Guest guest Posted October 9, 2009 Report Share Posted October 9, 2009 If you VA Dr. has you on spiro then that would be a start. You can refer him to the recent articles on the value of adding spiro to those with drug resistant HTN. I assume he is up to date on the literature and has been stressing the DASH diet in your management as well. May your pressure be low!Clarence E. Grim, BS, MS, MDSpecializing in Primary Aldosteronism the most common cause of "Difficult/Drug Resistant High Blood Pressure". Other research interests focus on the interactions of recent evolutionary forces on the body's ability to handle salt and the effect of dietary salt on blood pressure in populations today.Listed in Best Doctors of America 2009. On Oct 9, 2009, at 9:26 PM, Valarie wrote: If you have PA, is is imperative that you block aldosterone and eat very low salt. Do you have a choice other than VA? Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Francis Bill Went to my VA doctor today. It is quite clear that he knows nothing about Conn's and doesn't want any part of Dr Gimm's information on it. I tried to get him to retest me off the meds. He said that there is no point to it, even if new tests showed Conn's the only way to treat it is to control B/P and K nothing about blocking the aldosterone. He says he is already doing this. He said the risk for surgery isn't worth it. He is sorry that I feel bad but he has done all that he knows how to do. As I am writing this I received a call from my Dr about the PRA ratio test that they did. Says when they do a PAR ratio tests there is no reason to stop meds as it doesn't make any difference in the PRA ratio. This is not what it says on the Quest Lab site this is who the VA uses. From quest lab site Aldosterone (LC/MS/MS)/Plasma Renin Activity Ratio CPT Code(s): 82088, 84244 Preferred Specimen(s) 4 mL (1 mL minimum) plasma from EDTA (lavender-top) tube transferred into plastic vial. Submit frozen. Avoid refrigerated temperatures. Patient should refrain from taking medications, preferably 3 weeks prior to draw. Patient should be ambulatory for 30 minutes prior to draw. Patient should be on a moderate sodium diet during collection. This test was developed and its performance characteristics determined by Quest Diagnostics Nichols Institute. It has not been cleared or approved by the U.S. Food and Drug Administration. The FDA has determined that such clearance or approval is not necessary. Performance characteristics refer to the analytical performance of the test. My doctor also told me since I had already see the VA Endocrinologist and he found nothing wrong. There Endocrinologist is a five minute wonder. He sees you for five minutes and you wonder why. Here is his report and my k readings up to the time I saw him. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 9, 2009 Report Share Posted October 9, 2009 As we mention in our files there are a number of ways to falsely increase measured blood K. or to falsely lower it. BTH as this is all in the literature we should assume your Dr. there knows all of this.We need to mention this in your letter to the VA chief as well. Does the VA have an ombudsman for vets that you can to go first? May your pressure be low!Clarence E. Grim, BS, MS, MDSpecializing in Primary Aldosteronism the most common cause of "Difficult/Drug Resistant High Blood Pressure". Other research interests focus on the interactions of recent evolutionary forces on the body's ability to handle salt and the effect of dietary salt on blood pressure in populations today.Listed in Best Doctors of America 2009. On Oct 9, 2009, at 9:26 PM, Valarie wrote: Your K will likely show higher than it is. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Francis Bill While at the VA today they took blood to check K and other things. they took 3 tubes of blood never took the tourniquet off until almost done with the last tube. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 9, 2009 Report Share Posted October 9, 2009 Both the lab problem and my doctor is bigger then just one doctor. and maybe bigger then just this one VA. If you know doctors that work in the VA system talk to them and see what they think. Any of them can look at my record. All they need is my last name and last four of my SS. I have delt with the VA enough to know it is hard to get any answers. They go by what is in your record not by what I might say. So this isn't going to easy? I will have to get an up date of my record. > > > > > Your K will likely show higher than it is. > > > > > > > > Val > > > > > > > > From: hyperaldosteronism > > [mailto:hyperaldosteronism ] On Behalf Of Francis Bill > > > > > > While at the VA today they took blood to check K and other things. > > they took 3 tubes of blood never took the tourniquet off until > > almost done with the last tube. > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2009 Report Share Posted October 10, 2009 My guess is many of my K blood tests have been done in the wrong way. Most that try to draw my blood have a hard time doing it. The nurses in the ED have the hardest time with it. It isn't unusual the have them stick the needle in me and then try to stick it in the vain. then since this doesn't work they will do it again. At the same time they will have me pump my fist and they will slap where they are trying to get the blood from. > > > > > Your K will likely show higher than it is. > > > > > > > > Val > > > > > > > > From: hyperaldosteronism > > [mailto:hyperaldosteronism ] On Behalf Of Francis Bill > > > > > > While at the VA today they took blood to check K and other things. > > they took 3 tubes of blood never took the tourniquet off until > > almost done with the last tube. > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2009 Report Share Posted October 10, 2009 The first time I herd of the DASH diet was on this group site. they have told me that I should be on a low salt diet. From my dr visit I don't think he does much with spiro. Maybe you should call him and find out what he dose understand about PA and how to treat it. I know he has never heard of of you. This was my first question for him. This tells me he hasn't done much to try to undrestand PA. I would guess that one wouldn't have to do much research before they would see your name. > > > > > If you have PA, is is imperative that you block aldosterone and eat > > very low salt. Do you have a choice other than VA? > > > > > > > > Val > > > > > > > > From: hyperaldosteronism > > [mailto:hyperaldosteronism ] On Behalf Of Francis Bill > > > > > > Went to my VA doctor today. It is quite clear that he knows nothing > > about Conn's and doesn't want any part of Dr Gimm's information on > > it. I tried to get him to retest me off the meds. He said that > > there is no point to it, even if new tests showed Conn's the only > > way to treat it is to control B/P and K nothing about blocking the > > aldosterone. He says he is already doing this. He said the risk for > > surgery isn't worth it. He is sorry that I feel bad but he has done > > all that he knows how to do. > > > > As I am writing this I received a call from my Dr about the PRA > > ratio test that they did. Says when they do a PAR ratio tests there > > is no reason to stop meds as it doesn't make any difference in the > > PRA ratio. This is not what it says on the Quest Lab site this is > > who the VA uses. > > > > From quest lab site > > Aldosterone (LC/MS/MS)/Plasma Renin Activity Ratio > > CPT Code(s): 82088, 84244 > > Preferred Specimen(s) > > 4 mL (1 mL minimum) plasma from EDTA (lavender-top) tube > > transferred into plastic vial. Submit frozen. Avoid refrigerated > > temperatures. Patient should refrain from taking medications, > > preferably 3 weeks prior to draw. Patient should be ambulatory for > > 30 minutes prior to draw. Patient should be on a moderate sodium > > diet during collection. This test was developed and its performance > > characteristics determined by Quest Diagnostics Nichols Institute. > > It has not been cleared or approved by the U.S. Food and Drug > > Administration. The FDA has determined that such clearance or > > approval is not necessary. Performance characteristics refer to the > > analytical performance of the test. > > > > My doctor also told me since I had already see the VA > > Endocrinologist and he found nothing wrong. There Endocrinologist > > is a five minute wonder. He sees you for five minutes and you > > wonder why. Here is his report and my k readings up to the time I > > saw him. > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2009 Report Share Posted October 10, 2009 My other choice is Dartmouth Medical Center. So far have had no luck there. > > If you have PA, is is imperative that you block aldosterone and eat very low > salt. Do you have a choice other than VA? > > Val > > From: hyperaldosteronism > [mailto:hyperaldosteronism ] On Behalf Of Francis Bill > > > Went to my VA doctor today. It is quite clear that he knows nothing about > Conn's and doesn't want any part of Dr Gimm's information on it. I tried to > get him to retest me off the meds. He said that there is no point to it, > even if new tests showed Conn's the only way to treat it is to control B/P > and K nothing about blocking the aldosterone. He says he is already doing > this. He said the risk for surgery isn't worth it. He is sorry that I feel > bad but he has done all that he knows how to do. > > As I am writing this I received a call from my Dr about the PRA ratio test > that they did. Says when they do a PAR ratio tests there is no reason to > stop meds as it doesn't make any difference in the PRA ratio. This is not > what it says on the Quest Lab site this is who the VA uses. > > From quest lab site > Aldosterone (LC/MS/MS)/Plasma Renin Activity Ratio > CPT Code(s): 82088, 84244 > Preferred Specimen(s) > 4 mL (1 mL minimum) plasma from EDTA (lavender-top) tube transferred into > plastic vial. Submit frozen. Avoid refrigerated temperatures. Patient should > refrain from taking medications, preferably 3 weeks prior to draw. Patient > should be ambulatory for 30 minutes prior to draw. Patient should be on a > moderate sodium diet during collection. This test was developed and its > performance characteristics determined by Quest Diagnostics Nichols > Institute. It has not been cleared or approved by the U.S. Food and Drug > Administration. The FDA has determined that such clearance or approval is > not necessary. Performance characteristics refer to the analytical > performance of the test. > > My doctor also told me since I had already see the VA Endocrinologist and he > found nothing wrong. There Endocrinologist is a five minute wonder. He sees > you for five minutes and you wonder why. Here is his report and my k > readings up to the time I saw him. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2009 Report Share Posted October 10, 2009 My only concern is that if you start low sodium before you do the ARR, then they'll have a harder time interpreting the results. I know someone had discrepancies re. meds/stop meds when testing and they were getting mixed answers. So if you stop sodium as well, the results may be harder to interpret even further. I know that the low sodium makes a huge diff. but unfortunately, at my lab the test is based on the 92% of the population (renin) on a normal sodium diet and they do not correlate with the 24 urine sodium on a nomogram. I'm back on salt and feeling sluggish today.. I had the family doctor order the 24h urine just to make sure my sodium (urine) was in the normal range so my results would be conclusive. Although, I'm thinking of post-poning my test x1 week further to fully wash-out the altace and get the aldo/renin truly reflecting my sodium ingestion. So, ultimately, MCRB are needed and low sodium but unfortunately, to test we can't be on either until we get diagnosed. Take care Chantal > > If you have PA, is is imperative that you block aldosterone and eat very low > salt. Do you have a choice other than VA? > > Val > > From: hyperaldosteronism > [mailto:hyperaldosteronism ] On Behalf Of Francis Bill > > > Went to my VA doctor today. It is quite clear that he knows nothing about > Conn's and doesn't want any part of Dr Gimm's information on it. I tried to > get him to retest me off the meds. He said that there is no point to it, > even if new tests showed Conn's the only way to treat it is to control B/P > and K nothing about blocking the aldosterone. He says he is already doing > this. He said the risk for surgery isn't worth it. He is sorry that I feel > bad but he has done all that he knows how to do. > > As I am writing this I received a call from my Dr about the PRA ratio test > that they did. Says when they do a PAR ratio tests there is no reason to > stop meds as it doesn't make any difference in the PRA ratio. This is not > what it says on the Quest Lab site this is who the VA uses. > > From quest lab site > Aldosterone (LC/MS/MS)/Plasma Renin Activity Ratio > CPT Code(s): 82088, 84244 > Preferred Specimen(s) > 4 mL (1 mL minimum) plasma from EDTA (lavender-top) tube transferred into > plastic vial. Submit frozen. Avoid refrigerated temperatures. Patient should > refrain from taking medications, preferably 3 weeks prior to draw. Patient > should be ambulatory for 30 minutes prior to draw. Patient should be on a > moderate sodium diet during collection. This test was developed and its > performance characteristics determined by Quest Diagnostics Nichols > Institute. It has not been cleared or approved by the U.S. Food and Drug > Administration. The FDA has determined that such clearance or approval is > not necessary. Performance characteristics refer to the analytical > performance of the test. > > My doctor also told me since I had already see the VA Endocrinologist and he > found nothing wrong. There Endocrinologist is a five minute wonder. He sees > you for five minutes and you wonder why. Here is his report and my k > readings up to the time I saw him. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2009 Report Share Posted October 10, 2009 The problem is that Francis has an adrenal bump, HTN, low K, but no one is willing to look further. His ARR does not indicate PA. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Chantal My only concern is that if you start low sodium before you do the ARR, then they'll have a harder time interpreting the results. I know someone had discrepancies re. meds/stop meds when testing and they were getting mixed answers. So if you stop sodium as well, the results may be harder to interpret even further. I know that the low sodium makes a huge diff. but unfortunately, at my lab the test is based on the 92% of the population (renin) on a normal sodium diet and they do not correlate with the 24 urine sodium on a nomogram. I'm back on salt and feeling sluggish today.. I had the family doctor order the 24h urine just to make sure my sodium (urine) was in the normal range so my results would be conclusive. Although, I'm thinking of post-poning my test x1 week further to fully wash-out the altace and get the aldo/renin truly reflecting my sodium ingestion. So, ultimately, MCRB are needed and low sodium but unfortunately, to test we can't be on either until we get diagnosed. Take care Chantal > > If you have PA, is is imperative that you block aldosterone and eat very low > salt. Do you have a choice other than VA? > > Val Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2009 Report Share Posted October 10, 2009 My guess is that he hasn't read much in years. Why should he? He has a comfortable salary regardless of what he does. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Francis Bill The first time I herd of the DASH diet was on this group site. they have told me that I should be on a low salt diet. From my dr visit I don't think he does much with spiro. Maybe you should call him and find out what he dose understand about PA and how to treat it. I know he has never heard of of you. This was my first question for him. This tells me he hasn't done much to try to undrestand PA. I would guess that one wouldn't have to do much research before they would see your name. > > If you VA Dr. has you on spiro then that would be a start. You can > refer him to the recent articles on the value of adding spiro to > those with drug resistant HTN. I assume he is up to date on the > literature and has been stressing the DASH diet in your management as > well. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2009 Report Share Posted October 10, 2009 I consider a trial of spiro as a pretty good test as well. Certainly if BP andd K do not get better then no reason to test. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertensionOn Oct 10, 2009, at 9:45 AM, Valarie <val@...> wrote: The problem is that Francis has an adrenal bump, HTN, low K, but no one is willing to look further. His ARR does not indicate PA. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Chantal My only concern is that if you start low sodium before you do the ARR, then they'll have a harder time interpreting the results. I know someone had discrepancies re. meds/stop meds when testing and they were getting mixed answers. So if you stop sodium as well, the results may be harder to interpret even further. I know that the low sodium makes a huge diff. but unfortunately, at my lab the test is based on the 92% of the population (renin) on a normal sodium diet and they do not correlate with the 24 urine sodium on a nomogram. I'm back on salt and feeling sluggish today.. I had the family doctor order the 24h urine just to make sure my sodium (urine) was in the normal range so my results would be conclusive. Although, I'm thinking of post-poning my test x1 week further to fully wash-out the altace and get the aldo/renin truly reflecting my sodium ingestion. So, ultimately, MCRB are needed and low sodium but unfortunately, to test we can't be on either until we get diagnosed. Take care Chantal > > If you have PA, is is imperative that you block aldosterone and eat very low > salt. Do you have a choice other than VA? > > Val Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2009 Report Share Posted October 10, 2009 To not recommend DASH in a VA HTN Pt is medico negligence in MHO and u should complain to them medical director. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertensionOn Oct 10, 2009, at 9:45 AM, Valarie <val@...> wrote: My guess is that he hasn't read much in years. Why should he? He has a comfortable salary regardless of what he does. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Francis Bill The first time I herd of the DASH diet was on this group site. they have told me that I should be on a low salt diet. From my dr visit I don't think he does much with spiro. Maybe you should call him and find out what he dose understand about PA and how to treat it. I know he has never heard of of you. This was my first question for him. This tells me he hasn't done much to try to undrestand PA. I would guess that one wouldn't have to do much research before they would see your name. > > If you VA Dr. has you on spiro then that would be a start. You can > refer him to the recent articles on the value of adding spiro to > those with drug resistant HTN. I assume he is up to date on the > literature and has been stressing the DASH diet in your management as > well. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2009 Report Share Posted October 10, 2009 You may be right about my doctor not reading much any more. He is 68 years old and semi retired. Not sure what the VA pays there doctors I know it is less then non VA hospitals but the VA doctors don't have to have malpractice insurance. They have no risk if they mess up. > > > > If you VA Dr. has you on spiro then that would be a start. You can > > refer him to the recent articles on the value of adding spiro to > > those with drug resistant HTN. I assume he is up to date on the > > literature and has been stressing the DASH diet in your management as > > well. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2009 Report Share Posted October 10, 2009 I think that if I was tested without the meds I would have a better chance to know what my real ARR was. I belive I have enough SX of PA to have it. Even if it isn't PA there is something wrong with me. Would sure like to find out what it is. My low K can be due to the furosemide but since I take potassium chloride and triamterene a potassium sparing diuretic this should off set the furosemide. From what I read on here and other places diuretics increase renin. I am alse taking atenolol A beta blocker. Depending on what I read this can make both aldosterone and renin decrease. If the diuretics and making my renin increase and the atenolol is making my aldosterone decrease. How can they know what my ARR is? > > > > If you have PA, is is imperative that you block aldosterone and eat very > low > > salt. Do you have a choice other than VA? > > > > Val > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2009 Report Share Posted October 10, 2009 It doesn't take much searching to find just how bad the VA is. At first I thought it was a lot of bull. Now I am not so sure. My own experiences with them haven't been the best. > > > > > > If you VA Dr. has you on spiro then that would be a start. You can > > > refer him to the recent articles on the value of adding spiro to > > > those with drug resistant HTN. I assume he is up to date on the > > > literature and has been stressing the DASH diet in your management > > as > > > well. > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2009 Report Share Posted October 10, 2009 Recently you've discussed serum potassium and method of collection. How about if they do a 24 h urine collection potassium (would have to do a serum potassium that day as well to compare the two, proper technique -request and this can reflect how much you are dishing out-has it been done yet? If it is super high in the urine, perhaps they'll see that you are dumping it in the urine even though the serum sometimes indicates " normal " levels. Again, the majority of the potassium is intracellular (in the cells) and to really see where your potassium is landed, they would have to check the muscle, which is not done. I think the symptoms/severity of hypokalemia will depend a lot on your sodium intake. Furosemide is a potent diuretic and can really flush out the potassium. Triamterene is a potassium-sparing but it all depends on the dose of each. I understand you take potassium but if your potassium is low to start off, maybe the dose isn't adequate esp. if you have aldosterone working against you. Have you listed all meds/their doses? What is your pressure like? I'm sorry if this has been discussed in the past.. I can see how the meds./ healthcare system is complicating things. I've read that the meds can affect results, sodium and potassium levels as well. Wouldn't it be nice to just try the spiro. and see how things go? It must be tempting but I understand beacause it will really affect the tests and you'd need a good 6 week washout period. Keep us posted Chantal > > > > > > If you have PA, is is imperative that you block aldosterone and eat very > > low > > > salt. Do you have a choice other than VA? > > > > > > Val > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2009 Report Share Posted October 10, 2009 U need both accurate blood and urine K to make sense of what is Going on. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertensionOn Oct 10, 2009, at 9:20 PM, Chantal <chantalrobichaud29@...> wrote: Recently you've discussed serum potassium and method of collection. How about if they do a 24 h urine collection potassium (would have to do a serum potassium that day as well to compare the two, proper technique -request and this can reflect how much you are dishing out-has it been done yet? If it is super high in the urine, perhaps they'll see that you are dumping it in the urine even though the serum sometimes indicates "normal" levels. Again, the majority of the potassium is intracellular (in the cells) and to really see where your potassium is landed, they would have to check the muscle, which is not done. I think the symptoms/severity of hypokalemia will depend a lot on your sodium intake. Furosemide is a potent diuretic and can really flush out the potassium. Triamterene is a potassium-sparing but it all depends on the dose of each. I understand you take potassium but if your potassium is low to start off, maybe the dose isn't adequate esp. if you have aldosterone working against you. Have you listed all meds/their doses? What is your pressure like? I'm sorry if this has been discussed in the past.. I can see how the meds./ healthcare system is complicating things. I've read that the meds can affect results, sodium and potassium levels as well. Wouldn't it be nice to just try the spiro. and see how things go? It must be tempting but I understand beacause it will really affect the tests and you'd need a good 6 week washout period. Keep us posted Chantal > > > > > > If you have PA, is is imperative that you block aldosterone and eat very > > low > > > salt. Do you have a choice other than VA? > > > > > > Val > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2009 Report Share Posted October 10, 2009 They can't. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertensionOn Oct 10, 2009, at 7:07 PM, Francis Bill <georgewbill@...> wrote: I think that if I was tested without the meds I would have a better chance to know what my real ARR was. I belive I have enough SX of PA to have it. Even if it isn't PA there is something wrong with me. Would sure like to find out what it is. My low K can be due to the furosemide but since I take potassium chloride and triamterene a potassium sparing diuretic this should off set the furosemide. From what I read on here and other places diuretics increase renin. I am alse taking atenolol A beta blocker. Depending on what I read this can make both aldosterone and renin decrease. If the diuretics and making my renin increase and the atenolol is making my aldosterone decrease. How can they know what my ARR is? > > > > If you have PA, is is imperative that you block aldosterone and eat very > low > > salt. Do you have a choice other than VA? > > > > Val > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2009 Report Share Posted October 10, 2009 Have you seen the video with Dr.Henry Black and Dr Domenic Sica? It is in files and there is a link to utube. > > > > If you have PA, is is imperative that you block aldosterone and eat very low > > salt. Do you have a choice other than VA? > > > > Val > > > > From: hyperaldosteronism > > [mailto:hyperaldosteronism ] On Behalf Of Francis Bill > > > > > > Went to my VA doctor today. It is quite clear that he knows nothing about > > Conn's and doesn't want any part of Dr Gimm's information on it. I tried to > > get him to retest me off the meds. He said that there is no point to it, > > even if new tests showed Conn's the only way to treat it is to control B/P > > and K nothing about blocking the aldosterone. He says he is already doing > > this. He said the risk for surgery isn't worth it. He is sorry that I feel > > bad but he has done all that he knows how to do. > > > > As I am writing this I received a call from my Dr about the PRA ratio test > > that they did. Says when they do a PAR ratio tests there is no reason to > > stop meds as it doesn't make any difference in the PRA ratio. This is not > > what it says on the Quest Lab site this is who the VA uses. > > > > From quest lab site > > Aldosterone (LC/MS/MS)/Plasma Renin Activity Ratio > > CPT Code(s): 82088, 84244 > > Preferred Specimen(s) > > 4 mL (1 mL minimum) plasma from EDTA (lavender-top) tube transferred into > > plastic vial. Submit frozen. Avoid refrigerated temperatures. Patient should > > refrain from taking medications, preferably 3 weeks prior to draw. Patient > > should be ambulatory for 30 minutes prior to draw. Patient should be on a > > moderate sodium diet during collection. This test was developed and its > > performance characteristics determined by Quest Diagnostics Nichols > > Institute. It has not been cleared or approved by the U.S. Food and Drug > > Administration. The FDA has determined that such clearance or approval is > > not necessary. Performance characteristics refer to the analytical > > performance of the test. > > > > My doctor also told me since I had already see the VA Endocrinologist and he > > found nothing wrong. There Endocrinologist is a five minute wonder. He sees > > you for five minutes and you wonder why. Here is his report and my k > > readings up to the time I saw him. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2009 Report Share Posted October 10, 2009 Many say they can. I have tried to see how they do it. Doesnt seem to be any way except to guess. > > > > > > > > If you have PA, is is imperative that you block aldosterone and > > eat very > > > low > > > > salt. Do you have a choice other than VA? > > > > > > > > Val > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2009 Report Share Posted October 10, 2009 I've heard your opinion many times. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Francis Bill It doesn't take much searching to find just how bad the VA is. At first I thought it was a lot of bull. Now I am not so sure. My own experiences with them haven't been the best. > > To not recommend DASH in a VA HTN Pt is medico negligence in MHO and u > should complain to them medical director. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 11, 2009 Report Share Posted October 11, 2009 I watched it last night. I couldn't find it in the files? Late perhaps. It was a great review of the principles etc. Thanks Chantal ps. Would love to e-mail to all the doctors who need reminders... BTW, do you have a great pharmacist caring for you? Maybe you could gently " educate them " with key articles-Dr.Grim's, etc., ARR correct interpretation/resistent hypertension/proper potassium collection and have them advocate on your behalf. The pharmacist could sum up your low K, hypertension concerns etc. (adrenal issue) and maybe talk to your Dr. with suggestions that could change your meds. I think if things are not going anywhere with your case, if you truly feel that you are at a dead end, if you could somehow get onto spiro (via pharmacist suggestion-slowly titrating off your other meds with an experts help ) then the physician will hopefully (if PA ) magically see your BP, symptoms and potassium improve. If that is the case then maybe you can " win " them over to the PA diagnosis and finally, in the future, go off spiro ago (ugh!) and do an ARR ratio/AVS to investigate that bump! Don't forget, get a good baseline, 24 h urine K and Na, proper collection as well as a proper serum K beforehand. Have a very complete journal of BP results/symptoms and share all this with your pharmacist. If these come back all over the map, then you can use the great results you see post-spiro (if PA) to convince them that you need to be investigated further. Discuss all this with your pharmacist. Good luck, I hope you have a good pharmacist- willing to listen and willing to learn if not familiar with PA. Maybe drop the articles off in advance to allow them to digest the info. Maybe in US a nominal fee would be charged?? Good luck Chantal Chores awaiting! > > > > > > If you have PA, is is imperative that you block aldosterone and eat very low > > > salt. Do you have a choice other than VA? > > > > > > Val > > > > > > From: hyperaldosteronism > > > [mailto:hyperaldosteronism ] On Behalf Of Francis Bill > > > > > > > > > Went to my VA doctor today. It is quite clear that he knows nothing about > > > Conn's and doesn't want any part of Dr Gimm's information on it. I tried to > > > get him to retest me off the meds. He said that there is no point to it, > > > even if new tests showed Conn's the only way to treat it is to control B/P > > > and K nothing about blocking the aldosterone. He says he is already doing > > > this. He said the risk for surgery isn't worth it. He is sorry that I feel > > > bad but he has done all that he knows how to do. > > > > > > As I am writing this I received a call from my Dr about the PRA ratio test > > > that they did. Says when they do a PAR ratio tests there is no reason to > > > stop meds as it doesn't make any difference in the PRA ratio. This is not > > > what it says on the Quest Lab site this is who the VA uses. > > > > > > From quest lab site > > > Aldosterone (LC/MS/MS)/Plasma Renin Activity Ratio > > > CPT Code(s): 82088, 84244 > > > Preferred Specimen(s) > > > 4 mL (1 mL minimum) plasma from EDTA (lavender-top) tube transferred into > > > plastic vial. Submit frozen. Avoid refrigerated temperatures. Patient should > > > refrain from taking medications, preferably 3 weeks prior to draw. Patient > > > should be ambulatory for 30 minutes prior to draw. Patient should be on a > > > moderate sodium diet during collection. This test was developed and its > > > performance characteristics determined by Quest Diagnostics Nichols > > > Institute. It has not been cleared or approved by the U.S. Food and Drug > > > Administration. The FDA has determined that such clearance or approval is > > > not necessary. Performance characteristics refer to the analytical > > > performance of the test. > > > > > > My doctor also told me since I had already see the VA Endocrinologist and he > > > found nothing wrong. There Endocrinologist is a five minute wonder. He sees > > > you for five minutes and you wonder why. Here is his report and my k > > > readings up to the time I saw him. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 11, 2009 Report Share Posted October 11, 2009 Here is the link to the the video in our files Resistant Hypertension.wmv. This will download the video to your computer. While some of this video is meant for others with a better education then I have. I find there is enough for me to understand. Much of what is on this is the same as what Dr Grim says. You can put the utube link in your e-mails. My pharmacist is the VA. I think that many times when someone has a hard to diagnose or treat problem there should be a team approach used. > > > > > > > > If you have PA, is is imperative that you block aldosterone and eat very low > > > > salt. Do you have a choice other than VA? > > > > > > > > Val > > > > > > > > From: hyperaldosteronism > > > > [mailto:hyperaldosteronism ] On Behalf Of Francis Bill > > > > > > > > > > > > Went to my VA doctor today. It is quite clear that he knows nothing about > > > > Conn's and doesn't want any part of Dr Gimm's information on it. I tried to > > > > get him to retest me off the meds. He said that there is no point to it, > > > > even if new tests showed Conn's the only way to treat it is to control B/P > > > > and K nothing about blocking the aldosterone. He says he is already doing > > > > this. He said the risk for surgery isn't worth it. He is sorry that I feel > > > > bad but he has done all that he knows how to do. > > > > > > > > As I am writing this I received a call from my Dr about the PRA ratio test > > > > that they did. Says when they do a PAR ratio tests there is no reason to > > > > stop meds as it doesn't make any difference in the PRA ratio. This is not > > > > what it says on the Quest Lab site this is who the VA uses. > > > > > > > > From quest lab site > > > > Aldosterone (LC/MS/MS)/Plasma Renin Activity Ratio > > > > CPT Code(s): 82088, 84244 > > > > Preferred Specimen(s) > > > > 4 mL (1 mL minimum) plasma from EDTA (lavender-top) tube transferred into > > > > plastic vial. Submit frozen. Avoid refrigerated temperatures. Patient should > > > > refrain from taking medications, preferably 3 weeks prior to draw. Patient > > > > should be ambulatory for 30 minutes prior to draw. Patient should be on a > > > > moderate sodium diet during collection. This test was developed and its > > > > performance characteristics determined by Quest Diagnostics Nichols > > > > Institute. It has not been cleared or approved by the U.S. Food and Drug > > > > Administration. The FDA has determined that such clearance or approval is > > > > not necessary. Performance characteristics refer to the analytical > > > > performance of the test. > > > > > > > > My doctor also told me since I had already see the VA Endocrinologist and he > > > > found nothing wrong. There Endocrinologist is a five minute wonder. He sees > > > > you for five minutes and you wonder why. Here is his report and my k > > > > readings up to the time I saw him. > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 11, 2009 Report Share Posted October 11, 2009 You ask good qustions. I don't mind repeting what I have already posted. I find it hard to go back and read even what I have posted. never mind trying to find out others have posted. I am still working on B/P readings. But have some readings around 125/80 to 200/100. Here is some of my blood work and Meds. PLASMA GLUCOSE BUN CREAT NA K CL Ref range low 65 7 .5 135 3.5 100 Ref range high 100 25 1.5 145 5 110 mg/dL mg/dL mg/dl mmol/L mmol/L mrnol/ date time 02/22/2009 12:15 99 11 1.0 142 3.7 105 01/02/2009 18:48 101 H 9 0.9 141 3.6 104 12/15/2008 06:00 98 6 L 0.9 140 3.5 109 12/13/2008 20:25 113 H 8 0.9 141 3.4 L 105 11/01/2008 12:05 92 9 1.0 140 3.7 104 FUROSEMIDE 3 20MG TAB 10/16/2008 10/16/2008 11:37 93 9 1.0 140 3.7 103 08/19/2008 11:33 99 7 1.0 140 3.8 106 07/18/2008 14:35 111 H 8 0.9 140 3.7 108 03/28/2008 14:46 96 12 1.1 142 3.6 108 01/08/2008 12:37 102 H 12 1.1 142 4.0 107 FUROSEMIDE 20MG TAB 12/04/2007 for a few days 10/24/2007 14:41 105 H 11 1.0 142 4.1 105 09/16/2007 12:10 97 10 1.1 140 4.1 108 08/03/2007 15:05 108 H 9 1.1 142 3.7 109 06/23/2007 12:45 97 11 1.0 140 4.1 110 POTASSIUM CHLORIDE 2 10MEQ SA TAB 06/07/2007 HYDROCHLOROTHIAZIDE STOPED FUROSEMIDE 40MG TAB 06/07/2007 05/01/2007 08:37 99 12 1.0 141 3.2 L 104 TRIAMTERENE 50MG CAP 03/27/2007 03/20/2007 10:10 139 3.4 L 102 03/13/2007 06:00 98 12 1.1 138 3.3 L 108 03/12/2007 06:00 114 H 11 1.1 135 3.2 L 106 03/11/2007 12:00 126 H 14 1.1 136 3.6 103 02/16/2007 15:33 105 H 10 1.1 140 3.9 101 HYDROCHLOROTHIAZIDE 25MG TAB 02/01/2007 06/06/2006 14:02 95 9 1.0 138 4.0 105 04/22/2006 14:20 94 7 0.9 138 3.9 105 11/16/2005 14:00 97 11 1.0 138 4.3 105 08/01/2005 11: 06 92 9 0.9 138 4.1 105 > > > > > > > > If you have PA, is is imperative that you block aldosterone and eat very > > > low > > > > salt. Do you have a choice other than VA? > > > > > > > > Val > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 11, 2009 Report Share Posted October 11, 2009 It was my intent to add the VA Endocrinologist report but somehow it didn't copy to here. so here it is. pt w/ 18 mm mass in left adrenal no Sx's of HA, no spells, no nervousness or tremolous episodes no DM Hx aunt w/ DM HTN treated for 3 yrs but ?elevated in past nl K A & P Pt w/ incidental small adrenal adenomas found on CT. Neg cortisol w/u and nl glu and K. No ~x's of pheo. Given the small size and lack of labs or Sx's, I would not proceed to any other testing at this time. ANDREW J BAUMAN Assistant Chief Medicine Signed: 04/28/2008 13:50 At the time I him I had 4 blood tests that my K was less then 3.5. and many B/P readings over 140/80. > > > > > > > > > > Hi I'm new here. I just completed a 24 hour cortisol urine test this > > > > > morning, I also had lab work yesterday to check for indicators of > > > > Conn's, > > > > > 's and Cushing's, however when I was at the Endo she and I > > > > agreed > > > > > that my symptoms most indicated conn's. I have been going through > > > > this for > > > > > 10 years. I was diagnosed with Hashimoto's thyroid 8 years ago and > > > > premature > > > > > ovarian failure. My symptoms of heart palps at night, muscle > > > > twitching, > > > > > fatigue, inability to exercise without getting wiped out have been > > > > > attributed to those 2 diseases, yet when I tried to take even the > > > > smallest > > > > > amount of thyroid or female hormones I ended up with adrenaline > > > > rushes and > > > > > spiking blood pressure. I have gone to the hospital 3 times in the > > > > last 8 > > > > > years with heart palaps that ended up being from low postassium, > > > > the last > > > > > trip was in February of this year and my postassium was 2.9, there > > > > are > > > > > plenty of other times that I know I should have gone but didn't. > > > > My bp has > > > > > gone up and down, it was always very low and my moms is very low, > > > > mine used > > > > > to run 90's over 70's. I'm very small. My 2 questions are 1. is it > > > > common > > > > > for the blood pressure and potassium to go up and down with Conn's > > > > or do > > > > > they usually stay high and low consistantly? I can have bp of > > > > 140/89 one day > > > > > and 101/68 the next for no apparent reason and most times my > > > > potassium is > > > > > normal. 2. Is it common in Conn's for people to have a bad > > > > reaction to > > > > > thyroid medicine? I can't take even the smallest dose without > > > > racing heart > > > > > and what I call night time adreanline rushes. I've been dealing > > > > with this > > > > > for so long that I am hoping to come to a diagnosis. > > > > > > > > > > Thanks! > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 11, 2009 Report Share Posted October 11, 2009 My father also uses the VA and has a great MD. Pretty much all healthcare systems are flawed. I work for a private owned, not for profit hospital and feel like I, even as an eemployee, get subpar care. My dad gets much better treatment for FREE thru the VA. One of his few entitled to benefits for serving our country for 20 plus yrs.He also worked for the governement and has private insurance thru them as well and it is HORRIBLE,about as bad as my group insurance is. I have found in general, after 17 yrs of working in healthcare, side by side Dr.s in ER, specialty and family practice that most physicians are extremely egotistical and very closed minded to anyone else's opinion, whether it be advice/literature/experience,etc. Lori From: jwwright <jwwright@...>Subject: Re: Re: New here, not yet diagnosed, being testedhyperaldosteronism Date: Sunday, October 11, 2009, 1:53 PM My bro goes to the VA AND a private dr. Gets advice from both worlds.He gets in easier at the VA and prescripts are timely and 7$.One bro-in-law wouldn't get caught dead there but got free hearing aids (notcheap). He has free retirement-provided health insurance, not countingMedicare. Problem is, there are long lines at the local hospital.Other bro-in-law likes the VA - no hassle, low cost meds, never had aproblem - he is also very healthy at 82 yo.A friend had a stroke at 58 yo - VA provided full care until the could walkwith a cane. They are experimenting with a new brainal technique toreconnect his right arm. Something you might not see in a regulated by alegally controlled world.Regards RE: [hyperaldosteronism ] Re: New here, not yet diagnosed, beingtestedI've heard your opinion many times.ValFrom: hyperaldosteronism[mailto:hyperaldosteronism] On Behalf Of Francis BillIt doesn't take much searching to find just how bad the VA is. At first Ithought it was a lot of bull. Now I am not so sure. My own experiences withthem haven't been the best.>> To not recommend DASH in a VA HTN Pt is medico negligence in MHO and u> should complain to them medical director. Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.