Re: Slight Ranting... in it for the money

[Guest guest]

My nephrologist (who admits being perplexed by my case, but is at least willing

to to figure it out) told me that is exactly the problem: there's no money is

treating/curing PA. He said that the only docs who are going to be willing to

work with us are those who have a genuine interest in PA, because the time they

will spend on us will not be cost-effective.

I've found that they rarely like the fact that we sometimes know more than they

do.

> >> >> >>

> >> >> >> Just saw the nephrologist for the first time since starting spiro

> >> >last

> >> >> >> Wednesday. He didn't seem too concerned that my BP while on spiro

> >> >is

> >> >> >> averaging about 168/106, although prior to that (on no BP meds) my

> >> >> >> average was 142/92. He thinks it still needs some time to kick in.

> >> >> >Does

> >> >> >> this sound right? I haven't seen BP readings this high except back

> >> >> >> during my oral salt loading test, and it's got me a little worried.

> >> >> >>

> >> >> >> My most recent K, taken the day after starting spiro and cutting K

> >> >> >tabs

> >> >> >> back to 20meq/day, was 3.7. I had bloodwork done today and if it's

> >> >not

> >> >> >> up to 4 or higher, the nephro is going to have me add in another K

> >> >> >tab.

> >> >> >>

> >> >> >> Interesting side note: the phlebotomist told me *not* to make a

> >> >fist,

> >> >> >> and pretty much recited to me the protocol for accurate K draw

> >> >exactly

> >> >> >> as recommended here. That was a first

> >> >> >>

> >> >> >>

> >> >> >> -msmith1928

> >> >> >> Nulliparous female, 46, 5'3 " , 120 lbs, polymenorrhea,

> >> >> >> hyperinsulinemia, hereditary fructose intolerance, lactose

> >> >> >intolerance,

> >> >> >> probable gluten intolerance. Current meds are spiro 12.5mg/dday,

> >> >> >> potassium 20MEQ/day, singulair 10mg, norethindrone .35mg to

> >> >regulate

> >> >> >> polymenorrhea, cyclobenzaprine 5-10mg when needed, fexofenadine

> >> >180mg

> >> >> >> as needed. Low sodium, fructose- and grain-free diet. Known drug

> >> >> >> allergies include PCN, sulfa, tetracycline.

> >> >> >> 1cm left adrenal nodule, supine aldosterone 28.5/renin 0.2,

> >> >potassium

> >> >> >> <2.9 (when not taking supplements), 25mg spiro caused gynecomastia

> >> >> >and

> >> >> >> polymenorrhea. AVS showed right adrenal overproduces aldo; unable

> >> >to

> >> >> >> sample left; proceeding as if my hyperaldosteronism is bilateral.

> >> >> >>

> >> >> >

> >> >>

> >> >

> >>

> >

> >

>

[Guest guest]

Totally agree with you but shortsighted on their part. They may work hard and

not break even on the first case or two but when they realize that ~10% of their

resistant HTN cases can be DXed with a couple of test and a visit or two they'll

realize it is all worth it. (I acknowledge it may take a few more tests and

visits for you two but you are the exceptions and it wouldn't be bad to be known

as " The hard to treat PA Guru " !)

A smart one will make the commitment while they have a willing Dr. Grim to draw

from! Can you imagine the time and effort we would have to expend if we didn't

have his expertiese to draw from! (Better get off my soapbox before I feel I

owe someone $500!)

- 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank &

testicle pain. I have decided against an adrenalectomy at this time since

Meds. are working so well. Current BP being watched after Oral Surgery and

associated dietary changes.

Other Issues/Opportunities: COPD w/ft Oxygen, OSA w Bi-Pap settings 13/19, Type

II Diab. and PTSD

Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Methadone 10 MG(titrating off

S-L-O-W-L-Y) , Metoprolol Tartrate 200 MG, Metformin 2000MG, Lisinopril 2.5MG

and Spironolactone 75 MG.

> > >> >> >>

> > >> >> >> Just saw the nephrologist for the first time since starting spiro

> > >> >last

> > >> >> >> Wednesday. He didn't seem too concerned that my BP while on spiro

> > >> >is

> > >> >> >> averaging about 168/106, although prior to that (on no BP meds) my

> > >> >> >> average was 142/92. He thinks it still needs some time to kick in.

> > >> >> >Does

> > >> >> >> this sound right? I haven't seen BP readings this high except back

> > >> >> >> during my oral salt loading test, and it's got me a little worried.

> > >> >> >>

> > >> >> >> My most recent K, taken the day after starting spiro and cutting K

> > >> >> >tabs

> > >> >> >> back to 20meq/day, was 3.7. I had bloodwork done today and if it's

> > >> >not

> > >> >> >> up to 4 or higher, the nephro is going to have me add in another K

> > >> >> >tab.

> > >> >> >>

> > >> >> >> Interesting side note: the phlebotomist told me *not* to make a

> > >> >fist,

> > >> >> >> and pretty much recited to me the protocol for accurate K draw

> > >> >exactly

> > >> >> >> as recommended here. That was a first

> > >> >> >>

> > >> >> >>

> > >> >> >> -msmith1928

> > >> >> >> Nulliparous female, 46, 5'3 " , 120 lbs, polymenorrhea,

> > >> >> >> hyperinsulinemia, hereditary fructose intolerance, lactose

> > >> >> >intolerance,

> > >> >> >> probable gluten intolerance. Current meds are spiro 12.5mg/dday,

> > >> >> >> potassium 20MEQ/day, singulair 10mg, norethindrone .35mg to

> > >> >regulate

> > >> >> >> polymenorrhea, cyclobenzaprine 5-10mg when needed, fexofenadine

> > >> >180mg

> > >> >> >> as needed. Low sodium, fructose- and grain-free diet. Known drug

> > >> >> >> allergies include PCN, sulfa, tetracycline.

> > >> >> >> 1cm left adrenal nodule, supine aldosterone 28.5/renin 0.2,

> > >> >potassium

> > >> >> >> <2.9 (when not taking supplements), 25mg spiro caused gynecomastia

> > >> >> >and

> > >> >> >> polymenorrhea. AVS showed right adrenal overproduces aldo; unable

> > >> >to

> > >> >> >> sample left; proceeding as if my hyperaldosteronism is bilateral.

> > >> >> >>

> > >> >> >

> > >> >>

> > >> >

> > >>

> > >

> > >

> >

>

[Guest guest]

Thanks Val, I wasn't aware that there was a generic for eplerenone. Good to know

in case spiro doesn't work out for me.

> >

> > Well have you priced inspra lately? They would make kilobucks I think. It

> btw is approved to treat HTN in general not approved to treat hyperaldo.

>

>

> .

>

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