Re: Re: Saline Sup. medical code

June 25, 2012

OMG that's too funny!To: hyperaldosteronism From: janeray1940@...Date: Tue, 26 Jun 2012 01:29:38 +0000Subject: Re: Saline Sup. medical code

No idea what the code is, but I will say this: few, if any, of the names of the tests I had done during my diagnosis corresponded to reality in any way!

The one that stands out in my memory the most is the code for my AVS - it translated to something like " adrenal tumor embolization " and for a couple days I was really freaked out that what I was booked for in the hospital was not what I had signed on for :)

--- In hyperaldosteronism , " catherinekerth1 " <catherinekerth@...> wrote:

>

> quick question. since this group is VERY knowledgeable about the tests for PA.... Does anyone know the medical order code for the saline suppression?

> i called the insurance company tonight to make sure if this had to be approved, that it is indeed approved. the lady said she had never heard of anything like the saline suppression. so it might not need approval but i should call my doctor or the hospital and get the code. and check with them first.

>

> i am a little nervous now. i was really counting on this happening on Wednesday...

>

> i have a feeling the hospital that i am going to doesn't really do this type of test often,considering my doctor himself handled the paper work and phones calls.

>

> 38 yrs

> aldo 30 (?-28)

> renin .38 (.25-5.89)

> ratio 78.9 (.9-28.9)

> Nifedipine 30 mg

> Bystolic 5mg

> CT scan normal

> Saline suppression june 27th!

> K- (3.2 thru 4.0) 3.2 was when i was training for half marathon.... 4.0 was with very little running for a few months...

> K-only low if I start to run or exercise vigorously. so i have shortened mileage and slowed pace a great deal to compensate. (a work in progress)

> BP avg 140-160's/80-100's on a good day

>

June 26, 2012

Jclark, you are the bomb!thanks for the info it was instrumental! talked to cigna, it does not need pre-approval. phew!we are a go tomorrow morning.

Kerth

http://mamallamaknits.com

http://www.knittycath.blogspot.com

http://thekerthfamily.4t.comTo: hyperaldosteronism From: jclark24p@...Date: Tue, 26 Jun 2012 01:50:47 +0000Subject: Re: Saline Sup. medical code

Try 80408 "Evoctive Suppression Test" No guarantee but you can see for yourself on page 7 here:

https://provider.medica.com/C14/ClaimPolicies/Document%20Library/Laboratory_Services_Policy.pdf

>> quick question. since this group is VERY knowledgeable about the tests for PA.... Does anyone know the medical order code for the saline suppression? > i called the insurance company tonight to make sure if this had to be approved, that it is indeed approved. the lady said she had never heard of anything like the saline suppression. so it might not need approval but i should call my doctor or the hospital and get the code. and check with them first.> > i am a little nervous now. i was really counting on this happening on Wednesday...> > i have a feeling the hospital that i am going to doesn't really do this type of test often,considering my doctor himself handled the paper work and phones calls.> > > 38 yrs> aldo 30 (?-28)> renin .38 (.25-5.89)> ratio 78.9 (.9-28.9)> Nifedipine 30 mg> Bystolic 5mg> CT scan normal> Saline suppression june 27th! > K- (3.2 thru 4.0) 3.2 was when i was training for half marathon.... 4.0 was with very little running for a few months...> K-only low if I start to run or exercise vigorously. so i have shortened mileage and slowed pace a great deal to compensate. (a work in progress)> BP avg 140-160's/80-100's on a good day >

June 26, 2012

In many places they have not done many and mess it up. Be certain to tell the to measure how mCh urine you pee from start to finish as the volume will tell if u have PA USING THE Grim pee test. Many forget to do this so write it down to ask Them to do it. If they say they don't do it ask them to pour t in a jug so u can measure it your self. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jun 26, 2012, at 11:30, <jclark24p@...> wrote:

JC

> >> > quick question. since this group is VERY knowledgeable about the tests for PA.... Does anyone know the medical order code for the saline suppression? > > i called the insurance company tonight to make sure if this had to be approved, that it is indeed approved. the lady said she had never heard of anything like the saline suppression. so it might not need approval but i should call my doctor or the hospital and get the code. and check with them first.> > > > i am a little nervous now. i was really counting on this happening on Wednesday...> > > > i have a feeling the hospital that i am going to doesn't really do this type of test often,considering my doctor himself

handled the paper work and phones calls.> > > > > > 38 yrs> > aldo 30 (?-28)> > renin .38 (.25-5.89)> > ratio 78.9 (.9-28.9)> > Nifedipine 30 mg> > Bystolic 5mg> > CT scan normal> > Saline suppression june 27th! > > K- (3.2 thru 4.0) 3.2 was when i was training for half marathon.... 4.0 was with very little running for a few months...> > K-only low if I start to run or exercise vigorously. so i have shortened mileage and slowed pace a great deal to compensate. (a work in progress)> > BP avg 140-160's/80-100's on a good day > >>

June 26, 2012

, good luck tomorrow! For what it is worth, I just had 2 saline suppression tests done in the last 2 months. Both were inconclusive. I was too shy/nervous to second guess anything, and didn't ask them to measure my urine output. Please do ask, it is a simple request and will help you have a better understanding later if the test is inconclusive. The NIH protocol (thanks ) indicates that you should not eat prior to test, my facility said it was ok to eat before, and I did. They even had snacks in the room and offered me soda/juice. I specifically asked if it was ok to eat and they said it was fine. I think they were wrong...I think NIH has a much better handle on this than most hospitals. I would ask them if they can get your

initial blood work back (they will take samples before and after test) ASAP, and if your K is low - even close to the low end of normal - I would ask Dr if you could get a K drip as well as the saline. All that saline makes you pee a lot (if you have PA) and with the urine goes the K. If your K is low prior to the test, see if they will just wait until your K gets back to normal range and then start. Both times I had my test my K dropped too low during the test which made it inconclusive. A lot of wasted time and money. After the fact, someone in the group told me they should have given me a K drip with the saline...I wish I would have known in advance. Good luck to you!! 39 y/o female2 cm adenoma on left adrenalAwaiting results from AVScurrently

on 140meq K per day & 180 mg Verapamil From: Kerth <catherinekerth@...> hyperaldosteronism Sent: Tuesday, June 26, 2012 11:43 AM Subject: RE: Re: Saline Sup. medical code

Jclark, you are the bomb!thanks for the info it was instrumental! talked to cigna, it does not need pre-approval. phew!we are a go tomorrow morning.

Kerth

http://mamallamaknits.com

http://www.knittycath.blogspot.com

http://thekerthfamily.4t.comTo: hyperaldosteronism From: jclark24p@...Date: Tue, 26 Jun 2012 01:50:47 +0000Subject: Re: Saline Sup. medical code

Try 80408 "Evoctive Suppression Test" No guarantee but you can see for yourself on page 7 here:

https://provider.medica.com/C14/ClaimPolicies/Document%20Library/Laboratory_Services_Policy.pdf

>> quick question. since this group is VERY knowledgeable about the tests for PA.... Does anyone know the medical order code for the saline suppression? > i called the insurance company tonight to make sure if this had to be approved, that it is indeed approved. the lady said she had never heard of anything like the saline suppression. so it might not need approval but i should call my doctor or the hospital and get the code. and check with them first.> > i am a little nervous now. i was really counting on this happening on Wednesday...> > i have a feeling the hospital that i am going to doesn't really do this type of test often,considering my doctor himself handled the paper work and phones calls.> > > 38 yrs> aldo 30 (?-28)> renin .38 (.25-5.89)> ratio 78.9

(.9-28.9)> Nifedipine 30 mg> Bystolic 5mg> CT scan normal> Saline suppression june 27th! > K- (3.2 thru 4.0) 3.2 was when i was training for half marathon.... 4.0 was with very little running for a few months...> K-only low if I start to run or exercise vigorously. so i have shortened mileage and slowed pace a great deal to compensate. (a work in progress)> BP avg 140-160's/80-100's on a good day >

June 26, 2012

Thank you . I am usually a very shy person as well. If I tell my husband he will speak up if I don't.On June 8th my K was 4.0So I think I am OK with it.I do want to take your advice tho ;)I hope my test is text book. I think I might cry if it comes back inconclusive as yours did.To: hyperaldosteronism From: jessdell72@...Date: Tue, 26 Jun 2012 17:55:14 -0700Subject: Re: Re: Saline Sup. medical code

, good luck tomorrow! For what it is worth, I just had 2 saline suppression tests done in the last 2 months. Both were inconclusive. I was too shy/nervous to second guess anything, and didn't ask them to measure my urine output. Please do ask, it is a simple request and will help you have a better understanding later if the test is inconclusive. The NIH protocol (thanks ) indicates that you should not eat prior to test, my facility said it was ok to eat before, and I did. They even had snacks in the room and offered me soda/juice. I specifically asked if it was ok to eat and they said it was fine. I think they were wrong...I think NIH has a much better handle on this than most hospitals. I would ask them if they can get your

initial blood work back (they will take samples before and after test) ASAP, and if your K is low - even close to the low end of normal - I would ask Dr if you could get a K drip as well as the saline. All that saline makes you pee a lot (if you have PA) and with the urine goes the K. If your K is low prior to the test, see if they will just wait until your K gets back to normal range and then start. Both times I had my test my K dropped too low during the test which made it inconclusive. A lot of wasted time and money. After the fact, someone in the group told me they should have given me a K drip with the saline...I wish I would have known in advance. Good luck to you!! :) 39 y/o female2 cm adenoma on left adrenalAwaiting results from AVScurrently

on 140meq K per day & 180 mg Verapamil From: Kerth <catherinekerth@...> To: hyperaldosteronism Sent: Tuesday, June 26, 2012 11:43 AM Subject: RE: Re: Saline Sup. medical code

Jclark, you are the bomb!thanks for the info it was instrumental! talked to cigna, it does not need pre-approval. phew!we are a go tomorrow morning.

Kerth

http://mamallamaknits.com

http://www.knittycath.blogspot.com

http://thekerthfamily.4t.comTo: hyperaldosteronism From: jclark24p@...Date: Tue, 26 Jun 2012 01:50:47 +0000Subject: Re: Saline Sup. medical code

Try 80408 " Evoctive Suppression Test " No guarantee but you can see for yourself on page 7 here:

https://provider.medica.com/C14/ClaimPolicies/Document%20Library/Laboratory_Services_Policy.pdf

--- In hyperaldosteronism , " catherinekerth1 " <catherinekerth@...> wrote:>> quick question. since this group is VERY knowledgeable about the tests for PA.... Does anyone know the medical order code for the saline suppression? > i called the insurance company tonight to make sure if this had to be approved, that it is indeed approved. the lady said she had never heard of anything like the saline suppression. so it might not need approval but i should call my doctor or the hospital and get the code. and check with them first.> > i am a little nervous now. i was really counting on this happening on Wednesday...> > i have a feeling the hospital that i am going to doesn't really do this type of test often,considering my doctor himself handled the paper work and phones calls.> > > 38 yrs> aldo 30 (?-28)> renin .38 (.25-5.89)> ratio 78.9

(.9-28.9)> Nifedipine 30 mg> Bystolic 5mg> CT scan normal> Saline suppression june 27th! > K- (3.2 thru 4.0) 3.2 was when i was training for half marathon.... 4.0 was with very little running for a few months...> K-only low if I start to run or exercise vigorously. so i have shortened mileage and slowed pace a great deal to compensate. (a work in progress)> BP avg 140-160's/80-100's on a good day >

June 26, 2012

Excellent!! Well, if nothing else, these mix ups by the medical team as well as encouragement from this group has greatly helped me overcome my shyness. You should have seen me grill the Interventional Radiologist (who did the AVS). I was so proud of myself...and much to my surprise he was very positive and encouraging about the fact that I was so well prepared and taking control of my health. I can't thank this group enough!! Best wishes! From: Kerth <catherinekerth@...> hyperaldosteronism Sent: Tuesday, June 26, 2012 8:16 PM Subject: RE: Re: Saline Sup. medical code

Thank you . I am usually a very shy person as well. If I tell my husband he will speak up if I don't.On June 8th my K was 4.0So I think I am OK with it.I do want to take your advice tho ;)I hope my test is text book. I think I might cry if it comes back inconclusive as yours did.hyperaldosteronism From: jessdell72@...Date: Tue, 26 Jun 2012 17:55:14 -0700Subject: Re: Re: Saline Sup. medical code

, good luck tomorrow! For what it is worth, I just had 2 saline suppression tests done in the last 2 months. Both were inconclusive. I was too shy/nervous to second guess anything, and didn't ask them to measure my urine output. Please do ask, it is a simple request and will help you have a better understanding later if the test is inconclusive. The NIH protocol (thanks ) indicates that you should not eat prior to test, my facility said it was ok to eat before, and I did. They even had snacks in the room and offered me soda/juice. I specifically asked if it was ok to eat and they said it was fine. I think they were wrong...I think NIH has a much better handle on this than most hospitals. I would ask them if

they can get your

initial blood work back (they will take samples before and after test) ASAP, and if your K is low - even close to the low end of normal - I would ask Dr if you could get a K drip as well as the saline. All that saline makes you pee a lot (if you have PA) and with the urine goes the K. If your K is low prior to the test, see if they will just wait until your K gets back to normal range and then start. Both times I had my test my K dropped too low during the test which made it inconclusive. A lot of wasted time and money. After the fact, someone in the group told me they should have given me a K drip with the saline...I wish I would have known in advance. Good luck to you!! 39 y/o female2 cm adenoma on left adrenalAwaiting results from AVScurrently

on 140meq K per day & 180 mg Verapamil From: Kerth <catherinekerth@...> hyperaldosteronism Sent: Tuesday, June 26, 2012 11:43 AM Subject: RE: Re: Saline Sup. medical code

Jclark, you are the bomb!thanks for the info it was instrumental! talked to cigna, it does not need pre-approval. phew!we are a go tomorrow morning.

Kerth

http://mamallamaknits.com

http://www.knittycath.blogspot.com

http://thekerthfamily.4t.comTo: hyperaldosteronism From: jclark24p@...Date: Tue, 26 Jun 2012 01:50:47 +0000Subject: Re: Saline Sup. medical code

Try 80408 "Evoctive Suppression Test" No guarantee but you can see for yourself on page 7 here:

https://provider.medica.com/C14/ClaimPolicies/Document%20Library/Laboratory_Services_Policy.pdf

>> quick question. since this group is VERY knowledgeable about the tests for PA.... Does anyone know the medical order code for the saline suppression? > i called the insurance company tonight to make sure if this had to be approved, that it is indeed approved. the lady said she had never heard of anything like the saline suppression. so it might not need approval but i should call my doctor or the hospital and get the code. and check with them first.> > i am a little nervous now. i was really counting on this happening on Wednesday...> > i have a feeling the hospital that i am going to doesn't really do this type of test often,considering my doctor himself handled the paper work and phones calls.> > > 38 yrs> aldo 30 (?-28)> renin .38 (.25-5.89)> ratio 78.9

(.9-28.9)> Nifedipine 30 mg> Bystolic 5mg> CT scan normal> Saline suppression june 27th! > K- (3.2 thru 4.0) 3.2 was when i was training for half marathon.... 4.0 was with very little running for a few months...> K-only low if I start to run or exercise vigorously. so i have shortened mileage and slowed pace a great deal to compensate. (a work in progress)> BP avg 140-160's/80-100's on a good day >

June 26, 2012

Remind them Dr. Grim developed this test and has used it in over 1000 persons.CE Grim MDOn Jun 26, 2012, at 6:29 PM, J. wrote: Excellent!! Well, if nothing else, these mix ups by the medical team as well as encouragement from this group has greatly helped me overcome my shyness. You should have seen me grill the Interventional Radiologist (who did the AVS). I was so proud of myself...and much to my surprise he was very positive and encouraging about the fact that I was so well prepared and taking control of my health. I can't thank this group enough!! Best wishes! From: Kerth <catherinekerth@...> hyperaldosteronism Sent: Tuesday, June 26, 2012 8:16 PM Subject: RE: Re: Saline Sup. medical code Thank you . I am usually a very shy person as well. If I tell my husband he will speak up if I don't.On June 8th my K was 4.0So I think I am OK with it.I do want to take your advice tho ;)I hope my test is text book. I think I might cry if it comes back inconclusive as yours did.hyperaldosteronism From: jessdell72@...Date: Tue, 26 Jun 2012 17:55:14 -0700Subject: Re: Re: Saline Sup. medical code , good luck tomorrow! For what it is worth, I just had 2 saline suppression tests done in the last 2 months. Both were inconclusive. I was too shy/nervous to second guess anything, and didn't ask them to measure my urine output. Please do ask, it is a simple request and will help you have a better understanding later if the test is inconclusive. The NIH protocol (thanks ) indicates that you should not eat prior to test, my facility said it was ok to eat before, and I did. They even had snacks in the room and offered me soda/juice. I specifically asked if it was ok to eat and they said it was fine. I think they were wrong...I think NIH has a much better handle on this than most hospitals. I would ask them if they can get your initial blood work back (they will take samples before and after test) ASAP, and if your K is low - even close to the low end of normal - I would ask Dr if you could get a K drip as well as the saline. All that saline makes you pee a lot (if you have PA) and with the urine goes the K. If your K is low prior to the test, see if they will just wait until your K gets back to normal range and then start. Both times I had my test my K dropped too low during the test which made it inconclusive. A lot of wasted time and money. After the fact, someone in the group told me they should have given me a K drip with the saline...I wish I would have known in advance. Good luck to you!! 39 y/o female2 cm adenoma on left adrenalAwaiting results from AVScurrently on 140meq K per day & 180 mg Verapamil From: Kerth <catherinekerth@...> hyperaldosteronism Sent: Tuesday, June 26, 2012 11:43 AM Subject: RE: Re: Saline Sup. medical code Jclark, you are the bomb!thanks for the info it was instrumental! talked to cigna, it does not need pre-approval. phew!we are a go tomorrow morning. Kerth http://mamallamaknits.com http://www.knittycath.blogspot.com http://thekerthfamily.4t.comTo: hyperaldosteronism From: jclark24p@...Date: Tue, 26 Jun 2012 01:50:47 +0000Subject: Re: Saline Sup. medical code Try 80408 "Evoctive Suppression Test" No guarantee but you can see for yourself on page 7 here: https://provider.medica.com/C14/ClaimPolicies/Document%20Library/Laboratory_Services_Policy.pdf >> quick question. since this group is VERY knowledgeable about the tests for PA.... Does anyone know the medical order code for the saline suppression? > i called the insurance company tonight to make sure if this had to be approved, that it is indeed approved. the lady said she had never heard of anything like the saline suppression. so it might not need approval but i should call my doctor or the hospital and get the code. and check with them first.> > i am a little nervous now. i was really counting on this happening on Wednesday...> > i have a feeling the hospital that i am going to doesn't really do this type of test often,considering my doctor himself handled the paper work and phones calls.> > > 38 yrs> aldo 30 (?-28)> renin .38 (.25-5.89)> ratio 78.9 (.9-28.9)> Nifedipine 30 mg> Bystolic 5mg> CT scan normal> Saline suppression june 27th! > K- (3.2 thru 4.0) 3.2 was when i was training for half marathon.... 4.0 was with very little running for a few months...> K-only low if I start to run or exercise vigorously. so i have shortened mileage and slowed pace a great deal to compensate. (a work in progress)> BP avg 140-160's/80-100's on a good day >

June 26, 2012

I have never given a K drip during Saline. And K rarely if ever dropped much in the 1000 I tested on no drugs for at least 2 weeks etc.CE Grim MDOn Jun 26, 2012, at 6:16 PM, Kerth wrote: Thank you . I am usually a very shy person as well. If I tell my husband he will speak up if I don't.On June 8th my K was 4.0So I think I am OK with it.I do want to take your advice tho ;)I hope my test is text book. I think I might cry if it comes back inconclusive as yours did.hyperaldosteronism From: jessdell72@...Date: Tue, 26 Jun 2012 17:55:14 -0700Subject: Re: Re: Saline Sup. medical code , good luck tomorrow! For what it is worth, I just had 2 saline suppression tests done in the last 2 months. Both were inconclusive. I was too shy/nervous to second guess anything, and didn't ask them to measure my urine output. Please do ask, it is a simple request and will help you have a better understanding later if the test is inconclusive. The NIH protocol (thanks ) indicates that you should not eat prior to test, my facility said it was ok to eat before, and I did. They even had snacks in the room and offered me soda/juice. I specifically asked if it was ok to eat and they said it was fine. I think they were wrong...I think NIH has a much better handle on this than most hospitals. I would ask them if they can get your initial blood work back (they will take samples before and after test) ASAP, and if your K is low - even close to the low end of normal - I would ask Dr if you could get a K drip as well as the saline. All that saline makes you pee a lot (if you have PA) and with the urine goes the K. If your K is low prior to the test, see if they will just wait until your K gets back to normal range and then start. Both times I had my test my K dropped too low during the test which made it inconclusive. A lot of wasted time and money. After the fact, someone in the group told me they should have given me a K drip with the saline...I wish I would have known in advance. Good luck to you!! 39 y/o female2 cm adenoma on left adrenalAwaiting results from AVScurrently on 140meq K per day & 180 mg Verapamil From: Kerth <catherinekerth@...> hyperaldosteronism Sent: Tuesday, June 26, 2012 11:43 AM Subject: RE: Re: Saline Sup. medical code Jclark, you are the bomb!thanks for the info it was instrumental! talked to cigna, it does not need pre-approval. phew!we are a go tomorrow morning. Kerth http://mamallamaknits.com http://www.knittycath.blogspot.com http://thekerthfamily.4t.comTo: hyperaldosteronism From: jclark24p@...Date: Tue, 26 Jun 2012 01:50:47 +0000Subject: Re: Saline Sup. medical code Try 80408 "Evoctive Suppression Test" No guarantee but you can see for yourself on page 7 here: https://provider.medica.com/C14/ClaimPolicies/Document%20Library/Laboratory_Services_Policy.pdf >> quick question. since this group is VERY knowledgeable about the tests for PA.... Does anyone know the medical order code for the saline suppression? > i called the insurance company tonight to make sure if this had to be approved, that it is indeed approved. the lady said she had never heard of anything like the saline suppression. so it might not need approval but i should call my doctor or the hospital and get the code. and check with them first.> > i am a little nervous now. i was really counting on this happening on Wednesday...> > i have a feeling the hospital that i am going to doesn't really do this type of test often,considering my doctor himself handled the paper work and phones calls.> > > 38 yrs> aldo 30 (?-28)> renin .38 (.25-5.89)> ratio 78.9 (.9-28.9)> Nifedipine 30 mg> Bystolic 5mg> CT scan normal> Saline suppression june 27th! > K- (3.2 thru 4.0) 3.2 was when i was training for half marathon.... 4.0 was with very little running for a few months...> K-only low if I start to run or exercise vigorously. so i have shortened mileage and slowed pace a great deal to compensate. (a work in progress)> BP avg 140-160's/80-100's on a good day >

June 26, 2012

Prob can bill more for adrenal embolization. One here was billed $18,000 as i recall for an AVS. Shana maybe?On Jun 25, 2012, at 6:29 PM, msmith_1928 wrote: No idea what the code is, but I will say this: few, if any, of the names of the tests I had done during my diagnosis corresponded to reality in any way! The one that stands out in my memory the most is the code for my AVS - it translated to something like "adrenal tumor embolization" and for a couple days I was really freaked out that what I was booked for in the hospital was not what I had signed on for > > quick question. since this group is VERY knowledgeable about the tests for PA.... Does anyone know the medical order code for the saline suppression? > i called the insurance company tonight to make sure if this had to be approved, that it is indeed approved. the lady said she had never heard of anything like the saline suppression. so it might not need approval but i should call my doctor or the hospital and get the code. and check with them first. > > i am a little nervous now. i was really counting on this happening on Wednesday... > > i have a feeling the hospital that i am going to doesn't really do this type of test often,considering my doctor himself handled the paper work and phones calls. > > > 38 yrs > aldo 30 (?-28) > renin .38 (.25-5.89) > ratio 78.9 (.9-28.9) > Nifedipine 30 mg > Bystolic 5mg > CT scan normal > Saline suppression june 27th! > K- (3.2 thru 4.0) 3.2 was when i was training for half marathon.... 4.0 was with very little running for a few months... > K-only low if I start to run or exercise vigorously. so i have shortened mileage and slowed pace a great deal to compensate. (a work in progress) > BP avg 140-160's/80-100's on a good day >

June 27, 2012

This reminds me of when I had a MRI of

the heart. The insurance company wanted a particular doctor to

do my heart biopsy at my hospital.

I swear every time that doctor goes into the cath lab or the

interventional radiology cath lab, then end up calling a code

blue. =-O

No thanks,

Phyllis

45yo AAF 20yr of BP 170/100-220/120. Previous 7 BP pills, hx. htn,

chf previous EF 20% now 50%, cardiomyapathy, lvh, cva,

sarcoidosis- no residual except I can't recall words at times,

current meds Spiro 25mg, Benicar 20mg bid, dashing

On 6/26/2012 11:44 PM, wrote:

, your comment made me smile, you should have seen

my IR when he

was getting ready for me to sign the release and his nurse

was

explaining the AVS. When I indicated I understood the

process she asked

if I had done it before. I explained I almost got there

until I found

out the IR had only done 6 in 15 years. Dr. Chang perked

up and asked

what Idid. I said, "I'm here". His answer, "Smart Man, we

are going

get along just fine!" I was Dr. Chang's 3d AVS that day!

I met with a phsychritist the other day in the VA's

walk-in clinic to

discuss finding a new doctor. I explained that I needed

someone who

understood how excess cortisol might be effecting my PTSD

& depression

and my concern that my reduced testosterone (androgen)

might be

exacerbating the issue in the area of the CYP11B2/CYP11B1

genes pumping

even more cortisol to interact with the sertonin and

causing me to

remain in constant state of stress! He wasn't offended, in

fact he

said, "You really know your $hit! I'm going to refer you

to a doctor

from DHMC who practices at the VA 1 day week. He has been

treating mood

disorders for years." (DHMC is the largest hospital in the

area and

associated with Dartmouth College.) So I may not have to

start off at

ground zero with this one!

Any doctor that takes umbrage with you being an informed

PTN is probably

not your best choice, IMHO! (of course you better know

your $hit!)

Don't get me wrong, I'm happy to work with a "young"

doctor who is

learning but they better include me as part of the team!

Most respect

the amount of time I have spent researching this in the

last 16 months

or so and I often give them the same references I supply

here. (Many of

the "young" doctors really appreciate that!)

> >

> > quick question. since this group is VERY

knowledgeable about the

tests for PA.... Does anyone know the medical order code

for the saline

suppression?

> > i called the insurance company tonight to make

sure if this had to

be approved, that it is indeed approved. the lady said she

had never

heard of anything like the saline suppression. so it might

not need

approval but i should call my doctor or the hospital and

get the code.

and check with them first.

> >

> > i am a little nervous now. i was really counting

on this happening

on Wednesday...

> >

> > i have a feeling the hospital that i am going to

doesn't really do

this type of test often,considering my doctor himself

handled the paper

work and phones calls.

> >

> > 38 yrs

> > aldo 30 (?-28)

> > renin .38 (.25-5.89)

> > ratio 78.9

> (.9-28.9)

> > Nifedipine 30 mg

> > Bystolic 5mg

> > CT scan normal

> > Saline suppression june 27th!

> > K- (3.2 thru 4.0) 3.2 was when i was training

for half marathon....

4.0 was with very little running for a few months...

> > K-only low if I start to run or exercise

vigorously. so i have

shortened mileage and slowed pace a great deal to

compensate. (a work in

progress)

> > BP avg 140-160's/80-100's on a good day

> >

>

June 27, 2012

This reminds me of when I had a MRI of

the heart. The insurance company wanted a particular doctor to

do my heart biopsy at my hospital.

I swear every time that doctor goes into the cath lab or the

interventional radiology cath lab, then end up calling a code

blue. =-O

No thanks,

Phyllis

45yo AAF 20yr of BP 170/100-220/120. Previous 7 BP pills, hx. htn,

chf previous EF 20% now 50%, cardiomyapathy, lvh, cva,

sarcoidosis- no residual except I can't recall words at times,

current meds Spiro 25mg, Benicar 20mg bid, dashing

On 6/26/2012 11:44 PM, wrote:

, your comment made me smile, you should have seen

my IR when he

was getting ready for me to sign the release and his nurse

was

explaining the AVS. When I indicated I understood the

process she asked

if I had done it before. I explained I almost got there

until I found

out the IR had only done 6 in 15 years. Dr. Chang perked

up and asked

what Idid. I said, "I'm here". His answer, "Smart Man, we

are going

get along just fine!" I was Dr. Chang's 3d AVS that day!

I met with a phsychritist the other day in the VA's

walk-in clinic to

discuss finding a new doctor. I explained that I needed

someone who

understood how excess cortisol might be effecting my PTSD

& depression

and my concern that my reduced testosterone (androgen)

might be

exacerbating the issue in the area of the CYP11B2/CYP11B1

genes pumping

even more cortisol to interact with the sertonin and

causing me to

remain in constant state of stress! He wasn't offended, in

fact he

said, "You really know your $hit! I'm going to refer you

to a doctor

from DHMC who practices at the VA 1 day week. He has been

treating mood

disorders for years." (DHMC is the largest hospital in the

area and

associated with Dartmouth College.) So I may not have to

start off at

ground zero with this one!

Any doctor that takes umbrage with you being an informed

PTN is probably

not your best choice, IMHO! (of course you better know

your $hit!)

Don't get me wrong, I'm happy to work with a "young"

doctor who is

learning but they better include me as part of the team!

Most respect

the amount of time I have spent researching this in the

last 16 months

or so and I often give them the same references I supply

here. (Many of

the "young" doctors really appreciate that!)

> >

> > quick question. since this group is VERY

knowledgeable about the

tests for PA.... Does anyone know the medical order code

for the saline

suppression?

> > i called the insurance company tonight to make

sure if this had to

be approved, that it is indeed approved. the lady said she

had never

heard of anything like the saline suppression. so it might

not need

approval but i should call my doctor or the hospital and

get the code.

and check with them first.

> >

> > i am a little nervous now. i was really counting

on this happening

on Wednesday...

> >

> > i have a feeling the hospital that i am going to

doesn't really do

this type of test often,considering my doctor himself

handled the paper

work and phones calls.

> >

> > 38 yrs

> > aldo 30 (?-28)

> > renin .38 (.25-5.89)

> > ratio 78.9

> (.9-28.9)

> > Nifedipine 30 mg

> > Bystolic 5mg

> > CT scan normal

> > Saline suppression june 27th!

> > K- (3.2 thru 4.0) 3.2 was when i was training

for half marathon....

4.0 was with very little running for a few months...

> > K-only low if I start to run or exercise

vigorously. so i have

shortened mileage and slowed pace a great deal to

compensate. (a work in

progress)

> > BP avg 140-160's/80-100's on a good day

> >

>

June 27, 2012

They billed my insurance for $18,000+. My insurance paid $5,000+ and they accepted it as payment in full. Of course if i would not have had insurance I'd have been liable for the entire bill. Makes sense, doesn't it? If I remember right, somebody else that used to be in the group got a $31,000 bill for his AVS.

a

From: Clarence Grim <lowerbp2@...>hyperaldosteronism Cc: Clarence Grim <lowerbp2@...> Sent: Wednesday, June 27, 2012 1:36 AMSubject: Re: Re: Saline Sup. medical code

Prob can bill more for adrenal embolization. One here was billed $18,000 as i recall for an AVS. Shana maybe?

On Jun 25, 2012, at 6:29 PM, msmith_1928 wrote:

No idea what the code is, but I will say this: few, if any, of the names of the tests I had done during my diagnosis corresponded to reality in any way!The one that stands out in my memory the most is the code for my AVS - it translated to something like "adrenal tumor embolization" and for a couple days I was really freaked out that what I was booked for in the hospital was not what I had signed on for >> quick question. since this group is VERY knowledgeable about the tests for PA.... Does anyone know the medical order code for the saline suppression? > i called the insurance company tonight to make sure if this had to be approved, that it is indeed approved. the lady

said she had never heard of anything like the saline suppression. so it might not need approval but i should call my doctor or the hospital and get the code. and check with them first.> > i am a little nervous now. i was really counting on this happening on Wednesday...> > i have a feeling the hospital that i am going to doesn't really do this type of test often,considering my doctor himself handled the paper work and phones calls.> > > 38 yrs> aldo 30 (?-28)> renin .38 (.25-5.89)> ratio 78.9 (.9-28.9)> Nifedipine 30 mg> Bystolic 5mg> CT scan normal> Saline suppression june 27th! > K- (3.2 thru 4.0) 3.2 was when i was training for half marathon.... 4.0 was with very little running for a few months...> K-only low if I start to run or exercise vigorously. so i have shortened mileage and slowed pace a great deal to compensate. (a work in

progress)> BP avg 140-160's/80-100's on a good day >

June 27, 2012

They billed my insurance for $18,000+. My insurance paid $5,000+ and they accepted it as payment in full. Of course if i would not have had insurance I'd have been liable for the entire bill. Makes sense, doesn't it? If I remember right, somebody else that used to be in the group got a $31,000 bill for his AVS.

a

From: Clarence Grim <lowerbp2@...>hyperaldosteronism Cc: Clarence Grim <lowerbp2@...> Sent: Wednesday, June 27, 2012 1:36 AMSubject: Re: Re: Saline Sup. medical code

Prob can bill more for adrenal embolization. One here was billed $18,000 as i recall for an AVS. Shana maybe?

On Jun 25, 2012, at 6:29 PM, msmith_1928 wrote:

No idea what the code is, but I will say this: few, if any, of the names of the tests I had done during my diagnosis corresponded to reality in any way!The one that stands out in my memory the most is the code for my AVS - it translated to something like "adrenal tumor embolization" and for a couple days I was really freaked out that what I was booked for in the hospital was not what I had signed on for >> quick question. since this group is VERY knowledgeable about the tests for PA.... Does anyone know the medical order code for the saline suppression? > i called the insurance company tonight to make sure if this had to be approved, that it is indeed approved. the lady

said she had never heard of anything like the saline suppression. so it might not need approval but i should call my doctor or the hospital and get the code. and check with them first.> > i am a little nervous now. i was really counting on this happening on Wednesday...> > i have a feeling the hospital that i am going to doesn't really do this type of test often,considering my doctor himself handled the paper work and phones calls.> > > 38 yrs> aldo 30 (?-28)> renin .38 (.25-5.89)> ratio 78.9 (.9-28.9)> Nifedipine 30 mg> Bystolic 5mg> CT scan normal> Saline suppression june 27th! > K- (3.2 thru 4.0) 3.2 was when i was training for half marathon.... 4.0 was with very little running for a few months...> K-only low if I start to run or exercise vigorously. so i have shortened mileage and slowed pace a great deal to compensate. (a work in

progress)> BP avg 140-160's/80-100's on a good day >

June 27, 2012

One of the issues is that sometimes patients THINK they are the most informed and they are not. Even the research on patients doing their own research has shown that patients, especially on the internet, are drawn to, or most likely ONLY click on worst-case scenarios, or the worst conditions, not the most likely or most common. So as you know that right there creates a bias that automatically may make the patients perceptions skewed and NOT the most informed. While you seem to be well-informed, you don't have nor can you have, the experience the other person has, and likewise they can't have your feelings or perception. But sadly doctors are not always right, just as patients are not always right even when some insist they are.

I harped the last few days on the American pain pill issue and from a providers perspective I can tell when the normally depressed or anxious patient is using their methadone as a dailly pick me up and not really for pain relief - especially back in a small town when I would see the "disabled" farmer loading 200lbs bales of hay, but is collecting disability because of a workplace back injury and then hobbles in with a cane and wheelchair once a month for a refill. Happened on a daily basis. But talking to them about it is useless because they "know" how "bad" their pain is and they will tell me what we need to hear to keep it coming and for them to keep getting it and for them to keep getting their disability check, so I see many that are not honest with me. But I am not stupid either. But if I deny them they will surely get out the word that I am stupid, that their pain IS the worst thing, that we ignore the patient,

and so on........patients are not always right even if they have internet access.

With that said, no doctor should be offended at all when a patient tries to be informed and should listen. The doc likely isn't going to go against what they feel is right or what they believe anyway so why make an ordeal of it. I always teach and tell medics, other PA's, nurses, nursing assistants, that if you piss the patient off - you just made your job a hell of a lot harder, so make the visit pleasant.

But it's a two way street. Always is.

, your comment made me smile, you should have seen my IR when hewas getting ready for me to sign the release and his nurse wasexplaining the AVS. When I indicated I understood the process she askedif I had done it before. I explained I almost got there until I foundout the IR had only done 6 in 15 years. Dr. Chang perked up and askedwhat Idid. I said, "I'm here". His answer, "Smart Man, we are goingget along just fine!" I was Dr. Chang's 3d AVS that day!I met with a phsychritist the other day in the VA's walk-in clinic todiscuss finding a new doctor. I explained that I needed someone whounderstood how excess cortisol might be effecting my PTSD & depressionand my concern that my reduced testosterone (androgen) might beexacerbating the issue in the area of the CYP11B2/CYP11B1 genes pumpingeven more cortisol to interact with the sertonin and causing me toremain in constant state of

stress! He wasn't offended, in fact hesaid, "You really know your $hit! I'm going to refer you to a doctorfrom DHMC who practices at the VA 1 day week. He has been treating mooddisorders for years." (DHMC is the largest hospital in the area andassociated with Dartmouth College.) So I may not have to start off atground zero with this one!Any doctor that takes umbrage with you being an informed PTN is probablynot your best choice, IMHO! (of course you better know your $hit!) Don't get me wrong, I'm happy to work with a "young" doctor who islearning but they better include me as part of the team! Most respectthe amount of time I have spent researching this in the last 16 monthsor so and I often give them the same references I supply here. (Many ofthe "young" doctors really appreciate that!)> >> > quick question. since this group is VERY knowledgeable about thetests for PA.... Does anyone know the medical order code for the salinesuppression?> > i called the insurance company tonight to make sure if this had tobe approved, that it is indeed approved. the lady said she had neverheard of anything like the saline suppression. so it might not needapproval but i should call my doctor or the hospital and get the code.and check with them first.> >> > i am a little nervous now. i was

really counting on this happeningon Wednesday...> >> > i have a feeling the hospital that i am going to doesn't really dothis type of test often,considering my doctor himself handled the paperwork and phones calls.> >> > > > 38 yrs> > aldo 30 (?-28)> > renin .38 (.25-5.89)> > ratio 78.9> (.9-28.9)> > Nifedipine 30 mg> > Bystolic 5mg> > CT scan normal> > Saline suppression june 27th!> > K- (3.2 thru 4.0) 3.2 was when i was training for half marathon....4.0 was with very little running for a few months...> > K-only low if I start to run or exercise vigorously. so i haveshortened mileage and slowed pace a great deal to compensate. (a work inprogress)> > BP avg 140-160's/80-100's on a good day >

>>

June 27, 2012

One of the issues is that sometimes patients THINK they are the most informed and they are not. Even the research on patients doing their own research has shown that patients, especially on the internet, are drawn to, or most likely ONLY click on worst-case scenarios, or the worst conditions, not the most likely or most common. So as you know that right there creates a bias that automatically may make the patients perceptions skewed and NOT the most informed. While you seem to be well-informed, you don't have nor can you have, the experience the other person has, and likewise they can't have your feelings or perception. But sadly doctors are not always right, just as patients are not always right even when some insist they are.

I harped the last few days on the American pain pill issue and from a providers perspective I can tell when the normally depressed or anxious patient is using their methadone as a dailly pick me up and not really for pain relief - especially back in a small town when I would see the "disabled" farmer loading 200lbs bales of hay, but is collecting disability because of a workplace back injury and then hobbles in with a cane and wheelchair once a month for a refill. Happened on a daily basis. But talking to them about it is useless because they "know" how "bad" their pain is and they will tell me what we need to hear to keep it coming and for them to keep getting it and for them to keep getting their disability check, so I see many that are not honest with me. But I am not stupid either. But if I deny them they will surely get out the word that I am stupid, that their pain IS the worst thing, that we ignore the patient,

and so on........patients are not always right even if they have internet access.

With that said, no doctor should be offended at all when a patient tries to be informed and should listen. The doc likely isn't going to go against what they feel is right or what they believe anyway so why make an ordeal of it. I always teach and tell medics, other PA's, nurses, nursing assistants, that if you piss the patient off - you just made your job a hell of a lot harder, so make the visit pleasant.

But it's a two way street. Always is.

, your comment made me smile, you should have seen my IR when hewas getting ready for me to sign the release and his nurse wasexplaining the AVS. When I indicated I understood the process she askedif I had done it before. I explained I almost got there until I foundout the IR had only done 6 in 15 years. Dr. Chang perked up and askedwhat Idid. I said, "I'm here". His answer, "Smart Man, we are goingget along just fine!" I was Dr. Chang's 3d AVS that day!I met with a phsychritist the other day in the VA's walk-in clinic todiscuss finding a new doctor. I explained that I needed someone whounderstood how excess cortisol might be effecting my PTSD & depressionand my concern that my reduced testosterone (androgen) might beexacerbating the issue in the area of the CYP11B2/CYP11B1 genes pumpingeven more cortisol to interact with the sertonin and causing me toremain in constant state of

stress! He wasn't offended, in fact hesaid, "You really know your $hit! I'm going to refer you to a doctorfrom DHMC who practices at the VA 1 day week. He has been treating mooddisorders for years." (DHMC is the largest hospital in the area andassociated with Dartmouth College.) So I may not have to start off atground zero with this one!Any doctor that takes umbrage with you being an informed PTN is probablynot your best choice, IMHO! (of course you better know your $hit!) Don't get me wrong, I'm happy to work with a "young" doctor who islearning but they better include me as part of the team! Most respectthe amount of time I have spent researching this in the last 16 monthsor so and I often give them the same references I supply here. (Many ofthe "young" doctors really appreciate that!)> >> > quick question. since this group is VERY knowledgeable about thetests for PA.... Does anyone know the medical order code for the salinesuppression?> > i called the insurance company tonight to make sure if this had tobe approved, that it is indeed approved. the lady said she had neverheard of anything like the saline suppression. so it might not needapproval but i should call my doctor or the hospital and get the code.and check with them first.> >> > i am a little nervous now. i was

really counting on this happeningon Wednesday...> >> > i have a feeling the hospital that i am going to doesn't really dothis type of test often,considering my doctor himself handled the paperwork and phones calls.> >> > > > 38 yrs> > aldo 30 (?-28)> > renin .38 (.25-5.89)> > ratio 78.9> (.9-28.9)> > Nifedipine 30 mg> > Bystolic 5mg> > CT scan normal> > Saline suppression june 27th!> > K- (3.2 thru 4.0) 3.2 was when i was training for half marathon....4.0 was with very little running for a few months...> > K-only low if I start to run or exercise vigorously. so i haveshortened mileage and slowed pace a great deal to compensate. (a work inprogress)> > BP avg 140-160's/80-100's on a good day >

>>

June 27, 2012

Thanks a and sorry about my spelling of your name. Can an individual look at their own data in the data base? How easy is it to add items to our data base without redoing the whole thing?Any suggestions from others regarding things to add. On Jun 27, 2012, at 6:13 AM, a Hall wrote: They billed my insurance for $18,000+. My insurance paid $5,000+ and they accepted it as payment in full. Of course if i would not have had insurance I'd have been liable for the entire bill. Makes sense, doesn't it? If I remember right, somebody else that used to be in the group got a $31,000 bill for his AVS. a From: Clarence Grim <lowerbp2@...>hyperaldosteronism Cc: Clarence Grim <lowerbp2@...> Sent: Wednesday, June 27, 2012 1:36 AMSubject: Re: Re: Saline Sup. medical code Prob can bill more for adrenal embolization. One here was billed $18,000 as i recall for an AVS. Shana maybe? On Jun 25, 2012, at 6:29 PM, msmith_1928 wrote: No idea what the code is, but I will say this: few, if any, of the names of the tests I had done during my diagnosis corresponded to reality in any way!The one that stands out in my memory the most is the code for my AVS - it translated to something like "adrenal tumor embolization" and for a couple days I was really freaked out that what I was booked for in the hospital was not what I had signed on for >> quick question. since this group is VERY knowledgeable about the tests for PA.... Does anyone know the medical order code for the saline suppression? > i called the insurance company tonight to make sure if this had to be approved, that it is indeed approved. the lady said she had never heard of anything like the saline suppression. so it might not need approval but i should call my doctor or the hospital and get the code. and check with them first.> > i am a little nervous now. i was really counting on this happening on Wednesday...> > i have a feeling the hospital that i am going to doesn't really do this type of test often,considering my doctor himself handled the paper work and phones calls.> > > 38 yrs> aldo 30 (?-28)> renin .38 (.25-5.89)> ratio 78.9 (.9-28.9)> Nifedipine 30 mg> Bystolic 5mg> CT scan normal> Saline suppression june 27th! > K- (3.2 thru 4.0) 3.2 was when i was training for half marathon.... 4.0 was with very little running for a few months...> K-only low if I start to run or exercise vigorously. so i have shortened mileage and slowed pace a great deal to compensate. (a work in progress)> BP avg 140-160's/80-100's on a good day >

June 27, 2012

Your cArdiomyopathy was most likely due to the hypokalemia of PA. WE HAVE HAD several here who were recommended for transplant but were quickly off the list once P was DXED and rxed with MCB AND DASH. Why did they want to do a heart BX?May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jun 27, 2012, at 5:15, Phyllis <phylisrn@...> wrote:

This reminds me of when I had a MRI of

the heart. The insurance company wanted a particular doctor to

do my heart biopsy at my hospital.

I swear every time that doctor goes into the cath lab or the

interventional radiology cath lab, then end up calling a code

blue. =-O

No thanks,

Phyllis

45yo AAF 20yr of BP 170/100-220/120. Previous 7 BP pills, hx. htn,

chf previous EF 20% now 50%, cardiomyapathy, lvh, cva,

sarcoidosis- no residual except I can't recall words at times,

current meds Spiro 25mg, Benicar 20mg bid, dashing

On 6/26/2012 11:44 PM, wrote:

, your comment made me smile, you should have seen

my IR when he

was getting ready for me to sign the release and his nurse

was

explaining the AVS. When I indicated I understood the

process she asked

if I had done it before. I explained I almost got there

until I found

out the IR had only done 6 in 15 years. Dr. Chang perked

up and asked

what Idid. I said, "I'm here". His answer, "Smart Man, we

are going

get along just fine!" I was Dr. Chang's 3d AVS that day!

I met with a phsychritist the other day in the VA's

walk-in clinic to

discuss finding a new doctor. I explained that I needed

someone who

understood how excess cortisol might be effecting my PTSD

& depression

and my concern that my reduced testosterone (androgen)

might be

exacerbating the issue in the area of the CYP11B2/CYP11B1

genes pumping

even more cortisol to interact with the sertonin and

causing me to

remain in constant state of stress! He wasn't offended, in

fact he

said, "You really know your $hit! I'm going to refer you

to a doctor

from DHMC who practices at the VA 1 day week. He has been

treating mood

disorders for years." (DHMC is the largest hospital in the

area and

associated with Dartmouth College.) So I may not have to

start off at

ground zero with this one!

Any doctor that takes umbrage with you being an informed

PTN is probably

not your best choice, IMHO! (of course you better know

your $hit!)

Don't get me wrong, I'm happy to work with a "young"

doctor who is

learning but they better include me as part of the team!

Most respect

the amount of time I have spent researching this in the

last 16 months

or so and I often give them the same references I supply

here. (Many of

the "young" doctors really appreciate that!)

> >

> > quick question. since this group is VERY

knowledgeable about the

tests for PA.... Does anyone know the medical order code

for the saline

suppression?

> > i called the insurance company tonight to make

sure if this had to

be approved, that it is indeed approved. the lady said she

had never

heard of anything like the saline suppression. so it might

not need

approval but i should call my doctor or the hospital and

get the code.

and check with them first.

> >

> > i am a little nervous now. i was really counting

on this happening

on Wednesday...

> >

> > i have a feeling the hospital that i am going to

doesn't really do

this type of test often,considering my doctor himself

handled the paper

work and phones calls.

> >

> > 38 yrs

> > aldo 30 (?-28)

> > renin .38 (.25-5.89)

> > ratio 78.9

> (.9-28.9)

> > Nifedipine 30 mg

> > Bystolic 5mg

> > CT scan normal

> > Saline suppression june 27th!

> > K- (3.2 thru 4.0) 3.2 was when i was training

for half marathon....

4.0 was with very little running for a few months...

> > K-only low if I start to run or exercise

vigorously. so i have

shortened mileage and slowed pace a great deal to

compensate. (a work in

progress)

> > BP avg 140-160's/80-100's on a good day

> >

>

June 28, 2012

The MRI showed very thick muscle andÂ

that it looked like sarcoid granulomas.Â With the symptoms this

and the MRI this is how I got the dx

of sarcoidosis.

Phyllis

45yo AAF 20yr of BP 170/100-220/120. Previous 7 BP pills, hx. htn,

chf previous EF 20% now 50%, cardiomyapathy, lvh, cva,

sarcoidosis- no residual except I can't recall words at times,

current meds Spiro 25mg, Benicar 20mg bid, dashing

On 6/28/2012 12:31 AM, Clarence Grim wrote:

Â

Your cArdiomyopathy was most likely due to the

hypokalemia of PA. WE HAVE HAD several here who were

recommended for transplant but were quickly off the list

once P was DXED and rxed with MCB AND DASH. Why did they

want to do a heart BX?

May your pressure be low!

CE Grim MS, MD

Specializing in Difficult

Hypertension

On Jun 27, 2012, at 5:15, Phyllis <phylisrn@...>

wrote:

Â

This reminds me of when I

had a MRI of the heart.Â The insurance company

wanted a particular doctorÂ to do my heart biopsy at

my hospital.

I swear every time that doctor goes into the cath

lab or the interventional radiology cath lab, then

end up calling a code blue. Â Â Â =-O

No thanks,

Phyllis

45yo AAF 20yr of BP 170/100-220/120. Previous 7 BP

pills, hx. htn, chf previous EF 20% now 50%,

cardiomyapathy, lvh, cva, sarcoidosis- no residual

except I can't recall words at times,

current meds Spiro 25mg, Benicar 20mg bid, dashing

On 6/26/2012 11:44 PM, wrote:

Â

, your comment made me smile, you should

have seen my IR when he

was getting ready for me to sign the release and

his nurse was

explaining the AVS. When I indicated I

understood the process she asked

if I had done it before. I explained I almost

got there until I found

out the IR had only done 6 in 15 years. Dr.

Chang perked up and asked

what Idid. I said, "I'm here". His answer,

"Smart Man, we are going

get along just fine!" I was Dr. Chang's 3d AVS

that day!

I met with a phsychritist the other day in the

VA's walk-in clinic to

discuss finding a new doctor. I explained that I

needed someone who

understood how excess cortisol might be

effecting my PTSD & depression

and my concern that my reduced testosterone

(androgen) might be

exacerbating the issue in the area of the

CYP11B2/CYP11B1 genes pumping

even more cortisol to interact with the sertonin

and causing me to

remain in constant state of stress! He wasn't

offended, in fact he

said, "You really know your $hit! I'm going to

refer you to a doctor

from DHMC who practices at the VA 1 day week. He

has been treating mood

disorders for years." (DHMC is the largest

hospital in the area and

associated with Dartmouth College.) So I may not

have to start off at

ground zero with this one!

Any doctor that takes umbrage with you being an

informed PTN is probably

not your best choice, IMHO! (of course you

better know your $hit!)

Don't get me wrong, I'm happy to work with a

"young" doctor who is

learning but they better include me as part of

the team! Most respect

the amount of time I have spent researching this

in the last 16 months

or so and I often give them the same references

I supply here. (Many of

the "young" doctors really appreciate that!)

> >

> > quick question. since this group is

VERY knowledgeable about the

tests for PA.... Does anyone know the medical

order code for the saline

suppression?

> > i called the insurance company tonight

to make sure if this had to

be approved, that it is indeed approved. the

lady said she had never

heard of anything like the saline suppression.

so it might not need

approval but i should call my doctor or the

hospital and get the code.

and check with them first.

> >

> > i am a little nervous now. i was

really counting on this happening

on Wednesday...

> >

> > i have a feeling the hospital that i

am going to doesn't really do

this type of test often,considering my doctor

himself handled the paper

work and phones calls.

> >

> > 38 yrs

> > aldo 30 (?-28)

> > renin .38 (.25-5.89)

> > ratio 78.9

> (.9-28.9)

> > Nifedipine 30 mg

> > Bystolic 5mg

> > CT scan normal

> > Saline suppression june 27th!

> > K- (3.2 thru 4.0) 3.2 was when i was

training for half marathon....

4.0 was with very little running for a few

months...

> > K-only low if I start to run or

exercise vigorously. so i have

shortened mileage and slowed pace a great deal

to compensate. (a work in

progress)

> > BP avg 140-160's/80-100's on a good

day

> >

>

June 28, 2012

Are you being treated for Sarcoid? CE GrimMDOn Jun 28, 2012, at 4:53 AM, Phyllis wrote: The MRI showed very thick muscle and that it looked like sarcoid granulomas. With the symptoms this and the MRI this is how I got the dx of sarcoidosis. Phyllis 45yo AAF 20yr of BP 170/100-220/120. Previous 7 BP pills, hx. htn, chf previous EF 20% now 50%, cardiomyapathy, lvh, cva, sarcoidosis- no residual except I can't recall words at times, current meds Spiro 25mg, Benicar 20mg bid, dashing On 6/28/2012 12:31 AM, Clarence Grim wrote: Your cArdiomyopathy was most likely due to the hypokalemia of PA. WE HAVE HAD several here who were recommended for transplant but were quickly off the list once P was DXED and rxed with MCB AND DASH. Why did they want to do a heart BX? May your pressure be low! CE Grim MS, MD Specializing in Difficult Hypertension On Jun 27, 2012, at 5:15, Phyllis <phylisrn@...> wrote: This reminds me of when I had a MRI of the heart. The insurance company wanted a particular doctor to do my heart biopsy at my hospital. I swear every time that doctor goes into the cath lab or the interventional radiology cath lab, then end up calling a code blue. =-O No thanks, Phyllis 45yo AAF 20yr of BP 170/100-220/120. Previous 7 BP pills, hx. htn, chf previous EF 20% now 50%, cardiomyapathy, lvh, cva, sarcoidosis- no residual except I can't recall words at times, current meds Spiro 25mg, Benicar 20mg bid, dashing On 6/26/2012 11:44 PM, wrote: , your comment made me smile, you should have seen my IR when he was getting ready for me to sign the release and his nurse was explaining the AVS. When I indicated I understood the process she asked if I had done it before. I explained I almost got there until I found out the IR had only done 6 in 15 years. Dr. Chang perked up and asked what Idid. I said, "I'm here". His answer, "Smart Man, we are going get along just fine!" I was Dr. Chang's 3d AVS that day! I met with a phsychritist the other day in the VA's walk-in clinic to discuss finding a new doctor. I explained that I needed someone who understood how excess cortisol might be effecting my PTSD & depression and my concern that my reduced testosterone (androgen) might be exacerbating the issue in the area of the CYP11B2/CYP11B1 genes pumping even more cortisol to interact with the sertonin and causing me to remain in constant state of stress! He wasn't offended, in fact he said, "You really know your $hit! I'm going to refer you to a doctor from DHMC who practices at the VA 1 day week. He has been treating mood disorders for years." (DHMC is the largest hospital in the area and associated with Dartmouth College.) So I may not have to start off at ground zero with this one! Any doctor that takes umbrage with you being an informed PTN is probably not your best choice, IMHO! (of course you better know your $hit!) Don't get me wrong, I'm happy to work with a "young" doctor who is learning but they better include me as part of the team! Most respect the amount of time I have spent researching this in the last 16 months or so and I often give them the same references I supply here. (Many of the "young" doctors really appreciate that!) > > > > quick question. since this group is VERY knowledgeable about the tests for PA.... Does anyone know the medical order code for the saline suppression? > > i called the insurance company tonight to make sure if this had to be approved, that it is indeed approved. the lady said she had never heard of anything like the saline suppression. so it might not need approval but i should call my doctor or the hospital and get the code. and check with them first. > > > > i am a little nervous now. i was really counting on this happening on Wednesday... > > > > i have a feeling the hospital that i am going to doesn't really do this type of test often,considering my doctor himself handled the paper work and phones calls. > > > > > > 38 yrs > > aldo 30 (?-28) > > renin .38 (.25-5.89) > > ratio 78.9 > (.9-28.9) > > Nifedipine 30 mg > > Bystolic 5mg > > CT scan normal > > Saline suppression june 27th! > > K- (3.2 thru 4.0) 3.2 was when i was training for half marathon.... 4.0 was with very little running for a few months... > > K-only low if I start to run or exercise vigorously. so i have shortened mileage and slowed pace a great deal to compensate. (a work in progress) > > BP avg 140-160's/80-100's on a good day > > >

June 28, 2012

Hmm Sarcoidosis of he heart. Must be very rare. Most likely low K I am betting and fibrosis related to PA and high salt diet.Did you discuss with Dr. Saunders? Recommend you do.CE Grim MDOn Jun 28, 2012, at 4:53 AM, Phyllis wrote: The MRI showed very thick muscle and that it looked like sarcoid granulomas. With the symptoms this and the MRI this is how I got the dx of sarcoidosis. Phyllis 45yo AAF 20yr of BP 170/100-220/120. Previous 7 BP pills, hx. htn, chf previous EF 20% now 50%, cardiomyapathy, lvh, cva, sarcoidosis- no residual except I can't recall words at times, current meds Spiro 25mg, Benicar 20mg bid, dashing On 6/28/2012 12:31 AM, Clarence Grim wrote: Your cArdiomyopathy was most likely due to the hypokalemia of PA. WE HAVE HAD several here who were recommended for transplant but were quickly off the list once P was DXED and rxed with MCB AND DASH. Why did they want to do a heart BX? May your pressure be low! CE Grim MS, MD Specializing in Difficult Hypertension On Jun 27, 2012, at 5:15, Phyllis <phylisrn@...> wrote: This reminds me of when I had a MRI of the heart. The insurance company wanted a particular doctor to do my heart biopsy at my hospital. I swear every time that doctor goes into the cath lab or the interventional radiology cath lab, then end up calling a code blue. =-O No thanks, Phyllis 45yo AAF 20yr of BP 170/100-220/120. Previous 7 BP pills, hx. htn, chf previous EF 20% now 50%, cardiomyapathy, lvh, cva, sarcoidosis- no residual except I can't recall words at times, current meds Spiro 25mg, Benicar 20mg bid, dashing On 6/26/2012 11:44 PM, wrote: , your comment made me smile, you should have seen my IR when he was getting ready for me to sign the release and his nurse was explaining the AVS. When I indicated I understood the process she asked if I had done it before. I explained I almost got there until I found out the IR had only done 6 in 15 years. Dr. Chang perked up and asked what Idid. I said, "I'm here". His answer, "Smart Man, we are going get along just fine!" I was Dr. Chang's 3d AVS that day! I met with a phsychritist the other day in the VA's walk-in clinic to discuss finding a new doctor. I explained that I needed someone who understood how excess cortisol might be effecting my PTSD & depression and my concern that my reduced testosterone (androgen) might be exacerbating the issue in the area of the CYP11B2/CYP11B1 genes pumping even more cortisol to interact with the sertonin and causing me to remain in constant state of stress! He wasn't offended, in fact he said, "You really know your $hit! I'm going to refer you to a doctor from DHMC who practices at the VA 1 day week. He has been treating mood disorders for years." (DHMC is the largest hospital in the area and associated with Dartmouth College.) So I may not have to start off at ground zero with this one! Any doctor that takes umbrage with you being an informed PTN is probably not your best choice, IMHO! (of course you better know your $hit!) Don't get me wrong, I'm happy to work with a "young" doctor who is learning but they better include me as part of the team! Most respect the amount of time I have spent researching this in the last 16 months or so and I often give them the same references I supply here. (Many of the "young" doctors really appreciate that!) > > > > quick question. since this group is VERY knowledgeable about the tests for PA.... Does anyone know the medical order code for the saline suppression? > > i called the insurance company tonight to make sure if this had to be approved, that it is indeed approved. the lady said she had never heard of anything like the saline suppression. so it might not need approval but i should call my doctor or the hospital and get the code. and check with them first. > > > > i am a little nervous now. i was really counting on this happening on Wednesday... > > > > i have a feeling the hospital that i am going to doesn't really do this type of test often,considering my doctor himself handled the paper work and phones calls. > > > > > > 38 yrs > > aldo 30 (?-28) > > renin .38 (.25-5.89) > > ratio 78.9 > (.9-28.9) > > Nifedipine 30 mg > > Bystolic 5mg > > CT scan normal > > Saline suppression june 27th! > > K- (3.2 thru 4.0) 3.2 was when i was training for half marathon.... 4.0 was with very little running for a few months... > > K-only low if I start to run or exercise vigorously. so i have shortened mileage and slowed pace a great deal to compensate. (a work in progress) > > BP avg 140-160's/80-100's on a good day > > >

June 28, 2012

Since I refused that heart biopsy,

my doc really didn't have any thing to work on. He offered

prednisone. I refused. My primary care doctor offered Benicar

which I take.

But here is the kicker--- I started Benicar 2 months ago and i

started Spiro 3 weeks ago, but most of my sarcoid symptoms have

gone away.

I was out in the sun yesterday, before I would feel like passing

out, I was in then sun for 4 hours without problems.

The knots on my legs/muscles are going away. I can now eat

calcium rich and vitamin d rich foods without getting

hypercalcemia and hypervitiminosis d. My phosphorus has also been

staple.

So does aldosterone do more to the body than we know? Does it

dysregulate calcium and vitamin d? So is it the Bencar or the

Spriro or both?

Of note, I was reading that people greater than 80 years had

autopsies of their hearts and a lot of people had granulomas of

the heart.

Mine was found incidentally doing a MRI of my heart to assess EF

and LVH. If you recall, I have never bought into this sarcoidosis

diagnosis.

Most people start with it in their lungs. My lungs are completely

normal.

Phyllis

5yo AAF 20yr of BP 170/100-220/120. Previous 7 BP pills, hx. htn,

chf previous EF 20% now 50%, cardiomyapathy, lvh, cva,

sarcoidosis? - no residual except I can't recall words at times,

current meds Spiro 25mg daily, Benicar 20mg bid, dashing, not

officially dx with PA, only dash and mcb work

On 6/28/2012 2:32 PM, Clarence Grim wrote:

Are you being treated for Sarcoid?

CE GrimMD

On Jun 28, 2012, at 4:53 AM, Phyllis wrote:

The MRI showed very

thick muscle and that it looked like sarcoid

granulomas. With the symptoms this and the MRI

this is how I got the dx

of sarcoidosis.

Phyllis

45yo AAF 20yr of BP 170/100-220/120. Previous 7

BP pills, hx. htn, chf previous EF 20% now 50%,

cardiomyapathy, lvh, cva, sarcoidosis- no

residual except I can't recall words at times,

current meds Spiro 25mg, Benicar 20mg bid,

dashing

On 6/28/2012 12:31 AM, Clarence Grim wrote:

Your cArdiomyopathy was most likely due

to the hypokalemia of PA. WE HAVE HAD

several here who were recommended for

transplant but were quickly off the list

once P was DXED and rxed with MCB AND DASH.

Why did they want to do a heart BX?

May your pressure be low!

CE Grim MS, MD

Specializing in Difficult

Hypertension

On Jun 27, 2012, at 5:15, Phyllis <phylisrn@...>

wrote:

This

reminds me of when I had a MRI of the

heart. The insurance company wanted a

particular doctor to do my heart

biopsy at my hospital.

I swear every time that doctor goes

into the cath lab or the

interventional radiology cath lab,

then end up calling a code blue. =-O

No thanks,

Phyllis

45yo AAF 20yr of BP 170/100-220/120.

Previous 7 BP pills, hx. htn, chf

previous EF 20% now 50%,

cardiomyapathy, lvh, cva, sarcoidosis-

no residual except I can't recall

words at times,

current meds Spiro 25mg, Benicar 20mg

bid, dashing

On 6/26/2012 11:44 PM,

wrote:

, your comment made me

smile, you should have seen my IR

when he

was getting ready for me to sign

the release and his nurse was

explaining the AVS. When I

indicated I understood the process

she asked

if I had done it before. I

explained I almost got there until

I found

out the IR had only done 6 in 15

years. Dr. Chang perked up and

asked

what Idid. I said, "I'm here". His

answer, "Smart Man, we are going

get along just fine!" I was Dr.

Chang's 3d AVS that day!

I met with a phsychritist the

other day in the VA's walk-in

clinic to

discuss finding a new doctor. I

explained that I needed someone

who

understood how excess cortisol

might be effecting my PTSD &

depression

and my concern that my reduced

testosterone (androgen) might be

exacerbating the issue in the area

of the CYP11B2/CYP11B1 genes

pumping

even more cortisol to interact

with the sertonin and causing me

to

remain in constant state of

stress! He wasn't offended, in

fact he

said, "You really know your $hit!

I'm going to refer you to a doctor

from DHMC who practices at the VA

1 day week. He has been treating

mood

disorders for years." (DHMC is the

largest hospital in the area and

associated with Dartmouth

College.) So I may not have to

start off at

ground zero with this one!

Any doctor that takes umbrage with

you being an informed PTN is

probably

not your best choice, IMHO! (of

course you better know your $hit!)

Don't get me wrong, I'm happy to

work with a "young" doctor who is

learning but they better include

me as part of the team! Most

respect

the amount of time I have spent

researching this in the last 16

months

or so and I often give them the

same references I supply here.

(Many of

the "young" doctors really

appreciate that!)

> >

> > quick question. since

this group is VERY knowledgeable

about the

tests for PA.... Does anyone know

the medical order code for the

saline

suppression?

> > i called the insurance

company tonight to make sure if

this had to

be approved, that it is indeed

approved. the lady said she had

never

heard of anything like the saline

suppression. so it might not need

approval but i should call my

doctor or the hospital and get the

code.

and check with them first.

> >

> > i am a little nervous

now. i was really counting on this

happening

on Wednesday...

> >

> > i have a feeling the

hospital that i am going to

doesn't really do

this type of test

often,considering my doctor

himself handled the paper

work and phones calls.

> >

> > 38 yrs

> > aldo 30 (?-28)

> > renin .38 (.25-5.89)

> > ratio 78.9

> (.9-28.9)

> > Nifedipine 30 mg

> > Bystolic 5mg

> > CT scan normal

> > Saline suppression june

27th!

> > K- (3.2 thru 4.0) 3.2

was when i was training for half

marathon....

4.0 was with very little running

for a few months...

> > K-only low if I start to

run or exercise vigorously. so i

have

shortened mileage and slowed pace

a great deal to compensate. (a

work in

progress)

> > BP avg

140-160's/80-100's on a good day

> >

>

June 28, 2012

Dr Grim, You are the bomb!

The requisition to do the heart biopsy did say granulomas vs.

fibrosis

Does fibrosis get better? You know Dr Saunders- he said " lets get

your blood pressure under control before we start to claim other

diesaeses" !!!!

Phyllis

45yo AAF 20yr of BP 170/100-220/120. Previous 7 BP pills, hx. htn,

chf previous EF 20% now 50%, cardiomyapathy, lvh, cva, sarcoidosis

?- no residual except I can't recall words at times,

current meds Spiro 25mg daily, Benicar 20mg bid, dashing not

officially diagnosed with PA but only mcb and dash work. Dr.Elijah

Saunders

On 6/28/2012 2:32 PM, Clarence Grim wrote:

Hmm Sarcoidosis of he heart. Must be very rare.

Most likely low K I am betting and fibrosis related to

PA and high salt diet.

Did you discuss with Dr. Saunders? Recommend you do.

CE Grim MD

On Jun 28, 2012, at 4:53 AM, Phyllis wrote:

The MRI showed very

thick muscle and that it looked like sarcoid

granulomas. With the symptoms this and the MRI

this is how I got the dx

of sarcoidosis.

Phyllis

45yo AAF 20yr of BP 170/100-220/120. Previous 7

BP pills, hx. htn, chf previous EF 20% now 50%,

cardiomyapathy, lvh, cva, sarcoidosis- no

residual except I can't recall words at times,

current meds Spiro 25mg, Benicar 20mg bid,

dashing

On 6/28/2012 12:31 AM, Clarence Grim wrote:

Your cArdiomyopathy was most likely due

to the hypokalemia of PA. WE HAVE HAD

several here who were recommended for

transplant but were quickly off the list

once P was DXED and rxed with MCB AND DASH.

Why did they want to do a heart BX?

May your pressure be low!

CE Grim MS, MD

Specializing in Difficult

Hypertension

On Jun 27, 2012, at 5:15, Phyllis <phylisrn@...>

wrote:

This

reminds me of when I had a MRI of the

heart. The insurance company wanted a

particular doctor to do my heart

biopsy at my hospital.

I swear every time that doctor goes

into the cath lab or the

interventional radiology cath lab,

then end up calling a code blue. =-O

No thanks,

Phyllis

45yo AAF 20yr of BP 170/100-220/120.

Previous 7 BP pills, hx. htn, chf

previous EF 20% now 50%,

cardiomyapathy, lvh, cva, sarcoidosis-

no residual except I can't recall

words at times,

current meds Spiro 25mg, Benicar 20mg

bid, dashing

On 6/26/2012 11:44 PM,

wrote:

, your comment made me

smile, you should have seen my IR

when he

was getting ready for me to sign

the release and his nurse was

explaining the AVS. When I

indicated I understood the process

she asked

if I had done it before. I

explained I almost got there until

I found

out the IR had only done 6 in 15

years. Dr. Chang perked up and

asked

what Idid. I said, "I'm here". His

answer, "Smart Man, we are going

get along just fine!" I was Dr.

Chang's 3d AVS that day!

I met with a phsychritist the

other day in the VA's walk-in

clinic to

discuss finding a new doctor. I

explained that I needed someone

who

understood how excess cortisol

might be effecting my PTSD &

depression

and my concern that my reduced

testosterone (androgen) might be

exacerbating the issue in the area

of the CYP11B2/CYP11B1 genes

pumping

even more cortisol to interact

with the sertonin and causing me

to

remain in constant state of

stress! He wasn't offended, in

fact he

said, "You really know your $hit!

I'm going to refer you to a doctor

from DHMC who practices at the VA

1 day week. He has been treating

mood

disorders for years." (DHMC is the

largest hospital in the area and

associated with Dartmouth

College.) So I may not have to

start off at

ground zero with this one!

Any doctor that takes umbrage with

you being an informed PTN is

probably

not your best choice, IMHO! (of

course you better know your $hit!)

Don't get me wrong, I'm happy to

work with a "young" doctor who is

learning but they better include

me as part of the team! Most

respect

the amount of time I have spent

researching this in the last 16

months

or so and I often give them the

same references I supply here.

(Many of

the "young" doctors really

appreciate that!)

> >

> > quick question. since

this group is VERY knowledgeable

about the

tests for PA.... Does anyone know

the medical order code for the

saline

suppression?

> > i called the insurance

company tonight to make sure if

this had to

be approved, that it is indeed

approved. the lady said she had

never

heard of anything like the saline

suppression. so it might not need

approval but i should call my

doctor or the hospital and get the

code.

and check with them first.

> >

> > i am a little nervous

now. i was really counting on this

happening

on Wednesday...

> >

> > i have a feeling the

hospital that i am going to

doesn't really do

this type of test

often,considering my doctor

himself handled the paper

work and phones calls.

> >

> > 38 yrs

> > aldo 30 (?-28)

> > renin .38 (.25-5.89)

> > ratio 78.9

> (.9-28.9)

> > Nifedipine 30 mg

> > Bystolic 5mg

> > CT scan normal

> > Saline suppression june

27th!

> > K- (3.2 thru 4.0) 3.2

was when i was training for half

marathon....

4.0 was with very little running

for a few months...

> > K-only low if I start to

run or exercise vigorously. so i

have

shortened mileage and slowed pace

a great deal to compensate. (a

work in

progress)

> > BP avg

140-160's/80-100's on a good day

> >

>

June 28, 2012

Francis, now that is a dx I can accept lolPhyllisSent from my Verizon Wireless BlackBerryFrom: "Francis Bill SUSPECTED PA" <georgewbill@...>Sender: hyperaldosteronism Date: Thu, 28 Jun 2012 21:23:28 +0000<hyperaldosteronism >Reply hyperaldosteronism Subject: Re: Saline Sup. medical code From pubmedCardiovasc Res. 1997 Jul;35(1):138-47.Fibrosis of atria and great vessels in response to angiotensin II or aldosterone infusion.Sun Y, Ramires FJ, Weber KT.SourceDepartment of Internal Medicine, University of Missouri Health Sciences Center, Columbia 65212, USA.AbstractOBJECTIVE: Myocardial fibrosis, associated with increased expression of angiotensin converting enzyme (ACE) and bradykinin (BK) receptor binding at sites of tissue repair, accompanies chronic elevations in circulating angiotensin II (AngII) and/or aldosterone (ALDO) that simulate chronic cardiac failure. A role for increased ventricular wall stress, associated with arterial hypertension, that can accompany such neurohormonal activation when ventricular function is not compromised, has been held responsible for this structural remodeling. To address this proposition, we monitored morphology of right and left atria and pulmonary artery, where stress is not increased, and compared these structures with hypertensive aorta.METHODS: Experimental groups included: (1) unoperated and untreated controls; (2) intact rats receiving AngII (9 micrograms/h) for 2 weeks and which causes arterial hypertension; (3) uninephrectomized control rats on a high sodium diet for 6 weeks; and (4) uninephrectomized rats receiving ALDO (0.75 micrograms/h) and a high sodium diet for 6 weeks and which results in gradual onset arterial hypertension. Fibrosis was identified by light microscopy in sections stained with collagen specific picrosirius red, while ACE, AngII and BK receptors binding were localized and quantitated by in vitro autoradiography using 125I-351A, 125I[sar1,Ile8]AngII, and 125I[Tyr8]BK, respectively. AngII receptor subtype was defined by the presence of excess AT1 (losartan) or AT2 (PD123177) receptor antagonists, respectively.RESULTS: With either AngII or ALDO administration, and compared to controls, we found: (1) microscopic scarring that replaced lost myocytes in both left and right atria; (2) an increase in adventitial collagen of both pulmonary artery and aorta (perivascular fibrosis); (3) markedly increased ACE binding at fibrous tissue sites in both atria and great vessels; (4) unchanged atrial and great vessel AT1 receptor binding; and (5) significantly increased BK receptor binding at sites of atrial and perivascular fibrosis.CONCLUSIONS: Thus, the appearance of atrial fibrosis and perivascular fibrosis of aorta and pulmonary artery, together with associated increase in ACE and BK receptor binding, in rats receiving AngII or ALDO suggests these responses are not related to altered ventricular wall stress or arterial hypertension, but rather to these effector hormones of the circulating renin-angiotensin-aldosterone system. Local BK, regulated by ACE found in fibrous tissue and BK receptor binding may play a role in structural remodeling of atria and great vessels in these rat models that stimulate chronic cardiac failure.> >>>>> > >> >>>>> > > quick question. since this group is VERY knowledgeable about the> >>>>> tests for PA.... Does anyone know the medical order code for the > >>>>> saline> >>>>> suppression?> >>>>> > > i called the insurance company tonight to make sure if this had to> >>>>> be approved, that it is indeed approved. the lady said she had never> >>>>> heard of anything like the saline suppression. so it might not need> >>>>> approval but i should call my doctor or the hospital and get the code.> >>>>> and check with them first.> >>>>> > >> >>>>> > > i am a little nervous now. i was really counting on this happening> >>>>> on Wednesday...> >>>>> > >> >>>>> > > i have a feeling the hospital that i am going to doesn't really do> >>>>> this type of test often,considering my doctor himself handled the > >>>>> paper> >>>>> work and phones calls.> >>>>> > >> >>>>> > > > >>>>> > > 38 yrs> >>>>> > > aldo 30 (?-28)> >>>>> > > renin .38 (.25-5.89)> >>>>> > > ratio 78.9> >>>>> > (.9-28.9)> >>>>> > > Nifedipine 30 mg> >>>>> > > Bystolic 5mg> >>>>> > > CT scan normal> >>>>> > > Saline suppression june 27th!> >>>>> > > K- (3.2 thru 4.0) 3.2 was when i was training for half > >>>>> marathon....> >>>>> 4.0 was with very little running for a few months...> >>>>> > > K-only low if I start to run or exercise vigorously. so i have> >>>>> shortened mileage and slowed pace a great deal to compensate. (a > >>>>> work in> >>>>> progress)> >>>>> > > BP avg 140-160's/80-100's on a good day > >>>>> > >> >>>>> >> >>>>>> >>>>> >>>>> >>> >>> >>> >> >>

June 28, 2012

Note the need for the high salt diet to get the damage. CE Grim MDOn Jun 28, 2012, at 2:23 PM, Francis Bill SUSPECTED PA wrote: From pubmed Cardiovasc Res. 1997 Jul;35(1):138-47. Fibrosis of atria and great vessels in response to angiotensin II or aldosterone infusion. Sun Y, Ramires FJ, Weber KT. Source Department of Internal Medicine, University of Missouri Health Sciences Center, Columbia 65212, USA. Abstract OBJECTIVE: Myocardial fibrosis, associated with increased expression of angiotensin converting enzyme (ACE) and bradykinin (BK) receptor binding at sites of tissue repair, accompanies chronic elevations in circulating angiotensin II (AngII) and/or aldosterone (ALDO) that simulate chronic cardiac failure. A role for increased ventricular wall stress, associated with arterial hypertension, that can accompany such neurohormonal activation when ventricular function is not compromised, has been held responsible for this structural remodeling. To address this proposition, we monitored morphology of right and left atria and pulmonary artery, where stress is not increased, and compared these structures with hypertensive aorta. METHODS: Experimental groups included: (1) unoperated and untreated controls; (2) intact rats receiving AngII (9 micrograms/h) for 2 weeks and which causes arterial hypertension; (3) uninephrectomized control rats on a high sodium diet for 6 weeks; and (4) uninephrectomized rats receiving ALDO (0.75 micrograms/h) and a high sodium diet for 6 weeks and which results in gradual onset arterial hypertension. Fibrosis was identified by light microscopy in sections stained with collagen specific picrosirius red, while ACE, AngII and BK receptors binding were localized and quantitated by in vitro autoradiography using 125I-351A, 125I[sar1,Ile8]AngII, and 125I[Tyr8]BK, respectively. AngII receptor subtype was defined by the presence of excess AT1 (losartan) or AT2 (PD123177) receptor antagonists, respectively. RESULTS: With either AngII or ALDO administration, and compared to controls, we found: (1) microscopic scarring that replaced lost myocytes in both left and right atria; (2) an increase in adventitial collagen of both pulmonary artery and aorta (perivascular fibrosis); (3) markedly increased ACE binding at fibrous tissue sites in both atria and great vessels; (4) unchanged atrial and great vessel AT1 receptor binding; and (5) significantly increased BK receptor binding at sites of atrial and perivascular fibrosis. CONCLUSIONS: Thus, the appearance of atrial fibrosis and perivascular fibrosis of aorta and pulmonary artery, together with associated increase in ACE and BK receptor binding, in rats receiving AngII or ALDO suggests these responses are not related to altered ventricular wall stress or arterial hypertension, but rather to these effector hormones of the circulating renin-angiotensin-aldosterone system. Local BK, regulated by ACE found in fibrous tissue and BK receptor binding may play a role in structural remodeling of atria and great vessels in these rat models that stimulate chronic cardiac failure. > >>>>> > > > >>>>> > > quick question. since this group is VERY knowledgeable about the > >>>>> tests for PA.... Does anyone know the medical order code for the > >>>>> saline > >>>>> suppression? > >>>>> > > i called the insurance company tonight to make sure if this had to > >>>>> be approved, that it is indeed approved. the lady said she had never > >>>>> heard of anything like the saline suppression. so it might not need > >>>>> approval but i should call my doctor or the hospital and get the code. > >>>>> and check with them first. > >>>>> > > > >>>>> > > i am a little nervous now. i was really counting on this happening > >>>>> on Wednesday... > >>>>> > > > >>>>> > > i have a feeling the hospital that i am going to doesn't really do > >>>>> this type of test often,considering my doctor himself handled the > >>>>> paper > >>>>> work and phones calls. > >>>>> > > > >>>>> > > > >>>>> > > 38 yrs > >>>>> > > aldo 30 (?-28) > >>>>> > > renin .38 (.25-5.89) > >>>>> > > ratio 78.9 > >>>>> > (.9-28.9) > >>>>> > > Nifedipine 30 mg > >>>>> > > Bystolic 5mg > >>>>> > > CT scan normal > >>>>> > > Saline suppression june 27th! > >>>>> > > K- (3.2 thru 4.0) 3.2 was when i was training for half > >>>>> marathon.... > >>>>> 4.0 was with very little running for a few months... > >>>>> > > K-only low if I start to run or exercise vigorously. so i have > >>>>> shortened mileage and slowed pace a great deal to compensate. (a > >>>>> work in > >>>>> progress) > >>>>> > > BP avg 140-160's/80-100's on a good day > >>>>> > > > >>>>> > > >>>>> > >>>> > >>>> > >> > >> > >> > > > > >

June 28, 2012

1. You do not have Sarcoid IMHO.2. Yes PA messes with CA metabolism and we have articles in our files.3. low Na and high K diet is the key from here on.AKA DASH.CE GrimMDOn Jun 28, 2012, at 1:37 PM, Phyllis wrote: Since I refused that heart biopsy, my doc really didn't have any thing to work on. He offered prednisone. I refused. My primary care doctor offered Benicar which I take. But here is the kicker--- I started Benicar 2 months ago and i started Spiro 3 weeks ago, but most of my sarcoid symptoms have gone away. I was out in the sun yesterday, before I would feel like passing out, I was in then sun for 4 hours without problems. The knots on my legs/muscles are going away. I can now eat calcium rich and vitamin d rich foods without getting hypercalcemia and hypervitiminosis d. My phosphorus has also been staple. So does aldosterone do more to the body than we know? Does it dysregulate calcium and vitamin d? So is it the Bencar or the Spriro or both? Of note, I was reading that people greater than 80 years had autopsies of their hearts and a lot of people had granulomas of the heart. Mine was found incidentally doing a MRI of my heart to assess EF and LVH. If you recall, I have never bought into this sarcoidosis diagnosis. Most people start with it in their lungs. My lungs are completely normal. Phyllis 5yo AAF 20yr of BP 170/100-220/120. Previous 7 BP pills, hx. htn, chf previous EF 20% now 50%, cardiomyapathy, lvh, cva, sarcoidosis? - no residual except I can't recall words at times, current meds Spiro 25mg daily, Benicar 20mg bid, dashing, not officially dx with PA, only dash and mcb work On 6/28/2012 2:32 PM, Clarence Grim wrote: Are you being treated for Sarcoid? CE GrimMD On Jun 28, 2012, at 4:53 AM, Phyllis wrote: The MRI showed very thick muscle and that it looked like sarcoid granulomas. With the symptoms this and the MRI this is how I got the dx of sarcoidosis. Phyllis 45yo AAF 20yr of BP 170/100-220/120. Previous 7 BP pills, hx. htn, chf previous EF 20% now 50%, cardiomyapathy, lvh, cva, sarcoidosis- no residual except I can't recall words at times, current meds Spiro 25mg, Benicar 20mg bid, dashing On 6/28/2012 12:31 AM, Clarence Grim wrote: Your cArdiomyopathy was most likely due to the hypokalemia of PA. WE HAVE HAD several here who were recommended for transplant but were quickly off the list once P was DXED and rxed with MCB AND DASH. Why did they want to do a heart BX? May your pressure be low! CE Grim MS, MD Specializing in Difficult Hypertension On Jun 27, 2012, at 5:15, Phyllis <phylisrn@...> wrote: This reminds me of when I had a MRI of the heart. The insurance company wanted a particular doctor to do my heart biopsy at my hospital. I swear every time that doctor goes into the cath lab or the interventional radiology cath lab, then end up calling a code blue. =-O No thanks, Phyllis 45yo AAF 20yr of BP 170/100-220/120. Previous 7 BP pills, hx. htn, chf previous EF 20% now 50%, cardiomyapathy, lvh, cva, sarcoidosis- no residual except I can't recall words at times, current meds Spiro 25mg, Benicar 20mg bid, dashing On 6/26/2012 11:44 PM, wrote: , your comment made me smile, you should have seen my IR when he was getting ready for me to sign the release and his nurse was explaining the AVS. When I indicated I understood the process she asked if I had done it before. I explained I almost got there until I found out the IR had only done 6 in 15 years. Dr. Chang perked up and asked what Idid. I said, "I'm here". His answer, "Smart Man, we are going get along just fine!" I was Dr. Chang's 3d AVS that day! I met with a phsychritist the other day in the VA's walk-in clinic to discuss finding a new doctor. I explained that I needed someone who understood how excess cortisol might be effecting my PTSD & depression and my concern that my reduced testosterone (androgen) might be exacerbating the issue in the area of the CYP11B2/CYP11B1 genes pumping even more cortisol to interact with the sertonin and causing me to remain in constant state of stress! He wasn't offended, in fact he said, "You really know your $hit! I'm going to refer you to a doctor from DHMC who practices at the VA 1 day week. He has been treating mood disorders for years." (DHMC is the largest hospital in the area and associated with Dartmouth College.) So I may not have to start off at ground zero with this one! Any doctor that takes umbrage with you being an informed PTN is probably not your best choice, IMHO! (of course you better know your $hit!) Don't get me wrong, I'm happy to work with a "young" doctor who is learning but they better include me as part of the team! Most respect the amount of time I have spent researching this in the last 16 months or so and I often give them the same references I supply here. (Many of the "young" doctors really appreciate that!) > > > > quick question. since this group is VERY knowledgeable about the tests for PA.... Does anyone know the medical order code for the saline suppression? > > i called the insurance company tonight to make sure if this had to be approved, that it is indeed approved. the lady said she had never heard of anything like the saline suppression. so it might not need approval but i should call my doctor or the hospital and get the code. and check with them first. > > > > i am a little nervous now. i was really counting on this happening on Wednesday... > > > > i have a feeling the hospital that i am going to doesn't really do this type of test often,considering my doctor himself handled the paper work and phones calls. > > > > > > 38 yrs > > aldo 30 (?-28) > > renin .38 (.25-5.89) > > ratio 78.9 > (.9-28.9) > > Nifedipine 30 mg > > Bystolic 5mg > > CT scan normal > > Saline suppression june 27th! > > K- (3.2 thru 4.0) 3.2 was when i was training for half marathon.... 4.0 was with very little running for a few months... > > K-only low if I start to run or exercise vigorously. so i have shortened mileage and slowed pace a great deal to compensate. (a work in progress) > > BP avg 140-160's/80-100's on a good day > > >

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