RE: Renewing Conn's journey

May 11, 2009

Called restless legs. May be overtreated but he is the expert.CE Grim MDOn May 10, 2009, at 9:57 PM, Carol Christie wrote:Dr Grim, yes, I was diagnosed with sleep apnoea in 2004 and have since used a CPAP machine. I had a further sleep study done in January this year, and it was found that I had a lot of leg movement (forgotten the medical term). The specialist prescribed clonazepam. This has certainly helped me to sleep through the night more often than not - a big improvement. Being wary of such medication I don't take it every night - only when I have very restless legs, and when they become achy and heavy.CarolClarence Grim wrote:>>> 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 <carolchgil.au > <mailto:carolch%40gil.com.au>> 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 > <mailto:hyperaldosteronism%40>>> >> *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 <mailto:lowerbp2%40mac.com>>> >> *To:* hyperaldosteronism > <mailto:hyperaldosteronism%40>> >> *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 11, 2009

I would discuss this with your sleep Dr and try being off clonazepam to assess its role in this. Were you on it before the problems emerged or after?CE Grim MDOn May 10, 2009, at 10:03 PM, Carol Christie wrote:Hello again Dr Grim. My current medications areverapamil 240mg/dayspiro 50mg/dayclonazepam .5mg(as required)vitamin D 2000iu/dayCarolClarence Grim wrote:>>> 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 <carolchgil.au > <mailto:carolch%40gil.com.au>> 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 > <mailto:hyperaldosteronism%40>>> >> *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 <mailto:lowerbp2%40mac.com>>> >> *To:* hyperaldosteronism > <mailto:hyperaldosteronism%40>> >> *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 11, 2009

DASH to the max.CE GrimMDOn May 10, 2009, at 10:36 PM, Helen Drewe wrote:I understand Carol, I have only been off spiro since Friday, and feel dreadful. Headaches, flushing, bloating, slight tremors, brain fog.......Dont know if it may be reaction from Verapamil. My sister told me she cant take calcium channel blockers, as she also had headaches and flushing. What do you do? I dont want to back out of having the AVS this time.HelenOn Mon, May 11, 2009 at 3:08 PM, Carol Christie <carolchgil.au> wrote:I should add that I was going to have a second AVS done at Greenslopes. However, after about 3 weeks without spiro I felt so terrible I decided to take it again. Dr Stowasser still recommends a dose of only 25mg, but I feel better on 50mg.CarolClarence Grim wrote:>>> 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 <carolchgil.au > <mailto:carolch%40gil.com.au>> 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 > <mailto:hyperaldosteronism%40>>> >> *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 <mailto:lowerbp2%40mac.com>>> >> *To:* hyperaldosteronism > <mailto:hyperaldosteronism%40>> >> *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 11, 2009

Again we go up to 400 here if needed if side effects develop then switch to spiro.CE Grim MDOn May 10, 2009, at 10:08 PM, Carol Christie wrote:I should add that I was going to have a second AVS done at Greenslopes. However, after about 3 weeks without spiro I felt so terrible I decided to take it again. Dr Stowasser still recommends a dose of only 25mg, but I feel better on 50mg.CarolClarence Grim wrote:>>> 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 <carolchgil.au > <mailto:carolch%40gil.com.au>> 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 > <mailto:hyperaldosteronism%40>>> >> *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 <mailto:lowerbp2%40mac.com>>> >> *To:* hyperaldosteronism > <mailto:hyperaldosteronism%40>> >> *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 11, 2009

But I am still 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? I do not suffer from sleep apnoea.

Thanks

From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of Clarence Grim

Sent: Monday, 11 May 2009 6:11 AM

hyperaldosteronism

Subject: Re: Renewing Conn's journey

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 MD

On 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 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 11, 2009

We don't know why. My guess is it is not enough MC blockade and not enough DASHING. But it could be a side effect of the spiro or epler. Only way to tell is to look at ur DASH record by adding up what u eat every day for Na and K or having ur dr do a 24 he urine Na /K and if below DASH GOALS THENEither increase MC SLOWLY ORDEC IT slowly to see if u feel better. So: is your BP at goal (<135/85) at home and your K normal? A number of other BP drugs may also may folks not feel right. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertensionOn May 11, 2009, at 5:40 PM, megra0409 <megra0409@...> wrote:

But I am still 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? I do not suffer from sleep apnoea.

Thanks

From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of Clarence Grim

Sent: Monday, 11 May 2009 6:11 AM

hyperaldosteronism

Subject: Re: Renewing Conn's journey

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 MD

On 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 canâ€™t

tolerate the drug â€“ 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 <lowerbp2mac>