Re: New here, not yet diagnosed, being tested

[Guest guest]

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.

[Guest guest]

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.

[Guest guest]

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.

> >

> >

> >

> >

>

[Guest guest]

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.

> >

> >

> >

> >

>

[Guest guest]

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.

> >

> >

> >

> >

>

[Guest guest]

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.

>

[Guest guest]

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.

>

[Guest guest]

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

[Guest guest]

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.

>

[Guest guest]

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

[Guest guest]

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.

>

[Guest guest]

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.

> >

>

[Guest guest]

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

>

[Guest guest]

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.

> > >

> >

> >

> >

>

[Guest guest]

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

> >

>

[Guest guest]

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

> >

>

[Guest guest]

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

>

[Guest guest]

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.

> >

>

[Guest guest]

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

> > >

> >

> >

>

[Guest guest]

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.

[Guest guest]

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.

> > >

> >

>

[Guest guest]

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.

> > > >

> > >

> >

>

[Guest guest]

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

> > >

> >

>

[Guest guest]

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!

> > > > >

> > > > >

> > > > >

> > > >

> > > >

> > >

> >

>

[Guest guest]

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.