Re: adrenal vein testing

[Guest guest]

,I believe everything that you said, is true in case if she doesn't have bilateral hyperplasia. Do you remember, the surgery was done without AVS. The very strange sign for me is that her BP is still so high and she doesn't feel well. I don't recall any after surgery reports here with the same outcome.About potassium - all of my doctors (except Dr. Grim) recommend me not to go on high K and low Na diet, since both of my BP medications spare potassium. It occurred not to be true. I think it's a lot what is still needed to be researched about K and Na balance. All of us do it experimentally by trial and error :-) I think she definitely needs more attention of

Dr. Grim and his private consultation. But of course, it's up to her and her family to decide. It would be very sorry if her doctors have already done wrong step by hurrying her to the surgery. NataliaFrom: <jclark24p@...> hyperaldosteronism Sent: Monday, February 27, 2012 10:59 PM Subject: Re: adrenal vein testing

Natlia, that is not what the experts recommend: "Postoperative iv fluids should be normal saline without potassium chloride unless serum potassium levels remain very low (i.e. <3.0 mmol/liter), and during the first few weeks after surgery, a generous sodium diet should be recommended to avoid the hyperkalemia that can develop from hypoaldosteronism due to chronic contralateral adrenal gland suppression (122)."

Refer to the study referenced in my post (2 posts back).

.....

>

> Dash and Spiro/Inspra! Don't take hctz! Unfortunately, probably you are right : you have bilateral PA. Read as much as you can in our files. And no sodium/ high potassium food!

>

> 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; on private consultation with Dr Grim.

>

>

> ________________________________

> From: Kalthoum Abdallah <kattabdallah77@...>

> "hyperaldosteronism " <hyperaldosteronism >

> Sent: Monday, February 27, 2012 8:02 PM

> Subject: Re: adrenal vein testing

>

>

> Â

> 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

>

[Guest guest]

,I believe everything that you said, is true in case if she doesn't have bilateral hyperplasia. Do you remember, the surgery was done without AVS. The very strange sign for me is that her BP is still so high and she doesn't feel well. I don't recall any after surgery reports here with the same outcome.About potassium - all of my doctors (except Dr. Grim) recommend me not to go on high K and low Na diet, since both of my BP medications spare potassium. It occurred not to be true. I think it's a lot what is still needed to be researched about K and Na balance. All of us do it experimentally by trial and error :-) I think she definitely needs more attention of

Dr. Grim and his private consultation. But of course, it's up to her and her family to decide. It would be very sorry if her doctors have already done wrong step by hurrying her to the surgery. NataliaFrom: <jclark24p@...> hyperaldosteronism Sent: Monday, February 27, 2012 10:59 PM Subject: Re: adrenal vein testing

Natlia, that is not what the experts recommend: "Postoperative iv fluids should be normal saline without potassium chloride unless serum potassium levels remain very low (i.e. <3.0 mmol/liter), and during the first few weeks after surgery, a generous sodium diet should be recommended to avoid the hyperkalemia that can develop from hypoaldosteronism due to chronic contralateral adrenal gland suppression (122)."

Refer to the study referenced in my post (2 posts back).

.....

>

> Dash and Spiro/Inspra! Don't take hctz! Unfortunately, probably you are right : you have bilateral PA. Read as much as you can in our files. And no sodium/ high potassium food!

>

> 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; on private consultation with Dr Grim.

>

>

> ________________________________

> From: Kalthoum Abdallah <kattabdallah77@...>

> "hyperaldosteronism " <hyperaldosteronism >

> Sent: Monday, February 27, 2012 8:02 PM

> Subject: Re: adrenal vein testing

>

>

> Â

> 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

>

[Guest guest]

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

> >

>

[Guest guest]

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

> >

>

[Guest guest]

You might remind her that in order to interpret an aldo and a renin she will need a 24 hr urine to document your sodium intake but them maybe Kaiser does not do this as it "can only be done in Academic Centers"Ask to get a copy of the pathology report from your adrenal surgery.Ask why you don't need an AVS less than 40 why is the Kaiser cure rate between 30-60%. I would want better odds before doing surgery but you team must have told you this.Better yet ask her specifically what is the Kaiser cure rate. They must have one of the largest experiences in the world. If she does not know tell her that would be a good research question she can submit to Kaiser. Finding the correct answer with save Kaiser many $. Ask why she has not recommended a low sodium diet it you now have or have had aldosterone/salt hypertension?Remind her that aldosterone only does its damage when there is excess salt in the diet.CE Grim MDOn Feb 29, 2012, at 11:55 PM, Kalthoum wrote: 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 > > >

[Guest guest]

You might remind her that in order to interpret an aldo and a renin she will need a 24 hr urine to document your sodium intake but them maybe Kaiser does not do this as it "can only be done in Academic Centers"Ask to get a copy of the pathology report from your adrenal surgery.Ask why you don't need an AVS less than 40 why is the Kaiser cure rate between 30-60%. I would want better odds before doing surgery but you team must have told you this.Better yet ask her specifically what is the Kaiser cure rate. They must have one of the largest experiences in the world. If she does not know tell her that would be a good research question she can submit to Kaiser. Finding the correct answer with save Kaiser many $. Ask why she has not recommended a low sodium diet it you now have or have had aldosterone/salt hypertension?Remind her that aldosterone only does its damage when there is excess salt in the diet.CE Grim MDOn Feb 29, 2012, at 11:55 PM, Kalthoum wrote: 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 > > >

[Guest guest]

Thanks for the prompt response. Did you feel her responses were valid at all? I feel i should have at least been given the option to have the testing. I had 24 hour urine collection done prior to surgery. Should I have it done again? Also someone mentioned that I should be tested for a pheochromocytoma, ( not sure of spelling) What is the correlation between the two conditions? I'm not very good with confrontation, and she's a very cut and dry Dr. and I clam up under pressure. I'm nervous honestly, but i do want some answers. Will she think it's strange if i ask for the pathology report? From: Clarence Grim <lowerbp2@...> hyperaldosteronism Cc: Clarence Grim <lowerbp2@...> Sent: Thursday, March 1, 2012 12:09 AM Subject: Re: Re: adrenal vein testing

You might remind her that in order to interpret an aldo and a renin she will need a 24 hr urine to document your sodium intake but them maybe Kaiser does not do this as it "can only be done in Academic Centers"Ask to get a copy of the pathology report from your adrenal surgery.Ask why you don't need an AVS less than 40 why is the Kaiser cure rate between 30-60%. I would want better odds before doing surgery but you team must have told you this.Better yet ask her specifically what is the Kaiser cure rate. They must have one of the largest experiences in the world. If she does not know tell her that would be a good research question she can submit to Kaiser. Finding the correct answer with save Kaiser many $. Ask why she has not recommended a low sodium diet it you now have or have had

aldosterone/salt hypertension?Remind her that aldosterone only does its damage when there is excess salt in the diet.CE Grim MDOn Feb 29, 2012, at 11:55 PM, Kalthoum wrote: 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 > > >

[Guest guest]

Thanks for the prompt response. Did you feel her responses were valid at all? I feel i should have at least been given the option to have the testing. I had 24 hour urine collection done prior to surgery. Should I have it done again? Also someone mentioned that I should be tested for a pheochromocytoma, ( not sure of spelling) What is the correlation between the two conditions? I'm not very good with confrontation, and she's a very cut and dry Dr. and I clam up under pressure. I'm nervous honestly, but i do want some answers. Will she think it's strange if i ask for the pathology report? From: Clarence Grim <lowerbp2@...> hyperaldosteronism Cc: Clarence Grim <lowerbp2@...> Sent: Thursday, March 1, 2012 12:09 AM Subject: Re: Re: adrenal vein testing

You might remind her that in order to interpret an aldo and a renin she will need a 24 hr urine to document your sodium intake but them maybe Kaiser does not do this as it "can only be done in Academic Centers"Ask to get a copy of the pathology report from your adrenal surgery.Ask why you don't need an AVS less than 40 why is the Kaiser cure rate between 30-60%. I would want better odds before doing surgery but you team must have told you this.Better yet ask her specifically what is the Kaiser cure rate. They must have one of the largest experiences in the world. If she does not know tell her that would be a good research question she can submit to Kaiser. Finding the correct answer with save Kaiser many $. Ask why she has not recommended a low sodium diet it you now have or have had

aldosterone/salt hypertension?Remind her that aldosterone only does its damage when there is excess salt in the diet.CE Grim MDOn Feb 29, 2012, at 11:55 PM, Kalthoum wrote: 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 > > >

[Guest guest]

I suggest you read " Laboratory Investigation of Primary Aldosteronism " . It is

in our files at:

http://f1.grp.fs.com/v1/wGRPT10VaBaW4lA0VlnpYMdML61pj0WQ0f7drfaB0zFNMeuDLTc\

55696H-F4QgV5L30DGOXmLhBPywNt_1dp-XEM0iChp2g/Stowasser%20et%20al%20PA%20Review.p\

df

You may need to read parts of it a couple of times but it is well structured so

you can concentrate on the parts you are really concerned about. I am not a

medical professional but being retired I have had the luxury of researching PA

full time for over a year now. IMHO Drs. Stowasser and Gordon from down under

are two of the current researchers looking at and writing about PA currently.

I'll address specific questions in another post.

- 65 yo super ob., fastidious 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, AmlodipineBesylate

5mg, 81mg aspirin and Metformin 2000MG. Started washing Spironolactone 12/20/11

to prepare for AVS.

> >

> > > 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

> > >

> >

>

[Guest guest]

I suggest you read " Laboratory Investigation of Primary Aldosteronism " . It is

in our files at:

http://f1.grp.fs.com/v1/wGRPT10VaBaW4lA0VlnpYMdML61pj0WQ0f7drfaB0zFNMeuDLTc\

55696H-F4QgV5L30DGOXmLhBPywNt_1dp-XEM0iChp2g/Stowasser%20et%20al%20PA%20Review.p\

df

You may need to read parts of it a couple of times but it is well structured so

you can concentrate on the parts you are really concerned about. I am not a

medical professional but being retired I have had the luxury of researching PA

full time for over a year now. IMHO Drs. Stowasser and Gordon from down under

are two of the current researchers looking at and writing about PA currently.

I'll address specific questions in another post.

- 65 yo super ob., fastidious 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, AmlodipineBesylate

5mg, 81mg aspirin and Metformin 2000MG. Started washing Spironolactone 12/20/11

to prepare for AVS.

> >

> > > 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

> > >

> >

>

[Guest guest]

This link doesn't work. This seems to be a problem with . Need to give the

file name as well as the link so if link doesn't work one can search files to

read it.

> > >

> > > > 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

> > > >

> > >

> >

>

[Guest guest]

Your doctor appears to be an " Alpha Female " and from the action you have

reported knowledgble and excellent in her field. I'm very impressed that she

took the time to respond in writing when she was meeting with you soon. That

shows me she wants to calm your fears and make sure you have clear answers.

A couple of suggestions that might help. I get my treatment through the VA

(Veterans) system. They recommend we bring someone with us to appointments. I

find it works really well and communication flows better. (We also can compare

notes later and make sure we heard the same think - you'll get " old " too some

day!)

Remember, you are a team and without you she is unemployed!

I'm not sure how old you are but I'm guessing you may be under 40? I posted a

year ago a flow chart (decision tree) that used 40 as the magic number for

skipping the AVS. We decided there was probably a twofold reason. $$$ rules

the world and government and insurance companies have decided that it is more

cost effective since the older you get the more likely it is you will grow

nonfunctioning bumps and tumors.

They also take into consider the risks and the experts determine the risks

outweigh the benefits. The reason she picked on acdemics is because they are

usually funded by an outside source so they don't have to justify tht $25,000 to

anyone! Why do they do " unnecessary " proceedures? Because they have to start

somewhere and somebody volunteered! All protocalls refer to a " very experienced

IR " so how do the new ones gain experience? (They start by giving shots to

oranges but eventially have to see real flesh - oranges don't have a groin or

enough vein structure to be able to test so they will use you if you will

volunteer and hold still!)

From my uneducated but knowledgble consumer prespective I say you are in very

good hands! She is following standard protocol closely! Keep us posted.

.....

> >>

> >> > 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

> >> >

> >>

> >

> >

>

[Guest guest]

Don't know what your problem is, it works for me! I always test any link I post

immediately after I post (it's the old " techie " in me after being on the other

end of the call for 20+ years!) It worked again a minute ago.

Are you clicking on it or cutting and pasting?

Anyway, I gave you the name and told you it was in our files so I don't know

what else you are asking for. I only gave Katt the link because I think she is

a newer member with heightened concern about her treatment. Let me know if you

can't find it.

> > > >

> > > > > 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

> > > > >

> > > >

> > >

> >

>

[Guest guest]

I have a great deal of experience in dealing with the Kaiser health care system, also in the SF Bay Area, and am writing to give you some of my painfully learned advice.1. Never go to your doctor without a list of notes and specific questions to ask him/her. Then jot down the answers.2. Bring a list/chart of your BP history for the last month with you to your appointment.3. If at all possible take someone with you to your appointment. It is sad, but true, that the doctor will pay closer attention to you within the presence of a witness who appears to be paying close attention. This witness can be the one jotting down the doctors answers to your questions.4. Bring a copy of Dr. Grim's Evolution of PA paper and a copy of his CV. Presumably you have already given a copy of his E of PA to your relevant doctors, but the

CV clues them in to the fact that you are not just getting your ideas from an Internet quack.5. Mention the fact that Dr. Grim trained with Dr. Conn, as in Conn's Syndrome. Your doctor's eyebrows will rise and his/her ears will open up. This way if you reference Dr. Grim you will be listened to.Having a "cut and dry" doctor can be a good thing if you are willing to be a cut and dry patient too. Personally I love a gentle, caring and kind doctor, but above everything I want good medicine and personality is less important. Do the above and you can deal with your cut-and-dry doctor because you will be speaking to him on his level.With Kaiser you can actually do a fair amount of pushing to get what you want. Don't be meekly compliant even if that's your nature, as it used to me mine. Bring hard questions and your research to back it up. It is your life and your health. No one is going to care as

much as you and your family do, but you can push to get the quality of care you need and deserve.It is not strange to ask for your pathology report. It is your right, and shows that you are taking your condition seriously. Tell your doctor that you want it for your files. If he/she gives you any static at all ask him/her how you can go about getting it?Believe me when I say that if I can now flex my muscles with Kaiser, you will be able to eventually do it too. If you need a pep-talk and/or more information about how I have dealt with Kaiser, you can call me: 510-527-6912. I live mid-way between the Oakland and Richmond Kaiser Hospitals.DianneF-69, bi-lateral adenomas, CKD from CT scan dye, 75mg Spiro, 37.5mg Atenolol. 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 > > >

[Guest guest]

Excellent, excellent, excellent Dianne - I couldn't have said it better myself!

The only observation I have is taht this is not unique to Kaiser!

> >

> > > 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

> > >

> >

>

[Guest guest]

I completely disagree. Even if you doctor is very confident and has a high self estimation , doesn't mean yet that she is excellent and knowledgeable. Very often it is contrary. Some of her statements bother me very much. Does she think that AVS is more intrusive than a surgery? It's you who lost some part of your body, it's not her. Her answering to your e-mail is very nice, but doesn't mean too much for me. Natalia From:

<jclark24p@...> hyperaldosteronism Sent: Thursday, March 1, 2012 11:40 AM Subject: Re: adrenal vein testing

Your doctor appears to be an "Alpha Female" and from the action you have reported knowledgble and excellent in her field. I'm very impressed that she took the time to respond in writing when she was meeting with you soon. That shows me she wants to calm your fears and make sure you have clear answers.

A couple of suggestions that might help. I get my treatment through the VA (Veterans) system. They recommend we bring someone with us to appointments. I find it works really well and communication flows better. (We also can compare notes later and make sure we heard the same think - you'll get "old" too some day!)

Remember, you are a team and without you she is unemployed!

I'm not sure how old you are but I'm guessing you may be under 40? I posted a year ago a flow chart (decision tree) that used 40 as the magic number for skipping the AVS. We decided there was probably a twofold reason. $$$ rules the world and government and insurance companies have decided that it is more cost effective since the older you get the more likely it is you will grow nonfunctioning bumps and tumors.

They also take into consider the risks and the experts determine the risks outweigh the benefits. The reason she picked on acdemics is because they are usually funded by an outside source so they don't have to justify tht $25,000 to anyone! Why do they do "unnecessary" proceedures? Because they have to start somewhere and somebody volunteered! All protocalls refer to a "very experienced IR" so how do the new ones gain experience? (They start by giving shots to oranges but eventially have to see real flesh - oranges don't have a groin or enough vein structure to be able to test so they will use you if you will volunteer and hold still!)

From my uneducated but knowledgble consumer prespective I say you are in very good hands! She is following standard protocol closely! Keep us posted.

.....

> >>

> >> > 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

> >> >

> >>

> >

> >

>

[Guest guest]

You are certainly entitled to your opinion BUT it is only an opinion and I am

not sure what you are basing it on. My comments are based on research of recent

trials and studies and the " best practice " results developed from them. I

specifically remember the 40y/o decision point and the discussion at the time.

Know that this is NOT her doctor's choice if it is " best prctice " because that

is what the insurance carrier will mandate, of course she can always pay the

$25,000 out of pocket if she wants!

It is too early to declare the opertion a failure from all I've read. In fact,

as her doctor pointed out, the immediate K resolution is a positive sign. I've

referenced where it sometimes takes up to a year to see the total benefit and,

as Dr. Grim often points out, total resolution of HTN from the operation is

often not attained (A point he uses for a strong recommendation of using MCBs nd

DASH.) That's a different discussion!

And finally the fact that the doctor wrote a response a couple days prior to a

face 2 face appointment spoke highly of her doctors concern and professionalism

IMHO. Most of us would have heard nothing or got a call from an nurse.

(Possibly a call from the doc but highly unlikely) The written word takes the

most effort usually, leaves no room for misinterpretation, and allows the PTN

time to review and be ready for any followup when they meet. It speaks nothing

of the accuracy or knowledge but certainly gives you an opportunity to verify

or refute and I respect her for that!

Maybe you could explain where you think she went astry.

> > >>

> > >> > 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

> > >> >

> > >>

> > >

> > >

> >

>

[Guest guest]

Kaiser has an email system that requires your physician to respond within two business days. So her responding to my questions was not going out of her way to keep me informed. She was simply following rules placed on all Kaiser Dr.'s. This same person, had a Medical assistant inform me of my diagnosis by calling and reading to me a computerised message regarding the ct scan. I asked her the size, she did not know . Not at all her fault of course... But in my opinion very irresponsible of the Dr. I was told to do a 24 hr. Urine collection.. And called so many times to ask questions and finally said please tell Dr. That I HER to call me. I'm extremely unhappy with the level of care, of lack there of. On Mar 2, 2012, at 3:58 PM, " " <jclark24p@...> wrote:

You are certainly entitled to your opinion BUT it is only an opinion and I am not sure what you are basing it on. My comments are based on research of recent trials and studies and the "best practice" results developed from them. I specifically remember the 40y/o decision point and the discussion at the time. Know that this is NOT her doctor's choice if it is "best prctice" because that is what the insurance carrier will mandate, of course she can always pay the $25,000 out of pocket if she wants!

It is too early to declare the opertion a failure from all I've read. In fact, as her doctor pointed out, the immediate K resolution is a positive sign. I've referenced where it sometimes takes up to a year to see the total benefit and, as Dr. Grim often points out, total resolution of HTN from the operation is often not attained (A point he uses for a strong recommendation of using MCBs nd DASH.) That's a different discussion!

And finally the fact that the doctor wrote a response a couple days prior to a face 2 face appointment spoke highly of her doctors concern and professionalism IMHO. Most of us would have heard nothing or got a call from an nurse. (Possibly a call from the doc but highly unlikely) The written word takes the most effort usually, leaves no room for misinterpretation, and allows the PTN time to review and be ready for any followup when they meet. It speaks nothing of the accuracy or knowledge but certainly gives you an opportunity to verify or refute and I respect her for that!

Maybe you could explain where you think she went astry.

> > >>

> > >> > 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

> > >> >

> > >>

> > >

> > >

> >

>

=

[Guest guest]

Kaiser has an email system that requires your physician to respond within two business days. So her responding to my questions was not going out of her way to keep me informed. She was simply following rules placed on all Kaiser Dr.'s. This same person, had a Medical assistant inform me of my diagnosis by calling and reading to me a computerised message regarding the ct scan. I asked her the size, she did not know . Not at all her fault of course... But in my opinion very irresponsible of the Dr. I was told to do a 24 hr. Urine collection.. And called so many times to ask questions and finally said please tell Dr. That I HER to call me. I'm extremely unhappy with the level of care, of lack there of. On Mar 2, 2012, at 3:58 PM, " " <jclark24p@...> wrote:

You are certainly entitled to your opinion BUT it is only an opinion and I am not sure what you are basing it on. My comments are based on research of recent trials and studies and the "best practice" results developed from them. I specifically remember the 40y/o decision point and the discussion at the time. Know that this is NOT her doctor's choice if it is "best prctice" because that is what the insurance carrier will mandate, of course she can always pay the $25,000 out of pocket if she wants!

It is too early to declare the opertion a failure from all I've read. In fact, as her doctor pointed out, the immediate K resolution is a positive sign. I've referenced where it sometimes takes up to a year to see the total benefit and, as Dr. Grim often points out, total resolution of HTN from the operation is often not attained (A point he uses for a strong recommendation of using MCBs nd DASH.) That's a different discussion!

And finally the fact that the doctor wrote a response a couple days prior to a face 2 face appointment spoke highly of her doctors concern and professionalism IMHO. Most of us would have heard nothing or got a call from an nurse. (Possibly a call from the doc but highly unlikely) The written word takes the most effort usually, leaves no room for misinterpretation, and allows the PTN time to review and be ready for any followup when they meet. It speaks nothing of the accuracy or knowledge but certainly gives you an opportunity to verify or refute and I respect her for that!

Maybe you could explain where you think she went astry.

> > >>

> > >> > 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

> > >> >

> > >>

> > >

> > >

> >

>

=

[Guest guest]

Katt, Kaiser is an HMO, the closest thing to socialized medicine except for Medicare.  I have a malpractice attorney friend who has filed hundreds of cases against Kaiser.  As long as you stay in Kaiser, you must do your own research and demand proper treatment.  You won't get it otherwise.  I had an HMO, Pacificare, nearly kill me. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Katt Abdallah Kaiser has an email system that requires your physician to respond within two business days. So her responding to my questions was not going out of her way to keep me informed. She was simply following rules placed on all Kaiser Dr.'s. This same person, had a Medical assistant inform me of my diagnosis by calling and reading to me a computerised message regarding the ct scan. I asked her the size, she did not know . Not at all her fault of course... But in my opinion very irresponsible of the Dr. I was told to do a 24 hr. Urine collection.. And called so many times to ask questions and finally said please tell Dr. That I HER to call me. I'm extremely unhappy with the level of care, of lack there of. On Mar 2, 2012, at 3:58 PM, " " <jclark24p@...> wrote: You are certainly entitled to your opinion BUT it is only an opinion and I am not sure what you are basing it on. My comments are based on research of recent trials and studies and the " best practice " results developed from them. I specifically remember the 40y/o decision point and the discussion at the time. Know that this is NOT her doctor's choice if it is " best prctice " because that is what the insurance carrier will mandate, of course she can always pay the $25,000 out of pocket if she wants!It is too early to declare the opertion a failure from all I've read. In fact, as her doctor pointed out, the immediate K resolution is a positive sign. I've referenced where it sometimes takes up to a year to see the total benefit and, as Dr. Grim often points out, total resolution of HTN from the operation is often not attained (A point he uses for a strong recommendation of using MCBs nd DASH.) That's a different discussion!And finally the fact that the doctor wrote a response a couple days prior to a face 2 face appointment spoke highly of her doctors concern and professionalism IMHO. Most of us would have heard nothing or got a call from an nurse. (Possibly a call from the doc but highly unlikely) The written word takes the most effort usually, leaves no room for misinterpretation, and allows the PTN time to review and be ready for any followup when they meet. It speaks nothing of the accuracy or knowledge but certainly gives you an opportunity to verify or refute and I respect her for that!Maybe you could explain where you think she went astry.>> I completely disagree. Even if you doctor is very confident and has a high self estimation , doesn't mean yet that she is excellent and knowledgeable. Very often it is contrary. Some of her statements bother me very much. Does she think that AVS is more intrusive than a surgery? It's you who lost some part of your body, it's not her. > > > Her answering to your e-mail is very nice, but doesn't mean too much for me.

[Guest guest]

Katt, Kaiser is an HMO, the closest thing to socialized medicine except for Medicare.  I have a malpractice attorney friend who has filed hundreds of cases against Kaiser.  As long as you stay in Kaiser, you must do your own research and demand proper treatment.  You won't get it otherwise.  I had an HMO, Pacificare, nearly kill me. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Katt Abdallah Kaiser has an email system that requires your physician to respond within two business days. So her responding to my questions was not going out of her way to keep me informed. She was simply following rules placed on all Kaiser Dr.'s. This same person, had a Medical assistant inform me of my diagnosis by calling and reading to me a computerised message regarding the ct scan. I asked her the size, she did not know . Not at all her fault of course... But in my opinion very irresponsible of the Dr. I was told to do a 24 hr. Urine collection.. And called so many times to ask questions and finally said please tell Dr. That I HER to call me. I'm extremely unhappy with the level of care, of lack there of. On Mar 2, 2012, at 3:58 PM, " " <jclark24p@...> wrote: You are certainly entitled to your opinion BUT it is only an opinion and I am not sure what you are basing it on. My comments are based on research of recent trials and studies and the " best practice " results developed from them. I specifically remember the 40y/o decision point and the discussion at the time. Know that this is NOT her doctor's choice if it is " best prctice " because that is what the insurance carrier will mandate, of course she can always pay the $25,000 out of pocket if she wants!It is too early to declare the opertion a failure from all I've read. In fact, as her doctor pointed out, the immediate K resolution is a positive sign. I've referenced where it sometimes takes up to a year to see the total benefit and, as Dr. Grim often points out, total resolution of HTN from the operation is often not attained (A point he uses for a strong recommendation of using MCBs nd DASH.) That's a different discussion!And finally the fact that the doctor wrote a response a couple days prior to a face 2 face appointment spoke highly of her doctors concern and professionalism IMHO. Most of us would have heard nothing or got a call from an nurse. (Possibly a call from the doc but highly unlikely) The written word takes the most effort usually, leaves no room for misinterpretation, and allows the PTN time to review and be ready for any followup when they meet. It speaks nothing of the accuracy or knowledge but certainly gives you an opportunity to verify or refute and I respect her for that!Maybe you could explain where you think she went astry.>> I completely disagree. Even if you doctor is very confident and has a high self estimation , doesn't mean yet that she is excellent and knowledgeable. Very often it is contrary. Some of her statements bother me very much. Does she think that AVS is more intrusive than a surgery? It's you who lost some part of your body, it's not her. > > > Her answering to your e-mail is very nice, but doesn't mean too much for me.

[Guest guest]

Val, I'm in the bay area. Where is your friend? Im thinking this all is screaming mal practice/negligence.On Mar 3, 2012, at 4:26 PM, "Valarie " <val@...> wrote:

Katt, Kaiser is an HMO, the closest thing to socialized medicine except for Medicare. I have a malpractice attorney friend who has filed hundreds of cases against Kaiser. As long as you stay in Kaiser, you must do your own research and demand proper treatment. You won't get it otherwise. I had an HMO, Pacificare, nearly kill me. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Katt Abdallah Kaiser has an email system that requires your physician to respond within two business days. So her responding to my questions was not going out of her way to keep me informed. She was simply following rules placed on all Kaiser Dr.'s. This same person, had a Medical assistant inform me of my diagnosis by calling and reading to me a computerised message regarding the ct scan. I asked her the size, she did not know . Not at all her fault of course... But in my opinion very irresponsible of the Dr. I was told to do a 24 hr. Urine collection.. And called so many times to ask questions and finally said please tell Dr. That I HER to call me. I'm extremely unhappy with the level of care, of lack there of. On Mar 2, 2012, at 3:58 PM, " " <jclark24p@...> wrote: You are certainly entitled to your opinion BUT it is only an opinion and I am not sure what you are basing it on. My comments are based on research of recent trials and studies and the "best practice" results developed from them. I specifically remember the 40y/o decision point and the discussion at the time. Know that this is NOT her doctor's choice if it is "best prctice" because that is what the insurance carrier will mandate, of course she can always pay the $25,000 out of pocket if she wants!It is too early to declare the opertion a failure from all I've read. In fact, as her doctor pointed out, the immediate K resolution is a positive sign. I've referenced where it sometimes takes up to a year to see the total benefit and, as Dr. Grim often points out, total resolution of HTN from the operation is often not attained (A point he uses for a strong recommendation of using MCBs nd DASH.) That's a different discussion!And finally the fact that the doctor wrote a response a couple days prior to a face 2 face appointment spoke highly of her doctors concern and professionalism IMHO. Most of us would have heard nothing or got a call from an nurse. (Possibly a call from the doc but highly unlikely) The written word takes the most effort usually, leaves no room for misinterpretation, and allows the PTN time to review and be ready for any followup when they meet. It speaks nothing of the accuracy or knowledge but certainly gives you an opportunity to verify or refute and I respect her for that!Maybe you could explain where you think she went astry.>> I completely disagree. Even if you doctor is very confident and has a high self estimation , doesn't mean yet that she is excellent and knowledgeable. Very often it is contrary. Some of her statements bother me very much. Does she think that AVS is more intrusive than a surgery? It's you who lost some part of your body, it's not her. > > > Her answering to your e-mail is very nice, but doesn't mean too much for me.

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[Guest guest]

Val, I'm in the bay area. Where is your friend? Im thinking this all is screaming mal practice/negligence.On Mar 3, 2012, at 4:26 PM, "Valarie " <val@...> wrote:

Katt, Kaiser is an HMO, the closest thing to socialized medicine except for Medicare. I have a malpractice attorney friend who has filed hundreds of cases against Kaiser. As long as you stay in Kaiser, you must do your own research and demand proper treatment. You won't get it otherwise. I had an HMO, Pacificare, nearly kill me. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Katt Abdallah Kaiser has an email system that requires your physician to respond within two business days. So her responding to my questions was not going out of her way to keep me informed. She was simply following rules placed on all Kaiser Dr.'s. This same person, had a Medical assistant inform me of my diagnosis by calling and reading to me a computerised message regarding the ct scan. I asked her the size, she did not know . Not at all her fault of course... But in my opinion very irresponsible of the Dr. I was told to do a 24 hr. Urine collection.. And called so many times to ask questions and finally said please tell Dr. That I HER to call me. I'm extremely unhappy with the level of care, of lack there of. On Mar 2, 2012, at 3:58 PM, " " <jclark24p@...> wrote: You are certainly entitled to your opinion BUT it is only an opinion and I am not sure what you are basing it on. My comments are based on research of recent trials and studies and the "best practice" results developed from them. I specifically remember the 40y/o decision point and the discussion at the time. Know that this is NOT her doctor's choice if it is "best prctice" because that is what the insurance carrier will mandate, of course she can always pay the $25,000 out of pocket if she wants!It is too early to declare the opertion a failure from all I've read. In fact, as her doctor pointed out, the immediate K resolution is a positive sign. I've referenced where it sometimes takes up to a year to see the total benefit and, as Dr. Grim often points out, total resolution of HTN from the operation is often not attained (A point he uses for a strong recommendation of using MCBs nd DASH.) That's a different discussion!And finally the fact that the doctor wrote a response a couple days prior to a face 2 face appointment spoke highly of her doctors concern and professionalism IMHO. Most of us would have heard nothing or got a call from an nurse. (Possibly a call from the doc but highly unlikely) The written word takes the most effort usually, leaves no room for misinterpretation, and allows the PTN time to review and be ready for any followup when they meet. It speaks nothing of the accuracy or knowledge but certainly gives you an opportunity to verify or refute and I respect her for that!Maybe you could explain where you think she went astry.>> I completely disagree. Even if you doctor is very confident and has a high self estimation , doesn't mean yet that she is excellent and knowledgeable. Very often it is contrary. Some of her statements bother me very much. Does she think that AVS is more intrusive than a surgery? It's you who lost some part of your body, it's not her. > > > Her answering to your e-mail is very nice, but doesn't mean too much for me.

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[Guest guest]

She is in Boulder, Colorado but is not practicing anymore.  Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Katt Abdallah Val, I'm in the bay area. Where is your friend? Im thinking this all is screaming mal practice/negligence.On Mar 3, 2012, at 4:26 PM, " Valarie " <val@...> wrote: Katt, Kaiser is an HMO, the closest thing to socialized medicine except for Medicare. I have a malpractice attorney friend who has filed hundreds of cases against Kaiser. As long as you stay in Kaiser, you must do your own research and demand proper treatment. You won't get it otherwise. I had an HMO, Pacificare, nearly kill me.

[Guest guest]

She is in Boulder, Colorado but is not practicing anymore.  Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Katt Abdallah Val, I'm in the bay area. Where is your friend? Im thinking this all is screaming mal practice/negligence.On Mar 3, 2012, at 4:26 PM, " Valarie " <val@...> wrote: Katt, Kaiser is an HMO, the closest thing to socialized medicine except for Medicare. I have a malpractice attorney friend who has filed hundreds of cases against Kaiser. As long as you stay in Kaiser, you must do your own research and demand proper treatment. You won't get it otherwise. I had an HMO, Pacificare, nearly kill me.