RE: Renewing Conn's journey

May 7, 2009

Dont recall your previous story. Do we need to update your story?CE Grim MDOn May 6, 2009, at 6:05 PM, hdrewe wrote:I have not been in contact with this site for a few weeks, however, am now back on track. I visited Dr Nikwan at Greenslopes Hospital, and am going ahead with the workups prior to maybe having surgery. He was certainly surprised to see me after 9 years. My Aldosterone/Renin assays were:-Aldosterone (upright) 1923 (pmol/L) (100 - 950)Renin (upright) 14 (mU/L) (3.3 - 41)Aldosterone/Renin Ratio 137These results were while on 25mg Spironolactone. I have been taken off Spiro and put on Verapamil SR 240mg/day, which I began this morning.I am to have CT scan of adrenal gland to see what has happened after all this time.Will revisit Dr Nikwan in 8 weeks.Helen D

May 7, 2009

Helen D's full story is in the files.

Val

From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of Clarence Grim

Dont recall your previous story. Do we need to update your

story?

CE

Grim MD

On

May 6, 2009, at 6:05 PM, hdrewe wrote:

I have not been in contact with this site for a few weeks,

however, am now back on track. I visited Dr Nikwan at Greenslopes Hospital, and

am going ahead with the workups prior to maybe having surgery. He was certainly

surprised to see me after 9 years.

My Aldosterone/Renin assays were:-

Aldosterone (upright) 1923 (pmol/L) (100 - 950)

Renin (upright) 14 (mU/L) (3.3 - 41)

Aldosterone/Renin Ratio 137

These results were while on 25mg Spironolactone.

I have been taken off Spiro and put on Verapamil

SR 240mg/day, which I began this morning.

I am to have CT scan of adrenal gland to see what

has happened after all this time.

Will revisit Dr Nikwan in 8 weeks.

Helen D_._,_.___

May 7, 2009

Dr. Grim, I am an attorney in Mississippi and have just recently been diagnosed with PA. My family physician was attempting to treat my extremely high bp to no avail and after nearly 3 years finally told me that he did not have a clue as to what was going on and referred me to an internist. The internist specializes in hypertension. I really don't know how much the internist understands about PA but I am glad that he has at least heard of it after I've suffered for about 15 or more years with nearly all the symptoms listed by others here. The internist ordered a blood workup and my aldosterone levels were 3 times the normal amount and my renin was undetected. No other tests were run. He did not order a CT scan of my adrenals. After being hospitalized, my family physician

(after I pushed for it) ordered a CT scan of my kidneys and renal arteries and stated that they looked fine. That was prior to seeing the internist. After reading postings in this group, I requested on May 5th to have a CT scan performed to look at my adrenal glands. He stated that he was not going to do it now, but might in about 2 months.

I told the internist that I am still extremely fatigued, that I have headaches, my mind is cloudy, having a problem with concentration and memory and that I am concerned because it was affecting my work (I have been off work for about a month). Internist told me that he believed that I was just depressed and prescribed lexapro. He stated that I should be excited because my blood pressure was coming down. I told him that I was excited but that I did not think that I was depressed to the point of needing medication. I am thinking of either going to the University of Birmingham to see a nephrologist and/or endo. Is this a good idea? Is UAB a good place to go for hyperaldosterinism? If not, can you refer a place near MS? I need to make sure that I have this condition ( I have all the symptoms and the spiro-75mg- is helping my bp) and if so, how I can cure or best treat it. The internist stated that he did not know what caused it and that he did not

believe that I had a tumor. I am grateful that he looked into hyperaldosteronism but I think the internist is more concentrated on the bp, since that is his specialty. I am concerned not only about the bp, but also the mental aspects of this condition because it emy livelihood. Please respond.

From: Clarence Grim <lowerbp2@...>hyperaldosteronism Sent: Thursday, May 7, 2009 1:32:35 AMSubject: Re: Renewing Conn's journey

Dont recall your previous story. Do we need to update your story?

CE Grim MD

On May 6, 2009, at 6:05 PM, hdrewe wrote:

I have not been in contact with this site for a few weeks, however, am now back on track. I visited Dr Nikwan at Greenslopes Hospital, and am going ahead with the workups prior to maybe having surgery. He was certainly surprised to see me after 9 years. My Aldosterone/ Renin assays were:-Aldosterone (upright) 1923 (pmol/L) (100 - 950)Renin (upright) 14 (mU/L) (3.3 - 41)Aldosterone/ Renin Ratio 137These results were while on 25mg Spironolactone. I have been taken off Spiro and put on Verapamil SR 240mg/day, which I began this morning.I am to have CT scan of adrenal gland to see

what has happened after all this time.Will revisit Dr Nikwan in 8 weeks.Helen D

May 7, 2009

I am thinking of either going to the University of Birmingham to see a

nephrologist and/or endo.

Is this a good idea?

Yes. The sooner the better.

On May 7, 2009, at 4:49 PM, Echols wrote:

> I am thinking of either going to the University of Birmingham to see a

> nephrologist and/or endo.

May 8, 2009

Go to UAB and ask to see Dr. Calhoun. Tell his office Dr. Grim is referring you. I know him well.CE Grim, MDI will have some comments on your story later today.CE Grim MDOn May 7, 2009, at 2:15 PM, arthur springer wrote:I am thinking of either going to the University of Birmingham to see a nephrologist and/or endo. Is this a good idea?Yes. The sooner the better. On May 7, 2009, at 4:49 PM, Echols wrote: I am thinking of either going to the University of Birmingham to see a nephrologist and/or endo.

May 8, 2009

As you can see from our group's stories we need to increase the knowledge base or everyone who sees pts with high blood pressure. HTN + low K = PA.At some point we would like to have your complete story as well if you have time. Your aldo and renin confirm this Dx.If you have not read my article on the evolution of PA please do so-and take to your Dr. I would be happy to work with him in your care but most Drs don't seem to be interested. Which blows my mind.Any family Hx of HTN and/or low K?If spiro works for BP and K and your are DASHing to the max that essentially confirms the Dx.If the first CT did not show a bump on the adrenal then others will not likely show anything.Our basic approach here(based on 45 years of experience) is to treat with medications and DASH and if BP and K are controlled and other Sx go away not to do any further Dx tests at this stage.If there is a single bump and Rx fails to get to feeling normal then would do AVS to see if the problem is unilateral or bilateral. I know folks in MS, in New Orleans and in Birmingham who are experts in PA. I would recommend you go to someone who has a lot of experience in this and has been doing it for some time. Clarence Grim BS, MS, MDClinical Professor of MedicineMedical College of WisconsinSenior Consultant to Shared Care Research and Education Consulting, Inc.Specializing in Difficult to control high blood pressure. On May 7, 2009, at 1:49 PM, Echols wrote:Dr. Grim, I am an attorney in Mississippi and have just recently been diagnosed with PA. My family physician was attempting to treat my extremely high bp to no avail and after nearly 3 years finally told me that he did not have a clue as to what was going on and referred me to an internist. The internist specializes in hypertension. I really don't know how much the internist understands about PA but I am glad that he has at least heard of it after I've suffered for about 15 or more years with nearly all the symptoms listed by others here. The internist ordered a blood workup and my aldosterone levels were 3 times the normal amount and my renin was undetected. No other tests were run. He did not order a CT scan of my adrenals. After being hospitalized, my family physician (after I pushed for it) ordered a CT scan of my kidneys and renal arteries and stated that they looked fine. That was prior to seeing the internist. After reading postings in this group, I requested on May 5th to have a CT scan performed to look at my adrenal glands. He stated that he was not going to do it now, but might in about 2 months. I told the internist that I am still extremely fatigued, that I have headaches, my mind is cloudy, having a problem with concentration and memory and that I am concerned because it was affecting my work (I have been off work for about a month). Internist told me that he believed that I was just depressed and prescribed lexapro. He stated that I should be excited because my blood pressure was coming down. I told him that I was excited but that I did not think that I was depressed to the point of needing medication. I am thinking of either going to the University of Birmingham to see a nephrologist and/or endo. Is this a good idea? Is UAB a good place to go for hyperaldosterinism? If not, can you refer a place near MS? I need to make sure that I have this condition ( I have all the symptoms and the spiro-75mg- is helping my bp) and if so, how I can cure or best treat it. The internist stated that he did not know what caused it and that he did not believe that I had a tumor. I am grateful that he looked into hyperaldosteronism but I think the internist is more concentrated on the bp, since that is his specialty. I am concerned not only about the bp, but also the mental aspects of this condition because it emy livelihood. Please respond.From: Clarence Grim <lowerbp2mac>To: hyperaldosteronism Sent: Thursday, May 7, 2009 1:32:35 AMSubject: Re: Renewing Conn's journeyDont recall your previous story. Do we need to update your story?CE Grim MDOn May 6, 2009, at 6:05 PM, hdrewe wrote:I have not been in contact with this site for a few weeks, however, am now back on track. I visited Dr Nikwan at Greenslopes Hospital, and am going ahead with the workups prior to maybe having surgery. He was certainly surprised to see me after 9 years. My Aldosterone/ Renin assays were:-Aldosterone (upright) 1923 (pmol/L) (100 - 950)Renin (upright) 14 (mU/L) (3.3 - 41)Aldosterone/ Renin Ratio 137These results were while on 25mg Spironolactone. I have been taken off Spiro and put on Verapamil SR 240mg/day, which I began this morning.I am to have CT scan of adrenal gland to see what has happened after all this time.Will revisit Dr Nikwan in 8 weeks.Helen D

May 8, 2009

Okay. Very well. I will be looking forward to it.

From: Clarence Grim <lowerbp2@...>hyperaldosteronism Sent: Friday, May 8, 2009 9:09:15 AMSubject: Re: Renewing Conn's journey

Go to UAB and ask to see Dr. Calhoun. Tell his office Dr. Grim is referring you. I know him well.

CE Grim, MD

I will have some comments on your story later today.

CE Grim MD

On May 7, 2009, at 2:15 PM, arthur springer wrote:

I am thinking of either going to the University of Birmingham to see a nephrologist and/or endo.

Is this a good idea?

Yes. The sooner the better.

On May 7, 2009, at 4:49 PM, Echols wrote:

I am thinking of either going to the University of Birmingham to see a nephrologist and/or endo.

May 8, 2009

I spoke to Dr Calhoun today and he said to call his office but I have lost his number. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertensionOn May 8, 2009, at 2:54 PM, Echols <daechols22@...> wrote:

Okay. Very well. I will be looking forward to it.

From: Clarence Grim <lowerbp2mac>hyperaldosteronism Sent: Friday, May 8, 2009 9:09:15 AMSubject: Re: Renewing Conn's journey

Go to UAB and ask to see Dr. Calhoun. Tell his office Dr. Grim is referring you. I know him well.

CE Grim, MD

I will have some comments on your story later today.

CE Grim MD

On May 7, 2009, at 2:15 PM, arthur springer wrote:

I am thinking of either going to the University of Birmingham to see a nephrologist and/or endo.

Is this a good idea?

Yes. The sooner the better.

On May 7, 2009, at 4:49 PM, Echols wrote:

I am thinking of either going to the University of Birmingham to see a nephrologist and/or endo.

May 9, 2009

Thanks, Doc. I will attempt to find it on the UAB website.

From: Clarence Grim <lowerbp2@...>"hyperaldosteronism " <hyperaldosteronism >Sent: Saturday, May 9, 2009 12:27:45 AMSubject: Re: Renewing Conn's journey

I spoke to Dr Calhoun today and he said to call his office but I have lost his number. Tiped sad Send form mi

iPhone ;-)

May your pressure be low!

CE Grim MD

Specializing in Difficult

Hypertension

On May 8, 2009, at 2:54 PM, Echols <daechols22 (DOT) com> wrote:

Okay. Very well. I will be looking forward to it.

From: Clarence Grim <lowerbp2mac (DOT) com>hyperaldosteronismSent: Friday, May 8, 2009 9:09:15 AMSubject: Re: [hyperaldosteronism ] Renewing Conn's journey

Go to UAB and ask to see Dr. Calhoun. Tell his office Dr. Grim is referring you. I know him well.

CE Grim, MD

I will have some comments on your story later today.

CE Grim MD

On May 7, 2009, at 2:15 PM, arthur springer wrote:

I am thinking of either going to the University of Birmingham to see a nephrologist and/or endo.

Is this a good idea?

Yes. The sooner the better.

On May 7, 2009, at 4:49 PM, Echols wrote:

I am thinking of either going to the University of Birmingham to see a nephrologist and/or endo.

May 9, 2009

Doc, I am closer to than I am Birmingham. To answer the family history question, my father was diagnosed with PA in 2007 but he stated that no CT was ran. It appears that the spiro is lowering my bp.

As far as my CT scan, would a scan of my renal arteries and kidneys reveal a bump? I am still suffering extreme fatigue and muscle weakness and tingling in my extremities, headaches, mental confusion and cloudiness (harde to concentrate), memory loss, language difficulty. I also have intermittent pain in the region of my coccyx bone. Further, when I am surprised, or see something that causes me to cringe, I feel a tingling sensation in my lower back that flows down toward my rear pelvic region.

Doc, I agree with your comment as to other physicians do not appear to want to work with others to assist in the care of their patients. I don't know if it is pride or the fact that the concern of keeping a patient overrides the overall health of the patient. I have the same concerns in the legal profession. I have heard attorneys say that "you can't help people". The statement broke my heart. Last I checked, there were three (3) noble professions: Doctors, lawyers and ministers. We provide a service. Don't misunderstand me, doc, this is my livelihood and I am not apologizing for the salaries in our respective professions. I pprovide a service and plan to receive compensation for those services. My concerned is that we need to keep in my that we are providing "people" with those services.

I am not a complainer. I have been told that I am kind of stoic in nature. However, in my profession, I cannot afford to lose my mental edge or acuity. My job depends on it and I am on a quest to feel better. Thanks for responding.

If the best doctors are in Birmingham, I will go there but if you know someone in , that is closer. Thanks, Doc.

From: Clarence Grim <lowerbp2@...>hyperaldosteronism Sent: Friday, May 8, 2009 10:39:57 AMSubject: Re: Renewing Conn's journey

As you can see from our group's stories we need to increase the knowledge base or everyone who sees pts with high blood pressure. HTN + low K = PA.

At some point we would like to have your complete story as well if you have time.

Your aldo and renin confirm this Dx.

If you have not read my article on the evolution of PA please do so-and take to your Dr. I would be happy to work with him in your care but most Drs don't seem to be interested. Which blows my mind.

Any family Hx of HTN and/or low K?

If spiro works for BP and K and your are DASHing to the max that essentially confirms the Dx.

If the first CT did not show a bump on the adrenal then others will not likely show anything.

Our basic approach here(based on 45 years of experience) is to treat with medications and DASH and if BP and K are controlled and other Sx go away not to do any further Dx tests at this stage.

If there is a single bump and Rx fails to get to feeling normal then would do AVS to see if the problem is unilateral or bilateral.

I know folks in MS, in New Orleans and in Birmingham who are experts in PA. I would recommend you go to someone who has a lot of experience in this and has been doing it for some time.

Clarence Grim BS, MS, MD

Clinical Professor of Medicine

Medical College of Wisconsin

Senior Consultant to Shared Care Research and Education Consulting, Inc.

Specializing in Difficult to control high blood pressure.

On May 7, 2009, at 1:49 PM, Echols wrote:

Dr. Grim, I am an attorney in Mississippi and have just recently been diagnosed with PA. My family physician was attempting to treat my extremely high bp to no avail and after nearly 3 years finally told me that he did not have a clue as to what was going on and referred me to an internist. The internist specializes in hypertension. I really don't know how much the internist understands about PA but I am glad that he has at least heard of it after I've suffered for about 15 or more years with nearly all the symptoms listed by others here. The internist ordered a blood workup and my aldosterone levels were 3 times the normal amount and my renin was undetected. No other tests were run. He did not order a CT scan of my adrenals. After being hospitalized, my family physician (after I pushed for it) ordered a CT scan of my kidneys and renal arteries and stated that they looked fine. That was prior to seeing the internist. After

reading postings in this group, I requested on May 5th to have a CT scan performed to look at my adrenal glands. He stated that he was not going to do it now, but might in about 2 months.

I told the internist that I am still extremely fatigued, that I have headaches, my mind is cloudy, having a problem with concentration and memory and that I am concerned because it was affecting my work (I have been off work for about a month). Internist told me that he believed that I was just depressed and prescribed lexapro. He stated that I should be excited because my blood pressure was coming down. I told him that I was excited but that I did not think that I was depressed to the point of needing medication. I am thinking of either going to the University of Birmingham to see a nephrologist and/or endo. Is this a good idea? Is UAB a good place to go for hyperaldosterinism? If not, can you refer a place near MS? I need to make sure that I have this condition ( I have all the symptoms and the spiro-75mg- is helping my bp) and if so, how I can cure or best treat it. The internist stated that he did not know what caused it and that he did not

believe that I had a tumor. I am grateful that he looked into hyperaldosteronism but I think the internist is more concentrated on the bp, since that is his specialty. I am concerned not only about the bp, but also the mental aspects of this condition because it emy livelihood. Please respond.

From: Clarence Grim <lowerbp2mac (DOT) com>hyperaldosteronismSent: Thursday, May 7, 2009 1:32:35 AMSubject: Re: [hyperaldosteronism ] Renewing Conn's journey

Dont recall your previous story. Do we need to update your story?

CE Grim MD

On May 6, 2009, at 6:05 PM, hdrewe wrote:

I have not been in contact with this site for a few weeks, however, am now back on track. I visited Dr Nikwan at Greenslopes Hospital, and am going ahead with the workups prior to maybe having surgery. He was certainly surprised to see me after 9 years. My Aldosterone/ Renin assays were:-Aldosterone (upright) 1923 (pmol/L) (100 - 950)Renin (upright) 14 (mU/L) (3.3 - 41)Aldosterone/ Renin Ratio 137These results were while on 25mg Spironolactone. I have been taken off Spiro and put on Verapamil SR 240mg/day, which I began this morning.I am to have CT scan of adrenal gland to see

what has happened after all this time.Will revisit Dr Nikwan in 8 weeks.Helen D

May 10, 2009

If you father had PA can you give us his story as well (check with him first of course).If he has clearly been diagnosed then it is likely that you and he have the same thing (assuming your have a Dx of PA that is clear as well). You likely have GRA which is an autosomal dominate genetic cause of PA in which 1/2 of all your first degree relatives will have it as well (on the average). Recommend you find out as much as you can about your FH of HTN, low K, causes and age of death as far back as you can go.I am looking for the Dr. in ville and should get back with you soon.Have you given us you complete story yet. I may have missed it as have been at the Am Soc of HTN meeting for last week. Lots of things to report to the group.On May 9, 2009, at 10:18 PM, Echols wrote:Doc, I am closer to than I am Birmingham. To answer the family history question, my father was diagnosed with PA in 2007 but he stated that no CT was ran. It appears that the spiro is lowering my bp.As far as my CT scan, would a scan of my renal arteries and kidneys reveal a bump? I am still suffering extreme fatigue and muscle weakness and tingling in my extremities, headaches, mental confusion and cloudiness (harde to concentrate), memory loss, language difficulty. I also have intermittent pain in the region of my coccyx bone. Further, when I am surprised, or see something that causes me to cringe, I feel a tingling sensation in my lower back that flows down toward my rear pelvic region.Doc, I agree with your comment as to other physicians do not appear to want to work with others to assist in the care of their patients. I don't know if it is pride or the fact that the concern of keeping a patient overrides the overall health of the patient. I have the same concerns in the legal profession. I have heard attorneys say that "you can't help people". The statement broke my heart. Last I checked, there were three (3) noble professions: Doctors, lawyers and ministers. We provide a service. Don't misunderstand me, doc, this is my livelihood and I am not apologizing for the salaries in our respective professions. I pprovide a service and plan to receive compensation for those services. My concerned is that we need to keep in my that we are providing "people" with those services. I am not a complainer. I have been told that I am kind of stoic in nature. However, in my profession, I cannot afford to lose my mental edge or acuity. My job depends on it and I am on a quest to feel better. Thanks for responding.If the best doctors are in Birmingham, I will go there but if you know someone in , that is closer. Thanks, Doc.From: Clarence Grim <lowerbp2mac>To: hyperaldosteronism Sent: Friday, May 8, 2009 10:39:57 AMSubject: Re: Renewing Conn's journeyAs you can see from our group's stories we need to increase the knowledge base or everyone who sees pts with high blood pressure. HTN + low K = PA.At some point we would like to have your complete story as well if you have time. Your aldo and renin confirm this Dx.If you have not read my article on the evolution of PA please do so-and take to your Dr. I would be happy to work with him in your care but most Drs don't seem to be interested. Which blows my mind.Any family Hx of HTN and/or low K?If spiro works for BP and K and your are DASHing to the max that essentially confirms the Dx.If the first CT did not show a bump on the adrenal then others will not likely show anything.Our basic approach here(based on 45 years of experience) is to treat with medications and DASH and if BP and K are controlled and other Sx go away not to do any further Dx tests at this stage.If there is a single bump and Rx fails to get to feeling normal then would do AVS to see if the problem is unilateral or bilateral. I know folks in MS, in New Orleans and in Birmingham who are experts in PA. I would recommend you go to someone who has a lot of experience in this and has been doing it for some time.Clarence Grim BS, MS, MDClinical Professor of MedicineMedical College of WisconsinSenior Consultant to Shared Care Research and Education Consulting, Inc.Specializing in Difficult to control high blood pressure.On May 7, 2009, at 1:49 PM, Echols wrote:Dr. Grim, I am an attorney in Mississippi and have just recently been diagnosed with PA. My family physician was attempting to treat my extremely high bp to no avail and after nearly 3 years finally told me that he did not have a clue as to what was going on and referred me to an internist. The internist specializes in hypertension. I really don't know how much the internist understands about PA but I am glad that he has at least heard of it after I've suffered for about 15 or more years with nearly all the symptoms listed by others here. The internist ordered a blood workup and my aldosterone levels were 3 times the normal amount and my renin was undetected. No other tests were run. He did not order a CT scan of my adrenals. After being hospitalized, my family physician (after I pushed for it) ordered a CT scan of my kidneys and renal arteries and stated that they looked fine. That was prior to seeing the internist. After reading postings in this group, I requested on May 5th to have a CT scan performed to look at my adrenal glands. He stated that he was not going to do it now, but might in about 2 months. I told the internist that I am still extremely fatigued, that I have headaches, my mind is cloudy, having a problem with concentration and memory and that I am concerned because it was affecting my work (I have been off work for about a month). Internist told me that he believed that I was just depressed and prescribed lexapro. He stated that I should be excited because my blood pressure was coming down. I told him that I was excited but that I did not think that I was depressed to the point of needing medication. I am thinking of either going to the University of Birmingham to see a nephrologist and/or endo. Is this a good idea? Is UAB a good place to go for hyperaldosterinism? If not, can you refer a place near MS? I need to make sure that I have this condition ( I have all the symptoms and the spiro-75mg- is helping my bp) and if so, how I can cure or best treat it. The internist stated that he did not know what caused it and that he did not believe that I had a tumor. I am grateful that he looked into hyperaldosteronism but I think the internist is more concentrated on the bp, since that is his specialty. I am concerned not only about the bp, but also the mental aspects of this condition because it emy livelihood. Please respond.From: Clarence Grim <lowerbp2mac (DOT) com>To: hyperaldosteronismSent: Thursday, May 7, 2009 1:32:35 AMSubject: Re: [hyperaldosteronism ] Renewing Conn's journeyDont recall your previous story. Do we need to update your story?CE Grim MDOn May 6, 2009, at 6:05 PM, hdrewe wrote:I have not been in contact with this site for a few weeks, however, am now back on track. I visited Dr Nikwan at Greenslopes Hospital, and am going ahead with the workups prior to maybe having surgery. He was certainly surprised to see me after 9 years. My Aldosterone/ Renin assays were:-Aldosterone (upright) 1923 (pmol/L) (100 - 950)Renin (upright) 14 (mU/L) (3.3 - 41)Aldosterone/ Renin Ratio 137These results were while on 25mg Spironolactone. I have been taken off Spiro and put on Verapamil SR 240mg/day, which I began this morning.I am to have CT scan of adrenal gland to see what has happened after all this time.Will revisit Dr Nikwan in 8 weeks.Helen D

May 10, 2009

Yes the CT would have shown a bump if it was big enough and the machine took small enough slices. I order what I call a HTN CT or MRI that looks at aorta, renal arteries, and adrenals at same sitting. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertensionOn May 10, 2009, at 12:18 AM, Echols <daechols22@...> wrote:

Doc, I am closer to than I am Birmingham. To answer the family history question, my father was diagnosed with PA in 2007 but he stated that no CT was ran. It appears that the spiro is lowering my bp.

As far as my CT scan, would a scan of my renal arteries and kidneys reveal a bump? I am still suffering extreme fatigue and muscle weakness and tingling in my extremities, headaches, mental confusion and cloudiness (harde to concentrate), memory loss, language difficulty. I also have intermittent pain in the region of my coccyx bone. Further, when I am surprised, or see something that causes me to cringe, I feel a tingling sensation in my lower back that flows down toward my rear pelvic region.

Doc, I agree with your comment as to other physicians do not appear to want to work with others to assist in the care of their patients. I don't know if it is pride or the fact that the concern of keeping a patient overrides the overall health of the patient. I have the same concerns in the legal profession. I have heard attorneys say that "you can't help people". The statement broke my heart. Last I checked, there were three (3) noble professions: Doctors, lawyers and ministers. We provide a service. Don't misunderstand me, doc, this is my livelihood and I am not apologizing for the salaries in our respective professions. I pprovide a service and plan to receive compensation for those services. My concerned is that we need to keep in my that we are providing "people" with those services.

I am not a complainer. I have been told that I am kind of stoic in nature. However, in my profession, I cannot afford to lose my mental edge or acuity. My job depends on it and I am on a quest to feel better. Thanks for responding.

If the best doctors are in Birmingham, I will go there but if you know someone in , that is closer. Thanks, Doc.

From: Clarence Grim <lowerbp2mac>hyperaldosteronism Sent: Friday, May 8, 2009 10:39:57 AMSubject: Re: Renewing Conn's journey

As you can see from our group's stories we need to increase the knowledge base or everyone who sees pts with high blood pressure. HTN + low K = PA.

At some point we would like to have your complete story as well if you have time.

Your aldo and renin confirm this Dx.

If you have not read my article on the evolution of PA please do so-and take to your Dr. I would be happy to work with him in your care but most Drs don't seem to be interested. Which blows my mind.

Any family Hx of HTN and/or low K?

If spiro works for BP and K and your are DASHing to the max that essentially confirms the Dx.

If the first CT did not show a bump on the adrenal then others will not likely show anything.

Our basic approach here(based on 45 years of experience) is to treat with medications and DASH and if BP and K are controlled and other Sx go away not to do any further Dx tests at this stage.

If there is a single bump and Rx fails to get to feeling normal then would do AVS to see if the problem is unilateral or bilateral.

I know folks in MS, in New Orleans and in Birmingham who are experts in PA. I would recommend you go to someone who has a lot of experience in this and has been doing it for some time.

Clarence Grim BS, MS, MD

Clinical Professor of Medicine

Medical College of Wisconsin

Senior Consultant to Shared Care Research and Education Consulting, Inc.

Specializing in Difficult to control high blood pressure.

On May 7, 2009, at 1:49 PM, Echols wrote:

Dr. Grim, I am an attorney in Mississippi and have just recently been diagnosed with PA. My family physician was attempting to treat my extremely high bp to no avail and after nearly 3 years finally told me that he did not have a clue as to what was going on and referred me to an internist. The internist specializes in hypertension. I really don't know how much the internist understands about PA but I am glad that he has at least heard of it after I've suffered for about 15 or more years with nearly all the symptoms listed by others here. The internist ordered a blood workup and my aldosterone levels were 3 times the normal amount and my renin was undetected. No other tests were run. He did not order a CT scan of my adrenals. After being hospitalized, my family physician (after I pushed for it) ordered a CT scan of my kidneys and renal arteries and stated that they looked fine. That was prior to seeing the internist. After

reading postings in this group, I requested on May 5th to have a CT scan performed to look at my adrenal glands. He stated that he was not going to do it now, but might in about 2 months.

I told the internist that I am still extremely fatigued, that I have headaches, my mind is cloudy, having a problem with concentration and memory and that I am concerned because it was affecting my work (I have been off work for about a month). Internist told me that he believed that I was just depressed and prescribed lexapro. He stated that I should be excited because my blood pressure was coming down. I told him that I was excited but that I did not think that I was depressed to the point of needing medication. I am thinking of either going to the University of Birmingham to see a nephrologist and/or endo. Is this a good idea? Is UAB a good place to go for hyperaldosterinism? If not, can you refer a place near MS? I need to make sure that I have this condition ( I have all the symptoms and the spiro-75mg- is helping my bp) and if so, how I can cure or best treat it. The internist stated that he did not know what caused it and that he did not

believe that I had a tumor. I am grateful that he looked into hyperaldosteronism but I think the internist is more concentrated on the bp, since that is his specialty. I am concerned not only about the bp, but also the mental aspects of this condition because it emy livelihood. Please respond.

From: Clarence Grim <lowerbp2mac (DOT) com>hyperaldosteronismSent: Thursday, May 7, 2009 1:32:35 AMSubject: Re: [hyperaldosteronism ] Renewing Conn's journey

Dont recall your previous story. Do we need to update your story?

CE Grim MD

On May 6, 2009, at 6:05 PM, hdrewe wrote:

I have not been in contact with this site for a few weeks, however, am now back on track. I visited Dr Nikwan at Greenslopes Hospital, and am going ahead with the workups prior to maybe having surgery. He was certainly surprised to see me after 9 years. My Aldosterone/ Renin assays were:-Aldosterone (upright) 1923 (pmol/L) (100 - 950)Renin (upright) 14 (mU/L) (3.3 - 41)Aldosterone/ Renin Ratio 137These results were while on 25mg Spironolactone. I have been taken off Spiro and put on Verapamil SR 240mg/day, which I began this morning.I am to have CT scan of adrenal gland to see

what has happened after all this time.Will revisit Dr Nikwan in 8 weeks.Helen D

lmsg #ygrp-msg p a span.yshortcuts {

font-family: Verdana;

font-size: 10px;

font-weight: normal;

}

#ygrp-msg p a {

font-family: Verdana;

font-size: 10px;

}

#ygrp-mlmsg a {

color: #1E66AE;

}

div.attach-table div div a {

text-decoration: none;

}

div.attach-table {

width: 400px;

}

-->

May 10, 2009

Dr Grim, I would be very interested in knowing what your thoughts

are as to why there are so many of us who appear to suffer confusion and

cloudiness as we battle this condition. Is it the Spiro/Inspra? Or

is it the condition itself?

Like , I too work with legislation here in Australia, and

for the last 15 months have not been able to work fulltime. I too suffer

from language difficulties on occasions, and struggle to recall various parts

of legislation that were once so familiar to me. Prior to the

commencement of this condition approximately 20 months ago, everything cognitively

worked extremely well, but now it is a struggle. When my BP sat around 240/120

prior to my AVS and diagnosis of bilateral hyperplasia causing PHA ,

cognitively I was very alive and capable. Now, not so much.

Like I too face constant fears about my future employment

and the security of my home (which would be lost if I have to stop work). I am

only 43 and rely on my cognitive ability to undertake my work, and now this is

a real challenge for me and a real worry.

In terms of my recent advice to the group re my medication, my

Doctor asked me to cease the Inspra for two weeks and return to Spiro.

After two weeks I am to trial the Inspra again (as the Dr states this is the

scientific approach to identifying if I can’t tolerate the drug –

not looking forward to that given my recent experience). I am feeling a

bit better now that I am back on the Spiro and my BP has come back to sitting

around 150/90.

Upon my asking my Doctor (Renal Physician), she said that I am

her ONE and only PHA patient but that she is in continual liaison with the

North Shore Hospital Endocrine and Hypertensive units to remain constantly up

to date.

As always best wishes to all, and thanks Dr G for all your

advice.

Kind regards

From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of Echols

Sent: Sunday, 10 May 2009 3:19 PM

hyperaldosteronism

Subject: Re: Renewing Conn's journey

Doc, I am closer to than I am Birmingham. To answer

the family history question, my father was diagnosed with PA in 2007 but he

stated that no CT was ran. It appears that the spiro is lowering my bp.

As far as my CT scan, would a scan of my renal arteries and

kidneys reveal a bump? I am still suffering extreme fatigue and muscle weakness

and tingling in my extremities, headaches, mental confusion and cloudiness

(harde to concentrate), memory loss, language difficulty. I also have

intermittent pain in the region of my coccyx bone. Further, when I am

surprised, or see something that causes me to cringe, I feel a tingling

sensation in my lower back that flows down toward my rear pelvic region.

Doc, I agree with your comment as to other physicians do not

appear to want to work with others to assist in the care of their patients. I

don't know if it is pride or the fact that the concern of keeping a

patient overrides the overall health of the patient. I have

the same concerns in the legal profession. I have heard attorneys say that

" you can't help people " . The statement broke my heart. Last

I checked, there were three (3) noble professions: Doctors, lawyers and

ministers. We provide a service. Don't misunderstand me, doc, this is my

livelihood and I am not apologizing for the salaries in our respective

professions. I pprovide a service and plan to receive compensation for

those services. My concerned is that we need to keep in my that we are providing

" people " with those services.

I am not a complainer. I have been told that I am kind

of stoic in nature. However, in my profession, I cannot afford to lose my

mental edge or acuity. My job depends on it and I am on a quest to feel

better. Thanks for responding.

If the best doctors are in Birmingham, I will go there but

if you know someone in , that is closer. Thanks, Doc.

From: Clarence Grim <lowerbp2@...>

hyperaldosteronism

Sent: Friday, May 8, 2009 10:39:57 AM

Subject: Re: Renewing Conn's journey

As you can see from our group's stories we need to increase the knowledge

base or everyone who sees pts with high blood pressure. HTN + low K = PA.

At some point we would like to have your complete story as

well if you have time.

Your aldo and renin confirm this Dx.

If you have not read my article on the evolution of PA

please do so-and take to your Dr. I would be happy to work with him in

your care but most Drs don't seem to be interested. Which blows my mind.

Any family Hx of HTN and/or low K?

If spiro works for BP and K and your are DASHing to the max

that essentially confirms the Dx.

If the first CT did not show a bump on the adrenal then

others will not likely show anything.

Our basic approach here(based on 45 years of experience) is

to treat with medications and DASH and if BP and K are controlled and other Sx

go away not to do any further Dx tests at this stage.

If there is a single bump and Rx fails to get to

feeling normal then would do AVS to see if the problem is unilateral

or bilateral.

I know folks in MS, in New Orleans and in Birmingham

who are experts in PA. I would recommend you go to someone who

has a lot of experience in this and has been doing it for some time.

Clarence Grim BS, MS, MD

Clinical Professor of Medicine

Medical College of Wisconsin

Senior Consultant to Shared Care Research and Education

Consulting, Inc.

Specializing in Difficult to control high blood pressure.

On May 7, 2009, at 1:49 PM, Echols wrote:

Dr. Grim, I am an attorney in

Mississippi and have just recently been diagnosed with PA. My family physician

was attempting to treat my extremely high bp to no avail and after nearly 3

years finally told me that he did not have a clue as to what was going on and

referred me to an internist. The internist specializes in hypertension. I

really don't know how much the internist understands about PA but I am glad

that he has at least heard of it after I've suffered for about 15 or more

years with nearly all the symptoms listed by others here. The internist

ordered a blood workup and my aldosterone levels were 3 times the normal amount

and my renin was undetected. No other tests were run. He did not order a CT

scan of my adrenals. After being hospitalized, my family physician (after

I pushed for it) ordered a CT scan of my kidneys and renal arteries and stated

that they looked fine. That was prior to seeing the internist. After

reading postings in this group, I requested on May 5th to have a CT

scan performed to look at my adrenal glands. He stated that he was

not going to do it now, but might in about 2 months.

I told the internist that I am

still extremely fatigued, that I have headaches, my mind is cloudy, having a

problem with concentration and memory and that I am concerned because it was

affecting my work (I have been off work for about a month). Internist told me

that he believed that I was just depressed and prescribed lexapro. He stated

that I should be excited because my blood pressure was coming down. I told him

that I was excited but that I did not think that I was depressed to the point

of needing medication. I am thinking of either going to the University of

Birmingham to see a nephrologist and/or endo. Is this a good idea? Is UAB a

good place to go for hyperaldosterinism? If not, can you refer a place near MS?

I need to make sure that I have this condition ( I have all the symptoms and

the spiro-75mg- is helping my bp) and if so, how I can cure or best treat it.

The internist stated that he did not know what caused it and that he did not

believe that I had a tumor. I am grateful that he looked into

hyperaldosteronism but I think the internist is more concentrated on the bp,

since that is his specialty. I am concerned not only about the bp, but also

the mental aspects of this condition because it emy livelihood. Please

respond.

From: Clarence Grim <lowerbp2mac (DOT) com>

hyperaldosteronism@

groups. com

Sent: Thursday, May 7,

2009 1:32:35 AM

Subject: Re:

[hyperaldosteronism ] Renewing Conn's journey

Dont recall your

previous story. Do we need to update your story?

CE

Grim MD

On

May 6, 2009, at 6:05 PM, hdrewe wrote:

I have not been in contact with this

site for a few weeks, however, am now back on track. I visited Dr Nikwan at

Greenslopes Hospital, and am going ahead with the workups prior to maybe having

surgery. He was certainly surprised to see me after 9 years.

My Aldosterone/ Renin assays were:-

Aldosterone (upright) 1923 (pmol/L) (100 - 950)

Renin (upright) 14 (mU/L) (3.3 - 41)

Aldosterone/ Renin Ratio 137

These results were while on 25mg Spironolactone.

I have been taken off Spiro and put on Verapamil

SR 240mg/day, which I began this morning.

I am to have CT scan of adrenal gland to see what

has happened after all this time.

Will revisit Dr Nikwan in 8 weeks.

Helen D

May 10, 2009

Thanks for the note. I trust you have taken them my article. Tell him I lectured (invited) at Greenslopes in 1983 (I think) and know Stowasser and Gordon very well. I also have written a paper with Dr. Judy Whitworth Australia's best know Nephrologist I think.He is welcome to join our group so he can get more experience with Conn's. I assure you he can learn more in a few hours that he can in a few years corresponding with Greenslopes.I am astounded that if he is a nephrologist he has only seen one case.I can assure you and him that he has seen many but just not recognized them.I suspect he gets referred to him many difficult HTN cases and in the US least it appears that 20% have PA for the reason given in my article.CE Grim MDOn May 10, 2009, at 5:22 AM, megra0409 wrote:Dr Grim, I would be very interested in knowing what your thoughts are as to why there are so many of us who appear to suffer confusion and cloudiness as we battle this condition. Is it the Spiro/Inspra? Or is it the condition itself? Like , I too work with legislation here in Australia, and for the last 15 months have not been able to work fulltime. I too suffer from language difficulties on occasions, and struggle to recall various parts of legislation that were once so familiar to me. Prior to the commencement of this condition approximately 20 months ago, everything cognitively worked extremely well, but now it is a struggle. When my BP sat around 240/120 prior to my AVS and diagnosis of bilateral hyperplasia causing PHA , cognitively I was very alive and capable. Now, not so much. Like I too face constant fears about my future employment and the security of my home (which would be lost if I have to stop work). I am only 43 and rely on my cognitive ability to undertake my work, and now this is a real challenge for me and a real worry. In terms of my recent advice to the group re my medication, my Doctor asked me to cease the Inspra for two weeks and return to Spiro. After two weeks I am to trial the Inspra again (as the Dr states this is the scientific approach to identifying if I can’t tolerate the drug – not looking forward to that given my recent experience). I am feeling a bit better now that I am back on the Spiro and my BP has come back to sitting around 150/90. Upon my asking my Doctor (Renal Physician), she said that I am her ONE and only PHA patient but that she is in continual liaison with the North Shore Hospital Endocrine and Hypertensive units to remain constantly up to date. As always best wishes to all, and thanks Dr G for all your advice.Kind regards From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of EcholsSent: Sunday, 10 May 2009 3:19 PMTo: hyperaldosteronism Subject: Re: Renewing Conn's journey Doc, I am closer to than I am Birmingham. To answer the family history question, my father was diagnosed with PA in 2007 but he stated that no CT was ran. It appears that the spiro is lowering my bp.As far as my CT scan, would a scan of my renal arteries and kidneys reveal a bump? I am still suffering extreme fatigue and muscle weakness and tingling in my extremities, headaches, mental confusion and cloudiness (harde to concentrate), memory loss, language difficulty. I also have intermittent pain in the region of my coccyx bone. Further, when I am surprised, or see something that causes me to cringe, I feel a tingling sensation in my lower back that flows down toward my rear pelvic region.Doc, I agree with your comment as to other physicians do not appear to want to work with others to assist in the care of their patients. I don't know if it is pride or the fact that the concern of keeping a patient overrides the overall health of the patient. I have the same concerns in the legal profession. I have heard attorneys say that "you can't help people". The statement broke my heart. Last I checked, there were three (3) noble professions: Doctors, lawyers and ministers. We provide a service. Don't misunderstand me, doc, this is my livelihood and I am not apologizing for the salaries in our respective professions. I pprovide a service and plan to receive compensation for those services. My concerned is that we need to keep in my that we are providing "people" with those services. I am not a complainer. I have been told that I am kind of stoic in nature. However, in my profession, I cannot afford to lose my mental edge or acuity. My job depends on it and I am on a quest to feel better. Thanks for responding.If the best doctors are in Birmingham, I will go there but if you know someone in , that is closer. Thanks, Doc. From: Clarence Grim <lowerbp2mac>To: hyperaldosteronism Sent: Friday, May 8, 2009 10:39:57 AMSubject: Re: Renewing Conn's journeyAs you can see from our group's stories we need to increase the knowledge base or everyone who sees pts with high blood pressure. HTN + low K = PA.At some point we would like to have your complete story as well if you have time. Your aldo and renin confirm this Dx. If you have not read my article on the evolution of PA please do so-and take to your Dr. I would be happy to work with him in your care but most Drs don't seem to be interested. Which blows my mind. Any family Hx of HTN and/or low K? If spiro works for BP and K and your are DASHing to the max that essentially confirms the Dx.If the first CT did not show a bump on the adrenal then others will not likely show anything. Our basic approach here(based on 45 years of experience) is to treat with medications and DASH and if BP and K are controlled and other Sx go away not to do any further Dx tests at this stage.If there is a single bump and Rx fails to get to feeling normal then would do AVS to see if the problem is unilateral or bilateral. I know folks in MS, in New Orleans and in Birmingham who are experts in PA. I would recommend you go to someone who has a lot of experience in this and has been doing it for some time. Clarence Grim BS, MS, MD Clinical Professor of MedicineMedical College of WisconsinSenior Consultant to Shared Care Research and Education Consulting, Inc. Specializing in Difficult to control high blood pressure. On May 7, 2009, at 1:49 PM, Echols wrote: Dr. Grim, I am an attorney in Mississippi and have just recently been diagnosed with PA. My family physician was attempting to treat my extremely high bp to no avail and after nearly 3 years finally told me that he did not have a clue as to what was going on and referred me to an internist. The internist specializes in hypertension. I really don't know how much the internist understands about PA but I am glad that he has at least heard of it after I've suffered for about 15 or more years with nearly all the symptoms listed by others here. The internist ordered a blood workup and my aldosterone levels were 3 times the normal amount and my renin was undetected. No other tests were run. He did not order a CT scan of my adrenals. After being hospitalized, my family physician (after I pushed for it) ordered a CT scan of my kidneys and renal arteries and stated that they looked fine. That was prior to seeing the internist. After reading postings in this group, I requested on May 5th to have a CT scan performed to look at my adrenal glands. He stated that he was not going to do it now, but might in about 2 months. I told the internist that I am still extremely fatigued, that I have headaches, my mind is cloudy, having a problem with concentration and memory and that I am concerned because it was affecting my work (I have been off work for about a month). Internist told me that he believed that I was just depressed and prescribed lexapro. He stated that I should be excited because my blood pressure was coming down. I told him that I was excited but that I did not think that I was depressed to the point of needing medication. I am thinking of either going to the University of Birmingham to see a nephrologist and/or endo. Is this a good idea? Is UAB a good place to go for hyperaldosterinism? If not, can you refer a place near MS? I need to make sure that I have this condition ( I have all the symptoms and the spiro-75mg- is helping my bp) and if so, how I can cure or best treat it. The internist stated that he did not know what caused it and that he did not believe that I had a tumor. I am grateful that he looked into hyperaldosteronism but I think the internist is more concentrated on the bp, since that is his specialty. I am concerned not only about the bp, but also the mental aspects of this condition because it emy livelihood. Please respond. From: Clarence Grim <lowerbp2mac (DOT) com>To: hyperaldosteronismSent: Thursday, May 7, 2009 1:32:35 AMSubject: Re: [hyperaldosteronism ] Renewing Conn's journeyDont recall your previous story. Do we need to update your story? CE Grim MDOn May 6, 2009, at 6:05 PM, hdrewe wrote:I have not been in contact with this site for a few weeks, however, am now back on track. I visited Dr Nikwan at Greenslopes Hospital, and am going ahead with the workups prior to maybe having surgery. He was certainly surprised to see me after 9 years. My Aldosterone/ Renin assays were:-Aldosterone (upright) 1923 (pmol/L) (100 - 950)Renin (upright) 14 (mU/L) (3.3 - 41)Aldosterone/ Renin Ratio 137These results were while on 25mg Spironolactone. I have been taken off Spiro and put on Verapamil SR 240mg/day, which I began this morning.I am to have CT scan of adrenal gland to see what has happened after all this time.Will revisit Dr Nikwan in 8 weeks.Helen D

May 10, 2009

I plan to check my history and talk with my dad (it may take me a little time though). I think I posted my story but I'll check my past posts.

From: Clarence Grim <lowerbp2@...>hyperaldosteronism Sent: Sunday, May 10, 2009 1:34:25 AMSubject: Re: Renewing Conn's journey

If you father had PA can you give us his story as well (check with him first of course).

If he has clearly been diagnosed then it is likely that you and he have the same thing (assuming your have a Dx of PA that is clear as well). You likely have GRA which is an autosomal dominate genetic cause of PA in which 1/2 of all your first degree relatives will have it as well (on the average).

Recommend you find out as much as you can about your FH of HTN, low K, causes and age of death as far back as you can go.

I am looking for the Dr. in ville and should get back with you soon.

Have you given us you complete story yet. I may have missed it as have been at the Am Soc of HTN meeting for last week. Lots of things to report to the group.

On May 9, 2009, at 10:18 PM, Echols wrote:

Doc, I am closer to than I am Birmingham. To answer the family history question, my father was diagnosed with PA in 2007 but he stated that no CT was ran. It appears that the spiro is lowering my bp.

As far as my CT scan, would a scan of my renal arteries and kidneys reveal a bump? I am still suffering extreme fatigue and muscle weakness and tingling in my extremities, headaches, mental confusion and cloudiness (harde to concentrate) , memory loss, language difficulty. I also have intermittent pain in the region of my coccyx bone. Further, when I am surprised, or see something that causes me to cringe, I feel a tingling sensation in my lower back that flows down toward my rear pelvic region.

Doc, I agree with your comment as to other physicians do not appear to want to work with others to assist in the care of their patients. I don't know if it is pride or the fact that the concern of keeping a patient overrides the overall health of the patient. I have the same concerns in the legal profession. I have heard attorneys say that "you can't help people". The statement broke my heart. Last I checked, there were three (3) noble professions: Doctors, lawyers and ministers. We provide a service. Don't misunderstand me, doc, this is my livelihood and I am not apologizing for the salaries in our respective professions. I pprovide a service and plan to receive compensation for those services. My concerned is that we need to keep in my that we are providing "people" with those services.

I am not a complainer. I have been told that I am kind of stoic in nature. However, in my profession, I cannot afford to lose my mental edge or acuity. My job depends on it and I am on a quest to feel better. Thanks for responding.

If the best doctors are in Birmingham, I will go there but if you know someone in , that is closer. Thanks, Doc.

From: Clarence Grim <lowerbp2mac (DOT) com>hyperaldosteronismSent: Friday, May 8, 2009 10:39:57 AMSubject: Re: [hyperaldosteronism ] Renewing Conn's journey

As you can see from our group's stories we need to increase the knowledge base or everyone who sees pts with high blood pressure. HTN + low K = PA.

At some point we would like to have your complete story as well if you have time.

Your aldo and renin confirm this Dx.

If you have not read my article on the evolution of PA please do so-and take to your Dr. I would be happy to work with him in your care but most Drs don't seem to be interested. Which blows my mind.

Any family Hx of HTN and/or low K?

If spiro works for BP and K and your are DASHing to the max that essentially confirms the Dx.

If the first CT did not show a bump on the adrenal then others will not likely show anything.

Our basic approach here(based on 45 years of experience) is to treat with medications and DASH and if BP and K are controlled and other Sx go away not to do any further Dx tests at this stage.

If there is a single bump and Rx fails to get to feeling normal then would do AVS to see if the problem is unilateral or bilateral.

I know folks in MS, in New Orleans and in Birmingham who are experts in PA. I would recommend you go to someone who has a lot of experience in this and has been doing it for some time.

Clarence Grim BS, MS, MD

Clinical Professor of Medicine

Medical College of Wisconsin

Senior Consultant to Shared Care Research and Education Consulting, Inc.

Specializing in Difficult to control high blood pressure.

On May 7, 2009, at 1:49 PM, Echols wrote:

Dr. Grim, I am an attorney in Mississippi and have just recently been diagnosed with PA. My family physician was attempting to treat my extremely high bp to no avail and after nearly 3 years finally told me that he did not have a clue as to what was going on and referred me to an internist. The internist specializes in hypertension. I really don't know how much the internist understands about PA but I am glad that he has at least heard of it after I've suffered for about 15 or more years with nearly all the symptoms listed by others here. The internist ordered a blood workup and my aldosterone levels were 3 times the normal amount and my renin was undetected. No other tests were run. He did not order a CT scan of my adrenals. After being hospitalized, my family physician (after I pushed for it) ordered a CT scan of my kidneys and renal arteries and stated that they looked fine. That was prior to seeing the internist. After

reading postings in this group, I requested on May 5th to have a CT scan performed to look at my adrenal glands. He stated that he was not going to do it now, but might in about 2 months.

I told the internist that I am still extremely fatigued, that I have headaches, my mind is cloudy, having a problem with concentration and memory and that I am concerned because it was affecting my work (I have been off work for about a month). Internist told me that he believed that I was just depressed and prescribed lexapro. He stated that I should be excited because my blood pressure was coming down. I told him that I was excited but that I did not think that I was depressed to the point of needing medication. I am thinking of either going to the University of Birmingham to see a nephrologist and/or endo. Is this a good idea? Is UAB a good place to go for hyperaldosterinism? If not, can you refer a place near MS? I need to make sure that I have this condition ( I have all the symptoms and the spiro-75mg- is helping my bp) and if so, how I can cure or best treat it. The internist stated that he did not know what caused it and that he did not

believe that I had a tumor. I am grateful that he looked into hyperaldosteronism but I think the internist is more concentrated on the bp, since that is his specialty. I am concerned not only about the bp, but also the mental aspects of this condition because it emy livelihood. Please respond.

From: Clarence Grim <lowerbp2mac (DOT) com>hyperaldosteronismSent: Thursday, May 7, 2009 1:32:35 AMSubject: Re: [hyperaldosteronism ] Renewing Conn's journey

Dont recall your previous story. Do we need to update your story?

CE Grim MD

On May 6, 2009, at 6:05 PM, hdrewe wrote:

I have not been in contact with this site for a few weeks, however, am now back on track. I visited Dr Nikwan at Greenslopes Hospital, and am going ahead with the workups prior to maybe having surgery. He was certainly surprised to see me after 9 years. My Aldosterone/ Renin assays were:-Aldosterone (upright) 1923 (pmol/L) (100 - 950)Renin (upright) 14 (mU/L) (3.3 - 41)Aldosterone/ Renin Ratio 137These results were while on 25mg Spironolactone. I have been taken off Spiro and put on Verapamil SR 240mg/day, which I began this morning.I am to have CT scan of adrenal gland to see

what has happened after all this time.Will revisit Dr Nikwan in 8 weeks.Helen D

May 10, 2009

-I can identify with your challenges RE mental sharpness. It seems, especially within the past six or so months, that my language (vocabulary) is suffering. I also find myself making silly mistakes. It makes things very hard with work. I often have to be "on" - and I am very aware that I am not. I've also recently been diagnosed - actually, I still have the salt-loading test yet to confirm. I believe my father had PA and will likely be tested for GRA. From what I have read, there is an increased risk of early stroke. My father began having small strokes in his 40's and died of a massive stroke in his early 5o's. Anyway, I encourage you to read as much as possible about GRA. DR Grim -are you aware of any differences in symptoms or treatment -or follow-up for those with GRA? , you should know that there are lots of understanding, helpful and experienced people on this board -welcome. Wishing you better health!Sent via BlackBerry from T-MobileFrom: Echols Date: Sun, 10 May 2009 19:17:24 -0700 (PDT)<hyperaldosteronism >Subject: Re: Renewing Conn's journey I plan to check my history and talk with my dad (it may take me a little time though). I think I posted my story but I'll check my past posts. From: Clarence Grim <lowerbp2mac>hyperaldosteronism Sent: Sunday, May 10, 2009 1:34:25 AMSubject: Re: Renewing Conn's journeyIf you father had PA can you give us his story as well (check with him first of course).If he has clearly been diagnosed then it is likely that you and he have the same thing (assuming your have a Dx of PA that is clear as well). You likely have GRA which is an autosomal dominate genetic cause of PA in which 1/2 of all your first degree relatives will have it as well (on the average). Recommend you find out as much as you can about your FH of HTN, low K, causes and age of death as far back as you can go.I am looking for the Dr. in ville and should get back with you soon.Have you given us you complete story yet. I may have missed it as have been at the Am Soc of HTN meeting for last week. Lots of things to report to the group.On May 9, 2009, at 10:18 PM, Echols wrote:Doc, I am closer to than I am Birmingham. To answer the family history question, my father was diagnosed with PA in 2007 but he stated that no CT was ran. It appears that the spiro is lowering my bp.As far as my CT scan, would a scan of my renal arteries and kidneys reveal a bump? I am still suffering extreme fatigue and muscle weakness and tingling in my extremities, headaches, mental confusion and cloudiness (harde to concentrate) , memory loss, language difficulty. I also have intermittent pain in the region of my coccyx bone. Further, when I am surprised, or see something that causes me to cringe, I feel a tingling sensation in my lower back that flows down toward my rear pelvic region.Doc, I agree with your comment as to other physicians do not appear to want to work with others to assist in the care of their patients. I don't know if it is pride or the fact that the concern of keeping a patient overrides the overall health of the patient. I have the same concerns in the legal profession. I have heard attorneys say that "you can't help people". The statement broke my heart. Last I checked, there were three (3) noble professions: Doctors, lawyers and ministers. We provide a service. Don't misunderstand me, doc, this is my livelihood and I am not apologizing for the salaries in our respective professions. I pprovide a service and plan to receive compensation for those services. My concerned is that we need to keep in my that we are providing "people" with those services. I am not a complainer. I have been told that I am kind of stoic in nature. However, in my profession, I cannot afford to lose my mental edge or acuity. My job depends on it and I am on a quest to feel better. Thanks for responding.If the best doctors are in Birmingham, I will go there but if you know someone in , that is closer. Thanks, Doc.From: Clarence Grim <lowerbp2mac (DOT) com>hyperaldosteronismSent: Friday, May 8, 2009 10:39:57 AMSubject: Re: [hyperaldosteronism ] Renewing Conn's journeyAs you can see from our group's stories we need to increase the knowledge base or everyone who sees pts with high blood pressure. HTN + low K = PA.At some point we would like to have your complete story as well if you have time. Your aldo and renin confirm this Dx.If you have not read my article on the evolution of PA please do so-and take to your Dr. I would be happy to work with him in your care but most Drs don't seem to be interested. Which blows my mind.Any family Hx of HTN and/or low K?If spiro works for BP and K and your are DASHing to the max that essentially confirms the Dx.If the first CT did not show a bump on the adrenal then others will not likely show anything.Our basic approach here(based on 45 years of experience) is to treat with medications and DASH and if BP and K are controlled and other Sx go away not to do any further Dx tests at this stage.If there is a single bump and Rx fails to get to feeling normal then would do AVS to see if the problem is unilateral or bilateral. I know folks in MS, in New Orleans and in Birmingham who are experts in PA. I would recommend you go to someone who has a lot of experience in this and has been doing it for some time.Clarence Grim BS, MS, MDClinical Professor of MedicineMedical College of WisconsinSenior Consultant to Shared Care Research and Education Consulting, Inc.Specializing in Difficult to control high blood pressure.On May 7, 2009, at 1:49 PM, Echols wrote:Dr. Grim, I am an attorney in Mississippi and have just recently been diagnosed with PA. My family physician was attempting to treat my extremely high bp to no avail and after nearly 3 years finally told me that he did not have a clue as to what was going on and referred me to an internist. The internist specializes in hypertension. I really don't know how much the internist understands about PA but I am glad that he has at least heard of it after I've suffered for about 15 or more years with nearly all the symptoms listed by others here. The internist ordered a blood workup and my aldosterone levels were 3 times the normal amount and my renin was undetected. No other tests were run. He did not order a CT scan of my adrenals. After being hospitalized, my family physician (after I pushed for it) ordered a CT scan of my kidneys and renal arteries and stated that they looked fine. That was prior to seeing the internist. After reading postings in this group, I requested on May 5th to have a CT scan performed to look at my adrenal glands. He stated that he was not going to do it now, but might in about 2 months. I told the internist that I am still extremely fatigued, that I have headaches, my mind is cloudy, having a problem with concentration and memory and that I am concerned because it was affecting my work (I have been off work for about a month). Internist told me that he believed that I was just depressed and prescribed lexapro. He stated that I should be excited because my blood pressure was coming down. I told him that I was excited but that I did not think that I was depressed to the point of needing medication. I am thinking of either going to the University of Birmingham to see a nephrologist and/or endo. Is this a good idea? Is UAB a good place to go for hyperaldosterinism? If not, can you refer a place near MS? I need to make sure that I have this condition ( I have all the symptoms and the spiro-75mg- is helping my bp) and if so, how I can cure or best treat it. The internist stated that he did not know what caused it and that he did not believe that I had a tumor. I am grateful that he looked into hyperaldosteronism but I think the internist is more concentrated on the bp, since that is his specialty. I am concerned not only about the bp, but also the mental aspects of this condition because it emy livelihood. Please respond.From: Clarence Grim <lowerbp2mac (DOT) com>hyperaldosteronismSent: Thursday, May 7, 2009 1:32:35 AMSubject: Re: [hyperaldosteronism ] Renewing Conn's journeyDont recall your previous story. Do we need to update your story?CE Grim MDOn May 6, 2009, at 6:05 PM, hdrewe wrote:I have not been in contact with this site for a few weeks, however, am now back on track. I visited Dr Nikwan at Greenslopes Hospital, and am going ahead with the workups prior to maybe having surgery. He was certainly surprised to see me after 9 years. My Aldosterone/ Renin assays were:-Aldosterone (upright) 1923 (pmol/L) (100 - 950)Renin (upright) 14 (mU/L) (3.3 - 41)Aldosterone/ Renin Ratio 137These results were while on 25mg Spironolactone. I have been taken off Spiro and put on Verapamil SR 240mg/day, which I began this morning.I am to have CT scan of adrenal gland to see what has happened after all this time.Will revisit Dr Nikwan in 8 weeks.Helen D

May 10, 2009

I, too identify strongly with dealing with mental changes.

I thought my personal papers filing was only a few months behind. I

started sorting yesterday and found it had been a year since I had

filed/sorted things out.

I used to be meticulous in recording payments due/made etc. My

organisational skills have deteriorated badly.

Carol

Isa Hackett wrote:

>

> -

>

> I can identify with your challenges RE mental sharpness. It seems,

> especially within the past six or so months, that my language

> (vocabulary) is suffering. I also find myself making silly mistakes.

> It makes things very hard with work. I often have to be " on " - and I

> am very aware that I am not.

>

> I've also recently been diagnosed - actually, I still have the

> salt-loading test yet to confirm. I believe my father had PA and will

> likely be tested for GRA. From what I have read, there is an increased

> risk of early stroke. My father began having small strokes in his 40's

> and died of a massive stroke in his early 5o's.

>

> Anyway, I encourage you to read as much as possible about GRA.

>

> DR Grim -are you aware of any differences in symptoms or treatment -or

> follow-up for those with GRA?

>

> , you should know that there are lots of understanding, helpf ul

> and experienced people on this board -welcome.

>

> Wishing you better health!

>

> Sent via BlackBerry from T-Mobile

>

> ------------------------------------------------------------------------

> *From*: Echols

> *Date*: Sun, 10 May 2009 19:17:24 -0700 (PDT)

> *To*: <hyperaldosteronism >

> *Subject*: Re: Renewing Conn's journey

> I plan to check my history and talk with my dad (it may take me a

> little time though). I think I posted my story but I'll check my past

> posts.

>

> ------------------------------------------------------------------------

> *From:* Clarence Grim <lowerbp2@...>

> *To:* hyperaldosteronism

> *Sent:* Sunday, May 10, 2009 1:34:25 AM

> *Subject:* Re: Renewing Conn's journey

>

> If you father had PA can you give us his story as well (check with him

> first of course).

>

> If he has clearly been diagnosed then it is likely that you and he

> have the same thing (assuming your have a Dx of PA that is clear as

> well). You likely have GRA which is an autosomal dominate genetic

> cause of PA in which 1/2 of all your first degree relatives will have

> it as well (on the average).

>

> Recommend you find out as much as you can about your FH of HTN, low K,

> causes and age of death as far back as you can go.

>

> I am looking for the Dr. in ville and should get back with you

> soon.

>

> Have you given us you complete story yet. I may have missed it as

> have been at the Am Soc of HTN meeting for last week. Lots of things

> to report to the group.

>

> On May 9, 2009, at 10:18 PM, Echols wrote:

>

>>

>> D oc, I am closer to than I am Birmingham. To answer the

>> family history question, my father was diagnosed with PA in 2007 but

>> he stated that no CT was ran. It appears that the spiro is lowering

>> my bp.

>> As far as my CT scan, would a scan of my renal arteries and kidneys

>> reveal a bump? I am still suffering extreme fatigue and muscle

>> weakness and tingling in my extremities, headaches, mental confusion

>> and cloudiness (harde to concentrate) , memory loss, language

>> difficulty. I also have intermittent pain in the region of my coccyx

>> bone. Further, when I am surprised, or see something that causes me

>> to cringe, I feel a tingling sensation in my lower back that flows

>> down toward my rear pelvic region.

>> Doc, I agree with your comment as to other physicians do not appear

>> to want to work with others to assist in the care of their patients.

>> I don't know if it is pride or the fact that the concern of keeping a

>> patient overrides the overall health of the & nbsp;patient. I have the

>> same concerns in the legal profession. I have heard attorneys say

>> that " you can't help people " . The statement broke my heart. Last I

>> checked, there were three (3) noble professions: Doctors, lawyers and

>> ministers. We provide a service. Don't misunderstand me, doc, this

>> is my livelihood and I am not apologizing for the salaries in our

>> respective professions. I pprovide a service and plan to receive

>> compensation for those services. My concerned is that we need to keep

>> in my that we are providing " people " with those services.

>> I am not a complainer. I have been told that I am kind of stoic in

>> nature. However, in my profession, I cannot afford to lose my mental

>> edge or acuity. My job depends on it and I am on a quest to feel

>> better. Thanks for responding.

>> If the best doctors are in Birmingham, I will go there but if you

>> know someone in , that is closer. Thanks, Doc.

>>

>> ------------------------------------------------------------------------

>> *From:* Clarence Grim <lowerbp2mac (DOT) com>

>> *To:* hyperaldosteronism

>> *Sent:* Friday, May 8, 2009 10:39:57 AM

>> *Subject:* Re: [hyperaldosteronism ] Renewing Conn's journey

>>

>> As you can see from our group's stories we need to increase the

>> knowledge base or every one who sees pts with high blood pressure.

>> HTN + low K = PA.

>>

>> At some point we would like to have your complete story as well if

>> you have time.

>>

>> Your aldo and renin confirm this Dx.

>>

>> If you have not read my article on the evolution of PA please do

>> so-and take to your Dr. I would be happy to work with him in your

>> care but most Drs don't seem to be interested. Which blows my mind.

>>

>> Any family Hx of HTN and/or low K?

>>

>> If spiro works for BP and K and your are DASHing to the max that

>> essentially confirms the Dx.

>> If the first CT did not show a bump on the adrenal then others will

>> not likely show anything.

>>

>> Our basic approach here(based on 45 years of experience) is to treat

>> with medications and DASH and if BP and K are controlled and other Sx

>> go away not to do any further D x tests at this stage.

>> If there is a single bump and Rx fails to get to feeling normal then

>> would do AVS to see if the problem is unilateral or bilateral.

>>

>> I know folks in MS, in New Orleans and in Birmingham who are

>> experts in PA. I would recommend you go to someone who has a lot of

>> experience in this and has been doing it for some time.

>>

>> Clarence Grim BS, MS, MD

>>

>> Clinical Professor of Medicine

>> Medical College of Wisconsin

>> Senior Consultant to Shared Care Research and Education Consulting, Inc.

>>

>> Specializing in Difficult to control high blood pre ssure.

>>

>> On May 7, 2009, at 1:49 PM, Echols wrote:

>>

>>>

>>> Dr. Grim, I am an attorney in Mississippi and have just recently

>>> been diagnosed with PA. My family physician was attempting to treat

>>> my extremely high bp to no avail and after nearly 3 years fina lly

>>> told me that he did not have a clue as to what was going on and

>>> referred me to an internist. The internist specializes in

>>> hypertension. I really don't know how much the internist understands

>>> about PA but I am glad that he has at least heard of it after I've

>>> suffered for about 15 or more years with nearly all the symptoms

>>> listed by others here. The internist ordered a blood workup and my

>>> aldosterone levels were 3 times the normal amount and my renin was

>>> undetected. No other tests were run. He did not order a CT scan of

>>> my adrenals. After being hospitalized, my family physician (after I

>>> pushed for it) ordered a CT scan of my kidneys and renal arteries

>>> and stated that they looked fine. That was prior to seeing the

>>> internist. After reading postings in this group, I requested on May

>>> 5th to have a CT scan performed to look at my adrenal glands. He

>>> stated that he was not going to do it now, but might in about 2

>>> months.

>>> I told the internist that I am still extremely fatigued, that I have

>>> headaches, my mind is cloudy, having a problem with concentration

>>> and memory and that I am concerned because it was affecting my work

>>> (I have been off work for about a month). Internist told me that he

>>> believed that I was just depressed and prescribed lexapro. He stated

>>> that I should be excited because my blood pressure was coming down.

>>> I told him that I was excited but that I did not think that I was

>>> depressed to the point of needing medication. I am thinking of

>>> either going to the University of Birmingham to see a nephrologist

>>> and/or endo. Is this a good idea? Is UAB a good place to go for

>>> hyperaldosterinism? If not, can you refer a place near MS? I need to

>>> make sure that I have this condition ( I have all the symptoms and

>>> the spiro-75mg- is helping my bp) and if so, how I can cure or best

>>> treat it. The internist stated that he did not know what caused it

>>> and that he did not believe that I had a tumor. I am grateful that

>>> he looked into hyperaldosteronism but I think the internist is more

>>> concentrated on the bp, since that is his specialty. I am concerned

>>> not only about the bp, but also the mental aspects of this condition

>>> because it emy livelihood. Please respond.

>>>

>>> ------------------------------------------------------------------------

>>> *From:* Clarence Grim <lowerbp2mac (DOT) com>

>>> *To:* hyperaldosteronism

>>> *Sent:* Thursday, May 7, 2009 1:32:35 AM

>>> *Subject:* Re: [hyperaldosteronism ] Renewing Conn's journey

>>>

>>> Dont recall your previous story. Do we need to update your story?

>>>

>>> CE Grim MD

>>> On May 6, 2009, at 6:05 PM, hdrewe wrote:

>>>

>>>> I have not been in contact with this site for a few weeks, however,

>>>> am now back on track. I visited Dr Nikwan at Greenslopes Hospital,

>>>> and am going ahead with the workups prior to maybe having surgery.

>>>> He was certainly surprised to see me after 9 years.

>>>>

>>>> My Aldosterone/ Renin assays wer e:-

>>>> Aldosterone (upright) 1923 (pmol/L) (100 - 950)

>>>> Renin (upright) 14 (mU/L) (3.3 - 41)

>>>> Aldosterone/ Renin Ratio 137

>>>>

>>>> These results were while on 25mg Spironolactone.

>>>>

>>>> I have been taken off Spiro and put on Verapamil SR 240mg/day,

>>>> which I began this morning.

>>>> I am to have CT scan of adrenal gland to see what has happened

>>>> after all this time.

>>>> Will revisit Dr Nikwan in 8 weeks.

>>>> Helen D

>>>

>>

>

May 10, 2009

The only unique feature of GRA IS that it is familial. If you have it 50% of ur first degree relatives will have it and all should be tested as it can be dxed at birth by DNA testing. Our team reported the first family with normal K. We have published a non generic test that can me done by ur DR. It is an over night dexamethason test and I can tell ur team how to do it. Please have them contact me. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertensionOn May 10, 2009, at 9:56 PM, Isa Hackett <icnhackett@...> wrote:

-I can identify with your challenges RE mental sharpness. It seems, especially within the past six or so months, that my language (vocabulary) is suffering. I also find myself making silly mistakes. It makes things very hard with work. I often have to be "on" - and I am very aware that I am not. I've also recently been diagnosed - actually, I still have the salt-loading test yet to confirm. I believe my father had PA and will likely be tested for GRA. From what I have read, there is an increased risk of early stroke. My father began having small strokes in his 40's and died of a massive stroke in his early 5o's. Anyway, I encourage you to read as much as possible about GRA. DR Grim -are you aware of any differences in symptoms or treatment -or follow-up for those with GRA? , you should know that there are lots of understanding,

helpful and experienced people on this board -welcome. Wishing you better health!Sent via BlackBerry from T-MobileFrom: Echols Date: Sun, 10 May 2009 19:17:24 -0700 (PDT)<hyperaldosteronism >Subject: Re: Renewing Conn's journey I plan to check my history and talk with my dad (it may take me a little time though). I think I posted my story but I'll check my past posts. From: Clarence Grim <lowerbp2mac>hyperaldosteronism Sent: Sunday, May 10, 2009 1:34:25 AMSubject: Re: Renewing Conn's journeyIf you father had PA can you give us his story as well (check with him first of course).If he has clearly been diagnosed then it is likely that you and he have the same thing (assuming your have a Dx of PA that is clear as well). You likely have GRA which is an autosomal dominate genetic cause of PA in which 1/2 of all your first degree relatives will have it as well (on the average). Recommend you find out as much as you can about your FH of HTN, low K, causes and age of death as far back as you can

go.I am looking for the Dr. in ville and should get back with you soon.Have you given us you complete story yet. I may have missed it as have been at the Am Soc of HTN meeting for last week. Lots of things to report to the group.On May 9, 2009, at 10:18 PM, Echols wrote:Doc, I am closer to than I am Birmingham. To answer the family history question, my father was diagnosed with PA in 2007 but he stated that no CT was ran. It appears that the spiro is lowering my bp.As far as my CT scan, would a scan of my renal arteries and kidneys reveal a bump? I am still suffering extreme fatigue and muscle weakness and tingling in my extremities, headaches, mental confusion and cloudiness (harde to concentrate) , memory loss, language difficulty. I also have intermittent pain in the region of my coccyx bone. Further, when I am surprised, or see something that causes me to cringe, I feel a tingling sensation in my lower back that flows down toward my rear pelvic region.Doc, I agree with your comment as to other physicians do not appear to want to work with others to assist in the care of their patients. I don't know if it is pride or the fact that the concern of keeping a patient overrides the overall health

of the patient. I have the same concerns in the legal profession. I have heard attorneys say that "you can't help people". The statement broke my heart. Last I checked, there were three (3) noble professions: Doctors, lawyers and ministers. We provide a service. Don't misunderstand me, doc, this is my livelihood and I am not apologizing for the salaries in our respective professions. I pprovide a service and plan to receive compensation for those services. My concerned is that we need to keep in my that we are providing "people" with those services. I am not a complainer. I have been told that I am kind of stoic in nature. However, in my profession, I cannot afford to lose my mental edge or acuity. My job depends on it and I am on a quest to feel better. Thanks for responding.If the best doctors are in Birmingham, I will go there but if you know someone in , that is closer. Thanks,

Doc.From: Clarence Grim <lowerbp2mac (DOT) com>hyperaldosteronismSent: Friday, May 8, 2009 10:39:57 AMSubject: Re: [hyperaldosteronism ] Renewing Conn's journeyAs you can see from our group's stories we need to increase the knowledge base or

everyone who sees pts with high blood pressure. HTN + low K = PA.At some point we would like to have your complete story as well if you have time. Your aldo and renin confirm this Dx.If you have not read my article on the evolution of PA please do so-and take to your Dr. I would be happy to work with him in your care but most Drs don't seem to be interested. Which blows my mind.Any family Hx of HTN and/or low K?If spiro works for BP and K and your are DASHing to the max that essentially confirms the Dx.If the first CT did not show a bump on the adrenal then others will not likely show anything.Our basic approach here(based on 45 years of experience) is to treat with medications and DASH and if BP and K are controlled and other Sx go away not to do any further Dx

tests at this stage.If there is a single bump and Rx fails to get to feeling normal then would do AVS to see if the problem is unilateral or bilateral. I know folks in MS, in New Orleans and in Birmingham who are experts in PA. I would recommend you go to someone who has a lot of experience in this and has been doing it for some time.Clarence Grim BS, MS, MDClinical Professor of MedicineMedical College of WisconsinSenior Consultant to Shared Care Research and Education Consulting, Inc.Specializing in Difficult to control high blood

pressure.On May 7, 2009, at 1:49 PM, Echols wrote:Dr. Grim, I am an attorney in Mississippi and have just recently been diagnosed with PA. My family physician was attempting to treat my extremely high bp to no avail and after nearly 3 years finally

told me that he did not have a clue as to what was going on and referred me to an internist. The internist specializes in hypertension. I really don't know how much the internist understands about PA but I am glad that he has at least heard of it after I've suffered for about 15 or more years with nearly all the symptoms listed by others here. The internist ordered a blood workup and my aldosterone levels were 3 times the normal amount and my renin was undetected. No other tests were run. He did not order a CT scan of my adrenals. After being hospitalized, my family physician (after I pushed for it) ordered a CT scan of my kidneys and renal arteries and stated that they looked fine. That was prior to seeing the internist. After reading postings in this group, I requested on May 5th to have a CT scan performed to look at my adrenal glands. He stated that he was not going to do it now, but might in about 2 months. I

told the internist that I am still extremely fatigued, that I have headaches, my mind is cloudy, having a problem with concentration and memory and that I am concerned because it was affecting my work (I have been off work for about a month). Internist told me that he believed that I was just depressed and prescribed lexapro. He stated that I should be excited because my blood pressure was coming down. I told him that I was excited but that I did not think that I was depressed to the point of needing medication. I am thinking of either going to the University of Birmingham to see a nephrologist and/or endo. Is this a good idea? Is UAB a good place to go for hyperaldosterinism? If not, can you refer a place near MS? I need to make sure that I have this condition ( I have all the symptoms and the spiro-75mg- is helping my bp) and if so, how I can cure or best treat it. The internist stated that he did not know what caused it and that he did not believe that I had a tumor. I am

grateful that he looked into hyperaldosteronism but I think the internist is more concentrated on the bp, since that is his specialty. I am concerned not only about the bp, but also the mental aspects of this condition because it emy livelihood. Please respond.From: Clarence Grim <lowerbp2mac (DOT) com>hyperaldosteronismSent: Thursday, May 7, 2009 1:32:35 AMSubject: Re: [hyperaldosteronism ] Renewing Conn's journeyDont recall your previous story. Do we need to update your story?CE Grim MDOn May 6, 2009, at 6:05 PM, hdrewe wrote:I have not been in contact with this site for a few weeks, however, am now back on track. I visited Dr Nikwan at Greenslopes Hospital, and am going ahead with the workups prior to maybe having surgery. He was certainly surprised to see me after 9 years. My Aldosterone/ Renin assays were:-Aldosterone

(upright) 1923 (pmol/L) (100 - 950)Renin (upright) 14 (mU/L) (3.3 - 41)Aldosterone/ Renin Ratio 137These results were while on 25mg Spironolactone. I have been taken off Spiro and put on Verapamil SR 240mg/day, which I began this morning.I am to have CT scan of adrenal gland to see what has happened after all this time.Will revisit Dr Nikwan in 8 weeks.Helen D

May 10, 2009

Tell us all meds u

Are taking.

Tiped sad Send form mi

iPhone ;-)

May your pressure be low!

CE Grim MD

Specializing in Difficult

Hypertension

On May 10, 2009, at 10:48 PM, Carol Christie <carolch@...> wrote:

> I, too identify strongly with dealing with mental changes.

> I thought my personal papers filing was only a few months behind. I

> started sorting yesterday and found it had been a year since I had

> filed/sorted things out.

> I used to be meticulous in recording payments due/made etc. My

> organisational skills have deteriorated badly.

> Carol

>

> Isa Hackett wrote:

>>

>> -

>>

>> I can identify with your challenges RE mental sharpness. It seems,

>> especially within the past six or so months, that my language

>> (vocabulary) is suffering. I also find myself making silly mistakes.

>> It makes things very hard with work. I often have to be " on " - and I

>> am very aware that I am not.

>>

>> I've also recently been diagnosed - actually, I still have the

>> salt-loading test yet to confirm. I believe my father had PA and will

>> likely be tested for GRA. From what I have read, there is an

>> increased

>> risk of early stroke. My father began having small strokes in his

>> 40's

>> and died of a massive stroke in his early 5o's.

>>

>> Anyway, I encourage you to read as much as possible about GRA.

>>

>> DR Grim -are you aware of any differences in symptoms or treatment -

>> or

>> follow-up for those with GRA?

>>

>> , you should know that there are lots of understanding, helpf ul

>> and experienced people on this board -welcome.

>>

>> Wishing you better health!

>>

>> Sent via BlackBerry from T-Mobile

>>

>> ---

>> ---------------------------------------------------------------------

>> *From*: Echols

>> *Date*: Sun, 10 May 2009 19:17:24 -0700 (PDT)

>> *To*: <hyperaldosteronism >

>> *Subject*: Re: Renewing Conn's journey

>> I plan to check my history and talk with my dad (it may take me a

>> little time though). I think I posted my story but I'll check my past

>> posts.

>>

>> ---

>> ---------------------------------------------------------------------

>> *From:* Clarence Grim <lowerbp2@...>

>> *To:* hyperaldosteronism

>> *Sent:* Sunday, May 10, 2009 1:34:25 AM

>> *Subject:* Re: Renewing Conn's journey

>>

>> If you father had PA can you give us his story as well (check with

>> him

>> first of course).

>>

>> If he has clearly been diagnosed then it is likely that you and he

>> have the same thing (assuming your have a Dx of PA that is clear as

>> well). You likely have GRA which is an autosomal dominate genetic

>> cause of PA in which 1/2 of all your first degree relatives will have

>> it as well (on the average).

>>

>> Recommend you find out as much as you can about your FH of HTN, low

>> K,

>> causes and age of death as far back as you can go.

>>

>> I am looking for the Dr. in ville and should get back with you

>> soon.

>>

>> Have you given us you complete story yet. I may have missed it as

>> have been at the Am Soc of HTN meeting for last week. Lots of things

>> to report to the group.

>>

>> On May 9, 2009, at 10:18 PM, Echols wrote:

>>

>>>

>>> D oc, I am closer to than I am Birmingham. To answer the

>>> family history question, my father was diagnosed with PA in 2007 but

>>> he stated that no CT was ran. It appears that the spiro is lowering

>>> my bp.

>>> As far as my CT scan, would a scan of my renal arteries and kidneys

>>> reveal a bump? I am still suffering extreme fatigue and muscle

>>> weakness and tingling in my extremities, headaches, mental confusion

>>> and cloudiness (harde to concentrate) , memory loss, language

>>> difficulty. I also have intermittent pain in the region of my coccyx

>>> bone. Further, when I am surprised, or see something that causes me

>>> to cringe, I feel a tingling sensation in my lower back that flows

>>> down toward my rear pelvic region.

>>> Doc, I agree with your comment as to other physicians do not appear

>>> to want to work with others to assist in the care of their patients.

>>> I don't know if it is pride or the fact that the concern of

>>> keeping a

>>> patient overrides the overall health of the & nbsp;patient. I have

>>> the

>>> same concerns in the legal profession. I have heard attorneys say

>>> that " you can't help people " . The statement broke my heart. Last I

>>> checked, there were three (3) noble professions: Doctors, lawyers

>>> and

>>> ministers. We provide a service. Don't misunderstand me, doc, this

>>> is my livelihood and I am not apologizing for the salaries in our

>>> respective professions. I pprovide a service and plan to receive

>>> compensation for those services. My concerned is that we need to

>>> keep

>>> in my that we are providing " people " with those services.

>>> I am not a complainer. I have been told that I am kind of stoic in

>>> nature. However, in my profession, I cannot afford to lose my mental

>>> edge or acuity. My job depends on it and I am on a quest to feel

>>> better. Thanks for responding.

>>> If the best doctors are in Birmingham, I will go there but if you

>>> know someone in , that is closer. Thanks, Doc.

>>>

>>> ---

>>> ------------------------------------------------------------------

>>> *From:* Clarence Grim <lowerbp2mac (DOT) com>

>>> *To:* hyperaldosteronism

>>> *Sent:* Friday, May 8, 2009 10:39:57 AM

>>> *Subject:* Re: [hyperaldosteronism ] Renewing Conn's journey

>>>

>>> As you can see from our group's stories we need to increase the

>>> knowledge base or every one who sees pts with high blood pressure.

>>> HTN + low K = PA.

>>>

>>> At some point we would like to have your complete story as well if

>>> you have time.

>>>

>>> Your aldo and renin confirm this Dx.

>>>

>>> If you have not read my article on the evolution of PA please do

>>> so-and take to your Dr. I would be happy to work with him in your

>>> care but most Drs don't seem to be interested. Which blows my mind.

>>>

>>> Any family Hx of HTN and/or low K?

>>>

>>> If spiro works for BP and K and your are DASHing to the max that

>>> essentially confirms the Dx.

>>> If the first CT did not show a bump on the adrenal then others will

>>> not likely show anything.

>>>

>>> Our basic approach here(based on 45 years of experience) is to treat

>>> with medications and DASH and if BP and K are controlled and other

>>> Sx

>>> go away not to do any further D x tests at this stage.

>>> If there is a single bump and Rx fails to get to feeling normal

>>> then

>>> would do AVS to see if the problem is unilateral or bilateral.

>>>

>>> I know folks in MS, in New Orleans and in Birmingham who are

>>> experts in PA. I would recommend you go to someone who has a lot

>>> of

>>> experience in this and has been doing it for some time.

>>>

>>> Clarence Grim BS, MS, MD

>>>

>>> Clinical Professor of Medicine

>>> Medical College of Wisconsin

>>> Senior Consultant to Shared Care Research and Education

>>> Consulting, Inc.

>>>

>>> Specializing in Difficult to control high blood pre ssure.

>>>

>>> On May 7, 2009, at 1:49 PM, Echols wrote:

>>>

>>>>

>>>> Dr. Grim, I am an attorney in Mississippi and have just recently

>>>> been diagnosed with PA. My family physician was attempting to treat

>>>> my extremely high bp to no avail and after nearly 3 years fina lly

>>>> told me that he did not have a clue as to what was going on and

>>>> referred me to an internist. The internist specializes in

>>>> hypertension. I really don't know how much the internist

>>>> understands

>>>> about PA but I am glad that he has at least heard of it after I've

>>>> suffered for about 15 or more years with nearly all the symptoms

>>>> listed by others here. The internist ordered a blood workup and my

>>>> aldosterone levels were 3 times the normal amount and my renin was

>>>> undetected. No other tests were run. He did not order a CT scan of

>>>> my adrenals. After being hospitalized, my family physician

>>>> (after I

>>>> pushed for it) ordered a CT scan of my kidneys and renal arteries

>>>> and stated that they looked fine. That was prior to seeing the

>>>> internist. After reading postings in this group, I requested on May

>>>> 5th to have a CT scan performed to look at my adrenal glands. He

>>>> stated that he was not going to do it now, but might in about 2

>>>> months.

>>>> I told the internist that I am still extremely fatigued, that I

>>>> have

>>>> headaches, my mind is cloudy, having a problem with concentration

>>>> and memory and that I am concerned because it was affecting my work

>>>> (I have been off work for about a month). Internist told me that he

>>>> believed that I was just depressed and prescribed lexapro. He

>>>> stated

>>>> that I should be excited because my blood pressure was coming down.

>>>> I told him that I was excited but that I did not think that I was

>>>> depressed to the point of needing medication. I am thinking of

>>>> either going to the University of Birmingham to see a nephrologist

>>>> and/or endo. Is this a good idea? Is UAB a good place to go for

>>>> hyperaldosterinism? If not, can you refer a place near MS? I need

>>>> to

>>>> make sure that I have this condition ( I have all the symptoms and

>>>> the spiro-75mg- is helping my bp) and if so, how I can cure or best

>>>> treat it. The internist stated that he did not know what caused it

>>>> and that he did not believe that I had a tumor. I am grateful that

>>>> he looked into hyperaldosteronism but I think the internist is more

>>>> concentrated on the bp, since that is his specialty. I am concerned

>>>> not only about the bp, but also the mental aspects of this

>>>> condition

>>>> because it emy livelihood. Please respond.

>>>>

>>>> ---

>>>> ------------------------------------------------------------------

>>>> *From:* Clarence Grim <lowerbp2mac (DOT) com>

>>>> *To:* hyperaldosteronism

>>>> *Sent:* Thursday, May 7, 2009 1:32:35 AM

>>>> *Subject:* Re: [hyperaldosteronism ] Renewing Conn's journey

>>>>

>>>> Dont recall your previous story. Do we need to update your story?

>>>>

>>>> CE Grim MD

>>>> On May 6, 2009, at 6:05 PM, hdrewe wrote:

>>>>

>>>>> I have not been in contact with this site for a few weeks,

>>>>> however,

>>>>> am now back on track. I visited Dr Nikwan at Greenslopes Hospital,

>>>>> and am going ahead with the workups prior to maybe having surgery.

>>>>> He was certainly surprised to see me after 9 years.

>>>>>

>>>>> My Aldosterone/ Renin assays wer e:-

>>>>> Aldosterone (upright) 1923 (pmol/L) (100 - 950)

>>>>> Renin (upright) 14 (mU/L) (3.3 - 41)

>>>>> Aldosterone/ Renin Ratio 137

>>>>>

>>>>> These results were while on 25mg Spironolactone.

>>>>>

>>>>> I have been taken off Spiro and put on Verapamil SR 240mg/day,

>>>>> which I began this morning.

>>>>> I am to have CT scan of adrenal gland to see what has happened

>>>>> after all this time.

>>>>> Will revisit Dr Nikwan in 8 weeks.

>>>>> Helen D

>>>>

>>>

>>

>

> ------------------------------------

>

May 10, 2009

Sleep apnea been checked?

Tiped sad Send form mi

iPhone ;-)

May your pressure be low!

CE Grim MD

Specializing in Difficult

Hypertension

On May 10, 2009, at 10:48 PM, Carol Christie <carolch@...> wrote:

> I, too identify strongly with dealing with mental changes.

> I thought my personal papers filing was only a few months behind. I

> started sorting yesterday and found it had been a year since I had

> filed/sorted things out.

> I used to be meticulous in recording payments due/made etc. My

> organisational skills have deteriorated badly.

> Carol

>

> Isa Hackett wrote:

>>

>> -

>>

>> I can identify with your challenges RE mental sharpness. It seems,

>> especially within the past six or so months, that my language

>> (vocabulary) is suffering. I also find myself making silly mistakes.

>> It makes things very hard with work. I often have to be " on " - and I

>> am very aware that I am not.

>>

>> I've also recently been diagnosed - actually, I still have the

>> salt-loading test yet to confirm. I believe my father had PA and will

>> likely be tested for GRA. From what I have read, there is an

>> increased

>> risk of early stroke. My father began having small strokes in his

>> 40's

>> and died of a massive stroke in his early 5o's.

>>

>> Anyway, I encourage you to read as much as possible about GRA.

>>

>> DR Grim -are you aware of any differences in symptoms or treatment -

>> or

>> follow-up for those with GRA?

>>

>> , you should know that there are lots of understanding, helpf ul

>> and experienced people on this board -welcome.

>>

>> Wishing you better health!

>>

>> Sent via BlackBerry from T-Mobile

>>

>> ---

>> ---------------------------------------------------------------------

>> *From*: Echols

>> *Date*: Sun, 10 May 2009 19:17:24 -0700 (PDT)

>> *To*: <hyperaldosteronism >

>> *Subject*: Re: Renewing Conn's journey

>> I plan to check my history and talk with my dad (it may take me a

>> little time though). I think I posted my story but I'll check my past

>> posts.

>>

>> ---

>> ---------------------------------------------------------------------

>> *From:* Clarence Grim <lowerbp2@...>

>> *To:* hyperaldosteronism

>> *Sent:* Sunday, May 10, 2009 1:34:25 AM

>> *Subject:* Re: Renewing Conn's journey

>>

>> If you father had PA can you give us his story as well (check with

>> him

>> first of course).

>>

>> If he has clearly been diagnosed then it is likely that you and he

>> have the same thing (assuming your have a Dx of PA that is clear as

>> well). You likely have GRA which is an autosomal dominate genetic

>> cause of PA in which 1/2 of all your first degree relatives will have

>> it as well (on the average).

>>

>> Recommend you find out as much as you can about your FH of HTN, low

>> K,

>> causes and age of death as far back as you can go.

>>

>> I am looking for the Dr. in ville and should get back with you

>> soon.

>>

>> Have you given us you complete story yet. I may have missed it as

>> have been at the Am Soc of HTN meeting for last week. Lots of things

>> to report to the group.

>>

>> On May 9, 2009, at 10:18 PM, Echols wrote:

>>

>>>

>>> D oc, I am closer to than I am Birmingham. To answer the

>>> family history question, my father was diagnosed with PA in 2007 but

>>> he stated that no CT was ran. It appears that the spiro is lowering

>>> my bp.

>>> As far as my CT scan, would a scan of my renal arteries and kidneys

>>> reveal a bump? I am still suffering extreme fatigue and muscle

>>> weakness and tingling in my extremities, headaches, mental confusion

>>> and cloudiness (harde to concentrate) , memory loss, language

>>> difficulty. I also have intermittent pain in the region of my coccyx

>>> bone. Further, when I am surprised, or see something that causes me

>>> to cringe, I feel a tingling sensation in my lower back that flows

>>> down toward my rear pelvic region.

>>> Doc, I agree with your comment as to other physicians do not appear

>>> to want to work with others to assist in the care of their patients.

>>> I don't know if it is pride or the fact that the concern of

>>> keeping a

>>> patient overrides the overall health of the & nbsp;patient. I have

>>> the

>>> same concerns in the legal profession. I have heard attorneys say

>>> that " you can't help people " . The statement broke my heart. Last I

>>> checked, there were three (3) noble professions: Doctors, lawyers

>>> and

>>> ministers. We provide a service. Don't misunderstand me, doc, this

>>> is my livelihood and I am not apologizing for the salaries in our

>>> respective professions. I pprovide a service and plan to receive

>>> compensation for those services. My concerned is that we need to

>>> keep

>>> in my that we are providing " people " with those services.

>>> I am not a complainer. I have been told that I am kind of stoic in

>>> nature. However, in my profession, I cannot afford to lose my mental

>>> edge or acuity. My job depends on it and I am on a quest to feel

>>> better. Thanks for responding.

>>> If the best doctors are in Birmingham, I will go there but if you

>>> know someone in , that is closer. Thanks, Doc.

>>>

>>> ---

>>> ------------------------------------------------------------------

>>> *From:* Clarence Grim <lowerbp2mac (DOT) com>

>>> *To:* hyperaldosteronism

>>> *Sent:* Friday, May 8, 2009 10:39:57 AM

>>> *Subject:* Re: [hyperaldosteronism ] Renewing Conn's journey

>>>

>>> As you can see from our group's stories we need to increase the

>>> knowledge base or every one who sees pts with high blood pressure.

>>> HTN + low K = PA.

>>>

>>> At some point we would like to have your complete story as well if

>>> you have time.

>>>

>>> Your aldo and renin confirm this Dx.

>>>

>>> If you have not read my article on the evolution of PA please do

>>> so-and take to your Dr. I would be happy to work with him in your

>>> care but most Drs don't seem to be interested. Which blows my mind.

>>>

>>> Any family Hx of HTN and/or low K?

>>>

>>> If spiro works for BP and K and your are DASHing to the max that

>>> essentially confirms the Dx.

>>> If the first CT did not show a bump on the adrenal then others will

>>> not likely show anything.

>>>

>>> Our basic approach here(based on 45 years of experience) is to treat

>>> with medications and DASH and if BP and K are controlled and other

>>> Sx

>>> go away not to do any further D x tests at this stage.

>>> If there is a single bump and Rx fails to get to feeling normal

>>> then

>>> would do AVS to see if the problem is unilateral or bilateral.

>>>

>>> I know folks in MS, in New Orleans and in Birmingham who are

>>> experts in PA. I would recommend you go to someone who has a lot

>>> of

>>> experience in this and has been doing it for some time.

>>>

>>> Clarence Grim BS, MS, MD

>>>

>>> Clinical Professor of Medicine

>>> Medical College of Wisconsin

>>> Senior Consultant to Shared Care Research and Education

>>> Consulting, Inc.

>>>

>>> Specializing in Difficult to control high blood pre ssure.

>>>

>>> On May 7, 2009, at 1:49 PM, Echols wrote:

>>>

>>>>

>>>> Dr. Grim, I am an attorney in Mississippi and have just recently

>>>> been diagnosed with PA. My family physician was attempting to treat

>>>> my extremely high bp to no avail and after nearly 3 years fina lly

>>>> told me that he did not have a clue as to what was going on and

>>>> referred me to an internist. The internist specializes in

>>>> hypertension. I really don't know how much the internist

>>>> understands

>>>> about PA but I am glad that he has at least heard of it after I've

>>>> suffered for about 15 or more years with nearly all the symptoms

>>>> listed by others here. The internist ordered a blood workup and my

>>>> aldosterone levels were 3 times the normal amount and my renin was

>>>> undetected. No other tests were run. He did not order a CT scan of

>>>> my adrenals. After being hospitalized, my family physician

>>>> (after I

>>>> pushed for it) ordered a CT scan of my kidneys and renal arteries

>>>> and stated that they looked fine. That was prior to seeing the

>>>> internist. After reading postings in this group, I requested on May

>>>> 5th to have a CT scan performed to look at my adrenal glands. He

>>>> stated that he was not going to do it now, but might in about 2

>>>> months.

>>>> I told the internist that I am still extremely fatigued, that I

>>>> have

>>>> headaches, my mind is cloudy, having a problem with concentration

>>>> and memory and that I am concerned because it was affecting my work

>>>> (I have been off work for about a month). Internist told me that he

>>>> believed that I was just depressed and prescribed lexapro. He

>>>> stated

>>>> that I should be excited because my blood pressure was coming down.

>>>> I told him that I was excited but that I did not think that I was

>>>> depressed to the point of needing medication. I am thinking of

>>>> either going to the University of Birmingham to see a nephrologist

>>>> and/or endo. Is this a good idea? Is UAB a good place to go for

>>>> hyperaldosterinism? If not, can you refer a place near MS? I need

>>>> to

>>>> make sure that I have this condition ( I have all the symptoms and

>>>> the spiro-75mg- is helping my bp) and if so, how I can cure or best

>>>> treat it. The internist stated that he did not know what caused it

>>>> and that he did not believe that I had a tumor. I am grateful that

>>>> he looked into hyperaldosteronism but I think the internist is more

>>>> concentrated on the bp, since that is his specialty. I am concerned

>>>> not only about the bp, but also the mental aspects of this

>>>> condition

>>>> because it emy livelihood. Please respond.

>>>>

>>>> ---

>>>> ------------------------------------------------------------------

>>>> *From:* Clarence Grim <lowerbp2mac (DOT) com>

>>>> *To:* hyperaldosteronism

>>>> *Sent:* Thursday, May 7, 2009 1:32:35 AM

>>>> *Subject:* Re: [hyperaldosteronism ] Renewing Conn's journey

>>>>

>>>> Dont recall your previous story. Do we need to update your story?

>>>>

>>>> CE Grim MD

>>>> On May 6, 2009, at 6:05 PM, hdrewe wrote:

>>>>

>>>>> I have not been in contact with this site for a few weeks,

>>>>> however,

>>>>> am now back on track. I visited Dr Nikwan at Greenslopes Hospital,

>>>>> and am going ahead with the workups prior to maybe having surgery.

>>>>> He was certainly surprised to see me after 9 years.

>>>>>

>>>>> My Aldosterone/ Renin assays wer e:-

>>>>> Aldosterone (upright) 1923 (pmol/L) (100 - 950)

>>>>> Renin (upright) 14 (mU/L) (3.3 - 41)

>>>>> Aldosterone/ Renin Ratio 137

>>>>>

>>>>> These results were while on 25mg Spironolactone.

>>>>>

>>>>> I have been taken off Spiro and put on Verapamil SR 240mg/day,

>>>>> which I began this morning.

>>>>> I am to have CT scan of adrenal gland to see what has happened

>>>>> after all this time.

>>>>> Will revisit Dr Nikwan in 8 weeks.

>>>>> Helen D

>>>>

>>>

>>

>

> ------------------------------------

>

May 10, 2009

Sleep apneaTested for?Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertensionOn May 10, 2009, at 9:56 PM, Isa Hackett <icnhackett@...> wrote: