Guest guest Posted February 4, 2009 Report Share Posted February 4, 2009 Spiro should stop all of this and allow you to get off other drugs if you have PA. Swelling means you are eating too much salt and not DASHing and/or the Norvasc. Not certain what you mean by a " nymph " Dr. My guess it there will be long line. ;-) May have meant to spell it Nephro or Nephrologist. " Nephros " is Greek for kidney. Probably a Freudian slip? May your pressure be low!  CE Grim BS, MS, MD High Blood Pressure Consulting Senior Consultant to Shared Care Research and Education Consulting Inc.(sharedcareinc.com) Clinical Professor of Internal Medicine Medical and Cardiology Medical College of Wisconsin Board certified in Internal Med, Geriatrics and Hypertension. Interests: 1. Difficult to control high blood pressure. 2. The effect of recent evolutionary forces on high blood pressure in human populations. 3. Improving blood pressure measurement in the office and out. On Feb 4, 2009, at 10:17 AM, Jay Man wrote: > Hi again---I read the paper last night. Will update you when I get > a new nymph doctor and finally see my endo. I requested a new > nymph doctor and we will see what happens. I went back to my other > med that was working better carvedilol 25mg twice a day with the > 40mg of lisinopril--(minus the norvasc) only problem with that is > my feet and legs with balloon up and without the Spiro nothing will > fix it because I cannot take a regular water pill for it dehydrates > me and makes me feel worse. That combo gave me by averages of high > 140's over 90's with those spikes of plus 10-20 on both readings > but thats better then what I have now. Talk soon and thanks. > > > > > > > > > > > > > > > > > > > > I'm new to this so bear with me. My endocrinologist has > scheduled > > me for > > > > AVS and I want to make sure I should do it. I have an adenoma on > > my right > > > > adrenal gland and the results of my aldosterol/renin are as > > follows: A/RA > > > > Ratio Calc: 164.0 Aldosterone 32.8 and Renin, D irec t .2 I have > > not yet > > > > been on any meds because I was just diagnosed. Shouldn't we try > > spiro first? > > > > > > > > > > > > Thanks for any advice! > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 4, 2009 Report Share Posted February 4, 2009 Yep, it was slip  and the line would be long!!!! Kidney doctor is what I meant. Spiro does help--last dose was 50mg but need to stay off of it until I see the new Endo. If where I have insurance does not call me I have a back-up appointment on Feb 10th at Loyola University with an Endo there. Does your hospital except financial arrangements in regads to tests and or procedures?? Talk soon and thanks. > > > > > > > > > > > > > > > > > > I'm new to this so bear with me. My endocrinologist has > scheduled > > me for > > > > AVS and I want to make sure I should do it. I have an adenoma on > > my right > > > > adrenal gland and the results of my aldosterol/renin are as > > follows: A/RA > > > > Ratio Calc: 164.0 Aldosterone 32.8 and Renin, D irec t .2 I have > > not yet > > > > been on any meds because I was just diagnosed. Shouldn't we try > > spiro first? > > > > > > > > > > > > Thanks for any advice! > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 4, 2009 Report Share Posted February 4, 2009 In our files is the article on the evolution of PA. Also we have the Endocrine Society Guidelines on Evaluationspiro of PA. My approach with severe HTN is to do the renin aldo tests on Rx and if + then begin sprio and taper other drugs. If controlled on spiro or Inspra then keep on this. If not then do CT. Can even do AVS on Rx if + (one side higher than the other) then consider surgery. If equal on both sides consider stopping Rx weighing risks and benefits of this with your health care team. May your pressure be low!  CE Grim BS, MS, MD High Blood Pressure Consulting Senior Consultant to Shared Care Research and Education Consulting Inc.(sharedcareinc.com) Clinical Professor of Internal Medicine Medical and Cardiology Medical College of Wisconsin Board certified in Internal Med, Geriatrics and Hypertension. Interests: 1. Difficult to control high blood pressure. 2. The effect of recent evolutionary forces on high blood pressure in human populations. 3. Improving blood pressure measurement in the office and out. On Feb 3, 2009, at 10:52 PM, Jay Man wrote: > Hi. I told them not to switch me to the labetalol for it did not > work in the past--but she insisted in order to do blood work and > try to improve my BP. When my BP started rising again then > clonidine was added--and that just drys out my mouth nothing else. > We had an arguement on the phone today and I asked to have another > doctor take over my case. I called her and told her my BP was now > at 190/130 and asked what was the game plan---she told me I could > just go back to my old medication now and that she never said I had > to stay off old meds but only for one test. Then she turns around > again and says if the Endo wants blood work or related I would have > to stay off the meds again for six weeks---Then I hung up the phone > on her. I have gone through a lot of articles--which one in > particular are u talking about? I am still waiting to see the new > endo. Thanks for your continued support. > > > > > > > > > > > > > > > > > > > > > I'm new to this so bear with me. My endocrinologist has > scheduled > > me for > > > > AVS and I want to make sure I should do it. I have an adenoma on > > my right > > > > adrenal gland and the results of my aldosterol/renin are as > > follows: A/RA > > > > Ratio Calc: 164.0 Aldosterone 32.8 and Renin, D irec t .2 I have > > not yet > > > > been on any meds because I was just diagnosed. Shouldn't we try > > spiro first? > > > > > > > > > > > > Thanks for any advice! > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 4, 2009 Report Share Posted February 4, 2009 Clonidine and labetalol is a potentially dangerous combo. If you stop or miss cloindine you may get very high spikes of BP due to withdrawal of clonidine rebound alpha discharge (vasoconstriction) and blocked beta dilator receptors (normally make arteries dilater). May your pressure be low!  CE Grim BS, MS, MD High Blood Pressure Consulting Senior Consultant to Shared Care Research and Education Consulting Inc.(sharedcareinc.com) Clinical Professor of Internal Medicine Medical and Cardiology Medical College of Wisconsin Board certified in Internal Med, Geriatrics and Hypertension. Interests: 1. Difficult to control high blood pressure. 2. The effect of recent evolutionary forces on high blood pressure in human populations. 3. Improving blood pressure measurement in the office and out. On Feb 3, 2009, at 10:52 PM, Jay Man wrote: > Hi. I told them not to switch me to the labetalol for it did not > work in the past--but she insisted in order to do blood work and > try to improve my BP. When my BP started rising again then > clonidine was added--and that just drys out my mouth nothing else. > We had an arguement on the phone today and I asked to have another > doctor take over my case. I called her and told her my BP was now > at 190/130 and asked what was the game plan---she told me I could > just go back to my old medication now and that she never said I had > to stay off old meds but only for one test. Then she turns around > again and says if the Endo wants blood work or related I would have > to stay off the meds again for six weeks---Then I hung up the phone > on her. I have gone through a lot of articles--which one in > particular are u talking about? I am still waiting to see the new > endo. Thanks for your continued support. > > > > > > > > > > > > > > > > > > > > > I'm new to this so bear with me. My endocrinologist has > scheduled > > me for > > > > AVS and I want to make sure I should do it. I have an adenoma on > > my right > > > > adrenal gland and the results of my aldosterol/renin are as > > follows: A/RA > > > > Ratio Calc: 164.0 Aldosterone 32.8 and Renin, D irec t .2 I have > > not yet > > > > been on any meds because I was just diagnosed. Shouldn't we try > > spiro first? > > > > > > > > > > > > Thanks for any advice! > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 4, 2009 Report Share Posted February 4, 2009 Tell him you work with Dr. Grim on this web site. May your pressure be low!  CE Grim BS, MS, MD High Blood Pressure Consulting Senior Consultant to Shared Care Research and Education Consulting Inc.(sharedcareinc.com) Clinical Professor of Internal Medicine Medical and Cardiology Medical College of Wisconsin Board certified in Internal Med, Geriatrics and Hypertension. Interests: 1. Difficult to control high blood pressure. 2. The effect of recent evolutionary forces on high blood pressure in human populations. 3. Improving blood pressure measurement in the office and out. On Feb 3, 2009, at 11:19 PM, Jay Man wrote: > Hi. I have been very patient and it does not seems to work. My > doctor is a resident or whataver it is called but has one year left > and works under someone---she does not listen when I tell her about > meds I have already taken and symptoms I have or had. I hate to > " stir the pot " but if you dont't make some kind of noise sometimes > you never get heard. I just want to get this under control and > taken care of before I get a stroke or something. The next doctor > will be number 6 or so I believe since 2004. It seems like they > think your lying about symptoms. Oh well, we will see what the next > endo guy says--he is supposed to be the top guy at the University > of Iowa. I just want my life back. Thanks for your comment and > talk again soon. > > > > > From: kappi98 <kappi98a@...> > Subject: Re: Is AVS nesessary? > hyperaldosteronism > Date: Wednesday, February 4, 2009, 5:07 AM > > , > > By all means-- CHANGE DOCTORS!!! I had similar experiences in the > past regarding doctors and their 'favorite' medications. At one > point, I was taking 13 pills a day and still had bp similar to > yours. It was the genius of a cardiologist (and endocrinologist) who > prescribed a completely new regimen of bp meds that I credit with > getting me to a current bp of 126/78. Some doctors are unfamiliar > with Conn's and think that throwing more of the same medication at > the condition will work. It took a change of doctors and medications > to help me. It seems like recent med school grads are more familiar > with Conn's than older doctors in my part of the country. Arguing > with your doctor won't work. Just get a new doctor and save your > time and frustrations! > > ------------ --------- --------- --------- --------- --------- - > > > > > > > > > > > > > > > > > > > > I'm new to this so bear with me. My endocrinologist has > scheduled > > > me for > > > > > AVS and I want to make sure I should do it. I have an adenoma > on > > > my right > > > > > adrenal gland and the results of my aldosterol/renin are as > > > follows: A/RA > > > > > Ratio Calc: 164.0 Aldosterone 32.8 and Renin, D irec t .2 I > have > > > not yet > > > > > been on any meds because I was just diagnosed. Shouldn't we > try > > > spiro first? > > > > > > > > > > > > > > > Thanks for any advice! > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 4, 2009 Report Share Posted February 4, 2009 Thanks. I read those- just wanted to make sure. I had all that done except the trying only Spiro and letting go other meds. The Spiro gives me the bad side effects and the Inspra when I was on it yesrs ago did not lower my BP at all--so dont know what that means. Maybe I was normal then...Wish my AVS was good on both sides. Talk soon and thanks again. > > > > > > > > > > > > > > > > > > I'm new to this so bear with me. My endocrinologist has > scheduled > > me for > > > > AVS and I want to make sure I should do it. I have an adenoma on > > my right > > > > adrenal gland and the results of my aldosterol/renin are as > > follows: A/RA > > > > Ratio Calc: 164.0 Aldosterone 32.8 and Renin, D irec t .2 I have > > not yet > > > > been on any meds because I was just diagnosed. Shouldn't we try > > spiro first? > > > > > > > > > > > > Thanks for any advice! > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 4, 2009 Report Share Posted February 4, 2009 I will for sure. Lunch or dinner is on me when we have some time. I appreciate all your help. > > From: kappi98 <kappi98amsn (DOT) com> > Subject: [hyperaldosteronism ] Re: Is AVS nesessary? > hyperaldosteronism > Date: Wednesday, February 4, 2009, 5:07 AM > > , > > By all means-- CHANGE DOCTORS!!! I had similar experiences in the > past regarding doctors and their 'favorite' medications. At one > point, I was taking 13 pills a day and still had bp similar to > yours. It was the genius of a cardiologist (and endocrinologist) who > prescribed a completely new regimen of bp meds that I credit with > getting me to a current bp of 126/78. Some doctors are unfamiliar > with Conn's and think that throwing more of the same medication at > the condition will work. It took a change of doctors and medications > to help me. It seems like recent med school grads are more familiar > with Conn's than older doctors in my part of the country. Arguing > with your doctor won't work. Just get a new doctor and save your > time and frustrations! > > ------------ --------- --------- --------- --------- --------- - > > > > > > > > > > > > > > > > > > > > I'm new to this so bear with me. My endocrinologist has > scheduled > > > me for > > > > > AVS and I want to make sure I should do it. I have an adenoma > on > > > my right > > > > > adrenal gland and the results of my aldosterol/renin are as > > > follows: A/RA > > > > > Ratio Calc: 164.0 Aldosterone 32.8 and Renin, D irec t .2 I > have > > > not yet > > > > > been on any meds because I was just diagnosed. Shouldn't we > try > > > spiro first? > > > > > > > > > > > > > > > Thanks for any advice! > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 4, 2009 Report Share Posted February 4, 2009 Also take my Evolution of PA article to them and ask them to please read. This will help update them as they have prob never seen the article. You could also take the Endo Guidelines which they also have not likely seen or heard of. Conn's was first reported in 1954. All Drs who graduated after this learned about Conn's. May your pressure be low!  CE Grim BS, MS, MD High Blood Pressure Consulting Senior Consultant to Shared Care Research and Education Consulting Inc.(sharedcareinc.com) Clinical Professor of Internal Medicine Medical and Cardiology Medical College of Wisconsin Board certified in Internal Med, Geriatrics and Hypertension. Interests: 1. Difficult to control high blood pressure. 2. The effect of recent evolutionary forces on high blood pressure in human populations. 3. Improving blood pressure measurement in the office and out. On Feb 4, 2009, at 10:51 AM, jwwright wrote: > My suggestion is put it on paper. > Make a presentation of 3 or 4 pages - in LARGE PRINT. > Put what you take now on one page, and the results. > History on a second page. > Prescribed medicines you've tried and results on a > third. > > And when I walk in the door I say I had to put it on > paper to clear my head - so you don't offend some > sensitive person. > Works for me, especially when seeing a new Doc. > > Regards > > Re: Re: Is AVS nesessary? > > Hi. I have been very patient and it does not seems to > work. My doctor is a resident or whataver it is called > but has one year left and works under someone---she > does not listen when I tell her about meds I have > already taken and symptoms I have or had. I hate to > " stir the pot " but if you dont't make some kind of > noise sometimes you never get heard. I just want to > get this under control and taken care of before I get a > stroke or something. The next doctor will be number 6 > or so I believe since 2004. It seems like they think > your lying about symptoms. Oh well, we will see what > the next endo guy says--he is supposed to be the top > guy at the University of Iowa. I just want my life > back. Thanks for your comment and talk again soon. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 4, 2009 Report Share Posted February 4, 2009 Inspra has only been out about 5 years. What do you mean years ago? I push spiro to 400 per day unless breasts begin to hurt or get sore. May your pressure be low!  CE Grim BS, MS, MD High Blood Pressure Consulting Senior Consultant to Shared Care Research and Education Consulting Inc.(sharedcareinc.com) Clinical Professor of Internal Medicine Medical and Cardiology Medical College of Wisconsin Board certified in Internal Med, Geriatrics and Hypertension. Interests: 1. Difficult to control high blood pressure. 2. The effect of recent evolutionary forces on high blood pressure in human populations. 3. Improving blood pressure measurement in the office and out. On Feb 4, 2009, at 11:52 AM, Jay Man wrote: > Thanks. I read those- just wanted to make sure. I had all that > done except the trying only Spiro and letting go other meds. The > Spiro gives me the bad side effects and the Inspra when I was on it > yesrs ago did not lower my BP at all--so dont know what that > means. Maybe I was normal then...Wish my AVS was good on both > sides. Talk soon and thanks again. > > > > > > > > > > > > > > > > > > > > > > > > > > I'm new to this so bear with me. My endocrinologist has > > scheduled > > > me for > > > > > AVS and I want to make sure I should do it. I have an > adenoma on > > > my right > > > > > adrenal gland and the results of my aldosterol/renin are as > > > follows: A/RA > > > > > Ratio Calc: 164.0 Aldosterone 32.8 and Renin, D irec t .2 I > have > > > not yet > > > > > been on any meds because I was just diagnosed. Shouldn't we > try > > > spiro first? > > > > > > > > > > > > > > > Thanks for any advice! > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 4, 2009 Report Share Posted February 4, 2009 When is your appointment with the new endo??? If I were you, I'd try to hold out until then. Going off spiro after being on it for a while was very difficult for me. Are you EXTREMELY controlling your sodium? I mean like 500 mg/day or so for right now? Val On Feb 3, 2009, at 10:52 PM, Jay Man wrote: > Hi. I told them not to switch me to the labetalol for it did not > work in the past--but she insisted in order to do blood work and > try to improve my BP. When my BP started rising again then > clonidine was added--and that just drys out my mouth nothing else. > We had an arguement on the phone today and I asked to have another > doctor take over my case. I called her and told her my BP was now > at 190/130 and asked what was the game plan---she told me I could > just go back to my old medication now and that she never said I had > to stay off old meds but only for one test. Then she turns around > again and says if the Endo wants blood work or related I would have > to stay off the meds again for six weeks---Then I hung up the phone > on her. I have gone through a lot of articles--which one in > particular are u talking about? I am still waiting to see the new > endo. Thanks for your continued support. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 4, 2009 Report Share Posted February 4, 2009 Hi. I have been off of it for over 9 weeks now. One of my appointments with an endo is Feb 10th and the other one which is covered by my insurance has not scheduled it yet. The referral has been sent twice but no calls. I just was told that Spiro will alter tests but went on old meds now for my bp is too high. I really watch my sodium and try my best. Just got the book by UPS today so will go through that now. The Spiro gives me bad effects but makes me feel better and solves my edema problem along with lowering my bp. I also tried Inspra in the past but that did nothing at all----Thanks and will keep you advised. > Hi. I told them not to switch me to the labetalol for it did not > work in the past--but she insisted in order to do blood work and > try to improve my BP. When my BP started rising again then > clonidine was added--and that just drys out my mouth nothing else. > We had an arguement on the phone today and I asked to have another > doctor take over my case. I called her and told her my BP was now > at 190/130 and asked what was the game plan---she told me I could > just go back to my old medication now and that she never said I had > to stay off old meds but only for one test. Then she turns around > again and says if the Endo wants blood work or related I would have > to stay off the meds again for six weeks---Then I hung up the phone > on her. I have gone through a lot of articles--which one in > particular are u talking about? I am still waiting to see the new > endo. Thanks for your continued support. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 4, 2009 Report Share Posted February 4, 2009 I started it in December of 2005 for probably 6 months or so. My breasts were very sore on Spiro 50mg per day and developed bumps. > > > > > > > > > > > > > > > > > > > > > > > > I'm new to this so bear with me. My endocrinologist has > > scheduled > > > me for > > > > > AVS and I want to make sure I should do it. I have an > adenoma on > > > my right > > > > > adrenal gland and the results of my aldosterol/renin are as > > > follows: A/RA > > > > > Ratio Calc: 164.0 Aldosterone 32.8 and Renin, D irec t .2 I > have > > > not yet > > > > > been on any meds because I was just diagnosed. Shouldn't we > try > > > spiro first? > > > > > > > > > > > > > > > Thanks for any advice! > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 4, 2009 Report Share Posted February 4, 2009 So spiro is out for you. So if you can't afford Inspra you must rely on DASH and other meds. See my difficult HTN paper for recommended combination of combinations to help with BP control. May your pressure be low!  CE Grim BS, MS, MD High Blood Pressure Consulting Senior Consultant to Shared Care Research and Education Consulting Inc.(sharedcareinc.com) Clinical Professor of Internal Medicine Medical and Cardiology Medical College of Wisconsin Board certified in Internal Med, Geriatrics and Hypertension. Interests: 1. Difficult to control high blood pressure. 2. The effect of recent evolutionary forces on high blood pressure in human populations. 3. Improving blood pressure measurement in the office and out. On Feb 4, 2009, at 1:49 PM, Jay Man wrote: > I started it in December of 2005 for probably 6 months or so. My > breasts were very sore on Spiro 50mg per day and developed bumps. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > I'm new to this so bear with me. My endocrinologist has > > > scheduled > > > > me for > > > > > > AVS and I want to make sure I should do it. I have an > > adenoma on > > > > my right > > > > > > adrenal gland and the results of my aldosterol/renin are as > > > > follows: A/RA > > > > > > Ratio Calc: 164.0 Aldosterone 32.8 and Renin, D irec t .2 I > > have > > > > not yet > > > > > > been on any meds because I was just diagnosed. Shouldn't we > > try > > > > spiro first? > > > > > > > > > > > > > > > > > > Thanks for any advice! > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 4, 2009 Report Share Posted February 4, 2009 A fellow should always present your case to the staff that day and then the staff should come in and examine you and ask more questions. A fellow in Endocrinology or Hypertension should know more about Conn's than most usual doctors. The fellow-staff combo is usually a good one as the fellow can spend lots of time with you getting all the details and then summarize it for the staff person. You want to know how many Conn's each has taken care of. May your pressure be low!  CE Grim BS, MS, MD High Blood Pressure Consulting Senior Consultant to Shared Care Research and Education Consulting Inc.(sharedcareinc.com) Clinical Professor of Internal Medicine Medical and Cardiology Medical College of Wisconsin Board certified in Internal Med, Geriatrics and Hypertension. Interests: 1. Difficult to control high blood pressure. 2. The effect of recent evolutionary forces on high blood pressure in human populations. 3. Improving blood pressure measurement in the office and out. On Feb 4, 2009, at 9:31 AM, Jay Man wrote: > Hi. Thanks for the suggestions. I usually bring my entire history > and what has happened/reaction everytime I see a > doctor..........but the look at it and turn the pages without > reading it. Before I leave the appointment they then ask me if I > need it back---funny as hell I have to say. I called them this > morning to see which doctor I can re-schedule with and they tried > to give me a first year fellow and I said no more of this so now am > waiting for them to call me back. I had a first year fellow finish > my adrenal veing sampling with no success. I don't want them to > practice on me and I don't think it's too much to ask especially > when someone has no experience on my problem. Anyway, I will > update you and hope everyone has a great day. > > > > > From: jwwright <jwwright@...> > Subject: Re: Re: Is AVS nesessary? > hyperaldosteronism > Date: Wednesday, February 4, 2009, 4:51 PM > > My suggestion is put it on paper. > Make a presentation of 3 or 4 pages - in LARGE PRINT. > Put what you take now on one page, and the results. > History on a second page. > Prescribed medicines you've tried and results on a > third. > > And when I walk in the door I say I had to put it on > paper to clear my head - so you don't offend some > sensitive person. > Works for me, especially when seeing a new Doc. > > Regards > > Re: [hyperaldosteronism ] Re: Is AVS nesessary? > > Hi. I have been very patient and it does not seems to > work. My doctor is a resident or whataver it is called > but has one year left and works under someone---she > does not listen when I tell her about meds I have > already taken and symptoms I have or had. I hate to > " stir the pot " but if you dont't make some kind of > noise sometimes you never get heard. I just want to > get this under control and taken care of before I get a > stroke or something. The next doctor will be number 6 > or so I believe since 2004. It seems like they think > your lying about symptoms. Oh well, we will see what > the next endo guy says--he is supposed to be the top > guy at the University of Iowa. I just want my life > back. Thanks for your comment and talk again soon. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 4, 2009 Report Share Posted February 4, 2009 We will see after we get the final results. Thanks. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > I'm new to this so bear with me. My endocrinologist has > > > scheduled > > > > me for > > > > > > AVS and I want to make sure I should do it. I have an > > adenoma on > > > > my right > > > > > > adrenal gland and the results of my aldosterol/renin are as > > > > follows: A/RA > > > > > > Ratio Calc: 164.0 Aldosterone 32.8 and Renin, D irec t .2 I > > have > > > > not yet > > > > > > been on any meds because I was just diagnosed. Shouldn't we > > try > > > > spiro first? > > > > > > > > > > > > > > > > > > Thanks for any advice! > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 4, 2009 Report Share Posted February 4, 2009 It is actually illegal in many hospitals (or impossible) to put patient's notes in the medical record. If it is not on an approved page it will not go in. One way to do that would be to ask the clinic or hospital to give you approved pages (progress notes) to write on. But my guess is that this would not fly. May your pressure be low!  CE Grim BS, MS, MD High Blood Pressure Consulting Senior Consultant to Shared Care Research and Education Consulting Inc.(sharedcareinc.com) Clinical Professor of Internal Medicine Medical and Cardiology Medical College of Wisconsin Board certified in Internal Med, Geriatrics and Hypertension. Interests: 1. Difficult to control high blood pressure. 2. The effect of recent evolutionary forces on high blood pressure in human populations. 3. Improving blood pressure measurement in the office and out. On Feb 4, 2009, at 9:31 AM, Jay Man wrote: > Hi. Thanks for the suggestions. I usually bring my entire history > and what has happened/reaction everytime I see a > doctor..........but the look at it and turn the pages without > reading it. Before I leave the appointment they then ask me if I > need it back---funny as hell I have to say. I called them this > morning to see which doctor I can re-schedule with and they tried > to give me a first year fellow and I said no more of this so now am > waiting for them to call me back. I had a first year fellow finish > my adrenal veing sampling with no success. I don't want them to > practice on me and I don't think it's too much to ask especially > when someone has no experience on my problem. Anyway, I will > update you and hope everyone has a great day. > > > > > From: jwwright <jwwright@...> > Subject: Re: Re: Is AVS nesessary? > hyperaldosteronism > Date: Wednesday, February 4, 2009, 4:51 PM > > My suggestion is put it on paper. > Make a presentation of 3 or 4 pages - in LARGE PRINT. > Put what you take now on one page, and the results. > History on a second page. > Prescribed medicines you've tried and results on a > third. > > And when I walk in the door I say I had to put it on > paper to clear my head - so you don't offend some > sensitive person. > Works for me, especially when seeing a new Doc. > > Regards > > Re: [hyperaldosteronism ] Re: Is AVS nesessary? > > Hi. I have been very patient and it does not seems to > work. My doctor is a resident or whataver it is called > but has one year left and works under someone---she > does not listen when I tell her about meds I have > already taken and symptoms I have or had. I hate to > " stir the pot " but if you dont't make some kind of > noise sometimes you never get heard. I just want to > get this under control and taken care of before I get a > stroke or something. The next doctor will be number 6 > or so I believe since 2004. It seems like they think > your lying about symptoms. Oh well, we will see what > the next endo guy says--he is supposed to be the top > guy at the University of Iowa. I just want my life > back. Thanks for your comment and talk again soon. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 5, 2009 Report Share Posted February 5, 2009 Hi. I looked it up when I started taking them and was worried when I seen interactions. Pharmacist told me I could taken em but need to be watched---The doctor told me that Clonidine was the only other thing I could take in order to do my tests and the results not be compromised. I appreciate your feedback. I will no linger switch or take meds without more work on my end at least. I stopped taking them 2 days ago. Talk soon. > > > > > > > > > > > > > > > > > > I'm new to this so bear with me. My endocrinologist has > scheduled > > me for > > > > AVS and I want to make sure I should do it. I have an adenoma on > > my right > > > > adrenal gland and the results of my aldosterol/renin are as > > follows: A/RA > > > > Ratio Calc: 164.0 Aldosterone 32.8 and Renin, D irec t .2 I have > > not yet > > > > been on any meds because I was just diagnosed. Shouldn't we try > > spiro first? > > > > > > > > > > > > Thanks for any advice! > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 5, 2009 Report Share Posted February 5, 2009 I forgot to say--my BP did go up and when teh doctor was called she advised me to take another .1 of Clonidine in teh am and at night. I did that combo once and will never do it again. Hard to expalin what I felt but didn't like it! > > > > > > > > > > > > > > > > > > I'm new to this so bear with me. My endocrinologist has > scheduled > > me for > > > > AVS and I want to make sure I should do it. I have an adenoma on > > my right > > > > adrenal gland and the results of my aldosterol/renin are as > > follows: A/RA > > > > Ratio Calc: 164.0 Aldosterone 32.8 and Renin, D irec t .2 I have > > not yet > > > > been on any meds because I was just diagnosed. Shouldn't we try > > spiro first? > > > > > > > > > > > > Thanks for any advice! > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 5, 2009 Report Share Posted February 5, 2009 What is a good medications combo that you see working well? Right now taking carvedilol 25mg twice a day and the lisinopril for BP. I see my old primary care doctor tomorrow and the new kindney doctor Monday. I know you sent an email regarding a suggested regimen but dont know what drugs they would fall under until I get to the office and would like to know. I did get a spike in BP with a reading of 182/121. Any suggestions would be appreciated. > > > > > > > > > > > > > > > > > > I'm new to this so bear with me. My endocrinologist has > scheduled > > me for > > > > AVS and I want to make sure I should do it. I have an adenoma on > > my right > > > > adrenal gland and the results of my aldosterol/renin are as > > follows: A/RA > > > > Ratio Calc: 164.0 Aldosterone 32.8 and Renin, D irec t .2 I have > > not yet > > > > been on any meds because I was just diagnosed. Shouldn't we try > > spiro first? > > > > > > > > > > > > Thanks for any advice! > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 5, 2009 Report Share Posted February 5, 2009 Much better to DASH. May your pressure be low!  CE Grim BS, MS, MD High Blood Pressure Consulting Senior Consultant to Shared Care Research and Education Consulting Inc.(sharedcareinc.com) Clinical Professor of Internal Medicine Medical and Cardiology Medical College of Wisconsin Board certified in Internal Med, Geriatrics and Hypertension. Interests: 1. Difficult to control high blood pressure. 2. The effect of recent evolutionary forces on high blood pressure in human populations. 3. Improving blood pressure measurement in the office and out. On Feb 5, 2009, at 5:57 AM, Jay Man wrote: > Hi. I looked it up when I started taking them and was worried when > I seen interactions. Pharmacist told me I could taken em but need > to be watched---The doctor told me that Clonidine was the only > other thing I could take in order to do my tests and the results > not be compromised. I appreciate your feedback. I will no linger > switch or take meds without more work on my end at least. I > stopped taking them 2 days ago. Talk soon. > > > > > > > > > > > > > > > > > > > > > > > > > > > I'm new to this so bear with me. My endocrinologist has > > scheduled > > > me for > > > > > AVS and I want to make sure I should do it. I have an > adenoma on > > > my right > > > > > adrenal gland and the results of my aldosterol/renin are as > > > follows: A/RA > > > > > Ratio Calc: 164.0 Aldosterone 32.8 and Renin, D irec t .2 I > have > > > not yet > > > > > been on any meds because I was just diagnosed. Shouldn't we > try > > > spiro first? > > > > > > > > > > > > > > > Thanks for any advice! > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 5, 2009 Report Share Posted February 5, 2009 Go to our file Difficult HTN and download take to your Dr. Assume you were started on HCTZ 12.5 or 25 My favorite combo is: use HCTZ 12.5 AND Lotrel (ACE, CCB) bid Start lowest capulse and work up every 2 weeks Ziac (BB, HCTX) bid but use generic start lowest dose and work up Once BP is controlled may be able to change to 1/day Ziac in am and loterl in pm or vv EVERYONE IS DIFFERENT. When maxed out then added minoxidil.2.5 bid and work up to 40/day. Hair will grow everywhere in most. May your pressure be low!  CE Grim BS, MS, MD High Blood Pressure Consulting Senior Consultant to Shared Care Research and Education Consulting Inc.(sharedcareinc.com) Clinical Professor of Internal Medicine Medical and Cardiology Medical College of Wisconsin Board certified in Internal Med, Geriatrics and Hypertension. Interests: 1. Difficult to control high blood pressure. 2. The effect of recent evolutionary forces on high blood pressure in human populations. 3. Improving blood pressure measurement in the office and out. On Feb 5, 2009, at 6:19 AM, Jay Man wrote: > What is a good medications combo that you see working well? Right > now taking carvedilol 25mg twice a day and the lisinopril for BP. > I see my old primary care doctor tomorrow and the new kindney > doctor Monday. I know you sent an email regarding a suggested > regimen but dont know what drugs they would fall under until I get > to the office and would like to know. I did get a spike in BP with > a reading of 182/121. Any suggestions would be appreciated. > > > > > > > > > > > > > > > > > > > > > > > > > > I'm new to this so bear with me. My endocrinologist has > > scheduled > > > me for > > > > > AVS and I want to make sure I should do it. I have an > adenoma on > > > my right > > > > > adrenal gland and the results of my aldosterol/renin are as > > > follows: A/RA > > > > > Ratio Calc: 164.0 Aldosterone 32.8 and Renin, D irec t .2 I > have > > > not yet > > > > > been on any meds because I was just diagnosed. Shouldn't we > try > > > spiro first? > > > > > > > > > > > > > > > Thanks for any advice! > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 5, 2009 Report Share Posted February 5, 2009 Thanks for your help. I will take a few things to them. Have a great day. > > > > > > > > > > > > > > > > > > > > > > > > I'm new to this so bear with me. My endocrinologist has > > scheduled > > > me for > > > > > AVS and I want to make sure I should do it. I have an > adenoma on > > > my right > > > > > adrenal gland and the results of my aldosterol/renin are as > > > follows: A/RA > > > > > Ratio Calc: 164.0 Aldosterone 32.8 and Renin, D irec t .2 I > have > > > not yet > > > > > been on any meds because I was just diagnosed. Shouldn't we > try > > > spiro first? > > > > > > > > > > > > > > > Thanks for any advice! > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 5, 2009 Report Share Posted February 5, 2009 Thanks for the info---talk soon . > > > > > > > > > > > > > > > > > > > > > > > > I'm new to this so bear with me. My endocrinologist has > > scheduled > > > me for > > > > > AVS and I want to make sure I should do it. I have an > adenoma on > > > my right > > > > > adrenal gland and the results of my aldosterol/renin are as > > > follows: A/RA > > > > > Ratio Calc: 164.0 Aldosterone 32.8 and Renin, D irec t .2 I > have > > > not yet > > > > > been on any meds because I was just diagnosed. Shouldn't we > try > > > spiro first? > > > > > > > > > > > > > > > Thanks for any advice! > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 5, 2009 Report Share Posted February 5, 2009 There is some kind of problem getting to that file in hyperaldo, so I point to: http://f1.grp.fs.com/v1/AA2LSYRvS32G7RLGieKSMkXLDgkjWbeoUQygWBTQ-yDjeacku7R\ A53k6R6uOOCO4819meZw4aE5PpI1gkqtK/%20Evaluation%20and%20RX/Difficult%20Hypertens\ ion.txt In bpline it's in a folder labeled: Evaluation and Rx text is: Difficult Hypertension CE Grim, BS, MS, MD, Hypertension Research, Medical College of Wisconsin 414-374-2733 lowerbp2@... 1. Review patient history; esp for low K problems. 2. PE for café-au-lait spots, fundi, heart, chest, upper abd for bruits. 3. Labs * Lytes, urine albumin, Plasma aldosterone/plasma renin ratio-to screen for excess aldosterone or mineralocorticoid production. 4. Review BP device. If they don't have one, have them get an Omron or AND device with right sized cuff (arm circum >33 use large cuff). 5. Instruct on self BP measurement: sit 5 min, take 3 write them all down and average last 2. * Take BP in am before taking Rx and then any other time they feel like BP is up or they are dizzy. * Record in book and bring in. 6. Have the pt get the DASH Diet for Hypertension Book by , read it and use it for the 14 day test. They may wish to go to bloodpressureline for support. I run this site. 7. Review medications * If not on a diuretic ALWAYS start one-HCTZ 1/2 25 mg (costs $8/100) have them buy this. * Consider stopping all other RX and placing on the following combination * Lotrel 2.5/10 bid * Bisoprolol 2.5 / HCZ 6.25 each am or bid. * Have pt call with BPs in 2-3 days. * If not at goal increase Lotrel two am( and two pm and BIS to two am, two pm. * If BP not at goal in two weeks then add Minoxidil 5 mg each am. Increase every few days by using 5 mg am, 5 pm, 10 mg am, 10 pm etc. Pt needs to weigh daily. If weight goes up then add furosemide 40 bid and increase. If still edema add metolazone 10 each am. 8. If BP not at goal and Aldo/Renin ratio high then add Spironolactone, 50 mg/day and may increase to 300 mg per day. 9. If the patient fails this combo do: * 24 hr urine for catecholamines , Na, K and creatinine. * Review diet for sodium should be less than 80 mM Na per day about 1500 mg. * Consider regular renal arteriogram-not MRA or Nuclear scan, the only way to exclude renal artery stenosis as a cause of HTN is by selective transfemoral angiography to get good details of main and branch renal arteries. RAPID BP CONTROL IN THE HOSPITAL 1. Take BP every hour. 2. Give HCTZ 25 po q 12 hours. If edema or Cr >2 use furosemide 40 q 12. ------------------------------------------------------------------------------- | Diuretic | Lotrel | Bisoprolol/HCTZ ------------------------------------------------------------------------------- 1st dose | 25 HCTZ or 40 furosemide | 2.5/10 | 2.5/6.25 8 AM | | | ------------------------------------------------------------------------------- 2 PM | BP not at goal give | 5/10 | 5/6.25 | At goal repeat | 2.5/10 | 2.5/6.25 -------------------------------------------------------------------------------- 8 PM | At goal | 2.5/10 q 12hr | 2.5/6.25 q 12 hr | Not at goal Repeat diuretic + | 5/20 | 5/6.25 ------------------------------------------------------------------------------- 2 AM | Not at goal | 10/20 | 10/6.25 | At goal | None | None ------------------------------------------------------------------------------- 8 AM |At goal -HCZ 12.5 or 25 q am |Give last dose q am |Give last dose q am | Not at goal | Minoxidil 5 |Lotrel 10/20 q am+ | | | Bis 10/6.25 q am ------------------------------------------------------------------------------- 2 PM | Not at goal | Minoxidil 10 | | At Goal | Minoxidil 5 mg q d | ------------------------------------------------------------------------------- 8 PM | Not at goal | Minoxidil 15 | | At Goal | Minoxidil 10 q d | ------------------------------------------------------------------------------- 2 AM | Not at goal | Minoxidil 20 mg | | At goal | Minoxidil 20 mg q d | -------------------------------------------------------------------------------- 8 AM | At goal Watch weight for | Repeat last dose |Lotrel 10/20 q am | increase on Minoxidil. May | of Minoxidil q day |Bis 10/6.25 q am, | need to add furosemide and | |Consider: | metolazone | |Lotrel 5/10 bid | | |Bis 5/6.25 bid -------------------------------------------------------------------------------- * Others to add as outpatient.: Spironolactone up to 300/day Cough-->ARB DRUG RESISTANT HTN, A SPECIALIST'S APPROACH: VD Alla, SJ Murtaza, C E Grim*, Medial College of Wisconsin, Milwaukee, WI. Presented at Am. Soc. HTN, 2000. Many hypertensive patients who fail to achieve goal blood pressure (BP) or have side effects are referred to special clinics for management. In our experience many will need 4 or more BP meds for control. In the last 3 years we have evolved an effective approach to control BP in this outpatient setting. The near simultaneous release of two new long acting drug combinations, Ziac, which contains the long acting beta blocker bisoprolol (2.5, 5 and 10 mg) combined with 6.25 mg of hydrochlorothiazide (HCTZ) and Lotrel which contains the calcium channel blocker amlodipine and the ACEI benazapril (2.5/10, 5/10 and 5/20) suggested a useful way to approach these difficult patients. This " LoZi " cocktail combined the administration of 4 classes of drugs in only two pills once a day with the ability to start at a low dose and titrate up. HCTZ was usually added at 25 mg/d. LoZi produces increasing blockade of the 4 major BP control systems: vasoconstriction, RAAS, SNS and sodium retention. We used this cocktail in 21 referred patients who had a BP of 183±24(SD)/108±12 on their referral medications at first consultation. At the second visit (2-4 weeks) the BP had decreased to 152±7/90±10. The combination has been effective in patients with severe HTN due to renal artery stenosis, mineralocorticoid excess and in HTN with resistant CHF. In 10% of the pts the ACEI was stopped because of cough and in 5% the Ziac because of BB side effects. Our impression is that LoZi is a simple and effective combination to improve BP control in this group of patients. Controlled trials comparing this " combination of combinations " approach to others will be of interest in patients with " drug resistant " hypertension. Difficult Hypertension and the Combination of Combinations Page 2 of 2 Re: Re: Is AVS nesessary? Go to our file Difficult HTN and download take to your Dr. Assume you were started on HCTZ 12.5 or 25 My favorite combo is: use HCTZ 12.5 AND Lotrel (ACE, CCB) bid Start lowest capulse and work up every 2 weeks Ziac (BB, HCTX) bid but use generic start lowest dose and work up Once BP is controlled may be able to change to 1/day Ziac in am and loterl in pm or vv EVERYONE IS DIFFERENT. When maxed out then added minoxidil.2.5 bid and work up to 40/day. Hair will grow everywhere in most. May your pressure be low! CE Grim BS, MS, MD High Blood Pressure Consulting Senior Consultant to Shared Care Research and Education Consulting Inc.(sharedcareinc.com) Clinical Professor of Internal Medicine Medical and Cardiology Medical College of Wisconsin Board certified in Internal Med, Geriatrics and Hypertension. Interests: 1. Difficult to control high blood pressure. 2. The effect of recent evolutionary forces on high blood pressure in human populations. 3. Improving blood pressure measurement in the office and out. On Feb 5, 2009, at 6:19 AM, Jay Man wrote: > What is a good medications combo that you see working well? Right > now taking carvedilol 25mg twice a day and the lisinopril for BP. > I see my old primary care doctor tomorrow and the new kindney > doctor Monday. I know you sent an email regarding a suggested > regimen but dont know what drugs they would fall under until I get > to the office and would like to know. I did get a spike in BP with > a reading of 182/121. Any suggestions would be appreciated. > > > . Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 5, 2009 Report Share Posted February 5, 2009 Keep your Dr posted on your BP tho. May your pressure be low!  CE Grim BS, MS, MD High Blood Pressure Consulting Senior Consultant to Shared Care Research and Education Consulting Inc.(sharedcareinc.com) Clinical Professor of Internal Medicine Medical and Cardiology Medical College of Wisconsin Board certified in Internal Med, Geriatrics and Hypertension. Interests: 1. Difficult to control high blood pressure. 2. The effect of recent evolutionary forces on high blood pressure in human populations. 3. Improving blood pressure measurement in the office and out. On Feb 5, 2009, at 6:00 AM, Jay Man wrote: > I forgot to say--my BP did go up and when teh doctor was called she > advised me to take another .1 of Clonidine in teh am and at night. > I did that combo once and will never do it again. Hard to expalin > what I felt but didn't like it! > > > > > > > > > > > > > > > > > > > > > > > > > > I'm new to this so bear with me. My endocrinologist has > > scheduled > > > me for > > > > > AVS and I want to make sure I should do it. I have an > adenoma on > > > my right > > > > > adrenal gland and the results of my aldosterol/renin are as > > > follows: A/RA > > > > > Ratio Calc: 164.0 Aldosterone 32.8 and Renin, D irec t .2 I > have > > > not yet > > > > > been on any meds because I was just diagnosed. Shouldn't we > try > > > spiro first? > > > > > > > > > > > > > > > Thanks for any advice! > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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