Re: Re: 34F - High Aldo, High Renin - ER Visit Last Night

January 7, 2011

Maybe you don't have PA. Maybe something else is making you feel

awful?

Val

From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of Jen

Wow you'd think with your medical background perhaps the dr's would have been

more responsive to you! Corona Regional has a bad rep, but my care there

previously wasn't " all that bad " ...and its my closest hospital, so I

went there. I will NEVER go again! In fact if I feel I need an ER again, I will

have someone take me out to UC Irvine or Loma .

There seems to be an epidemic of doctors treating only symptoms and not

actually attempting to find the causes. I'm tired of being looked at by doctors

as if " its all in my head " . Or being told that I'm depressed or

dealing with anxiety. Do I have panic attacks, actually on occasion yes, but

they are mild, and they are very different than these chest

pain/palpitation/irregular heartbeat episodes.

My endo at Loma does not feel that I have PA as my renin is too high. But

has yet to find any reason for secondary aldo. In the mean time I'm feeling

worse and worse and worse, I cannot continue to live like this.

January 7, 2011

And of course there are some great docs out there, but I do agree with the sentiment. I've told my wife lately that I sure see a change in medical providers, I will call it an "I don't care attitude," that is among providers lately and it is concerning. I will concede that prescription and non-prescription drug abuse and the sheer numbers of dishonest, lying patients, to get to those things has became epidemic and wears one down. But it is the nature of the beast today and we still have to treat people as individuals. ER's I know are not meant for the long term care but should be the first step for many, and not a worthless visit in my opinion.

We had a policy, and I have worked at a number of emergency rooms, some big some small (I usually worked alone in rural settings for most of my career) and we never let someone leave with a critical blood pressure. We CYA I guess, but cared too, and if we did not get it to a respectable number we admitted them at least for observation, or I consulted with cardiology or nephrology etc, or we transferred them. But they did not walk out with a pressure of 160/120. I did as a patient walk out of an ER at that or higher so many times I became SO frustrated and ready to throw in the towel. I was told we don't know and follow up with your provider - who I had been and who would say they didn't know. And some treated me wonderful and others not so much so and I am a very quiet patient and because I tend to know the buttons to push that usually get a provider angry I avoided those. I should have fought for myself and self-advocated a little

harder though.

But by the grace of God, I only have a murmur caused by the long term high blood pressure (it was not present 1 year ago on echo, CT or anything so....I guess that could be construed as damage and legally I could........ ) some cardiomyopathy and so far kidneys look good. And no stroke - which does run in the males in my immediate family so I was getting more and more worried by the day (I am ONLY 43!). They sometimes blamed my blood pressure on an assumption of "bad living" even though I am a sports fanatic and aerobic athletics (up until about 2 years ago when I became so winded all the time and fatigued I played in basketball leagues 3 times a week, and tennis and softball in between), no drug or alcohol use, or caffeine, no smoking were part of my everyday life. I think my GOOD living has actually saved me!

B ---

January 7, 2011

have you had thyroid tested? if you have and have been told it's fine chances are good it's NOT! Their are some FABULOUS moderators on the thyroid yahoo support groups. email me privately if you want those addresses.kannsuzanne@...Sent from my iPad

Maybe you don't have PA. Maybe something else is making you feel

awful?

Val

From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of Jen

Wow you'd think with your medical background perhaps the dr's would have been

more responsive to you! Corona Regional has a bad rep, but my care there

previously wasn't "all that bad"...and its my closest hospital, so I

went there. I will NEVER go again! In fact if I feel I need an ER again, I will

have someone take me out to UC Irvine or Loma .

There seems to be an epidemic of doctors treating only symptoms and not

actually attempting to find the causes. I'm tired of being looked at by doctors

as if "its all in my head". Or being told that I'm depressed or

dealing with anxiety. Do I have panic attacks, actually on occasion yes, but

they are mild, and they are very different than these chest

pain/palpitation/irregular heartbeat episodes.

My endo at Loma does not feel that I have PA as my renin is too high. But

has yet to find any reason for secondary aldo. In the mean time I'm feeling

worse and worse and worse, I cannot continue to live like this.

January 8, 2011

Give us your renin numbers as many drs have not read my article. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

,

Wow you'd think with your medical background perhaps the dr's would have been more responsive to you! Corona Regional has a bad rep, but my care there previously wasn't "all that bad"...and its my closest hospital, so I went there. I will NEVER go again! In fact if I feel I need an ER again, I will have someone take me out to UC Irvine or Loma .

There seems to be an epidemic of doctors treating only symptoms and not actually attempting to find the causes. I'm tired of being looked at by doctors as if "its all in my head". Or being told that I'm depressed or dealing with anxiety. Do I have panic attacks, actually on occasion yes, but they are mild, and they are very different than these chest pain/palpitation/irregular heartbeat episodes.

My endo at Loma does not feel that I have PA as my renin is too high. But has yet to find any reason for secondary aldo. In the mean time I'm feeling worse and worse and worse, I cannot continue to live like this.

>

> Subject: 34F - High Aldo, High Renin - ER Visit Last Night

> To: hyperaldosteronism

> Received: Friday, January 7, 2011, 10:02 AM

>

> Ã‚

>

> I've been following the posts but haven't posted in awhile on myself as there hasn't been much to post. The Dr. at Loma is still running tests (slowly I might add...like one test every 6-8 weeks grrrr!!!!). He believes its Secondary Aldo, but still no idea whatsoever what is causing it. In the mean time my primary Dr. is sending me to a Rheumatologist for testing for fibromyalgia.

>

> But the last two weeks I've been feeling really off. The last week I've been having chest palps and pain again, initially kinda of mild so figured my potassium must be a bit low. I'm still on the 40MEQ of potassium. Well yesterday I went to work after taking a couple days off due to feeling so poorly and scared the hell out of my coworkers yesterday afternoon when my chest pain went from mild to SEVERE and radiating up to my shoulder. I got extremely dizzy, and nearly passed out. They rushed me to the ER where I got the worst treatment I have ever experienced at my local hospital (yes I have been there before and have never been much impressed with them).

>

> Corona Regional Hospital (never go to them!)did immediately take an EKG which according to them "didn't show any abnormalities" even though I could feel my heart skipping a beat! My blood pressure, the first time they took it was 201/120!! They then put me in the waiting room! Finally an HOUR later, a PA talked to me for all of 3 minutes, said they were "extremely busy" and would call me for blood work soon. Half an hour later they called me in for a chest xray. Half an hour after that, blood work. All the while still sitting in the waiting room with a bunch of people with the flu. Then almost 2 hours later they finally put me in a bed. The ER Dr. came in, asked all of maybe 3 questions, told me that the EKG and blood work did not show a heart attack, that my Potassium was "only slightly low at 3.3" and they would give me potassium and send me home immediately. I asked about my blood pressure, he said to see my regular Dr. since it had come down (to ONLY

> 172/103!) I asked about the skipped heart beats that I could clearly make out on the heart monitor I was on, and he told me "it might be caused by the slightly low potassium, but really the potassium wasn't that low and that I wasn't having a heart attack, so go home!" They never game me anything to bring down my blood pressure and didn't even address it!

>

> I thought blood pressure that high is considered an hypertensive emergency. I am still feeling very bad this morning, despite the extra potassium, still having chest pains/palps and skipped beats, shortness of breath, severe headache and dizziness. I have called my primary Dr's office (my primary isn't in on Fridays) and they are having me come in this afternoon. I am sick of these dr's taking their sweet time to determine what is wrong with me!

>

Reply to sender |

Reply to group |

Reply via web post |

Start a New Topic

Messages in this topic

(7)

Recent Activity:

New Members

8

New Links

1

New Files

1

Visit Your Group

Switch to: Text-Only,

January 8, 2011

Everyone with HTN has some cardiac thickening and it begins within minutes of the BP going up. At least if u are a rat. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

And of course there are some great docs out there, but I do agree with the sentiment. I've told my wife lately that I sure see a change in medical providers, I will call it an "I don't care attitude," that is among providers lately and it is concerning. I will concede that prescription and non-prescription drug abuse and the sheer numbers of dishonest, lying patients, to get to those things has became epidemic and wears one down. But it is the nature of the beast today and we still have to treat people as individuals. ER's I know are not meant for the long term care but should be the first step for many, and not a worthless visit in my opinion.

We had a policy, and I have worked at a number of emergency rooms, some big some small (I usually worked alone in rural settings for most of my career) and we never let someone leave with a critical blood pressure. We CYA I guess, but cared too, and if we did not get it to a respectable number we admitted them at least for observation, or I consulted with cardiology or nephrology etc, or we transferred them. But they did not walk out with a pressure of 160/120. I did as a patient walk out of an ER at that or higher so many times I became SO frustrated and ready to throw in the towel. I was told we don't know and follow up with your provider - who I had been and who would say they didn't know. And some treated me wonderful and others not so much so and I am a very quiet patient and because I tend to know the buttons to push that usually get a provider angry I avoided those. I should have fought for myself and self-advocated a little

harder though.

But by the grace of God, I only have a murmur caused by the long term high blood pressure (it was not present 1 year ago on echo, CT or anything so....I guess that could be construed as damage and legally I could........ ) some cardiomyopathy and so far kidneys look good. And no stroke - which does run in the males in my immediate family so I was getting more and more worried by the day (I am ONLY 43!). They sometimes blamed my blood pressure on an assumption of "bad living" even though I am a sports fanatic and aerobic athletics (up until about 2 years ago when I became so winded all the time and fatigued I played in basketball leagues 3 times a week, and tennis and softball in between), no drug or alcohol use, or caffeine, no smoking were part of my everyday life. I think my GOOD living has actually saved me!

B ---

January 8, 2011

I can Assure you that very dr in the US IS MAILED at least one copy of JNC and it is discussed in every major medical J. YET when I used to talk to drs a lot I would hold up a copy and ask how many have ever seen this? Rarely someone would hold up their hand. Guess we should all ask every Dr we see Gave you read the last JNC 7? #8 should be out soon. Everyone here can down load and read it. But it takes about 3 hours to read. I recommend her that everyone get and reAd the AHA hypertension primer but suspect maybe 2 of 1000 hAve done this. Have you. So guess folks here are just like all the drs you are complaining about. Welcome to the crowd. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Since part of the American Heart Association job is to educaute us about high blood pressure. They say that one out of ten with it also have PA why don't they educaute ever one about this?

>

> Subject: 34F - High Aldo, High Renin - ER Visit Last Night

> To: hyperaldosteronism

> Received: Friday, January 7, 2011, 10:02 AM

>

> Ã‚

>

> I've been following the posts but haven't posted in awhile on myself as there hasn't been much to post. The Dr. at Loma is still running tests (slowly I might add...like one test every 6-8 weeks grrrr!!!!). He believes its Secondary Aldo, but still no idea whatsoever what is causing it. In the mean time my primary Dr. is sending me to a Rheumatologist for testing for fibromyalgia.

>

> But the last two weeks I've been feeling really off. The last week I've been having chest palps and pain again, initially kinda of mild so figured my potassium must be a bit low. I'm still on the 40MEQ of potassium. Well yesterday I went to work after taking a couple days off due to feeling so poorly and scared the hell out of my coworkers yesterday afternoon when my chest pain went from mild to SEVERE and radiating up to my shoulder. I got extremely dizzy, and nearly passed out. They rushed me to the ER where I got the worst treatment I have ever experienced at my local hospital (yes I have been there before and have never been much impressed with them).

>

> Corona Regional Hospital (never go to them!)did immediately take an EKG which according to them "didn't show any abnormalities" even though I could feel my heart skipping a beat! My blood pressure, the first time they took it was 201/120!! They then put me in the waiting room! Finally an HOUR later, a PA talked to me for all of 3 minutes, said they were "extremely busy" and would call me for blood work soon. Half an hour later they called me in for a chest xray. Half an hour after that, blood work. All the while still sitting in the waiting room with a bunch of people with the flu. Then almost 2 hours later they finally put me in a bed. The ER Dr. came in, asked all of maybe 3 questions, told me that the EKG and blood work did not show a heart attack, that my Potassium was "only slightly low at 3.3" and they would give me potassium and send me home immediately. I asked about my blood pressure, he said to see my regular Dr. since it had come down (to ONLY

> 172/103!) I asked about the skipped heart beats that I could clearly make out on the heart monitor I was on, and he told me "it might be caused by the slightly low potassium, but really the potassium wasn't that low and that I wasn't having a heart attack, so go home!" They never game me anything to bring down my blood pressure and didn't even address it!

>

> I thought blood pressure that high is considered an hypertensive emergency. I am still feeling very bad this morning, despite the extra potassium, still having chest pains/palps and skipped beats, shortness of breath, severe headache and dizziness. I have called my primary Dr's office (my primary isn't in on Fridays) and they are having me come in this afternoon. I am sick of these dr's taking their sweet time to determine what is wrong with me!

>

Reply to sender |

Reply to group |

Reply via web post |

Start a New Topic

Messages in this topic

(11)

Recent Activity:

New Members

7

New Links

1

January 8, 2011

You can look at the leading AHA J called HTN AND READ ALL about it. But drs don't read it seems nTiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Since part of the American Heart Association job is to educaute us about high blood pressure. They say that one out of ten with it also have PA why don't they educaute ever one about this?

>

> Subject: 34F - High Aldo, High Renin - ER Visit Last Night

> To: hyperaldosteronism

> Received: Friday, January 7, 2011, 10:02 AM

>

> Ã‚

>

> I've been following the posts but haven't posted in awhile on myself as there hasn't been much to post. The Dr. at Loma is still running tests (slowly I might add...like one test every 6-8 weeks grrrr!!!!). He believes its Secondary Aldo, but still no idea whatsoever what is causing it. In the mean time my primary Dr. is sending me to a Rheumatologist for testing for fibromyalgia.

>

> But the last two weeks I've been feeling really off. The last week I've been having chest palps and pain again, initially kinda of mild so figured my potassium must be a bit low. I'm still on the 40MEQ of potassium. Well yesterday I went to work after taking a couple days off due to feeling so poorly and scared the hell out of my coworkers yesterday afternoon when my chest pain went from mild to SEVERE and radiating up to my shoulder. I got extremely dizzy, and nearly passed out. They rushed me to the ER where I got the worst treatment I have ever experienced at my local hospital (yes I have been there before and have never been much impressed with them).

>

> Corona Regional Hospital (never go to them!)did immediately take an EKG which according to them "didn't show any abnormalities" even though I could feel my heart skipping a beat! My blood pressure, the first time they took it was 201/120!! They then put me in the waiting room! Finally an HOUR later, a PA talked to me for all of 3 minutes, said they were "extremely busy" and would call me for blood work soon. Half an hour later they called me in for a chest xray. Half an hour after that, blood work. All the while still sitting in the waiting room with a bunch of people with the flu. Then almost 2 hours later they finally put me in a bed. The ER Dr. came in, asked all of maybe 3 questions, told me that the EKG and blood work did not show a heart attack, that my Potassium was "only slightly low at 3.3" and they would give me potassium and send me home immediately. I asked about my blood pressure, he said to see my regular Dr. since it had come down (to ONLY

> 172/103!) I asked about the skipped heart beats that I could clearly make out on the heart monitor I was on, and he told me "it might be caused by the slightly low potassium, but really the potassium wasn't that low and that I wasn't having a heart attack, so go home!" They never game me anything to bring down my blood pressure and didn't even address it!

>

> I thought blood pressure that high is considered an hypertensive emergency. I am still feeling very bad this morning, despite the extra potassium, still having chest pains/palps and skipped beats, shortness of breath, severe headache and dizziness. I have called my primary Dr's office (my primary isn't in on Fridays) and they are having me come in this afternoon. I am sick of these dr's taking their sweet time to determine what is wrong with me!

>

January 8, 2011

I always read it (the JNC) and did extensively recently as I renewed board status this past year and passed with flying colors. My point is while not as familiar as I should have been, I was familiar with it, thus I had to fight for myself and I have had to insist or try in a political way to have them/get them to look elsewhere for the issue of my critical hypertension, low K+ and a myriad of other s/s. I thought it was adrenal or similar for a long time.

Unfortunately, when it came to my patients,I am usually the temporary driver as the PA, especially in the ER, with the patients going to the specialists. Maybe this is why I was not in the mindset to look for these things. I still could have, but guilty of not. But still you will not leave my ER with a critical blood pressure unless; 1. we get it down, 2. we find the reason, 3. I send you to a specialist, or last I am told to by the patient's doctor or my supervising physician.

My other point would be on a personal level I never ignored critical HTN and never let someone leave with it. I got them somewhere.

As for me, I was dismissed at least 20 times over 3-4 years from ER's with a critical BP, two inpatient visits, one for 5 days so they could find the cause of my critical HTN and simply ended up d/c with an "We don't know," and literally walked out with a BP of 160/120 (I came in with a over 180/130 so maybe they helped some ). Also during this last 5 day stay, and mind you, they were incredibly kind and caring, they did a kidney U/S while I was in and told me there was no Pheo or adrenal issues, did a 24 hour urine, but did not stop the HCTZ, metoprolol, Lisinopril, or clonidine (my normal meds) and had actually added hydrazaline to it (until it made my heart rate hit the roof). No serum renin/aldosterone, no serum catecholamines at all.

I asked for the CT and pheo scan (the admitting resident thought a pheo was the cause anyway) but was told my kidneys looked fine and they would not do it. I suggested that the 24 hour catecholamines might be best if they stop the other blood pressure meds, but 1. risk was too high, 2. and they said it would not affect it anyway. I discussed at length the chronic low potassium but my kidney function tests and u/s normal and the topic was just dropped. I was low at 2.7 coming in.

Unfortunately, it is still not taught well in circles about those secondary causes. We, in a general sense, tend to focus on heart, lifestyle, and medications as the cause(s) of HTN (yes I have been guilty IF I have this history in the patients, but I never assume that is the only "IT")

No one ever has me stop the lisinopril, clonidine, metoprolol, or hctz for any of the tests. I try not to doctor myself and listen to those treating me, and "suggesting" something for oneself often leads to a quick change in the Dr/patient relationship and the "know-it-all" perception that his often met with sarcasm back at the desk/station, and so even I must tread with caution. I cannot order all my own tests, nor prescribe myself medications.

The last tests I have had listed below are on spiro too. I have since dropped the lisinopril, hctz, and clonidine. I did this on my own.

I did attempt to ask the cardiologist if he was comfortable if I stopped them at my last visit, but there was a very strange something going on with him. I think I noted in previous post that he cut me off as I was very politely trying to ask if I could stop the other meds since the spiro - that he put me on - was working so well and he started angrily saying "I get it I get it, the spiro is working!" over and over and then for 5 minutes he kept saying while looking down at the chart and never looking up, "I am just trying to help, I am just trying to help. " Odd and was really a bit sad (literally, not sarcastically).

I wish Dr Grimm that these were exaggerations, but I think everyone is under immense financial and professional stress and it seemed he had some personal issues as I heard similar from others about their visits. I was not angry, just concerned for him - maybe this is what I meant about things just seem different lately with providers. The focus many times seems to be on the ancillary issues that abound in a practice and not on the patient.

Continuing......in trying to set up my lab values and scenario, I am occasionally on the metoprolol due to some rate issues, but the spiro and dash have worked so dramatically, I don't need the others, and I am grateful for that. But I was on them last tests and the Endocrinologist said it would not affect the blood test for renin/aldosterone, and cat's anyway so I was on them for the recent tests 4 weeks ago. I asked, and suggested maybe stopping them, but pushing it was futile and I surely want to trust him.

Again I have to tread a bit lightly with him too as he (the endocrinologist) was already a bit offended, or maybe hurt feelings, and he told me so - because when I first met him for the initial visit I told him all about my blood pressure issues, but we were focused only on the hyperthyroidism and he had forgot he was the one who referred me back to cardiology (for the very same HTN). I had changed insurance so I needed a new referall to a new one.

So when I came back to see him, after a number of visits already to see him, (and I had the critical HTN in his office during those other visits) on the spironolactone and told him I was really pleased as my pressure was down for the first time in 3-4 years (I was just sincerely excited) he said he wasn't aware of my blood pressure problems and asked me why I didn't tell him previously. What do you say to that? I tried to appease him by reminding him that HE sent me to the cardiologist and I thanked him for that, but he does not carry the same demeanor lately with me, but he still is generally very thorough, polite, and he since has ordered the other testing. And he follows up with me very quickly.

Most recent:

My Renin (serum) was 0.73 Aldosterone (blood) 27.9 sitting up

Cortisol (serum) 78 nmol/L (morning)

Aldosterone (urine) 40.38

K+ 4.3

Norepi 694 (serum)

EPI WNL (serum)

Dopamine WNL

Testosterone is markedly low also, but do not have the exact value in front of me.

Since part of the American Heart Association job is to educaute us about high blood pressure. They say that one out of ten with it also have PA why don't they educaute ever one about this? > > > > Subject: 34F - High Aldo, High Renin - ER Visit Last Night> To: hyperaldosteronism > Received: Friday, January 7, 2011, 10:02 AM> > > Ã‚ > > I've been following the posts but haven't posted in awhile on myself as there hasn't been much to post. The Dr. at Loma is still running tests (slowly I might add...like one test every 6-8 weeks grrrr!!!!). He believes its Secondary Aldo, but still no

idea whatsoever what is causing it. In the mean time my primary Dr. is sending me to a Rheumatologist for testing for fibromyalgia. > > But the last two weeks I've been feeling really off. The last week I've been having chest palps and pain again, initially kinda of mild so figured my potassium must be a bit low. I'm still on the 40MEQ of potassium. Well yesterday I went to work after taking a couple days off due to feeling so poorly and scared the hell out of my coworkers yesterday afternoon when my chest pain went from mild to SEVERE and radiating up to my shoulder. I got extremely dizzy, and nearly passed out. They rushed me to the ER where I got the worst treatment I have ever experienced at my local hospital (yes I have been there before and have never been much impressed with them).> > Corona Regional Hospital (never go to them!)did immediately take an EKG which according to them "didn't show any abnormalities" even

though I could feel my heart skipping a beat! My blood pressure, the first time they took it was 201/120!! They then put me in the waiting room! Finally an HOUR later, a PA talked to me for all of 3 minutes, said they were "extremely busy" and would call me for blood work soon. Half an hour later they called me in for a chest xray. Half an hour after that, blood work. All the while still sitting in the waiting room with a bunch of people with the flu. Then almost 2 hours later they finally put me in a bed. The ER Dr. came in, asked all of maybe 3 questions, told me that the EKG and blood work did not show a heart attack, that my Potassium was "only slightly low at 3.3" and they would give me potassium and send me home immediately. I asked about my blood pressure, he said to see my regular Dr. since it had come down (to ONLY> 172/103!) I asked about the skipped heart beats that I could clearly make out on the heart monitor I was on, and he told me

"it might be caused by the slightly low potassium, but really the potassium wasn't that low and that I wasn't having a heart attack, so go home!" They never game me anything to bring down my blood pressure and didn't even address it! > > I thought blood pressure that high is considered an hypertensive emergency. I am still feeling very bad this morning, despite the extra potassium, still having chest pains/palps and skipped beats, shortness of breath, severe headache and dizziness. I have called my primary Dr's office (my primary isn't in on Fridays) and they are having me come in this afternoon. I am sick of these dr's taking their sweet time to determine what is wrong with me!>

Reply to sender | Reply to group | Reply via web post | Start a New Topic Messages in this topic (11)

Recent Activity:

New Members 7

New Links 1

January 8, 2011

The best thing I did for my thyroid issues, that went misdiagnosed for three years and many doctors later, was to read the book "Stop The thyroid Maddness" Fabulous book, great information, changed my life completely!!!!! I think you will also be able to help your Mom and Grandma if you read this. Thyroid disorders are very common among women in the same family. Chances are if your grandmother has trouble and your mother you will too. I've seen it in my family and many others.I bought the book at Amazon.com. It has the references in the back of the book for the yahoo support groups. The woman who wrote the book started the support groups. I think there are at least three different groups. All the moderators are wonderful people.One thing to remember is that if your labs come back "in the range" it doesn't mean anything, whats important

is WHERE YOU FALL IN THE RANGE! Believe me I am walking proof.Do yourself, mom, and grandmother a favor and get a copy of this book. Good luck, SuzanneSent from my iPad

They have tested twice previously and told me it was fine. Just retested and I get those results on Tuesday. My mom has thyroid issues, and my grandma is now getting tested for thyroid issues.

>

> Maybe you don't have PA. Maybe something else is making you feel awful?

>

> Val

>

> From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Jen

>

> Wow you'd think with your medical background perhaps the dr's would have been more responsive to you! Corona Regional has a bad rep, but my care there previously wasn't "all that bad"...and its my closest hospital, so I went there. I will NEVER go again! In fact if I feel I need an ER again, I will have someone take me out to UC Irvine or Loma .

>

> There seems to be an epidemic of doctors treating only symptoms and not actually attempting to find the causes. I'm tired of being looked at by doctors as if "its all in my head". Or being told that I'm depressed or dealing with anxiety. Do I have panic attacks, actually on occasion yes, but they are mild, and they are very different than these chest pain/palpitation/irregular heartbeat episodes.

>

> My endo at Loma does not feel that I have PA as my renin is too high. But has yet to find any reason for secondary aldo. In the mean time I'm feeling worse and worse and worse, I cannot continue to live like this.

>

January 8, 2011

The do have them. JNCs are cosponsored by AHA. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

The AHA could just make up a Pamphlet like they do for other things.

> > >

> > > From: Jen <singlemomx2@>

> > > Subject: 34F - High Aldo, High Renin - ER Visit Last Night

> > > To: hyperaldosteronism

> > > Received: Friday, January 7, 2011, 10:02 AM

> > >

> > > Ãƒâ€š

> > >

> > > I've been following the posts but haven't posted in awhile on myself as there hasn't been much to post. The Dr. at Loma is still running tests (slowly I might add...like one test every 6-8 weeks grrrr!!!!). He believes its Secondary Aldo, but still no idea whatsoever what is causing it. In the mean time my primary Dr. is sending me to a Rheumatologist for testing for fibromyalgia.

> > >

> > > But the last two weeks I've been feeling really off. The last week I've been having chest palps and pain again, initially kinda of mild so figured my potassium must be a bit low. I'm still on the 40MEQ of potassium. Well yesterday I went to work after taking a couple days off due to feeling so poorly and scared the hell out of my coworkers yesterday afternoon when my chest pain went from mild to SEVERE and radiating up to my shoulder. I got extremely dizzy, and nearly passed out. They rushed me to the ER where I got the worst treatment I have ever experienced at my local hospital (yes I have been there before and have never been much impressed with them).

> > >

> > > Corona Regional Hospital (never go to them!)did immediately take an EKG which according to them "didn't show any abnormalities" even though I could feel my heart skipping a beat! My blood pressure, the first time they took it was 201/120!! They then put me in the waiting room! Finally an HOUR later, a PA talked to me for all of 3 minutes, said they were "extremely busy" and would call me for blood work soon. Half an hour later they called me in for a chest xray. Half an hour after that, blood work. All the while still sitting in the waiting room with a bunch of people with the flu. Then almost 2 hours later they finally put me in a bed. The ER Dr. came in, asked all of maybe 3 questions, told me that the EKG and blood work did not show a heart attack, that my Potassium was "only slightly low at 3.3" and they would give me potassium and send me home immediately. I asked about my blood pressure, he said to see my regular Dr. since it had come down (to ONLY

> > > 172/103!) I asked about the skipped heart beats that I could clearly make out on the heart monitor I was on, and he told me "it might be caused by the slightly low potassium, but really the potassium wasn't that low and that I wasn't having a heart attack, so go home!" They never game me anything to bring down my blood pressure and didn't even address it!

> > >

> > > I thought blood pressure that high is considered an hypertensive emergency. I am still feeling very bad this morning, despite the extra potassium, still having chest pains/palps and skipped beats, shortness of breath, severe headache and dizziness. I have called my primary Dr's office (my primary isn't in on Fridays) and they are having me come in this afternoon. I am sick of these dr's taking their sweet time to determine what is wrong with me!

> > >

> >

> > Reply to sender | Reply to group | Reply via web post | Start a New Topic

> > Messages in this topic (11)

> > RECENT ACTIVITY: New Members 7 New Links 1

>

January 8, 2011

, spiro raises aldosterone so your tests

on spiro are probably not accurate.Â

Maybe you need to go to docs out of town and tell them you're unemployed?

My docs don't fool with me anymore because they know I read.Â One of my Lyme docs read my history and was

aghast at what I'd been through.Â I told

him I'd just stopped going to any doc for three years and he said he understood.Â

Your story is very informative.Â Proof positive that spiro and DASH work for

some.

Val

From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of Bingham

I

always read it (the JNC) and did extensively recently as I renewed board

status this past year and passed with flying colors. My point is while not as

familiar as I should have been, I was familiar with it, thus I had to fight

for myself and I have had to insist or try in a political way to have

them/get them to look elsewhere for the issue of my critical

hypertension, low K+ and a myriad of other s/s. I thought it was adrenal or

similar for a long time.

Unfortunately,

when it came to my patients,I am usually the temporary driver as the PA,

especially in the ER, with the patients going to the specialists. Maybe

this is why I was not in the mindset to look for these things. I still could

have, but guilty of not. But still you will not leave my ER with a

critical blood pressure unless; 1. we get it down, 2. we find the

reason, 3. I send you to a specialist, or last I am told to by the

patient's doctor or my supervising physician.

My

other point would be on a personal level I never ignored critical HTN and

never let someone leave with it. I got them somewhere.

As

for me, I was dismissed at least 20 times over 3-4 years from ER's

with a critical BP, two inpatient visits, one for 5 days so

they could find the cause of my critical HTN and

simply ended up d/c with an " We don't know, " and

literally walked out with a BP of 160/120 (I came in with a over 180/130 so

maybe they helped some ). Also

during this last 5 day stay, and mind you, they were incredibly kind and

caring, they did a kidney U/S while I was in and told me there was no

Pheo or adrenal issues, did a 24 hour urine, but did not stop the HCTZ,

metoprolol, Lisinopril, or clonidine (my normal meds) and had actually added

hydrazaline to it (until it made my heart rate hit the roof). No serum

renin/aldosterone, no serum catecholamines at all.

I

asked for the CT and pheo scan (the admitting resident thought a pheo was the

cause anyway) but was told my kidneys looked fine and they would not do it. I

suggested that the 24 hour catecholamines might be best if they stop the

other blood pressure meds, but 1. risk was too high, 2. and they said it

would not affect it anyway. I discussed at length the chronic low potassium

but my kidney function tests and u/s normal and the topic was just

dropped. I was low at 2.7 coming in.

Unfortunately, it

is still not taught well in circles about those secondary causes. We, in a

general sense, tend to focus on heart, lifestyle, and medications as the

cause(s) of HTN (yes I have been guilty IF I have this history in

the patients, but I never assume that is the only " IT " )

No

one ever has me stop the lisinopril, clonidine, metoprolol, or hctz for any

of the tests. I try not to doctor myself and listen to those treating

me, and " suggesting " something for oneself often leads to a

quick change in the Dr/patient relationship and the " know-it-all "

perception that his often met with sarcasm back at the desk/station, and so

even I must tread with caution. I cannot order all my own tests, nor

prescribe myself medications.

The

last tests I have had listed below are on spiro too. I have since

dropped the lisinopril, hctz, and clonidine. I did this on my own.

I

did attempt to ask the cardiologist if he was comfortable if I stopped

them at my last visit, but there was a very strange something going on

with him. I think I noted in previous post that he cut me off as I was

very politely trying to ask if I could stop the other meds since the

spiro - that he put me on - was working so well and he started angrily

saying " I get it I get it, the spiro is working! " over and over and

then for 5 minutes he kept saying while looking down at the chart and never

looking up, " I am just trying to help, I am just trying to help. "

Odd and was really a bit sad (literally, not sarcastically).

I

wish Dr Grimm that these were exaggerations, but I think everyone is

under immense financial and professional stress and it seemed he had some

personal issues as I heard similar from others about their visits. I was not

angry, just concerned for him - maybe this is what I meant about things just

seem different lately with providers. The focus many times seems to be

on the ancillary issues that abound in a practice and not on the patient.

Continuing......in

trying to set up my lab values and scenario, I am occasionally on the

metoprolol due to some rate issues, but the spiro and dash have worked so

dramatically, I don't need the others, and I am grateful for that. But I was

on them last tests and the Endocrinologist said it would not affect the

blood test for renin/aldosterone, and cat's anyway so I was on them for the

recent tests 4 weeks ago. I asked, and suggested maybe stopping them,

but pushing it was futile and I surely want to trust him.

Again

I have to tread a bit lightly with him too as he (the

endocrinologist) was already a bit offended, or maybe hurt

feelings, and he told me so - because when I first met him for

the initial visit I told him all about my blood pressure issues, but we

were focused only on the hyperthyroidism and he had forgot he was the one who

referred me back to cardiology (for the very same HTN). I had

changed insurance so I needed a new referall to a new one.

So when

I came back to see him, after a number of visits already to see him, (and I

had the critical HTN in his office during those other visits) on the

spironolactone and told him I was really pleased as my pressure was down for

the first time in 3-4 years (I was just sincerely excited) he said he

wasn't aware of my blood pressure problems and asked me why I didn't tell him

previously. What do you say to that? I tried to appease him by reminding him

that HE sent me to the cardiologist and I thanked him for that, but he does

not carry the same demeanor lately with me, but he still is generally very

thorough, polite, and he since has ordered the other testing. And he

follows up with me very quickly.

Most

recent:

My

Renin (serum) was 0.73 Aldosterone (blood) 27.9 sitting up

Cortisol

(serum) 78 nmol/L (morning)

Aldosterone

(urine) 40.38

K+

4.3

Norepi

694 (serum)

EPI

WNL (serum)

Dopamine

WNL

Testosterone

is markedly low also, but do not have the exact value in front of me.

January 8, 2011

Be very careful of advice you get through STTM

or the group.Â I have a friend who tried

to push her Armour higher and higher (up to 3 grains) because she was told that

anything less would just depress her own thyroid.Â She ended up with an extremely high FT3.Â She's now doing nicely on 1 grain.

Suzanne is correct that many docs have

virtually no understanding of thyroid and don't even know what tests to do.

Val

From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of Suzanne Kann

The

best thing I did for my thyroid issues, that went misdiagnosed for three years

and many doctors later, was to read the book " Stop The thyroid Maddness "

Fabulous book, great information, changed my life completely!!!!! I think you

will also be able to help your Mom and Grandma if you read this. Thyroid

disorders are very common among women in the same family. Chances are if your

grandmother has trouble and your mother you will too. I've seen it in my family

and many others.

I

bought the book at Amazon.com. It has the

references in the back of the book for the yahoo support groups. The woman who

wrote the book started the support groups. I think there are at least three

different groups. All the moderators are wonderful people.

One

thing to remember is that if your labs come back " in the range " it

doesn't mean anything, whats important is WHERE YOU FALL IN THE RANGE! Believe

me I am walking proof.

Do

yourself, mom, and grandmother a favor and get a copy of this book. Good luck,

Suzanne

Sent from my iPad

They have tested twice previously and told me

it was fine. Just retested and I get those results on Tuesday. My mom has

thyroid issues, and my grandma is now getting tested for thyroid issues.

>

> Maybe you don't have PA. Maybe something else is making you feel awful?

>

> Val

>

> From: hyperaldosteronism

[mailto:hyperaldosteronism ]

On Behalf Of Jen

>

> Wow you'd think with your medical background perhaps the dr's would have

been more responsive to you! Corona Regional has a bad rep, but my care there

previously wasn't " all that bad " ...and its my closest hospital, so I

went there. I will NEVER go again! In fact if I feel I need an ER again, I will

have someone take me out to UC Irvine or Loma .

>

> There seems to be an epidemic of doctors treating only symptoms and not

actually attempting to find the causes. I'm tired of being looked at by doctors

as if " its all in my head " . Or being told that I'm depressed or

dealing with anxiety. Do I have panic attacks, actually on occasion yes, but

they are mild, and they are very different than these chest

pain/palpitation/irregular heartbeat episodes.

>

> My endo at Loma does not feel that I have PA as my renin is too

high. But has yet to find any reason for secondary aldo. In the mean time I'm

feeling worse and worse and worse, I cannot continue to live like this.

>

January 8, 2011

Hmm. Last time I checked it one copy was free. But then the AHA does like Money. It used to be $35.I guess most don't value their life above $60. So you pays your money and live or waste your life.CE Grim MDOn Jan 8, 2011, at 10:30 AM, Francis Bill SUSPECTED PA wrote:@ $60 per copy not many will buy it.> > > > > > > > > From: Jen <singlemomx2@>> > > Subject: 34F - High Aldo, High Renin - ER Visit Last Night> > > To: hyperaldosteronism > > > Received: Friday, January 7, 2011, 10:02 AM> > > > > > > > > Ã‚ > > > > > > I've been following the posts but haven't posted in awhile on myself as there hasn't been much to post. The Dr. at Loma is still running tests (slowly I might add...like one test every 6-8 weeks grrrr!!!!). He believes its Secondary Aldo, but still no idea whatsoever what is causing it. In the mean time my primary Dr. is sending me to a Rheumatologist for testing for fibromyalgia. > > > > > > But the last two weeks I've been feeling really off. The last week I've been having chest palps and pain again, initially kinda of mild so figured my potassium must be a bit low. I'm still on the 40MEQ of potassium. Well yesterday I went to work after taking a couple days off due to feeling so poorly and scared the hell out of my coworkers yesterday afternoon when my chest pain went from mild to SEVERE and radiating up to my shoulder. I got extremely dizzy, and nearly passed out. They rushed me to the ER where I got the worst treatment I have ever experienced at my local hospital (yes I have been there before and have never been much impressed with them).> > > > > > Corona Regional Hospital (never go to them!)did immediately take an EKG which according to them "didn't show any abnormalities" even though I could feel my heart skipping a beat! My blood pressure, the first time they took it was 201/120!! They then put me in the waiting room! Finally an HOUR later, a PA talked to me for all of 3 minutes, said they were "extremely busy" and would call me for blood work soon. Half an hour later they called me in for a chest xray. Half an hour after that, blood work. All the while still sitting in the waiting room with a bunch of people with the flu. Then almost 2 hours later they finally put me in a bed. The ER Dr. came in, asked all of maybe 3 questions, told me that the EKG and blood work did not show a heart attack, that my Potassium was "only slightly low at 3.3" and they would give me potassium and send me home immediately. I asked about my blood pressure, he said to see my regular Dr. since it had come down (to ONLY> > > 172/103!) I asked about the skipped heart beats that I could clearly make out on the heart monitor I was on, and he told me "it might be caused by the slightly low potassium, but really the potassium wasn't that low and that I wasn't having a heart attack, so go home!" They never game me anything to bring down my blood pressure and didn't even address it! > > > > > > I thought blood pressure that high is considered an hypertensive emergency. I am still feeling very bad this morning, despite the extra potassium, still having chest pains/palps and skipped beats, shortness of breath, severe headache and dizziness. I have called my primary Dr's office (my primary isn't in on Fridays) and they are having me come in this afternoon. I am sick of these dr's taking their sweet time to determine what is wrong with me!> > >> > > > > > Reply to sender | Reply to group | Reply via web post | Start a New Topic> > Messages in this topic (11)> > RECENT ACTIVITY: New Members 7 New Links 1>

January 8, 2011

Never tell us or accept "it was just fine". You need the numbers for your records. They have tested twice previously and told me it was fine. Just retested and I get those results on Tuesday. My mom has thyroid issues, and my grandma is now getting tested for thyroid issues. > > Maybe you don't have PA. Maybe something else is making you feel awful?> > > > Val> > > > From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Jen> > Wow you'd think with your medical background perhaps the dr's would have been more responsive to you! Corona Regional has a bad rep, but my care there previously wasn't "all that bad"...and its my closest hospital, so I went there. I will NEVER go again! In fact if I feel I need an ER again, I will have someone take me out to UC Irvine or Loma . > > There seems to be an epidemic of doctors treating only symptoms and not actually attempting to find the causes. I'm tired of being looked at by doctors as if "its all in my head". Or being told that I'm depressed or dealing with anxiety. Do I have panic attacks, actually on occasion yes, but they are mild, and they are very different than these chest pain/palpitation/irregular heartbeat episodes.> > My endo at Loma does not feel that I have PA as my renin is too high. But has yet to find any reason for secondary aldo. In the mean time I'm feeling worse and worse and worse, I cannot continue to live like this.>

January 8, 2011

Remind your Endo that spiro is a diagnostic test. If BP and K does not get better you do not have PA. If you do then it is the treatment of choice till if fails. So do you have hidden HTN (high at home, normal in Dr office) or is your device wrong or is the Drs device wrong or are they not following our guidelines-see our Consumer Guidelines.Have the validated you device on you?They prob do not know how to do that but think the method is in our files.CE Grim MDI am dashing but am not on spiro yet, the endo wants to finish testing before he puts me on spiro. I am on Verapamil 240mg, HCTZ 25mg, Carvedilol 12.5mg, Potassium 40MEQ, Prilosec 20mg (and now Protonix not sure of dose, I start it today).My daily bp that I test at home is running 160/105ish...sometimes lower, sometimes higher. When I go to my primary dr's, its running 125/80 to 139/90 ish. I have given your article to my dr's but I can't tell you if they have actually read it...I get the impression that probably not.> > > I've been following the posts but haven't posted in awhile on myself as there hasn't been much to post. The Dr. at Loma is still running tests (slowly I might add...like one test every 6-8 weeks grrrr!!!!). He believes its Secondary Aldo, but still no idea whatsoever what is causing it. In the mean time my primary Dr. is sending me to a Rheumatologist for testing for fibromyalgia. > > > > But the last two weeks I've been feeling really off. The last week I've been having chest palps and pain again, initially kinda of mild so figured my potassium must be a bit low. I'm still on the 40MEQ of potassium. Well yesterday I went to work after taking a couple days off due to feeling so poorly and scared the hell out of my coworkers yesterday afternoon when my chest pain went from mild to SEVERE and radiating up to my shoulder. I got extremely dizzy, and nearly passed out. They rushed me to the ER where I got the worst treatment I have ever experienced at my local hospital (yes I have been there before and have never been much impressed with them).> > > > Corona Regional Hospital (never go to them!)did immediately take an EKG which according to them "didn't show any abnormalities" even though I could feel my heart skipping a beat! My blood pressure, the first time they took it was 201/120!! They then put me in the waiting room! Finally an HOUR later, a PA talked to me for all of 3 minutes, said they were "extremely busy" and would call me for blood work soon. Half an hour later they called me in for a chest xray. Half an hour after that, blood work. All the while still sitting in the waiting room with a bunch of people with the flu. Then almost 2 hours later they finally put me in a bed. The ER Dr. came in, asked all of maybe 3 questions, told me that the EKG and blood work did not show a heart attack, that my Potassium was "only slightly low at 3.3" and they would give me potassium and send me home immediately. I asked about my blood pressure, he said to see my regular Dr. since it had come down (to ONLY 172/103!) I asked about the skipped heart beats that I could clearly make out on the heart monitor I was on, and he told me "it might be caused by the slightly low potassium, but really the potassium wasn't that low and that I wasn't having a heart attack, so go home!" They never game me anything to bring down my blood pressure and didn't even address it! > > > > I thought blood pressure that high is considered an hypertensive emergency. I am still feeling very bad this morning, despite the extra potassium, still having chest pains/palps and skipped beats, shortness of breath, severe headache and dizziness. I have called my primary Dr's office (my primary isn't in on Fridays) and they are having me come in this afternoon. I am sick of these dr's taking their sweet time to determine what is wrong with me!> > > >>

January 8, 2011

Note that I am responding to you as though you were my PA student.I always read it (the JNC) and did extensively recently as I renewed board status this past year and passed with flying colors. My point is while not as familiar as I should have been, I was familiar with it, thus I had to fight for myself and I have had to insist or try in a political way to have them/get them to look elsewhere for the issue of my critical hypertension, low K+ and a myriad of other s/s. I thought it was adrenal or similar for a long time.AS you can see reading and knowing are not the same things. Did you give it to your health care team to bring them up to date? Unfortunately, when it came to my patients,I am usually the temporary driver as the PA, especially in the ER, with the patients going to the specialists. Maybe this is why I was not in the mindset to look for these things. I still could have, but guilty of not. But still you will not leave my ER with a critical blood pressure unless; 1. we get it down, 2. we find the reason, 3. I send you to a specialist, or last I am told to by the patient's doctor or my supervising physician.FYI the highest BP I have sent out of my office was 240/160, he had Grade IV retinopathy but stated he had to go pick up his daughter from school and could not come back the next am. I understood and send him out on Apresoline, Inderal and a diuretic in my old AID regimen of increasing doses every 4 hours and measuring his own BP. He returned the next day and was admitted and BP was brought under control in 2 days and he was out. No cause found. Suddenly lowering BP in the ER causes strokes, MI, blindness. So I go slow.CE Grim MD My other point would be on a personal level I never ignored critical HTN and never let someone leave with it. I got them somewhere. As for me, I was dismissed at least 20 times over 3-4 years from ER's with a critical BP, two inpatient visits, one for 5 days so they could find the cause of my critical HTN and simply ended up d/c with an "We don't know," and literally walked out with a BP of 160/120 (I came in with a over 180/130 so maybe they helped some ). Also during this last 5 day stay, and mind you, they were incredibly kind and caring, they did a kidney U/S while I was in and told me there was no Pheo or adrenal issues, did a 24 hour urine, but did not stop the HCTZ, metoprolol, Lisinopril, or clonidine (my normal meds) and had actually added hydrazaline to it (until it made my heart rate hit the roof). No serum renin/aldosterone, no serum catecholamines at all. I asked for the CT and pheo scan (the admitting resident thought a pheo was the cause anyway) but was told my kidneys looked fine and they would not do it. I suggested that the 24 hour catecholamines might be best if they stop the other blood pressure meds, but 1. risk was too high, 2. and they said it would not affect it anyway. I discussed at length the chronic low potassium but my kidney function tests and u/s normal and the topic was just dropped. I was low at 2.7 coming in. Unfortunately, it is still not taught well in circles about those secondary causes. We, in a general sense, tend to focus on heart, lifestyle, and medications as the cause(s) of HTN (yes I have been guilty IF I have this history in the patients, but I never assume that is the only "IT") No one ever has me stop the lisinopril, clonidine, metoprolol, or hctz for any of the tests. I try not to doctor myself and listen to those treating me, and "suggesting" something for oneself often leads to a quick change in the Dr/patient relationship and the "know-it-all" perception that his often met with sarcasm back at the desk/station, and so even I must tread with caution. I cannot order all my own tests, nor prescribe myself medications. The last tests I have had listed below are on spiro too. I have since dropped the lisinopril, hctz, and clonidine. I did this on my own. I did attempt to ask the cardiologist if he was comfortable if I stopped them at my last visit, but there was a very strange something going on with him. I think I noted in previous post that he cut me off as I was very politely trying to ask if I could stop the other meds since the spiro - that he put me on - was working so well and he started angrily saying "I get it I get it, the spiro is working!" over and over and then for 5 minutes he kept saying while looking down at the chart and never looking up, "I am just trying to help, I am just trying to help. " Odd and was really a bit sad (literally, not sarcastically). I wish Dr Grimm that these were exaggerations, but I think everyone is under immense financial and professional stress and it seemed he had some personal issues as I heard similar from others about their visits. I was not angry, just concerned for him - maybe this is what I meant about things just seem different lately with providers. The focus many times seems to be on the ancillary issues that abound in a practice and not on the patient. Continuing......in trying to set up my lab values and scenario, I am occasionally on the metoprolol due to some rate issues, but the spiro and dash have worked so dramatically, I don't need the others, and I am grateful for that. But I was on them last tests and the Endocrinologist said it would not affect the blood test for renin/aldosterone, and cat's anyway so I was on them for the recent tests 4 weeks ago. I asked, and suggested maybe stopping them, but pushing it was futile and I surely want to trust him. Again I have to tread a bit lightly with him too as he (the endocrinologist) was already a bit offended, or maybe hurt feelings, and he told me so - because when I first met him for the initial visit I told him all about my blood pressure issues, but we were focused only on the hyperthyroidism and he had forgot he was the one who referred me back to cardiology (for the very same HTN). I had changed insurance so I needed a new referall to a new one. So when I came back to see him, after a number of visits already to see him, (and I had the critical HTN in his office during those other visits) on the spironolactone and told him I was really pleased as my pressure was down for the first time in 3-4 years (I was just sincerely excited) he said he wasn't aware of my blood pressure problems and asked me why I didn't tell him previously. What do you say to that? I tried to appease him by reminding him that HE sent me to the cardiologist and I thanked him for that, but he does not carry the same demeanor lately with me, but he still is generally very thorough, polite, and he since has ordered the other testing. And he follows up with me very quickly. Most recent:My Renin (serum) was 0.73 Aldosterone (blood) 27.9 sitting upCortisol (serum) 78 nmol/L (morning)Aldosterone (urine) 40.38K+ 4.3Norepi 694 (serum)EPI WNL (serum)Dopamine WNL Testosterone is markedly low also, but do not have the exact value in front of me.

January 8, 2011

I would focus on the BP issue first. IMHO.CE Grim MDThank you Suzanne! I'm going to order the book now!> > > > Maybe you don't have PA. Maybe something else is making you feel awful?> > > > > > > > Val> > > > > > > > From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Jen> > > > Wow you'd think with your medical background perhaps the dr's would have been more responsive to you! Corona Regional has a bad rep, but my care there previously wasn't "all that bad"...and its my closest hospital, so I went there. I will NEVER go again! In fact if I feel I need an ER again, I will have someone take me out to UC Irvine or Loma . > > > > There seems to be an epidemic of doctors treating only symptoms and not actually attempting to find the causes. I'm tired of being looked at by doctors as if "its all in my head". Or being told that I'm depressed or dealing with anxiety. Do I have panic attacks, actually on occasion yes, but they are mild, and they are very different than these chest pain/palpitation/irregular heartbeat episodes.> > > > My endo at Loma does not feel that I have PA as my renin is too high. But has yet to find any reason for secondary aldo. In the mean time I'm feeling worse and worse and worse, I cannot continue to live like this.> >>

January 8, 2011

I see new for ~$6 for new ones. Seems to me this should be worth one's life.If you don't like it you can always give it to your health care team. This primer only contains what we (the AHA) expect every medical student to master before graduation. Few do and fewer even know about this primer.CE Grim MD Will change my intro note to go to Amazon.comamazon.com does have used ones starting $.92 + $3.99 shipping. We pay Dr good money to.> > > > >> > > > >> > > > > From: Jen <singlemomx2@>> > > > > Subject: 34F - High Aldo, High Renin - ER > > Visit Last Night> > > > > To: hyperaldosteronism > > > > > Received: Friday, January 7, 2011, 10:02 AM> > > > >> > > > >> > > > > Ã‚> > > > >> > > > > I've been following the posts but haven't posted in awhile on > > myself as there hasn't been much to post. The Dr. at Loma is > > still running tests (slowly I might add...like one test every 6-8 > > weeks grrrr!!!!). He believes its Secondary Aldo, but still no idea > > whatsoever what is causing it. In the mean time my primary Dr. is > > sending me to a Rheumatologist for testing for fibromyalgia.> > > > >> > > > > But the last two weeks I've been feeling really off. The last > > week I've been having chest palps and pain again, initially kinda of > > mild so figured my potassium must be a bit low. I'm still on the > > 40MEQ of potassium. Well yesterday I went to work after taking a > > couple days off due to feeling so poorly and scared the hell out of > > my coworkers yesterday afternoon when my chest pain went from mild > > to SEVERE and radiating up to my shoulder. I got extremely dizzy, > > and nearly passed out. They rushed me to the ER where I got the > > worst treatment I have ever experienced at my local hospital (yes I > > have been there before and have never been much impressed with them).> > > > >> > > > > Corona Regional Hospital (never go to them!)did immediately > > take an EKG which according to them "didn't show any abnormalities" > > even though I could feel my heart skipping a beat! My blood > > pressure, the first time they took it was 201/120!! They then put me > > in the waiting room! Finally an HOUR later, a PA talked to me for > > all of 3 minutes, said they were "extremely busy" and would call me > > for blood work soon. Half an hour later they called me in for a > > chest xray. Half an hour after that, blood work. All the while still > > sitting in the waiting room with a bunch of people with the flu. > > Then almost 2 hours later they finally put me in a bed. The ER Dr. > > came in, asked all of maybe 3 questions, told me that the EKG and > > blood work did not show a heart attack, that my Potassium was "only > > slightly low at 3.3" and they would give me potassium and send me > > home immediately. I asked about my blood pressure, he said to see my > > regular Dr. since it had come down (to ONLY> > > > > 172/103!) I asked about the skipped heart beats that I could > > clearly make out on the heart monitor I was on, and he told me "it > > might be caused by the slightly low potassium, but really the > > potassium wasn't that low and that I wasn't having a heart attack, > > so go home!" They never game me anything to bring down my blood > > pressure and didn't even address it!> > > > >> > > > > I thought blood pressure that high is considered an > > hypertensive emergency. I am still feeling very bad this morning, > > despite the extra potassium, still having chest pains/palps and > > skipped beats, shortness of breath, severe headache and dizziness. I > > have called my primary Dr's office (my primary isn't in on Fridays) > > and they are having me come in this afternoon. I am sick of these > > dr's taking their sweet time to determine what is wrong with me!> > > > >> > > >> > > >> > > > Reply to sender | Reply to group | Reply via web post | Start a > > New Topic> > > > Messages in this topic (11)> > > > RECENT ACTIVITY: New Members 7 New Links 1> > >> >> >> >>

January 8, 2011

Points well taken.

Gave your article to my docs, JNC no. Now NOT controlling HTN ALSO causes strokes, blindness, MI , paralysis, speech difficulties etc... but long ago, in my prior life as 15 year career a paramedic out on the mean streets, we learned to not lower pressure in the field, or to lower it slowly. This was 'bout the time procardia came off the units since we were CAUSING more strokes (for the very reasons you said below) than saving them with it.

Your still not leaving my ER with a 160/130, even if you eat salty french fries every day for all three meals and smoke 10 packs a day. If in consultation with doc(s) we decide or I am told otherwise than so be it. But that's not simply an anomaly and after double double checking and a good history (BP cuff error, poor method of taking BP, use of amphetamines, etc giving us a good clue to the cause) I need to assume the patient is in some danger due to the HTN, or to an illness causing the HTN. Of course answers are elusive and if I see s/s of a cerebral bleed, CVA (embolic), PE, etc I use extreme caution in lowering it, if at all.

I will aways err on the patient's side and I do not ignore the BP or associated s/s, I have just kept PA and other endocrine conditions too low on my list (and I am blessed to say there have been no (zilch) lawsuits or malpractice or pending complaints in 10 years as a PA-C).

Plus I did/do not usually get strong f/u on the patient's as I primarily worked solo in rural ER's with no ICU, no surgery, and no CT scan. So I usually had to send them out and maybe there were many who got some good care and the diagnosis of an endocrine etiology was found. BUT...for me, yes I did not put PA and some others high on the list. Thyroid yes, but adrenal, no.

I stand guilty but am going to fix it.

The difference now? PA, and some of the other similar conditions are looked at much more deeper from me now than previously. My point in the other postings was mostly that I myself was sent home or out of the hospital/clinics with a critical high blood pressure many many times over the past 3-4 years. If I, or yourself I am certain, had a patient that came in many times, with the same condition, we would at least have new googles on and look deeper. Never happened in my case and I am also just as certain the providers I saw had varying and myriad reasons for NOT looking or worrying about my BP and low potassium at every single visit (I have never had a normal K at the er!).

Sorry to say PA was never even mentioned. EVER.

I have already learned alot, or refreshed alot, from you. So thank you. I have seen the light.

Note that I am responding to you as though you were my PA student.

I always read it (the JNC) and did extensively recently as I renewed board status this past year and passed with flying colors. My point is while not as familiar as I should have been, I was familiar with it, thus I had to fight for myself and I have had to insist or try in a political way to have them/get them to look elsewhere for the issue of my critical hypertension, low K+ and a myriad of other s/s. I thought it was adrenal or similar for a long time.

AS you can see reading and knowing are not the same things. Did you give it to your health care team to bring them up to date?

Unfortunately, when it came to my patients,I am usually the temporary driver as the PA, especially in the ER, with the patients going to the specialists. Maybe this is why I was not in the mindset to look for these things. I still could have, but guilty of not. But still you will not leave my ER with a critical blood pressure unless; 1. we get it down, 2. we find the reason, 3. I send you to a specialist, or last I am told to by the patient's doctor or my supervising physician.FYI the highest BP I have sent out of my office was 240/160, he had Grade IV retinopathy but stated he had to go pick up his daughter from school and could not come back the next am. I understood and send him out on Apresoline, Inderal and a diuretic in my old AID regimen of increasing doses every 4 hours and measuring his own BP. He returned the next day and was admitted and BP was brought under control

in 2 days and he was out. No cause found.

Suddenly lowering BP in the ER causes strokes, MI, blindness.

So I go slow.

CE Grim MD

My other point would be on a personal level I never ignored critical HTN and never let someone leave with it. I got them somewhere.

As for me, I was dismissed at least 20 times over 3-4 years from ER's with a critical BP, two inpatient visits, one for 5 days so they could find the cause of my critical HTN and simply ended up d/c with an "We don't know," and literally walked out with a BP of 160/120 (I came in with a over 180/130 so maybe they helped some ). Also during this last 5 day stay, and mind you, they were incredibly kind and caring, they did a kidney U/S while I was in and told me there was no Pheo or adrenal issues, did a 24 hour urine, but did not stop the HCTZ, metoprolol, Lisinopril, or clonidine (my normal meds) and had actually added hydrazaline to it (until it made my heart rate hit the roof). No serum