Re: Re: Talking to the doc

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ASK for ALL your records, reports or otherwise - you'd be amused, maybe terrified, sometimes to find what's in there

Ok this is a response from my Endo, when I emailed her regarding my BP and concerns that it remains high almost one month post op. I had asked about AVS and why I was not tested. I have my appointment tomorrow and looking for feedback and wondering how accurate her response is. I'm dealing with Kaiser here, and my experiences with them thus far have been negative to say the least. This was her response below. Any feedback would be much appreciated.Thanks!Ms. Abdallah,The main purpose of your appointment with me later this week is, in fact, to go over several of the issues/questions you raised in your email. We always repeat the aldosterone and renin levels after surgery to assess for surgical cure. As you've read, hypertension is improved after surgery for all patients with unilateral disease and is cured (meaning blood pressure medications are no longer required) in about 30-60% of patients. So, very often we are able to reduce

the medications but not stop them all together. I think the significant improvement in your potassium levels is telling in and of itself that you've benefited from the surgery.The adrenal vein sampling tends to be used more in academic and tertiary care level medical centers. Even in these settings, the general guidelines developed by the experts in the field (a consensus report with guidelines was published just a few years ago) indicates that for a patient under the age of 40 with a well defined unilateral adrenal mass the vein sampling could be deferred. If the CT was unclear( meaning the adrenal gland(S) had a nodular or "lumpy" appearance or just appeared generous in size) or did not show a definite mass, then we would have had to pursue the vein sampling. It is a difficult procedure and it is recommended that it only be done by Radiologists with specific training for it (since it can lead to serious complications), so if we had had more

indicators that it was needed, then we would have referred you to get it done at one of the other Kaiser facilities (Hayward does not have a designated Radiologist for this test). So, many patients in your situation do not undergo the AS.My plan was to order the aldosterone and renin test for you when you come in this week (it needs to be done in the morning, before AM). Since your appointment is only 2 days away, I don't think I'd have the results AT the appointment if you do them tomorrow, but I've placed the order for your anyway. You can wait and do them after I see if that's easier. I can try to answer any other questions you have at your appointment.> > > Question regarding avs testing. I had an adenoma on my left gland removed Feb 2nd. Potassium has since returned to normal range 5.0 actually. BP remains on the high side, around 160/105. I never was offered AVS test. Having severe bouts with anxiety, irritability, like PMS times 10, most of the time! My family is fed up, I'm frustrated! Is it posible I had bilateral aldosterone over production? I have endo appt. March 1st. I've requested aldo renin tests again. Anything else I should ask the Endo? Still taking hctz 50 mg. Took myself off Amlodipine10 mg, Lisinopril

20 mg, and Atenolol 50 mg.> > Thanks guys> >>