Re: Aldosteronism's effect on COPD (Lung Function)?

July 19, 2011

Responses imbedded - JC

>

> > My puppies decided to do a pulmonary test this morning! They

> > loosened the connection on my concentrator causing the 4L oxygen

> > flow between my concentrator and bi-pap machine to cease! (That's my

> > wife's story and she is sticking with it!) When I changed the hose

> > over to the canular I realized there was no airflow so I engaged my

> > Oximeter and was surprised to find o2 level was 93-94 (they tell me

> > it needs to be >90)! I don't know how long I had been with suppl. O2

> > but I watch it for an additional 30 mins. and it never got below 93

> > and up as high as 95. With suppl. O2 ir ran 96-97. I went without

> > again while on the computer and it stayed at 95 for over 30 mins. It

> > went down to 90 when I climbed the stairs and immediately rebounded

> > to 94 when I sat down.

> >

> > Not long ago it would have gone down into the low 80's and

> > mostlikely not gotten as high as 90 w/o suppl. O2.

> >

> > Dr. Grim, Is this an indicator of my lungs improving since I got the

> > excess aldo. under control ~3mos. ago? I also have noticed I am

> > getting a lot better times on my bi-pap which could also be a sign

> > I'm breathing better. I know you spoke of this when you first

> > learned I was on O2 and had COPD and OSA but I didn't realize

> > changes might be so soon or " visable " ! I'm going to do some more

> > looking but am hoping you can enlighten me or point me where to

> > look. (I have a 6mo. follow up in a couple weeks and am preparing

> > and will give the Doctor a headsup if appropriate!)

> >

> > - 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: 130/77

> > Other Issues/Opportunities: COPD w/ft Oxygen, OSA w Bi-Pap settings

> > 13/19, DM2. and PTSD

> > Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate

> > 200 MG, Metformin 2000MG and Spironolactone 75 MG.

> >

>

July 19, 2011

Just how was COPD DX? I know you said they had you walk with Oximeter and this

showed low OX. Did they then do lung function test?

On ECHO report what is the estimated ejection fraction? This tells if you have

CHF.

> >

> > > My puppies decided to do a pulmonary test this morning! They

> > > loosened the connection on my concentrator causing the 4L oxygen

> > > flow between my concentrator and bi-pap machine to cease! (That's my

> > > wife's story and she is sticking with it!) When I changed the hose

> > > over to the canular I realized there was no airflow so I engaged my

> > > Oximeter and was surprised to find o2 level was 93-94 (they tell me

> > > it needs to be >90)! I don't know how long I had been with suppl. O2

> > > but I watch it for an additional 30 mins. and it never got below 93

> > > and up as high as 95. With suppl. O2 ir ran 96-97. I went without

> > > again while on the computer and it stayed at 95 for over 30 mins. It

> > > went down to 90 when I climbed the stairs and immediately rebounded

> > > to 94 when I sat down.

> > >

> > > Not long ago it would have gone down into the low 80's and

> > > mostlikely not gotten as high as 90 w/o suppl. O2.

> > >

> > > Dr. Grim, Is this an indicator of my lungs improving since I got the

> > > excess aldo. under control ~3mos. ago? I also have noticed I am

> > > getting a lot better times on my bi-pap which could also be a sign

> > > I'm breathing better. I know you spoke of this when you first

> > > learned I was on O2 and had COPD and OSA but I didn't realize

> > > changes might be so soon or " visable " ! I'm going to do some more

> > > looking but am hoping you can enlighten me or point me where to

> > > look. (I have a 6mo. follow up in a couple weeks and am preparing

> > > and will give the Doctor a headsup if appropriate!)

> > >

> > > - 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: 130/77

> > > Other Issues/Opportunities: COPD w/ft Oxygen, OSA w Bi-Pap settings

> > > 13/19, DM2. and PTSD

> > > Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate

> > > 200 MG, Metformin 2000MG and Spironolactone 75 MG.

> > >

> >

>

July 19, 2011

Francis, First thanks for pointing me to LVEF. I looked back at the ECHO and

so far have only been able to find the summary. I found it (LVEF = 56%) in a

stress test done 1/31/2007.

COPD DX is a little more convoluted. It started with a failed sleep study in

early 2010. 2nd sleep study determined I needed 4L nocturnal. This prompted a

discussion and walk with Dr. Webster where she RXed 2L at rest and 3L with

exhertion. She also did a referral to Pulmonary. On 10/6/2010 under COPD/OSN

she entered the comment, " He deserve to visit with the pulmonologist to obtain a

diagnosis, and advise ... "

Saw Plm (Dr. Simira Shojaee) on 11/22/2010. She said it was emphyesma but

difficult to DX due to obesity hypoventilation syndrome. She RXed Spriva and

Albuterl w/RTC 6months - 8/2011.

Dr. Kelley, Chief, Pulmonary Section confirmed it as copd-obstruction on

pfts, morbid obesity and osa. (same date)

> > >

> > > > My puppies decided to do a pulmonary test this morning! They

> > > > loosened the connection on my concentrator causing the 4L oxygen

> > > > flow between my concentrator and bi-pap machine to cease! (That's my

> > > > wife's story and she is sticking with it!) When I changed the hose

> > > > over to the canular I realized there was no airflow so I engaged my

> > > > Oximeter and was surprised to find o2 level was 93-94 (they tell me

> > > > it needs to be >90)! I don't know how long I had been with suppl. O2

> > > > but I watch it for an additional 30 mins. and it never got below 93

> > > > and up as high as 95. With suppl. O2 ir ran 96-97. I went without

> > > > again while on the computer and it stayed at 95 for over 30 mins. It

> > > > went down to 90 when I climbed the stairs and immediately rebounded

> > > > to 94 when I sat down.

> > > >

> > > > Not long ago it would have gone down into the low 80's and

> > > > mostlikely not gotten as high as 90 w/o suppl. O2.

> > > >

> > > > Dr. Grim, Is this an indicator of my lungs improving since I got the

> > > > excess aldo. under control ~3mos. ago? I also have noticed I am

> > > > getting a lot better times on my bi-pap which could also be a sign

> > > > I'm breathing better. I know you spoke of this when you first

> > > > learned I was on O2 and had COPD and OSA but I didn't realize

> > > > changes might be so soon or " visable " ! I'm going to do some more

> > > > looking but am hoping you can enlighten me or point me where to

> > > > look. (I have a 6mo. follow up in a couple weeks and am preparing

> > > > and will give the Doctor a headsup if appropriate!)

> > > >

> > > > - 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: 130/77

> > > > Other Issues/Opportunities: COPD w/ft Oxygen, OSA w Bi-Pap settings

> > > > 13/19, DM2. and PTSD

> > > > Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate

> > > > 200 MG, Metformin 2000MG and Spironolactone 75 MG.

> > > >

> > >

> >

>

July 19, 2011

Looks like you are a poster elder for DASH and MCBs.Has Dr. reduced other BP meds yet?Dr Grim adds: This is one reason we should be teaching some of the physiology o medicine in grade and highs school I think.Almost everyone who lives long enough will get HTN. So the more you know about it the better able you are to defend against this. Most likely this is due to our high salt intake. Knowledge does not assure action of course.Responses imbedded - JC> > > My puppies decided to do a pulmonary test this morning! They > > loosened the connection on my concentrator causing the 4L oxygen > > flow between my concentrator and bi-pap machine to cease! (That's my > > wife's story and she is sticking with it!) When I changed the hose > > over to the canular I realized there was no airflow so I engaged my > > Oximeter and was surprised to find o2 level was 93-94 (they tell me > > it needs to be >90)! I don't know how long I had been with suppl. O2 > > but I watch it for an additional 30 mins. and it never got below 93 > > and up as high as 95. With suppl. O2 ir ran 96-97. I went without > > again while on the computer and it stayed at 95 for over 30 mins. It > > went down to 90 when I climbed the stairs and immediately rebounded > > to 94 when I sat down.> >> > Not long ago it would have gone down into the low 80's and > > mostlikely not gotten as high as 90 w/o suppl. O2.> >> > Dr. Grim, Is this an indicator of my lungs improving since I got the > > excess aldo. under control ~3mos. ago? I also have noticed I am > > getting a lot better times on my bi-pap which could also be a sign > > I'm breathing better. I know you spoke of this when you first > > learned I was on O2 and had COPD and OSA but I didn't realize > > changes might be so soon or "visable"! I'm going to do some more > > looking but am hoping you can enlighten me or point me where to > > look. (I have a 6mo. follow up in a couple weeks and am preparing > > and will give the Doctor a headsup if appropriate!)> >> > - 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: 130/77> > Other Issues/Opportunities: COPD w/ft Oxygen, OSA w Bi-Pap settings > > 13/19, DM2. and PTSD> > Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate > > 200 MG, Metformin 2000MG and Spironolactone 75 MG.> >> >> >>

July 19, 2011

On Jul 19, 2011, at 6:41 AM, Francis Bill SUSPECTED PA wrote:Just how was COPD DX? I know you said they had you walk with Oximeter and this showed low OX. Did they then do lung function test? On ECHO report what is the estimated ejection fraction? This tells if you have CHF. Echo tells if you have bad CHF. Sx start before low EF on echo.Reason I like to take a good Hx. > > > > > My puppies decided to do a pulmonary test this morning! They > > > loosened the connection on my concentrator causing the 4L oxygen > > > flow between my concentrator and bi-pap machine to cease! (That's my > > > wife's story and she is sticking with it!) When I changed the hose > > > over to the canular I realized there was no airflow so I engaged my > > > Oximeter and was surprised to find o2 level was 93-94 (they tell me > > > it needs to be >90)! I don't know how long I had been with suppl. O2 > > > but I watch it for an additional 30 mins. and it never got below 93 > > > and up as high as 95. With suppl. O2 ir ran 96-97. I went without > > > again while on the computer and it stayed at 95 for over 30 mins. It > > > went down to 90 when I climbed the stairs and immediately rebounded > > > to 94 when I sat down.> > >> > > Not long ago it would have gone down into the low 80's and > > > mostlikely not gotten as high as 90 w/o suppl. O2.> > >> > > Dr. Grim, Is this an indicator of my lungs improving since I got the > > > excess aldo. under control ~3mos. ago? I also have noticed I am > > > getting a lot better times on my bi-pap which could also be a sign > > > I'm breathing better. I know you spoke of this when you first > > > learned I was on O2 and had COPD and OSA but I didn't realize > > > changes might be so soon or "visable"! I'm going to do some more > > > looking but am hoping you can enlighten me or point me where to > > > look. (I have a 6mo. follow up in a couple weeks and am preparing > > > and will give the Doctor a headsup if appropriate!)> > >> > > - 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: 130/77> > > Other Issues/Opportunities: COPD w/ft Oxygen, OSA w Bi-Pap settings > > > 13/19, DM2. and PTSD> > > Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate > > > 200 MG, Metformin 2000MG and Spironolactone 75 MG.> > >> > >> > >> >>

July 19, 2011

You might want to read C. Dickins about the fat boy in Pickwick Papers after whom Pickwickian syndrome is named or look in the mirror. CE Grim MD Francis, First thanks for pointing me to LVEF. I looked back at the ECHO and so far have only been able to find the summary. I found it (LVEF = 56%) in a stress test done 1/31/2007.COPD DX is a little more convoluted. It started with a failed sleep study in early 2010. 2nd sleep study determined I needed 4L nocturnal. This prompted a discussion and walk with Dr. Webster where she RXed 2L at rest and 3L with exhertion. She also did a referral to Pulmonary. On 10/6/2010 under COPD/OSN she entered the comment, "He deserve to visit with the pulmonologist to obtain a diagnosis, and advise ..."Saw Plm (Dr. Simira Shojaee) on 11/22/2010. She said it was emphyesma but difficult to DX due to obesity hypoventilation syndrome. She RXed Spriva and Albuterl w/RTC 6months - 8/2011.Dr. Kelley, Chief, Pulmonary Section confirmed it as copd-obstruction on pfts, morbid obesity and osa. (same date)> > > > > > > My puppies decided to do a pulmonary test this morning! They > > > > loosened the connection on my concentrator causing the 4L oxygen > > > > flow between my concentrator and bi-pap machine to cease! (That's my > > > > wife's story and she is sticking with it!) When I changed the hose > > > > over to the canular I realized there was no airflow so I engaged my > > > > Oximeter and was surprised to find o2 level was 93-94 (they tell me > > > > it needs to be >90)! I don't know how long I had been with suppl. O2 > > > > but I watch it for an additional 30 mins. and it never got below 93 > > > > and up as high as 95. With suppl. O2 ir ran 96-97. I went without > > > > again while on the computer and it stayed at 95 for over 30 mins. It > > > > went down to 90 when I climbed the stairs and immediately rebounded > > > > to 94 when I sat down.> > > >> > > > Not long ago it would have gone down into the low 80's and > > > > mostlikely not gotten as high as 90 w/o suppl. O2.> > > >> > > > Dr. Grim, Is this an indicator of my lungs improving since I got the > > > > excess aldo. under control ~3mos. ago? I also have noticed I am > > > > getting a lot better times on my bi-pap which could also be a sign > > > > I'm breathing better. I know you spoke of this when you first > > > > learned I was on O2 and had COPD and OSA but I didn't realize > > > > changes might be so soon or "visable"! I'm going to do some more > > > > looking but am hoping you can enlighten me or point me where to > > > > look. (I have a 6mo. follow up in a couple weeks and am preparing > > > > and will give the Doctor a headsup if appropriate!)> > > >> > > > - 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: 130/77> > > > Other Issues/Opportunities: COPD w/ft Oxygen, OSA w Bi-Pap settings > > > > 13/19, DM2. and PTSD> > > > Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate > > > > 200 MG, Metformin 2000MG and Spironolactone 75 MG.> > > >> > > >> > > >> > >> >>

July 19, 2011

You're LVEF is normal BTW......that's good!

Francis, First thanks for pointing me to LVEF. I looked back at the ECHO and so far have only been able to find the summary. I found it (LVEF = 56%) in a stress test done 1/31/2007.COPD DX is a little more convoluted. It started with a failed sleep study in early 2010. 2nd sleep study determined I needed 4L nocturnal. This prompted a discussion and walk with Dr. Webster where she RXed 2L at rest and 3L with exhertion. She also did a referral to Pulmonary. On 10/6/2010 under COPD/OSN she entered the comment, "He deserve to visit with the pulmonologist to obtain a diagnosis, and advise ..."Saw Plm (Dr. Simira Shojaee) on 11/22/2010. She said it was emphyesma but difficult to DX due to obesity hypoventilation syndrome. She RXed Spriva and Albuterl w/RTC 6months - 8/2011.Dr. Kelley, Chief, Pulmonary Section confirmed it as copd-obstruction on pfts, morbid obesity and osa. (same date)> > > > > > > My puppies decided to do a pulmonary test this morning! They > > > > loosened the connection on my concentrator causing the 4L oxygen > > > > flow between my

concentrator and bi-pap machine to cease! (That's my > > > > wife's story and she is sticking with it!) When I changed the hose > > > > over to the canular I realized there was no airflow so I engaged my > > > > Oximeter and was surprised to find o2 level was 93-94 (they tell me > > > > it needs to be >90)! I don't know how long I had been with suppl. O2 > > > > but I watch it for an additional 30 mins. and it never got below 93 > > > > and up as high as 95. With suppl. O2 ir ran 96-97. I went without > > > > again while on the computer and it stayed at 95 for over 30 mins. It > > > > went down to 90 when I climbed the stairs and immediately rebounded > > > > to 94 when I sat down.> > > >> > > > Not long ago it would have gone down into the low 80's and > > > > mostlikely not gotten as high as 90 w/o suppl. O2.> > > >> > > > Dr. Grim, Is this an indicator of my lungs improving since I got the > > > > excess aldo. under control ~3mos. ago? I also have noticed I am > > > > getting a lot better times on my bi-pap which could also be a sign > > > > I'm breathing better. I know you spoke of this when you first > > > > learned I was on O2 and had COPD and OSA but I didn't realize > > > > changes might be so soon or "visable"! I'm going to do some more > > > > looking but am hoping you can enlighten me or point me where to > > > > look. (I have a 6mo. follow up in a couple weeks and am preparing > > > > and

will give the Doctor a headsup if appropriate!)> > > >> > > > - 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: 130/77> > > > Other Issues/Opportunities: COPD w/ft Oxygen, OSA w Bi-Pap settings > > > > 13/19, DM2. and PTSD> > > > Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate > > > > 200 MG, Metformin 2000MG and Spironolactone 75 MG.> > > >> > > >> > > >> >

>> >>

July 19, 2011

Careful with the caption on that poster, It should read, " Young Elder's results

with MCB's and Low NA! " DASH is coming now that I'm getting better with new

teeth! I actually pulled DASH info out yesterday to discuss with the shopper

and chief cook!

Funny you should ask about stopping BP meds. I was accused of stopping them on

my own so I set the record straight this w/e via a letter. Neper. docs stopped

Minoxidil & Lisinopril (A Dr. Kolankiewicz, 2nd Neper., also noticed no one had

stopped Potassium Suppl. - K=5.0! and added a caution to watch ACEIs and ARBs!)

Dr, Trask, Endo., stopped Losartan 2 wks later, I can only surmise she didn't

want to watch with K running right on the edge @4.8! Or hopefully knew it was

doing nothing anyway! She also instructed us to " slowly withdraw other

antihypertensive, stopping one every 1-2 weeks. Patient will let us (PCP &

Endo) know if BP is greater than 140/90. "

From there I did the last three only getting in a little trouble when I stopped

Metoprolol cold from 200mg bid! Quich lesson learned which I learned from you,

and Dr. Webster! Dr. Webster then titrated it down to 100mg bid. That is

where I am today (Metoprolol 100mg bid) and I have asked if we can cut that more

now that HR is running in the high 50s to very low 70s.

Your suggestion re. teaching the physiology of medicine in grade and high school

is a good one and I sure could have used it back in the early 80s - 97 when I

was on a weekly recall for BP check - dxed as White Coat Syndrome don't you

know! In fact I liked it so much I just called the principal of BFA Fairfax to

suggest a curriculum change! (He happens to be my son, a few years ago I would

have called a Policy & Curr. meeting, I was chair for the 7 yrs I was on local

H.S Board!)

Thanks for your detailed " The classic evolution of CHF " . That's going on file

for a discussion at the VA. Won't they be excited to learn I have branched out

to more on HTN! Is HTN normally combined with Nephrology?

- 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: 130/77

Other Issues/Opportunities: COPD w/ft Oxygen, OSA w Bi-Pap settings 13/19, DM2.

and PTSD

Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG,

Metformin 2000MG and Spironolactone 75 MG.

> > >

> > > > My puppies decided to do a pulmonary test this morning! They

> > > > loosened the connection on my concentrator causing the 4L oxygen

> > > > flow between my concentrator and bi-pap machine to cease!

> > (That's my

> > > > wife's story and she is sticking with it!) When I changed the hose

> > > > over to the canular I realized there was no airflow so I engaged

> > my

> > > > Oximeter and was surprised to find o2 level was 93-94 (they tell

> > me

> > > > it needs to be >90)! I don't know how long I had been with

> > suppl. O2

> > > > but I watch it for an additional 30 mins. and it never got below

> > 93

> > > > and up as high as 95. With suppl. O2 ir ran 96-97. I went without

> > > > again while on the computer and it stayed at 95 for over 30

> > mins. It

> > > > went down to 90 when I climbed the stairs and immediately

> > rebounded

> > > > to 94 when I sat down.

> > > >

> > > > Not long ago it would have gone down into the low 80's and

> > > > mostlikely not gotten as high as 90 w/o suppl. O2.

> > > >

> > > > Dr. Grim, Is this an indicator of my lungs improving since I got

> > the

> > > > excess aldo. under control ~3mos. ago? I also have noticed I am

> > > > getting a lot better times on my bi-pap which could also be a sign

> > > > I'm breathing better. I know you spoke of this when you first

> > > > learned I was on O2 and had COPD and OSA but I didn't realize

> > > > changes might be so soon or " visable " ! I'm going to do some more

> > > > looking but am hoping you can enlighten me or point me where to

> > > > look. (I have a 6mo. follow up in a couple weeks and am preparing

> > > > and will give the Doctor a headsup if appropriate!)

> > > >

> > > > - 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: 130/77

> > > > Other Issues/Opportunities: COPD w/ft Oxygen, OSA w Bi-Pap

> > settings

> > > > 13/19, DM2. and PTSD

> > > > Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate

> > > > 200 MG, Metformin 2000MG and Spironolactone 75 MG.

> > > >

> > >

> >

>

July 19, 2011

Well HTN has usually been aligned with IM or cards or Endo but none of them receive much training in HTN. ALLEGEDLY because everyone knows how to manage HTN. Today one needs to be a Board Certified Hypertensionologist to be reasonably certain that your expert knows the field. As I have trained in Neph 1 yr Endo 1 yr and been on faculty in Cards Neph and Endo as well as HTN and have over 240 pubs in the broad area of HTN I am relatively unique in knowledge and practice. How do I know my pt has been seen by an expert?1. Did they take BP in both arms and follow AHA Guidelines?2. Did they ask if you eat licorice every day?3. Did they ask about nocturia?4. Did they recommend a DASH eating plan?5. Did they validate the accuracy of your home device and their office device (if it was an electronic device) on you. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Careful with the caption on that poster, It should read,"Young Elder's results with MCB's and Low NA!" DASH is coming now that I'm getting better with new teeth! I actually pulled DASH info out yesterday to discuss with the shopper and chief cook!

Funny you should ask about stopping BP meds. I was accused of stopping them on my own so I set the record straight this w/e via a letter. Neper. docs stopped Minoxidil & Lisinopril (A Dr. Kolankiewicz, 2nd Neper., also noticed no one had stopped Potassium Suppl. - K=5.0! and added a caution to watch ACEIs and ARBs!) Dr, Trask, Endo., stopped Losartan 2 wks later, I can only surmise she didn't want to watch with K running right on the edge @4.8! Or hopefully knew it was doing nothing anyway! She also instructed us to "slowly withdraw other antihypertensive, stopping one every 1-2 weeks. Patient will let us (PCP & Endo) know if BP is greater than 140/90."

From there I did the last three only getting in a little trouble when I stopped Metoprolol cold from 200mg bid! Quich lesson learned which I learned from you, and Dr. Webster! Dr. Webster then titrated it down to 100mg bid. That is where I am today (Metoprolol 100mg bid) and I have asked if we can cut that more now that HR is running in the high 50s to very low 70s.

Your suggestion re. teaching the physiology of medicine in grade and high school is a good one and I sure could have used it back in the early 80s - 97 when I was on a weekly recall for BP check - dxed as White Coat Syndrome don't you know! In fact I liked it so much I just called the principal of BFA Fairfax to suggest a curriculum change! (He happens to be my son, a few years ago I would have called a Policy & Curr. meeting, I was chair for the 7 yrs I was on local H.S Board!)

Thanks for your detailed "The classic evolution of CHF". That's going on file for a discussion at the VA. Won't they be excited to learn I have branched out to more on HTN! Is HTN normally combined with Nephrology?

- 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: 130/77

Other Issues/Opportunities: COPD w/ft Oxygen, OSA w Bi-Pap settings 13/19, DM2. and PTSD

Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, Metformin 2000MG and Spironolactone 75 MG.

> > >

> > > > My puppies decided to do a pulmonary test this morning! They

> > > > loosened the connection on my concentrator causing the 4L oxygen

> > > > flow between my concentrator and bi-pap machine to cease!

> > (That's my

> > > > wife's story and she is sticking with it!) When I changed the hose

> > > > over to the canular I realized there was no airflow so I engaged

> > my

> > > > Oximeter and was surprised to find o2 level was 93-94 (they tell

> > me

> > > > it needs to be >90)! I don't know how long I had been with

> > suppl. O2

> > > > but I watch it for an additional 30 mins. and it never got below

> > 93

> > > > and up as high as 95. With suppl. O2 ir ran 96-97. I went without

> > > > again while on the computer and it stayed at 95 for over 30

> > mins. It

> > > > went down to 90 when I climbed the stairs and immediately

> > rebounded

> > > > to 94 when I sat down.

> > > >

> > > > Not long ago it would have gone down into the low 80's and

> > > > mostlikely not gotten as high as 90 w/o suppl. O2.

> > > >

> > > > Dr. Grim, Is this an indicator of my lungs improving since I got

> > the

> > > > excess aldo. under control ~3mos. ago? I also have noticed I am

> > > > getting a lot better times on my bi-pap which could also be a sign

> > > > I'm breathing better. I know you spoke of this when you first

> > > > learned I was on O2 and had COPD and OSA but I didn't realize

> > > > changes might be so soon or "visable"! I'm going to do some more

> > > > looking but am hoping you can enlighten me or point me where to

> > > > look. (I have a 6mo. follow up in a couple weeks and am preparing

> > > > and will give the Doctor a headsup if appropriate!)

> > > >

> > > > - 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: 130/77

> > > > Other Issues/Opportunities: COPD w/ft Oxygen, OSA w Bi-Pap

> > settings

> > > > 13/19, DM2. and PTSD

> > > > Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate

> > > > 200 MG, Metformin 2000MG and Spironolactone 75 MG.

> > > >

> > >

> >

>

July 19, 2011

As to COPD you may find this link interesting

http://copd.about.com/od/copdbasics/a/copdlifeexpectancy.htm

> > > >

> > > > > My puppies decided to do a pulmonary test this morning! They

> > > > > loosened the connection on my concentrator causing the 4L oxygen

> > > > > flow between my concentrator and bi-pap machine to cease!

> > > (That's my

> > > > > wife's story and she is sticking with it!) When I changed the hose

> > > > > over to the canular I realized there was no airflow so I engaged

> > > my

> > > > > Oximeter and was surprised to find o2 level was 93-94 (they tell

> > > me

> > > > > it needs to be >90)! I don't know how long I had been with

> > > suppl. O2

> > > > > but I watch it for an additional 30 mins. and it never got below

> > > 93

> > > > > and up as high as 95. With suppl. O2 ir ran 96-97. I went without

> > > > > again while on the computer and it stayed at 95 for over 30

> > > mins. It

> > > > > went down to 90 when I climbed the stairs and immediately

> > > rebounded

> > > > > to 94 when I sat down.

> > > > >

> > > > > Not long ago it would have gone down into the low 80's and

> > > > > mostlikely not gotten as high as 90 w/o suppl. O2.

> > > > >

> > > > > Dr. Grim, Is this an indicator of my lungs improving since I got

> > > the

> > > > > excess aldo. under control ~3mos. ago? I also have noticed I am

> > > > > getting a lot better times on my bi-pap which could also be a sign

> > > > > I'm breathing better. I know you spoke of this when you first

> > > > > learned I was on O2 and had COPD and OSA but I didn't realize

> > > > > changes might be so soon or " visable " ! I'm going to do some more

> > > > > looking but am hoping you can enlighten me or point me where to

> > > > > look. (I have a 6mo. follow up in a couple weeks and am preparing

> > > > > and will give the Doctor a headsup if appropriate!)

> > > > >

> > > > > - 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: 130/77

> > > > > Other Issues/Opportunities: COPD w/ft Oxygen, OSA w Bi-Pap

> > > settings

> > > > > 13/19, DM2. and PTSD

> > > > > Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate

> > > > > 200 MG, Metformin 2000MG and Spironolactone 75 MG.

> > > > >

> > > >

> > >

> >

>

July 19, 2011

Better next time to ask a about the dangers of cold turkeying BB. DANGEROUS. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension