Re: Symptoms and Thanks

January 12, 2012

>Sorry DASHing and eplere will kick the renin and aldo up. We dont have normal values to make judgements tho. Then why I am the only one in this group with so high renin as 74 and aldo as 66? Does it mean that I am Dashing much better than anyone else here? :-) Natalia From: Clarence Grim <lowerbp2@...> hyperaldosteronism Cc: Clarence Grim

<lowerbp2@...> Sent: Thursday, January 12, 2012 1:09 AM Subject: Re: Re: Symptoms and Thanks

Sorry DASHing and eplere will kick the renin and aldo up. We dont have normal values to make judgements tho. When we used to give Lasix and a low sodium diet for one day even PAs had an increase in renin and aldo but it was not normal. See my CV for some references. CE Grim MDOn Jan 11, 2012, at 5:35 PM, Natalia Kamneva wrote: >She he low renins before.True. My original renin was

0.1. >I recall this was when she was adItted when dehydrated. False. The blood test was done in October 5, 2011, when I was home, Dashing and on 100 eplerenone, feeling more or less okay, no dehydration and nothing special. NataliaFrom: Clarence Grim <lowerbp2@...> "hyperaldosteronism " <hyperaldosteronism > Sent: Monday, January 9, 2012 9:18 AM Subject: Re: Re: Symptoms and Thanks She he low renins before. I recall this was when she was adItted when dehydrated. This can cause high renin as both tKicks adrenal to make more aldo to hold onto salt to repair dehydreationMay your pressure be

low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jan 9, 2012, at 6:11, Francis Bill SUSPECTED PA <georgewbill@...> wrote: Isn't renin of 74.16 very high? If someone is diabetic and has somewhat high cholesterol at more as risk of having renal artery stenosis? With Renin this high isn't it more likely that DX would be secondary hyperaldosteronism? I do know she could have both Primary and secondary as she says she has adrenal tumor. > > > >> > > > > > > > > > >> > > > >> > > > > > > > > > >> > > > >> > > > > > > > > > >> Did I answer your question,

? > > > >> > > > > > > > > > >> In the time when I had this visit to my > > PCP I already subscribed > > > >> > > > > > > > > > >> to this group and learned about spiro and > > eplerenone, but I didn't > > > >> > > > > > > > > > >> communicate either with group or with Dr. > > Grim yet. I started > > > >> > > > > > > > > > >> eplerenone without any proof and hope, > > just out of desperation, > > > >> > > > > > > > > > >> since my BP and my condition were killing > > me and EVERY BB, Calcium > > > >> > > > > > > > > > >> channel, and other made me feel terrible. > > No

mention that clonidine > > > >> > > > > > > > > > >> almost killed me. > > > >> > > > > > > > > > >> After the first day on eplerenone, my BP > > was 130/80 - I do not > > > >> > > > > > > > > > >> remember that I ever had this BP in my life. > > > >> > > > > > > > > > >> > > > >> > > > > > > > > > >> Natalia > > > >> > > > > > > > > > >> From: Bingham <jlkbbk2003@> > > > >> > > > > > > > > > >> "hyperaldosteronism " <hyperaldosteronism > > > >> > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > >

January 12, 2012

Let's hope 20! But you have to try spiro :-) Natalia From: Francis Bill SUSPECTED PA <georgewbill@...> hyperaldosteronism Sent: Thursday, January 12, 2012 3:32 PM Subject: Re: Symptoms and Thanks

This is true. Still hopefuly we have a few more years left.

> > > > > > > > > > > > >> > >> >

> > > > > > > > > > > > >> > >> > According to your analyses and symptoms, it seems that you

> > > > > > > > > > > > >> have the same Conn's that most of us have. Start to Dash

> > > > > > > > > > > > >> IMMEDIATELY, if you feel better and if you are not afraid, try

> > > > > > > > > > > > >> spiro or eplerenone, even small dosage. If your BP behaves better

> > > > > > > > > > > > >> with this medication, that's it! Don't wait 6 months until your

> > > > > > > > > > > > >> appointment and some more years until you are going to be

> > > > > > > > > > > > >> diagnosed. Some of us, including myself, are still undiagnosed

> > > > > > > > > > > > >> after several years and many doctors.

> > > > > > > > > > > > >> > >> >

> > > > > > > > > > > > >> > >> > ÃƒÆ’Ã†'ÃƒÂ¢Ã¢â€šÂ¬Ã…Â¡

> > > > > > > > > > > > >> > >> > Natalia Kamneva 67 Russian F with 2 cm left adrenal adenoma,

> > > > > > > > > > > > >> diabetic; on 100 mg eplerenone, 80 mg Micardis, 2000 mg metformin,

> > > > > > > > > > > > >> 60 mg Dexilant and 2 mg Lorazepam; Dashing; still have some

> > > > > > > > > > > > >> occasional problems with BP, K and Na when over-salt eplerenone ;

> > > > > > > > > > > > >> on private consultation with Dr Grim.

> > > > > > > > > > > > >> > >> >

> > > > > > > > > > > > >> > >> > ________________________________

> > > > > > > > > > > > >> > >> > From: lff_409 <.>

> > > > > > > > > > > > >> > >> > To:

> > > > > > > > > > > > >> > >> > Sent: Monday, January 2, 2012 1:45 PM

> > > > > > > > > > > > >> > >> > Subject: Symptoms and Thanks

> > > > > > > > > > > > >> > >> >

> > > > > > > > > > > > >> > >> > ÃƒÆ’Ã†'ÃƒÂ¢Ã¢â€šÂ¬Ã…Â¡

> > > > > > > > > > > > >> > >> > First of all, thanks to all that responded.

> > > > > > > > > > > > >> > >> >

> > > > > > > > > > > > >> > >> > My GP sent me to the Endo for new sudden onset hypertension,

> > > > > > > > > > > > >> slightly Low K (3.1), heat intolerance, weakness, tachycardia,

> > > > > > > > > > > > >> headache, fatigue, and emotional swings. I am a 58 yo male, retired

> > > > > > > > > > > > >> firefighter. Only other medical Hx is small Pineal gland tumor and

> > > > > > > > > > > > >> hashimoto thyroiditis controlled with synthesis for past 20 years.

> > > > > > > > > > > > >> > >> >

> > > > > > > > > > > > >> > >>

> > > > > > > > > > > > >> >

> > > > > > > > > > > > >>

> > > > > > > > > > > > >

> > > > > > > > > > > >

> > > > > > > > > > >

> > > > > > > > > >

> > > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

January 12, 2012

Max, You always had an excellent GFR!!! Nothing to worry about. Natalia From: Study Circle <studycircle@...> hyperaldosteronism Sent: Thursday, January 12, 2012 9:49 PM Subject: Re: Symptoms and Thanks

It is in Attachments Folder at link:

hyperaldosteronism/attachments/folder/0/list

Max.

> >Ã‚

> Ã‚

>

January 13, 2012

It is not me that doesn't thing I need sprio. I am with my fourth PCP and can't

seen to get any of them to think I might need it.

> > > >

> > > > What u want is a trial of Spiro to see if it helps BP K AND you. Most

> > > important you. Only u can tell them u are not feeling well. No one else

can

> > > measure that. So give us a review of how you do not feel well zoned can

help

> > > get it organized.

> >

>

January 13, 2012

Do not think Renal ultrasonogram can rule it out.

> > > > > > >> > > > > > > > > > >>

> > > > > > >> > > > > > > > > > >> Did I answer your question, ?

> > > > > > >> > > > > > > > > > >> In the time when I had this visit to my

> > > > > PCP I already subscribed

> > > > > > >> > > > > > > > > > >> to this group and learned about spiro and

> > > > > eplerenone, but I didn't

> > > > > > >> > > > > > > > > > >> communicate either with group or with Dr.

> > > > > Grim yet. I started

> > > > > > >> > > > > > > > > > >> eplerenone without any proof and hope,

> > > > > just out of desperation,

> > > > > > >> > > > > > > > > > >> since my BP and my condition were killing

> > > > > me and EVERY BB, Calcium

> > > > > > >> > > > > > > > > > >> channel, and other made me feel terrible.

> > > > > No mention that clonidine

> > > > > > >> > > > > > > > > > >> almost killed me.

> > > > > > >> > > > > > > > > > >> After the first day on eplerenone, my BP

> > > > > was 130/80 - I do not

> > > > > > >> > > > > > > > > > >> remember that I ever had this BP in my life.

> > > > > > >> > > > > > > > > > >>

> > > > > > >> > > > > > > > > > >> Natalia

> > > > > > >> > > > > > > > > > >> From: Bingham <jlkbbk2003@>

> > > > > > >> > > > > > > > > > >> " hyperaldosteronism "

<hyperaldosteronism

> > > > > > >> > > > > > > > > > >>

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

January 13, 2012

They would need to do an renal artery arteriogram to know if you have renal

stenosis.

> > > > > > > >> > > > > > > > > > >>

> > > > > > > >> > > > > > > > > > >> Did I answer your question, ?

> > > > > > > >> > > > > > > > > > >> In the time when I had this visit to my

> > > > > > PCP I already subscribed

> > > > > > > >> > > > > > > > > > >> to this group and learned about spiro and

> > > > > > eplerenone, but I didn't

> > > > > > > >> > > > > > > > > > >> communicate either with group or with Dr.

> > > > > > Grim yet. I started

> > > > > > > >> > > > > > > > > > >> eplerenone without any proof and hope,

> > > > > > just out of desperation,

> > > > > > > >> > > > > > > > > > >> since my BP and my condition were killing

> > > > > > me and EVERY BB, Calcium

> > > > > > > >> > > > > > > > > > >> channel, and other made me feel terrible.

> > > > > > No mention that clonidine

> > > > > > > >> > > > > > > > > > >> almost killed me.

> > > > > > > >> > > > > > > > > > >> After the first day on eplerenone, my BP

> > > > > > was 130/80 - I do not

> > > > > > > >> > > > > > > > > > >> remember that I ever had this BP in my

life.

> > > > > > > >> > > > > > > > > > >>

> > > > > > > >> > > > > > > > > > >> Natalia

> > > > > > > >> > > > > > > > > > >> From: Bingham <jlkbbk2003@>

> > > > > > > >> > > > > > > > > > >> " hyperaldosteronism "

<hyperaldosteronism

> > > > > > > >> > > > > > > > > > >>

> > > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

January 13, 2012

No woukd. BP get better on eplereMay your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jan 12, 2012, at 21:43, Natalia Kamneva <natalia_kamneva@...> wrote:

>They must have used a dye if they thought they might put a stent in. Due you have a copy of that report. That's what I found in a medical discharge report: " Renal ultrasonogram was obtained, which showed no evidence of renal artery stenosis."> Eplerenone will work if you have stenosis. Stenosis causes you to have high Aldo.The paradox is that my aldo was 1.9 ng/dL in the time. Now, when I am for 1 year on epler it's 66 ng/dL. Still think that it might be renal stenosis?

Natalia From: Francis Bill SUSPECTED PA <georgewbill@...> hyperaldosteronism Sent: Wednesday, January 11, 2012 8:32 PM Subject: Re: Symptoms and Thanks

They must have used a dye if they thought they might put a stent in. Due you have a copy of that report.

Eplerenone will work if you have stenosis. Stenosis causes you to have high Aldo.

> > > > > >> > > > > > > > > > >>

> > > > > >> > > > > > > > > > >> Did I answer your question, ?

> > > > > >> > > > > > > > > > >> In the time when I had this visit to my

> > > > PCP I already subscribed

> > > > > >> > > > > > > > > > >> to this group and learned about spiro and

> > > > eplerenone, but I didn't

> > > > > >> > > > > > > > > > >> communicate either with group or with Dr.

> > > > Grim yet. I started

> > > > > >> > > > > > > > > > >> eplerenone without any proof and hope,

> > > > just out of desperation,

> > > > > >> > > > > > > > > > >> since my BP and my condition were killing

> > > > me and EVERY BB, Calcium

> > > > > >> > > > > > > > > > >> channel, and other made me feel terrible.

> > > > No mention that clonidine

> > > > > >> > > > > > > > > > >> almost killed me.

> > > > > >> > > > > > > > > > >> After the first day on eplerenone, my BP

> > > > was 130/80 - I do not

> > > > > >> > > > > > > > > > >> remember that I ever had this BP in my life.

> > > > > >> > > > > > > > > > >>

> > > > > >> > > > > > > > > > >> Natalia

> > > > > >> > > > > > > > > > >> From: Bingham <jlkbbk2003@>

> > > > > >> > > > > > > > > > >> "hyperaldosteronism " <hyperaldosteronism

> > > > > >> > > > > > > > > > >>

> > > > > >

> > > > >

> > > >

> > >

> >

>

January 13, 2012

Eplerenone would be my choice. What is your BP DOING. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jan 12, 2012, at 20:04, Natalia Kamneva <natalia_kamneva@...> wrote:

From your posting (see below the whole thing):>A fall in eGFR with epeler or any other drug that lowers BP may well be the result of lowering the >perfusion pressure to a damaged glomerlus (kidney). If the damage was due to the HTN or high >salt/aldo then we expect it to improve over time... If not, and low diet Na is documented by urine >testing if pt has PA, then may want to choose another BP med.> Not sure what u mean. If doing well I would not change. Yes, I feel much better on epler, but my eGFR is low and other kidneys function tests are not good. So, for how long should I experiment with epler before changing it to spiro? No other medications are considered be me at all. Many thanks, Natalia From: Clarence Grim <lowerbp2@...> To:

"hyperaldosteronism " <hyperaldosteronism > Sent: Wednesday, January 11, 2012 12:47 AM Subject: Re: Re: Symptoms and Thanks

Not sure what u mean. If doing well I would not change. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jan 10, 2012, at 16:28, Natalia Kamneva <natalia_kamneva@...> wrote:

Who long do you recommend to wait on epler until switching it to sipro, Dr. Grim? Natalia From: Clarence Grim <lowerbp2@...> hyperaldosteronism Cc:

Clarence Grim <lowerbp2@...> Sent: Saturday, January 7, 2012 1:18 PM Subject: Re: Re: Symptoms

and Thanks

A fall in eGFR with epeler or any other drug that lowers BP may well be the result of lowering the perfusion pressure to a damaged glomerlus (kidney). If the damage was due to the HTN or high salt/aldo then we expect it to improve over time. This has been documented over 40 years ago with older BP meds. So the issue is does the Dr. have enough experience to wait this out and see if renal function improves. If not, and low diet Na is documented by urine testing if pt has PA, then may want to choose another BP med. And watch eGFR as well with it.CE Grim. On Jan 7, 2012, at 10:41 AM, wrote: I pointed out sodium because it appears to be trending down BUT I don't

know what else was going; diarrhea, too much beer or water, etc. Probably easier to review yourself at: http://www.diagnose-me.com/cond/C549291.html If I had to guess I might think your doctor is looking for a larger database to determine if changes are needed. When did you start Epler? - 65 yo super ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank pain. Treating with DASH. 2-Day ave w/o meds = BP 133/77 HR 61 BS 132. D/C Spironolactone 12/20/2011 due to adverse SX. Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, Gynecomastia, MDD and PTSD. Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000MG. Started washing Spironolactone 12/20/11 to prepare for AVS. > > > > > > > > > > > > >> > >> > > > > > > > > > > > > > >> > >> > According to your analyses and symptoms, it seems that you > > > > > > > > > > > > >> have the same Conn's that most of us have. Start to Dash > > > > > > > > > > > > >> IMMEDIATELY, if you feel better and if you are not afraid, try > > > > > > > > > > > > >> spiro or eplerenone, even small dosage. If your BP behaves better > > > > > > > > > > > > >>

with this medication, that's it! Don't wait 6 months until your > > > > > > > > > > > > >> appointment and some more years until you are going to be > > > > > > > > > > > > >> diagnosed. Some of us, including myself, are still undiagnosed > > > > > > > > > > > > >> after several years and many doctors. > > > > > > > > > > > > >> > >> > > > > > > > > > > > > > >> > >> > Ãƒâ€š > > > > > > > > > > > > >> > >> > Natalia Kamneva 67 Russian F with 2 cm left adrenal adenoma, > > > > > > > > > > > > >> diabetic; on 100 mg eplerenone, 80 mg Micardis, 2000 mg metformin, > > > > > >

> > > > > > >> 60 mg Dexilant and 2 mg Lorazepam; Dashing; still have some > > > > > > > > > > > > >> occasional problems with BP, K and Na when over-salt eplerenone ; > > > > > > > > > > > > >> on private consultation with Dr Grim. > > > > > > > > > > > > >> > >> > > > > > > > > > > > > > >> > >> > > > > > > > > > > > > > >> > >> > ________________________________ > > > > > > > > > > > > >> > >> > From: lff_409 <.> > > > > > > > > > > > > >> > >> > > > > > > > > > > > > > >> > >> >

Sent: Monday, January 2, 2012 1:45 PM > > > > > > > > > > > > >> > >> > Subject: Symptoms and Thanks > > > > > > > > > > > > >> > >> > > > > > > > > > > > > > >> > >> > > > > > > > > > > > > > >> > >> > Ãƒâ€š > > > > > > > > > > > > >> > >> > First of all, thanks to all that responded. > > > > > > > > > > > > >> > >> > > > > > > > > > > > > > >> > >> > My GP sent me to the Endo for new sudden onset hypertension, > > > > > > > > > > > > >> slightly Low K (3.1), heat intolerance, weakness,

tachycardia, > > > > > > > > > > > > >> headache, fatigue, and emotional swings. I am a 58 yo male, retired > > > > > > > > > > > > >> firefighter. Only other medical Hx is small Pineal gland tumor and > > > > > > > > > > > > >> hashimoto thyroiditis controlled with synthesis for past 20 years. > > > > > > > > > > > > >> > >> > > > > > > > > > > > > > >> > >> > > > > > > > > > > > > >> > >> > > > > > > > > > > > > >> > >> > > > > > > > > > > > > >> > >> > > > > > > > > > > > > >> > >

> > > > > > > > > > > >> > > > > > > > > > > > > >> > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

January 13, 2012

Do not use dye for ultra sound. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jan 12, 2012, at 21:43, Natalia Kamneva <natalia_kamneva@...> wrote:

>They must have used a dye if they thought they might put a stent in. Due you have a copy of that report. That's what I found in a medical discharge report: " Renal ultrasonogram was obtained, which showed no evidence of renal artery stenosis."> Eplerenone will work if you have stenosis. Stenosis causes you to have high Aldo.The paradox is that my aldo was 1.9 ng/dL in the time. Now, when I am for 1 year on epler it's 66 ng/dL. Still think that it might be renal stenosis?

Natalia From: Francis Bill SUSPECTED PA <georgewbill@...> hyperaldosteronism Sent: Wednesday, January 11, 2012 8:32 PM Subject: Re: Symptoms and Thanks

They must have used a dye if they thought they might put a stent in. Due you have a copy of that report.

Eplerenone will work if you have stenosis. Stenosis causes you to have high Aldo.

> > > > > >> > > > > > > > > > >>

> > > > > >> > > > > > > > > > >> Did I answer your question, ?

> > > > > >> > > > > > > > > > >> In the time when I had this visit to my

> > > > PCP I already subscribed

> > > > > >> > > > > > > > > > >> to this group and learned about spiro and

> > > > eplerenone, but I didn't

> > > > > >> > > > > > > > > > >> communicate either with group or with Dr.

> > > > Grim yet. I started

> > > > > >> > > > > > > > > > >> eplerenone without any proof and hope,

> > > > just out of desperation,

> > > > > >> > > > > > > > > > >> since my BP and my condition were killing

> > > > me and EVERY BB, Calcium

> > > > > >> > > > > > > > > > >> channel, and other made me feel terrible.

> > > > No mention that clonidine

> > > > > >> > > > > > > > > > >> almost killed me.

> > > > > >> > > > > > > > > > >> After the first day on eplerenone, my BP

> > > > was 130/80 - I do not

> > > > > >> > > > > > > > > > >> remember that I ever had this BP in my life.

> > > > > >> > > > > > > > > > >>

> > > > > >> > > > > > > > > > >> Natalia

> > > > > >> > > > > > > > > > >> From: Bingham <jlkbbk2003@>

> > > > > >> > > > > > > > > > >> "hyperaldosteronism " <hyperaldosteronism

> > > > > >> > > > > > > > > > >>

> > > > > >

> > > > >

> > > >

> > >

> >

>

January 13, 2012

Eplere and good DASHing. What is BP DOING? May want to step down eplere. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jan 12, 2012, at 20:06, Natalia Kamneva <natalia_kamneva@...> wrote:

Thanks a lot. But what? :-) NataliaFrom: Clarence Grim <lowerbp2@...> "hyperaldosteronism " <hyperaldosteronism > Sent: Wednesday, January 11, 2012 12:47 AM Subject: Re: Re: Symptoms and Thanks

Not a renin tumor. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jan 10, 2012, at 17:23, Natalia Kamneva <natalia_kamneva@...> wrote:

So, in my case it might be low Na intake + epler ? It also might be renin secreting tumor, but how likely it's if my renin was 0.1 before starting epler? Tumor was there before. Natalia From: Clarence Grim <lowerbp2@...> hyperaldosteronism Cc: Clarence Grim <lowerbp2@...> Sent: Saturday, January 7, 2012 1:28 PM Subject: Re: Re: Symptoms and Thanks

low Na intake, BP lowering drugs, renin secreting tumor, estrogens, pregnancy, rare syndromes like Bartter's but low BP. On Jan 6, 2012, at 10:31 PM, wrote: Dr. Grim, what causes the high renin? 74.16 (0.25-5.82) - 65 yo super ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank pain. Treating with DASH. 2-Day ave w/o meds = BP 133/77 HR 61 BS 132. D/C Spironolactone 12/20/2011 due to adverse SX. Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, Gynecomastia, MDD and PTSD. Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000MG. Started washing Spironolactone 12/20/11 to prepare for AVS. > >> > > > > > > > > > >> > >> > > > > > > > > > >> > >> > > > > > > > > > >> Did I answer your question, ? > >> > > > > > > > > > >> In the time when I had this visit to my PCP I already subscribed > >> > > > > > > > > > >> to this group and learned about spiro and eplerenone, but I didn't > >> > > > > > > > > > >> communicate either with group or with Dr. Grim yet. I started > >> > > > > > > > > > >> eplerenone without any proof and hope, just out of desperation, > >> >

> > > > > > > > >> since my BP and my condition were killing me and EVERY BB, Calcium > >> > > > > > > > > > >> channel, and other made me feel terrible. No mention that clonidine > >> > > > > > > > > > >> almost killed me. > >> > > > > > > > > > >> After the first day on eplerenone, my BP was 130/80 - I do not > >> > > > > > > > > > >> remember that I ever had this BP in my life. > >> > > > > > > > > > >> > >> > > > > > > > > > >> Natalia > >> > > > > > > > > > >> From: Bingham <jlkbbk2003@> > >> > > > > > > > > > >> "hyperaldosteronism " <hyperaldosteronism > >> > > > > > > > > > >> > > > > > > >

January 13, 2012

If lab doesn't do many aldo renin tests they may not handle the blood in the

right way. From Quest lab site. After collection, sample can be stored at room

temperature up to 24 hours. Do not refrigerate the sample. Refrigeration will

cause cryoactivation to occur and prorenin will convert to renin causing falsely

high renin activity result.

> > > > > > > >> > > > > > > > > > >>

> > > > > > > >> > > > > > > > > > >> Did I answer your question, ?

> > > > > > > >> > > > > > > > > > >> In the time when I had this visit to my

> > > > > > PCP I already subscribed

> > > > > > > >> > > > > > > > > > >> to this group and learned about spiro and

> > > > > > eplerenone, but I didn't

> > > > > > > >> > > > > > > > > > >> communicate either with group or with Dr.

> > > > > > Grim yet. I started

> > > > > > > >> > > > > > > > > > >> eplerenone without any proof and hope,

> > > > > > just out of desperation,

> > > > > > > >> > > > > > > > > > >> since my BP and my condition were killing

> > > > > > me and EVERY BB, Calcium

> > > > > > > >> > > > > > > > > > >> channel, and other made me feel terrible.

> > > > > > No mention that clonidine

> > > > > > > >> > > > > > > > > > >> almost killed me.

> > > > > > > >> > > > > > > > > > >> After the first day on eplerenone, my BP

> > > > > > was 130/80 - I do not

> > > > > > > >> > > > > > > > > > >> remember that I ever had this BP in my

life.

> > > > > > > >> > > > > > > > > > >>

> > > > > > > >> > > > > > > > > > >> Natalia

> > > > > > > >> > > > > > > > > > >> From: Bingham <jlkbbk2003@>

> > > > > > > >> > > > > > > > > > >> " hyperaldosteronism "

<hyperaldosteronism

> > > > > > > >> > > > > > > > > > >>

> > > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

January 13, 2012

Natalia, I would consider that a renin of 74 with aldo at 66 may be a lab error.Â Have you had the tests more than once? Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Natalia KamnevaThen why I am the only one in this group with so high renin as 74 and aldo as 66? Does it mean that I am Dashing much better than anyone else here? :-) Natalia

January 13, 2012

>What is your BP DOING. Excellent!!!! About 125/70 stable at day time and 110/65 at night time.>Eplerenone would be my choice.I will follow your choice! Natalia From: Clarence Grim <lowerbp2@...> "hyperaldosteronism " <hyperaldosteronism > Sent: Friday, January 13, 2012 9:26 AM Subject: Re: Re: Symptoms and Thanks

Eplerenone would be my choice. What is your BP DOING. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jan 12, 2012, at 20:04, Natalia Kamneva <natalia_kamneva@...> wrote:

From your posting (see below the whole thing):>A fall in eGFR with epeler or any other drug that lowers BP may well be the result of lowering the >perfusion pressure to a damaged glomerlus (kidney). If the damage was due to the HTN or high >salt/aldo then we expect it to improve over time... If not, and low diet Na is documented by urine >testing if pt has PA, then may want to choose another BP med.> Not sure what u mean. If doing well I would not change. Yes, I feel much better on epler, but my eGFR is low and other kidneys function tests are not good. So, for how long should I experiment with epler before changing it to spiro? No other medications are considered be me at all. Many thanks, Natalia From: Clarence Grim <lowerbp2@...> To:

"hyperaldosteronism " <hyperaldosteronism > Sent: Wednesday, January 11, 2012 12:47 AM Subject: Re: Re: Symptoms and Thanks

Not sure what u mean. If doing well I would not change. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jan 10, 2012, at 16:28, Natalia Kamneva <natalia_kamneva@...> wrote:

Who long do you recommend to wait on epler until switching it to sipro, Dr. Grim? Natalia From: Clarence Grim <lowerbp2@...> hyperaldosteronism Cc:

Clarence Grim <lowerbp2@...> Sent: Saturday, January 7, 2012 1:18 PM Subject: Re: Re: Symptoms

and Thanks

A fall in eGFR with epeler or any other drug that lowers BP may well be the result of lowering the perfusion pressure to a damaged glomerlus (kidney). If the damage was due to the HTN or high salt/aldo then we expect it to improve over time. This has been documented over 40 years ago with older BP meds. So the issue is does the Dr. have enough experience to wait this out and see if renal function improves. If not, and low diet Na is documented by urine testing if pt has PA, then may want to choose another BP med. And watch eGFR as well with it.CE Grim. On Jan 7, 2012, at 10:41 AM, wrote: I pointed out sodium because it appears to be trending down BUT I don't

know what else was going; diarrhea, too much beer or water, etc. Probably easier to review yourself at: http://www.diagnose-me.com/cond/C549291.html If I had to guess I might think your doctor is looking for a larger database to determine if changes are needed. When did you start Epler? - 65 yo super ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank pain. Treating with DASH. 2-Day ave w/o meds = BP 133/77 HR 61 BS 132. D/C Spironolactone 12/20/2011 due to adverse SX. Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, Gynecomastia, MDD and PTSD. Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000MG. Started washing Spironolactone 12/20/11 to prepare for AVS. > > > > > > > > > > > > >> > >> > > > > > > > > > > > > > >> > >> > According to your analyses and symptoms, it seems that you > > > > > > > > > > > > >> have the same Conn's that most of us have. Start to Dash > > > > > > > > > > > > >> IMMEDIATELY, if you feel better and if you are not afraid, try > > > > > > > > > > > > >> spiro or eplerenone, even small dosage. If your BP behaves better > > > > > > > > > > > > >>

with this medication, that's it! Don't wait 6 months until your > > > > > > > > > > > > >> appointment and some more years until you are going to be > > > > > > > > > > > > >> diagnosed. Some of us, including myself, are still undiagnosed > > > > > > > > > > > > >> after several years and many doctors. > > > > > > > > > > > > >> > >> > > > > > > > > > > > > > >> > >> > Ãƒâ€š > > > > > > > > > > > > >> > >> > Natalia Kamneva 67 Russian F with 2 cm left adrenal adenoma, > > > > > > > > > > > > >> diabetic; on 100 mg eplerenone, 80 mg Micardis, 2000 mg metformin, > > > > > >

> > > > > > >> 60 mg Dexilant and 2 mg Lorazepam; Dashing; still have some > > > > > > > > > > > > >> occasional problems with BP, K and Na when over-salt eplerenone ; > > > > > > > > > > > > >> on private consultation with Dr Grim. > > > > > > > > > > > > >> > >> > > > > > > > > > > > > > >> > >> > > > > > > > > > > > > > >> > >> > ________________________________ > > > > > > > > > > > > >> > >> > From: lff_409 <.> > > > > > > > > > > > > >> > >> > > > > > > > > > > > > > >> > >> >

Sent: Monday, January 2, 2012 1:45 PM > > > > > > > > > > > > >> > >> > Subject: Symptoms and Thanks > > > > > > > > > > > > >> > >> > > > > > > > > > > > > > >> > >> > > > > > > > > > > > > > >> > >> > Ãƒâ€š > > > > > > > > > > > > >> > >> > First of all, thanks to all that responded. > > > > > > > > > > > > >> > >> > > > > > > > > > > > > > >> > >> > My GP sent me to the Endo for new sudden onset hypertension, > > > > > > > > > > > > >> slightly Low K (3.1), heat intolerance, weakness,

tachycardia, > > > > > > > > > > > > >> headache, fatigue, and emotional swings. I am a 58 yo male, retired > > > > > > > > > > > > >> firefighter. Only other medical Hx is small Pineal gland tumor and > > > > > > > > > > > > >> hashimoto thyroiditis controlled with synthesis for past 20 years. > > > > > > > > > > > > >> > >> > > > > > > > > > > > > > >> > >> > > > > > > > > > > > > >> > >> > > > > > > > > > > > > >> > >> > > > > > > > > > > > > >> > >> > > > > > > > > > > > > >> > >

> > > > > > > > > > > >> > > > > > > > > > > > > >> > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

January 13, 2012

BP is stable about 125/75 at day time. I take 50 mg of epler in the morning and 37.5 mg in the evening. How we are going to step down? Is it okay 50 mg + 25 mg? I prefer to decrease the evening dosage since I am still going many times to a bathroom during night. Natalia From: Clarence Grim <lowerbp2@...> "hyperaldosteronism " <hyperaldosteronism > Sent: Friday, January 13, 2012 9:28 AM Subject: Re: Re: Symptoms and Thanks

Eplere and good DASHing. What is BP DOING? May want to step down eplere. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jan 12, 2012, at 20:06, Natalia Kamneva <natalia_kamneva@...> wrote:

Thanks a lot. But what? :-) NataliaFrom: Clarence Grim <lowerbp2@...> "hyperaldosteronism " <hyperaldosteronism > Sent: Wednesday, January 11, 2012 12:47 AM Subject: Re: Re: Symptoms and Thanks

Not a renin tumor. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jan 10, 2012, at 17:23, Natalia Kamneva <natalia_kamneva@...> wrote:

So, in my case it might be low Na intake + epler ? It also might be renin secreting tumor, but how likely it's if my renin was 0.1 before starting epler? Tumor was there before. Natalia From: Clarence Grim <lowerbp2@...> hyperaldosteronism Cc: Clarence Grim <lowerbp2@...> Sent: Saturday, January 7, 2012 1:28 PM Subject: Re: Re: Symptoms and Thanks

low Na intake, BP lowering drugs, renin secreting tumor, estrogens, pregnancy, rare syndromes like Bartter's but low BP. On Jan 6, 2012, at 10:31 PM, wrote: Dr. Grim, what causes the high renin? 74.16 (0.25-5.82) - 65 yo super ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank pain. Treating with DASH. 2-Day ave w/o meds = BP 133/77 HR 61 BS 132. D/C Spironolactone 12/20/2011 due to adverse SX. Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, Gynecomastia, MDD and PTSD. Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000MG. Started washing Spironolactone 12/20/11 to prepare for AVS. > >> > > > > > > > > > >> > >> > > > > > > > > > >> > >> > > > > > > > > > >> Did I answer your question, ? > >> > > > > > > > > > >> In the time when I had this visit to my PCP I already subscribed > >> > > > > > > > > > >> to this group and learned about spiro and eplerenone, but I didn't > >> > > > > > > > > > >> communicate either with group or with Dr. Grim yet. I started > >> > > > > > > > > > >> eplerenone without any proof and hope, just out of desperation, > >> >

> > > > > > > > >> since my BP and my condition were killing me and EVERY BB, Calcium > >> > > > > > > > > > >> channel, and other made me feel terrible. No mention that clonidine > >> > > > > > > > > > >> almost killed me. > >> > > > > > > > > > >> After the first day on eplerenone, my BP was 130/80 - I do not > >> > > > > > > > > > >> remember that I ever had this BP in my life. > >> > > > > > > > > > >> > >> > > > > > > > > > >> Natalia > >> > > > > > > > > > >> From: Bingham <jlkbbk2003@> > >> > > > > > > > > > >> "hyperaldosteronism " <hyperaldosteronism > >> > > > > > > > > > >> > > > > > > >

January 13, 2012

Thanks, Francis. Good to know. My test was done in Quest Lab, but who knows:-) I will repeat it in couple of months. Natalia From: Francis Bill SUSPECTED PA <georgewbill@...> hyperaldosteronism Sent: Friday, January 13, 2012 9:37 AM Subject: Re: Symptoms and Thanks

If lab doesn't do many aldo renin tests they may not handle the blood in the right way. From Quest lab site. After collection, sample can be stored at room temperature up to 24 hours. Do not refrigerate the sample. Refrigeration will cause cryoactivation to occur and prorenin will convert to renin causing falsely high renin activity result.

> > > > > > > >> > > > > > > > > > >>

> > > > > > > >> > > > > > > > > > >> Did I answer your question, ?

> > > > > > > >> > > > > > > > > > >> In the time when I had this visit to my

> > > > > > PCP I already subscribed

> > > > > > > >> > > > > > > > > > >> to this group and learned about spiro and

> > > > > > eplerenone, but I didn't

> > > > > > > >> > > > > > > > > > >> communicate either with group or with Dr.

> > > > > > Grim yet. I started

> > > > > > > >> > > > > > > > > > >> eplerenone without any proof and hope,

> > > > > > just out of desperation,

> > > > > > > >> > > > > > > > > > >> since my BP and my condition were killing

> > > > > > me and EVERY BB, Calcium

> > > > > > > >> > > > > > > > > > >> channel, and other made me feel terrible.

> > > > > > No mention that clonidine

> > > > > > > >> > > > > > > > > > >> almost killed me.

> > > > > > > >> > > > > > > > > > >> After the first day on eplerenone, my BP

> > > > > > was 130/80 - I do not

> > > > > > > >> > > > > > > > > > >> remember that I ever had this BP in my life.

> > > > > > > >> > > > > > > > > > >>

> > > > > > > >> > > > > > > > > > >> Natalia

> > > > > > > >> > > > > > > > > > >> From: Bingham <jlkbbk2003@>

> > > > > > > >> > > > > > > > > > >> "hyperaldosteronism " <hyperaldosteronism

> > > > > > > >> > > > > > > > > > >>

> > > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

January 13, 2012

Was the blood drawn at a quest lab or only tested there?

> > > > > > > > >> > > > > > > > > > >>

> > > > > > > > >> > > > > > > > > > >> Did I answer your question, ?

> > > > > > > > >> > > > > > > > > > >> In the time when I had this visit to my

> > > > > > > PCP I already subscribed

> > > > > > > > >> > > > > > > > > > >> to this group and learned about spiro

and

> > > > > > > eplerenone, but I didn't

> > > > > > > > >> > > > > > > > > > >> communicate either with group or with

Dr.

> > > > > > > Grim yet. I started

> > > > > > > > >> > > > > > > > > > >> eplerenone without any proof and hope,

> > > > > > > just out of desperation,

> > > > > > > > >> > > > > > > > > > >> since my BP and my condition were

killing

> > > > > > > me and EVERY BB, Calcium

> > > > > > > > >> > > > > > > > > > >> channel, and other made me feel

terrible.

> > > > > > > No mention that clonidine

> > > > > > > > >> > > > > > > > > > >> almost killed me.

> > > > > > > > >> > > > > > > > > > >> After the first day on eplerenone, my BP

> > > > > > > was 130/80 - I do not

> > > > > > > > >> > > > > > > > > > >> remember that I ever had this BP in my

life.

> > > > > > > > >> > > > > > > > > > >>

> > > > > > > > >> > > > > > > > > > >> Natalia

> > > > > > > > >> > > > > > > > > > >> From: Bingham <jlkbbk2003@>

> > > > > > > > >> > > > > > > > > > >> " hyperaldosteronism "

<hyperaldosteronism

> > > > > > > > >> > > > > > > > > > >>

> > > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

January 13, 2012

Several time going to bathroom at night I suspect means you still have too much salt (other than taking Eplr in the evening) L Max. BP is stable about 125/75 at day time. I take 50 mg of epler in the morning and 37.5 mg in the evening. How we are going to step down? Is it okay 50 mg + 25 mg? I prefer to decrease the evening dosage since I am still going many times to a bathroom during night. Natalia

January 13, 2012

Max might be onto something, my BP was great immediately after starting spiro.

It took 10 months to get NA low enough to allow all SX of PA, including night

urinating, to disappear.

- 65 yo super ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank

pain. Treating with DASH. Stats w/o meds = BP 175/90 HR 59 BS 125. D/C

Spironolactone 12/20/2011 due to adverse SX.

Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, Gynecomastia, MDD

and PTSD.

Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and

Metformin 2000MG. Started washing Spironolactone 12/20/11 to prepare for AVS.

>

> Several time going to bathroom at night I suspect means you still have too

much salt (other than taking Eplr in the evening) :-(

>

> Max.

>

> BP is stable about 125/75 at day time. I take 50 mg of epler in the morning

and 37.5 mg in the evening. How we are going to step down? Is it okay 50 mg + 25

mg? I prefer to decrease the evening dosage since I am still going many times to

a bathroom during night.

>

> Natalia

>

> _____

>

January 13, 2012

I was on 50/25 for a while until I found I couldn't go above 25/25 due to

gastric issues. Actually I've seen recommendations for " once or twice a day " so

that may be an option also. For a good discussion see this:

http://www.ccjm.org/content/73/3/257.full.pdf

- 65 yo super ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank

pain. Treating with DASH. Stats w/o meds = BP 175/90 HR 59 BS 125. D/C

Spironolactone 12/20/2011 due to adverse SX.

Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, Gynecomastia, MDD

and PTSD.

Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and

Metformin 2000MG. Started washing Spironolactone 12/20/11 to prepare for AVS.

> >>>> >> > > > > > > > > > >>

> >>>> >> > > > > > > > > > >> Did I answer your question, ?

> >>>> >> > > > > > > > > > >> In the time when I had this visit to my PCP I

already subscribed

> >>>> >> > > > > > > > > > >> to this group and learned about spiro and

eplerenone, but I didn't

> >>>> >> > > > > > > > > > >> communicate either with group or with Dr. Grim

yet. I started

> >>>> >> > > > > > > > > > >> eplerenone without any proof and hope, just out

of desperation,

> >>>> >> >

> > > > > > > > > >> since my BP and my condition were killing me and EVERY BB,

Calcium

> >>>> >> > > > > > > > > > >> channel, and other made me feel terrible. No

mention that clonidine

> >>>> >> > > > > > > > > > >> almost killed me.

> >>>> >> > > > > > > > > > >> After the first day on eplerenone, my BP was

130/80 - I do not

> >>>> >> > > > > > > > > > >> remember that I ever had this BP in my life.

> >>>> >> > > > > > > > > > >>

> >>>> >> > > > > > > > > > >> Natalia

> >>>> >> > > > > > > > > > >> From: Bingham <jlkbbk2003@>

> >>>> >> > > > > > > > > > >> " hyperaldosteronism "

<hyperaldosteronism

> >>>> >> > > > > > > > > > >>

> >>>> >

> >>>>

> >>>

> >>

> >

>

January 14, 2012

Most have not had renin and aldo repeated on DASH or EplereOn Jan 12, 2012, at 9:51 PM, Natalia Kamneva wrote: >Sorry DASHing and eplere will kick the renin and aldo up. We dont have normal values to make judgements tho. Then why I am the only one in this group with so high renin as 74 and aldo as 66? Does it mean that I am Dashing much better than anyone else here? :-) Natalia From: Clarence Grim <lowerbp2@...> hyperaldosteronism Cc: Clarence Grim <lowerbp2@...> Sent: Thursday, January 12, 2012 1:09 AM Subject: Re: Re: Symptoms and Thanks Sorry DASHing and eplere will kick the renin and aldo up. We dont have normal values to make judgements tho. When we used to give Lasix and a low sodium diet for one day even PAs had an increase in renin and aldo but it was not normal. See my CV for some references. CE Grim MDOn Jan 11, 2012, at 5:35 PM, Natalia Kamneva wrote: >She he low renins before.True. My original renin was 0.1. >I recall this was when she was adItted when dehydrated. False. The blood test was done in October 5, 2011, when I was home, Dashing and on 100 eplerenone, feeling more or less okay, no dehydration and nothing special. NataliaFrom: Clarence Grim <lowerbp2@...> "hyperaldosteronism " <hyperaldosteronism > Sent: Monday, January 9, 2012 9:18 AM Subject: Re: Re: Symptoms and Thanks She he low renins before. I recall this was when she was adItted when dehydrated. This can cause high renin as both tKicks adrenal to make more aldo to hold onto salt to repair dehydreationMay your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jan 9, 2012, at 6:11, Francis Bill SUSPECTED PA <georgewbill@...> wrote: Isn't renin of 74.16 very high? If someone is diabetic and has somewhat high cholesterol at more as risk of having renal artery stenosis? With Renin this high isn't it more likely that DX would be secondary hyperaldosteronism? I do know she could have both Primary and secondary as she says she has adrenal tumor. > > > >> > > > > > > > > > >> > > > >> > > > > > > > > > >> > > > >> > > > > > > > > > >> Did I answer your question, ? > > > >> > > > > > > > > > >> In the time when I had this visit to my > > PCP I already subscribed > > > >> > > > > > > > > > >> to this group and learned about spiro and > > eplerenone, but I didn't > > > >> > > > > > > > > > >> communicate either with group or with Dr. > > Grim yet. I started > > > >> > > > > > > > > > >> eplerenone without any proof and hope, > > just out of desperation, > > > >> > > > > > > > > > >> since my BP and my condition were killing > > me and EVERY BB, Calcium > > > >> > > > > > > > > > >> channel, and other made me feel terrible. > > No mention that clonidine > > > >> > > > > > > > > > >> almost killed me. > > > >> > > > > > > > > > >> After the first day on eplerenone, my BP > > was 130/80 - I do not > > > >> > > > > > > > > > >> remember that I ever had this BP in my life. > > > >> > > > > > > > > > >> > > > >> > > > > > > > > > >> Natalia > > > >> > > > > > > > > > >> From: Bingham <jlkbbk2003@> > > > >> > > > > > > > > > >> "hyperaldosteronism " <hyperaldosteronism > > > >> > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > >

January 14, 2012

Well if your BP and K are good and you are feeling normal/well on current regimen then I would sit tight. CE Grim MDOn Jan 13, 2012, at 5:38 AM, Francis Bill SUSPECTED PA wrote: It is not me that doesn't thing I need sprio. I am with my fourth PCP and can't seen to get any of them to think I might need it. > > > > > > > > What u want is a trial of Spiro to see if it helps BP K AND you. Most > > > important you. Only u can tell them u are not feeling well. No one else can > > > measure that. So give us a review of how you do not feel well zoned can help > > > get it organized. > > >

January 14, 2012

Eplere in evening will OT affect your night peeing i would thBk. indeed taking more at night might be better but u can try it out. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jan 13, 2012, at 18:46, Natalia Kamneva <natalia_kamneva@...> wrote:

BP is stable about 125/75 at day time. I take 50 mg of epler in the morning and 37.5 mg in the evening. How we are going to step down? Is it okay 50 mg + 25 mg? I prefer to decrease the evening dosage since I am still going many times to a bathroom during night. Natalia From: Clarence Grim <lowerbp2@...> "hyperaldosteronism " <hyperaldosteronism > Sent: Friday, January 13, 2012 9:28 AM Subject: Re: Re: Symptoms and Thanks

Eplere and good DASHing. What is BP DOING? May want to step down eplere. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jan 12, 2012, at 20:06, Natalia Kamneva <natalia_kamneva@...> wrote:

Thanks a lot. But what? :-) NataliaFrom: Clarence Grim <lowerbp2@...> "hyperaldosteronism " <hyperaldosteronism > Sent: Wednesday, January 11, 2012 12:47 AM Subject: Re: Re: Symptoms and Thanks

Not a renin tumor. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jan 10, 2012, at 17:23, Natalia Kamneva <natalia_kamneva@...> wrote:

So, in my case it might be low Na intake + epler ? It also might be renin secreting tumor, but how likely it's if my renin was 0.1 before starting epler? Tumor was there before. Natalia From: Clarence Grim <lowerbp2@...> hyperaldosteronism Cc: Clarence Grim <lowerbp2@...> Sent: Saturday, January 7, 2012 1:28 PM Subject: Re: Re: Symptoms and Thanks

low Na intake, BP lowering drugs, renin secreting tumor, estrogens, pregnancy, rare syndromes like Bartter's but low BP. On Jan 6, 2012, at 10:31 PM, wrote: Dr. Grim, what causes the high renin? 74.16 (0.25-5.82) - 65 yo super ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank pain. Treating with DASH. 2-Day ave w/o meds = BP 133/77 HR 61 BS 132. D/C Spironolactone 12/20/2011 due to adverse SX. Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, Gynecomastia, MDD and PTSD. Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000MG. Started washing Spironolactone 12/20/11 to prepare for AVS. > >> > > > > > > > > > >> > >> > > > > > > > > > >> > >> > > > > > > > > > >> Did I answer your question, ? > >> > > > > > > > > > >> In the time when I had this visit to my PCP I already subscribed > >> > > > > > > > > > >> to this group and learned about spiro and eplerenone, but I didn't > >> > > > > > > > > > >> communicate either with group or with Dr. Grim yet. I started > >> > > > > > > > > > >> eplerenone without any proof and hope, just out of desperation, > >> >

> > > > > > > > >> since my BP and my condition were killing me and EVERY BB, Calcium > >> > > > > > > > > > >> channel, and other made me feel terrible. No mention that clonidine > >> > > > > > > > > > >> almost killed me. > >> > > > > > > > > > >> After the first day on eplerenone, my BP was 130/80 - I do not > >> > > > > > > > > > >> remember that I ever had this BP in my life. > >> > > > > > > > > > >> > >> > > > > > > > > > >> Natalia > >> > > > > > > > > > >> From: Bingham <jlkbbk2003@> > >> > > > > > > > > > >> "hyperaldosteronism " <hyperaldosteronism > >> > > > > > > > > > >> > > > > > > >

January 14, 2012

The echo is good in here. Most can get Na low enoughr in 7 days if they work on it. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jan 13, 2012, at 19:21, <jclark24p@...> wrote:

Max might be onto something, my BP was great immediately after starting spiro. It took 10 months to get NA low enough to allow all SX of PA, including night urinating, to disappear.

- 65 yo super ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank pain. Treating with DASH. Stats w/o meds = BP 175/90 HR 59 BS 125. D/C Spironolactone 12/20/2011 due to adverse SX.

Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, Gynecomastia, MDD and PTSD.

Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000MG. Started washing Spironolactone 12/20/11 to prepare for AVS.

>

> Several time going to bathroom at night I suspect means you still have too much salt (other than taking Eplr in the evening) :-(

>

> Max.

>

> BP is stable about 125/75 at day time. I take 50 mg of epler in the morning and 37.5 mg in the evening. How we are going to step down? Is it okay 50 mg + 25 mg? I prefer to decrease the evening dosage since I am still going many times to a bathroom during night.

>

> Natalia

>

> _____

>

January 14, 2012

That should be will not. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jan 14, 2012, at 1:45, Clarence Grim <lowerbp2@...> wrote: