Re: Hospitalized with very high BP

August 1, 2012

I had a bad hypertensive crisis once.

It was the omeprazole.

Check this out.. this is how I found out about omeprazole. Also

proton pump inhibitors are no good because they interfere with

good acid in the stomach.

Proton pump inhibitor causes C-diff, which will cause diarrhea.

http://www.askapatient.com/viewrating.asp?drug=19810 & name=prilosec

http://www.ncbi.nlm.nih.gov/pubmed/22781139

Phyllis

On 8/1/2012 5:24 PM, Grim Clarence wrote:

One issue is are you salt depleted with the hot weather

and the eplerenone?

Recommend you take your BP seated and then stand for 1

min with arm supported so the cuff is at heart level and

check the BP again. If is drops by more that 20 this

suggests that you may be salt depelted and more salt may

actually help.

Did your BP fall a lot in the hospital as the numbers

are if anything low on the record you sent but they may

have loaded you up with BP meds.

Did they stop or taper the metformin. You were on a

lot as I recall.

What other meds have been tired for DM?

Has your weight been stable during all of this?

How they take your BP when it was 230/130. Were you in

pain or acutely ill?

Clarence Grim MD

lowerbp2@...

On Aug 1, 2012, at 12:22 PM, Natalia Kamneva

wrote:

Hi Dr. Grim and the group,

I again was hospitalized with BP

230/130 and spent five days in the

hospital. I don't have yet all medical

records from the hospital, but I have

Report from MRI without contrast and some

blood test results. See the attachment.

I also have images from MRI in case

if Dr. Grim would like to take a look at

them.

Please, note, that my blood K was

5.0 and blood Na was 132, pretty much the

same as it was a year ago when I was

hospitalized with the same symptoms and a

very high blood pressure.

I really don't know why it happened

again and such high BP all of the sudden

scares me to death.

The reasons that I consider:

1. 4th of July picnic, where I ate

much more salty food than usually. But

after that I was on my dash for two weeks

and felt pretty well.

2. Summer heat. I was hospitalized

five times for last two years and it

always happened during summer heat.

3. Constant diarrhea over last two

months since I overdosed metformin.

4. All the above together!?

I am not on any diabetes

medications now and my BS is really high,

average fasting is 150-160. I also

consider to change eplerenone to sipro,

since eplerenone also causes diarrhea.

Now I feel unstable and my BP

varies from 110/65 to 160/100. It's

especially high at 8 am and 8 pm, when I

also feel very badly. I am on higher

dosage of eplerenone and micardis and

Dashing very strictly, restricting Na <

700 - 800 mg a day.

Many, many thanks. I would

appreciate any responses.

Natalia

Kamneva 68 F with 3.5 cm left adrenal

adenoma, diagnosed with PA in 2011;

diabetic; on 100 mg eplerenone, 160 mg

Micardis, currently not diabetic medication

, 20 mg Omeprazol and 3 - 4 mg Lorazepam;

Dashing; still have some occasional problems

with BP, K and Na; on private consultation

with Dr Grim.

August 1, 2012

> One issue is are you salt depleted with the hot weather and the eplerenone?I assume that I am. When I eat a jar of marinated mushrooms (approximately 250 mg on Na), I feel immediately better. Should I eat more Na and less K?Does salt depletion cause spikes in blood pressure? >Recommend you take your BP seated and then stand for 1 min with arm supported so the cuff is at heart level and check the BP again. If is drops by more that 20 this suggests that you may be salt depelted and more salt may actually help.Seated 129/78, standing 123/78. HR is 115. >Did your BP fall a lot in the hospital as the numbers are if anything low on the record you sent but they may have loaded you up with BP meds.Yes, my BP fall a lot in a hospital and became worse at home. I was there and here on the same 100 mg dosage of eplerenone and 160 of micardis. They did 2 shots of BB when I arrived with 230/130. Next day my BP was still high, after that normal. > Did they stop or taper the metformin. You were on a lot as I recall.I was on 2000 mg until I overdosed it for three weeks to 4000mg. The endo stopped it completely. I am not on any diabetic medications right now. I was in insulin in the hospital.>What other meds have been tired for DM?I tried januvia in addition to metformin several years ago, but didn't see any positive effect. I was on glukophage when the insurance covered it. >Has your weight been stable during all of

this?Pretty much.> How they take your BP when it was 230/130. Were you in pain or acutely ill?I lay down. I was feeling terribly: shortness of breath, headache and all other symptoms of PA. Many thanks, Natalia Kamneva 68 F with 2.5 cm left adrenal adenoma, recently diagnosed with PA; diabetic; on 100 mg eplerenone, 40 mg Micardis, 2000 mg metformin, 60 mg Dexilant and 2 mg Lorazepam; Dashing; still have some occasional problems with BP, K and Na; on private consultation with Dr Grim. From: Grim Clarence <lowerbp2@...> hyperaldosteronism Cc: Grim Clarence <lowerbp2@...> Sent: Wednesday, August 1, 2012 4:24 PM Subject: Re: Hospitalized with very high BP

One issue is are you salt depleted with the hot weather and the eplerenone?Recommend you take your BP seated and then stand for 1 min with arm supported so the cuff is at heart level and check the BP again. If is drops by more that 20 this suggests that you may be salt depelted and more salt may actually help.Did your BP fall a lot in the hospital as the numbers are if anything low on the record you sent but they may have loaded you up with BP meds.Did they stop or taper the metformin. You were on a lot as I recall.What other meds have been tired for DM?Has your weight been stable during all of this?How they take your BP when it was 230/130. Were you in pain or acutely ill?

Clarence Grim MDlowerbp2@...

On Aug 1, 2012, at 12:22 PM, Natalia Kamneva wrote:

Hi Dr. Grim and the group,I again was hospitalized with BP 230/130 and spent five days in the hospital. I don't have yet all medical records from the hospital, but I have Report from MRI without contrast and some blood test results. See the attachment. I also have images from MRI in case if Dr. Grim would like to take a look at them. Please, note, that my blood K was 5.0 and blood Na was 132, pretty much the same as it was a year ago when I was hospitalized with the same symptoms and a very high blood pressure. I really don't know why it happened

again and such high BP all of the sudden scares me to

death. The reasons that I consider:1. 4th of July picnic, where I ate much more salty food than usually. But after that I was on my dash for two weeks and felt pretty well.2. Summer heat. I was hospitalized five times for last two years and it always happened during summer heat. 3. Constant diarrhea over last two months since I overdosed metformin. 4. All the above together!?I am not on any diabetes medications now and my BS is really high, average fasting is 150-160. I also consider to change eplerenone to sipro, since eplerenone also causes diarrhea.Now I feel unstable and my BP varies from 110/65 to 160/100.

It's especially high at 8 am and 8 pm, when I also feel very badly. I am on higher dosage of eplerenone and micardis and Dashing very strictly, restricting Na < 700 - 800 mg a day. Many, many thanks. I would appreciate any responses. Natalia Kamneva 68 F with 3.5 cm left adrenal adenoma, diagnosed with PA in 2011; diabetic; on 100 mg eplerenone, 160 mg Micardis, currently not diabetic medication , 20 mg Omeprazol and 3 - 4 mg Lorazepam; Dashing; still have some occasional problems with BP, K and Na; on private consultation with Dr Grim.

August 1, 2012

Thank you, Phyllis. Is Protonix better? They gave me Protonix in a hospital and I felt better there. What do you do with a heartburn?Many thanks,Natalia From: Phyllis <phylisrn@...> hyperaldosteronism Sent: Wednesday, August 1, 2012 6:03 PM Subject: Re: Hospitalized with very high BP

I had a bad hypertensive crisis once.

It was the omeprazole.

Check this out.. this is how I found out about omeprazole. Also

proton pump inhibitors are no good because they interfere with

good acid in the stomach.

Proton pump inhibitor causes C-diff, which will cause diarrhea.

http://www.askapatient.com/viewrating.asp?drug=19810 & name=prilosec

http://www.ncbi.nlm.nih.gov/pubmed/22781139

Phyllis

On 8/1/2012 5:24 PM, Grim Clarence wrote:

One issue is are you salt depleted with the hot weather

and the eplerenone?

Recommend you take your BP seated and then stand for 1

min with arm supported so the cuff is at heart level and

check the BP again. If is drops by more that 20 this

suggests that you may be salt depelted and more salt may

actually help.

Did your BP fall a lot in the hospital as the numbers

are if anything low on the record you sent but they may

have loaded you up with BP meds.

Did they stop or taper the metformin. You were on a

lot as I recall.

What other meds have been tired for DM?

Has your weight been stable during all of this?

How they take your BP when it was 230/130. Were you in

pain or acutely ill?

Clarence Grim MD

lowerbp2@...

On Aug 1, 2012, at 12:22 PM, Natalia Kamneva

wrote:

Hi Dr. Grim and the group,

I again was hospitalized with BP

230/130 and spent five days in the

hospital. I don't have yet all medical

records from the hospital, but I have

Report from MRI without contrast and some

blood test results. See the attachment.

I also have images from MRI in case

if Dr. Grim would like to take a look at

them.

Please, note, that my blood K was

5.0 and blood Na was 132, pretty much the

same as it was a year ago when I was

hospitalized with the same symptoms and a

very high blood pressure.

I really don't know why it happened

again and such high BP all of the sudden

scares me to death.

The reasons that I consider:

1. 4th of July picnic, where I ate

much more salty food than usually. But

after that I was on my dash for two weeks

and felt pretty well.

2. Summer heat. I was hospitalized

five times for last two years and it

always happened during summer heat.

3. Constant diarrhea over last two

months since I overdosed metformin.

4. All the above together!?

I am not on any diabetes

medications now and my BS is really high,

average fasting is 150-160. I also

consider to change eplerenone to sipro,

since eplerenone also causes diarrhea.

Now I feel unstable and my BP

varies from 110/65 to 160/100. It's

especially high at 8 am and 8 pm, when I

also feel very badly. I am on higher

dosage of eplerenone and micardis and

Dashing very strictly, restricting Na <

700 - 800 mg a day.

Many, many thanks. I would

appreciate any responses.

Natalia

Kamneva 68 F with 3.5 cm left adrenal

adenoma, diagnosed with PA in 2011;

diabetic; on 100 mg eplerenone, 160 mg

Micardis, currently not diabetic medication

, 20 mg Omeprazol and 3 - 4 mg Lorazepam;

Dashing; still have some occasional problems

with BP, K and Na; on private consultation

with Dr Grim.

August 1, 2012

, I dont take any proton-pump

inhibitors. They also prevent magnesium from being absorbed.

I take real ginger and make a tea . It works wonders.

Phylli

On 8/1/2012 7:23 PM, Natalia Kamneva wrote:

Thank you, Phyllis. Is Protonix better? They

gave me Protonix in a hospital and I felt better

there. What do you do with a heartburn?

Many thanks,

Natalia

From:

Phyllis <phylisrn@...>

To:

hyperaldosteronism

Sent:

Wednesday, August 1, 2012 6:03 PM

Subject:

Re: Hospitalized with very

high BP

I had

a bad hypertensive crisis once. It was the

omeprazole.

Check this out.. this is how I found out about

omeprazole. Also proton pump inhibitors are

no good because they interfere with good acid

in the stomach.

Proton pump inhibitor causes C-diff, which

will cause diarrhea.

http://www.askapatient.com/viewrating.asp?drug=19810 & name=prilosec

http://www.ncbi.nlm.nih.gov/pubmed/22781139

Phyllis

On 8/1/2012 5:24 PM, Grim Clarence wrote:

One issue is are you salt depleted with

the hot weather and the eplerenone?

Recommend you take your BP seated and

then stand for 1 min with arm supported so

the cuff is at heart level and check the

BP again. If is drops by more that 20

this suggests that you may be salt

depelted and more salt may actually help.

Did your BP fall a lot in the hospital

as the numbers are if anything low on the

record you sent but they may have loaded

you up with BP meds.

Did they stop or taper the metformin.

You were on a lot as I recall.

What other meds have been tired for DM?

Has your weight been stable during all

of this?

How they take your BP when it was

230/130. Were you in pain or acutely ill?

Clarence Grim MD

lowerbp2@...

On Aug 1, 2012, at 12:22 PM,

Natalia Kamneva wrote:

Hi Dr. Grim and the

group,

I again was

hospitalized with BP

230/130 and spent five

days in the hospital. I

don't have yet all medical

records from the hospital,

but I have Report from MRI

without contrast and some

blood test results. See

the attachment.

I also have images

from MRI in case if Dr.

Grim would like to take a

look at them.

Please, note, that

my blood K was 5.0 and

blood Na was 132, pretty

much the same as it was a

year ago when I was

hospitalized with the same

symptoms and a very high

blood pressure.

I really don't know

why it happened again and

such high BP all of the

sudden scares me to

death.

The reasons that I

consider:

1. 4th of July

picnic, where I ate much

more salty food than

usually. But after that I

was on my dash for two

weeks and felt pretty

well.

2. Summer heat. I

was hospitalized five

times for last two years

and it always happened

during summer heat.

3. Constant

diarrhea over last two

months since I overdosed

metformin.

4. All the above

together!?

I am not on any

diabetes medications now

and my BS is really high,

average fasting is

150-160. I also consider

to change eplerenone to

sipro, since eplerenone

also causes diarrhea.

Now I feel unstable

and my BP varies from

110/65 to 160/100. It's

especially high at 8 am

and 8 pm, when I also feel

very badly. I am on higher

dosage of eplerenone and

micardis and Dashing very

strictly, restricting Na

< 700 - 800 mg a day.

Many, many thanks.

I would appreciate any

responses.

Natalia

Kamneva 68 F with 3.5 cm

left adrenal adenoma,

diagnosed with PA in 2011;

diabetic; on 100 mg

eplerenone, 160 mg Micardis,

currently not diabetic

medication , 20 mg Omeprazol

and 3 - 4 mg Lorazepam;

Dashing; still have some

occasional problems with BP,

K and Na; on private

consultation with Dr Grim.

August 1, 2012

Thank you,Phyllis. How do you make a tea from real ginger? How much do you drink it? Once a day? Every time when you have a heartburn? From: Phyllis <phylisrn@...> hyperaldosteronism Sent: Wednesday, August 1, 2012 7:45 PM Subject: Re: Hospitalized with very high BP

, I dont take any proton-pump

inhibitors. They also prevent magnesium from being absorbed.

I take real ginger and make a tea . It works wonders.

Phylli

On 8/1/2012 7:23 PM, Natalia Kamneva wrote:

Thank you, Phyllis. Is Protonix better? They

gave me Protonix in a hospital and I felt better

there. What do you do with a heartburn?

Many thanks,

Natalia

From:

Phyllis <phylisrn@...>

To:

hyperaldosteronism

Sent:

Wednesday, August 1, 2012 6:03 PM

Subject:

Re: Hospitalized with very

high BP

I had

a bad hypertensive crisis once. It was the

omeprazole.

Check this out.. this is how I found out about

omeprazole. Also proton pump inhibitors are

no good because they interfere with good acid

in the stomach.

Proton pump inhibitor causes C-diff, which

will cause diarrhea.

http://www.askapatient.com/viewrating.asp?drug=19810 & name=prilosec

http://www.ncbi.nlm.nih.gov/pubmed/22781139

Phyllis

On 8/1/2012 5:24 PM, Grim Clarence wrote:

One issue is are you salt depleted with

the hot weather and the eplerenone?

Recommend you take your BP seated and

then stand for 1 min with arm supported so

the cuff is at heart level and check the

BP again. If is drops by more that 20

this suggests that you may be salt

depelted and more salt may actually help.

Did your BP fall a lot in the hospital

as the numbers are if anything low on the

record you sent but they may have loaded

you up with BP meds.

Did they stop or taper the metformin.

You were on a lot as I recall.

What other meds have been tired for DM?

Has your weight been stable during all

of this?

How they take your BP when it was

230/130. Were you in pain or acutely ill?

Clarence Grim MD

lowerbp2@...

On Aug 1, 2012, at 12:22 PM,

Natalia Kamneva wrote:

Hi Dr. Grim and the

group,

I again was

hospitalized with BP

230/130 and spent five

days in the hospital. I

don't have yet all medical

records from the hospital,

but I have Report from MRI

without contrast and some

blood test results. See

the attachment.

I also have images

from MRI in case if Dr.

Grim would like to take a

look at them.

Please, note, that

my blood K was 5.0 and

blood Na was 132, pretty

much the same as it was a

year ago when I was

hospitalized with the same

symptoms and a very high

blood pressure.

I really don't know

why it happened again and

such high BP all of the

sudden scares me to

death.

The reasons that I

consider:

1. 4th of July

picnic, where I ate much

more salty food than

usually. But after that I

was on my dash for two

weeks and felt pretty

well.

2. Summer heat. I

was hospitalized five

times for last two years

and it always happened

during summer heat.

3. Constant

diarrhea over last two

months since I overdosed

metformin.

4. All the above

together!?

I am not on any

diabetes medications now

and my BS is really high,

average fasting is

150-160. I also consider

to change eplerenone to

sipro, since eplerenone

also causes diarrhea.

Now I feel unstable

and my BP varies from

110/65 to 160/100. It's

especially high at 8 am

and 8 pm, when I also feel

very badly. I am on higher

dosage of eplerenone and

micardis and Dashing very

strictly, restricting Na

< 700 - 800 mg a day.

Many, many thanks.

I would appreciate any

responses.

Natalia

Kamneva 68 F with 3.5 cm

left adrenal adenoma,

diagnosed with PA in 2011;

diabetic; on 100 mg

eplerenone, 160 mg Micardis,

currently not diabetic

medication , 20 mg Omeprazol

and 3 - 4 mg Lorazepam;

Dashing; still have some

occasional problems with BP,

K and Na; on private

consultation with Dr Grim.

August 1, 2012

I would try adding back a little salt each day to see if you feel any better. Especially if it has been very hot there.I would just add an increasing amount of sodium each day to see what happens. Keep K the same as you are on now.When some get very salt depleted the BP control system can fluctuate up and down.I would add about 1/4 teaspoon every 2 days and see what happens. Avoid big salt loads tho.Keep us posted.

Clarence Grim MDlowerbp2@...

On Aug 1, 2012, at 6:08 PM, Natalia Kamneva wrote:

> One issue is are you salt depleted with the hot weather and the eplerenone?I assume that I am. When I eat a jar of marinated mushrooms (approximately 250 mg on Na), I feel immediately better. Should I eat more Na and less K?Does salt depletion cause spikes in blood pressure? >Recommend you take your BP seated and then stand for 1 min with arm supported so the cuff is at heart level and check the BP again. If is drops by more that 20 this suggests that you may be salt depelted and more salt may actually help.Seated 129/78, standing 123/78. HR is 115. >Did your BP fall a lot in the hospital as the numbers are if anything low on the record you sent but they may have loaded you up with BP meds.Yes, my BP fall a lot in a hospital and became worse at home. I was there and here on the same 100 mg dosage of eplerenone and 160 of micardis. They did 2 shots of BB when I arrived with 230/130. Next day my BP was still high, after that normal. > Did they stop or taper the metformin. You were on a lot as I recall.I was on 2000 mg until I overdosed it for three weeks to 4000mg. The endo stopped it completely. I am not on any diabetic medications right now. I was in insulin in the hospital.>What other meds have been tired for DM?I tried januvia in addition to metformin several years ago, but didn't see any positive effect. I was on glukophage when the insurance covered it. >Has your weight been stable during all of

this?Pretty much.> How they take your BP when it was 230/130. Were you in pain or acutely ill?I lay down. I was feeling terribly: shortness of breath, headache and all other symptoms of PA. Many thanks, Natalia Kamneva 68 F with 2.5 cm left adrenal adenoma, recently diagnosed with PA; diabetic; on 100 mg eplerenone, 40 mg Micardis, 2000 mg metformin, 60 mg Dexilant and 2 mg Lorazepam; Dashing; still have some occasional problems with BP, K and Na; on private consultation with Dr Grim. From: Grim Clarence <lowerbp2@...> hyperaldosteronism Cc: Grim Clarence <lowerbp2@...> Sent: Wednesday, August 1, 2012 4:24 PM Subject: Re: Hospitalized with very high BP

One issue is are you salt depleted with the hot weather and the eplerenone?Recommend you take your BP seated and then stand for 1 min with arm supported so the cuff is at heart level and check the BP again. If is drops by more that 20 this suggests that you may be salt depelted and more salt may actually help.Did your BP fall a lot in the hospital as the numbers are if anything low on the record you sent but they may have loaded you up with BP meds.Did they stop or taper the metformin. You were on a lot as I recall.What other meds have been tired for DM?Has your weight been stable during all of this?How they take your BP when it was 230/130. Were you in pain or acutely ill?

Clarence Grim MDlowerbp2@...

On Aug 1, 2012, at 12:22 PM, Natalia Kamneva wrote:

Hi Dr. Grim and the group,I again was hospitalized with BP 230/130 and spent five days in the hospital. I don't have yet all medical records from the hospital, but I have Report from MRI without contrast and some blood test results. See the attachment. I also have images from MRI in case if Dr. Grim would like to take a look at them. Please, note, that my blood K was 5.0 and blood Na was 132, pretty much the same as it was a year ago when I was hospitalized with the same symptoms and a very high blood pressure. I really don't know why it happened

again and such high BP all of the sudden scares me to

death. The reasons that I consider:1. 4th of July picnic, where I ate much more salty food than usually. But after that I was on my dash for two weeks and felt pretty well.2. Summer heat. I was hospitalized five times for last two years and it always happened during summer heat. 3. Constant diarrhea over last two months since I overdosed metformin. 4. All the above together!?I am not on any diabetes medications now and my BS is really high, average fasting is 150-160. I also consider to change eplerenone to sipro, since eplerenone also causes diarrhea.Now I feel unstable and my BP varies from 110/65 to 160/100.

It's especially high at 8 am and 8 pm, when I also feel very badly. I am on higher dosage of eplerenone and micardis and Dashing very strictly, restricting Na < 700 - 800 mg a day. Many, many thanks. I would appreciate any responses. Natalia Kamneva 68 F with 3.5 cm left adrenal adenoma, diagnosed with PA in 2011; diabetic; on 100 mg eplerenone, 160 mg Micardis, currently not diabetic medication , 20 mg Omeprazol and 3 - 4 mg Lorazepam; Dashing; still have some occasional problems with BP, K and Na; on private consultation with Dr Grim.

August 1, 2012

They do not cause C. diff. C diff causes C diff.

Clarence Grim MDlowerbp2@...

On Aug 1, 2012, at 6:23 PM, Natalia Kamneva wrote:

Thank you, Phyllis. Is Protonix better? They gave me Protonix in a hospital and I felt better there. What do you do with a heartburn?Many thanks,Natalia From: Phyllis <phylisrn@...> hyperaldosteronism Sent: Wednesday, August 1, 2012 6:03 PM Subject: Re: Hospitalized with very high BP

I had a bad hypertensive crisis once.

It was the omeprazole.

Check this out.. this is how I found out about omeprazole. Also

proton pump inhibitors are no good because they interfere with

good acid in the stomach.

Proton pump inhibitor causes C-diff, which will cause diarrhea.

http://www.askapatient.com/viewrating.asp?drug=19810 & name=prilosec

http://www.ncbi.nlm.nih.gov/pubmed/22781139

Phyllis

On 8/1/2012 5:24 PM, Grim Clarence wrote:

One issue is are you salt depleted with the hot weather

and the eplerenone?

Recommend you take your BP seated and then stand for 1

min with arm supported so the cuff is at heart level and

check the BP again. If is drops by more that 20 this

suggests that you may be salt depelted and more salt may

actually help.

Did your BP fall a lot in the hospital as the numbers

are if anything low on the record you sent but they may

have loaded you up with BP meds.

Did they stop or taper the metformin. You were on a

lot as I recall.

What other meds have been tired for DM?

Has your weight been stable during all of this?

How they take your BP when it was 230/130. Were you in

pain or acutely ill?

Clarence Grim MD

lowerbp2@...

On Aug 1, 2012, at 12:22 PM, Natalia Kamneva

wrote:

Hi Dr. Grim and the group,

I again was hospitalized with BP

230/130 and spent five days in the

hospital. I don't have yet all medical

records from the hospital, but I have

Report from MRI without contrast and some

blood test results. See the attachment.

I also have images from MRI in case

if Dr. Grim would like to take a look at

them.

Please, note, that my blood K was

5.0 and blood Na was 132, pretty much the

same as it was a year ago when I was

hospitalized with the same symptoms and a

very high blood pressure.

I really don't know why it happened

again and such high BP all of the sudden

scares me to death.

The reasons that I consider:

1. 4th of July picnic, where I ate

much more salty food than usually. But

after that I was on my dash for two weeks

and felt pretty well.

2. Summer heat. I was hospitalized

five times for last two years and it

always happened during summer heat.

3. Constant diarrhea over last two

months since I overdosed metformin.

4. All the above together!?

I am not on any diabetes

medications now and my BS is really high,

average fasting is 150-160. I also

consider to change eplerenone to sipro,

since eplerenone also causes diarrhea.

Now I feel unstable and my BP

varies from 110/65 to 160/100. It's

especially high at 8 am and 8 pm, when I

also feel very badly. I am on higher

dosage of eplerenone and micardis and

Dashing very strictly, restricting Na <

700 - 800 mg a day.

Many, many thanks. I would

appreciate any responses.

Natalia

Kamneva 68 F with 3.5 cm left adrenal

adenoma, diagnosed with PA in 2011;

diabetic; on 100 mg eplerenone, 160 mg

Micardis, currently not diabetic medication

, 20 mg Omeprazol and 3 - 4 mg Lorazepam;

Dashing; still have some occasional problems

with BP, K and Na; on private consultation

with Dr Grim.

August 1, 2012

They do indeed causes symptomatic

cdiff, - Many people have c-diff in their bodies , but there has

to be a catalyst to set it off. PPI destroy the normal flora of

the intestine which allows bad bacteria to take over. Cdiff is an

opportunistic infection.

Your favorite site pubmed has many articles about it.

http://www.ncbi.nlm.nih.gov/pubmed/22781139

http://www.ncbi.nlm.nih.gov/pubmed/15238493

http://www.ncbi.nlm.nih.gov/pubmed/22701180

Phyllis

On 8/1/2012 11:02 PM, Grim Clarence wrote:

They do not cause C. diff. C diff causes C diff.

Clarence Grim MD

lowerbp2@...

On Aug 1, 2012, at 6:23 PM, Natalia Kamneva wrote:

Thank you, Phyllis. Is Protonix

better? They gave me Protonix in a hospital

and I felt better there. What do you do with

a heartburn?

Many thanks,

Natalia

From:

Phyllis <phylisrn@...>

To:

hyperaldosteronism

Sent:

Wednesday, August 1, 2012 6:03 PM

Subject:

Re: Hospitalized

with very high BP

I

had a bad hypertensive crisis once.

It was the omeprazole.

Check this out.. this is how I found

out about omeprazole. Also proton

pump inhibitors are no good because

they interfere with good acid in the

stomach.

Proton pump inhibitor causes C-diff,

which will cause diarrhea.

http://www.askapatient.com/viewrating.asp?drug=19810 & name=prilosec

http://www.ncbi.nlm.nih.gov/pubmed/22781139

Phyllis

On 8/1/2012 5:24 PM, Grim Clarence

wrote:

One issue is are you salt

depleted with the hot weather

and the eplerenone?

Recommend you take your BP

seated and then stand for 1 min

with arm supported so the cuff

is at heart level and check the

BP again. If is drops by more

that 20 this suggests that you

may be salt depelted and more

salt may actually help.

Did your BP fall a lot in the

hospital as the numbers are if

anything low on the record you

sent but they may have loaded

you up with BP meds.

Did they stop or taper the

metformin. You were on a lot

as I recall.

What other meds have been

tired for DM?

Has your weight been stable

during all of this?

How they take your BP when it

was 230/130. Were you in pain or

acutely ill?

Clarence Grim MD

lowerbp2@...

On Aug 1, 2012, at

12:22 PM, Natalia Kamneva

wrote:

Hi Dr.

Grim and the

group,

I again

was hospitalized

with BP 230/130

and spent five

days in the

hospital. I

don't have yet

all medical

records from the

hospital, but I

have Report from

MRI without

contrast and

some blood test

results. See the

attachment.

I also

have images from

MRI in case if

Dr. Grim would

like to take a

look at them.

Please,

note, that my

blood K was 5.0

and blood Na was

132, pretty much

the same as it

was a year ago

when I was

hospitalized

with the same

symptoms and a

very high blood

pressure.

I really

don't know why

it happened

again and such

high BP all of

the sudden

scares me to

death.

The

reasons that I

consider:

1. 4th of

July picnic,

where I ate much

more salty food

than usually.

But after that I

was on my dash

for two weeks

and felt pretty

well.

2. Summer

heat. I was

hospitalized

five times for

last two years

and it always

happened during

summer heat.

3.

Constant

diarrhea over

last two months

since I

overdosed

metformin.

4. All

the above

together!?

I am not

on any diabetes

medications now

and my BS is

really high,

average fasting

is 150-160. I

also consider to

change

eplerenone to

sipro, since

eplerenone also

causes diarrhea.

Now I

feel unstable

and my BP

varies from

110/65 to

160/100. It's

especially high

at 8 am and 8

pm, when I also

feel very badly.

I am on higher

dosage of

eplerenone and

micardis and

Dashing very

strictly,

restricting Na

< 700 - 800

mg a day.

Many,

many thanks. I

would appreciate

any responses.

Natalia

Kamneva 68 F with

3.5 cm left

adrenal adenoma,

diagnosed with PA

in 2011; diabetic;

on 100 mg

eplerenone, 160 mg

Micardis,

currently not

diabetic

medication , 20 mg

Omeprazol and 3 -

4 mg Lorazepam;

Dashing; still

have some

occasional

problems with BP,

K and Na; on

private

consultation with

Dr Grim.

August 1, 2012

Phyllis you need to interpret your sources better.I would not trust ask a patient mostly.

Clarence Grim MDlowerbp2@...

On Aug 1, 2012, at 6:03 PM, Phyllis wrote:

I had a bad hypertensive crisis once.

It was the omeprazole.

Check this out.. this is how I found out about omeprazole. Also

proton pump inhibitors are no good because they interfere with

good acid in the stomach.

Proton pump inhibitor causes C-diff, which will cause diarrhea.

http://www.askapatient.com/viewrating.asp?drug=19810 & name=prilosec

http://www.ncbi.nlm.nih.gov/pubmed/22781139

Phyllis

On 8/1/2012 5:24 PM, Grim Clarence wrote:

One issue is are you salt depleted with the hot weather

and the eplerenone?

Recommend you take your BP seated and then stand for 1

min with arm supported so the cuff is at heart level and

check the BP again. If is drops by more that 20 this

suggests that you may be salt depelted and more salt may

actually help.

Did your BP fall a lot in the hospital as the numbers

are if anything low on the record you sent but they may

have loaded you up with BP meds.

Did they stop or taper the metformin. You were on a

lot as I recall.

What other meds have been tired for DM?

Has your weight been stable during all of this?

How they take your BP when it was 230/130. Were you in

pain or acutely ill?

Clarence Grim MD

lowerbp2@...

On Aug 1, 2012, at 12:22 PM, Natalia Kamneva

wrote:

Hi Dr. Grim and the group,

I again was hospitalized with BP

230/130 and spent five days in the

hospital. I don't have yet all medical

records from the hospital, but I have

Report from MRI without contrast and some

blood test results. See the attachment.

I also have images from MRI in case

if Dr. Grim would like to take a look at

them.

Please, note, that my blood K was

5.0 and blood Na was 132, pretty much the

same as it was a year ago when I was

hospitalized with the same symptoms and a

very high blood pressure.

I really don't know why it happened

again and such high BP all of the sudden

scares me to death.

The reasons that I consider:

1. 4th of July picnic, where I ate

much more salty food than usually. But

after that I was on my dash for two weeks

and felt pretty well.

2. Summer heat. I was hospitalized

five times for last two years and it

always happened during summer heat.

3. Constant diarrhea over last two

months since I overdosed metformin.

4. All the above together!?

I am not on any diabetes

medications now and my BS is really high,

average fasting is 150-160. I also

consider to change eplerenone to sipro,

since eplerenone also causes diarrhea.

Now I feel unstable and my BP

varies from 110/65 to 160/100. It's

especially high at 8 am and 8 pm, when I

also feel very badly. I am on higher

dosage of eplerenone and micardis and

Dashing very strictly, restricting Na <

700 - 800 mg a day.

Many, many thanks. I would

appreciate any responses.

Natalia

Kamneva 68 F with 3.5 cm left adrenal

adenoma, diagnosed with PA in 2011;

diabetic; on 100 mg eplerenone, 160 mg

Micardis, currently not diabetic medication

, 20 mg Omeprazol and 3 - 4 mg Lorazepam;

Dashing; still have some occasional problems

with BP, K and Na; on private consultation

with Dr Grim.

August 1, 2012

Good references but none say PPIs causes CDiff.Use of PPIs inappropriate (meaning uncalled for) was associated with CDiff. Never confuse association with causation.

Clarence Grim MDlowerbp2@...

On Aug 1, 2012, at 10:25 PM, Phyllis wrote:

They do indeed causes symptomatic

cdiff, - Many people have c-diff in their bodies , but there has

to be a catalyst to set it off. PPI destroy the normal flora of

the intestine which allows bad bacteria to take over. Cdiff is an

opportunistic infection.

Your favorite site pubmed has many articles about it.

http://www.ncbi.nlm.nih.gov/pubmed/22781139

http://www.ncbi.nlm.nih.gov/pubmed/15238493

http://www.ncbi.nlm.nih.gov/pubmed/22701180

Phyllis

On 8/1/2012 11:02 PM, Grim Clarence wrote:

They do not cause C. diff. C diff causes C diff.

Clarence Grim MD

lowerbp2@...

On Aug 1, 2012, at 6:23 PM, Natalia Kamneva wrote:

Thank you, Phyllis. Is Protonix

better? They gave me Protonix in a hospital

and I felt better there. What do you do with

a heartburn?

Many thanks,

Natalia

From:

Phyllis <phylisrn@...>

To:

hyperaldosteronism

Sent:

Wednesday, August 1, 2012 6:03 PM

Subject:

Re: Hospitalized

with very high BP

I

had a bad hypertensive crisis once.

It was the omeprazole.

Check this out.. this is how I found

out about omeprazole. Also proton

pump inhibitors are no good because

they interfere with good acid in the

stomach.

Proton pump inhibitor causes C-diff,

which will cause diarrhea.

http://www.askapatient.com/viewrating.asp?drug=19810 & name=prilosec

http://www.ncbi.nlm.nih.gov/pubmed/22781139

Phyllis

On 8/1/2012 5:24 PM, Grim Clarence

wrote:

One issue is are you salt

depleted with the hot weather

and the eplerenone?

Recommend you take your BP

seated and then stand for 1 min

with arm supported so the cuff

is at heart level and check the

BP again. If is drops by more

that 20 this suggests that you

may be salt depelted and more

salt may actually help.

Did your BP fall a lot in the

hospital as the numbers are if

anything low on the record you

sent but they may have loaded

you up with BP meds.

Did they stop or taper the

metformin. You were on a lot

as I recall.

What other meds have been

tired for DM?

Has your weight been stable

during all of this?

How they take your BP when it

was 230/130. Were you in pain or

acutely ill?

Clarence Grim MD

lowerbp2@...

On Aug 1, 2012, at

12:22 PM, Natalia Kamneva

wrote:

Hi Dr.

Grim and the

group,

I again

was hospitalized

with BP 230/130

and spent five

days in the

hospital. I

don't have yet

all medical

records from the

hospital, but I

have Report from

MRI without

contrast and

some blood test

results. See the

attachment.

I also

have images from

MRI in case if

Dr. Grim would

like to take a

look at them.

Please,

note, that my

blood K was 5.0

and blood Na was

132, pretty much

the same as it

was a year ago

when I was

hospitalized

with the same

symptoms and a

very high blood

pressure.

I really

don't know why

it happened

again and such

high BP all of

the sudden

scares me to

death.

The

reasons that I

consider:

1. 4th of

July picnic,

where I ate much

more salty food

than usually.

But after that I

was on my dash

for two weeks

and felt pretty

well.

2. Summer

heat. I was

hospitalized

five times for

last two years

and it always

happened during

summer heat.

3.

Constant

diarrhea over

last two months

since I

overdosed

metformin.

4. All

the above

together!?

I am not

on any diabetes

medications now

and my BS is

really high,

average fasting

is 150-160. I

also consider to

change

eplerenone to

sipro, since

eplerenone also

causes diarrhea.

Now I

feel unstable

and my BP

varies from

110/65 to

160/100. It's

especially high

at 8 am and 8

pm, when I also

feel very badly.

I am on higher

dosage of

eplerenone and

micardis and

Dashing very

strictly,

restricting Na

< 700 - 800

mg a day.

Many,

many thanks. I

would appreciate

any responses.

Natalia

Kamneva 68 F with

3.5 cm left

adrenal adenoma,

diagnosed with PA

in 2011; diabetic;

on 100 mg

eplerenone, 160 mg

Micardis,

currently not

diabetic

medication , 20 mg

Omeprazol and 3 -

4 mg Lorazepam;

Dashing; still

have some

occasional

problems with BP,

K and Na; on

private

consultation with

Dr Grim.

August 2, 2012

FR Grim, you said you wouldn't trust a

patient? Then who would you trust to be able to tell you how they

feel?

Phyllis

On 8/2/2012 1:00 AM, Grim Clarence wrote:

Phyllis you need to interpret your sources better.

I would not trust ask a patient mostly.

Clarence Grim MD

lowerbp2@...

On Aug 1, 2012, at 6:03 PM, Phyllis wrote:

I had a bad

hypertensive crisis once. It was the

omeprazole.

Check this out.. this is how I found out

about omeprazole. Also proton pump

inhibitors are no good because they

interfere with good acid in the stomach.

Proton pump inhibitor causes C-diff, which

will cause diarrhea.

http://www.askapatient.com/viewrating.asp?drug=19810 & name=prilosec

http://www.ncbi.nlm.nih.gov/pubmed/22781139

Phyllis

On 8/1/2012 5:24 PM, Grim Clarence wrote:

One issue is are you salt depleted with

the hot weather and the eplerenone?

Recommend you take your BP seated and

then stand for 1 min with arm supported

so the cuff is at heart level and check

the BP again. If is drops by more that

20 this suggests that you may be salt

depelted and more salt may actually

help.

Did your BP fall a lot in the

hospital as the numbers are if anything

low on the record you sent but they may

have loaded you up with BP meds.

Did they stop or taper the metformin.

You were on a lot as I recall.

What other meds have been tired for

DM?

Has your weight been stable during

all of this?

How they take your BP when it was

230/130. Were you in pain or acutely

ill?

Clarence Grim MD

lowerbp2@...

On Aug 1, 2012, at 12:22 PM,

Natalia Kamneva wrote:

Hi Dr. Grim and

the group,

I again was

hospitalized with BP

230/130 and spent five

days in the hospital. I

don't have yet all

medical records from the

hospital, but I have

Report from MRI without

contrast and some blood

test results. See the

attachment.

I also have

images from MRI in case

if Dr. Grim would like

to take a look at them.

Please, note,

that my blood K was 5.0

and blood Na was 132,

pretty much the same as

it was a year ago when

I was hospitalized with

the same symptoms and a

very high blood

pressure.

I really don't

know why it happened

again and such high BP

all of the sudden scares

me to death.

The reasons that

I consider:

1. 4th of July

picnic, where I ate much

more salty food than

usually. But after that

I was on my dash for two

weeks and felt pretty

well.

2. Summer heat. I

was hospitalized five

times for last two years

and it always happened

during summer heat.

3. Constant

diarrhea over last two

months since I overdosed

metformin.

4. All the above

together!?

I am not on any

diabetes medications now

and my BS is really

high, average fasting is

150-160. I also consider

to change eplerenone to

sipro, since eplerenone

also causes diarrhea.

Now I feel

unstable and my BP

varies from 110/65 to

160/100. It's especially

high at 8 am and 8 pm,

when I also feel very

badly. I am on higher

dosage of eplerenone and

micardis and Dashing

very strictly,

restricting Na < 700

- 800 mg a day.

Many, many

thanks. I would

appreciate any

responses.

Natalia Kamneva

68 F with 3.5 cm left

adrenal adenoma, diagnosed

with PA in 2011; diabetic;

on 100 mg eplerenone, 160

mg Micardis, currently not

diabetic medication , 20

mg Omeprazol and 3 - 4 mg

Lorazepam; Dashing; still

have some occasional

problems with BP, K and

Na; on private

consultation with Dr Grim.

August 2, 2012

I thought he was referring to your source link (www.askapatient.com)

> >>>

> >>>>

> >>>> Hi Dr. Grim and the group,

> >>>>

> >>>> I again was hospitalized with BP 230/130 and spent five days in the

> >>>> hospital. I don't have yet all medical records from the hospital,

> >>>> but I have Report from MRI without contrast and some blood test

> >>>> results. See the attachment.

> >>>>

> >>>> I also have images from MRI in case if Dr. Grim would like to take

> >>>> a look at them.

> >>>>

> >>>> Please, note, that my blood K was 5.0 and blood Na was 132, pretty

> >>>> much the same as it was a year ago when I was hospitalized with

> >>>> the same symptoms and a very high blood pressure.

> >>>>

> >>>> I really don't know why it happened again and such high BP all of

> >>>> the sudden scares me to death.

> >>>>

> >>>> The reasons that I consider:

> >>>>

> >>>> 1. 4th of July picnic, where I ate much more salty food than

> >>>> usually. But after that I was on my dash for two weeks and felt

> >>>> pretty well.

> >>>> 2. Summer heat. I was hospitalized five times for last two years

> >>>> and it always happened during summer heat.

> >>>> 3. Constant diarrhea over last two months since I overdosed metformin.

> >>>> 4. All the above together!?

> >>>>

> >>>> I am not on any diabetes medications now and my BS is really high,

> >>>> average fasting is 150-160. I also consider to change eplerenone to

> >>>> sipro, since eplerenone also causes diarrhea.

> >>>>

> >>>> Now I feel unstable and my BP varies from 110/65 to 160/100. It's

> >>>> especially high at 8 am and 8 pm, when I also feel very badly. I am

> >>>> on higher dosage of eplerenone and micardis and Dashing very

> >>>> strictly, restricting Na < 700 - 800 mg a day.

> >>>>

> >>>> Many, many thanks. I would appreciate any responses.

> >>>>

> >>>> Natalia Kamneva 68 F with 3.5 cm left adrenal adenoma, diagnosed

> >>>> with PA in 2011; diabetic; on 100 mg eplerenone, 160 mg Micardis,

> >>>> currently not diabetic medication , 20 mg Omeprazol and 3 - 4 mg

> >>>> Lorazepam; Dashing; still have some occasional problems with BP, K

> >>>> and Na; on private consultation with Dr Grim.

> >>>>

> >>>

> >>

> >

>

August 2, 2012

>When some get very salt depleted the BP control system can fluctuate up and down.That's probably what happens. Yesterday my BP was 83/53 and in two hours 170/100. > I would add about 1/4 teaspoon every 2 days and see what happens. Avoid big salt loads tho. How much is it in mg? Can I get 2000 mg a day?Many thanks.Natalia From: Grim Clarence

<lowerbp2@...> hyperaldosteronism Cc: Grim Clarence <lowerbp2@...> Sent: Wednesday, August 1, 2012 10:01 PM Subject: Re: Hospitalized with very high BP

I would try adding back a little salt each day to see if you feel any better. Especially if it has been very hot there.I would just add an increasing amount of sodium each day to see what happens. Keep K the same as you are on now.When some get very salt depleted the BP control system can fluctuate up and down.I would add about 1/4 teaspoon every 2 days and see what happens. Avoid big salt loads tho.Keep us posted.

Clarence Grim MDlowerbp2@...

On Aug 1, 2012, at 6:08 PM, Natalia Kamneva wrote:

> One issue is are you salt depleted with the hot weather and the eplerenone?I assume that I am. When I eat a jar of marinated mushrooms (approximately 250 mg on Na), I feel immediately better. Should I eat more Na and less K?Does salt depletion cause spikes in blood pressure? >Recommend you take your BP seated and then stand for 1 min with arm supported so the cuff is at heart level and check the BP again. If is drops by more that 20 this suggests that you may be salt depelted and more salt may actually help.Seated 129/78, standing 123/78. HR is 115. >Did your BP fall a lot in the hospital as the numbers are if anything low on the record you sent but they may have loaded you up with BP meds.Yes, my BP fall a lot in a hospital and became worse at home. I was there and here on the same 100 mg dosage of eplerenone and 160 of micardis. They did 2 shots of BB when I arrived with 230/130. Next day my BP was still high, after that normal. > Did they stop or taper the metformin. You were on a lot as I recall.I was on 2000 mg until I overdosed it for three weeks to 4000mg. The endo stopped it completely. I am not on any diabetic medications right now. I was in insulin in the hospital.>What other meds have been tired for DM?I tried januvia in addition to metformin several years ago, but didn't see any positive effect. I was on glukophage when the insurance covered it. >Has your weight been stable during all of

this?Pretty much.> How they take your BP when it was 230/130. Were you in pain or acutely ill?I lay down. I was feeling terribly: shortness of breath, headache and all other symptoms of PA. Many thanks, Natalia Kamneva 68 F with 2.5 cm left adrenal adenoma, recently diagnosed with PA; diabetic; on 100 mg eplerenone, 40 mg Micardis, 2000 mg metformin, 60 mg Dexilant and 2 mg Lorazepam; Dashing; still have some occasional problems with BP, K and Na; on private consultation with Dr Grim. From: Grim Clarence <lowerbp2@...> hyperaldosteronism Cc: Grim Clarence <lowerbp2@...> Sent: Wednesday, August 1, 2012 4:24 PM Subject: Re: Hospitalized with very high BP

One issue is are you salt depleted with the hot weather and the eplerenone?Recommend you take your BP seated and then stand for 1 min with arm supported so the cuff is at heart level and check the BP again. If is drops by more that 20 this suggests that you may be salt depelted and more salt may actually help.Did your BP fall a lot in the hospital as the numbers are if anything low on the record you sent but they may have loaded you up with BP meds.Did they stop or taper the metformin. You were on a lot as I recall.What other meds have been tired for DM?Has your weight been stable during all of this?How they take your BP when it was 230/130. Were you in pain or acutely ill?

Clarence Grim MDlowerbp2@...

On Aug 1, 2012, at 12:22 PM, Natalia Kamneva wrote:

Hi Dr. Grim and the group,I again was hospitalized with BP 230/130 and spent five days in the hospital. I don't have yet all medical records from the hospital, but I have Report from MRI without contrast and some blood test results. See the attachment. I also have images from MRI in case if Dr. Grim would like to take a look at them. Please, note, that my blood K was 5.0 and blood Na was 132, pretty much the same as it was a year ago when I was hospitalized with the same symptoms and a very high blood pressure. I really don't know why it happened

again and such high BP all of the sudden scares me to

death. The reasons that I consider:1. 4th of July picnic, where I ate much more salty food than usually. But after that I was on my dash for two weeks and felt pretty well.2. Summer heat. I was hospitalized five times for last two years and it always happened during summer heat. 3. Constant diarrhea over last two months since I overdosed metformin. 4. All the above together!?I am not on any diabetes medications now and my BS is really high, average fasting is 150-160. I also consider to change eplerenone to sipro, since eplerenone also causes diarrhea.Now I feel unstable and my BP varies from 110/65 to 160/100.

It's especially high at 8 am and 8 pm, when I also feel very badly. I am on higher dosage of eplerenone and micardis and Dashing very strictly, restricting Na < 700 - 800 mg a day. Many, many thanks. I would appreciate any responses. Natalia Kamneva 68 F with 3.5 cm left adrenal adenoma, diagnosed with PA in 2011; diabetic; on 100 mg eplerenone, 160 mg Micardis, currently not diabetic medication , 20 mg Omeprazol and 3 - 4 mg Lorazepam; Dashing; still have some occasional problems with BP, K and Na; on private consultation with Dr Grim.

August 2, 2012

Could Proton Pump Inhibitors be a cause of BP spikes? Could they introduce something in BP rise?Thank you,Natalia From: Grim Clarence <lowerbp2@...> hyperaldosteronism Cc: Grim Clarence <lowerbp2@...> Sent: Wednesday, August 1,

2012 10:02 PM Subject: Re: Hospitalized with very high BP

They do not cause C. diff. C diff causes C diff.

Clarence Grim MDlowerbp2@...

On Aug 1, 2012, at 6:23 PM, Natalia Kamneva wrote:

Thank you, Phyllis. Is Protonix better? They gave me Protonix in a hospital and I felt better there. What do you do with a heartburn?Many thanks,Natalia From: Phyllis <phylisrn@...> hyperaldosteronism Sent: Wednesday, August 1, 2012 6:03 PM Subject: Re: Hospitalized with very high BP

I had a bad hypertensive crisis once.

It was the omeprazole.

Check this out.. this is how I found out about omeprazole. Also

proton pump inhibitors are no good because they interfere with

good acid in the stomach.

Proton pump inhibitor causes C-diff, which will cause diarrhea.

http://www.askapatient.com/viewrating.asp?drug=19810 & name=prilosec

http://www.ncbi.nlm.nih.gov/pubmed/22781139

Phyllis

On 8/1/2012 5:24 PM, Grim Clarence wrote:

One issue is are you salt depleted with the hot weather

and the eplerenone?

Recommend you take your BP seated and then stand for 1

min with arm supported so the cuff is at heart level and

check the BP again. If is drops by more that 20 this

suggests that you may be salt depelted and more salt may

actually help.

Did your BP fall a lot in the hospital as the numbers

are if anything low on the record you sent but they may

have loaded you up with BP meds.

Did they stop or taper the metformin. You were on a

lot as I recall.

What other meds have been tired for DM?

Has your weight been stable during all of this?

How they take your BP when it was 230/130. Were you in

pain or acutely ill?

Clarence Grim MD

lowerbp2@...

On Aug 1, 2012, at 12:22 PM, Natalia Kamneva

wrote:

Hi Dr. Grim and the group,

I again was hospitalized with BP

230/130 and spent five days in the

hospital. I don't have yet all medical

records from the hospital, but I have

Report from MRI without contrast and some

blood test results. See the attachment.

I also have images from MRI in case

if Dr. Grim would like to take a look at

them.

Please, note, that my blood K was

5.0 and blood Na was 132, pretty much the

same as it was a year ago when I was

hospitalized with the same symptoms and a

very high blood pressure.

I really don't know why it happened

again and such high BP all of the sudden

scares me to death.

The reasons that I consider:

1. 4th of July picnic, where I ate

much more salty food than usually. But

after that I was on my dash for two weeks

and felt pretty well.

2. Summer heat. I was hospitalized

five times for last two years and it

always happened during summer heat.

3. Constant diarrhea over last two

months since I overdosed metformin.

4. All the above together!?

I am not on any diabetes

medications now and my BS is really high,

average fasting is 150-160. I also

consider to change eplerenone to sipro,

since eplerenone also causes diarrhea.

Now I feel unstable and my BP

varies from 110/65 to 160/100. It's

especially high at 8 am and 8 pm, when I

also feel very badly. I am on higher

dosage of eplerenone and micardis and

Dashing very strictly, restricting Na <

700 - 800 mg a day.

Many, many thanks. I would

appreciate any responses.

Natalia

Kamneva 68 F with 3.5 cm left adrenal

adenoma, diagnosed with PA in 2011;

diabetic; on 100 mg eplerenone, 160 mg

Micardis, currently not diabetic medication

, 20 mg Omeprazol and 3 - 4 mg Lorazepam;

Dashing; still have some occasional problems

with BP, K and Na; on private consultation

with Dr Grim.

August 2, 2012

, I only know about my

experience... it did cause spikes in my blood pressure.

Phyllis

On 8/2/2012 12:41 PM, Natalia Kamneva wrote:

Could Proton Pump Inhibitors be a cause of BP

spikes? Could they introduce something in BP rise?

Thank you,

Natalia

From:

Grim Clarence <lowerbp2@...>

To:

hyperaldosteronism

Cc:

Grim Clarence <lowerbp2@...>

Sent:

Wednesday, August 1, 2012 10:02 PM

Subject:

Re: Hospitalized with very

high BP

They do not cause C. diff. C diff causes C

diff.

Clarence Grim MD

lowerbp2@...

On Aug 1, 2012, at 6:23 PM, Natalia

Kamneva wrote:

Thank you, Phyllis. Is

Protonix better? They gave me

Protonix in a hospital and I

felt better there. What do you

do with a heartburn?

Many thanks,

Natalia

From:

Phyllis <phylisrn@...>

To:

hyperaldosteronism

Sent:

Wednesday, August 1, 2012

6:03 PM

Subject:

Re:

Hospitalized with very high

BP

I

had a bad hypertensive

crisis once. It was the

omeprazole.

Check this out.. this is

how I found out about

omeprazole. Also proton

pump inhibitors are no

good because they

interfere with good acid

in the stomach.

Proton pump inhibitor

causes C-diff, which

will cause diarrhea.

http://www.askapatient.com/viewrating.asp?drug=19810 & name=prilosec

http://www.ncbi.nlm.nih.gov/pubmed/22781139

Phyllis

On 8/1/2012 5:24 PM,

Grim Clarence wrote:

One issue is are

you salt depleted

with the hot weather

and the eplerenone?

Recommend you

take your BP seated

and then stand for 1

min with arm

supported so the

cuff is at heart

level and check the

BP again. If is

drops by more that

20 this suggests

that you may be salt

depelted and more

salt may actually

help.

Did your BP fall

a lot in the

hospital as the

numbers are if

anything low on the

record you sent but

they may have loaded

you up with BP meds.

Did they stop or

taper the metformin.

You were on a lot

as I recall.

What other meds

have been tired for

DM?

Has your weight

been stable during

all of this?

How they take

your BP when it was

230/130. Were you in

pain or acutely ill?

Clarence

Grim MD

lowerbp2@...

On Aug 1,

2012, at 12:22

PM, Natalia

Kamneva wrote:

Hi

Dr. Grim and

the group,

I

again was

hospitalized

with BP

230/130 and

spent five

days in the

hospital. I

don't have yet

all medical

records from

the hospital,

but I have

Report from

MRI without

contrast and

some blood

test results.

See the

attachment.

I

also have

images from

MRI in case if

Dr. Grim would

like to take a

look at them.

Please,

note, that my

blood K was

5.0 and blood

Na was 132,

pretty much

the same as it

was a year

ago when I was

hospitalized

with the same

symptoms and a

very high

blood

pressure.

I

really don't

know why it

happened again

and such high

BP all of the

sudden scares

me to death.

The

reasons that I

consider:

1.

4th of July

picnic, where

I ate much

more salty

food than

usually. But

after that I

was on my dash

for two weeks

and felt

pretty well.

2.

Summer heat. I

was

hospitalized

five times for

last two years

and it always

happened

during summer

heat.

3.

Constant

diarrhea over

last two

months since I

overdosed

metformin.

4.

All the above

together!?

I

am not on any

diabetes

medications

now and my BS

is really

high, average

fasting is

150-160. I

also consider

to change

eplerenone to

sipro, since

eplerenone

also causes

diarrhea.

Now

I feel

unstable and

my BP varies

from 110/65 to

160/100. It's

especially

high at 8 am

and 8 pm, when

I also feel

very badly. I

am on higher

dosage of

eplerenone and

micardis and

Dashing very

strictly,

restricting Na

< 700 - 800

mg a day.

Many,

many thanks. I

would

appreciate any

responses.

Natalia

Kamneva 68 F

with 3.5 cm

left adrenal

adenoma,

diagnosed with

PA in 2011;

diabetic; on

100 mg

eplerenone,

160 mg

Micardis,

currently not

diabetic

medication ,

20 mg

Omeprazol and

3 - 4 mg

Lorazepam;

Dashing; still

have some

occasional

problems with

BP, K and Na;

on private

consultation

with Dr Grim.

August 2, 2012

Yes, Phyllis, and probably you are right. That's how I can see itPPI can contribute to a diarrhea ->Diarrhea and hot weather contribute to salt depletion ->Salt depletion causes BP spikes.Can you, please, give me an instruction how to use ginger?Many thanks,Natalia

From: Phyllis <phylisrn@...> hyperaldosteronism Sent: Thursday, August 2, 2012 12:09 PM Subject: Re: Hospitalized with very high BP

, I only know about my

experience... it did cause spikes in my blood pressure.

Phyllis

On 8/2/2012 12:41 PM, Natalia Kamneva wrote:

Could Proton Pump Inhibitors be a cause of BP

spikes? Could they introduce something in BP rise?

Thank you,

Natalia

From:

Grim Clarence <lowerbp2@...>

To:

hyperaldosteronism

Cc:

Grim Clarence <lowerbp2@...>

Sent:

Wednesday, August 1, 2012 10:02 PM

Subject:

Re: Hospitalized with very

high BP

They do not cause C. diff. C diff causes C

diff.

Clarence Grim MD

lowerbp2@...

On Aug 1, 2012, at 6:23 PM, Natalia

Kamneva wrote:

Thank you, Phyllis. Is

Protonix better? They gave me

Protonix in a hospital and I

felt better there. What do you

do with a heartburn?

Many thanks,

Natalia

From:

Phyllis <phylisrn@...>

To:

hyperaldosteronism

Sent:

Wednesday, August 1, 2012

6:03 PM

Subject:

Re:

Hospitalized with very high

BP

I

had a bad hypertensive

crisis once. It was the

omeprazole.

Check this out.. this is

how I found out about

omeprazole. Also proton

pump inhibitors are no

good because they

interfere with good acid

in the stomach.

Proton pump inhibitor

causes C-diff, which

will cause diarrhea.

http://www.askapatient.com/viewrating.asp?drug=19810 & name=prilosec

http://www.ncbi.nlm.nih.gov/pubmed/22781139

Phyllis

On 8/1/2012 5:24 PM,

Grim Clarence wrote:

One issue is are

you salt depleted

with the hot weather

and the eplerenone?

Recommend you

take your BP seated

and then stand for 1

min with arm

supported so the

cuff is at heart

level and check the

BP again. If is

drops by more that

20 this suggests

that you may be salt

depelted and more

salt may actually

help.

Did your BP fall

a lot in the

hospital as the

numbers are if

anything low on the

record you sent but

they may have loaded

you up with BP meds.

Did they stop or

taper the metformin.

You were on a lot

as I recall.

What other meds

have been tired for

DM?

Has your weight

been stable during

all of this?

How they take

your BP when it was

230/130. Were you in

pain or acutely ill?

Clarence

Grim MD

lowerbp2@...

On Aug 1,

2012, at 12:22

PM, Natalia

Kamneva wrote:

Hi

Dr. Grim and

the group,

I

again was

hospitalized

with BP

230/130 and

spent five

days in the

hospital. I

don't have yet

all medical

records from

the hospital,

but I have

Report from

MRI without

contrast and

some blood

test results.

See the

attachment.

I

also have

images from

MRI in case if

Dr. Grim would

like to take a

look at them.

Please,

note, that my

blood K was

5.0 and blood

Na was 132,

pretty much

the same as it

was a year

ago when I was

hospitalized

with the same

symptoms and a

very high

blood

pressure.

I

really don't

know why it

happened again

and such high

BP all of the

sudden scares

me to death.

The

reasons that I

consider:

1.

4th of July

picnic, where

I ate much

more salty

food than

usually. But

after that I

was on my dash

for two weeks

and felt

pretty well.

2.

Summer heat. I

was

hospitalized

five times for

last two years

and it always

happened

during summer

heat.

3.

Constant

diarrhea over

last two

months since I

overdosed

metformin.

4.

All the above

together!?

I

am not on any

diabetes

medications

now and my BS

is really

high, average

fasting is

150-160. I

also consider

to change

eplerenone to

sipro, since

eplerenone

also causes

diarrhea.

Now

I feel

unstable and

my BP varies

from 110/65 to

160/100. It's

especially

high at 8 am

and 8 pm, when

I also feel

very badly. I

am on higher

dosage of

eplerenone and

micardis and

Dashing very

strictly,

restricting Na

< 700 - 800

mg a day.

Many,

many thanks. I

would

appreciate any

responses.

Natalia

Kamneva 68 F

with 3.5 cm

left adrenal

adenoma,

diagnosed with

PA in 2011;

diabetic; on

100 mg

eplerenone,

160 mg

Micardis,

currently not

diabetic

medication ,

20 mg

Omeprazol and

3 - 4 mg

Lorazepam;

Dashing; still

have some

occasional

problems with

BP, K and Na;

on private

consultation

with Dr Grim.

August 2, 2012

And don't forget we're not "everybody" ...we alreadyhave a glitch in our system and overproduce aldosterone which the average person does not. So we most likely had or have also developed a salt sensitivity also and both together to throw us our pressures high (and sometimes low too).

I have noticed binging on salt does this to me for a few days (not as high as hers though) and there's not enough spiro to combat it when I get over my salt limits.

Hi Dr. Grim and the group,

I again was hospitalized with BP 230/130 and spent five days in the hospital. I don't have yet all medical records from the hospital, but I have Report from MRI without contrast and some blood test results. See the attachment.

I also have images from MRI in case if Dr. Grim would like to take a look at them.

Please, note, that my blood K was 5.0 and blood Na was 132, pretty much the same as it was a year ago when I was hospitalized with the same symptoms and a very high blood pressure.

I really don't know why it happened again and such high BP all of the sudden scares me to death.

The reasons that I consider:

1. 4th of July picnic, where I ate much more salty food than usually. But after that I was on my dash for two weeks and felt pretty well.

2. Summer heat. I was hospitalized five times for last two years and it always happened during summer heat.

3. Constant diarrhea over last two months since I overdosed metformin.

4. All the above together!?

I am not on any diabetes medications now and my BS is really high, average fasting is 150-160. I also consider to change eplerenone to sipro, since eplerenone also causes diarrhea.

Now I feel unstable and my BP varies from 110/65 to 160/100. It's especially high at 8 am and 8 pm, when I also feel very badly. I am on higher dosage of eplerenone and micardis and Dashing very strictly, restricting Na < 700 - 800 mg a day.

Many, many thanks. I would appreciate any responses.

Natalia Kamneva 68 F with 3.5 cm left adrenal adenoma, diagnosed with PA in 2011; diabetic; on 100 mg eplerenone, 160 mg Micardis, currently not diabetic medication , 20 mg Omeprazol and 3 - 4 mg Lorazepam; Dashing; still have some occasional problems with BP, K and Na; on private consultation with Dr Grim.

August 2, 2012

I was. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Aug 2, 2012, at 8:23, NJ Roadie <junk@...> wrote:

I thought he was referring to your source link (www.askapatient.com)

> >>>

> >>>>

> >>>> Hi Dr. Grim and the group,

> >>>>

> >>>> I again was hospitalized with BP 230/130 and spent five days in the

> >>>> hospital. I don't have yet all medical records from the hospital,

> >>>> but I have Report from MRI without contrast and some blood test

> >>>> results. See the attachment.

> >>>>

> >>>> I also have images from MRI in case if Dr. Grim would like to take

> >>>> a look at them.

> >>>>

> >>>> Please, note, that my blood K was 5.0 and blood Na was 132, pretty

> >>>> much the same as it was a year ago when I was hospitalized with

> >>>> the same symptoms and a very high blood pressure.

> >>>>

> >>>> I really don't know why it happened again and such high BP all of

> >>>> the sudden scares me to death.

> >>>>

> >>>> The reasons that I consider:

> >>>>

> >>>> 1. 4th of July picnic, where I ate much more salty food than

> >>>> usually. But after that I was on my dash for two weeks and felt

> >>>> pretty well.

> >>>> 2. Summer heat. I was hospitalized five times for last two years

> >>>> and it always happened during summer heat.

> >>>> 3. Constant diarrhea over last two months since I overdosed metformin.

> >>>> 4. All the above together!?

> >>>>

> >>>> I am not on any diabetes medications now and my BS is really high,

> >>>> average fasting is 150-160. I also consider to change eplerenone to

> >>>> sipro, since eplerenone also causes diarrhea.

> >>>>

> >>>> Now I feel unstable and my BP varies from 110/65 to 160/100. It's

> >>>> especially high at 8 am and 8 pm, when I also feel very badly. I am

> >>>> on higher dosage of eplerenone and micardis and Dashing very

> >>>> strictly, restricting Na < 700 - 800 mg a day.

> >>>>

> >>>> Many, many thanks. I would appreciate any responses.

> >>>>

> >>>> Natalia Kamneva 68 F with 3.5 cm left adrenal adenoma, diagnosed

> >>>> with PA in 2011; diabetic; on 100 mg eplerenone, 160 mg Micardis,

> >>>> currently not diabetic medication , 20 mg Omeprazol and 3 - 4 mg

> >>>> Lorazepam; Dashing; still have some occasional problems with BP, K

> >>>> and Na; on private consultation with Dr Grim.

> >>>>

> >>>

> >>

> >

>

August 2, 2012

3/4 tsp ~1500 mg so 1/4 = 500McDs packet has 250May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Aug 2, 2012, at 11:37, Natalia Kamneva <natalia_kamneva@...> wrote:

>When some get very salt depleted the BP control system can fluctuate up and down.That's probably what happens. Yesterday my BP was 83/53 and in two hours 170/100. > I would add about 1/4 teaspoon every 2 days and see what happens. Avoid big salt loads tho. How much is it in mg? Can I get 2000 mg a day?Many thanks.Natalia From: Grim Clarence

<lowerbp2@...> hyperaldosteronism Cc: Grim Clarence <lowerbp2@...> Sent: Wednesday, August 1, 2012 10:01 PM Subject: Re: Hospitalized with very high BP

I would try adding back a little salt each day to see if you feel any better. Especially if it has been very hot there.I would just add an increasing amount of sodium each day to see what happens. Keep K the same as you are on now.When some get very salt depleted the BP control system can fluctuate up and down.I would add about 1/4 teaspoon every 2 days and see what happens. Avoid big salt loads tho.Keep us posted.

Clarence Grim MDlowerbp2@...

On Aug 1, 2012, at 6:08 PM, Natalia Kamneva wrote:

> One issue is are you salt depleted with the hot weather and the eplerenone?I assume that I am. When I eat a jar of marinated mushrooms (approximately 250 mg on Na), I feel immediately better. Should I eat more Na and less K?Does salt depletion cause spikes in blood pressure? >Recommend you take your BP seated and then stand for 1 min with arm supported so the cuff is at heart level and check the BP again. If is drops by more that 20 this suggests that you may be salt depelted and more salt may actually help.Seated 129/78, standing 123/78. HR is 115. >Did your BP fall a lot in the hospital as the numbers are if anything low on the record you sent but they may have loaded you up with BP meds.Yes, my BP fall a lot in a hospital and became worse at home. I was there and here on the same 100 mg dosage of eplerenone and 160 of micardis. They did 2 shots of BB when I arrived with 230/130. Next day my BP was still high, after that normal. > Did they stop or taper the metformin. You were on a lot as I recall.I was on 2000 mg until I overdosed it for three weeks to 4000mg. The endo stopped it completely. I am not on any diabetic medications right now. I was in insulin in the hospital.>What other meds have been tired for DM?I tried januvia in addition to metformin several years ago, but didn't see any positive effect. I was on glukophage when the insurance covered it. >Has your weight been stable during all of

this?Pretty much.> How they take your BP when it was 230/130. Were you in pain or acutely ill?I lay down. I was feeling terribly: shortness of breath, headache and all other symptoms of PA. Many thanks, Natalia Kamneva 68 F with 2.5 cm left adrenal adenoma, recently diagnosed with PA; diabetic; on 100 mg eplerenone, 40 mg Micardis, 2000 mg metformin, 60 mg Dexilant and 2 mg Lorazepam; Dashing; still have some occasional problems with BP, K and Na; on private consultation with Dr Grim. From: Grim Clarence <lowerbp2@...> hyperaldosteronism Cc: Grim Clarence <lowerbp2@...> Sent: Wednesday, August 1, 2012 4:24 PM Subject: Re: Hospitalized with very high BP

One issue is are you salt depleted with the hot weather and the eplerenone?Recommend you take your BP seated and then stand for 1 min with arm supported so the cuff is at heart level and check the BP again. If is drops by more that 20 this suggests that you may be salt depelted and more salt may actually help.Did your BP fall a lot in the hospital as the numbers are if anything low on the record you sent but they may have loaded you up with BP meds.Did they stop or taper the metformin. You were on a lot as I recall.What other meds have been tired for DM?Has your weight been stable during all of this?How they take your BP when it was 230/130. Were you in pain or acutely ill?

Clarence Grim MDlowerbp2@...

On Aug 1, 2012, at 12:22 PM, Natalia Kamneva wrote:

Hi Dr. Grim and the group,I again was hospitalized with BP 230/130 and spent five days in the hospital. I don't have yet all medical records from the hospital, but I have Report from MRI without contrast and some blood test results. See the attachment. I also have images from MRI in case if Dr. Grim would like to take a look at them. Please, note, that my blood K was 5.0 and blood Na was 132, pretty much the same as it was a year ago when I was hospitalized with the same symptoms and a very high blood pressure. I really don't know why it happened

again and such high BP all of the sudden scares me to

death. The reasons that I consider:1. 4th of July picnic, where I ate much more salty food than usually. But after that I was on my dash for two weeks and felt pretty well.2. Summer heat. I was hospitalized five times for last two years and it always happened during summer heat. 3. Constant diarrhea over last two months since I overdosed metformin. 4. All the above together!?I am not on any diabetes medications now and my BS is really high, average fasting is 150-160. I also consider to change eplerenone to sipro, since eplerenone also causes diarrhea.Now I feel unstable and my BP varies from 110/65 to 160/100.

It's especially high at 8 am and 8 pm, when I also feel very badly. I am on higher dosage of eplerenone and micardis and Dashing very strictly, restricting Na < 700 - 800 mg a day. Many, many thanks. I would appreciate any responses. Natalia Kamneva 68 F with 3.5 cm left adrenal adenoma, diagnosed with PA in 2011; diabetic; on 100 mg eplerenone, 160 mg Micardis, currently not diabetic medication , 20 mg Omeprazol and 3 - 4 mg Lorazepam; Dashing; still have some occasional problems with BP, K and Na; on private consultation with Dr Grim.

August 2, 2012

only way to see is to stop them, start them, stop them etc till you decide they affect your pressure. Not likely tho.

May your salt intake and pressure be low!Clarence Grim BS, MS, MDRetired (Semi) Professor of MedicineMedical College of WisconsinBoard Certified Internal Medicine, Geriatrics, Hypertension SpecialistSpecializing in difficult to control high blood pressure especially the numerous forms of Primary Aldsoteronism.Mission: Training you and your health care team to get BP, HbA1 and lipids to goal by merging lifestyle and pharmaceutical modalities.ALL advice given by me MUST be discussed with your heath care team. They know you best. Don't gamble with your life. Don't become a cyberchondriac by looking at fringe groups on the web. We encourage members of your health care team to join our efforts to learn what is new as well to refresh what is old but still good in the BP business.

On Aug 2, 2012, at 11:41 AM, Natalia Kamneva wrote:

Could Proton Pump Inhibitors be a cause of BP spikes? Could they introduce something in BP rise?Thank you,Natalia From: Grim Clarence <lowerbp2@...> hyperaldosteronism Cc: Grim Clarence <lowerbp2@...> Sent: Wednesday, August 1,

2012 10:02 PM Subject: Re: Hospitalized with very high BP

They do not cause C. diff. C diff causes C diff.

Clarence Grim MDlowerbp2@...

On Aug 1, 2012, at 6:23 PM, Natalia Kamneva wrote:

Thank you, Phyllis. Is Protonix better? They gave me Protonix in a hospital and I felt better there. What do you do with a heartburn?Many thanks,Natalia From: Phyllis <phylisrn@...> hyperaldosteronism Sent: Wednesday, August 1, 2012 6:03 PM Subject: Re: Hospitalized with very high BP

I had a bad hypertensive crisis once.

It was the omeprazole.

Check this out.. this is how I found out about omeprazole. Also

proton pump inhibitors are no good because they interfere with

good acid in the stomach.

Proton pump inhibitor causes C-diff, which will cause diarrhea.

http://www.askapatient.com/viewrating.asp?drug=19810 & name=prilosec

http://www.ncbi.nlm.nih.gov/pubmed/22781139

Phyllis

On 8/1/2012 5:24 PM, Grim Clarence wrote:

One issue is are you salt depleted with the hot weather

and the eplerenone?

Recommend you take your BP seated and then stand for 1

min with arm supported so the cuff is at heart level and

check the BP again. If is drops by more that 20 this

suggests that you may be salt depelted and more salt may

actually help.

Did your BP fall a lot in the hospital as the numbers

are if anything low on the record you sent but they may

have loaded you up with BP meds.

Did they stop or taper the metformin. You were on a

lot as I recall.

What other meds have been tired for DM?

Has your weight been stable during all of this?

How they take your BP when it was 230/130. Were you in

pain or acutely ill?

Clarence Grim MD

lowerbp2@...

On Aug 1, 2012, at 12:22 PM, Natalia Kamneva

wrote:

Hi Dr. Grim and the group,

I again was hospitalized with BP

230/130 and spent five days in the

hospital. I don't have yet all medical

records from the hospital, but I have

Report from MRI without contrast and some

blood test results. See the attachment.

I also have images from MRI in case

if Dr. Grim would like to take a look at

them.

Please, note, that my blood K was

5.0 and blood Na was 132, pretty much the

same as it was a year ago when I was

hospitalized with the same symptoms and a

very high blood pressure.

I really don't know why it happened

again and such high BP all of the sudden

scares me to death.

The reasons that I consider:

1. 4th of July picnic, where I ate

much more salty food than usually. But

after that I was on my dash for two weeks

and felt pretty well.

2. Summer heat. I was hospitalized

five times for last two years and it

always happened during summer heat.

3. Constant diarrhea over last two

months since I overdosed metformin.

4. All the above together!?

I am not on any diabetes

medications now and my BS is really high,

average fasting is 150-160. I also

consider to change eplerenone to sipro,

since eplerenone also causes diarrhea.

Now I feel unstable and my BP

varies from 110/65 to 160/100. It's

especially high at 8 am and 8 pm, when I

also feel very badly. I am on higher

dosage of eplerenone and micardis and

Dashing very strictly, restricting Na <

700 - 800 mg a day.

Many, many thanks. I would

appreciate any responses.

Natalia

Kamneva 68 F with 3.5 cm left adrenal

adenoma, diagnosed with PA in 2011;

diabetic; on 100 mg eplerenone, 160 mg

Micardis, currently not diabetic medication

, 20 mg Omeprazol and 3 - 4 mg Lorazepam;

Dashing; still have some occasional problems

with BP, K and Na; on private consultation

with Dr Grim.

August 3, 2012

I just got the results of my 24 urine test, done on 07/27/2012: Total volume 2030 mLMICROALBUMIN, 24 HOUR URINE (W/CREAT) less than 0.2 mg/DlCreatinine 1.0 G/24 HR (0.63 - 2.50)POTASSIUM 87 MMOL/24 HR (20

-100)SODIUM 45 MMOL/G CREAT (50 -230)Also in attachment for a comparison with previous tests.Does low sodium confirms your sodium depletion hypothesis, Dr. Grim? Many, many thanks.Natalia From: Grim Clarence <lowerbp2@...> hyperaldosteronism Cc: Grim Clarence <lowerbp2@...> Sent: Wednesday, August 1, 2012 10:01 PM Subject: Re: Hospitalized with very high BP

I would try adding back a little salt each day to see if you feel any better. Especially if it has been very hot there.I would just add an increasing amount of sodium each day to see what happens. Keep K the same as you are on now.When some get very salt depleted the BP control system can fluctuate up and down.I would add about 1/4 teaspoon every 2 days and see what happens. Avoid big salt loads tho.Keep us posted.

Clarence Grim MDlowerbp2@...

On Aug 1, 2012, at 6:08 PM, Natalia Kamneva wrote:

> One issue is are you salt depleted with the hot weather and the eplerenone?I assume that I am. When I eat a jar of marinated mushrooms (approximately 250 mg on Na), I feel immediately better. Should I eat more Na and less K?Does salt depletion cause spikes in blood pressure? >Recommend you take your BP seated and then stand for 1 min with arm supported so the cuff is at heart level and check the BP again. If is drops by more that 20 this suggests that you may be salt depelted and more salt may actually help.Seated 129/78, standing 123/78. HR is 115. >Did your BP fall a lot in the hospital as the numbers are if anything low on the record you sent but they may have loaded you up with BP meds.Yes, my BP fall a lot in a hospital and became worse at home. I was there and here on the same 100 mg dosage of eplerenone and 160 of micardis. They did 2 shots of BB when I arrived with 230/130. Next day my BP was still high, after that normal. > Did they stop or taper the metformin. You were on a lot as I recall.I was on 2000 mg until I overdosed it for three weeks to 4000mg. The endo stopped it completely. I am not on any diabetic medications right now. I was in insulin in the hospital.>What other meds have been tired for DM?I tried januvia in addition to metformin several years ago, but didn't see any positive effect. I was on glukophage when the insurance covered it. >Has your weight been stable during all of

this?Pretty much.> How they take your BP when it was 230/130. Were you in pain or acutely ill?I lay down. I was feeling terribly: shortness of breath, headache and all other symptoms of PA. Many thanks, Natalia Kamneva 68 F with 2.5 cm left adrenal adenoma, recently diagnosed with PA; diabetic; on 100 mg eplerenone, 40 mg Micardis, 2000 mg metformin, 60 mg Dexilant and 2 mg Lorazepam; Dashing; still have some occasional problems with BP, K and Na; on private consultation with Dr Grim. From: Grim Clarence <lowerbp2@...> hyperaldosteronism Cc: Grim Clarence <lowerbp2@...> Sent: Wednesday, August 1, 2012 4:24 PM Subject: Re: Hospitalized with very high BP

One issue is are you salt depleted with the hot weather and the eplerenone?Recommend you take your BP seated and then stand for 1 min with arm supported so the cuff is at heart level and check the BP again. If is drops by more that 20 this suggests that you may be salt depelted and more salt may actually help.Did your BP fall a lot in the hospital as the numbers are if anything low on the record you sent but they may have loaded you up with BP meds.Did they stop or taper the metformin. You were on a lot as I recall.What other meds have been tired for DM?Has your weight been stable during all of this?How they take your BP when it was 230/130. Were you in pain or acutely ill?

Clarence Grim MDlowerbp2@...

On Aug 1, 2012, at 12:22 PM, Natalia Kamneva wrote:

Hi Dr. Grim and the group,I again was hospitalized with BP 230/130 and spent five days in the hospital. I don't have yet all medical records from the hospital, but I have Report from MRI without contrast and some blood test results. See the attachment. I also have images from MRI in case if Dr. Grim would like to take a look at them. Please, note, that my blood K was 5.0 and blood Na was 132, pretty much the same as it was a year ago when I was hospitalized with the same symptoms and a very high blood pressure. I really don't know why it happened

again and such high BP all of the sudden scares me to

death. The reasons that I consider:1. 4th of July picnic, where I ate much more salty food than usually. But after that I was on my dash for two weeks and felt pretty well.2. Summer heat. I was hospitalized five times for last two years and it always happened during summer heat. 3. Constant diarrhea over last two months since I overdosed metformin. 4. All the above together!?I am not on any diabetes medications now and my BS is really high, average fasting is 150-160. I also consider to change eplerenone to sipro, since eplerenone also causes diarrhea.Now I feel unstable and my BP varies from 110/65 to 160/100.

It's especially high at 8 am and 8 pm, when I also feel very badly. I am on higher dosage of eplerenone and micardis and Dashing very strictly, restricting Na < 700 - 800 mg a day. Many, many thanks. I would appreciate any responses. Natalia Kamneva 68 F with 3.5 cm left adrenal adenoma, diagnosed with PA in 2011; diabetic; on 100 mg eplerenone, 160 mg Micardis, currently not diabetic medication , 20 mg Omeprazol and 3 - 4 mg Lorazepam; Dashing; still have some occasional problems with BP, K and Na; on private consultation with Dr Grim.

1 of 1 File(s)

urine and blood tests_2012.xlsx

August 3, 2012

Ah I trust the pt mostly. But data shows very clearly that pts do not always report their true BP or glucose or take their meds reliably.So if I ask a pt if they have any problem taking their meds exactly as directed and they yes I cannot be sure they are telling the truth. If you tell me yes you have problems then I can at least believe that you are having a problem taking your meds. Pts rarely admit to not taking meds correctly if they are not having problems taking meds regularly.

Clarence Grim MDlowerbp2@...

On Aug 2, 2012, at 8:22 AM, Phyllis wrote:

FR Grim, you said you wouldn't trust a

patient? Then who would you trust to be able to tell you how they

feel?

Phyllis

On 8/2/2012 1:00 AM, Grim Clarence wrote:

Phyllis you need to interpret your sources better.

I would not trust ask a patient mostly.

Clarence Grim MD

lowerbp2@...

On Aug 1, 2012, at 6:03 PM, Phyllis wrote:

I had a bad

hypertensive crisis once. It was the

omeprazole.

Check this out.. this is how I found out

about omeprazole. Also proton pump

inhibitors are no good because they

interfere with good acid in the stomach.

Proton pump inhibitor causes C-diff, which

will cause diarrhea.

http://www.askapatient.com/viewrating.asp?drug=19810 & name=prilosec

http://www.ncbi.nlm.nih.gov/pubmed/22781139

Phyllis

On 8/1/2012 5:24 PM, Grim Clarence wrote:

One issue is are you salt depleted with

the hot weather and the eplerenone?

Recommend you take your BP seated and

then stand for 1 min with arm supported

so the cuff is at heart level and check

the BP again. If is drops by more that

20 this suggests that you may be salt

depelted and more salt may actually

help.

Did your BP fall a lot in the

hospital as the numbers are if anything

low on the record you sent but they may

have loaded you up with BP meds.

Did they stop or taper the metformin.

You were on a lot as I recall.

What other meds have been tired for

DM?

Has your weight been stable during

all of this?

How they take your BP when it was

230/130. Were you in pain or acutely

ill?

Clarence Grim MD

lowerbp2@...

On Aug 1, 2012, at 12:22 PM,

Natalia Kamneva wrote:

Hi Dr. Grim and

the group,

I again was

hospitalized with BP

230/130 and spent five

days in the hospital. I

don't have yet all

medical records from the

hospital, but I have

Report from MRI without

contrast and some blood

test results. See the

attachment.

I also have

images from MRI in case

if Dr. Grim would like

to take a look at them.

Please, note,

that my blood K was 5.0

and blood Na was 132,

pretty much the same as

it was a year ago when

I was hospitalized with

the same symptoms and a

very high blood

pressure.

I really don't

know why it happened

again and such high BP

all of the sudden scares

me to death.

The reasons that

I consider:

1. 4th of July

picnic, where I ate much

more salty food than

usually. But after that

I was on my dash for two

weeks and felt pretty

well.

2. Summer heat. I

was hospitalized five

times for last two years

and it always happened

during summer heat.

3. Constant

diarrhea over last two

months since I overdosed

metformin.

4. All the above

together!?

I am not on any

diabetes medications now

and my BS is really

high, average fasting is

150-160. I also consider

to change eplerenone to

sipro, since eplerenone

also causes diarrhea.

Now I feel

unstable and my BP

varies from 110/65 to

160/100. It's especially

high at 8 am and 8 pm,

when I also feel very

badly. I am on higher

dosage of eplerenone and

micardis and Dashing

very strictly,

restricting Na < 700

- 800 mg a day.

Many, many

thanks. I would

appreciate any

responses.

Natalia Kamneva

68 F with 3.5 cm left

adrenal adenoma, diagnosed

with PA in 2011; diabetic;

on 100 mg eplerenone, 160

mg Micardis, currently not

diabetic medication , 20

mg Omeprazol and 3 - 4 mg

Lorazepam; Dashing; still

have some occasional

problems with BP, K and

Na; on private

consultation with Dr Grim.

August 3, 2012

Come on surely patients never lie, they really did spill their pain pills in the toilet when they were trying to take one and need a refill after one week.......just being stupid, but I hear that one alot, or a cousin stole them (more likely I'd say)

Hi Dr. Grim and the group,

I again was hospitalized with BP 230/130 and spent five days in the hospital. I don't have yet all medical records from the hospital, but I have Report from MRI without contrast and some blood test results. See the attachment.

I also have images from MRI in case if Dr. Grim would like to take a look at them.

Please, note, that my blood K was 5.0 and blood Na was 132, pretty much the same as it was a year ago when I was hospitalized with the same symptoms and a very high blood pressure.

I really don't know why it happened again and such high BP all of the sudden scares me to death.

The reasons that I consider:

1. 4th of July picnic, where I ate much more salty food than usually. But after that I was on my dash for two weeks and felt pretty well.

2. Summer heat. I was hospitalized five times for last two years and it always happened during summer heat.

3. Constant diarrhea over last two months since I overdosed metformin.

4. All the above together!?

I am not on any diabetes medications now and my BS is really high, average fasting is 150-160. I also consider to change eplerenone to sipro, since eplerenone also causes diarrhea.

Now I feel unstable and my BP varies from 110/65 to 160/100. It's especially high at 8 am and 8 pm, when I also feel very badly. I am on higher dosage of eplerenone and micardis and Dashing very strictly, restricting Na < 700 - 800 mg a day.

Many, many thanks. I would appreciate any responses.

Natalia Kamneva 68 F with 3.5 cm left adrenal adenoma, diagnosed with PA in 2011; diabetic; on 100 mg eplerenone, 160 mg Micardis, currently not diabetic medication , 20 mg Omeprazol and 3 - 4 mg Lorazepam; Dashing; still have some occasional problems with BP, K and Na; on private consultation with Dr Grim.

August 4, 2012

I presume when they tell you somebody stole them you ask to see the police

report! (Should be an easy case if they know who did it or I bet they don't use

that excuse again!)

>

> Â

>

> Hi Dr. Grim and the group,

>

> I again was hospitalized with BP 230/130 and spent five days in the hospital.

I don't have yet all medical records from the hospital, but I have Report from

MRI without contrast and some blood test results. See the attachment.

>

> I also have images from MRI in case if Dr. Grim would like to take a look at

them.

>

> Please, note, that my blood K was 5.0 and blood Na was 132, pretty much the

same as it wasÂ a year ago when I was hospitalized with the same symptoms and a

very high blood pressure.Â

>

> I really don't know why it happened again and such high BP all of the sudden

scares me to death.Â

>

> The reasons that I consider:

>

> 1. 4th of July picnic, where I ate much more salty food than usually. But

after that I was on my dash for two weeks and felt pretty well.

> 2. Summer heat. I was hospitalized five times for last two years andÂ it

always happened during summer heat.Â

> 3. Constant diarrhea over last two months since I overdosed metformin.Â

> 4. AllÂ the above together!?

>

> I am not on any diabetes medications now and my BS is really high, average

fasting is 150-160. I also consider to change eplerenone to sipro, since

eplerenone also causes diarrhea.

>

> Now I feel unstable andÂ my BP varies from 110/65 to 160/100. It's especially

high at 8 am and 8 pm, when I also feel very badly. I am on higher dosage of

eplerenone and micardis and Dashing very strictly, restricting Na < 700 - 800 mg

a day.Â Â

>

> Many, many thanks. I would appreciate any responses.

>

> Â

> Natalia Kamneva 68 F with 3.5 cm left adrenal adenoma, diagnosed with PA in

2011; diabetic; on 100 mg eplerenone, 160 mg Micardis, currently not diabetic

medication , 20 mg Omeprazol and 3 - 4 mg Lorazepam; Dashing; still have some

occasional problems with BP, K and Na; on private consultation with Dr Grim.

>

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