Re: Re: Question about Saline Infusion Test

[Guest guest]

They have to r/o pheos but they are so incredibly rare - relatively speaking - that they waste too much time on them and then never think of PA. I have said it before, that I think they, the medical profession, find a pheo exciting and most do not even remember about PA from school because it is taught as a ho hum topic and as a rare disease even though the JNC guidelines make it very very clear and it's not so rare. Another thing, the nature of the headaches, and the way they can be lessened point away from a pheo. Likely not changing the nature of a pheo headache once it starts. But nearly all of us fought the intense headaches with the low K.

One of the cautionary take aways is that they rarely, if ever, draw the blood right to avoid a falsely high potassium. So when it's "borderline" normal, suspect it isn't in our cases. But your docs will treat the labs as they do the bible (well except the part about stoning adulterers to death since we wouldn't have may left in our country to run for office anymore ) and stick to the labs as if there could be no mistake. Most do not know, or remember, that K gets falsely elevated all the time due to the tourniquets and tecnique.

I had a couple of 24 hour urines IN THE HOSPITAL once and looking at my records they never checked aldosterone or renin - I had assumed they were until I got my records (I used to make the same assumption about my leg weakness, headaches, fatigue, HTN and that they were checking my thyroid too - which I had hyperthyroid - that of course was also missed, though it couldn't have been more obvious based on symptoms).

And I was even in for 5 days for resistant HTN and low K! They got excited about a pheo because one can clearly push down on my right mid abdomen (where I have some odd lumps that come and go - making it NOT likely a pheo ) and it without fail increases the heart rate significantly without causing pain (BP was always already high so how'd we know if that changed back then). But that is a "sign" of a pheo, yet I have had the MIBG scans and no pheo seen or found.

Point is, they never checked, talked about, discussed, thought of PA, but were eager to be one who "found" a pheo and ignored the obvious.

Your headaches have a good - GREAT - chance they are low K caused as low K seems to creep into every system we have. And/or you have a salt sensitivity as many of us have found that when we fail to DASH right, or let the salt get over 1500 a day, the symptoms and BP creep back, headaches, bad ones, being one of them.

From: Francis Bill SUSPECTED PA <georgewbill@...>Subject: Re: Question about Saline Infusion Testhyperaldosteronism Date: Wednesday, April 11, 2012, 12:33 PM

Headaches and High B/P more likey SX of Pheochromocytomas. But low K doesn't seem to be listed as a SX. > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > I went ahead and had the saline infusion > > > > > > test done but> > > > > > > > > > > > > > > > wondered if Dr. Grim could answer a question > > > > > > about it for me. I know> > > > > > > > > > > > > > >

> you do not do it anymore, but I thought that > > > > > > since I do not intake> > > > > > > > > > > > > > >> > > > > > > > >> > > > > > > >> > > > > > > >> > > > > > >> > > > > >> > > > > >> > > > >> > > >> > >> >>

[Guest guest]

Most of us seemed to have "classic" pheo symptoms, but in reality our signs and symptoms were also "classic" low K

From: msmith_1928 <janeray1940@...>Subject: Re: Question about Saline Infusion Testhyperaldosteronism Date: Wednesday, April 11, 2012, 1:10 PM

That headache sounds really similar to the kind of headaches I used to get before my adrenal adenoma was removed. For this reason, I was screened for pheo before I was screened for PA as my symptoms were almost textbook pheo symptoms.-msmith1928Successful left laparoscopic adrenalectomy 10/13/11> > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > I went ahead and had the saline infusion > > > > > > > test done but> > > > > > > > > > > > > > > > > wondered if Dr. Grim could answer a question > > > > > > > about it for me. I know> > > > > > > > > > > > > > > > > you do not do it anymore, but I thought that > > > > > > > since I do not intake> > > > > > > > > > > > > > > >> > > > > > > > > >> > > > > >

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

[Guest guest]

As I say there are likely 1,000,000 x more folks with Sx of pheo than have it.So while Sx are the classic "Hs" which can occur in "spells". HypertensionHeadachesHyperhidrosisHyper-metabolismHigh heart ratemost who have this will not have a pheo. Even with an adrenal bump.There is an excellent book called Pheochromocytoma by Gifford and Manger that should be required reading by all Drs who see HTN-which BTW is every Dr. CE Grim MDOn Apr 11, 2012, at 1:10 PM, msmith_1928 wrote: That headache sounds really similar to the kind of headaches I used to get before my adrenal adenoma was removed. For this reason, I was screened for pheo before I was screened for PA as my symptoms were almost textbook pheo symptoms. -msmith1928 Successful left laparoscopic adrenalectomy 10/13/11 > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > I went ahead and had the saline infusion > > > > > > > test done but > > > > > > > > > > > > > > > > > wondered if Dr. Grim could answer a question > > > > > > > about it for me. I know > > > > > > > > > > > > > > > > > you do not do it anymore, but I thought that > > > > > > > since I do not intake > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

[Guest guest]

Headaches are very common with or without HTN. Indeed some studies suggest HA are no more common in HTN than in the general population. Others disagree. I can only say a headache is due to HTN when it goes away with BP control.Many BP meds also cause headaches: apresoline, minioxidil, and CCBs to mention a few.Again the only way to tell if this is the cause is to stop meds and observe.CE Grim MDOn Apr 11, 2012, at 1:15 PM, Bingham wrote: They have to r/o pheos but they are so incredibly rare - relatively speaking - that they waste too much time on them and then never think of PA. I have said it before, that I think they, the medical profession, find a pheo exciting and most do not even remember about PA from school because it is taught as a ho hum topic and as a rare disease even though the JNC guidelines make it very very clear and it's not so rare. Another thing, the nature of the headaches, and the way they can be lessened point away from a pheo. Likely not changing the nature of a pheo headache once it starts. But nearly all of us fought the intense headaches with the low K. One of the cautionary take aways is that they rarely, if ever, draw the blood right to avoid a falsely high potassium. So when it's "borderline" normal, suspect it isn't in our cases. But your docs will treat the labs as they do the bible (well except the part about stoning adulterers to death since we wouldn't have may left in our country to run for office anymore ) and stick to the labs as if there could be no mistake. Most do not know, or remember, that K gets falsely elevated all the time due to the tourniquets and tecnique. I had a couple of 24 hour urines IN THE HOSPITAL once and looking at my records they never checked aldosterone or renin - I had assumed they were until I got my records (I used to make the same assumption about my leg weakness, headaches, fatigue, HTN and that they were checking my thyroid too - which I had hyperthyroid - that of course was also missed, though it couldn't have been more obvious based on symptoms). And I was even in for 5 days for resistant HTN and low K! They got excited about a pheo because one can clearly push down on my right mid abdomen (where I have some odd lumps that come and go - making it NOT likely a pheo ) and it without fail increases the heart rate significantly without causing pain (BP was always already high so how'd we know if that changed back then). But that is a "sign" of a pheo, yet I have had the MIBG scans and no pheo seen or found. Point is, they never checked, talked about, discussed, thought of PA, but were eager to be one who "found" a pheo and ignored the obvious. Your headaches have a good - GREAT - chance they are low K caused as low K seems to creep into every system we have. And/or you have a salt sensitivity as many of us have found that when we fail to DASH right, or let the salt get over 1500 a day, the symptoms and BP creep back, headaches, bad ones, being one of them. From: Francis Bill SUSPECTED PA <georgewbill@...>Subject: Re: Question about Saline Infusion Testhyperaldosteronism Date: Wednesday, April 11, 2012, 12:33 PM Headaches and High B/P more likey SX of Pheochromocytomas. But low K doesn't seem to be listed as a SX. > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > I went ahead and had the saline infusion > > > > > > test done but> > > > > > > > > > > > > > > > wondered if Dr. Grim could answer a question > > > > > > about it for me. I know> > > > > > > > > > > > > > > > you do not do it anymore, but I thought that > > > > > > since I do not intake> > > > > > > > > > > > > > >> > > > > > > > >> > > > > > > >> > > > > > > >> > > > > > >> > > > > >> > > > > >> > > > >> > > >> > >> >>

[Guest guest]

Again textbook Sx of pheo are very poor predictors of having a pheo in and many HTN experts I talk to. We don't know what pseudopheos have but there are many of the.Nevertheless in difficult HTN it is easy to screen for by urine testing. But a rare person who has intermittent discharges of the pheo will only have high urine testing during a spell.CE Grim MDOn Apr 11, 2012, at 1:17 PM, Bingham wrote: Most of us seemed to have "classic" pheo symptoms, but in reality our signs and symptoms were also "classic" low K From: msmith_1928 <janeray1940@...>Subject: Re: Question about Saline Infusion Testhyperaldosteronism Date: Wednesday, April 11, 2012, 1:10 PM That headache sounds really similar to the kind of headaches I used to get before my adrenal adenoma was removed. For this reason, I was screened for pheo before I was screened for PA as my symptoms were almost textbook pheo symptoms.-msmith1928Successful left laparoscopic adrenalectomy 10/13/11> > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > I went ahead and had the saline infusion > > > > > > > test done but> > > > > > > > > > > > > > > > > wondered if Dr. Grim could answer a question > > > > > > > about it for me. I know> > > > > > > > > > > > > > > > > you do not do it anymore, but I thought that > > > > > > > since I do not intake> > > > > > > > > > > > > > > >> > > > > > > > > >> > > > > > > > >> > > > > > > > >> > > > > > > >> > > > > > >> > > > > > >> > > > > >> > > > >> > > >> > >> >>

[Guest guest]

ACE will do nothing for headaches or BP in PA as the renin is so low. Reread my evolution of PA article and take to your team. Same for BB and ACEs. thiazides will lower K. Trust you are not on BCP or eat licorice every day as they can do same thing as you are having.Did anyone hear a bruit in your belly between your lower breast bone and belly button.See my approach to difficult HTN in our files.CE Grim MDOn Apr 11, 2012, at 11:47 AM, Francis Bill SUSPECTED PA wrote: They must have done CT or MRI on your head. Just to rule one thing out did you have a change in eye glasse short time before headaches started? > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > I went ahead and had the saline infusion > > > > > test done but > > > > > > > > > > > > > > > wondered if Dr. Grim could answer a question > > > > > about it for me. I know > > > > > > > > > > > > > > > you do not do it anymore, but I thought that > > > > > since I do not intake > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

[Guest guest]

My first suspicion would be renal artery stenosis: 70% of which can be Dxed in young women by listening carefully over the renal arteries in the abd and back--in a quiet room.Assuming you are not on BCPs or eat licorice every day (including licorice flavored chewing tobacco or snuff).CE Grim MDOn Apr 11, 2012, at 11:13 AM, StaceyF wrote: woke with it December 30,2008 and I never really get headaches. Behind eyes and over the top of my head like a strip over the top of my head ending at the top of the back of my head. I get shock like pain behind my ears, but that is not all the time. Head pain is usually about a 3 out 10 on pain scale and climbs for no known reason when it wants to to a 7-8/10. It feels like your eyeballs have no room and it is pushing out. Compression like. Although, putting pressure on my head and eyes makes the pain lessen. I sleep with a rice eye bag tightly pressed to my eyes every night. They call it New Daily Persistent Headache but it came at the same time as the high BP, shortness of breath doing minimal activity, cramping pain in legs on inclines/stairs, generalized exhaustion that is not relieved by sleep. It was like having the flu with no respiratory problems. My BP then shot to 170/100 in 3 days, went to ER, had minor EKG changes, found out it was likely due to low K. my K was 3.1. Given a K pill and did stress test, heart ok, sent home. Then went on ACE for bp problems and K went up to 3.6. Tests and drugs, nothing could stop the headache. I go to sleep at night with it and wake (when I am aware of being awake) the headache is there. SO I do not fit the new daily headache diagnosis cause it does not cause all the other problems, and I refuse to believe that I have 3 or 4 diagnoses that just popped up the same day. to much of a coincidence. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > I went ahead and had the saline infusion > > > > test done but > > > > > > > > > > > > > > wondered if Dr. Grim could answer a question > > > > about it for me. I know > > > > > > > > > > > > > > you do not do it anymore, but I thought that > > > > since I do not intake > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

[Guest guest]

I had written in my journal that for 2011, I do not recall having a headache the whole year after years and years of headaches etc. When the PA was controlled late 2010, and when I found this list and started DASHing and took care of my K issue, headaches went away.

I have had some last few months, BUT they do not feel like the old headaches, and I have been anemic, which I think is the cause. But they certainly had gone when HTN and K was fixed.

From: Francis Bill SUSPECTED PA <georgewbill@...>Subject: Re: Question about Saline Infusion Testhyperaldosteronism Date: Wednesday, April 11, 2012, 12:33 PM

Headaches and High B/P more likey SX of Pheochromocytomas. But low K doesn't seem to be listed as a SX. > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > I went ahead and had the saline infusion > > > > > > test done but> > > > > > > > > > > > > > > > wondered if Dr. Grim could answer a question >

> > > > > about it for me. I know> > > > > > > > > > > > > > > > you do not do it anymore, but I thought that > > > > > > since I do not intake> > > > > > > > > > > > > > >> > > > > > > > >> > > > > > > >> > > > > > > >> > > > > > >> > > > > >> > > > > >> > > > >> > > >> > >> >>

[Guest guest]

What meds as many cause headache May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Apr 11, 2012, at 21:10, StaceyF <ssminnow@...> wrote:

Agree. I however was on NO medicines when the "headache" started dec 2008. I say headache because it is always there, not just come and go, but always there. I have had the BP under control too with 3 meds for a time, well it would go low to normal and headache was there just as before. So I do not see how it is due to HTN, but that it may be the Low K. I have not gotten it up high enough yet to see if my headache improves. I pray it does.

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[Guest guest]

Ultrasound DOES not rule out RAS. ONLY a properly done renal arteriogram will do that--with selective studies of each renal arterial system. Anyone listen carefully for bruits?May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Apr 11, 2012, at 21:20, StaceyF <ssminnow@...> wrote:

Answered my last question. Had renal ultrasound to rule out renal artery stenosis already. I am just one of those people that do not fit in the box. Wish I did.

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

> > > > > > > > > > > > > > > > > > > > I went ahead and had the saline

> > infusion

> > > > > > test done but

> > > > > > > > > > > > > > > > wondered if Dr. Grim could answer a

> > question

> > > > > > about it for me. I know

> > > > > > > > > > > > > > > > you do not do it anymore, but I thought

> > that

> > > > > > since I do not intake

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[Guest guest]

Renal artery stenosis. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Apr 11, 2012, at 21:18, StaceyF <ssminnow@...> wrote:

I am off all of the BP meds except for Spiro now, but BP is still high. Very careful to keep low sodium. Newest Blood test showing iron deficiency too. Did take your article to them. No licorice or BCP. Never been told about a bruit, what would that be caused from?

Stacey

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

> > > > > > > > > > > > > > > > > > > > > I went ahead and had the

> > saline infusion

> > > > > > > test done but

> > > > > > > > > > > > > > > > > wondered if Dr. Grim could answer a

> > question

> > > > > > > about it for me. I know

> > > > > > > > > > > > > > > > > you do not do it anymore, but I

> > thought that

> > > > > > > since I do not intake

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

> > > > > > > > > >

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[Guest guest]

Ask if he is Board Certified in HTN. PROB not is he assumed that a renal US WAS adequate. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Apr 11, 2012, at 21:34, StaceyF <ssminnow@...> wrote:

I am pretty sure it was only an US. I will bring it up to the cardiologist when I go back next month. I am pretty sure he did not carefully listen for bruits. He spends less than 5 minutes with me at a visit and is dictating his note for half of that time.

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

> > > > > > > > > > > > > > > > > > > > > > I went ahead and had the saline

> > > > infusion

> > > > > > > > test done but

> > > > > > > > > > > > > > > > > > wondered if Dr. Grim could answer a

> > > > question

> > > > > > > > about it for me. I know

> > > > > > > > > > > > > > > > > > you do not do it anymore, but I thought

> > > > that

> > > > > > > > since I do not intake

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

> > > > > > > > > > >

> > > > > > > > > >

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[Guest guest]

No BCPS or OTC stuff. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Apr 11, 2012, at 21:36, StaceyF <ssminnow@...> wrote:

I was taking No medicines, well except for synthroid which I had taken since 1998. Before that day, I was healthy and medicine free except for hypothyroid.

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

> > > > > > > > > > > > > > > > > > > > > > > > I went ahead and had the

> > > > saline infusion

> > > > > > > > > > test done but

> > > > > > > > > > > > > > > > > > > > wondered if Dr. Grim could answer a

> > > > question

> > > > > > > > > > about it for me. I know

> > > > > > > > > > > > > > > > > > > > you do not do it anymore, but I

> > > > thought that

> > > > > > > > > > since I do not intake

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

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

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[Guest guest]

These posts are sure finding my buttons today. ...hee hee (with a diabolical tone of course)

Awe, I sure love EMR these days. Not. Most of the time they aren't even looking at me/us when they, or I talk, as they are at the computer console hurrying to type so they can be done and get to the next room.

Part of the art of medicine is or should be understanding a patients affect, mood, movements, eye contact (sometimes the eyes can tell you everything, in my opinion), posture, speech patterns, and so on. I think that is nearly gone now and wonder if they teach it much. I always taught the paramedics when I ws teaching full-time that it takes about 30 seconds, if that, to know if a patient is critical, by those factors above, and of course touching them, feeling a pulse, watching them breath, etc. I teach PA's the same now too. LOOK at your patient, learn people, understand people. I am not perfect at it I am sure, but after 25 + years, I can at least pick out a threat in about 10 seconds.

It seems they come in, THEY talk, direct the conversation and questions to the apporopriate "template" on the computer program, steer us away from saying too much so they can stay in the same template and not have to open a new window, and type fast so they can also input labs they want, print the script and have the diagnosis done before they exit the room. And have you all noticed they are getting worse about making sure it is ONE SINGLE complaint so they don't have to do any extra? If we're lucky (maybe lucky) they put a stethoscope to our chest.

Where have all the good times gone?

From: StaceyF <ssminnow@...>Subject: Re: Question about Saline Infusion Testhyperaldosteronism Date: Wednesday, April 11, 2012, 9:34 PM

I am pretty sure it was only an US. I will bring it up to the cardiologist when I go back next month. I am pretty sure he did not carefully listen for bruits. He spends less than 5 minutes with me at a visit and is dictating his note for half of that time.> > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > I went ahead and had the saline > > > > infusion> > > > > > > > test done but> > > > > > > > > > > > > > > > > > wondered if Dr. Grim could answer a > > > > question> > > > > > > > about it for me. I know> > > > > > > > > > > > > > > > > >

you do not do it anymore, but I thought > > > > that> > > > > > > > since I do not intake> > > > > > > > > > > > > > > > >> > > > > > > > > > >> > > > > > > > > >> > > > > > > > > >> > > > > > > > >> > > > > > > >> > > > > > > >> > > > > > >> > > > > >> > > > >> > > >> > > >> > >> > > >>

[Guest guest]

These posts are sure finding my buttons today. ...hee hee (with a diabolical tone of course)

Awe, I sure love EMR these days. Not. Most of the time they aren't even looking at me/us when they, or I talk, as they are at the computer console hurrying to type so they can be done and get to the next room.

Part of the art of medicine is or should be understanding a patients affect, mood, movements, eye contact (sometimes the eyes can tell you everything, in my opinion), posture, speech patterns, and so on. I think that is nearly gone now and wonder if they teach it much. I always taught the paramedics when I ws teaching full-time that it takes about 30 seconds, if that, to know if a patient is critical, by those factors above, and of course touching them, feeling a pulse, watching them breath, etc. I teach PA's the same now too. LOOK at your patient, learn people, understand people. I am not perfect at it I am sure, but after 25 + years, I can at least pick out a threat in about 10 seconds.

It seems they come in, THEY talk, direct the conversation and questions to the apporopriate "template" on the computer program, steer us away from saying too much so they can stay in the same template and not have to open a new window, and type fast so they can also input labs they want, print the script and have the diagnosis done before they exit the room. And have you all noticed they are getting worse about making sure it is ONE SINGLE complaint so they don't have to do any extra? If we're lucky (maybe lucky) they put a stethoscope to our chest.

Where have all the good times gone?

From: StaceyF <ssminnow@...>Subject: Re: Question about Saline Infusion Testhyperaldosteronism Date: Wednesday, April 11, 2012, 9:34 PM

I am pretty sure it was only an US. I will bring it up to the cardiologist when I go back next month. I am pretty sure he did not carefully listen for bruits. He spends less than 5 minutes with me at a visit and is dictating his note for half of that time.> > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > I went ahead and had the saline > > > > infusion> > > > > > > > test done but> > > > > > > > > > > > > > > > > > wondered if Dr. Grim could answer a > > > > question> > > > > > > > about it for me. I know> > > > > > > > > > > > > > > > > >

you do not do it anymore, but I thought > > > > that> > > > > > > > since I do not intake> > > > > > > > > > > > > > > > >> > > > > > > > > > >> > > > > > > > > >> > > > > > > > > >> > > > > > > > >> > > > > > > >> > > > > > > >> > > > > > >> > > > > >> > > > >> > > >> > > >> > >> > > >>

[Guest guest]

Dr G they only seem to listen in the groin. HOW do you recommend we check for renal bruits the best?

Answered my last question. Had renal ultrasound to rule out renal artery stenosis already. I am just one of those people that do not fit in the box. Wish I did. > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > I went ahead and had the saline > > infusion> > > > > > test done but> > > > > > > > > > > > > > > > wondered if Dr. Grim could answer a > > question> > > > > > about it for me. I know> > > > > > > > > > > > > >

> > you do not do it anymore, but I thought > > that> > > > > > since I do not intake> > > > > > > > > > > > > > >> > > > > > > > >> > > > > > > >> > > > > > > >> > > > > > >> > > > > >> > > > > >> > > > >> > > >> > >> >> >>

[Guest guest]

Dr G they only seem to listen in the groin. HOW do you recommend we check for renal bruits the best?

Answered my last question. Had renal ultrasound to rule out renal artery stenosis already. I am just one of those people that do not fit in the box. Wish I did. > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > I went ahead and had the saline > > infusion> > > > > > test done but> > > > > > > > > > > > > > > > wondered if Dr. Grim could answer a > > question> > > > > > about it for me. I know> > > > > > > > > > > > > >

> > you do not do it anymore, but I thought > > that> > > > > > since I do not intake> > > > > > > > > > > > > > >> > > > > > > > >> > > > > > > >> > > > > > > >> > > > > > >> > > > > >> > > > > >> > > > >> > > >> > >> >> >>

[Guest guest]

Heh. I am available to help for hire. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Apr 11, 2012, at 22:10, StaceyF <ssminnow@...> wrote:

I know. This Dr. is my 2nd cardiologist as the first one would not even do any tests, just wanted me on meds when the HTN started suddenly. Did not believe me that it was sudden, tells me that I just did not realize it. I am a physical therapist and checked my BP regularly and told him so. Still did not buy it. Family history = essential hypertension regardless of the other sxs.

At least this one did some testing, but every time I go there, he seems to listen less to me. Once he was dictating and said I had no episodes of presyncope. I stopped him and said I did last week, he never even asked so why would he be dictating that I had none. He just shook his head and kept dictating on his little recorder. Never added or changed what he said. There are really no good alternatives here. I am stuck trying to diagnose myself. My neurologist and primary doctor actually listen to me. Get this, the endocrinologist I went to that took 2 months for follow up on testing saw me and said she needed to research a couple things for tests she may want to do and if the meds would affect results. I get a call from her office the next day because she forgot what it was she was suppose to look up and wanted me to tell her what it was. Now that is professionalism at its best.

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[Guest guest]

That ain't HTN. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Apr 11, 2012, at 22:00, StaceyF <ssminnow@...> wrote:

Board certified in cardiology and internal medicine.

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

> > > > > > > > > > > > > > I never pee that much in a day usually. The average

> > > > > > was 1.2

> > > > > > > > > > L per day. I am always told to drink more, but even with 8-10

> > > > > > > > > > glasses per day, I never produce more than 1.5 L. Here are

> > > > > > my saline

> > > > > > > > > > results from before, you had already commented on them as it

> > > > > > was in

> > > > > > > > > > Feb., but here they are again.

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

> > > > > > > > > > > > > > Got my results back. Will not convince anyone that I

> > > > > > have PA

> > > > > > > > > > > > > > now.

> > > > > > > > > > > > > > Renin -.23ng/ml/hr at 8 am and less than .15 ng/ml/

> > > > > > hr at

> > > > > > > > > > 12:45 pm.

> > > > > > > > > > > > > > aldosterone- 11.8 ng//dl and 3.1 after the infusion.

> > > > > > > > > > > > > > Cortisol is 10.6 ug/dl at 8 am and 6.3 at 12:45 pm.

> > > > > > > > > > > > > > Serum K was 3.7 before and 3.6 after. I was doubling

> > > > > > my k

> > > > > > > > > > > > > > supp. so 40 meq and drinking coconut water to get

> > > > > > more k and

> > > > > > > > > > still

> > > > > > > > > > > > > > has such a low norm level.

> > > > > > > > > > > > > > NA serum was 138 before and 1

[Guest guest]

Supine quiet room knees flexed belly relaxed listen with bell. No pressure at first tune harder. Listen carefully move stethoscope to right and left. Have pt take deep breath and hold and listen. The take slow deep breath as in some the K moves up and down in some. So have pt sit up and listen over kidneys in back. Unless air or heating fan is turned off the brui may be buried in the white lose in background. Need to time bruit by feeling carotid or apical pulse. If it extends into diastole then almost certain a RAS. Few have been trained to listen cArefully unless I trained them. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Apr 11, 2012, at 22:01, Bingham <jlkbbk2003@...> wrote:

Dr G they only seem to listen in the groin. HOW do you recommend we check for renal bruits the best?

Answered my last question. Had renal ultrasound to rule out renal artery stenosis already. I am just one of those people that do not fit in the box. Wish I did. > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > I went ahead and had the saline > > infusion> > > > > > test done but> > > > > > > > > > > > > > > > wondered if Dr. Grim could answer a > > question> > > > > > about it for me. I know> > > > > > > > > > > > > >

> > you do not do it anymore, but I thought > > that> > > > > > since I do not intake> > > > > > > > > > > > > > >> > > > > > > > >> > > > > > > >> > > > > > > >> > > > > > >> > > > > >> > > > > >> > > > >> > > >> > >> >> >>

[Guest guest]

Thanks!

Of course, I was never taught that nor has any doc in my life ever done all that.

Answered my last question. Had renal ultrasound to rule out renal artery stenosis already. I am just one of those people that do not fit in the box. Wish I did. > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > I went ahead and had the saline > > infusion> > > > > > test

done but> > > > > > > > > > > > > > > > wondered if Dr. Grim could answer a > > question> > > > > > about it for me. I know> > > > > > > > > > > > > > > > you do not do it anymore, but I thought > > that> > > > > > since I do not intake> > > > > > > > > > > > > > >> > > > > > > > >> > > > > > > >> > > > > > > >> > > > > > >> > > > > >> > > > > >> > > > >> > > >> > >> >> >>

[Guest guest]

This of course should be done in everyone with HTN as easy way to DX RAS. Still very rare.Same for measuring BP in arms and legs or at least testing from radial femoral pulse lag.And looking for cafe-au-lait spots etc. Some details in my notes in our files on difficult HTN.Examine the hand for short fingers for example.I think I have a list of causes you can suspect when the pt walks into the room, and how they smell (to you). Prob should put this all together for a quick guide for all who take care of HTN.But most is covered in JNC.On Apr 12, 2012, at 12:44 PM, Bingham wrote: Thanks! Of course, I was never taught that nor has any doc in my life ever done all that. Answered my last question. Had renal ultrasound to rule out renal artery stenosis already. I am just one of those people that do not fit in the box. Wish I did. > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > I went ahead and had the saline > > infusion> > > > > > test done but> > > > > > > > > > > > > > > > wondered if Dr. Grim could answer a > > question> > > > > > about it for me. I know> > > > > > > > > > > > > > > > you do not do it anymore, but I thought > > that> > > > > > since I do not intake> > > > > > > > > > > > > > >> > > > > > > > >> > > > > > > >> > > > > > > >> > > > > > >> > > > > >> > > > > >> > > > >> > > >> > >> >> >>