Re: Re: Adrenal tumor vs bilateral hyperplasia

[Guest guest]

Yes quite! This amongst other things is what i have to consider. One thing i certainly have to consider is 'risk' of surgery. Particularly as i am a lone parent, and my son only has me! From: Clarence Grim <lowerbp2@...> hyperaldosteronism Cc: Clarence Grim <lowerbp2@...> Sent: Sunday, 12 February 2012, 23:48 Subject: Re: Re: Adrenal tumor vs bilateral hyperplasia

On Feb 12, 2012, at 4:41 AM, Francis Bill SUSPECTED PA wrote: Having one adrenal removed of you have bilateral hyperplasia may reduce the amount of meds you need to take. But is the risk of surgery worth it? > > > Â > >My nephrologist insists that based on the results of AVS, I have bilateral hyperplasia, although I have a large adenoma on the left adrenal. Dr. Grim shares the same point of view. > > > > > > > >You cannot be sure that the remaining adrenal is completely healthy. How do you feel? It's the only factor, that you have to consider. Who knows, maybe you are lucky! > > > >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: parkinsoniowa

<parkinsoniowa@...> > >hyperaldosteronism > >Sent: Wednesday, February 8, 2012 9:19 AM > >Subject: Adrenal tumor vs bilateral hyperplasia > > > > > >Â > >Can someone have an adrenal tumor and bilateral hyperplasia at the same time? > > > >I had an adrenal tumor on the right side that was removed 6 years ago. I did not have AVS. How do I know the remaining adrenal gland is healthy if I did not have the AVS? Thank you. > > > > > > > > >

[Guest guest]

If you read my Evolution Article and take to all who have missed you you will note that Ramapril, Atenolol work poorly in PA and may increase BP. Same for Amlodipine. You may need more Spiro as that is a low dose but do not have your complete story. Get the DASH book and more as close to it as you can. The key is to get the sodium to 1500 mg a day or less.CE Grim MDOn Feb 13, 2012, at 2:04 AM, Chambers wrote: When my HTN was at it's worst (bearing in mind it has never come within the normal range in the last four years!) I was taking Ramipril 2.5mg, Amlodopine 10mg, and Atenolol 25mg daily. Often i'd take further Atenolol if i was feeling anxious, so up to 100mg daily. At it's lowest my BP was 158/85 and highest 210/105.I took the 1st Spironolactone (25mg) on Saturday. I was told not to take Atenolol or Ramipril, but i could take the Amlodopine if my BP was still high. I have also stopped taking potassium. I HAVE taken my Amlodopine in addition to the Spiro as on Saturday my BP was 168/98, yesterday 167/101 and 165/90. My GP will review the dosages this week.I've sent an email to Prof. Brown. Anybody else in the South-East you could recommend??Currently i feel terrible. In fact i've hardly stepped out of the house in the last week! I will get to DASHing eventually, but as i've said, i already have a healthy well-balanced, low salt diet because of my Coeliac disease. Not sure if i've stated my age?! but i am 45yrs oldI'm grateful for any advice Dr Grim From: Clarence Grim <lowerbp2@...> hyperaldosteronism Cc: Clarence Grim <lowerbp2@...> Sent: Sunday, 12 February 2012, 23:49 Subject: Re: Re: Adrenal tumor vs bilateral hyperplasia Hop out of the lights.How much spiro and what else are you taking?DASHing yet?CE Grim MDOn Feb 12, 2012, at 5:20 AM, Chambers wrote: Yes, this is what i've still got to work out. I've just started taking Spironolactone in the last few days, and currently feeling quite anxious. Bit like a rabbit in headlights! But hopefully that will settle down and i'll be able to think more clearly about where to go and what to do next, particularly as i am currently pretty unsatisfied with the testing/treatment i've been getting From: Francis Bill SUSPECTED PA <georgewbill@...> hyperaldosteronism Sent: Sunday, 12 February 2012, 12:41 Subject: Re: Adrenal tumor vs bilateral hyperplasia Having one adrenal removed of you have bilateral hyperplasia may reduce the amount of meds you need to take. But is the risk of surgery worth it? > > > Â > >My nephrologist insists that based on the results of AVS, I have bilateral hyperplasia, although I have a large adenoma on the left adrenal. Dr. Grim shares the same point of view. > > > > > > > >You cannot be sure that the remaining adrenal is completely healthy. How do you feel? It's the only factor, that you have to consider. Who knows, maybe you are lucky! > > > >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: parkinsoniowa <parkinsoniowa@...> > >hyperaldosteronism > >Sent: Wednesday, February 8, 2012 9:19 AM > >Subject: Adrenal tumor vs bilateral hyperplasia > > > > > >Â > >Can someone have an adrenal tumor and bilateral hyperplasia at the same time? > > > >I had an adrenal tumor on the right side that was removed 6 years ago. I did not have AVS. How do I know the remaining adrenal gland is healthy if I did not have the AVS? Thank you. > > > > > > > > >

[Guest guest]

Ah yes this must go into your risk-benefit analysis. On Feb 13, 2012, at 2:13 AM, Chambers wrote: Yes quite! This amongst other things is what i have to consider. One thing i certainly have to consider is 'risk' of surgery. Particularly as i am a lone parent, and my son only has me! From: Clarence Grim <lowerbp2@...> hyperaldosteronism Cc: Clarence Grim <lowerbp2@...> Sent: Sunday, 12 February 2012, 23:48 Subject: Re: Re: Adrenal tumor vs bilateral hyperplasia On Feb 12, 2012, at 4:41 AM, Francis Bill SUSPECTED PA wrote: Having one adrenal removed of you have bilateral hyperplasia may reduce the amount of meds you need to take. But is the risk of surgery worth it? > > > Â > >My nephrologist insists that based on the results of AVS, I have bilateral hyperplasia, although I have a large adenoma on the left adrenal. Dr. Grim shares the same point of view. > > > > > > > >You cannot be sure that the remaining adrenal is completely healthy. How do you feel? It's the only factor, that you have to consider. Who knows, maybe you are lucky! > > > >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: parkinsoniowa <parkinsoniowa@...> > >hyperaldosteronism > >Sent: Wednesday, February 8, 2012 9:19 AM > >Subject: Adrenal tumor vs bilateral hyperplasia > > > > > >Â > >Can someone have an adrenal tumor and bilateral hyperplasia at the same time? > > > >I had an adrenal tumor on the right side that was removed 6 years ago. I did not have AVS. How do I know the remaining adrenal gland is healthy if I did not have the AVS? Thank you. > > > > > > > > >

[Guest guest]

Thanks for you comments about Atenolol. I too find that this is the only think that helps with the heart racing/fluttering arythmias. I have increased my Spriro to 50mg as my BP was so high (195/95) yesterday, and feeling incapable of doing anything. As i've decided to hold off with surgery for now. Am taking Atenolol when i need to. Self medicating a little as can't get hold of my Endocrinologist! Will see my GP today instead.Hope all goes well with the AVS ! From:

<jclark24p@...> hyperaldosteronism Sent: Tuesday, 14 February 2012, 1:39 Subject: Re: Adrenal tumor vs bilateral hyperplasia

I haven't heard yet. Dr. L. asked for a referal, meds and ct-scans. I left a message for PCP and she responded Thurs afternoon that she would make the referral and I sent a release for the scans which the VA should have received today. Hopefully will know later this week.

> > > >

> > > > > ÂÂ

> > > >

> > > > >

> > > >

> > > > > > >My nephrologist insists that based on the results of AVS, I

> > > have bilateral hyperplasia, although I have a large adenoma on the

> > > left adrenal. Dr. Grim shares the same point of view.

> > > >

> > > > >

> > > >

> > > > > > >

> > > >

> > > > >

> > > >

> > > > > > >

> > > >

> > > > >

> > > >

> > > > > > >

> > > >

> > > > >

> > > >

> > > > > > >You cannot be sure that the remaining adrenal is completely

> > > healthy. How do you feel? It's the only factor, that you have to

> > > consider. Who knows, maybe you are lucky!

> > > >

> > > > >

> > > >

> > > > > > >

> > > >

> > > > >

> > > >

> > > > > > >ÂÂÂ

> > > >

> > > > >

> > > >

> > > > > > >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: parkinsoniowa <parkinsoniowa@>

> > > >

> > > > >

> > > >

> > > > > > >hyperaldosteronism

> > > >

> > > > >

> > > >

> > > > > > >Sent: Wednesday, February 8, 2012 9:19 AM

> > > >

> > > > >

> > > >

> > > > > > >Subject: Adrenal tumor vs bilateral

> > > hyperplasia

> > > >

> > > > >

> > > >

> > > > > > >

> > > >

> > > > >

> > > >

> > > > > > >

> > > >

> > > > >

> > > >

> > > > > > >ÂÂÂ

> > > >

> > > > >

> > > >

> > > > > > >Can someone have an adrenal tumor and bilateral hyperplasia

> > > at the same time?

> > > >

> > > > >

> > > >

> > > > > > >

> > > >

> > > > >

> > > >

> > > > > > >I had an adrenal tumor on the right side that was removed 6

> > > years ago. I did not have AVS. How do I know the remaining adrenal

> > > gland is healthy if I did not have the AVS? Thank you.

> > > >

> > > > >

> > > >

> > > > > > >

> > > >

> > > > >

> > > >

> > > > > > >

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>

[Guest guest]

DASH DASH! you can out salt spiro and all other BP meds.Start Chapter 9 now. exactly.CE Grim MDOn Feb 13, 2012, at 10:55 PM, Chambers wrote: Thanks for you comments about Atenolol. I too find that this is the only think that helps with the heart racing/fluttering arythmias. I have increased my Spriro to 50mg as my BP was so high (195/95) yesterday, and feeling incapable of doing anything. As i've decided to hold off with surgery for now. Am taking Atenolol when i need to. Self medicating a little as can't get hold of my Endocrinologist! Will see my GP today instead.Hope all goes well with the AVS ! From: <jclark24p@...> hyperaldosteronism Sent: Tuesday, 14 February 2012, 1:39 Subject: Re: Adrenal tumor vs bilateral hyperplasia I haven't heard yet. Dr. L. asked for a referal, meds and ct-scans. I left a message for PCP and she responded Thurs afternoon that she would make the referral and I sent a release for the scans which the VA should have received today. Hopefully will know later this week. > > > > > > > > >  > > > > > > > > > > > > > > > > > > > >My nephrologist insists that based on the results of AVS, I > > > have bilateral hyperplasia, although I have a large adenoma on the > > > left adrenal. Dr. Grim shares the same point of view. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >You cannot be sure that the remaining adrenal is completely > > > healthy. How do you feel? It's the only factor, that you have to > > > consider. Who knows, maybe you are lucky! > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >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: parkinsoniowa <parkinsoniowa@> > > > > > > > > > > > > > > > > > > > >hyperaldosteronism > > > > > > > > > > > > > > > > > > > >Sent: Wednesday, February 8, 2012 9:19 AM > > > > > > > > > > > > > > > > > > > >Subject: Adrenal tumor vs bilateral > > > hyperplasia > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >Can someone have an adrenal tumor and bilateral hyperplasia > > > at the same time? > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >I had an adrenal tumor on the right side that was removed 6 > > > years ago. I did not have AVS. How do I know the remaining adrenal > > > gland is healthy if I did not have the AVS? Thank you. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

[Guest guest]

,I'm a little concerned that you are taking Atenolol "when I need to". I have no medical background, so I'm not sure, but I think Atenolol is something you need to take regularly, not like taking an aspirin when you have a headache. Others on this list can correct me if I'm wrong.Also, any fluttering heart arrhythmias are generally caused by letting your K get too low and have little to do with Atenolol. Atenolol helps with the racing heart, not flutters. Dehydration can also be a cause. If I get careless and my K drops, heart flutters or foot/leg cramping will soon

follow.DianneF-69, bi-lateral adenomas, CKD from CT scan contrast dye, 75mg Spiro, 37.5 mg. AtenololFrom: Chambers <rebeccac66@...>

Thanks for you comments about Atenolol. I too find that this is the only think that helps with the heart racing/fluttering arythmias. I have increased my Spriro to 50mg as my BP was so high (195/95) hold off with surgery for now. Am taking Atenolol when i need to. Self medicating a little as can't get hold of my Endocrinologist! Will see my GP today instead.Hope all goes well with the AVS !

[Guest guest]

Atenolol which is a beta blocker will indeed cause palpitations in

some people. I took Coreg which is a beta blocker and the doc had to

take me off of it

because of ectopic beats, fluttering, etc.

Phyllis

On 2/14/2012 12:23 PM, Dianne strong wrote:

,

I'm a little concerned that you are

taking Atenolol "when I need to". I

have no medical background, so I'm not

sure, but I think Atenolol is

something you need to take regularly,

not like taking an aspirin when you

have a headache. Others on this list

can correct me if I'm wrong.

Also, any fluttering heart

arrhythmias are generally caused by

letting your K get too low and have

little to do with Atenolol. Atenolol

helps with the racing heart, not

flutters. Dehydration can also be a

cause. If I get careless and my K

drops, heart flutters or foot/leg

cramping will soon follow.

Dianne

F-69, bi-lateral adenomas, CKD from

CT scan contrast dye, 75mg Spiro, 37.5

mg. Atenolol

From: Chambers

<rebeccac66@...>

Thanks for you

comments about Atenolol.

I too find that this is

the only think that

helps with the heart

racing/fluttering

arythmias. I have

increased my Spriro to

50mg as my BP was so

high (195/95) hold off

with surgery for now. Am

taking Atenolol when i

need to. Self medicating

a little as can't get

hold of my

Endocrinologist!

Will see my GP today

instead.

Hope all goes well with

the AVS !

[Guest guest]

>If for some unlikely reason you loose both adrenals you will be on meds for the rest of your life, just like the MCB/DASH option but it will start later!Just one comment: it's not just like, because you will be on steroids/hormones, not on MCB/DASH. In my opinion, it's much worse. 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: <jclark24p@...> hyperaldosteronism Sent: Sunday, February 12,

2012 12:02 PM Subject: Re: Adrenal tumor vs bilateral hyperplasia

First, I assume you mean "suspected adenoma" as confirmed by AVS. If the AVS was done correctly, a unilateral adenoma found and the correct adrenal was removed I think the odds of you having bilateral hyperplasia would be extremely low.

After the adrenalectomy the odds of you having bilateral is zero because bi means two and you only have one! ;>) Now that I've made my "smartassed" comment, I'm sure you meant developing an adenoma in the other adrenal, the info I have read indicates it is "very rare". In fact, I believe there would be a warning in every study that recommends removal of unilateral adenomas, the first choice in every study I've seen!

Maybe we should look at pros and cons. If you elect MCBs and DASH you will probably be on meds the rest of your life. Many still need K supplements. I've heard with low NA it is possible to eliminate MCBs but don't recall anyone reporting that situation. You should continue to monitor with scans (first at 6-12 months and if no change every 3 to 5 years, hopefully w/o contrast!)

If you elect surgery you MAY be off all meds for PA. From what I've read K always resolves. BP resolves in 30% to 40% of the cases and improves in ~97% of the cases. You should be on no or less meds and not need any followup scans!

If you have surgery and do develop PA in the other adrenal, I believe your assumption is correct. If for some unlikely reason you loose both adrenals you will be on meds for the rest of your life, just like the MCB/DASH option but it will start later!

I have a couple questions I have yet to find answers to: Odds of an adenoma growing? Odds of a benign adenoma becoming malignant? Odds of a producing adenoma increasing amount of aldosterone? Risk of adverse/unexpected consequences of long term medicine vs risk of surgery! (Feel free to add your own!)

In case you haven't "heard" enough, here is some food for thought:

Laparoscopic adrenalectomy for bilateral metachronous aldosteronomas

http://www.ncbi.nlm.nih.gov/pubmed/21902953

Primary aldosteronism: results of adrenalectomy for nonsingle adenoma.

http://www.ncbi.nlm.nih.gov/pubmed/21489832

Bilateral, incidentally found adrenal tumours - results of observation of 1790 patients registered at a single endocrinological centre.

http://www.ncbi.nlm.nih.gov/pubmed/20205107

- 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.

>

>

> Â

> >My nephrologist insists that based on the results of AVS, I have bilateral hyperplasia, although I have a large adenoma on the left adrenal. Dr. Grim shares the same point of view.

> >

> >

> >

> >You cannot be sure that the remaining adrenal is completely healthy. How do you feel? It's the only factor, that you have to consider. Who knows, maybe you are lucky!

> >

> >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: parkinsoniowa <parkinsoniowa@...>

> >hyperaldosteronism

> >Sent: Wednesday, February 8, 2012 9:19 AM

> >Subject: Adrenal tumor vs bilateral hyperplasia

> >

> >

> >Â

> >Can someone have an adrenal tumor and bilateral hyperplasia at the same time?

> >

> >I had an adrenal tumor on the right side that was removed 6 years ago. I did not have AVS. How do I know the remaining adrenal gland is healthy if I did not have the AVS? Thank you.

> >

> >

> >

> >

>

[Guest guest]

Agree having no adrenals is not like DASHING AND MCBing. One can die. Erg quickly with no adrenals. Say with a fractures leg or vomiting diarrhea and lack of access to cortisol. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Feb 14, 2012, at 18:13, Natalia Kamneva <natalia_kamneva@...> wrote:

>If for some unlikely reason you loose both adrenals you will be on meds for the rest of your life, just like the MCB/DASH option but it will start later!Just one comment: it's not just like, because you will be on steroids/hormones, not on MCB/DASH. In my opinion, it's much worse. 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: <jclark24p@...> hyperaldosteronism Sent: Sunday, February 12,

2012 12:02 PM Subject: Re: Adrenal tumor vs bilateral hyperplasia

First, I assume you mean "suspected adenoma" as confirmed by AVS. If the AVS was done correctly, a unilateral adenoma found and the correct adrenal was removed I think the odds of you having bilateral hyperplasia would be extremely low.

After the adrenalectomy the odds of you having bilateral is zero because bi means two and you only have one! ;>) Now that I've made my "smartassed" comment, I'm sure you meant developing an adenoma in the other adrenal, the info I have read indicates it is "very rare". In fact, I believe there would be a warning in every study that recommends removal of unilateral adenomas, the first choice in every study I've seen!

Maybe we should look at pros and cons. If you elect MCBs and DASH you will probably be on meds the rest of your life. Many still need K supplements. I've heard with low NA it is possible to eliminate MCBs but don't recall anyone reporting that situation. You should continue to monitor with scans (first at 6-12 months and if no change every 3 to 5 years, hopefully w/o contrast!)

If you elect surgery you MAY be off all meds for PA. From what I've read K always resolves. BP resolves in 30% to 40% of the cases and improves in ~97% of the cases. You should be on no or less meds and not need any followup scans!

If you have surgery and do develop PA in the other adrenal, I believe your assumption is correct. If for some unlikely reason you loose both adrenals you will be on meds for the rest of your life, just like the MCB/DASH option but it will start later!

I have a couple questions I have yet to find answers to: Odds of an adenoma growing? Odds of a benign adenoma becoming malignant? Odds of a producing adenoma increasing amount of aldosterone? Risk of adverse/unexpected consequences of long term medicine vs risk of surgery! (Feel free to add your own!)

In case you haven't "heard" enough, here is some food for thought:

Laparoscopic adrenalectomy for bilateral metachronous aldosteronomas

http://www.ncbi.nlm.nih.gov/pubmed/21902953

Primary aldosteronism: results of adrenalectomy for nonsingle adenoma.

http://www.ncbi.nlm.nih.gov/pubmed/21489832

Bilateral, incidentally found adrenal tumours - results of observation of 1790 patients registered at a single endocrinological centre.

http://www.ncbi.nlm.nih.gov/pubmed/20205107

- 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.

>

>

> Â

> >My nephrologist insists that based on the results of AVS, I have bilateral hyperplasia, although I have a large adenoma on the left adrenal. Dr. Grim shares the same point of view.

> >

> >

> >

> >You cannot be sure that the remaining adrenal is completely healthy. How do you feel? It's the only factor, that you have to consider. Who knows, maybe you are lucky!

> >

> >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: parkinsoniowa <parkinsoniowa@...>

> >hyperaldosteronism

> >Sent: Wednesday, February 8, 2012 9:19 AM

> >Subject: Adrenal tumor vs bilateral hyperplasia

> >

> >

> >Â

> >Can someone have an adrenal tumor and bilateral hyperplasia at the same time?

> >

> >I had an adrenal tumor on the right side that was removed 6 years ago. I did not have AVS. How do I know the remaining adrenal gland is healthy if I did not have the AVS? Thank you.

> >

> >

> >

> >

>

[Guest guest]

Agree having no adrenals is not like DASHING AND MCBing. One can die. Erg quickly with no adrenals. Say with a fractures leg or vomiting diarrhea and lack of access to cortisol. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Feb 14, 2012, at 18:13, Natalia Kamneva <natalia_kamneva@...> wrote:

>If for some unlikely reason you loose both adrenals you will be on meds for the rest of your life, just like the MCB/DASH option but it will start later!Just one comment: it's not just like, because you will be on steroids/hormones, not on MCB/DASH. In my opinion, it's much worse. 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: <jclark24p@...> hyperaldosteronism Sent: Sunday, February 12,

2012 12:02 PM Subject: Re: Adrenal tumor vs bilateral hyperplasia

First, I assume you mean "suspected adenoma" as confirmed by AVS. If the AVS was done correctly, a unilateral adenoma found and the correct adrenal was removed I think the odds of you having bilateral hyperplasia would be extremely low.

After the adrenalectomy the odds of you having bilateral is zero because bi means two and you only have one! ;>) Now that I've made my "smartassed" comment, I'm sure you meant developing an adenoma in the other adrenal, the info I have read indicates it is "very rare". In fact, I believe there would be a warning in every study that recommends removal of unilateral adenomas, the first choice in every study I've seen!

Maybe we should look at pros and cons. If you elect MCBs and DASH you will probably be on meds the rest of your life. Many still need K supplements. I've heard with low NA it is possible to eliminate MCBs but don't recall anyone reporting that situation. You should continue to monitor with scans (first at 6-12 months and if no change every 3 to 5 years, hopefully w/o contrast!)

If you elect surgery you MAY be off all meds for PA. From what I've read K always resolves. BP resolves in 30% to 40% of the cases and improves in ~97% of the cases. You should be on no or less meds and not need any followup scans!

If you have surgery and do develop PA in the other adrenal, I believe your assumption is correct. If for some unlikely reason you loose both adrenals you will be on meds for the rest of your life, just like the MCB/DASH option but it will start later!

I have a couple questions I have yet to find answers to: Odds of an adenoma growing? Odds of a benign adenoma becoming malignant? Odds of a producing adenoma increasing amount of aldosterone? Risk of adverse/unexpected consequences of long term medicine vs risk of surgery! (Feel free to add your own!)

In case you haven't "heard" enough, here is some food for thought:

Laparoscopic adrenalectomy for bilateral metachronous aldosteronomas

http://www.ncbi.nlm.nih.gov/pubmed/21902953

Primary aldosteronism: results of adrenalectomy for nonsingle adenoma.

http://www.ncbi.nlm.nih.gov/pubmed/21489832

Bilateral, incidentally found adrenal tumours - results of observation of 1790 patients registered at a single endocrinological centre.

http://www.ncbi.nlm.nih.gov/pubmed/20205107

- 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.

>

>

> Â

> >My nephrologist insists that based on the results of AVS, I have bilateral hyperplasia, although I have a large adenoma on the left adrenal. Dr. Grim shares the same point of view.

> >

> >

> >

> >You cannot be sure that the remaining adrenal is completely healthy. How do you feel? It's the only factor, that you have to consider. Who knows, maybe you are lucky!

> >

> >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: parkinsoniowa <parkinsoniowa@...>

> >hyperaldosteronism

> >Sent: Wednesday, February 8, 2012 9:19 AM

> >Subject: Adrenal tumor vs bilateral hyperplasia

> >

> >

> >Â

> >Can someone have an adrenal tumor and bilateral hyperplasia at the same time?

> >

> >I had an adrenal tumor on the right side that was removed 6 years ago. I did not have AVS. How do I know the remaining adrenal gland is healthy if I did not have the AVS? Thank you.

> >

> >

> >

> >

>

[Guest guest]

Coreg is not a pure BB. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Feb 14, 2012, at 11:22, Phyllis <phylisrn@...> wrote:

Atenolol which is a beta blocker will indeed cause palpitations in

some people. I took Coreg which is a beta blocker and the doc had to

take me off of it

because of ectopic beats, fluttering, etc.

Phyllis

On 2/14/2012 12:23 PM, Dianne strong wrote:

,

I'm a little concerned that you are

taking Atenolol "when I need to". I

have no medical background, so I'm not

sure, but I think Atenolol is

something you need to take regularly,

not like taking an aspirin when you

have a headache. Others on this list

can correct me if I'm wrong.

Also, any fluttering heart

arrhythmias are generally caused by

letting your K get too low and have

little to do with Atenolol. Atenolol

helps with the racing heart, not

flutters. Dehydration can also be a

cause. If I get careless and my K

drops, heart flutters or foot/leg

cramping will soon follow.

Dianne

F-69, bi-lateral adenomas, CKD from

CT scan contrast dye, 75mg Spiro, 37.5

mg. Atenolol

From: Chambers

<rebeccac66@...>

Thanks for you

comments about Atenolol.

I too find that this is

the only think that

helps with the heart

racing/fluttering

arythmias. I have

increased my Spriro to

50mg as my BP was so

high (195/95) hold off

with surgery for now. Am

taking Atenolol when i

need to. Self medicating

a little as can't get

hold of my

Endocrinologist!

Will see my GP today

instead.

Hope all goes well with

the AVS !

[Guest guest]

Coreg is not a pure BB. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Feb 14, 2012, at 11:22, Phyllis <phylisrn@...> wrote:

Atenolol which is a beta blocker will indeed cause palpitations in

some people. I took Coreg which is a beta blocker and the doc had to

take me off of it

because of ectopic beats, fluttering, etc.

Phyllis

On 2/14/2012 12:23 PM, Dianne strong wrote:

,

I'm a little concerned that you are

taking Atenolol "when I need to". I

have no medical background, so I'm not

sure, but I think Atenolol is

something you need to take regularly,

not like taking an aspirin when you

have a headache. Others on this list

can correct me if I'm wrong.

Also, any fluttering heart

arrhythmias are generally caused by

letting your K get too low and have

little to do with Atenolol. Atenolol

helps with the racing heart, not

flutters. Dehydration can also be a

cause. If I get careless and my K

drops, heart flutters or foot/leg

cramping will soon follow.

Dianne

F-69, bi-lateral adenomas, CKD from

CT scan contrast dye, 75mg Spiro, 37.5

mg. Atenolol

From: Chambers

<rebeccac66@...>

Thanks for you

comments about Atenolol.

I too find that this is

the only think that

helps with the heart

racing/fluttering

arythmias. I have

increased my Spriro to

50mg as my BP was so

high (195/95) hold off

with surgery for now. Am

taking Atenolol when i

need to. Self medicating

a little as can't get

hold of my

Endocrinologist!

Will see my GP today

instead.

Hope all goes well with

the AVS !

[Guest guest]

The makers of Atenolol says it will cause palpitations.

Phyllis

On 2/14/2012 9:47 PM, Clarence Grim wrote:

Coreg is not a pure BB.

May your pressure be low!

CE Grim MS, MD

Specializing in Difficult

Hypertension

On Feb 14, 2012, at 11:22, Phyllis <phylisrn@...>

wrote:

Atenolol which is a beta blocker will indeed cause

palpitations in some people. I took Coreg which is a

beta blocker and the doc had to take me off of it

because of ectopic beats, fluttering, etc.

Phyllis

On 2/14/2012 12:23 PM, Dianne strong wrote:

,

I'm a little concerned that

you are taking Atenolol "when

I need to". I have no medical

background, so I'm not sure,

but I think Atenolol is

something you need to take

regularly, not like taking an

aspirin when you have a

headache. Others on this list

can correct me if I'm wrong.

Also, any fluttering heart

arrhythmias are generally

caused by letting your K get

too low and have little to do

with Atenolol. Atenolol helps

with the racing heart, not

flutters. Dehydration can also

be a cause. If I get careless

and my K drops, heart flutters

or foot/leg cramping will soon

follow.

Dianne

F-69, bi-lateral adenomas,

CKD from CT scan contrast dye,

75mg Spiro, 37.5 mg. Atenolol

From: Chambers <rebeccac66@...>

Thanks

for you comments

about Atenolol.

I too find that

this is the only

think that helps

with the heart

racing/fluttering

arythmias. I

have increased

my Spriro to

50mg as my BP

was so high

(195/95) hold

off with surgery

for now. Am

taking Atenolol

when i need to.

Self medicating

a little as

can't get hold

of my

Endocrinologist!

Will see my GP

today instead.

Hope all goes

well with the AVS

!

[Guest guest]

The makers of Atenolol says it will cause palpitations.

Phyllis

On 2/14/2012 9:47 PM, Clarence Grim wrote:

Coreg is not a pure BB.

May your pressure be low!

CE Grim MS, MD

Specializing in Difficult

Hypertension

On Feb 14, 2012, at 11:22, Phyllis <phylisrn@...>

wrote:

Atenolol which is a beta blocker will indeed cause

palpitations in some people. I took Coreg which is a

beta blocker and the doc had to take me off of it

because of ectopic beats, fluttering, etc.

Phyllis

On 2/14/2012 12:23 PM, Dianne strong wrote:

,

I'm a little concerned that

you are taking Atenolol "when

I need to". I have no medical

background, so I'm not sure,

but I think Atenolol is

something you need to take

regularly, not like taking an

aspirin when you have a

headache. Others on this list

can correct me if I'm wrong.

Also, any fluttering heart

arrhythmias are generally

caused by letting your K get

too low and have little to do

with Atenolol. Atenolol helps

with the racing heart, not

flutters. Dehydration can also

be a cause. If I get careless

and my K drops, heart flutters

or foot/leg cramping will soon

follow.

Dianne

F-69, bi-lateral adenomas,

CKD from CT scan contrast dye,

75mg Spiro, 37.5 mg. Atenolol

From: Chambers <rebeccac66@...>

Thanks

for you comments

about Atenolol.

I too find that

this is the only

think that helps

with the heart

racing/fluttering

arythmias. I

have increased

my Spriro to

50mg as my BP

was so high

(195/95) hold

off with surgery

for now. Am

taking Atenolol

when i need to.

Self medicating

a little as

can't get hold

of my

Endocrinologist!

Will see my GP

today instead.

Hope all goes

well with the AVS

!

[Guest guest]

Thanks Diane,Don't worry i don't exactly take Atenolol like Smarties :-) i always stay within my daily dosage. I'm still mid-diagnosis, so at the moment still trying to get the meds right. Currenly my K is within normal range, but as i've just started taking Spironolactone it's being checked weekly. It's all a balancing act at the moment, and still very new to me. Am keeping my Sodium intake low and getting to grips with DASHing! From: Dianne strong

<dianstrong@...> hyperaldosteronism Sent: Tuesday, 14 February 2012, 17:23 Subject: Re: Re: Adrenal tumor vs bilateral hyperplasia

,I'm a little concerned that you are taking Atenolol "when I need to". I have no medical background, so I'm not sure, but I think Atenolol is something you need to take regularly, not like taking an aspirin when you have a headache. Others on this list can correct me if I'm wrong.Also, any fluttering heart arrhythmias are generally caused by letting your K get too low and have little to do with Atenolol. Atenolol helps with the racing heart, not flutters. Dehydration can also be a cause. If I get careless and my K drops, heart flutters or foot/leg cramping will soon

follow.DianneF-69, bi-lateral adenomas, CKD from CT scan contrast dye, 75mg Spiro, 37.5 mg. AtenololFrom: Chambers <rebeccac66@...>

Thanks for you comments about Atenolol. I too find that this is the only think that helps with the heart racing/fluttering arythmias. I have increased my Spriro to 50mg as my BP was so high (195/95) hold off with surgery for now. Am taking Atenolol when i need to. Self medicating a little as can't get hold of my Endocrinologist! Will see my GP today instead.Hope all goes well with the AVS !

[Guest guest]

Thanks Diane,Don't worry i don't exactly take Atenolol like Smarties :-) i always stay within my daily dosage. I'm still mid-diagnosis, so at the moment still trying to get the meds right. Currenly my K is within normal range, but as i've just started taking Spironolactone it's being checked weekly. It's all a balancing act at the moment, and still very new to me. Am keeping my Sodium intake low and getting to grips with DASHing! From: Dianne strong

<dianstrong@...> hyperaldosteronism Sent: Tuesday, 14 February 2012, 17:23 Subject: Re: Re: Adrenal tumor vs bilateral hyperplasia

,I'm a little concerned that you are taking Atenolol "when I need to". I have no medical background, so I'm not sure, but I think Atenolol is something you need to take regularly, not like taking an aspirin when you have a headache. Others on this list can correct me if I'm wrong.Also, any fluttering heart arrhythmias are generally caused by letting your K get too low and have little to do with Atenolol. Atenolol helps with the racing heart, not flutters. Dehydration can also be a cause. If I get careless and my K drops, heart flutters or foot/leg cramping will soon

follow.DianneF-69, bi-lateral adenomas, CKD from CT scan contrast dye, 75mg Spiro, 37.5 mg. AtenololFrom: Chambers <rebeccac66@...>

Thanks for you comments about Atenolol. I too find that this is the only think that helps with the heart racing/fluttering arythmias. I have increased my Spriro to 50mg as my BP was so high (195/95) hold off with surgery for now. Am taking Atenolol when i need to. Self medicating a little as can't get hold of my Endocrinologist! Will see my GP today instead.Hope all goes well with the AVS !

[Guest guest]

OK which book?! I've ordered the eating plan?!Anybody you can recommend to me perhaps in London?! Haven't heard from Prof. Brown as yet.My GP has written to the Endo. voiceing my concerns about surgery without further investigation From: Clarence Grim <lowerbp2@...> hyperaldosteronism Cc: Clarence Grim <lowerbp2@...> Sent: Tuesday, 14 February 2012, 15:31 Subject: Re: Re: Adrenal tumor vs bilateral hyperplasia

DASH DASH! you can out salt spiro and all other BP meds.Start Chapter 9 now. exactly.CE Grim MDOn Feb 13, 2012, at 10:55 PM, Chambers wrote: Thanks for you comments about Atenolol. I too find that this is the only think that helps with the heart racing/fluttering arythmias. I have increased my Spriro to 50mg as my BP was so high (195/95) yesterday, and feeling incapable of doing anything. As i've decided to hold off with surgery for now. Am taking Atenolol when i need to. Self medicating a little as can't get hold

of my Endocrinologist! Will see my GP today instead.Hope all goes well with the AVS ! From: <jclark24p@...> hyperaldosteronism Sent: Tuesday, 14 February 2012, 1:39 Subject: Re: Adrenal

tumor vs bilateral hyperplasia I haven't heard yet. Dr. L. asked for a referal, meds and ct-scans. I left a message for PCP and she responded Thurs afternoon that she would make the referral and I sent a release for the scans which the VA should have received today. Hopefully will know later this week. > > > > > > > > >  > > > > > > > > > > > > > > > > > > > >My nephrologist insists that based on the results of AVS, I > > > have bilateral hyperplasia, although I have a large adenoma on the >

> > left adrenal. Dr. Grim shares the same point of view. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >You cannot be sure that the remaining adrenal is completely > > > healthy. How do you feel? It's the only factor, that you have to > > > consider. Who knows, maybe you are lucky! > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

> > > > > > > > > > > > > > > > > > > > >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: parkinsoniowa <parkinsoniowa@> > > > > > > > > > > > > > > > > > > > >hyperaldosteronism > > > > > > > > > > > > > > > > > > > >Sent: Wednesday, February 8, 2012 9:19 AM > > > > > > > > > > > > > > > > > > > >Subject: Adrenal tumor vs bilateral > > > hyperplasia > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >Can someone have an adrenal tumor and bilateral hyperplasia > > > at the same time? > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >I had an adrenal tumor on the right side that was removed 6 > > > years ago. I did not have AVS. How do I know the remaining adrenal > > > gland is healthy if I did not have the AVS? Thank you. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

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

[Guest guest]

I think is says it MAY cause them. But see if you can find it it caused more than a placebo. Palps are very common. CE Grim MDOn Feb 14, 2012, at 7:56 PM, Phyllis wrote: The makers of Atenolol says it will cause palpitations. Phyllis On 2/14/2012 9:47 PM, Clarence Grim wrote: Coreg is not a pure BB. May your pressure be low! CE Grim MS, MD Specializing in Difficult Hypertension On Feb 14, 2012, at 11:22, Phyllis <phylisrn@...> wrote: Atenolol which is a beta blocker will indeed cause palpitations in some people. I took Coreg which is a beta blocker and the doc had to take me off of it because of ectopic beats, fluttering, etc. Phyllis On 2/14/2012 12:23 PM, Dianne strong wrote: , I'm a little concerned that you are taking Atenolol "when I need to". I have no medical background, so I'm not sure, but I think Atenolol is something you need to take regularly, not like taking an aspirin when you have a headache. Others on this list can correct me if I'm wrong. Also, any fluttering heart arrhythmias are generally caused by letting your K get too low and have little to do with Atenolol. Atenolol helps with the racing heart, not flutters. Dehydration can also be a cause. If I get careless and my K drops, heart flutters or foot/leg cramping will soon follow. Dianne F-69, bi-lateral adenomas, CKD from CT scan contrast dye, 75mg Spiro, 37.5 mg. Atenolol From: Chambers <rebeccac66@...> Thanks for you comments about Atenolol. I too find that this is the only think that helps with the heart racing/fluttering arythmias. I have increased my Spriro to 50mg as my BP was so high (195/95) hold off with surgery for now. Am taking Atenolol when i need to. Self medicating a little as can't get hold of my Endocrinologist! Will see my GP today instead. Hope all goes well with the AVS !

[Guest guest]

DASH Dietary Approach to Stopping Hypertension by . Paper back from Amazon.com for about $8.Did you not get this welcome? Welcome to the exciting world of Hyperaldosteronism You are in the right place! I am Dr. CE Grim a retired Professor of Medicine and Endocrinology. I have had a long standing interest is Primary Aldosteronism since medical school days when I saw my first patient with Primary Aldosteronism in 1963 as a 4th year medical student. I did a Nephrology Fellowship at Duke and an Endocrinology and Metabolism Fellowship with Dr. Conn (1969-70). I have been on the faculty of the University of MO, Indiana Univ, UCLA/ R. Drew, and the Medical College of Wisconsin in Divisions of Nephrology, Endocrinology, Hypertension, Cardiology and Epidemiology. I have published over 240 papers and book chapters in most areas of the broad discipline of High Blood Pressure. My CV is in our files for details. The GOAL of our group is to teach you and your health care team about the ins and outs of the causes, diagnosis and control of the many forms of hyperaldosteronism. The steps below will introduce you into the fascinating world of high blood pressure, salt and potassium and the role of the adrenal hormone aldosterone in health and disease. Doing these in sequence will save you time and effort in getting up to speed in taking control of you health and educating your own health care team. While we can’t make you a doctor we will make you into a pretty good BP doctor-a skill that you will have for life. 1. Overview: Read my article in our files on the evolution of PA (Evolution_of_PA-Grim.pdf ) and take to all members of health care team. Tell us what stage you believe you are in. This is a brief review of most causes of hyperaldosteronism, high blood pressure, low potassium (K). Be certain that you and your health care team understand the key role of excess diet salt in HTN and especially in PA. Go to: http://www.worldactiononsalt.com/evidence/treatment_trials.htm For a state of the art and science discussion of salt and health. 2. Other patients with hyperaldosteronism (Conn’s syndrome). Read our Conn's stories in our files and then give us your own in as much detail as you can. Dr. Conn was the first to describe this disease process and the syndrome is named after him. To see others' stories, on the Hyperaldosteronism home page, go to Files/Conn’s Stories. You'll find instructions in "A - How to put your story here.doc "Then send us your story in an email and then we will likely ask more questions and make suggestions before you upload it to our files. 3. Hyperaldosteronism and Salt: The deadly Duo. Eating Plan to control high blood pressure due to hyperaldosteronism and most others with high blood pressure. This will reduce your need for medications and in many will get your BP and K to goal without meds.. Get the DASH diet book by T. et al, read it and use it: $8 in paperback at your local bookstore. If they don’t have it ask them to order it for you. Learning to eat the DASH way will play a major role in your road to good BP and K control and, in many of our folks here, will revolutionize your life. Go to chapter 9 and do the 14 day challenge. Tell your Dr you are doing this as your BP may plummet if you are on other meds in only 2-3 days. or go to http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf download this 64 page booklet free and do the Week on the DASH Diet for 2 weeks. If you are on BP meds be prepared for a large fall in BP and let your Dr. know you are doing this. Or go to (but costs money) DASH Diet for Health ProgramThe DASH Diet for Health Program is designed to help you improve your eating and exercise habits. Twice each week we will provide you with information on our website about food, food preparation, eating out, losing weight, getting fit and much more. In addition to providing new information each week on our website, we create a web page specially for you where you can track progress in areas such as your weight, blood pressure, and exercise.http://www.dashforhealth.com/ I strongly recommend you get the book and read it now! 4. Measure your BP: Measure your BP daily so you can see if it is getting better. If you are taking meds be sure to tell your health care team you are doing this as your BP may plummet to normal quickly. We recommend you use a device you listen to and will help you learn how to do this. If this is not something you want to do we can teach a significant other how to do it. See sharedcareinc.com or email to sharedcare@... to order a video on how to do this. If you already have one we will teach you how to teach your health care team how to validate your device. Your life and health depends on accurate BP measurements. Go to the amricanheart.org and download the Guidelines for Human Blood Pressure Measurement. Insist the your health care team do BP the AHA way. Your life is in the hands of those who measure your BP. Never trust your life to an automatic BP machine unless you know it is accurate on YOU. 5. Genetics and your BP: Go to familyhistory.hhs.gov and do your detailed family medical history so we can review with you to help Dx familial causes of high blood pressure and heart disease. If BP runs in your family you may save lives in your family by checking their BP yourself. There is a brief discussion of this in my Evolution Article. 6. How to DX and treat PA: Go to our file/Conn's Articles of Note/Medications/Bravo spir 1973.pdf and read this article and take to your health care team. It is old but still one of the best in the medical management of PA. Also see our file from the Endocrine Society Guidelines on PA. Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a high salt diet for 2 weeks-at least 4000 mg of Na a day.2. No BP meds in last 4-12 weeks depending on meds and Drs advice.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 1-4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. I call this Dr. Grim’s “Quick Pee Test” for PA. Our PA Registry: If you have been Dxed with PA already and are on Rx or have had surgery please go to http://www.kwiksurveys.com/online-survey.php?surveyID=HIJIO_f2685379 and complete our survey with as much information as you know. If there is some information you don't know ask us and we will help. If you need to update this as you journey thru the diagnostic/treatment process you can add another entry but label it as Nameyymmdd. For example today 4/20/11 for me would be Grim110420. This way of writing the date is an ever increasing number and will allow us and you to sort your multiple entries into a dated order. We are working on a more extensive database. 8. Learn the language: If you are new to medical lingo then download the acroyms from bloodpressureline/message/291869. Salt and high blood pressure: To learn the state of the science of salt and blood pressure please spend some time looking at http://www.worldactiononsalt.com/evidence/treatment_trials.htm10. Become a HBP expert consumer: Expect that it will take at least several weeks to get all this digested and to learn the new language of high blood pressure health care. As most doctors and nurses in practice have had very little training in high blood pressure you must become an expert yourself. For example most have never had anyone listen with them with a double stethoscope to verify that they can hear BP sounds. We cannot make you a doctor but we will make you a pretty good BP doctor.11. How High Blood Pressure should be managed: Go to nih.gov and download and read the Joint National Commission (JNC) Report 7 to get an overview on current guidelines. I ask all my secretaries to read this so they can communicate the importance of high blood pressure to my patients. JNC 8 will be out soon.Then: get (and study) the Hypertension Primer from americanheart.org. This is the most up-to-date compendium of what is known about high blood pressure and what every Dr. should know when they graduate from Medical School. Every chapter is only 2-3 pages. Read one chapter every week-night and you will finish it in about a year. I am working on a reading guide for lay people for the Primer. Stay tuned.12. Ask us questions: Ask any questions about high blood pressure you want answered. That is what we are here for.13. One-on-one Consulting: I can provide individual consulting if you do not want to go public. If you want individual one-on-one consulting for you and your Doctor contract me directly at lowerbp2@....May your pressure be low!Clarence E. Grim BS, MS, MD, FACP, FACCBoard Certified in Internal Medicine, Geriatrics, and High Blood Pressure Specializing in Primary Aldosteronism and Difficult to Control High Blood Pressure. On Feb 15, 2012, at 12:55 AM, Chambers wrote: OK which book?! I've ordered the eating plan?!Anybody you can recommend to me perhaps in London?! Haven't heard from Prof. Brown as yet.My GP has written to the Endo. voiceing my concerns about surgery without further investigation From: Clarence Grim <lowerbp2@...> hyperaldosteronism Cc: Clarence Grim <lowerbp2@...> Sent: Tuesday, 14 February 2012, 15:31 Subject: Re: Re: Adrenal tumor vs bilateral hyperplasia DASH DASH! you can out salt spiro and all other BP meds.Start Chapter 9 now. exactly.CE Grim MDOn Feb 13, 2012, at 10:55 PM, Chambers wrote: Thanks for you comments about Atenolol. I too find that this is the only think that helps with the heart racing/fluttering arythmias. I have increased my Spriro to 50mg as my BP was so high (195/95) yesterday, and feeling incapable of doing anything. As i've decided to hold off with surgery for now. Am taking Atenolol when i need to. Self medicating a little as can't get hold of my Endocrinologist! Will see my GP today instead.Hope all goes well with the AVS ! From: <jclark24p@...> hyperaldosteronism Sent: Tuesday, 14 February 2012, 1:39 Subject: Re: Adrenal tumor vs bilateral hyperplasia I haven't heard yet. Dr. L. asked for a referal, meds and ct-scans. I left a message for PCP and she responded Thurs afternoon that she would make the referral and I sent a release for the scans which the VA should have received today. Hopefully will know later this week. > > > > > > > > >  > > > > > > > > > > > > > > > > > > > >My nephrologist insists that based on the results of AVS, I > > > have bilateral hyperplasia, although I have a large adenoma on the > > > left adrenal. Dr. Grim shares the same point of view. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >You cannot be sure that the remaining adrenal is completely > > > healthy. How do you feel? It's the only factor, that you have to > > > consider. Who knows, maybe you are lucky! > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >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: parkinsoniowa <parkinsoniowa@> > > > > > > > > > > > > > > > > > > > >hyperaldosteronism > > > > > > > > > > > > > > > > > > > >Sent: Wednesday, February 8, 2012 9:19 AM > > > > > > > > > > > > > > > > > > > >Subject: Adrenal tumor vs bilateral > > > hyperplasia > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >Can someone have an adrenal tumor and bilateral hyperplasia > > > at the same time? > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >I had an adrenal tumor on the right side that was removed 6 > > > years ago. I did not have AVS. How do I know the remaining adrenal > > > gland is healthy if I did not have the AVS? Thank you. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

[Guest guest]

can you send me an email at lowerbp2@... so I have your email. Have some new infor on testing home urine Na and even K. CE Grim MDOn Feb 13, 2012, at 5:39 PM, wrote: I haven't heard yet. Dr. L. asked for a referal, meds and ct-scans. I left a message for PCP and she responded Thurs afternoon that she would make the referral and I sent a release for the scans which the VA should have received today. Hopefully will know later this week. > > > > > > > > >  > > > > > > > > > > > > > > > > > > > >My nephrologist insists that based on the results of AVS, I > > > have bilateral hyperplasia, although I have a large adenoma on the > > > left adrenal. Dr. Grim shares the same point of view. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >You cannot be sure that the remaining adrenal is completely > > > healthy. How do you feel? It's the only factor, that you have to > > > consider. Who knows, maybe you are lucky! > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >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: parkinsoniowa <parkinsoniowa@> > > > > > > > > > > > > > > > > > > > >hyperaldosteronism > > > > > > > > > > > > > > > > > > > >Sent: Wednesday, February 8, 2012 9:19 AM > > > > > > > > > > > > > > > > > > > >Subject: Adrenal tumor vs bilateral > > > hyperplasia > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >Can someone have an adrenal tumor and bilateral hyperplasia > > > at the same time? > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >I had an adrenal tumor on the right side that was removed 6 > > > years ago. I did not have AVS. How do I know the remaining adrenal > > > gland is healthy if I did not have the AVS? Thank you. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

[Guest guest]

can you send me an email at lowerbp2@... so I have your email. Have some new infor on testing home urine Na and even K. CE Grim MDOn Feb 13, 2012, at 5:39 PM, wrote: I haven't heard yet. Dr. L. asked for a referal, meds and ct-scans. I left a message for PCP and she responded Thurs afternoon that she would make the referral and I sent a release for the scans which the VA should have received today. Hopefully will know later this week. > > > > > > > > >  > > > > > > > > > > > > > > > > > > > >My nephrologist insists that based on the results of AVS, I > > > have bilateral hyperplasia, although I have a large adenoma on the > > > left adrenal. Dr. Grim shares the same point of view. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >You cannot be sure that the remaining adrenal is completely > > > healthy. How do you feel? It's the only factor, that you have to > > > consider. Who knows, maybe you are lucky! > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >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: parkinsoniowa <parkinsoniowa@> > > > > > > > > > > > > > > > > > > > >hyperaldosteronism > > > > > > > > > > > > > > > > > > > >Sent: Wednesday, February 8, 2012 9:19 AM > > > > > > > > > > > > > > > > > > > >Subject: Adrenal tumor vs bilateral > > > hyperplasia > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >Can someone have an adrenal tumor and bilateral hyperplasia > > > at the same time? > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >I had an adrenal tumor on the right side that was removed 6 > > > years ago. I did not have AVS. How do I know the remaining adrenal > > > gland is healthy if I did not have the AVS? Thank you. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >