Re: 's AVS Results-Warning do not do surgery based on these results until discussed with your team in detail to make certain the results you sent are correct.

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Dr. Grim's Interpretation of AVE on J. Based on the numbers from 's email.My interpretation is that the "right" adrenal sample is not a right adrenal sample. It is most likely a hepatic (liver) vein sample.This is a very common problem and the interpretation likey comes from a Dr. who has not done many of these.It appears ACTH was not used?

Why?1. Aldo is lower than IVC supra or infra. Thus most likely a liver vein as liver clears blood of aldo.2. The cortisol is also lower than the IVC above or below renals.3. The yellow highlighed area seems to be the average of the two samples and not the aldo/cortisol ratio.Please be certain the numbers you sent me are the correct ones.If they are then Please ask your team to review these comments before any surgery is planned.I attach the AVS report form that I prefer to use.Note to others on Group. Please verify that my numbers that sent have been entered into the correct boxes.This is an update of the AVE report form.CE Grim MDCE Grim MD On Jun 30, 2012, at 1:38 PM, J. wrote: This is what they sent me. It is all greek to me... According to the Interv Rad, it is very clear that my left gland is the trouble maker. Right seems to be fine. The yellow highlight to the right are the ratio of of the Aldosterone/Cortisol from the samples to the peripheral samples with normal equal or less than 1. Your left side is 11.6. ALDOSTERONE U/L Time AVG Time 1 RT Adrenal 1 11:28 4.0 5.2 Sheath RA1 11:28 11.0 2 RT Adrenal 2 11:31 6.4 Sheath RA2 11:31 15.0 3 LT Adrenal 1 10:30 690.0 615.0 Sheath LA1 10:30 15.0 4 LT Adrenal 2 10:31 540.0 Sheath LA2 10:31 16.0 5 Suprarenal IVC 1 10:36 14.0 15.5 Sheath SI1 10:36 14.0 6 Suprarenal IVC 2 10:40 17.0 Sheath SI2 10:40 17.0 7 Infrarenal IVC 1 12:03 14.0 14.0 Sheath II1 10:32 14.0 8 Infrarenal IVC 2 12:01 14.0 Sheath II2 12:00 14.0 CORTISOL UG/DL Time Time 1 RT Adrenal 1 11:28 2.4 2.4 Sheath RA1 11:28 2.1 2 RT Adrenal 2 11:31 2.3 Sheath RA2 11:31 2.0 3 LT Adrenal 1 10:30 13.9 12.4 Sheath LA1 10:30 3.6 4 LT Adrenal 2 10:31 10.9 Sheath LA2 10:31 3.7 5 Suprarenal IVC 1 10:36 3.3 3.2 Sheath SI1 10:36 3.4 6 Suprarenal IVC 2 10:40 3.1 Sheath SI2 10:40 3.2 7 Infrarenal IVC 1 12:03 3.6 3.6 Sheath II1 10:32 3.6 8 Infrarenal IVC 2 12:01 3.6 Sheath II2 12:00 3.5 From: Clarence Grim <lowerbp2@...> "hyperaldosteronism " <hyperaldosteronism > Sent: Saturday, June 30, 2012 1:39 PM Subject: Re: Nasal Congestion due to PA (retitled from Subject: RE: Virginia's AVS) Send us your AVS numbers so we can see them. We have picked up errors missed by the local team. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jun 30, 2012, at 7:39, " J." <jessdell72@...> wrote: I will try this too! I never realized nasal congestion might be related to PA. Nasal congestion is what made me visit the doctor in the first place, which lead to discovery of HTN, etc, etc. The HTN become the more pressing issue and we put the Nasal congestion issue on the back burner. But mine also, is much worse at night. Fascinating stuff. Have I mentioned I love this group! 39 y/o female2 cm adenoma on left adrenalMy AVS results just came back and confirmed the left gland is hormone producingBP currently high 140s over 80s (Was in 180's/90's when I went in for Nasal Congestion)On 180mg Verapamil SR140 mEgs of K daily From: Bingham <jlkbbk2003@...> hyperaldosteronism Sent: Wednesday, June 27, 2012 8:45 PM Subject: RE: Virginia's AVS Thanks!!! I am going to try that. I'll let you know if it works or at least helps. I learned that nasal inflammation occurs due to too much salt as well as it makes my nasal fluid as hard as concrete that no amount of hot water can below it out J and consequently it was impossible for me to sleep at night until I discovered this…prior to my discovery, my doc prescribed Vaseline rubbing into my nose and also a stupid medical spray that caused headaches and after a while both did not do any good…until I found out salt/K ratio has been high and now with a glass of 25mEq K-citrate my nasal fluid comes back to normal fluidity and inflammation gradually disappears and I can sleep normally J of course all my findings are from you Dr. Grim in discussions of this Group and I am very much grateful to you for all your efforts and comment. Max. 62M HTN (since 1995) L adenoma by NP59 scan. Aldos=1065…2056 [28-860] pmol/L, Renin=6 [<30] ng/L (DX 2009). med combo #79={Spiro=100, Amlo=2x5mg, Indap=2.5mg, Ramip=2x2.5mg, Metf=2x500mg, Crestor=20mg, Feno=67mg, K.Cl=6x20mEq, Motilium=10mg, B12=1000µg/m}{K=4.5}{not DASHing but low-salt diet just slightly above craving while keeping K/Na ratio constant, heat intolerance, insulin resistance, tingling right leg & hand}

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AVS 120630.xls

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He can always consult with me for guidance.But assumes he gave them to us correctly and I got them in the right place. This is what I get paid for sometimes.CE Grim MDOn Jun 30, 2012, at 7:29 PM, J. wrote: Dr. Grim, Thank you so much for your interpretation. The IR did mention that my vein was "unique" and I believe he said my adrenal vein and and another vein were connected or sharing a vein. Does that seem possible? Aagghh. This is so frustrating. I was so happy to have a clear cut answer, so my decision for surgery was black and white. From: Clarence Grim <lowerbp2@...> hyperaldosteronism Cc: Clarence Grim <lowerbp2@...> Sent: Saturday, June 30, 2012 8:37 PM Subject: Re: 's AVS Results-Warning do not do surgery based on these results until discussed with your team in detail to make certain the results you sent are correct. [1 Attachment] Dr. Grim's Interpretation of AVE on J. Based on the numbers from 's email.My interpretation is that the "right" adrenal sample is not a right adrenal sample. It is most likely a hepatic (liver) vein sample.This is a very common problem and the interpretation likey comes from a Dr. who has not done many of these.It appears ACTH was not used? Why?1. Aldo is lower than IVC supra or infra. Thus most likely a liver vein as liver clears blood of aldo.2. The cortisol is also lower than the IVC above or below renals.3. The yellow highlighed area seems to be the average of the two samples and not the aldo/cortisol ratio.Please be certain the numbers you sent me are the correct ones.If they are then Please ask your team to review these comments before any surgery is planned.I attach the AVS report form that I prefer to use.Note to others on Group. Please verify that my numbers that sent have been entered into the correct boxes.This is an update of the AVE report form.CE Grim MDCE Grim MD On Jun 30, 2012, at 1:38 PM, J. wrote: This is what they sent me. It is all greek to me... According to the Interv Rad, it is very clear that my left gland is the trouble maker. Right seems to be fine. The yellow highlight to the right are the ratio of of the Aldosterone/Cortisol from the samples to the peripheral samples with normal equal or less than 1. Your left side is 11.6. ALDOSTERONE U/L Time AVG Time 1 RT Adrenal 1 11:28 4.0 5.2 Sheath RA1 11:28 11.0 2 RT Adrenal 2 11:31 6.4 Sheath RA2 11:31 15.0 3 LT Adrenal 1 10:30 690.0 615.0 Sheath LA1 10:30 15.0 4 LT Adrenal 2 10:31 540.0 Sheath LA2 10:31 16.0 5 Suprarenal IVC 1 10:36 14.0 15.5 Sheath SI1 10:36 14.0 6 Suprarenal IVC 2 10:40 17.0 Sheath SI2 10:40 17.0 7 Infrarenal IVC 1 12:03 14.0 14.0 Sheath II1 10:32 14.0 8 Infrarenal IVC 2 12:01 14.0 Sheath II2 12:00 14.0 CORTISOL UG/DL Time Time 1 RT Adrenal 1 11:28 2.4 2.4 Sheath RA1 11:28 2.1 2 RT Adrenal 2 11:31 2.3 Sheath RA2 11:31 2.0 3 LT Adrenal 1 10:30 13.9 12.4 Sheath LA1 10:30 3.6 4 LT Adrenal 2 10:31 10.9 Sheath LA2 10:31 3.7 5 Suprarenal IVC 1 10:36 3.3 3.2 Sheath SI1 10:36 3.4 6 Suprarenal IVC 2 10:40 3.1 Sheath SI2 10:40 3.2 7 Infrarenal IVC 1 12:03 3.6 3.6 Sheath II1 10:32 3.6 8 Infrarenal IVC 2 12:01 3.6 Sheath II2 12:00 3.5 From: Clarence Grim <lowerbp2@...> "hyperaldosteronism " <hyperaldosteronism > Sent: Saturday, June 30, 2012 1:39 PM Subject: Re: Nasal Congestion due to PA (retitled from Subject: RE: Virginia's AVS) Send us your AVS numbers so we can see them. We have picked up errors missed by the local team. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension On Jun 30, 2012, at 7:39, " J." <jessdell72@...> wrote: I will try this too! I never realized nasal congestion might be related to PA. Nasal congestion is what made me visit the doctor in the first place, which lead to discovery of HTN, etc, etc. The HTN become the more pressing issue and we put the Nasal congestion issue on the back burner. But mine also, is much worse at night. Fascinating stuff. Have I mentioned I love this group! 39 y/o female2 cm adenoma on left adrenalMy AVS results just came back and confirmed the left gland is hormone producingBP currently high 140s over 80s (Was in 180's/90's when I went in for Nasal Congestion)On 180mg Verapamil SR140 mEgs of K daily From: Bingham <jlkbbk2003@...> hyperaldosteronism Sent: Wednesday, June 27, 2012 8:45 PM Subject: RE: Virginia's AVS Thanks!!! I am going to try that. I'll let you know if it works or at least helps. I learned that nasal inflammation occurs due to too much salt as well as it makes my nasal fluid as hard as concrete that no amount of hot water can below it out J and consequently it was impossible for me to sleep at night until I discovered this…prior to my discovery, my doc prescribed Vaseline rubbing into my nose and also a stupid medical spray that caused headaches and after a while both did not do any good…until I found out salt/K ratio has been high and now with a glass of 25mEq K-citrate my nasal fluid comes back to normal fluidity and inflammation gradually disappears and I can sleep normally J of course all my findings are from you Dr. Grim in discussions of this Group and I am very much grateful to you for all your efforts and comment. Max. 62M HTN (since 1995) L adenoma by NP59 scan. Aldos=1065…2056 [28-860] pmol/L, Renin=6 [<30] ng/L (DX 2009). med combo #79={Spiro=100, Amlo=2x5mg, Indap=2.5mg, Ramip=2x2.5mg, Metf=2x500mg, Crestor=20mg, Feno=67mg, K.Cl=6x20mEq, Motilium=10mg, B12=1000µg/m}{K=4.5}{not DASHing but low-salt diet just slightly above craving while keeping K/Na ratio constant, heat intolerance, insulin resistance, tingling right leg & hand}