update of older post.

[Guest guest]

This is part of an older posting. I have notes that my Dr put in the record about this visit. Went to my VA doctor today. It is quite clear that he knows nothing about Conn'sand doesn't want any part of Dr Gimm's information on it. I tried to get him toretest me off the meds. He said that there is no point to it, even if new testsshowed Conn's the only way to treat it is to control B/P and K nothing aboutblocking the aldosterone. He says he is already doing this. He said the risk forsurgery isn't worth it. He is sorry that I feel bad but he has done all that heknows how to do.

As I am writing this I received a call from my Dr about the PRA ratio test thatthey did. Says when they do a PAR ratio tests there is no reason to stop meds asit doesn't make any difference in the PRA ratio. This is not what it says on theQuest Lab site this is who the VA uses.

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.

This is from notes on lab repores and if my Dr was reading this then he didn't understand it.as it does say Treatment with medications such as diuretics or ACE inhibitors increase PRA levels.

Blood Drawn 12/24/2008 14:19Test performed at Quest Diag. Lab.Evaluation for RENIN: 1.8 ng/mL/hrCurrent 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: <0.65Primary aldosteronsim possible: <0.65Renin-mediated hypertension likely: >=0.65Renovascular hypertension possible: >1.5Renovascular 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.

Assess 62 yo man with hypertension now poorly controlled Poorly understood diffuse distress - "wooziness" Hypokalemia correctable with triamterene and K Normal Plasma Aldosterone concentration/Plasma Renin Activity ratio Dec 2008 Adrenal adenoma by CT scan

Plan Difficult problem. Normal PAC/PRA ratio speaks against Conn's syndrome. This test can apparently be done with patients on antihyopertensives other than spironolactone. And even if he does have Huyuperaldosteronism this would not explain his complaints of light-headedness/wooziness which have plagued him ever since exposure to antifreeze now 5 years ago. Have urged him to return to Diltiazem. Will come to hypertension clinic when he returns for repeat CT of abdomen in three weeks.

UA shows 6 RBC's. Culture pending. months ago. Repeat CT scheduled in STATUS: COMPLETED Has compliczted renal cyst on CT of 6 months ago /es/ R. PETER MOGIELNICKI Staff MD Signed: 10/09/2009 18:44

STANDARD TITLE: PRIMARY CARE NOTE DATE OF NOTE: OCT 09, 2009@16:25:10 ENTRY DATE: OCT 09, 2009@16:25:10 AUTHOR: MOGIELNICKI,R PETER EXP COSIGNER: URGENCY: STATUS: COMPLETED *** Primary Care Clinic Note Has ADDENDA *** He is about the same. Still quite focused on our overlooking some occult diagnosis, searching web, reviewing the lab data I have sent him at his request. Main issue remains his feeling "not right" since exposed to antifreeze. Appetite is OK. Has not fallen or lost weight but feels as though his head is clogged up. Says he has not been taking his diltiazem because he was concerned that it might have been making him feel worse. BP 160/82 Pi 84 reg