Re: adrenal vein testing

[Guest guest]

That's great! Sounds like you will be having the best of care. Looking forward

to hearing your report back.

> > > > > > > > > >

> > > > > > > > > > ÃÆ'‚ÂÂ

> > > > > > > > > > >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 cente

> > > >

> > >

> >

>

[Guest guest]

Oooh ahh...well, then, I'll play.

ok, I would still opt for avs. Since we don't know the answers to all those

questions and that seems the best option if I can't have meds or have to wait

until 45 to really get an idea of the tumors, which by then, could've ruined my

fertility, life, etc.

Radiation is another story...I think I'm screwed with that one. Had way too

many cat scans and xrays without lead protection before anyone cared.

> > > > > > > >

> > > > > > > > ÃÆ'‚ÂÂ

> > > > > > > > >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 cente

> >

>

[Guest guest]

We all have other issues to bring into the mix. Take a young woman who has

hypertrophic cardiomyopathy or wolf parkinsons white syndrome Not bad enough

for a defibrolater, but bad enough to faint every now and then. Add to that

chronic low potassium. high aldo ratio, hypothyroidism, metabolic syndrome,

polycystic syndrome, and infertility issues too. She's below the age

threshold...but continued PA in her case could add more thickness to her left

ventricle wall, putting her at more cardiac risk. All the endocrine issues

could get worse and impair her ability to bear children or balance her thyroid,

she may develop fibroids, she may get more ovarian cysts...she already faints,

and the low k would make her faint more. Fainting causes broken bones which

need radiation and xrays. By 50, she might develop diabetes II. If she has PA,

then maybe she should have AVS and the whole picture with all of her questions

answered about the entire endocrine, cardiac, infertility issues on the table.

I don't even know if they are all related, but you wanted devils advocacy,

didn't you? Maybe she had brain trauma too.

> > > > > > > > >

> > > > > > > > > ÃÆ'‚ÂÂ

> > > > > > > > > >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 cente

> > >

> >

>

[Guest guest]

Maggie, I have to go vote but I will get to you when I get back!

> > > > > > > >

> > > > > > > > ÃÆ'‚ÂÂ

> > > > > > > > >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 cente

> >

>

[Guest guest]

Np59 = np58+np1

|

|what's an np59 scan?

|

[Guest guest]

A Conn's tumor has not been reported in the testis. Theoretically they could occur anywhere adrenal rests rest. Conn's adenomas have been reported in the brain and in the ovary. Have not looked recently. Would do a pubmed for extra-adrenal Conn's syndrome. CE Grim MD On Mar 6, 2012, at 1:10 PM, wrote: If it is ovary or brain is there n underlying tumor? You mentioned ovary, is testis an option? > >>> > >>> > >>> Ms. Abdallah, > >>> > >>> Attached, please, find some results of my AVS and the conclusion of my nephrologist. It was done in August 2011, but I got it only recently. Dr. Grim told me practically the same thing about 6 -8 months ago. > >>> > >>> So yes, even if I have a huge left 3 cm adenoma, my PA is bilateral according to the results of AVS. Even my right side produces slightly more hormones. And it's a common case according to Dr. Grim. > >>> > >>> >So what if it does turn out to be bilateral..then what? > >>> > >>> I only can give you my advices, what would I do in this case. It's up to you to decide. > >>> > >>> 1. I would IMMEDIATELY go to low Na/high K diet. > >>> 2. I would ask to prescribe me Inspra or spiro. > >>> 3. I would go on private consultation with Dr. Grim. I will not overestimate anything saying that he saved my life. > >>> 4. I would do all tests that Dr. Grim and your team recommend to do to figure out what happened. > >>> 5. I would prepare to tomorrow's appointment very well. I would be especially interested to get all prove that the doctor has, that it's not bilateral. > >>> 6. After all of that it's a long road to regulate your diet and your dosage/medications. It's not that simple at all. > >>> > >>> Just remember, we are still lucky, that by a medication and diet we can control this disease. > >>> > >>> Good luck with tomorrow. > >>> > >>> > >>> Natalia Kamneva 67 Russian F with 3 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; on private consultation with Dr Grim. >

[Guest guest]

Assume the informed consent you signed detailed all the risks.May want to read it again. CE Grim MDOn Mar 6, 2012, at 1:41 PM, maggiekat7 wrote: My point, , is not about my judgement about these odds, it's about the desire that each patient be able to evaluate their situation and have all choices available to them for further care. Then, they can figure out those odds and pick the choice themselves. For me, I am now concerned about something you just wrote...a 1.5% chance of ruining an adrenal gland or other complications of AVS???? PLlllleeeeaaase tell me more! OMG!!! I guess I'd better up my cyberchondriosis cause I've missed all this! Scheduled for it next Friday...and I'm always in that percentage! > > > > > > > > > > > > > > ÃÆ'‚ÂÂ > > > > > > > >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 cente >

[Guest guest]

Ask them to use ACTH if they know how during the AVS and to use two catheters.CE Grim MDOn Mar 6, 2012, at 1:52 PM, msmith_1928 wrote: Hi Maggiekat, I've been through 2 AVS procedures and I have to say this: the stuff they legally have to tell you beforehand about the 1.5% chance of rupturing an adrenal, not to mention the 1% chance of DEATH (yes, they really do tell you this) is far more scary than the actual procedure, at least if you are in good hands. Did I understand correctly that you are scheduled for one next Friday? Please don't put too much effort into worrying - just be aware that there are risks, and that you are willing to take those risks in order to get better. -msmith1928 Successful left laparoscopic adrenalectomy 10/13/11 > > > > > > > > > > > > > > > > ÃÆ'‚ÂÂ > > > > > > > > >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 cente > > >

[Guest guest]

acth? two catheters? please explain?

> > > > > > > > > >

> > > > > > > > > > ÃÆ'‚ÂÂ

> > > > > > > > > > >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 cente

> > > >

> > >

> >

> >

>

[Guest guest]

Read the Endo guidelines in our files. ACTH is to minimze minute to minute variations in Aldo and cortisol. Some use it some do not. I and others recommend it.Two caths (one in each adrenal) are to assure simultaneous sampling from L and R adrenal. Some use only 1, I and others recommend 2. CE Grim MDOn Mar 6, 2012, at 5:16 PM, maggiekat7 wrote: acth? two catheters? please explain? > > > > > > > > > > > > > > > > > > > > ÃÆ'‚ÂÂ > > > > > > > > > > >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 cente > > > > > > > > > > > >

[Guest guest]

Read the Endo guidelines in our files. ACTH is to minimze minute to minute variations in Aldo and cortisol. Some use it some do not. I and others recommend it.Two caths (one in each adrenal) are to assure simultaneous sampling from L and R adrenal. Some use only 1, I and others recommend 2. CE Grim MDOn Mar 6, 2012, at 5:16 PM, maggiekat7 wrote: acth? two catheters? please explain? > > > > > > > > > > > > > > > > > > > > ÃÆ'‚ÂÂ > > > > > > > > > > >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 cente > > > > > > > > > > > >

[Guest guest]

Excellent. Keep us posted and mention our site to others you see there who may benefit themselves and our members. CE Grim MDOn Mar 6, 2012, at 2:02 PM, maggiekat7 wrote: yes, going to NIH this coming Saturday...scheduled for bloodwork, other labs, kidney and coratid ultrasounds, cat scan, and avs, and maybe more. They will send me home and then I go back if I opt to have further treatment with them (like laparascopic adrenalectomy). I am scheduled to be there 8 days...and believe it or not, I am looking forward to it. > > > > > > > > > > > > > > > > > > ÃÆ'‚ÂÂ > > > > > > > > > >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 cente > > > > > >

[Guest guest]

Dr. Grim, isn't NIH testing/verifying latest methods? I would think they would

be following standard protocol or their tests would be flawed. I guess it

wouldn't hurt to ask but I wouldn't be alarmed if the answer isn't what you

expected.

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

> > > > > > > > > > > > ÃÆ'‚ÂÂ

> > > > > > > > > > > > >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 cente

> > > > > >

> > > > >

> > > >

> > > >

> > >

> >

> >

>

[Guest guest]

I would hope so. They should be the best. Keep us posted. They will not have seen many as well informed as you. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Mar 6, 2012, at 21:12, <jclark24p@...> wrote:

Dr. Grim, isn't NIH testing/verifying latest methods? I would think they would be following standard protocol or their tests would be flawed. I guess it wouldn't hurt to ask but I wouldn't be alarmed if the answer isn't what you expected.

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

> > > > > > > > > > > > ÃÆ'‚ÂÂ

> > > > > > > > > > > > >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 cente

> > > > > >

> > > > >

> > > >

> > > >

> > >

> >

> >

>

[Guest guest]

Well Maggie, it looks like you heard right from someone who has been there, done

that, twice so experience talks, thanks ms.... As she indicates, don't spend

time and energy worring about it. In fact if you feel obligated to worry, you

probably have a much higher risk just getting there! (Remember, I rolled the

" big wheels " of a tour bus for 7 years!)

There's some risk in just about everything we do. Who knows, you could jump out

of bed, take couple of steps, pass out and fall and break your neck! ;>) Have

a good trip and the more answers you get means the less questions I have to ask!

> > > > > > > > >

> > > > > > > > > ÃÆ'‚ÂÂ

> > > > > > > > > >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 cente

> > >

> >

>

[Guest guest]

Thank You. I'm really looking forward to as much info as I can get and

seeing if I can make a difference at the VA in WRJ.

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

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

ÃÆ'Æ'‚ÃÆ'‚Â

> > > > > > > > > > > > > > >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 cente

> > > > > > > >

> > > > > > >

> > > > > >

> > > > > >

> > > > >

> > > >

> > > >

> > >

> >

> >

>

[Guest guest]

Thank You. I'm really looking forward to as much info as I can get and

seeing if I can make a difference at the VA in WRJ.

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

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

ÃÆ'Æ'‚ÃÆ'‚Â

> > > > > > > > > > > > > > >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 cente

> > > > > > > >

> > > > > > >

> > > > > >

> > > > > >

> > > > >

> > > >

> > > >

> > >

> >

> >

>

[Guest guest]

Send us your results as soon as you get them as we have found errors in local interpretation.We have a form in our files to use.Should go well.CE Grim MDOn Mar 6, 2012, at 10:17 PM, wrote: Thank You. I'm really looking forward to as much info as I can get and seeing if I can make a difference at the VA in WRJ. > > > > > > > > > > > > > > > > > > > > > > > > > > > > ÃÆ'Æ'‚ÃÆ'‚Â > > > > > > > > > > > > > > >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 cente > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

[Guest guest]

Me also. The procedure is much less stressful and painful that I expected. Much, much less. Don't worry too much. Just ask the radiologist how many AVS has he done. 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; on private consultation with Dr Grim. From: msmith_1928

<janeray1940@...> hyperaldosteronism Sent: Tuesday, March 6, 2012 1:52 PM Subject: Re: adrenal vein testing

Hi Maggiekat, I've been through 2 AVS procedures and I have to say this: the stuff they legally have to tell you beforehand about the 1.5% chance of rupturing an adrenal, not to mention the 1% chance of DEATH (yes, they really do tell you this) is far more scary than the actual procedure, at least if you are in good hands. Did I understand correctly that you are scheduled for one next Friday? Please don't put too much effort into worrying - just be aware that there are risks, and that you are willing to take those risks in order to get better.

-msmith1928

Successful left laparoscopic adrenalectomy 10/13/11

> > > > > > > >

> > > > > > > > ÃÆ'‚ÂÂ

> > > > > > > > >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 cente

> >

>

[Guest guest]

Me also. The procedure is much less stressful and painful that I expected. Much, much less. Don't worry too much. Just ask the radiologist how many AVS has he done. 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; on private consultation with Dr Grim. From: msmith_1928

<janeray1940@...> hyperaldosteronism Sent: Tuesday, March 6, 2012 1:52 PM Subject: Re: adrenal vein testing

Hi Maggiekat, I've been through 2 AVS procedures and I have to say this: the stuff they legally have to tell you beforehand about the 1.5% chance of rupturing an adrenal, not to mention the 1% chance of DEATH (yes, they really do tell you this) is far more scary than the actual procedure, at least if you are in good hands. Did I understand correctly that you are scheduled for one next Friday? Please don't put too much effort into worrying - just be aware that there are risks, and that you are willing to take those risks in order to get better.

-msmith1928

Successful left laparoscopic adrenalectomy 10/13/11

> > > > > > > >

> > > > > > > > ÃÆ'‚ÂÂ

> > > > > > > > >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 cente

> >

>

[Guest guest]

Go ahead! You are the lucky one! NataliaFrom: maggiekat7 <ljurkovic@...> hyperaldosteronism Sent: Tuesday, March 6, 2012 2:02 PM Subject: Re: adrenal vein testing

yes, going to NIH this coming Saturday...scheduled for bloodwork, other labs, kidney and coratid ultrasounds, cat scan, and avs, and maybe more. They will send me home and then I go back if I opt to have further treatment with them (like laparascopic adrenalectomy). I am scheduled to be there 8 days...and believe it or not, I am looking forward to it.

> > > > > > > > >

> > > > > > > > > ÃÆ'‚ÂÂ

> > > > > > > > > >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 cente

> > >

> >

>

[Guest guest]

The scan was difficult to get (radioisotope and even the Univ. of Mich, where it was developed has not published recently on it). But maybe it is better. New technology always looks good when it first comes out. See Gastric Freezing in the Book Risks, Costs, Risks Benefits of surgery. I think that is the title. This book is the early bible for doing risk/cost/benefits in Medicine and Surgery. I can recommend it to lay readers even. The best one I used in teaching fellows is Clinical Epidemiology by B Haynes et all. Older issues should be very cheap on the web. Recommended for all who are interested in getting up to snuff in cost/risk/benefit analysis for their health care. CE Grim MD On Mar 6, 2012, at 2:00 PM, wrote: The reason I started with the caveat regarding the numbers is because the discussion of the actual numbers is not the point, I purposely biased them! This has been studied by many professional and that is their conclusion. I'm sure every study must survive the review of their peers. The concensus after many years appears to be to skip AVS if under 40. If you disagree, your "beef" is with them! It is highly unlikely that a birthday switches a switch so I hope the actual age is closer to 45 and they have included a margin of error. Now what is your experience? How many AVSs have proved the scan incorrect? Of those, how many were < 40? Of the latter, how was the incorrect answer confirmed? Of the ones that persued treatment with MCBs and Dash, either by choice or DX, how many have experienced adverse side effects? Do adenomas advance with time, either in size or production of excess aldosterone? How often should you rescan if you keep the adenoma? If you add exposure to radition, what is the risk and do you consider other things that add radiation? (Both now and in the future!) I probably have other questions but there are some of the "easy" ones! .... > > > > > > > > > > > > > > ÃÆ'‚ÂÂ > > > > > > > >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 cente >

[Guest guest]

Natalia: Looked at your labs you sent. If you could put them into the form I have in our files for AVS results it would be a big help.Will need to bring them all together. I think I have seen these before?CE Grim MDOn Mar 7, 2012, at 12:41 AM, Natalia Kamneva wrote: Go ahead! You are the lucky one! NataliaFrom: maggiekat7 <ljurkovic@...> hyperaldosteronism Sent: Tuesday, March 6, 2012 2:02 PM Subject: Re: adrenal vein testing yes, going to NIH this coming Saturday...scheduled for bloodwork, other labs, kidney and coratid ultrasounds, cat scan, and avs, and maybe more. They will send me home and then I go back if I opt to have further treatment with them (like laparascopic adrenalectomy). I am scheduled to be there 8 days...and believe it or not, I am looking forward to it. > > > > > > > > > > > > > > > > > > ÃÆ'‚ÂÂ > > > > > > > > > >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 cente > > > > > >