low K as they didnt even bother to get their labs they ordered. I got those labs through primary care 4 days later. Its like missing out on life being sickly with Conns.

I dont know about my heart as no one has checked it out yet. I guess something to do next.