Re: Been a little while

[Guest guest]

I'm not sure if I can allay any of your fears but I'll try. I live in Barre, VT

and was raised in Woodstock, VT. Dartmouth Hitchcock and its predecessor,

Hitchcock Memorial Hospital has always been our hospital of record (4 of us

being veterans use the VA as a first line but it is tied very closely with DHMC)

My wife was also raised in Woodstock and has many relatives still there. They

all use DHMC and I can't recall a bad experience being reported by any of us.

Now to the issue at hand, Adrenal Gland Experts. I recently meant with a Dr.

Laycock from there. He is a surgeon and we were discussing my upcoming

adrenalectomy, he does most of their laprosocpic surgeries. When I was

" qualifying him " he indicated he averaged 15 adrenalectomies a year, most of

them referred from doctors within the hospital. I asked something about them

having doctors that worked on adrenal problems and he named three or four.

At some point Francis, on this site, gave us an address of where to look to find

out about doctors at

DHMC:(http://www.dhmc.org/webpage.cfm?site_id=2 & org_id=500 & morg_id=0 & sec_id=0 & gs\

ec_id=40382 & item_id=40382) I went out there and looked for people with

Endocrinology as their area of expertieze and found 12 professionals. I noted 7

of them had something called " Endocrine Tumor Program " listed in their field of

expertise. I then looked at the General Surgeons and found that field of

expertise listed for 4 of them including Dr. Lowcock.

Hopefully that gives you some level of comfort. If you " scoop " any other good

information, let me know....Good Luck...thanks...

>

> Just read through some posts. Playing catch up. I've been busy trying to get

records, copies of lab reports,med records etc. I want them in my possesion

seeing things never faxed like I am told they will be. I'm frustrated and wonder

if going to Dartmouth in New Hampshire will be a waste of time. I have been on

the phone with my local endo trying to get copies of records (sign this and that

first), had to call Beth Israel 3x to get blood work results (and now over a

week later still haven't recieved a copy in the mail. The tests she did came

back " negative " but I am not even sure what she was testing for. What I do know

is she said " the adrenal glands produce more hormones besides aldosterone " she

ran a few tests to disprove my diagnosis of PA. I am waiting for the results in

the mail so I can post all my numbers. Basically she told me she wasn't

convinced it was PA when I saw her and now after labs came back she is agreeing

it is. I have called Dartmouth to verify they treat people with PA and are

experienced, talked to them in length and they have reassured me they will treat

me. Somehow I feel it is going to be another waste of time. It is a 3 and 1/2 hr

drive for me one way so I am leary. Hopefully all my records will come tomorrow

so I can post about myself in numbers. Unfortunetly I have been feeling like

crap so it is hard to stay focused.

>

[Guest guest]

Thank you , . I have an appointment with a Kathleen Belbruno. I have looked

at her info and I have called there to find out if she has treated PA before.

Her nurse or med assistant said she talked to her and was told in her 25 year

career she has treated PA x3 and that if this was complicated in any way there

is a whole team of endocinologists, an interventional radiologist etc right

there. The infor didn't give me a sence either way. I don't know, I just feel it

is such a long way for a consultation. I did ask if she would want any kind of

bloodwork etc before my appointment (the last doc had me do bloodwork) so that I

can make the most of this appointment but they said she wouldn't need anything.

We'll see. Thanks again for the insight.

> >

> > Just read through some posts. Playing catch up. I've been busy trying to get

records, copies of lab reports,med records etc. I want them in my possesion

seeing things never faxed like I am told they will be. I'm frustrated and wonder

if going to Dartmouth in New Hampshire will be a waste of time. I have been on

the phone with my local endo trying to get copies of records (sign this and that

first), had to call Beth Israel 3x to get blood work results (and now over a

week later still haven't recieved a copy in the mail. The tests she did came

back " negative " but I am not even sure what she was testing for. What I do know

is she said " the adrenal glands produce more hormones besides aldosterone " she

ran a few tests to disprove my diagnosis of PA. I am waiting for the results in

the mail so I can post all my numbers. Basically she told me she wasn't

convinced it was PA when I saw her and now after labs came back she is agreeing

it is. I have called Dartmouth to verify they treat people with PA and are

experienced, talked to them in length and they have reassured me they will treat

me. Somehow I feel it is going to be another waste of time. It is a 3 and 1/2 hr

drive for me one way so I am leary. Hopefully all my records will come tomorrow

so I can post about myself in numbers. Unfortunetly I have been feeling like

crap so it is hard to stay focused.

> >

>

[Guest guest]

Mattie: always have who you are in your intro so I can keep you straight.I would begin to collect a 24 hr urine and take in in with you and go in fasting to save another trip.Take her my article and tell her we are here to help.See Item 7 below.List all meds you are on as well. CE Grim MD Welcome to the exciting world of Hyperaldosteronism! You are in the right place! I am Dr. CE Grim a retired Professor of Medicine and Endocrinology. I have a long standing interest is Primary Aldosteronism since medical school days when I saw my first patient with Primary Aldosteronism in 1963. I trained with Dr. Jerome W. Conn in Endocrinology and Metabolism 1969-70 and have published over 240 papers and book chapters in most areas of the discipline of High Blood Pressure. My CV is in our files for details. The goal of our group is to teach you and your health care team about the ins and outs of the causes, diagnosis and control of the many forms of hyperaldosteronism. The steps below will introduce you into the fascinating world of high blood pressure, salt (sodium(Na) chloride (Cl) or NaCL) and potassium (K) and the role of the adrenal hormone aldosterone in health and disease. Doing these in sequence will save you time and effort in getting up to speed in taking control of you health and educating your own health care team. While we can’t make you into a doctor we will make you into a pretty good BP doctor-a skill that you will have for life and you can transfer to the rest of your family who will likely have high blood pressure eventually-if they live long enough. 1. A brief history of Primary Aldosteronsim and why it is so common today in drug resistant high blood pressure. Read my article in our files on the evolution of PA (Evolution_of_PA-Grim.pdf ) and take to all members of health care team. Tell us what stage you believe you are in. This is a brief review of most causes of hyperaldosteronism, high blood pressure, low potassium (K). READING THIS WILL SAVE YOU TIME AND MONEY. By taking it to your health care team they will not treat their other patients in the future as badly as they may have treated you in the past. 2. Read about other patients with hyperaldosteronism (Conn’s syndrome). Read our Conn's stories in our files and then give us your own in as much detail as you can. Dr. Conn was the first to describe this disease process and the syndrome is named after him. The first patient is described in my review article.To see others' stories, on the Hyperaldosteronism home page, go to Files/Conn’s Stories. You'll find instructions in "A - How to put your story here.doc " First send us your story in an email and they we may have questions and suggestions before you upload it to our files. 3. DASH to lower your BP. Your and my tax dollars funded the most important series of studies on how to improve blood pressure, blood sugar, blood lipids and make your heart smaller: The DASH Eating Plan to control high blood pressure due to hyperaldosteronism and most others with high blood pressure. This will reduce your need for medications and in many will get your BP and K to goal without meds.. Get the DASH diet book by T. et al, (http://www.amazon.com/DASH-Diet-Hypertension--/dp/0743202953) read it and use it: ~$8 in paperback at your local bookstore or online. If they don’t have it ask them to order it for you. You can also get the hardback larger print version as well at Amazon. Learning to eat the DASH way will play a major role in your road to good BP and K control and, in many of our folks here, will revolutionize your life. See http://en.wikipedia.org/wiki/DASH_diet for an overview and more details. In the book go to chapter 9 and do the 14 day challenge. Tell your Dr you are doing this as your BP may plummet if you are on other meds. Measure your BP every day and post to us. or go to http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf download this 64 page booklet free and do the Week on the DASH Diet for 2 weeks. If you are on BP meds be prepared for a large fall in BP (20/10 mm Hg or more) and let your Dr. know you are doing this. And/Or go to (but costs money monthly) DASH Diet for Health Program (http://www.dashforhealth.com/pages/public/tour.php)The DASH Diet for Health Program is designed to help you improve your eating and exercise habits. Twice each week they will provide you with information on our website about food, food preparation, eating out, losing weight, getting fit and much more. In addition to providing new information each week on the website, they create a web page specially for you where you can track progress in areas such as your weight, blood pressure, and exercise. I strongly recommend you get this book by .... and read it. 4. Measure your BP: Measure your BP daily so you can see if it is getting better. If you are taking meds be sure to tell your health care team you are doing this as your BP may plummet to normal quickly. We recommend you use a device you listen to and will help you learn how to do this. If this is not something you want to do we can teach a significant other how to do it. See sharedcareinc.com or email to sharedcare@... to order a video on how to do this. If you already have one we will teach you how to teach your health care team how to validate your device. Your life and health depends on accurate BP measurements. Go to the amricanheart.org and download the Guidelines for Human Blood Pressure Measurement. Insist that your health care team do BP the AHA way. Never trust your life to an automatic BP machine unless you know it is accurate on YOU. 5. Genetics and your BP: If you have a twin be sure to let us know. Go to familyhistory.hhs.gov and do your detailed family medical history (FHx or FH) so we can review with you to help diagnosis (Dx) and treat (Rx) familial causes of high blood pressure and heart disease. If BP runs in your family you may save lives in your family by checking their BP yourself. 6. How to DX and treat PA: Go to our file/Conn's Articles of Note/Medications/Bravo spir 1973.pdf and read this article and take to your health care team. It is old but still one of the best in the medical management of PA. Note one with PA whose BP and K normalized with low Na, High K diet and only 25 mg of spiro. DX: Also see our file from the Endocrine Society Guidelines on PA. 7. Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a regular to high salt diet for 2 weeks.2. No BP meds in last 4-12 weeks depending on meds.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K (http://groups.yahoo.com/group/hyperaldosteronism/files/Investigating%20elevated%20potassium%20values..txt) Try to get this done about 4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. I helped perfect this test and have probably done more saline infusions than anyone in the world. 8. Become a participant in our PA Registry and contribute to our large database on PA: If you have been Dxed with PA already and are on Rx or have had surgery please go to http://www.kwiksurveys.com/online-survey.php?surveyID=HIJIO_f2685379 and complete our survey with as much information as you know. If there is some information you don't know ask us and we will help. If you need to update this as you journey thru the diagnostic/treatment process you can add another entry but label it as Nameyymmdd. For example today 6/12/09 for me would be Grim090612. This ever increasing number will allow us and you to sort your multiple entries into a dated order. 9. Learn the language: If you are new to medical lingo then download the acroyms from http://health.groups.yahoo.com/group/bloodpressureline/message/2918610. Salt and high blood pressure: To learn the state of the science of salt and blood pressure please spend some time looking at http://www.worldactiononsalt.com/evidence/treatment_trials.htm11. Become a HBP expert consumer: Expect that it will take at least several weeks to get all this digested and to learn the new language of high blood pressure health care. As most doctors and nurses in practice have had very little training in high blood pressure you must become an expert yourself. For example most have never had anyone listen with them with a double stethoscope to verify that they can hear BP sounds. We cannot make you a doctor but we will make you a pretty good BP doctor. Read our consumer's guide to an accurate blood pressure.12. How High Blood Pressure should be managed: Go to nih.gov and download and read the Joint National Commission (JNC) Report 7 to get an overview on current guidelines. I ask all my secretaries to read this so they can communicate the importance of high blood pressure to my patients. JNC 8 will be out soon.Then: get (and study) the Hypertension Primer from americanheart.org 4th addition. I coauthored the chapter on BP measurement. You can also get this for about $6 from Amazon.com. This is the most up-to-date compendium of what is known about high blood pressure and what every Dr. should know when they graduate from Medical School. Every chapter is only 2-3 pages. Read one chapter every week-night and you will finish it in about a year. I am working on a reading guide for lay people for the Primer. Stay tuned. If you don't like it take it to your health care team so they will know what every medical student today should know.13. Ask us questions: Ask any questions about high blood pressure you want answered. That is what we are here for. We have had this site for 10 years and over 30,000 emails are searchable. This is the largest collection of communications about Conn's Syndrome in the World. 14. One-on-one Consulting: I can provide individual consulting if you do not want to go public. If you want individual one-on-one consulting for you and your Doctor contract me directly at lowerbp2@....15: Abbreviations of common use in aldo speak include: AME apparent mineralocorticoid excess AVS adrenal vein sampling BB beta blockers CCB calcium channel blockers Dx diagnosis FHx family history GRE glucocorticoid remedial aldosteronism LNaV8 low sodium V8 juice. MCB mineralocorticoid blocker also called AB aldosterone blocker. MHx medical history Rx treatment SHx social history UNaKCr urinary sodium, potassium, creatinine May your pressure be low!Clarence E. Grim BS, MS, MD, FACP, FACC, FAHA Council for High Blood Pressure Research. Board Certified in Internal Medicine, Geriatrics, and High Blood Pressure by the American Society of Hypertension. Retired Faculty/Professor of Medicine (U of MO, Indiana, UCLA/DREW, Medical College of Wisconsin in Nephrology, Endocrinology, Cardiology, and Epidemiology. Specializing in Primary Aldosteronism and Difficult to Control High Blood Pressure. Thank you , . I have an appointment with a Kathleen Belbruno. I have looked at her info and I have called there to find out if she has treated PA before. Her nurse or med assistant said she talked to her and was told in her 25 year career she has treated PA x3 and that if this was complicated in any way there is a whole team of endocinologists, an interventional radiologist etc right there. The infor didn't give me a sence either way. I don't know, I just feel it is such a long way for a consultation. I did ask if she would want any kind of bloodwork etc before my appointment (the last doc had me do bloodwork) so that I can make the most of this appointment but they said she wouldn't need anything. We'll see. Thanks again for the insight. > >> > Just read through some posts. Playing catch up. I've been busy trying to get records, copies of lab reports,med records etc. I want them in my possesion seeing things never faxed like I am told they will be. I'm frustrated and wonder if going to Dartmouth in New Hampshire will be a waste of time. I have been on the phone with my local endo trying to get copies of records (sign this and that first), had to call Beth Israel 3x to get blood work results (and now over a week later still haven't recieved a copy in the mail. The tests she did came back "negative" but I am not even sure what she was testing for. What I do know is she said "the adrenal glands produce more hormones besides aldosterone" she ran a few tests to disprove my diagnosis of PA. I am waiting for the results in the mail so I can post all my numbers. Basically she told me she wasn't convinced it was PA when I saw her and now after labs came back she is agreeing it is. I have called Dartmouth to verify they treat people with PA and are experienced, talked to them in length and they have reassured me they will treat me. Somehow I feel it is going to be another waste of time. It is a 3 and 1/2 hr drive for me one way so I am leary. Hopefully all my records will come tomorrow so I can post about myself in numbers. Unfortunetly I have been feeling like crap so it is hard to stay focused.> >>

[Guest guest]

Sounds like we need to find one to bring up to speed in the Hypertension area. Let us know.CE Grim MDI'm not sure if I can allay any of your fears but I'll try. I live in Barre, VT and was raised in Woodstock, VT. Dartmouth Hitchcock and its predecessor, Hitchcock Memorial Hospital has always been our hospital of record (4 of us being veterans use the VA as a first line but it is tied very closely with DHMC) My wife was also raised in Woodstock and has many relatives still there. They all use DHMC and I can't recall a bad experience being reported by any of us.Now to the issue at hand, Adrenal Gland Experts. I recently meant with a Dr. Laycock from there. He is a surgeon and we were discussing my upcoming adrenalectomy, he does most of their laprosocpic surgeries. When I was "qualifying him" he indicated he averaged 15 adrenalectomies a year, most of them referred from doctors within the hospital. I asked something about them having doctors that worked on adrenal problems and he named three or four.At some point Francis, on this site, gave us an address of where to look to find out about doctors at DHMC:(http://www.dhmc.org/webpage.cfm?site_id=2 & org_id=500 & morg_id=0 & sec_id=0 & gsec_id=40382 & item_id=40382) I went out there and looked for people with Endocrinology as their area of expertieze and found 12 professionals. I noted 7 of them had something called "Endocrine Tumor Program" listed in their field of expertise. I then looked at the General Surgeons and found that field of expertise listed for 4 of them including Dr. Lowcock.Hopefully that gives you some level of comfort. If you "scoop" any other good information, let me know....Good Luck...thanks...>> Just read through some posts. Playing catch up. I've been busy trying to get records, copies of lab reports,med records etc. I want them in my possesion seeing things never faxed like I am told they will be. I'm frustrated and wonder if going to Dartmouth in New Hampshire will be a waste of time. I have been on the phone with my local endo trying to get copies of records (sign this and that first), had to call Beth Israel 3x to get blood work results (and now over a week later still haven't recieved a copy in the mail. The tests she did came back "negative" but I am not even sure what she was testing for. What I do know is she said "the adrenal glands produce more hormones besides aldosterone" she ran a few tests to disprove my diagnosis of PA. I am waiting for the results in the mail so I can post all my numbers. Basically she told me she wasn't convinced it was PA when I saw her and now after labs came back she is agreeing it is. I have called Dartmouth to verify they treat people with PA and are experienced, talked to them in length and they have reassured me they will treat me. Somehow I feel it is going to be another waste of time. It is a 3 and 1/2 hr drive for me one way so I am leary. Hopefully all my records will come tomorrow so I can post about myself in numbers. Unfortunetly I have been feeling like crap so it is hard to stay focused.>

[Guest guest]

Lettie-who are you? Need intro please.CE Grim MDJust read through some posts. Playing catch up. I've been busy trying to get records, copies of lab reports,med records etc. I want them in my possesion seeing things never faxed like I am told they will be. I'm frustrated and wonder if going to Dartmouth in New Hampshire will be a waste of time. I have been on the phone with my local endo trying to get copies of records (sign this and that first), had to call Beth Israel 3x to get blood work results (and now over a week later still haven't recieved a copy in the mail. The tests she did came back "negative" but I am not even sure what she was testing for. What I do know is she said "the adrenal glands produce more hormones besides aldosterone" she ran a few tests to disprove my diagnosis of PA. I am waiting for the results in the mail so I can post all my numbers. Basically she told me she wasn't convinced it was PA when I saw her and now after labs came back she is agreeing it is. I have called Dartmouth to verify they treat people with PA and are experienced, talked to them in length and they have reassured me they will treat me. Somehow I feel it is going to be another waste of time. It is a 3 and 1/2 hr drive for me one way so I am leary. Hopefully all my records will come tomorrow so I can post about myself in numbers. Unfortunetly I have been feeling like crap so it is hard to stay focused.

[Guest guest]

Dr Grim, I'm not sure but what they are up to speed. It's hard for us to review

and evaluate the depth and quality of their programs and expertiese. If you on

the otherhand gave a quick call, you could do a peer review and probably

validate the situation in short order. We have heard about their Endocrine

Tumors Program and in addition to the 16 individuals that list that as an

Affiliation there are 5 doctors that list Nephrology and Hypertension as there

speciality.

If I had to pick the one to start with I recommend Dr. Turco. He has been

there 30+ years and lists Adrenal Disorders among his specialties. They all

can be reached at (603)650-8630.

> > >

> > > Just read through some posts. Playing catch up. I've been busy

> > trying to get records, copies of lab reports,med records etc. I want

> > them in my possesion seeing things never faxed like I am told they

> > will be. I'm frustrated and wonder if going to Dartmouth in New

> > Hampshire will be a waste of time. I have been on the phone with my

> > local endo trying to get copies of records (sign this and that

> > first), had to call Beth Israel 3x to get blood work results (and

> > now over a week later still haven't recieved a copy in the mail. The

> > tests she did came back " negative " but I am not even sure what she

> > was testing for. What I do know is she said " the adrenal glands

> > produce more hormones besides aldosterone " she ran a few tests to

> > disprove my diagnosis of PA. I am waiting for the results in the

> > mail so I can post all my numbers. Basically she told me she wasn't

> > convinced it was PA when I saw her and now after labs came back she

> > is agreeing it is. I have called Dartmouth to verify they treat

> > people with PA and are experienced, talked to them in length and

> > they have reassured me they will treat me. Somehow I feel it is

> > going to be another waste of time. It is a 3 and 1/2 hr drive for me

> > one way so I am leary. Hopefully all my records will come tomorrow

> > so I can post about myself in numbers. Unfortunetly I have been

> > feeling like crap so it is hard to stay focused.

> > >

> >

> >

> >

>

[Guest guest]

Meds I now take and was on for the two PRA ratio test. PAR ratio wasn't high to

DX PA

ATENOLOL25MG TRIAMTERENE50MG POTASSIUM CHLORIDE 20MEQ

FUROSEMIDE 60MG TAB.

Information from Test done at the VA and quest labs.

Blood Drawn 12/24/2008 14:19

Test performed at Quest Diag. Lab.

Evaluation for RENIN: 1.8 ng/mL/hr

Current Range:

Non-hypertensive adults:

RENIN: (upright/sitting) 0.65-5.0 ng/mL/hr

Clinical Cutoffs for Hypertensive Individual(ng/mL/hr)s:

Low-renin sodium/volume-mediated hypertension likely: <0.65

Primary aldosteronsim possible: <0.65

Renin-mediated hypertension likely: >=0.65

Renovascular hypertension possible: >1.5

Renovascular hypertension more likely: >10.0

Approximately 1/3 of subjects with essential hypertension have low-renin

(PRA<0.65 mg/mL/hr) hypertension, while the remainder have PRA values above 0.65

ng/mL/jr.

Treatment with medications such as diuretics or ACE inhibitors increase PRA

levels.

This information is also it the Endocrine Society PA Guidelines to DX PA.

SERUM ALDOS: 16 ng/dL

Test performed at Quest Diag. Lab.

Evaluation for ALDOS:

Current adult reference range:

Upright 8:00-10:00 am < or = 28 ng/dL

Upright 4:00-6:00 pm < or = 21 ng/dL

Supine 8:00-10:00 am 3-16 ng/dL

Test done At Dartmouth Belive test was done by Mayo lab

Blood drawn 03/03/2009 at 3 PM

RENIN ACTIVITY .8 no range given

ALDOSTERONE-MAYO 5.5 range <=21

> > > > >

> > > > > Just read through some posts. Playing catch up. I've been busy

> > > > trying to get records, copies of lab reports,med records etc. I want

> > > > them in my possesion seeing things never faxed like I am told they

> > > > will be. I'm frustrated and wonder if going to Dartmouth in New

> > > > Hampshire will be a waste of time. I have been on the phone with my

> > > > local endo trying to get copies of records (sign this and that

> > > > first), had to call Beth Israel 3x to get blood work results (and

> > > > now over a week later still haven't recieved a copy in the mail. The

> > > > tests she did came back " negative " but I am not even sure what she

> > > > was testing for. What I do know is she said " the adrenal glands

> > > > produce more hormones besides aldosterone " she ran a few tests to

> > > > disprove my diagnosis of PA. I am waiting for the results in the

> > > > mail so I can post all my numbers. Basically she told me she wasn't

> > > > convinced it was PA when I saw her and now after labs came back she

> > > > is agreeing it is. I have called Dartmouth to verify they treat

> > > > people with PA and are experienced, talked to them in length and

> > > > they have reassured me they will treat me. Somehow I feel it is

> > > > going to be another waste of time. It is a 3 and 1/2 hr drive for me

> > > > one way so I am leary. Hopefully all my records will come tomorrow

> > > > so I can post about myself in numbers. Unfortunetly I have been

> > > > feeling like crap so it is hard to stay focused.

> > > > >

> > > >

> > > >

> > > >

> > >

> >

>

[Guest guest]

What do they say is lowering the renin but not the Aldo. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Meds I now take and was on for the two PRA ratio test. PAR ratio wasn't high to DX PA

ATENOLOL25MG TRIAMTERENE50MG POTASSIUM CHLORIDE 20MEQ

FUROSEMIDE 60MG TAB.

Information from Test done at the VA and quest labs.

Blood Drawn 12/24/2008 14:19

Test performed at Quest Diag. Lab.

Evaluation for RENIN: 1.8 ng/mL/hr

Current Range:

Non-hypertensive adults:

RENIN: (upright/sitting) 0.65-5.0 ng/mL/hr

Clinical Cutoffs for Hypertensive Individual(ng/mL/hr)s:

Low-renin sodium/volume-mediated hypertension likely: <0.65

Primary aldosteronsim possible: <0.65

Renin-mediated hypertension likely: >=0.65

Renovascular hypertension possible: >1.5

Renovascular hypertension more likely: >10.0

Approximately 1/3 of subjects with essential hypertension have low-renin (PRA<0.65 mg/mL/hr) hypertension, while the remainder have PRA values above 0.65 ng/mL/jr.

Treatment with medications such as diuretics or ACE inhibitors increase PRA levels.

This information is also it the Endocrine Society PA Guidelines to DX PA.

SERUM ALDOS: 16 ng/dL

Test performed at Quest Diag. Lab.

Evaluation for ALDOS:

Current adult reference range:

Upright 8:00-10:00 am < or = 28 ng/dL

Upright 4:00-6:00 pm < or = 21 ng/dL

Supine 8:00-10:00 am 3-16 ng/dL

Test done At Dartmouth Belive test was done by Mayo lab

Blood drawn 03/03/2009 at 3 PM

RENIN ACTIVITY .8 no range given

ALDOSTERONE-MAYO 5.5 range <=21

> > > > >

> > > > > Just read through some posts. Playing catch up. I've been busy

> > > > trying to get records, copies of lab reports,med records etc. I want

> > > > them in my possesion seeing things never faxed like I am told they

> > > > will be. I'm frustrated and wonder if going to Dartmouth in New

> > > > Hampshire will be a waste of time. I have been on the phone with my

> > > > local endo trying to get copies of records (sign this and that

> > > > first), had to call Beth Israel 3x to get blood work results (and

> > > > now over a week later still haven't recieved a copy in the mail. The

> > > > tests she did came back "negative" but I am not even sure what she

> > > > was testing for. What I do know is she said "the adrenal glands

> > > > produce more hormones besides aldosterone" she ran a few tests to

> > > > disprove my diagnosis of PA. I am waiting for the results in the

> > > > mail so I can post all my numbers. Basically she told me she wasn't

> > > > convinced it was PA when I saw her and now after labs came back she

> > > > is agreeing it is. I have called Dartmouth to verify they treat

> > > > people with PA and are experienced, talked to them in length and

> > > > they have reassured me they will treat me. Somehow I feel it is

> > > > going to be another waste of time. It is a 3 and 1/2 hr drive for me

> > > > one way so I am leary. Hopefully all my records will come tomorrow

> > > > so I can post about myself in numbers. Unfortunetly I have been

> > > > feeling like crap so it is hard to stay focused.

> > > > >

> > > >

> > > >

> > > >

> > >

> >

>

[Guest guest]

They don't say. Since ratio is less then 20 they say don't have PA.

> > > > > > >

> > > > > > > Just read through some posts. Playing catch up. I've been busy

> > > > > > trying to get records, copies of lab reports,med records etc. I want

> > > > > > them in my possesion seeing things never faxed like I am told they

> > > > > > will be. I'm frustrated and wonder if going to Dartmouth in New

> > > > > > Hampshire will be a waste of time. I have been on the phone with my

> > > > > > local endo trying to get copies of records (sign this and that

> > > > > > first), had to call Beth Israel 3x to get blood work results (and

> > > > > > now over a week later still haven't recieved a copy in the mail. The

> > > > > > tests she did came back " negative " but I am not even sure what she

> > > > > > was testing for. What I do know is she said " the adrenal glands

> > > > > > produce more hormones besides aldosterone " she ran a few tests to

> > > > > > disprove my diagnosis of PA. I am waiting for the results in the

> > > > > > mail so I can post all my numbers. Basically she told me she wasn't

> > > > > > convinced it was PA when I saw her and now after labs came back she

> > > > > > is agreeing it is. I have called Dartmouth to verify they treat

> > > > > > people with PA and are experienced, talked to them in length and

> > > > > > they have reassured me they will treat me. Somehow I feel it is

> > > > > > going to be another waste of time. It is a 3 and 1/2 hr drive for me

> > > > > > one way so I am leary. Hopefully all my records will come tomorrow

> > > > > > so I can post about myself in numbers. Unfortunetly I have been

> > > > > > feeling like crap so it is hard to stay focused.

> > > > > > >

> > > > > >

> > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

> >

>

[Guest guest]

Reasons why I think I have PA. BP readings that have been as high 199/100 K drop

from 4.3 to 3.2 after being started 25 MG of HYDROCHLOROTHIAZIDE fulid retention

Dizziness Fatigue Tachycardia shortness of breath brain fog 2 cm tumor on left

adrenal gland

> > > > > > > >

> > > > > > > > Just read through some posts. Playing catch up. I've been busy

> > > > > > > trying to get records, copies of lab reports,med records etc. I

want

> > > > > > > them in my possesion seeing things never faxed like I am told they

> > > > > > > will be. I'm frustrated and wonder if going to Dartmouth in New

> > > > > > > Hampshire will be a waste of time. I have been on the phone with

my

> > > > > > > local endo trying to get copies of records (sign this and that

> > > > > > > first), had to call Beth Israel 3x to get blood work results (and

> > > > > > > now over a week later still haven't recieved a copy in the mail.

The

> > > > > > > tests she did came back " negative " but I am not even sure what she

> > > > > > > was testing for. What I do know is she said " the adrenal glands

> > > > > > > produce more hormones besides aldosterone " she ran a few tests to

> > > > > > > disprove my diagnosis of PA. I am waiting for the results in the

> > > > > > > mail so I can post all my numbers. Basically she told me she

wasn't

> > > > > > > convinced it was PA when I saw her and now after labs came back

she

> > > > > > > is agreeing it is. I have called Dartmouth to verify they treat

> > > > > > > people with PA and are experienced, talked to them in length and

> > > > > > > they have reassured me they will treat me. Somehow I feel it is

> > > > > > > going to be another waste of time. It is a 3 and 1/2 hr drive for

me

> > > > > > > one way so I am leary. Hopefully all my records will come tomorrow

> > > > > > > so I can post about myself in numbers. Unfortunetly I have been

> > > > > > > feeling like crap so it is hard to stay focused.

> > > > > > > >

> > > > > > >

> > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> > >

> >

>

[Guest guest]

IS THERE ANY CHANCE YOU COULD CHANGE THE SUBJECT? WE WERE TALKING ABOUT GETTING

DHMC UP TO SPEED AND YOU DUMPED YOUR NUMBERS RIGHT INTO THE MIDDLE. DR. GRIM

GOT SO EXCITED SEEING YOUR NUMBERS THAT HE JUMPED RIGHT OVER TRYING TO GET DHMC

UP TO SPEED FOR ALL OF US! I spent a fair amount of time researching and

drafting and should be able to get a response! Thank-You - .

> > > > > >

> > > > > > Just read through some posts. Playing catch up. I've been busy

> > > > > trying to get records, copies of lab reports,med records etc. I want

> > > > > them in my possesion seeing things never faxed like I am told they

> > > > > will be. I'm frustrated and wonder if going to Dartmouth in New

> > > > > Hampshire will be a waste of time. I have been on the phone with my

> > > > > local endo trying to get copies of records (sign this and that

> > > > > first), had to call Beth Israel 3x to get blood work results (and

> > > > > now over a week later still haven't recieved a copy in the mail. The

> > > > > tests she did came back " negative " but I am not even sure what she

> > > > > was testing for. What I do know is she said " the adrenal glands

> > > > > produce more hormones besides aldosterone " she ran a few tests to

> > > > > disprove my diagnosis of PA. I am waiting for the results in the

> > > > > mail so I can post all my numbers. Basically she told me she wasn't

> > > > > convinced it was PA when I saw her and now after labs came back she

> > > > > is agreeing it is. I have called Dartmouth to verify they treat

> > > > > people with PA and are experienced, talked to them in length and

> > > > > they have reassured me they will treat me. Somehow I feel it is

> > > > > going to be another waste of time. It is a 3 and 1/2 hr drive for me

> > > > > one way so I am leary. Hopefully all my records will come tomorrow

> > > > > so I can post about myself in numbers. Unfortunetly I have been

> > > > > feeling like crap so it is hard to stay focused.

> > > > > >

> > > > >

> > > > >

> > > > >

> > > >

> > >

> >

>

[Guest guest]

Francis, Would you care to elaborate as to where/how you got your information?

If you will reread my suggestion you will notice I was talking about something

called the " Endocrine Tumors Program " . I picked Dr. Turco because he lists

" Adrenal Disorders " as a speciality and with 30 years is probably one of the

senior members on staff. My guess is that if he is not the right one he might

know who would be better. Have you got a better suggestion?

As an aside, if what you say is true, Dr. Grim might be able to give him a hint

or two!

> > > > >

> > > > > Just read through some posts. Playing catch up. I've been busy

> > > > trying to get records, copies of lab reports,med records etc. I want

> > > > them in my possesion seeing things never faxed like I am told they

> > > > will be. I'm frustrated and wonder if going to Dartmouth in New

> > > > Hampshire will be a waste of time. I have been on the phone with my

> > > > local endo trying to get copies of records (sign this and that

> > > > first), had to call Beth Israel 3x to get blood work results (and

> > > > now over a week later still haven't recieved a copy in the mail. The

> > > > tests she did came back " negative " but I am not even sure what she

> > > > was testing for. What I do know is she said " the adrenal glands

> > > > produce more hormones besides aldosterone " she ran a few tests to

> > > > disprove my diagnosis of PA. I am waiting for the results in the

> > > > mail so I can post all my numbers. Basically she told me she wasn't

> > > > convinced it was PA when I saw her and now after labs came back she

> > > > is agreeing it is. I have called Dartmouth to verify they treat

> > > > people with PA and are experienced, talked to them in length and

> > > > they have reassured me they will treat me. Somehow I feel it is

> > > > going to be another waste of time. It is a 3 and 1/2 hr drive for me

> > > > one way so I am leary. Hopefully all my records will come tomorrow

> > > > so I can post about myself in numbers. Unfortunetly I have been

> > > > feeling like crap so it is hard to stay focused.

> > > > >

> > > >

> > > >

> > > >

> > >

> >

>

[Guest guest]

Late Breaking news: I don't find Dr, Coti in the database this morning, did he

retire? If that is the case I would go with BelBruno. I might go with her

anyway. aqasa65d

> > > > > > > > > >

> > > > > > > > > > Just read through some posts. Playing catch up. I've been

busy

> > > > > > > > > trying to get records, copies of lab reports,med records etc.

I want

> > > > > > > > > them in my possesion seeing things never faxed like I am told

they

> > > > > > > > > will be. I'm frustrated and wonder if going to Dartmouth in

New

> > > > > > > > > Hampshire will be a waste of time. I have been on the phone

with my

> > > > > > > > > local endo trying to get copies of records (sign this and that

> > > > > > > > > first), had to call Beth Israel 3x to get blood work results

(and

> > > > > > > > > now over a week later still haven't recieved a copy in the

mail. The

> > > > > > > > > tests she did came back " negative " but I am not even sure what

she

> > > > > > > > > was testing for. What I do know is she said " the adrenal

glands

> > > > > > > > > produce more hormones besides aldosterone " she ran a few tests

to

> > > > > > > > > disprove my diagnosis of PA. I am waiting for the results in

the

> > > > > > > > > mail so I can post all my numbers. Basically she told me she

wasn't

> > > > > > > > > convinced it was PA when I saw her and now after labs came

back she

> > > > > > > > > is agreeing it is. I have called Dartmouth to verify they

treat

> > > > > > > > > people with PA and are experienced, talked to them in length

and

> > > > > > > > > they have reassured me they will treat me. Somehow I feel it

is

> > > > > > > > > going to be another waste of time. It is a 3 and 1/2 hr drive

for me

> > > > > > > > > one way so I am leary. Hopefully all my records will come

tomorrow

> > > > > > > > > so I can post about myself in numbers. Unfortunetly I have

been

> > > > > > > > > feeling like crap so it is hard to stay focused.

> > > > > > > > > >

> > > > > > > > >

> > > > > > > > >

> > > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

[Guest guest]

You have the name wrong it is Comi.

> > > > > > > > > > >

> > > > > > > > > > > Just read through some posts. Playing catch up. I've been

busy

> > > > > > > > > > trying to get records, copies of lab reports,med records

etc. I want

> > > > > > > > > > them in my possesion seeing things never faxed like I am

told they

> > > > > > > > > > will be. I'm frustrated and wonder if going to Dartmouth in

New

> > > > > > > > > > Hampshire will be a waste of time. I have been on the phone

with my

> > > > > > > > > > local endo trying to get copies of records (sign this and

that

> > > > > > > > > > first), had to call Beth Israel 3x to get blood work results

(and

> > > > > > > > > > now over a week later still haven't recieved a copy in the

mail. The

> > > > > > > > > > tests she did came back " negative " but I am not even sure

what she

> > > > > > > > > > was testing for. What I do know is she said " the adrenal

glands

> > > > > > > > > > produce more hormones besides aldosterone " she ran a few

tests to

> > > > > > > > > > disprove my diagnosis of PA. I am waiting for the results in

the

> > > > > > > > > > mail so I can post all my numbers. Basically she told me she

wasn't

> > > > > > > > > > convinced it was PA when I saw her and now after labs came

back she

> > > > > > > > > > is agreeing it is. I have called Dartmouth to verify they

treat

> > > > > > > > > > people with PA and are experienced, talked to them in length

and

> > > > > > > > > > they have reassured me they will treat me. Somehow I feel it

is

> > > > > > > > > > going to be another waste of time. It is a 3 and 1/2 hr

drive for me

> > > > > > > > > > one way so I am leary. Hopefully all my records will come

tomorrow

> > > > > > > > > > so I can post about myself in numbers. Unfortunetly I have

been

> > > > > > > > > > feeling like crap so it is hard to stay focused.

> > > > > > > > > > >

> > > > > > > > > >

> > > > > > > > > >

> > > > > > > > > >

> > > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

[Guest guest]

THANKS, it does help to spell it correctly!

I'm still a little confused, Turco is at Norris Cotton I believe after I look at

it again. My guess is probably better to stay in the main hospital with this

one. Still leaning toward BelBruno!

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

> > > > > > > > > > > > Just read through some posts. Playing catch up. I've

been busy

> > > > > > > > > > > trying to get records, copies of lab reports,med records

etc. I want

> > > > > > > > > > > them in my possesion seeing things never faxed like I am

told they

> > > > > > > > > > > will be. I'm frustrated and wonder if going to Dartmouth

in New

> > > > > > > > > > > Hampshire will be a waste of time. I have been on the

phone with my

> > > > > > > > > > > local endo trying to get copies of records (sign this and

that

> > > > > > > > > > > first), had to call Beth Israel 3x to get blood work

results (and

> > > > > > > > > > > now over a week later still haven't recieved a copy in the

mail. The

> > > > > > > > > > > tests she did came back " negative " but I am not even sure

what she

> > > > > > > > > > > was testing for. What I do know is she said " the adrenal

glands

> > > > > > > > > > > produce more hormones besides aldosterone " she ran a few

tests to

> > > > > > > > > > > disprove my diagnosis of PA. I am waiting for the results

in the

> > > > > > > > > > > mail so I can post all my numbers. Basically she told me

she wasn't

> > > > > > > > > > > convinced it was PA when I saw her and now after labs came

back she

> > > > > > > > > > > is agreeing it is. I have called Dartmouth to verify they

treat

> > > > > > > > > > > people with PA and are experienced, talked to them in

length and

> > > > > > > > > > > they have reassured me they will treat me. Somehow I feel

it is

> > > > > > > > > > > going to be another waste of time. It is a 3 and 1/2 hr

drive for me

> > > > > > > > > > > one way so I am leary. Hopefully all my records will come

tomorrow

> > > > > > > > > > > so I can post about myself in numbers. Unfortunetly I have

been

> > > > > > > > > > > feeling like crap so it is hard to stay focused.

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

> > > > > > > > > > >

> > > > > > > > > > >

> > > > > > > > > > >

> > > > > > > > > >

> > > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

[Guest guest]

The Endocrine Tumors Program is done at Norris Cotton.

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

> > > > > > > > > > > > > Just read through some posts. Playing catch up. I've

been busy

> > > > > > > > > > > > trying to get records, copies of lab reports,med records

etc. I want

> > > > > > > > > > > > them in my possesion seeing things never faxed like I am

told they

> > > > > > > > > > > > will be. I'm frustrated and wonder if going to Dartmouth

in New

> > > > > > > > > > > > Hampshire will be a waste of time. I have been on the

phone with my

> > > > > > > > > > > > local endo trying to get copies of records (sign this

and that

> > > > > > > > > > > > first), had to call Beth Israel 3x to get blood work

results (and

> > > > > > > > > > > > now over a week later still haven't recieved a copy in

the mail. The

> > > > > > > > > > > > tests she did came back " negative " but I am not even

sure what she

> > > > > > > > > > > > was testing for. What I do know is she said " the adrenal

glands

> > > > > > > > > > > > produce more hormones besides aldosterone " she ran a few

tests to

> > > > > > > > > > > > disprove my diagnosis of PA. I am waiting for the

results in the

> > > > > > > > > > > > mail so I can post all my numbers. Basically she told me

she wasn't

> > > > > > > > > > > > convinced it was PA when I saw her and now after labs

came back she

> > > > > > > > > > > > is agreeing it is. I have called Dartmouth to verify

they treat

> > > > > > > > > > > > people with PA and are experienced, talked to them in

length and

> > > > > > > > > > > > they have reassured me they will treat me. Somehow I

feel it is

> > > > > > > > > > > > going to be another waste of time. It is a 3 and 1/2 hr

drive for me

> > > > > > > > > > > > one way so I am leary. Hopefully all my records will

come tomorrow

> > > > > > > > > > > > so I can post about myself in numbers. Unfortunetly I

have been

> > > > > > > > > > > > feeling like crap so it is hard to stay focused.

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

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

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

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

> > > > > > > > > > >

> > > > > > > > > >

> > > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

[Guest guest]

Ok. I will do this Dr. Grim. Thanks.

Lettie

> > > >

> > > > Just read through some posts. Playing catch up. I've been busy

> > trying to get records, copies of lab reports,med records etc. I want

> > them in my possesion seeing things never faxed like I am told they

> > will be. I'm frustrated and wonder if going to Dartmouth in New

> > Hampshire will be a waste of time. I have been on the phone with my

> > local endo trying to get copies of records (sign this and that

> > first), had to call Beth Israel 3x to get blood work results (and

> > now over a week later still haven't recieved a copy in the mail. The

> > tests she did came back " negative " but I am not even sure what she

> > was testing for. What I do know is she said " the adrenal glands

> > produce more hormones besides aldosterone " she ran a few tests to

> > disprove my diagnosis of PA. I am waiting for the results in the

> > mail so I can post all my numbers. Basically she told me she wasn't

> > convinced it was PA when I saw her and now after labs came back she

> > is agreeing it is. I have called Dartmouth to verify they treat

> > people with PA and are experienced, talked to them in length and

> > they have reassured me they will treat me. Somehow I feel it is

> > going to be another waste of time. It is a 3 and 1/2 hr drive for me

> > one way so I am leary. Hopefully all my records will come tomorrow

> > so I can post about myself in numbers. Unfortunetly I have been

> > feeling like crap so it is hard to stay focused.

> > > >

> > >

> >

> >

> >

>

[Guest guest]

Doesn't the Lab have to supply the jug for 24 hr urine?

> > > > >

> > > > > Just read through some posts. Playing catch up. I've been busy

> > > trying to get records, copies of lab reports,med records etc. I want

> > > them in my possesion seeing things never faxed like I am told they

> > > will be. I'm frustrated and wonder if going to Dartmouth in New

> > > Hampshire will be a waste of time. I have been on the phone with my

> > > local endo trying to get copies of records (sign this and that

> > > first), had to call Beth Israel 3x to get blood work results (and

> > > now over a week later still haven't recieved a copy in the mail. The

> > > tests she did came back " negative " but I am not even sure what she

> > > was testing for. What I do know is she said " the adrenal glands

> > > produce more hormones besides aldosterone " she ran a few tests to

> > > disprove my diagnosis of PA. I am waiting for the results in the

> > > mail so I can post all my numbers. Basically she told me she wasn't

> > > convinced it was PA when I saw her and now after labs came back she

> > > is agreeing it is. I have called Dartmouth to verify they treat

> > > people with PA and are experienced, talked to them in length and

> > > they have reassured me they will treat me. Somehow I feel it is

> > > going to be another waste of time. It is a 3 and 1/2 hr drive for me

> > > one way so I am leary. Hopefully all my records will come tomorrow

> > > so I can post about myself in numbers. Unfortunetly I have been

> > > feeling like crap so it is hard to stay focused.

> > > > >

> > > >

> > >

> > >

> > >

> >

>

[Guest guest]

my lab not only supplied the jug, but reminded me to keep it cold,  void hte first urine of the first day of collection and then catch up to the first morning urine the next day.

also they needed a lab slip with the specifics on which tests to do.

Pam

 

Doesn't the Lab have to supply the jug for 24 hr urine? > > > > >> > > > > Just read through some posts. Playing catch up. I've been busy > > > trying to get records, copies of lab reports,med records etc. I want

> > > them in my possesion seeing things never faxed like I am told they > > > will be. I'm frustrated and wonder if going to Dartmouth in New > > > Hampshire will be a waste of time. I have been on the phone with my

> > > local endo trying to get copies of records (sign this and that > > > first), had to call Beth Israel 3x to get blood work results (and > > > now over a week later still haven't recieved a copy in the mail. The

> > > tests she did came back " negative " but I am not even sure what she > > > was testing for. What I do know is she said " the adrenal glands > > > produce more hormones besides aldosterone " she ran a few tests to

> > > disprove my diagnosis of PA. I am waiting for the results in the > > > mail so I can post all my numbers. Basically she told me she wasn't > > > convinced it was PA when I saw her and now after labs came back she

> > > is agreeing it is. I have called Dartmouth to verify they treat > > > people with PA and are experienced, talked to them in length and > > > they have reassured me they will treat me. Somehow I feel it is

> > > going to be another waste of time. It is a 3 and 1/2 hr drive for me > > > one way so I am leary. Hopefully all my records will come tomorrow > > > so I can post about myself in numbers. Unfortunetly I have been

> > > feeling like crap so it is hard to stay focused.> > > > >> > > >> > >> > >> > >> >>

[Guest guest]

Not for Na,k for creat need to keep cold. Was the jug first. Doing so will save repeat testing. Without this testing renin and Aldo is pissing in the wind. Well maybe not pissing in the wind. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

my lab not only supplied the jug, but reminded me to keep it cold, void hte first urine of the first day of collection and then catch up to the first morning urine the next day.

also they needed a lab slip with the specifics on which tests to do.

Pam

Doesn't the Lab have to supply the jug for 24 hr urine? > > > > >> > > > > Just read through some posts. Playing catch up. I've been busy > > > trying to get records, copies of lab reports,med records etc. I want

> > > them in my possesion seeing things never faxed like I am told they > > > will be. I'm frustrated and wonder if going to Dartmouth in New > > > Hampshire will be a waste of time. I have been on the phone with my

> > > local endo trying to get copies of records (sign this and that > > > first), had to call Beth Israel 3x to get blood work results (and > > > now over a week later still haven't recieved a copy in the mail. The

> > > tests she did came back "negative" but I am not even sure what she > > > was testing for. What I do know is she said "the adrenal glands > > > produce more hormones besides aldosterone" she ran a few tests to

> > > disprove my diagnosis of PA. I am waiting for the results in the > > > mail so I can post all my numbers. Basically she told me she wasn't > > > convinced it was PA when I saw her and now after labs came back she

> > > is agreeing it is. I have called Dartmouth to verify they treat > > > people with PA and are experienced, talked to them in length and > > > they have reassured me they will treat me. Somehow I feel it is

> > > going to be another waste of time. It is a 3 and 1/2 hr drive for me > > > one way so I am leary. Hopefully all my records will come tomorrow > > > so I can post about myself in numbers. Unfortunetly I have been

> > > feeling like crap so it is hard to stay focused.> > > > >> > > >> > >> > >> > >> >>

[Guest guest]

Better to ask them for a jug. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

my lab not only supplied the jug, but reminded me to keep it cold, void hte first urine of the first day of collection and then catch up to the first morning urine the next day.

also they needed a lab slip with the specifics on which tests to do.

Pam

Doesn't the Lab have to supply the jug for 24 hr urine? > > > > >> > > > > Just read through some posts. Playing catch up. I've been busy > > > trying to get records, copies of lab reports,med records etc. I want

> > > them in my possesion seeing things never faxed like I am told they > > > will be. I'm frustrated and wonder if going to Dartmouth in New > > > Hampshire will be a waste of time. I have been on the phone with my

> > > local endo trying to get copies of records (sign this and that > > > first), had to call Beth Israel 3x to get blood work results (and > > > now over a week later still haven't recieved a copy in the mail. The

> > > tests she did came back "negative" but I am not even sure what she > > > was testing for. What I do know is she said "the adrenal glands > > > produce more hormones besides aldosterone" she ran a few tests to

> > > disprove my diagnosis of PA. I am waiting for the results in the > > > mail so I can post all my numbers. Basically she told me she wasn't > > > convinced it was PA when I saw her and now after labs came back she

> > > is agreeing it is. I have called Dartmouth to verify they treat > > > people with PA and are experienced, talked to them in length and > > > they have reassured me they will treat me. Somehow I feel it is

> > > going to be another waste of time. It is a 3 and 1/2 hr drive for me > > > one way so I am leary. Hopefully all my records will come tomorrow > > > so I can post about myself in numbers. Unfortunetly I have been

> > > feeling like crap so it is hard to stay focused.> > > > >> > > >> > >> > >> > >> >>

[Guest guest]

While doing 24 hr urine at the same time as testing renin and aldo gives a

better idea is to what is going on. Isn't doing just the renin aldo going to

give some information.

> > > > > > >

> > > > > > > Just read through some posts. Playing catch up. I've been busy

> > > > > trying to get records, copies of lab reports,med records etc. I want

> > > > > them in my possesion seeing things never faxed like I am told they

> > > > > will be. I'm frustrated and wonder if going to Dartmouth in New

> > > > > Hampshire will be a waste of time. I have been on the phone with my

> > > > > local endo trying to get copies of records (sign this and that

> > > > > first), had to call Beth Israel 3x to get blood work results (and

> > > > > now over a week later still haven't recieved a copy in the mail. The

> > > > > tests she did came back " negative " but I am not even sure what she

> > > > > was testing for. What I do know is she said " the adrenal glands

> > > > > produce more hormones besides aldosterone " she ran a few tests to

> > > > > disprove my diagnosis of PA. I am waiting for the results in the

> > > > > mail so I can post all my numbers. Basically she told me she wasn't

> > > > > convinced it was PA when I saw her and now after labs came back she

> > > > > is agreeing it is. I have called Dartmouth to verify they treat

> > > > > people with PA and are experienced, talked to them in length and

> > > > > they have reassured me they will treat me. Somehow I feel it is

> > > > > going to be another waste of time. It is a 3 and 1/2 hr drive for me

> > > > > one way so I am leary. Hopefully all my records will come tomorrow

> > > > > so I can post about myself in numbers. Unfortunetly I have been

> > > > > feeling like crap so it is hard to stay focused.

> > > > > > >

> > > > > >

> > > > >

> > > > >

> > > > >

> > > >

> > >

> >

> >

> >

> >

>

[Guest guest]

Yes it tells you what is is at the time it was tested. However you cannot tell if it is high or low or what without a 24 hr urine Na ,K and Creatinine. This has been stressed since about 1955. But most ignore it. Thus they cannot properly interpret it. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

While doing 24 hr urine at the same time as testing renin and aldo gives a better idea is to what is going on. Isn't doing just the renin aldo going to give some information.

> > > >

> > > > Mattie: always have who you are in your intro so I can keep you

> > > > straight.

> > > >

> > > > I would begin to collect a 24 hr urine and take in in with you and go

> > > > in fasting to save another trip.

> > > >

> > > > Take her my article and tell her we are here to help.

> > > >

> > > > See Item 7 below.

> > > >

> > > > List all meds you are on as well.

> > > >

> > > > CE Grim MD

> > > > Welcome to the exciting world of Hyperaldosteronism!

> > > >

> > > > You are in the right place!

> > > >

> > > > I am Dr. CE Grim a retired Professor of Medicine and Endocrinology.

> > > >

> > > > I have a long standing interest is Primary Aldosteronism since medical

> > > > school days when I saw my first patient with Primary Aldosteronism in

> > > > 1963. I trained with Dr. Jerome W. Conn in Endocrinology and

> > > > Metabolism 1969-70 and have published over 240 papers and book

> > > > chapters in most areas of the discipline of High Blood Pressure. My

> > > > CV is in our files for details.

> > > >

> > > > The goal of our group is to teach you and your health care team about

> > > > the ins and outs of the causes, diagnosis and control of the many

> > > > forms of hyperaldosteronism.

> > > >

> > > > The steps below will introduce you into the fascinating world of high

> > > > blood pressure, salt (sodium(Na) chloride (Cl) or NaCL) and potassium

> > > > (K) and the role of the adrenal hormone aldosterone in health and

> > > > disease. Doing these in sequence will save you time and effort in

> > > > getting up to speed in taking control of you health and educating your

> > > > own health care team.

> > > >

> > > > While we can't make you into a doctor we will make you into a pretty

> > > > good BP doctor-a skill that you will have for life and you can

> > > > transfer to the rest of your family who will likely have high blood

> > > > pressure eventually-if they live long enough.

> > > >

> > > > 1. A brief history of Primary Aldosteronsim and why it is so common

> > > > today in drug resistant high blood pressure. Read my article in our

> > > > files on the evolution of PA (Evolution_of_PA-Grim.pdf ) and take to

> > > > all members of health care team. Tell us what stage you believe you

> > > > are in. This is a brief review of most causes of hyperaldosteronism,

> > > > high blood pressure, low potassium (K). READING THIS WILL SAVE YOU

> > > > TIME AND MONEY. By taking it to your health care team they will not

> > > > treat their other patients in the future as badly as they may have

> > > > treated you in the past.

> > > >

> > > > 2. Read about other patients with hyperaldosteronism (Conn's

> > > > syndrome). Read our Conn's stories in our files and then give us your

> > > > own in as much detail as you can. Dr. Conn was the first to describe

> > > > this disease process and the syndrome is named after him. The first

> > > > patient is described in my review article.

> > > >

> > > > To see others' stories, on the Hyperaldosteronism home page, go to

> > > > Files/Conn's Stories.

> > > > You'll find instructions in "A - How to put your story here.doc "

> > > > First send us your story in an email and they we may have questions

> > > > and suggestions before you upload it to our files.

> > > >

> > > > 3. DASH to lower your BP. Your and my tax dollars funded the most

> > > > important series of studies on how to improve blood pressure, blood

> > > > sugar, blood lipids and make your heart smaller: The DASH Eating Plan

> > > > to control high blood pressure due to hyperaldosteronism and most

> > > > others with high blood pressure. This will reduce your need for

> > > > medications and in many will get your BP and K to goal without meds..

> > > > Get the DASH diet book by T. et al, (http://www.amazon.com/DASH-Diet-Hypertension--/dp/0743202953

> > > > ) read it and use it: ~$8 in paperback at your local bookstore or

> > > > online. If they don't have it ask them to order it for you. You can

> > > > also get the hardback larger print version as well at Amazon. Learning

> > > > to eat the DASH way will play a major role in your road to good BP and

> > > > K control and, in many of our folks here, will revolutionize your

> > > > life. See http://en.wikipedia.org/wiki/DASH_diet for an overview and

> > > > more details.

> > > >

> > > > In the book go to chapter 9 and do the 14 day challenge. Tell

> > > > your Dr you are doing this as your BP may plummet if you are on other

> > > > meds. Measure your BP every day and post to us.

> > > >

> > > > or

> > > >

> > > > go to http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf

> > > >

> > > > download this 64 page booklet free and do the Week on the DASH Diet

> > > > for 2 weeks. If you are on BP meds be prepared for a large fall in BP

> > > > (20/10 mm Hg or more) and let your Dr. know you are doing this.

> > > >

> > > > And/Or go to (but costs money monthly)

> > > >

> > > > DASH Diet for Health Program (http://www.dashforhealth.com/pages/public/tour.php

> > > > )

> > > > The DASH Diet for Health Program is designed to help you improve your

> > > > eating and exercise habits. Twice each week they will provide you with

> > > > information on our website about food, food preparation, eating out,

> > > > losing weight, getting fit and much more. In addition to providing new

> > > > information each week on the website, they create a web page specially

> > > > for you where you can track progress in areas such as your weight,

> > > > blood pressure, and exercise.

> > > >

> > > > I strongly recommend you get this book by .... and read it.

> > > >

> > > > 4. Measure your BP: Measure your BP daily so you can see if it is

> > > > getting better. If you are taking meds be sure to tell your health

> > > > care team you are doing this as your BP may plummet to normal

> > > > quickly. We recommend you use a device you listen to and will help

> > > > you learn how to do this. If this is not something you want to do we

> > > > can teach a significant other how to do it. See sharedcareinc.com or

> > > > email to sharedcare@ to order a video on how to do this. If you

> > > > already have one we will teach you how to teach your health care team

> > > > how to validate your device. Your life and health depends on accurate

> > > > BP measurements.

> > > >

> > > > Go to the amricanheart.org and download the Guidelines for Human Blood

> > > > Pressure Measurement. Insist that your health care team do BP the AHA

> > > > way. Never trust your life to an automatic BP machine unless you know

> > > > it is accurate on YOU.

> > > >

> > > > 5. Genetics and your BP: If you have a twin be sure to let us know.

> > > > Go to familyhistory.hhs.gov and do your detailed family medical

> > > > history (FHx or FH) so we can review with you to help diagnosis (Dx)

> > > > and treat (Rx) familial causes of high blood pressure and heart

> > > > disease. If BP runs in your family you may save lives in your family

> > > > by checking their BP yourself.

> > > >

> > > > 6. How to DX and treat PA: Go to our file

> > > > /Conn's Articles of Note/Medications/Bravo spir 1973.pdf and read this

> > > > article and take to your health care team. It is old but still one of

> > > > the best in the medical management of PA. Note one with PA whose BP

> > > > and K normalized with low Na, High K diet and only 25 mg of spiro.

> > > >

> > > > DX: Also see our file from the Endocrine Society Guidelines on PA.

> > > >

> > > > 7. Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing

> > > > to diagnose PA in one day.

> > > >

> > > > 1. Eat a regular to high salt diet for 2 weeks.

> > > > 2. No BP meds in last 4-12 weeks depending on meds.

> > > > 3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do

> > > > not lose a drop of this liquid gold. It is impossible to interpret

> > > > the renin and aldo without this.

> > > > 4. The morning you finish the 24 hr urine have fasting blood drawn for

> > > > renin, aldo and K using our guidelines to get an accurate K (http://groups.yahoo.com/group/hyperaldosteronism/files/Investigating%20elevated%20potassium%20values..txt

> > > > ) Try to get this done about 4 hours after you have been out of bed.

> > > > 5. Send us the results with the normal values for your lab.

> > > > 6. If you ever have a salt (saline) infusion test for PA be certain to

> > > > ask them to measure how much you pee during the 4 hours of the

> > > > infusion. If it is 1-1.5 liter of urine it strongly suggests that you

> > > > may have PA. If more tha 1.5 L you almost certainly have PA. I helped

> > > > perfect this test and have probably done more saline infusions than

> > > > anyone in the world.

> > > >

> > > > 8. Become a participant in our PA Registry and contribute to our

> > > > large database on PA: If you have been Dxed with PA already and are

> > > > on Rx or have had surgery please go

> > > >

> > > > to http://www.kwiksurveys.com/online-survey.php?

> > > > surveyID=HIJIO_f2685379

> > > >

> > > > and complete our survey with as much information as you know. If

> > > > there is some information you don't know ask us and we will help. If

> > > > you need to update this as you journey thru the diagnostic/treatment

> > > > process you can add another entry but label it as Nameyymmdd. For

> > > > example today 6/12/09 for me would be Grim090612. This ever

> > > > increasing number will allow us and you to sort your multiple entries

> > > > into a dated order.

> > > >

> > > > 9. Learn the language: If you are new to medical lingo then

> > > > download the acroyms from

> > > >

> > > > http://health.groups.yahoo.com/group/bloodpressureline/message/29186

> > > >

> > > > 10. Salt and high blood pressure: To learn the state of the science

> > > > of salt and blood pressure please spend some time looking at

> > > > http://www.worldactiononsalt.com/evidence/treatment_trials.htm

> > > >

> > > > 11. Become a HBP expert consumer: Expect that it will take at least

> > > > several weeks to get all this digested and to learn the new language

> > > > of high blood pressure health care. As most doctors and nurses in

> > > > practice have had very little training in high blood pressur

[Guest guest]

We need to understand this more. Are you saying one can have blood test show

renin of .5 and aldo of 40 they may not have PA. They do say renin aldo test is

only screening test. Not a DX test. Without doing 24 hour urine you are saying

above blood test isn't going to mean much.

> > > > > >

> > > > > > Mattie: always have who you are in your intro so I can keep you

> > > > > > straight.

> > > > > >

> > > > > > I would begin to collect a 24 hr urine and take in in with you and

go

> > > > > > in fasting to save another trip.

> > > > > >

> > > > > > Take her my article and tell her we are here to help.

> > > > > >

> > > > > > See Item 7 below.

> > > > > >

> > > > > > List all meds you are on as well.

> > > > > >

> > > > > > CE Grim MD

> > > > > > Welcome to the exciting world of Hyperaldosteronism!

> > > > > >

> > > > > > You are in the right place!

> > > > > >

> > > > > > I am Dr. CE Grim a retired Professor of Medicine and Endocrinology.

> > > > > >

> > > > > > I have a long standing interest is Primary Aldosteronism since

medical

> > > > > > school days when I saw my first patient with Primary Aldosteronism

in

> > > > > > 1963. I trained with Dr. Jerome W. Conn in Endocrinology and

> > > > > > Metabolism 1969-70 and have published over 240 papers and book

> > > > > > chapters in most areas of the discipline of High Blood Pressure. My

> > > > > > CV is in our files for details.

> > > > > >

> > > > > > The goal of our group is to teach you and your health care team

about

> > > > > > the ins and outs of the causes, diagnosis and control of the many

> > > > > > forms of hyperaldosteronism.

> > > > > >

> > > > > > The steps below will introduce you into the fascinating world of

high

> > > > > > blood pressure, salt (sodium(Na) chloride (Cl) or NaCL) and

potassium

> > > > > > (K) and the role of the adrenal hormone aldosterone in health and

> > > > > > disease. Doing these in sequence will save you time and effort in

> > > > > > getting up to speed in taking control of you health and educating

your

> > > > > > own health care team.

> > > > > >

> > > > > > While we can't make you into a doctor we will make you into a pretty

> > > > > > good BP doctor-a skill that you will have for life and you can

> > > > > > transfer to the rest of your family who will likely have high blood

> > > > > > pressure eventually-if they live long enough.

> > > > > >

> > > > > > 1. A brief history of Primary Aldosteronsim and why it is so common

> > > > > > today in drug resistant high blood pressure. Read my article in our

> > > > > > files on the evolution of PA (Evolution_of_PA-Grim.pdf ) and take to

> > > > > > all members of health care team. Tell us what stage you believe you

> > > > > > are in. This is a brief review of most causes of hyperaldosteronism,

> > > > > > high blood pressure, low potassium (K). READING THIS WILL SAVE YOU

> > > > > > TIME AND MONEY. By taking it to your health care team they will not

> > > > > > treat their other patients in the future as badly as they may have

> > > > > > treated you in the past.

> > > > > >

> > > > > > 2. Read about other patients with hyperaldosteronism (Conn's

> > > > > > syndrome). Read our Conn's stories in our files and then give us

your

> > > > > > own in as much detail as you can. Dr. Conn was the first to describe

> > > > > > this disease process and the syndrome is named after him. The first

> > > > > > patient is described in my review article.

> > > > > >

> > > > > > To see others' stories, on the Hyperaldosteronism home page, go to

> > > > > > Files/Conn's Stories.

> > > > > > You'll find instructions in " A - How to put your story here.doc "

> > > > > > First send us your story in an email and they we may have questions

> > > > > > and suggestions before you upload it to our files.

> > > > > >

> > > > > > 3. DASH to lower your BP. Your and my tax dollars funded the most

> > > > > > important series of studies on how to improve blood pressure, blood

> > > > > > sugar, blood lipids and make your heart smaller: The DASH Eating

Plan

> > > > > > to control high blood pressure due to hyperaldosteronism and most

> > > > > > others with high blood pressure. This will reduce your need for

> > > > > > medications and in many will get your BP and K to goal without

meds..

> > > > > > Get the DASH diet book by T. et al,

(http://www.amazon.com/DASH-Diet-Hypertension--/dp/0743202953

> > > > > > ) read it and use it: ~$8 in paperback at your local bookstore or

> > > > > > online. If they don't have it ask them to order it for you. You can

> > > > > > also get the hardback larger print version as well at Amazon.

Learning

> > > > > > to eat the DASH way will play a major role in your road to good BP

and

> > > > > > K control and, in many of our folks here, will revolutionize your

> > > > > > life. See http://en.wikipedia.org/wiki/DASH_diet for an overview and

> > > > > > more details.

> > > > > >

> > > > > > In the book go to chapter 9 and do the 14 day challenge. Tell

> > > > > > your Dr you are doing this as your BP may plummet if you are on

other

> > > > > > meds. Measure your BP every day and post to us.

> > > > > >

> > > > > > or

> > > > > >

> > > > > > go to

http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf

> > > > > >

> > > > > > download this 64 page booklet free and do the Week on the DASH Diet

> > > > > > for 2 weeks. If you are on BP meds be prepared for a large fall in

BP

> > > > > > (20/10 mm Hg or more) and let your Dr. know you are doing this.

> > > > > >

> > > > > > And/Or go to (but costs money monthly)

> > > > > >

> > > > > > DASH Diet for Health Program

(http://www.dashforhealth.com/pages/public/tour.php

> > > > > > )

> > > > > > The DASH Diet for Health Program is designed to help you improve

your

> > > > > > eating and exercise habits. Twice each week they will provide you

with

> > > > > > information on our website about food, food preparation, eating out,

> > > > > > losing weight, getting fit and much more. In addition to providing

new

> > > > > > information each week on the website, they create a web page

specially

> > > > > > for you where you can track progress in areas such as your weight,

> > > > > > blood pressure, and exercise.

> > > > > >

> > > > > > I strongly recommend you get this book by .... and read it.

> > > > > >

> > > > > > 4. Measure your BP: Measure your BP daily so you can see if it is

> > > > > > getting better. If you are taking meds be sure to tell your health

> > > > > > care team you are doing this as your BP may plummet to normal

> > > > > > quickly. We recommend you use a device you listen to and will help

> > > > > > you learn how to do this. If this is not something you want to do we

> > > > > > can teach a significant other how to do it. See sharedcareinc.com or

> > > > > > email to sharedcare@ to order a video on how to do this. If you

> > > > > > already have one we will teach you how to teach your health care

team

> > > > > > how to validate your device. Your life and health depends on

accurate

> > > > > > BP measurements.

> > > > > >

> > > > > > Go to the amricanheart.org and download the Guidelines for Human

Blood

> > > > > > Pressure Measurement. Insist that your health care team do BP the

AHA

> > > > > > way. Never trust your life to an automatic BP machine unless you

know

> > > > > > it is accurate on YOU.

> > > > > >

> > > > > > 5. Genetics and your BP: If you have a twin be sure to let us know.

> > > > > > Go to familyhistory.hhs.gov and do your detailed family medical

> > > > > > history (FHx or FH) so we can review with you to help diagnosis (Dx)

> > > > > > and treat (Rx) familial causes of high blood pressure and heart

> > > > > > disease. If BP runs in your family you may save lives in your family

> > > > > > by checking their BP yourself.

> > > > > >

> > > > > > 6. How to DX and treat PA: Go to our file

> > > > > > /Conn's Articles of Note/Medications/Bravo spir 1973.pdf and read

this

> > > > > > article and take to your health care team. It is old but still one

of

> > > > > > the best in the medical management of PA. Note one with PA whose BP

> > > > > > and K normalized with low Na, High K diet and only 25 mg of spiro.

> > > > > >

> > > > > > DX: Also see our file from the Endocrine Society Guidelines on PA.

> > > > > >

> > > > > > 7. Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing

> > > > > > to diagnose PA in one day.

> > > > > >

> > > > > > 1. Eat a regular to high salt diet for 2 weeks.

> > > > > > 2. No BP meds in last 4-12 weeks depending on meds.

> > > > > > 3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do

> > > > > > not lose a drop of this liquid gold. It is impossible to interpret

> > > > > > the renin and aldo without this.

> > > > > > 4. The morning you finish the 24 hr urine have fasting blood drawn

for

> > > > > > renin, aldo and K using our guidelines to get an accurate K

(http://groups.yahoo.com/group/hyperaldosteronism/files/Investigating%20elevated\

%20potassium%20values..txt

> > > > > > ) Try to get this done about 4 hours after you have been out of bed.

> > > > > > 5. Send us the results with the normal values for your lab.

> > > > > > 6. If you ever have a salt (saline) infusion test for PA be certain

to

> > > > > > ask them to measure how much you pee during the 4 hours of the

> > > > > > infusion. If it is 1-1.5 liter of urine it strongly suggests that

you

> > > > > > may have PA. If more tha 1.5 L you almost certainly have PA. I

helped

> > > > > > perfect this test and have probably done more saline infusions than

> > > > > > anyone in the world.

> > > > > >

> > > > > > 8. Become a participant in our PA Registry and contribute to our

> > > > > > large database on PA: If you have been Dxed with PA already and are

> > > > > > on Rx or have had surgery please go

> > > > > >

> > > > > > to http://www.kwiksurveys.com/online-survey.php?

> > > > > > surveyID=HIJIO_f2685379

> > > > > >

> > > > > > and complete our survey with as much information as you know. If

> > > > > > there is some information you don't know ask us and we will help. If

> > > > > > you need to update this as you journey thru the diagnostic/treatment

> > > > > > process you can add another entry but label it as Nameyymmdd. For

> > > > > > example today 6/12/09 for me would be Grim090612. This ever

> > > > > > increasing number will allow us and you to sort your multiple

entries

> > > > > > into a dated order.

> > > > > >

> > > > > > 9. Learn the language: If you are new to medical lingo then

> > > > > > download the acroyms from

> > > > > >

> > > > > > http://health.groups.yahoo.com/group/bloodpressureline/message/29186

> > > > > >

> > > > > > 10. Salt and high blood pressure: To learn the state of the science

> > > > > > of salt and blood pressure please spend some time looking at

> > > > > > http://www.worldactiononsalt.com/evidence/treatment_trials.htm

> > > > > >

> > > > > > 11. Become a HBP expert consumer: Expect that it will take at least

> > > > > > several weeks to get all this digested and to learn the new language

> > > > > > of high blood pressure health care. As most doctors and nurses in

> > > > > > practice have had very little training in high blood pressur

>

[Guest guest]

If one were on a very high Na intake the renin could be normal but the also is high or normal or even low depending on the that labs normal values. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

We need to understand this more. Are you saying one can have blood test show renin of .5 and aldo of 40 they may not have PA. They do say renin aldo test is only screening test. Not a DX test. Without doing 24 hour urine you are saying above blood test isn't going to mean much.

> > > > > >

> > > > > > Mattie: always have who you are in your intro so I can keep you

> > > > > > straight.

> > > > > >

> > > > > > I would begin to collect a 24 hr urine and take in in with you and go

> > > > > > in fasting to save another trip.

> > > > > >

> > > > > > Take her my article and tell her we are here to help.

> > > > > >

> > > > > > See Item 7 below.

> > > > > >

> > > > > > List all meds you are on as well.

> > > > > >

> > > > > > CE Grim MD

> > > > > > Welcome to the exciting world of Hyperaldosteronism!

> > > > > >

> > > > > > You are in the right place!

> > > > > >

> > > > > > I am Dr. CE Grim a retired Professor of Medicine and Endocrinology.

> > > > > >

> > > > > > I have a long standing interest is Primary Aldosteronism since medical

> > > > > > school days when I saw my first patient with Primary Aldosteronism in

> > > > > > 1963. I trained with Dr. Jerome W. Conn in Endocrinology and

> > > > > > Metabolism 1969-70 and have published over 240 papers and book

> > > > > > chapters in most areas of the discipline of High Blood Pressure. My

> > > > > > CV is in our files for details.

> > > > > >

> > > > > > The goal of our group is to teach you and your health care team about

> > > > > > the ins and outs of the causes, diagnosis and control of the many

> > > > > > forms of hyperaldosteronism.

> > > > > >

> > > > > > The steps below will introduce you into the fascinating world of high

> > > > > > blood pressure, salt (sodium(Na) chloride (Cl) or NaCL) and potassium

> > > > > > (K) and the role of the adrenal hormone aldosterone in health and

> > > > > > disease. Doing these in sequence will save you time and effort in

> > > > > > getting up to speed in taking control of you health and educating your

> > > > > > own health care team.

> > > > > >

> > > > > > While we can't make you into a doctor we will make you into a pretty

> > > > > > good BP doctor-a skill that you will have for life and you can

> > > > > > transfer to the rest of your family who will likely have high blood

> > > > > > pressure eventually-if they live long enough.

> > > > > >

> > > > > > 1. A brief history of Primary Aldosteronsim and why it is so common

> > > > > > today in drug resistant high blood pressure. Read my article in our

> > > > > > files on the evolution of PA (Evolution_of_PA-Grim.pdf ) and take to

> > > > > > all members of health care team. Tell us what stage you believe you

> > > > > > are in. This is a brief review of most causes of hyperaldosteronism,

> > > > > > high blood pressure, low potassium (K). READING THIS WILL SAVE YOU

> > > > > > TIME AND MONEY. By taking it to your health care team they will not

> > > > > > treat their other patients in the future as badly as they may have

> > > > > > treated you in the past.

> > > > > >

> > > > > > 2. Read about other patients with hyperaldosteronism (Conn's

> > > > > > syndrome). Read our Conn's stories in our files and then give us your

> > > > > > own in as much detail as you can. Dr. Conn was the first to describe

> > > > > > this disease process and the syndrome is named after him. The first

> > > > > > patient is described in my review article.

> > > > > >

> > > > > > To see others' stories, on the Hyperaldosteronism home page, go to

> > > > > > Files/Conn's Stories.

> > > > > > You'll find instructions in "A - How to put your story here.doc "

> > > > > > First send us your story in an email and they we may have questions

> > > > > > and suggestions before you upload it to our files.

> > > > > >

> > > > > > 3. DASH to lower your BP. Your and my tax dollars funded the most

> > > > > > important series of studies on how to improve blood pressure, blood

> > > > > > sugar, blood lipids and make your heart smaller: The DASH Eating Plan

> > > > > > to control high blood pressure due to hyperaldosteronism and most

> > > > > > others with high blood pressure. This will reduce your need for

> > > > > > medications and in many will get your BP and K to goal without meds..

> > > > > > Get the DASH diet book by T. et al, (http://www.amazon.com/DASH-Diet-Hypertension--/dp/0743202953

> > > > > > ) read it and use it: ~$8 in paperback at your local bookstore or

> > > > > > online. If they don't have it ask them to order it for you. You can

> > > > > > also get the hardback larger print version as well at Amazon. Learning

> > > > > > to eat the DASH way will play a major role in your road to good BP and

> > > > > > K control and, in many of our folks here, will revolutionize your

> > > > > > life. See http://en.wikipedia.org/wiki/DASH_diet for an overview and

> > > > > > more details.

> > > > > >

> > > > > > In the book go to chapter 9 and do the 14 day challenge. Tell

> > > > > > your Dr you are doing this as your BP may plummet if you are on other

> > > > > > meds. Measure your BP every day and post to us.

> > > > > >

> > > > > > or

> > > > > >

> > > > > > go to http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf

> > > > > >

> > > > > > download this 64 page booklet free and do the Week on the DASH Diet

> > > > > > for 2 weeks. If you are on BP meds be prepared for a large fall in BP

> > > > > > (20/10 mm Hg or more) and let your Dr. know you are doing this.

> > > > > >

> > > > > > And/Or go to (but costs money monthly)

> > > > > >

> > > > > > DASH Diet for Health Program (http://www.dashforhealth.com/pages/public/tour.php

> > > > > > )

> > > > > > The DASH Diet for Health Program is designed to help you improve your

> > > > > > eating and exercise habits. Twice each week they will provide you with

> > > > > > information on our website about food, food preparation, eating out,

> > > > > > losing weight, getting fit and much more. In addition to providing new

> > > > > > information each week on the website, they create a web page specially

> > > > > > for you where you can track progress in areas such as your weight,

> > > > > > blood pressure, and exercise.

> > > > > >

> > > > > > I strongly recommend you get this book by .... and read it.

> > > > > >

> > > > > > 4. Measure your BP: Measure your BP daily so you can see if it is

> > > > > > getting better. If you are taking meds be sure to tell your health

> > > > > > care team you are doing this as your BP may plummet to normal

> > > > > > quickly. We recommend you use a device you listen to and will help

> > > > > > you learn how to do this. If this is not something you want to do we

> > > > > > can teach a significant other how to do it. See sharedcareinc.com or

> > > > > > email to sharedcare@ to order a video on how to do this. If you

> > > > > > already have one we will teach you how to teach your health care team

> > > > > > how to validate your device. Your life and health depends on accurate

> > > > > > BP measurements.

> > > > > >

> > > > > > Go to the amricanheart.org and download the Guidelines for Human Blood

> > > > > > Pressure Measurement. Insist that your health care team do BP the AHA

> > > > > > way. Never trust your life to an automatic BP machine unless you know

> > > > > > it is accurate on YOU.

> > > > > >

> > > > > > 5. Genetics and your BP: If you have a twin be sure to let us know.

> > > > > > Go to familyhistory.hhs.gov and do your detailed family medical

> > > > > > history (FHx or FH) so we can review with you to help diagnosis (Dx)

> > > > > > and treat (Rx) familial causes of high blood pressure and heart

> > > > > > disease. If BP runs in your family you may save lives in your family

> > > > > > by checking their BP yourself.

> > > > > >

> > > > > > 6. How to DX and treat PA: Go to our file

> > > > > > /Conn's Articles of Note/Medications/Bravo spir 1973.pdf and read this

> > > > > > article and take to your health care team. It is old but still one of

> > > > > > the best in the medical management of PA. Note one with PA whose BP

> > > > > > and K normalized with low Na, High K diet and only 25 mg of spiro.

> > > > > >

> > > > > > DX: Also see our file from the Endocrine Society Guidelines on PA.

> > > > > >

> > > > > > 7. Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing

> > > > > > to diagnose PA in one day.

> > > > > >

> > > > > > 1. Eat a regular to high salt diet for 2 weeks.

> > > > > > 2. No BP meds in last 4-12 weeks depending on meds.

> > > > > > 3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do

> > > > > > not lose a drop of this liquid gold. It is impossible to interpret

> > > > > > the renin and aldo without this.

> > > > > > 4. The morning you finish the 24 hr urine have fasting blood drawn for

> > > > > > renin, aldo and K using our guidelines to get an accurate K (http://groups.yahoo.com/group/hyperaldosteronism/files/Investigating%20elevated%20potassium%20values..txt

> > > > > > ) Try to get this done about 4 hours after you have been out of bed.