Re: Results At Last - What do you think?

[Guest guest]

We really need 24 urine on same day as renin and Aldo. Need rest of your story. You would appear to have normokalemic PA now assuming are on no meds. NED more details. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

I have been waiting a month for the results of my Aldo and Renin tests to come in. I just picked them up at the doctors and notice that it says at the bottom that it is an "Interim Report". Not sure what that means!

These are the results:

Random Aldosterone - 473 pmol/L

The screen for aldosteronism is positive. The aldosterone exceeds the minimum threshold concentration (250 pmol/L for supine collections and 300 pmol/L for upright collections) and the ratio is >2500 pmol/L per ng/L/s.

Consistent with but not diagnostic for primary hyperaldosteronism. Generally, diagnosis requires confirmation by means of a saline suppression, fludrocortisone suppression, or oral salt loading test.

Dr. Andre Mattman, MD

New Method. Performed by Mass Spectrometry at St. 's Hospital.

Aldosterone/Renin Ratio --- >9460 [<1500]

Renin Random --- <0.05 ng/L/s

Reference interval for plasma renin

activity are: upright: 0.05 to 0.55 ng/L/s

and supine: <0.28 ng/L/s.

Sodium 141 Reference range 135-145

Potassium 4.0 Reference range 3.5 - 5.0

Urea 5.4 Reference range 3.0 - 7.5

Creatinine 54 umol/L Reference 50 - 90

Estimated GFR 98 mL/min/l.73 sq m

Observation Notes: eGFR within accepted reference interval. Diet, drugs, and clinical state may affect calculation. See www.bcguidelines.ca/gpac/pdf/ckd.pdf

So, those are my results. My doctor was not in today but I made an appointment to see him on Wednesday to go over these results and I presume he will order one of the other diagnostic tests. Which do you think is the best one to do now.

I am thinking that my aldo/renin ratio at >9460 is probably quite high. What are your thoughts.

Also, do you think it is a good idea to start of one of the two medications that are used the PA along with going on the DASH diet. I have just received the Dash Diet Book by Dr. .

Thanks for your input.

This site has been such a help to me.

[Guest guest]

Hi Dr. Grim:This is my medical history:67 year old female.  Suffered for years with ovarian cysts.  Eventually had a hysterectomy at age 36.  They said my uterus was a pulpy mess.  Suffered from thyroid problems and adrenal problems since my late 20s.  Was told I had adrenal exhaustion.  Took thyroid meds for low thyroid since I was 29 years old.

..  Had malignant melanoma about 12 years ago.  OK now.Had thyroid cancer 5 years ago.  Had thyroid completely removed.  Now taking replacement medication.Suffered with HBP since my late 30s or early 40s.  Tried every medication under the sun.  Nothing works for me plus the side effects were so bad.  Mother also had HBP as well as my sister and brother.  My siblings control their BP with medication.

Some sample BP readings:June 29th @ 8.00 a.m.  210/127June 30th @11.16 a.m. 149/116July lst @ 10.50 p.m. 142/103July 2nd @ 8.00 a.m. 209/126July 5th @7.00 a.m. 202/132July 8th @ 7.54 p.m.  164/120

July 13th @ 11.11 a.m.  152/105July 19th @ 8.33 p.m.  171/117July 23rd @ 6.30 p.m. 144/100July 28th @ 7.31 a.m. 160/116July 29th @ 8.29 a.m.  172/119Suffering with severe fatigue.  Can sleep for 11 hours and still feel awful the

next day.Get up about  3 - 4 times each night to use the bathroom.  I urinate so muchmore during the night that during the day.Lately I have been putting on weight in the area above my waist and below

my chest area.  I just can't seem to lose the weight regardless of whatI do.   From what I have read a number of PA patients have this problem.I know that I am salt sensitive.  Chinese food really does a number on me.

I am on no meds for my high blood pressure.Is my aldosterone/renin ratio of >9460 classified as very high?I will be going to the doctors on Wednesday to go over these results withhim.  The lab said that a confirmation diagnosis would require either a

saline suppression test, a fludrocortisone suppression test or an oral salt loading test.  Do you recommend one of these in particular?Also, should we start on one of the two medications that is recommended

for PA or should we get a confirming diagnosis first?Should I hold off on going on the DASH diet until a absolutely definitediagnosis is made?Thanks for your kind help.Jan

 

We really need 24 urine on same day as renin and Aldo. Need rest of your story. You would appear to have normokalemic PA now assuming are on no meds. NED more details. Tiped sad Send form mi

iPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

 

I have been waiting a month for the results of my Aldo and Renin tests to come in. I just picked them up at the doctors and notice that it says at the bottom that it is an " Interim Report " . Not sure what that means!

These are the results:

Random Aldosterone - 473 pmol/L

The screen for aldosteronism is positive. The aldosterone exceeds the minimum threshold concentration (250 pmol/L for supine collections and 300 pmol/L for upright collections) and the ratio is >2500 pmol/L per ng/L/s.

Consistent with but not diagnostic for primary hyperaldosteronism. Generally, diagnosis requires confirmation by means of a saline suppression, fludrocortisone suppression, or oral salt loading test.

Dr. Andre Mattman, MD

New Method. Performed by Mass Spectrometry at St. 's Hospital.

Aldosterone/Renin Ratio --- >9460 [<1500]

Renin Random --- <0.05 ng/L/s

Reference interval for plasma renin

activity are: upright: 0.05 to 0.55 ng/L/s

and supine: <0.28 ng/L/s.

Sodium 141 Reference range 135-145

Potassium 4.0 Reference range 3.5 - 5.0

Urea 5.4 Reference range 3.0 - 7.5

Creatinine 54 umol/L Reference 50 - 90

Estimated GFR 98 mL/min/l.73 sq m

Observation Notes: eGFR within accepted reference interval. Diet, drugs, and clinical state may affect calculation. See www.bcguidelines.ca/gpac/pdf/ckd.pdf

So, those are my results. My doctor was not in today but I made an appointment to see him on Wednesday to go over these results and I presume he will order one of the other diagnostic tests. Which do you think is the best one to do now.

I am thinking that my aldo/renin ratio at >9460 is probably quite high. What are your thoughts.

Also, do you think it is a good idea to start of one of the two medications that are used the PA along with going on the DASH diet. I have just received the Dash Diet Book by Dr. .

Thanks for your input.

This site has been such a help to me.

-- Jan ShimanoHealth & Wellness Advocate

[Guest guest]

No need to confirm with these numbers IMHO. My approach is to observe BP RESPONSE & K to DASH and Spiro. If both normal and you are back to normal then no reason to do scans. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Hi Dr. Grim:This is my medical history:67 year old female. Suffered for years with ovarian cysts. Eventually had a hysterectomy at age 36. They said my uterus was a pulpy mess. Suffered from thyroid problems and adrenal problems since my late 20s. Was told I had adrenal exhaustion. Took thyroid meds for low thyroid since I was 29 years old.

.. Had malignant melanoma about 12 years ago. OK now.Had thyroid cancer 5 years ago. Had thyroid completely removed. Now taking replacement medication.Suffered with HBP since my late 30s or early 40s. Tried every medication under the sun. Nothing works for me plus the side effects were so bad. Mother also had HBP as well as my sister and brother. My siblings control their BP with medication.

Some sample BP readings:June 29th @ 8.00 a.m. 210/127June 30th @11.16 a.m. 149/116July lst @ 10.50 p.m. 142/103July 2nd @ 8.00 a.m. 209/126July 5th @7.00 a.m. 202/132July 8th @ 7.54 p.m. 164/120

July 13th @ 11.11 a.m. 152/105July 19th @ 8.33 p.m. 171/117July 23rd @ 6.30 p.m. 144/100July 28th @ 7.31 a.m. 160/116July 29th @ 8.29 a.m. 172/119Suffering with severe fatigue. Can sleep for 11 hours and still feel awful the

next day.Get up about 3 - 4 times each night to use the bathroom. I urinate so muchmore during the night that during the day.Lately I have been putting on weight in the area above my waist and below

my chest area. I just can't seem to lose the weight regardless of whatI do. From what I have read a number of PA patients have this problem.I know that I am salt sensitive. Chinese food really does a number on me.

I am on no meds for my high blood pressure.Is my aldosterone/renin ratio of >9460 classified as very high?I will be going to the doctors on Wednesday to go over these results withhim. The lab said that a confirmation diagnosis would require either a

saline suppression test, a fludrocortisone suppression test or an oral salt loading test. Do you recommend one of these in particular?Also, should we start on one of the two medications that is recommended

for PA or should we get a confirming diagnosis first?Should I hold off on going on the DASH diet until a absolutely definitediagnosis is made?Thanks for your kind help.Jan

We really need 24 urine on same day as renin and Aldo. Need rest of your story. You would appear to have normokalemic PA now assuming are on no meds. NED more details. Tiped sad Send form mi

iPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

I have been waiting a month for the results of my Aldo and Renin tests to come in. I just picked them up at the doctors and notice that it says at the bottom that it is an "Interim Report". Not sure what that means!

These are the results:

Random Aldosterone - 473 pmol/L

The screen for aldosteronism is positive. The aldosterone exceeds the minimum threshold concentration (250 pmol/L for supine collections and 300 pmol/L for upright collections) and the ratio is >2500 pmol/L per ng/L/s.

Consistent with but not diagnostic for primary hyperaldosteronism. Generally, diagnosis requires confirmation by means of a saline suppression, fludrocortisone suppression, or oral salt loading test.

Dr. Andre Mattman, MD

New Method. Performed by Mass Spectrometry at St. 's Hospital.

Aldosterone/Renin Ratio --- >9460 [<1500]

Renin Random --- <0.05 ng/L/s

Reference interval for plasma renin

activity are: upright: 0.05 to 0.55 ng/L/s

and supine: <0.28 ng/L/s.

Sodium 141 Reference range 135-145

Potassium 4.0 Reference range 3.5 - 5.0

Urea 5.4 Reference range 3.0 - 7.5

Creatinine 54 umol/L Reference 50 - 90

Estimated GFR 98 mL/min/l.73 sq m

Observation Notes: eGFR within accepted reference interval. Diet, drugs, and clinical state may affect calculation. See www.bcguidelines.ca/gpac/pdf/ckd.pdf

So, those are my results. My doctor was not in today but I made an appointment to see him on Wednesday to go over these results and I presume he will order one of the other diagnostic tests. Which do you think is the best one to do now.

I am thinking that my aldo/renin ratio at >9460 is probably quite high. What are your thoughts.

Also, do you think it is a good idea to start of one of the two medications that are used the PA along with going on the DASH diet. I have just received the Dash Diet Book by Dr. .

Thanks for your input.

This site has been such a help to me.

-- Jan ShimanoHealth & Wellness Advocate

[Guest guest]

As Dr Grimm said, it would be better to have your 24 urine NA for the day your

test was done, this is easy to explain

That day you should eat a LOT of salt, if your body is loaded with salt then it

will not produce a lot of aldo, however if in the test it shows you still have a

lot of aldo, then something is making that aldo, and it's not made in response

to typical stimuli.

That means that something is doing aldo all by itself ( the PA )

so really with your tests just on the ARR being so extremly high it basically

screams PA.

But to not only scream PA but to have the 100% positive result you would have

required the 24 hour NA test... too bad you did not have it.

however, if that day you ate normal to high sodium with that ARR ration for most

people you will have PA.

Ideally the tests should be repeated with the NA in urine.

But really, you will end up doing the same one way or another taking spiro and

dashing, so really that should be started ASAP, specially the dash, personally I

have been lowering my spiro a LOT because I dash.

I take 6.25mg of spiro and my BP is low actually... but I dash a lot... somedays

I do not even need the spiro, and I wonder if 6.25 mg is even worth the

bother... Anyhow the key to this is not even spiro but the dash.

I hope your BP gets controlled very soon !

>

> I have been waiting a month for the results of my Aldo and Renin tests to come

in. I just picked them up at the doctors and notice that it says at the bottom

that it is an " Interim Report " . Not sure what that means!

>

> These are the results:

>

> Random Aldosterone - 473 pmol/L

> The screen for aldosteronism is positive. The

aldosterone exceeds the minimum threshold concentration (250 pmol/L for supine

collections and 300 pmol/L for upright collections) and the ratio is >2500

pmol/L per ng/L/s.

>

> Consistent with but not diagnostic for primary hyperaldosteronism. Generally,

diagnosis requires confirmation by means of a saline suppression,

fludrocortisone suppression, or oral salt loading test.

>

> Dr. Andre Mattman, MD

>

> New Method. Performed by Mass Spectrometry at St. 's Hospital.

>

> Aldosterone/Renin Ratio --- >9460 [<1500]

>

> Renin Random --- <0.05 ng/L/s

>

> Reference interval for plasma renin

> activity are: upright: 0.05 to 0.55 ng/L/s

> and supine: <0.28 ng/L/s.

>

> Sodium 141 Reference range 135-145

> Potassium 4.0 Reference range 3.5 - 5.0

> Urea 5.4 Reference range 3.0 - 7.5

>

> Creatinine 54 umol/L Reference 50 - 90

> Estimated GFR 98 mL/min/l.73 sq m

>

> Observation Notes: eGFR within accepted reference interval. Diet, drugs, and

clinical state may affect calculation. See www.bcguidelines.ca/gpac/pdf/ckd.pdf

>

>

> So, those are my results. My doctor was not in today but I made an

appointment to see him on Wednesday to go over these results and I presume he

will order one of the other diagnostic tests. Which do you think is the best

one to do now.

>

> I am thinking that my aldo/renin ratio at >9460 is probably quite high. What

are your thoughts.

>

> Also, do you think it is a good idea to start of one of the two medications

that are used the PA along with going on the DASH diet. I have just received

the Dash Diet Book by Dr. .

>

> Thanks for your input.

>

> This site has been such a help to me.

>

[Guest guest]

I went to the Dr. last Wednesday and he put me on 25 mg. of Spirotwice a day.  I also started the DASH diet a few days before goingto the Dr.At first I thought I was experiencing more energy and I had a few

lower BP readings but these last two days I have not been feelingso good.  I feel overheated and have started sweating, which issomething that I never do.  Also, my sleep has not been good for thelast two evenings. 

The Dr. wants to see me again next Wednesday to see if he shouldincrease the meds.  My BP first thing this morning was 177/128.Two days ago I had a reading at 4.46 p.m. of 128/92 which is amazinglylow for me.  I take my BP at random times during the day and it is

all over the map.  Is that how most people with PH are?I have also been having dizzy spells since being on the Sprio.If I am not feeling good on 50 mg. of Spiro a day I can't imagine whatI would feel like on a higher dose.

Any thoughts and ideas would be much appreciated.  Thanks.

 

As Dr Grimm said, it would be better to have your 24 urine NA for the day your test was done, this is easy to explain

That day you should eat a LOT of salt, if your body is loaded with salt then it will not produce a lot of aldo, however if in the test it shows you still have a lot of aldo, then something is making that aldo, and it's not made in response to typical stimuli.

That means that something is doing aldo all by itself ( the PA )

so really with your tests just on the ARR being so extremly high it basically screams PA.

But to not only scream PA but to have the 100% positive result you would have required the 24 hour NA test... too bad you did not have it.

however, if that day you ate normal to high sodium with that ARR ration for most people you will have PA.

Ideally the tests should be repeated with the NA in urine.

But really, you will end up doing the same one way or another taking spiro and dashing, so really that should be started ASAP, specially the dash, personally I have been lowering my spiro a LOT because I dash.

I take 6.25mg of spiro and my BP is low actually... but I dash a lot... somedays I do not even need the spiro, and I wonder if 6.25 mg is even worth the bother... Anyhow the key to this is not even spiro but the dash.

I hope your BP gets controlled very soon !

>

> I have been waiting a month for the results of my Aldo and Renin tests to come in. I just picked them up at the doctors and notice that it says at the bottom that it is an " Interim Report " . Not sure what that means!

>

> These are the results:

>

> Random Aldosterone - 473 pmol/L

> The screen for aldosteronism is positive. The aldosterone exceeds the minimum threshold concentration (250 pmol/L for supine collections and 300 pmol/L for upright collections) and the ratio is >2500 pmol/L per ng/L/s.

>

> Consistent with but not diagnostic for primary hyperaldosteronism. Generally, diagnosis requires confirmation by means of a saline suppression, fludrocortisone suppression, or oral salt loading test.

>

> Dr. Andre Mattman, MD

>

> New Method. Performed by Mass Spectrometry at St. 's Hospital.

>

> Aldosterone/Renin Ratio --- >9460 [<1500]

>

> Renin Random --- <0.05 ng/L/s

>

> Reference interval for plasma renin

> activity are: upright: 0.05 to 0.55 ng/L/s

> and supine: <0.28 ng/L/s.

>

> Sodium 141 Reference range 135-145

> Potassium 4.0 Reference range 3.5 - 5.0

> Urea 5.4 Reference range 3.0 - 7.5

>

> Creatinine 54 umol/L Reference 50 - 90

> Estimated GFR 98 mL/min/l.73 sq m

>

> Observation Notes: eGFR within accepted reference interval. Diet, drugs, and clinical state may affect calculation. See www.bcguidelines.ca/gpac/pdf/ckd.pdf

>

>

> So, those are my results. My doctor was not in today but I made an appointment to see him on Wednesday to go over these results and I presume he will order one of the other diagnostic tests. Which do you think is the best one to do now.

>

> I am thinking that my aldo/renin ratio at >9460 is probably quite high. What are your thoughts.

>

> Also, do you think it is a good idea to start of one of the two medications that are used the PA along with going on the DASH diet. I have just received the Dash Diet Book by Dr. .

>

> Thanks for your input.

>

> This site has been such a help to me.

>

-- Jan ShimanoHealth & Wellness Advocate

[Guest guest]

Jan, a few questions: Other meds. you are on? Do you know what your urine NA

(sodium) is? Are you taking your BP according to Dr. Grim's perscribed method?

(Take 3, average last 2.) Titrating Spiro up in only 2 weeks may be too soon,

HTN Primer recommends 4-6 weeks.

When I started Spiro the doctor also started me on a loop diutetic (furosemide)

to control fluid and NA. I saw some immediate benefit to my BP but other

symptoms didn't change for 10 mos! (Dr. Grim told me I FINALLY got my NA under

control!) Once that happened the changes have been dramatic and amazing!

Update us and somebody will have some suggestions (I'm not a doctor but love to

read and research!) (My questions are some of the standard info. required by

Dr. G. to get you started.)

- 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(last week ave): 124/61

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,

81mg asprin, Metformin 2000MG and Spironolactone 75 MG.

> > >

> > > I have been waiting a month for the results of my Aldo and Renin tests to

> > come in. I just picked them up at the doctors and notice that it says at the

> > bottom that it is an " Interim Report " . Not sure what that means!

> > >

> > > These are the results:

> > >

> > > Random Aldosterone - 473 pmol/L

> > > The screen for aldosteronism is positive. The aldosterone exceeds the

> > minimum threshold concentration (250 pmol/L for supine collections and 300

> > pmol/L for upright collections) and the ratio is >2500 pmol/L per ng/L/s.

> > >

> > > Consistent with but not diagnostic for primary hyperaldosteronism.

> > Generally, diagnosis requires confirmation by means of a saline suppression,

> > fludrocortisone suppression, or oral salt loading test.

> > >

> > > Dr. Andre Mattman, MD

> > >

> > > New Method. Performed by Mass Spectrometry at St. 's Hospital.

> > >

> > > Aldosterone/Renin Ratio --- >9460 [<1500]

> > >

> > > Renin Random --- <0.05 ng/L/s

> > >

> > > Reference interval for plasma renin

> > > activity are: upright: 0.05 to 0.55 ng/L/s

> > > and supine: <0.28 ng/L/s.

> > >

> > > Sodium 141 Reference range 135-145

> > > Potassium 4.0 Reference range 3.5 - 5.0

> > > Urea 5.4 Reference range 3.0 - 7.5

> > >

> > > Creatinine 54 umol/L Reference 50 - 90

> > > Estimated GFR 98 mL/min/l.73 sq m

> > >

> > > Observation Notes: eGFR within accepted reference interval. Diet, drugs,

> > and clinical state may affect calculation. See

> > www.bcguidelines.ca/gpac/pdf/ckd.pdf

> > >

> > >

> > > So, those are my results. My doctor was not in today but I made an

> > appointment to see him on Wednesday to go over these results and I presume

> > he will order one of the other diagnostic tests. Which do you think is the

> > best one to do now.

> > >

> > > I am thinking that my aldo/renin ratio at >9460 is probably quite high.

> > What are your thoughts.

> > >

> > > Also, do you think it is a good idea to start of one of the two

> > medications that are used the PA along with going on the DASH diet. I have

> > just received the Dash Diet Book by Dr. .

> > >

> > > Thanks for your input.

> > >

> > > This site has been such a help to me.

> > >

> >

> >

> >

>

>

>

> --

>

> Jan Shimano

> Health & Wellness Advocate

>

[Guest guest]

I recommend taking BP in am before meds as described in our files. Don't waste time and energy doing it at other times unless you are feeling dizzy then check it seated and standing as described in our files.Please add a thumbnail so I know who you are.Be sure your device is accurate. Many are not in individuals.CE Grim MD I went to the Dr. last Wednesday and he put me on 25 mg. of Spirotwice a day. I also started the DASH diet a few days before goingto the Dr.At first I thought I was experiencing more energy and I had a few lower BP readings but these last two days I have not been feelingso good. I feel overheated and have started sweating, which issomething that I never do. Also, my sleep has not been good for thelast two evenings. The Dr. wants to see me again next Wednesday to see if he shouldincrease the meds. My BP first thing this morning was 177/128.Two days ago I had a reading at 4.46 p.m. of 128/92 which is amazinglylow for me. I take my BP at random times during the day and it is all over the map. Is that how most people with PH are?I have also been having dizzy spells since being on the Sprio.If I am not feeling good on 50 mg. of Spiro a day I can't imagine whatI would feel like on a higher dose. Any thoughts and ideas would be much appreciated. Thanks. As Dr Grimm said, it would be better to have your 24 urine NA for the day your test was done, this is easy to explain That day you should eat a LOT of salt, if your body is loaded with salt then it will not produce a lot of aldo, however if in the test it shows you still have a lot of aldo, then something is making that aldo, and it's not made in response to typical stimuli. That means that something is doing aldo all by itself ( the PA ) so really with your tests just on the ARR being so extremly high it basically screams PA. But to not only scream PA but to have the 100% positive result you would have required the 24 hour NA test... too bad you did not have it. however, if that day you ate normal to high sodium with that ARR ration for most people you will have PA. Ideally the tests should be repeated with the NA in urine. But really, you will end up doing the same one way or another taking spiro and dashing, so really that should be started ASAP, specially the dash, personally I have been lowering my spiro a LOT because I dash. I take 6.25mg of spiro and my BP is low actually... but I dash a lot... somedays I do not even need the spiro, and I wonder if 6.25 mg is even worth the bother... Anyhow the key to this is not even spiro but the dash. I hope your BP gets controlled very soon ! > > I have been waiting a month for the results of my Aldo and Renin tests to come in. I just picked them up at the doctors and notice that it says at the bottom that it is an "Interim Report". Not sure what that means! > > These are the results: > > Random Aldosterone - 473 pmol/L > The screen for aldosteronism is positive. The aldosterone exceeds the minimum threshold concentration (250 pmol/L for supine collections and 300 pmol/L for upright collections) and the ratio is >2500 pmol/L per ng/L/s. > > Consistent with but not diagnostic for primary hyperaldosteronism. Generally, diagnosis requires confirmation by means of a saline suppression, fludrocortisone suppression, or oral salt loading test. > > Dr. Andre Mattman, MD > > New Method. Performed by Mass Spectrometry at St. 's Hospital. > > Aldosterone/Renin Ratio --- >9460 [<1500] > > Renin Random --- <0.05 ng/L/s > > Reference interval for plasma renin > activity are: upright: 0.05 to 0.55 ng/L/s > and supine: <0.28 ng/L/s. > > Sodium 141 Reference range 135-145 > Potassium 4.0 Reference range 3.5 - 5.0 > Urea 5.4 Reference range 3.0 - 7.5 > > Creatinine 54 umol/L Reference 50 - 90 > Estimated GFR 98 mL/min/l.73 sq m > > Observation Notes: eGFR within accepted reference interval. Diet, drugs, and clinical state may affect calculation. See www.bcguidelines.ca/gpac/pdf/ckd.pdf > > > So, those are my results. My doctor was not in today but I made an appointment to see him on Wednesday to go over these results and I presume he will order one of the other diagnostic tests. Which do you think is the best one to do now. > > I am thinking that my aldo/renin ratio at >9460 is probably quite high. What are your thoughts. > > Also, do you think it is a good idea to start of one of the two medications that are used the PA along with going on the DASH diet. I have just received the Dash Diet Book by Dr. . > > Thanks for your input. > > This site has been such a help to me. > -- Jan ShimanoHealth & Wellness Advocate

[Guest guest]

Tell them I trained with Dr ConnTiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

:Sorry for delay in responding. I get lost in all the messages and find it trickyto figure out who is answering who when there is a long list of responses to amessage.Other meds -- only my thyroid medication. I had my thyroid removed 5 years

ago for thyroid cancer. I stopped taking BP meds a few years ago even thoughmy BP was very high. The meds didn't work and I had awful side effects fromthem. Acftually, I was able to tolerate both Diovan and Micardis (they are the

same family of BP meds). However, it was a waste of time taking them becausethey didn't reduce my BP.Dr. Grim recently told me over at Yahoo Groups that I should take my BP justonce a day before I take my Spiro. He didn't mention taking 3 and then averaging

the last two.When I see the Dr. on Wednesday I will discuss with him whether I should beincreasing the meds so early. I had one good reading over the last 12 daysbut it seems to have settled into the slightest improvement so far....and I mean

slight. Example...this morning it was 165/107 and 9 days ago it was164/108. This comparison shows no change.I can take my BP 6 times a day and get huge differences, so I think that perhapsthat's why Dr. Grim said to take it just once a day before my Spiro.

I have read where some people are only taking 6.5 mg. of Spiro. I didn't thinkthe pills came in that small a dosage. My doc. said "We'll just start you offon 25 mgs. twice a day" as if this was a real beginners dose.

When you say "other symptoms did not change for 10 months" what would thoseother symptoms have been? I am so unbelievable fatigued all the time and I feellike there is cotton wool or something stuffed in my brain. Also, I am not too

steady on my feet. It's not full blown dizzyness but sometimes I think I am walkinglike a drunk person.I appreciate your comments and enjoy reading your messages.

Jan, a few questions: Other meds. you are on? Do you know what your urine NA (sodium) is? Are you taking your BP according to Dr. Grim's perscribed method? (Take 3, average last 2.) Titrating Spiro up in only 2 weeks may be too soon, HTN Primer recommends 4-6 weeks.

When I started Spiro the doctor also started me on a loop diutetic (furosemide) to control fluid and NA. I saw some immediate benefit to my BP but other symptoms didn't change for 10 mos! (Dr. Grim told me I FINALLY got my NA under control!) Once that happened the changes have been dramatic and amazing!

Update us and somebody will have some suggestions (I'm not a doctor but love to read and research!) (My questions are some of the standard info. required by Dr. G. to get you started.)

- 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(last week ave): 124/61

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, 81mg asprin, Metformin 2000MG and Spironolactone 75 MG.

> > >

> > > I have been waiting a month for the results of my Aldo and Renin tests to

> > come in. I just picked them up at the doctors and notice that it says at the

> > bottom that it is an "Interim Report". Not sure what that means!

> > >

> > > These are the results:

> > >

> > > Random Aldosterone - 473 pmol/L

> > > The screen for aldosteronism is positive. The aldosterone exceeds the

> > minimum threshold concentration (250 pmol/L for supine collections and 300

> > pmol/L for upright collections) and the ratio is >2500 pmol/L per ng/L/s.

> > >

> > > Consistent with but not diagnostic for primary hyperaldosteronism.

> > Generally, diagnosis requires confirmation by means of a saline suppression,

> > fludrocortisone suppression, or oral salt loading test.

> > >

> > > Dr. Andre Mattman, MD

> > >

> > > New Method. Performed by Mass Spectrometry at St. 's Hospital.

> > >

> > > Aldosterone/Renin Ratio --- >9460 [<1500]

> > >

> > > Renin Random --- <0.05 ng/L/s

> > >

> > > Reference interval for plasma renin

> > > activity are: upright: 0.05 to 0.55 ng/L/s

> > > and supine: <0.28 ng/L/s.

> > >

> > > Sodium 141 Reference range 135-145

> > > Potassium 4.0 Reference range 3.5 - 5.0

> > > Urea 5.4 Reference range 3.0 - 7.5

> > >

> > > Creatinine 54 umol/L Reference 50 - 90

> > > Estimated GFR 98 mL/min/l.73 sq m

> > >

> > > Observation Notes: eGFR within accepted reference interval. Diet, drugs,

> > and clinical state may affect calculation. See

> > www.bcguidelines.ca/gpac/pdf/ckd.pdf

> > >

> > >

> > > So, those are my results. My doctor was not in today but I made an

> > appointment to see him on Wednesday to go over these results and I presume

> > he will order one of the other diagnostic tests. Which do you think is the

> > best one to do now.

> > >

> > > I am thinking that my aldo/renin ratio at >9460 is probably quite high.

> > What are your thoughts.

> > >

> > > Also, do you think it is a good idea to start of one of the two

> > medications that are used the PA along with going on the DASH diet. I have

> > just received the Dash Diet Book by Dr. .

> > >

> > > Thanks for your input.

> > >

> > > This site has been such a help to me.

> > >

> >

> >

> >

>

>

>

> --

>

> Jan Shimano

> Health & Wellness Advocate

>

-- Jan ShimanoHealth & Wellness Advocate

Reply to sender |

Reply to group |

Reply via web post |

Start a New Topic

Messages in this topic

(27)

End Recommendations

[Guest guest]

Dr. Grim:I have read Evolution of Diagnostic Criteria for Primary Aldosteronism:Why Is It More Common in " Drug-Resistant " Hypertension Today? " anumber of times now, but find no reference to doses for Spiro.

Is there another Paper that I should be reading.No quite sure what " 50 is avoid starting dose " actually means.  Couldyou please explain further.  Thank you.Jan

 

He is correct 50 is avoid starting doseYou will recognize your self if you read the evolution article and take to your team. Tiped sad Send form mi

iPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

 

:Sorry for delay in responding.  I get lost in all the messages and find it trickyto figure out who is answering who when there is a long list of responses to amessage.Other meds -- only my thyroid medication.  I had my thyroid removed 5 years

ago for thyroid cancer.  I stopped taking BP meds a few years ago even thoughmy BP was very high.  The meds didn't work and I had awful side effects fromthem.  Acftually, I was able to tolerate both Diovan and Micardis (they are the

same family of BP meds).  However, it was a waste of time taking them becausethey didn't reduce my BP.Dr. Grim recently told me over at Yahoo Groups that I should take my BP justonce a day before I take my Spiro.  He didn't mention taking 3 and then averaging

the last two.When I see the Dr. on Wednesday I will discuss with him whether I should beincreasing the meds so early.  I had one good reading over the last 12 daysbut it seems to have settled into the slightest improvement so far....and I mean

slight.  Example...this morning it was 165/107 and 9 days ago it was164/108.  This comparison shows no change.I can take my BP 6 times a day and get huge differences, so I think that perhapsthat's why Dr. Grim said to take it just once a day before my Spiro.

I have read where some people are only taking 6.5 mg. of Spiro.  I didn't thinkthe pills came in that small a dosage.  My doc. said " We'll just start you offon 25 mgs. twice a day " as if this was a real beginners dose.

When you say " other symptoms did not change for 10 months " what would thoseother symptoms have been?  I am so unbelievable fatigued all the time and I feellike there is cotton wool or something stuffed in my brain.  Also, I am not too

steady on my feet.  It's not full blown dizzyness but sometimes I think I am walkinglike a drunk person.I appreciate your comments and enjoy reading your messages.

 

Jan, a few questions: Other meds. you are on? Do you know what your urine NA (sodium) is? Are you taking your BP according to Dr. Grim's perscribed method? (Take 3, average last 2.) Titrating Spiro up in only 2 weeks may be too soon, HTN Primer recommends 4-6 weeks.

When I started Spiro the doctor also started me on a loop diutetic (furosemide) to control fluid and NA. I saw some immediate benefit to my BP but other symptoms didn't change for 10 mos! (Dr. Grim told me I FINALLY got my NA under control!) Once that happened the changes have been dramatic and amazing!

Update us and somebody will have some suggestions (I'm not a doctor but love to read and research!) (My questions are some of the standard info. required by Dr. G. to get you started.)

- 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(last week ave): 124/61

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, 81mg asprin, Metformin 2000MG and Spironolactone 75 MG.

> > >

> > > I have been waiting a month for the results of my Aldo and Renin tests to

> > come in. I just picked them up at the doctors and notice that it says at the

> > bottom that it is an " Interim Report " . Not sure what that means!

> > >

> > > These are the results:

> > >

> > > Random Aldosterone - 473 pmol/L

> > > The screen for aldosteronism is positive. The aldosterone exceeds the

> > minimum threshold concentration (250 pmol/L for supine collections and 300

> > pmol/L for upright collections) and the ratio is >2500 pmol/L per ng/L/s.

> > >

> > > Consistent with but not diagnostic for primary hyperaldosteronism.

> > Generally, diagnosis requires confirmation by means of a saline suppression,

> > fludrocortisone suppression, or oral salt loading test.

> > >

> > > Dr. Andre Mattman, MD

> > >

> > > New Method. Performed by Mass Spectrometry at St. 's Hospital.

> > >

> > > Aldosterone/Renin Ratio --- >9460 [<1500]

> > >

> > > Renin Random --- <0.05 ng/L/s

> > >

> > > Reference interval for plasma renin

> > > activity are: upright: 0.05 to 0.55 ng/L/s

> > > and supine: <0.28 ng/L/s.

> > >

> > > Sodium 141 Reference range 135-145

> > > Potassium 4.0 Reference range 3.5 - 5.0

> > > Urea 5.4 Reference range 3.0 - 7.5

> > >

> > > Creatinine 54 umol/L Reference 50 - 90

> > > Estimated GFR 98 mL/min/l.73 sq m

> > >

> > > Observation Notes: eGFR within accepted reference interval. Diet, drugs,

> > and clinical state may affect calculation. See

> > www.bcguidelines.ca/gpac/pdf/ckd.pdf

> > >

> > >

> > > So, those are my results. My doctor was not in today but I made an

> > appointment to see him on Wednesday to go over these results and I presume

> > he will order one of the other diagnostic tests. Which do you think is the

> > best one to do now.

> > >

> > > I am thinking that my aldo/renin ratio at >9460 is probably quite high.

> > What are your thoughts.

> > >

> > > Also, do you think it is a good idea to start of one of the two

> > medications that are used the PA along with going on the DASH diet. I have

> > just received the Dash Diet Book by Dr. .

> > >

> > > Thanks for your input.

> > >

> > > This site has been such a help to me.

> > >

> >

> >

> >

>

>

>

> --

>

> Jan Shimano

> Health & Wellness Advocate

>

-- Jan ShimanoHealth & Wellness Advocate

Reply to sender |

Reply to group |

Reply via web post |

Start a New Topic

Messages in this topic

(27)

End Recommendations

-- Jan ShimanoHealth & Wellness Advocate

[Guest guest]

Yes read the Bravo paper mentioned in the intro need to update my paper I think. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Dr. Grim:I have read Evolution of Diagnostic Criteria for Primary Aldosteronism:Why Is It More Common in "Drug-Resistant" Hypertension Today?" anumber of times now, but find no reference to doses for Spiro.

Is there another Paper that I should be reading.No quite sure what "50 is avoid starting dose" actually means. Couldyou please explain further. Thank you.Jan

He is correct 50 is avoid starting doseYou will recognize your self if you read the evolution article and take to your team. Tiped sad Send form mi

iPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

:Sorry for delay in responding. I get lost in all the messages and find it trickyto figure out who is answering who when there is a long list of responses to amessage.Other meds -- only my thyroid medication. I had my thyroid removed 5 years

ago for thyroid cancer. I stopped taking BP meds a few years ago even thoughmy BP was very high. The meds didn't work and I had awful side effects fromthem. Acftually, I was able to tolerate both Diovan and Micardis (they are the

same family of BP meds). However, it was a waste of time taking them becausethey didn't reduce my BP.Dr. Grim recently told me over at Yahoo Groups that I should take my BP justonce a day before I take my Spiro. He didn't mention taking 3 and then averaging

the last two.When I see the Dr. on Wednesday I will discuss with him whether I should beincreasing the meds so early. I had one good reading over the last 12 daysbut it seems to have settled into the slightest improvement so far....and I mean

slight. Example...this morning it was 165/107 and 9 days ago it was164/108. This comparison shows no change.I can take my BP 6 times a day and get huge differences, so I think that perhapsthat's why Dr. Grim said to take it just once a day before my Spiro.

I have read where some people are only taking 6.5 mg. of Spiro. I didn't thinkthe pills came in that small a dosage. My doc. said "We'll just start you offon 25 mgs. twice a day" as if this was a real beginners dose.

When you say "other symptoms did not change for 10 months" what would thoseother symptoms have been? I am so unbelievable fatigued all the time and I feellike there is cotton wool or something stuffed in my brain. Also, I am not too

steady on my feet. It's not full blown dizzyness but sometimes I think I am walkinglike a drunk person.I appreciate your comments and enjoy reading your messages.

Jan, a few questions: Other meds. you are on? Do you know what your urine NA (sodium) is? Are you taking your BP according to Dr. Grim's perscribed method? (Take 3, average last 2.) Titrating Spiro up in only 2 weeks may be too soon, HTN Primer recommends 4-6 weeks.

When I started Spiro the doctor also started me on a loop diutetic (furosemide) to control fluid and NA. I saw some immediate benefit to my BP but other symptoms didn't change for 10 mos! (Dr. Grim told me I FINALLY got my NA under control!) Once that happened the changes have been dramatic and amazing!

Update us and somebody will have some suggestions (I'm not a doctor but love to read and research!) (My questions are some of the standard info. required by Dr. G. to get you started.)

- 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(last week ave): 124/61

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, 81mg asprin, Metformin 2000MG and Spironolactone 75 MG.

> > >

> > > I have been waiting a month for the results of my Aldo and Renin tests to

> > come in. I just picked them up at the doctors and notice that it says at the

> > bottom that it is an "Interim Report". Not sure what that means!

> > >

> > > These are the results:

> > >

> > > Random Aldosterone - 473 pmol/L

> > > The screen for aldosteronism is positive. The aldosterone exceeds the

> > minimum threshold concentration (250 pmol/L for supine collections and 300

> > pmol/L for upright collections) and the ratio is >2500 pmol/L per ng/L/s.

> > >

> > > Consistent with but not diagnostic for primary hyperaldosteronism.

> > Generally, diagnosis requires confirmation by means of a saline suppression,

> > fludrocortisone suppression, or oral salt loading test.

> > >

> > > Dr. Andre Mattman, MD

> > >

> > > New Method. Performed by Mass Spectrometry at St. 's Hospital.

> > >

> > > Aldosterone/Renin Ratio --- >9460 [<1500]

> > >

> > > Renin Random --- <0.05 ng/L/s

> > >

> > > Reference interval for plasma renin

> > > activity are: upright: 0.05 to 0.55 ng/L/s

> > > and supine: <0.28 ng/L/s.

> > >

> > > Sodium 141 Reference range 135-145

> > > Potassium 4.0 Reference range 3.5 - 5.0

> > > Urea 5.4 Reference range 3.0 - 7.5

> > >

> > > Creatinine 54 umol/L Reference 50 - 90

> > > Estimated GFR 98 mL/min/l.73 sq m

> > >

> > > Observation Notes: eGFR within accepted reference interval. Diet, drugs,

> > and clinical state may affect calculation. See

> > www.bcguidelines.ca/gpac/pdf/ckd.pdf

> > >

> > >

> > > So, those are my results. My doctor was not in today but I made an

> > appointment to see him on Wednesday to go over these results and I presume

> > he will order one of the other diagnostic tests. Which do you think is the

> > best one to do now.

> > >

> > > I am thinking that my aldo/renin ratio at >9460 is probably quite high.

> > What are your thoughts.

> > >

> > > Also, do you think it is a good idea to start of one of the two

> > medications that are used the PA along with going on the DASH diet. I have

> > just received the Dash Diet Book by Dr. .

> > >

> > > Thanks for your input.

> > >

> > > This site has been such a help to me.

> > >

> >

> >

> >

>

>

>

> --

>

> Jan Shimano

> Health & Wellness Advocate

>

-- Jan ShimanoHealth & Wellness Advocate

Reply to sender |

Reply to group |

Reply via web post |

Start a New Topic

Messages in this topic

(27)

End Recommendations

-- Jan ShimanoHealth & Wellness Advocate

[Guest guest]

Jan, no need to be sorry - I know how hard it can be to get up to speed,

especially if you aren't feeling well and with Brain Fog. It's funny that if

anyone had asked me if I was affected by Brain Fog while it was happening I

would have said " No " . In reviewing my 6 years of reports from the VA I would

now have to say that would have been a lie, God, I was a pain in the old you

know what!

On to your questions. Other issues that resolved when I got NA at the correct

level in addition to the pains were primarily around urinating and endema.

Previously I was peeing every hour or so during the day and got up 3-4 times at

night. I now need to go every 6 hrs or so and do NOT need to get up at all at

night. Most nights I sleep uninterupted for 8-9 hrs! (An indirect advantage of

this new sleep pattern is that after ~4hrs you go into REM Sleep which is where

the body burns up stored Fat cells among other things!)

The endema resolved right along about that time and I was also on a loop

duretic, Furosemide. I didn't think I'd ever see my ankle bones again! Not

sure how much of that was the Furosemide and how much was getting the excess

Aldostrone under control but since I had been on the F. from the start and it

resolved along with the pain, I tend to credit the latter!

Your comment re. taking BP readings multiple times a day is how I did it at the

start. Got into a big discussion with my Neprologist when he accused me of only

recording the best readings! I assured him I didn't cheat and that I also don't

cheat at solitaire! I now get up, void (and check urine for color and foam),

weigh myself which I don't record but just to make sure there isn't any sudden

gain that might indicate fluid retention. Then I take my BS (for diabettes) and

this gives me a chance to sit quietly. And finally take 3 BP readings and

average the last 2 and record. Then it's Dash out to the kitchen and fix my

Dash breakfast (usually a whole grain cereal, fruit and a cup of skim milk and

one cup of coffee!) Now I'm ready to take on the world! (Just as an aside,

since I started Dashing my BP has been very stable with the top # below 130 all

but once (134) and the bottom # always below 76 - my goal is 130/80 due to DM2!)

I think you were the one that mentioned a blood NA of 140 (135-145). I'll just

mention that I notice the spiro starts to be less effective when I get to that

level. (I can start to feel my flank pain returning.) My system seems to work

best when NA around 137-138. For what it's worth, everyone's system seems to be

different! That was my key, hope you find your's soon! Let me know if I missed

anything or can be of more help.

- 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(last week ave): 124/61

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

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

81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

> > > > >

> > > > > I have been waiting a month for the results of my Aldo and Renin

> > tests to

> > > > come in. I just picked them up at the doctors and notice that it says

> > at the

> > > > bottom that it is an " Interim Report " . Not sure what that means!

> > > > >

> > > > > These are the results:

> > > > >

> > > > > Random Aldosterone - 473 pmol/L

> > > > > The screen for aldosteronism is positive. The aldosterone exceeds the

> > > > minimum threshold concentration (250 pmol/L for supine collections and

> > 300

> > > > pmol/L for upright collections) and the ratio is >2500 pmol/L per

> > ng/L/s.

> > > > >

> > > > > Consistent with but not diagnostic for primary hyperaldosteronism.

> > > > Generally, diagnosis requires confirmation by means of a saline

> > suppression,

> > > > fludrocortisone suppression, or oral salt loading test.

> > > > >

> > > > > Dr. Andre Mattman, MD

> > > > >

> > > > > New Method. Performed by Mass Spectrometry at St. 's Hospital.

> > > > >

> > > > > Aldosterone/Renin Ratio --- >9460 [<1500]

> > > > >

> > > > > Renin Random --- <0.05 ng/L/s

> > > > >

> > > > > Reference interval for plasma renin

> > > > > activity are: upright: 0.05 to 0.55 ng/L/s

> > > > > and supine: <0.28 ng/L/s.

> > > > >

> > > > > Sodium 141 Reference range 135-145

> > > > > Potassium 4.0 Reference range 3.5 - 5.0

> > > > > Urea 5.4 Reference range 3.0 - 7.5

> > > > >

> > > > > Creatinine 54 umol/L Reference 50 - 90

> > > > > Estimated GFR 98 mL/min/l.73 sq m

> > > > >

> > > > > Observation Notes: eGFR within accepted reference interval. Diet,

> > drugs,

> > > > and clinical state may affect calculation. See

> > > > www.bcguidelines.ca/gpac/pdf/ckd.pdf

> > > > >

> > > > >

> > > > > So, those are my results. My doctor was not in today but I made an

> > > > appointment to see him on Wednesday to go over these results and I

> > presume

> > > > he will order one of the other diagnostic tests. Which do you think is

> > the

> > > > best one to do now.

> > > > >

> > > > > I am thinking that my aldo/renin ratio at >9460 is probably quite

> > high.

> > > > What are your thoughts.

> > > > >

> > > > > Also, do you think it is a good idea to start of one of the two

> > > > medications that are used the PA along with going on the DASH diet. I

> > have

> > > > just received the Dash Diet Book by Dr. .

> > > > >

> > > > > Thanks for your input.

> > > > >

> > > > > This site has been such a help to me.

> > > > >

> > > >

> > > >

> > > >

> > >

> > >

> > >

> > > --

> > >

> > > Jan Shimano

> > > Health & Wellness Advocate

> > >

> >

> >

> >

>

>

>

> --

>

> Jan Shimano

> Health & Wellness Advocate

>

[Guest guest]

Recon it has been worth $500 yet? ;-)CE Grim MD Jan, no need to be sorry - I know how hard it can be to get up to speed, especially if you aren't feeling well and with Brain Fog. It's funny that if anyone had asked me if I was affected by Brain Fog while it was happening I would have said "No". In reviewing my 6 years of reports from the VA I would now have to say that would have been a lie, God, I was a pain in the old you know what! On to your questions. Other issues that resolved when I got NA at the correct level in addition to the pains were primarily around urinating and endema. Previously I was peeing every hour or so during the day and got up 3-4 times at night. I now need to go every 6 hrs or so and do NOT need to get up at all at night. Most nights I sleep uninterupted for 8-9 hrs! (An indirect advantage of this new sleep pattern is that after ~4hrs you go into REM Sleep which is where the body burns up stored Fat cells among other things!) The endema resolved right along about that time and I was also on a loop duretic, Furosemide. I didn't think I'd ever see my ankle bones again! Not sure how much of that was the Furosemide and how much was getting the excess Aldostrone under control but since I had been on the F. from the start and it resolved along with the pain, I tend to credit the latter! Your comment re. taking BP readings multiple times a day is how I did it at the start. Got into a big discussion with my Neprologist when he accused me of only recording the best readings! I assured him I didn't cheat and that I also don't cheat at solitaire! I now get up, void (and check urine for color and foam), weigh myself which I don't record but just to make sure there isn't any sudden gain that might indicate fluid retention. Then I take my BS (for diabettes) and this gives me a chance to sit quietly. And finally take 3 BP readings and average the last 2 and record. Then it's Dash out to the kitchen and fix my Dash breakfast (usually a whole grain cereal, fruit and a cup of skim milk and one cup of coffee!) Now I'm ready to take on the world! (Just as an aside, since I started Dashing my BP has been very stable with the top # below 130 all but once (134) and the bottom # always below 76 - my goal is 130/80 due to DM2!) I think you were the one that mentioned a blood NA of 140 (135-145). I'll just mention that I notice the spiro starts to be less effective when I get to that level. (I can start to feel my flank pain returning.) My system seems to work best when NA around 137-138. For what it's worth, everyone's system seems to be different! That was my key, hope you find your's soon! Let me know if I missed anything or can be of more help. - 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(last week ave): 124/61 Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and PTSD. Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG. > > > > > > > > > > I have been waiting a month for the results of my Aldo and Renin > > tests to > > > > come in. I just picked them up at the doctors and notice that it says > > at the > > > > bottom that it is an "Interim Report". Not sure what that means! > > > > > > > > > > These are the results: > > > > > > > > > > Random Aldosterone - 473 pmol/L > > > > > The screen for aldosteronism is positive. The aldosterone exceeds the > > > > minimum threshold concentration (250 pmol/L for supine collections and > > 300 > > > > pmol/L for upright collections) and the ratio is >2500 pmol/L per > > ng/L/s. > > > > > > > > > > Consistent with but not diagnostic for primary hyperaldosteronism. > > > > Generally, diagnosis requires confirmation by means of a saline > > suppression, > > > > fludrocortisone suppression, or oral salt loading test. > > > > > > > > > > Dr. Andre Mattman, MD > > > > > > > > > > New Method. Performed by Mass Spectrometry at St. 's Hospital. > > > > > > > > > > Aldosterone/Renin Ratio --- >9460 [<1500] > > > > > > > > > > Renin Random --- <0.05 ng/L/s > > > > > > > > > > Reference interval for plasma renin > > > > > activity are: upright: 0.05 to 0.55 ng/L/s > > > > > and supine: <0.28 ng/L/s. > > > > > > > > > > Sodium 141 Reference range 135-145 > > > > > Potassium 4.0 Reference range 3.5 - 5.0 > > > > > Urea 5.4 Reference range 3.0 - 7.5 > > > > > > > > > > Creatinine 54 umol/L Reference 50 - 90 > > > > > Estimated GFR 98 mL/min/l.73 sq m > > > > > > > > > > Observation Notes: eGFR within accepted reference interval. Diet, > > drugs, > > > > and clinical state may affect calculation. See > > > > www.bcguidelines.ca/gpac/pdf/ckd.pdf > > > > > > > > > > > > > > > So, those are my results. My doctor was not in today but I made an > > > > appointment to see him on Wednesday to go over these results and I > > presume > > > > he will order one of the other diagnostic tests. Which do you think is > > the > > > > best one to do now. > > > > > > > > > > I am thinking that my aldo/renin ratio at >9460 is probably quite > > high. > > > > What are your thoughts. > > > > > > > > > > Also, do you think it is a good idea to start of one of the two > > > > medications that are used the PA along with going on the DASH diet. I > > have > > > > just received the Dash Diet Book by Dr. . > > > > > > > > > > Thanks for your input. > > > > > > > > > > This site has been such a help to me. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > -- > > > > > > Jan Shimano > > > Health & Wellness Advocate > > > > > > > > > > > > > -- > > Jan Shimano > Health & Wellness Advocate >

[Guest guest]

Hi :I just realized that you are the same person who sent me a replyover on the other website dealing with rare health issues.  I havejust responded to your last message over there.I just called the Drs. office and the secretary is going to get a

requisition ready for me to pick up today so that I can go and getthe random urine test for Na, K and creatinine done today, so thatthe Dr. will have the results by my appointment time tomorrow.I was interested to learn that your frequent urination and the edema

resolved when you the PA treated properly.  Yesterday, I decided todrink more water because I drink hardly anything as I am runningback and fore to the washroom.  However, I realized that I neededthe fluids.  Well, just by drinking what most people would call a

normal amount of fluids, I was going every 15 minutes for a while.I had been getting up 4 - 5 times a night but I do see an improvementin that now I am getting up 2 - 3 times a night.  I agree with you that by not getting enough REM sleep, we wake

up feeling lousy.  I went to a sleep monitoring clinic once and theycould not get good readings from me because I seemed to be awakemost of the night.  Mind you, with all those wires they hook you upto, it would be hard for anyone to sleep normally.

My ankles swell up by the end of the day and they are actuallyvery sore to the touch.  I don't travel by airplane very well, becauseof my venous insufficiency. (poor blood circulation...the blood justpools around my ankles)  I have to wear special stockings when

I fly.(My doctor just called me and said he would rather titrate up mySpiro before taking any urine readings.  I will see him tomorrow andhe will increase the Spiro and I believe he is going to add a BP

med.  I will see what he says about the Furosemide.  The Dr. just mentioned on the phone to me that he thought thatmy high BP was not solely due to PA so that is why he would wantto add another BP medication.  I now have a history of over 22 years

of high BP.How often do you have your sodium level checked and do youhave the blood or urine test?It sounds like you are doing fantastic .  Congratulations toyou.  I hope to be able to report a similar story in the months to

come. ...Jan

 

Jan, no need to be sorry - I know how hard it can be to get up to speed, especially if you aren't feeling well and with Brain Fog. It's funny that if anyone had asked me if I was affected by Brain Fog while it was happening I would have said " No " . In reviewing my 6 years of reports from the VA I would now have to say that would have been a lie, God, I was a pain in the old you know what!

On to your questions. Other issues that resolved when I got NA at the correct level in addition to the pains were primarily around urinating and endema. Previously I was peeing every hour or so during the day and got up 3-4 times at night. I now need to go every 6 hrs or so and do NOT need to get up at all at night. Most nights I sleep uninterupted for 8-9 hrs! (An indirect advantage of this new sleep pattern is that after ~4hrs you go into REM Sleep which is where the body burns up stored Fat cells among other things!)

The endema resolved right along about that time and I was also on a loop duretic, Furosemide. I didn't think I'd ever see my ankle bones again! Not sure how much of that was the Furosemide and how much was getting the excess Aldostrone under control but since I had been on the F. from the start and it resolved along with the pain, I tend to credit the latter!

Your comment re. taking BP readings multiple times a day is how I did it at the start. Got into a big discussion with my Neprologist when he accused me of only recording the best readings! I assured him I didn't cheat and that I also don't cheat at solitaire! I now get up, void (and check urine for color and foam), weigh myself which I don't record but just to make sure there isn't any sudden gain that might indicate fluid retention. Then I take my BS (for diabettes) and this gives me a chance to sit quietly. And finally take 3 BP readings and average the last 2 and record. Then it's Dash out to the kitchen and fix my Dash breakfast (usually a whole grain cereal, fruit and a cup of skim milk and one cup of coffee!) Now I'm ready to take on the world! (Just as an aside, since I started Dashing my BP has been very stable with the top # below 130 all but once (134) and the bottom # always below 76 - my goal is 130/80 due to DM2!)

I think you were the one that mentioned a blood NA of 140 (135-145). I'll just mention that I notice the spiro starts to be less effective when I get to that level. (I can start to feel my flank pain returning.) My system seems to work best when NA around 137-138. For what it's worth, everyone's system seems to be different! That was my key, hope you find your's soon! Let me know if I missed anything or can be of more help.

- 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(last week ave): 124/61

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

Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

> > > > >

> > > > > I have been waiting a month for the results of my Aldo and Renin

> > tests to

> > > > come in. I just picked them up at the doctors and notice that it says

> > at the

> > > > bottom that it is an " Interim Report " . Not sure what that means!

> > > > >

> > > > > These are the results:

> > > > >

> > > > > Random Aldosterone - 473 pmol/L

> > > > > The screen for aldosteronism is positive. The aldosterone exceeds the

> > > > minimum threshold concentration (250 pmol/L for supine collections and

> > 300

> > > > pmol/L for upright collections) and the ratio is >2500 pmol/L per

> > ng/L/s.

> > > > >

> > > > > Consistent with but not diagnostic for primary hyperaldosteronism.

> > > > Generally, diagnosis requires confirmation by means of a saline

> > suppression,

> > > > fludrocortisone suppression, or oral salt loading test.

> > > > >

> > > > > Dr. Andre Mattman, MD

> > > > >

> > > > > New Method. Performed by Mass Spectrometry at St. 's Hospital.

> > > > >

> > > > > Aldosterone/Renin Ratio --- >9460 [<1500]

> > > > >

> > > > > Renin Random --- <0.05 ng/L/s

> > > > >

> > > > > Reference interval for plasma renin

> > > > > activity are: upright: 0.05 to 0.55 ng/L/s

> > > > > and supine: <0.28 ng/L/s.

> > > > >

> > > > > Sodium 141 Reference range 135-145

> > > > > Potassium 4.0 Reference range 3.5 - 5.0

> > > > > Urea 5.4 Reference range 3.0 - 7.5

> > > > >

> > > > > Creatinine 54 umol/L Reference 50 - 90

> > > > > Estimated GFR 98 mL/min/l.73 sq m

> > > > >

> > > > > Observation Notes: eGFR within accepted reference interval. Diet,

> > drugs,

> > > > and clinical state may affect calculation. See

> > > > www.bcguidelines.ca/gpac/pdf/ckd.pdf

> > > > >

> > > > >

> > > > > So, those are my results. My doctor was not in today but I made an

> > > > appointment to see him on Wednesday to go over these results and I

> > presume

> > > > he will order one of the other diagnostic tests. Which do you think is

> > the

> > > > best one to do now.

> > > > >

> > > > > I am thinking that my aldo/renin ratio at >9460 is probably quite

> > high.

> > > > What are your thoughts.

> > > > >

> > > > > Also, do you think it is a good idea to start of one of the two

> > > > medications that are used the PA along with going on the DASH diet. I

> > have

> > > > just received the Dash Diet Book by Dr. .

> > > > >

> > > > > Thanks for your input.

> > > > >

> > > > > This site has been such a help to me.

> > > > >

> > > >

> > > >

> > > >

> > >

> > >

> > >

> > > --

> > >

> > > Jan Shimano

> > > Health & Wellness Advocate

> > >

> >

> >

> >

>

>

>

> --

>

> Jan Shimano

> Health & Wellness Advocate

>

-- Jan ShimanoHealth & Wellness Advocate

[Guest guest]

Sounds like your Dr hasn't treated many with PA. He needs to get up to speed on

what sodium does in PA.

> > > > > > >

> > > > > > > I have been waiting a month for the results of my Aldo and Renin

> > > > tests to

> > > > > > come in. I just picked them up at the doctors and notice that it

> > says

> > > > at the

> > > > > > bottom that it is an " Interim Report " . Not sure what that means!

> > > > > > >

> > > > > > > These are the results:

> > > > > > >

> > > > > > > Random Aldosterone - 473 pmol/L

> > > > > > > The screen for aldosteronism is positive. The aldosterone exceeds

> > the

> > > > > > minimum threshold concentration (250 pmol/L for supine collections

> > and

> > > > 300

> > > > > > pmol/L for upright collections) and the ratio is >2500 pmol/L per

> > > > ng/L/s.

> > > > > > >

> > > > > > > Consistent with but not diagnostic for primary

> > hyperaldosteronism.

> > > > > > Generally, diagnosis requires confirmation by means of a saline

> > > > suppression,

> > > > > > fludrocortisone suppression, or oral salt loading test.

> > > > > > >

> > > > > > > Dr. Andre Mattman, MD

> > > > > > >

> > > > > > > New Method. Performed by Mass Spectrometry at St. 's

> > Hospital.

> > > > > > >

> > > > > > > Aldosterone/Renin Ratio --- >9460 [<1500]

> > > > > > >

> > > > > > > Renin Random --- <0.05 ng/L/s

> > > > > > >

> > > > > > > Reference interval for plasma renin

> > > > > > > activity are: upright: 0.05 to 0.55 ng/L/s

> > > > > > > and supine: <0.28 ng/L/s.

> > > > > > >

> > > > > > > Sodium 141 Reference range 135-145

> > > > > > > Potassium 4.0 Reference range 3.5 - 5.0

> > > > > > > Urea 5.4 Reference range 3.0 - 7.5

> > > > > > >

> > > > > > > Creatinine 54 umol/L Reference 50 - 90

> > > > > > > Estimated GFR 98 mL/min/l.73 sq m

> > > > > > >

> > > > > > > Observation Notes: eGFR within accepted reference interval. Diet,

> > > > drugs,

> > > > > > and clinical state may affect calculation. See

> > > > > > www.bcguidelines.ca/gpac/pdf/ckd.pdf

> > > > > > >

> > > > > > >

> > > > > > > So, those are my results. My doctor was not in today but I made

> > an

> > > > > > appointment to see him on Wednesday to go over these results and I

> > > > presume

> > > > > > he will order one of the other diagnostic tests. Which do you think

> > is

> > > > the

> > > > > > best one to do now.

> > > > > > >

> > > > > > > I am thinking that my aldo/renin ratio at >9460 is probably quite

> > > > high.

> > > > > > What are your thoughts.

> > > > > > >

> > > > > > > Also, do you think it is a good idea to start of one of the two

> > > > > > medications that are used the PA along with going on the DASH diet.

> > I

> > > > have

> > > > > > just received the Dash Diet Book by Dr. .

> > > > > > >

> > > > > > > Thanks for your input.

> > > > > > >

> > > > > > > This site has been such a help to me.

> > > > > > >

> > > > > >

> > > > > >

> > > > > >

> > > > >

> > > > >

> > > > >

> > > > > --

> > > > >

> > > > > Jan Shimano

> > > > > Health & Wellness Advocate

> > > > >

> > > >

> > > >

> > > >

> > >

> > >

> > >

> > > --

> > >

> > > Jan Shimano

> > > Health & Wellness Advocate

> > >

> >

> >

> >

>

>

>

> --

>

> Jan Shimano

> Health & Wellness Advocate

>

[Guest guest]

Swelling means you are eAting too much salt. You are looking to have aburine test that shows you are eating more K than Na which will show in the urine test. Even if on Spiro I would recommend DASHing before diuretics (furosemide). A problem that can be treated by diet should be treated by no other means. If you have Pa most BP DRUGS will not work. WSee my review and take to your team. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Hi :I just realized that you are the same person who sent me a replyover on the other website dealing with rare health issues. I havejust responded to your last message over there.I just called the Drs. office and the secretary is going to get a

requisition ready for me to pick up today so that I can go and getthe random urine test for Na, K and creatinine done today, so thatthe Dr. will have the results by my appointment time tomorrow.I was interested to learn that your frequent urination and the edema

resolved when you the PA treated properly. Yesterday, I decided todrink more water because I drink hardly anything as I am runningback and fore to the washroom. However, I realized that I neededthe fluids. Well, just by drinking what most people would call a

normal amount of fluids, I was going every 15 minutes for a while.I had been getting up 4 - 5 times a night but I do see an improvementin that now I am getting up 2 - 3 times a night. I agree with you that by not getting enough REM sleep, we wake

up feeling lousy. I went to a sleep monitoring clinic once and theycould not get good readings from me because I seemed to be awakemost of the night. Mind you, with all those wires they hook you upto, it would be hard for anyone to sleep normally.

My ankles swell up by the end of the day and they are actuallyvery sore to the touch. I don't travel by airplane very well, becauseof my venous insufficiency. (poor blood circulation...the blood justpools around my ankles) I have to wear special stockings when

I fly.(My doctor just called me and said he would rather titrate up mySpiro before taking any urine readings. I will see him tomorrow andhe will increase the Spiro and I believe he is going to add a BP

med. I will see what he says about the Furosemide. The Dr. just mentioned on the phone to me that he thought thatmy high BP was not solely due to PA so that is why he would wantto add another BP medication. I now have a history of over 22 years

of high BP.How often do you have your sodium level checked and do youhave the blood or urine test?It sounds like you are doing fantastic . Congratulations toyou. I hope to be able to report a similar story in the months to

come. ...Jan

Jan, no need to be sorry - I know how hard it can be to get up to speed, especially if you aren't feeling well and with Brain Fog. It's funny that if anyone had asked me if I was affected by Brain Fog while it was happening I would have said "No". In reviewing my 6 years of reports from the VA I would now have to say that would have been a lie, God, I was a pain in the old you know what!

On to your questions. Other issues that resolved when I got NA at the correct level in addition to the pains were primarily around urinating and endema. Previously I was peeing every hour or so during the day and got up 3-4 times at night. I now need to go every 6 hrs or so and do NOT need to get up at all at night. Most nights I sleep uninterupted for 8-9 hrs! (An indirect advantage of this new sleep pattern is that after ~4hrs you go into REM Sleep which is where the body burns up stored Fat cells among other things!)

The endema resolved right along about that time and I was also on a loop duretic, Furosemide. I didn't think I'd ever see my ankle bones again! Not sure how much of that was the Furosemide and how much was getting the excess Aldostrone under control but since I had been on the F. from the start and it resolved along with the pain, I tend to credit the latter!

Your comment re. taking BP readings multiple times a day is how I did it at the start. Got into a big discussion with my Neprologist when he accused me of only recording the best readings! I assured him I didn't cheat and that I also don't cheat at solitaire! I now get up, void (and check urine for color and foam), weigh myself which I don't record but just to make sure there isn't any sudden gain that might indicate fluid retention. Then I take my BS (for diabettes) and this gives me a chance to sit quietly. And finally take 3 BP readings and average the last 2 and record. Then it's Dash out to the kitchen and fix my Dash breakfast (usually a whole grain cereal, fruit and a cup of skim milk and one cup of coffee!) Now I'm ready to take on the world! (Just as an aside, since I started Dashing my BP has been very stable with the top # below 130 all but once (134) and the bottom # always below 76 - my goal is 130/80 due to DM2!)

I think you were the one that mentioned a blood NA of 140 (135-145). I'll just mention that I notice the spiro starts to be less effective when I get to that level. (I can start to feel my flank pain returning.) My system seems to work best when NA around 137-138. For what it's worth, everyone's system seems to be different! That was my key, hope you find your's soon! Let me know if I missed anything or can be of more help.

- 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(last week ave): 124/61

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

Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

> > > > >

> > > > > I have been waiting a month for the results of my Aldo and Renin

> > tests to

> > > > come in. I just picked them up at the doctors and notice that it says

> > at the

> > > > bottom that it is an "Interim Report". Not sure what that means!

> > > > >

> > > > > These are the results:

> > > > >

> > > > > Random Aldosterone - 473 pmol/L

> > > > > The screen for aldosteronism is positive. The aldosterone exceeds the

> > > > minimum threshold co

[Guest guest]

Looks like Francis took the words right out of my mouth! Mom always said,

" Opinions are like noses, everyone has one! " I would point blank ask your

doctor what he is basing his on.. I'm not saying he doesn't have a valid

position but he should lay it on the table for review by some of the

professionals here. If he is just guessing, some call it " the shotgun

approach " , he is just wasting your time and suffering of more side effects. As

I learn more and more about LVH I get madder and madder as I realize how

seriously it was affecting me and how different the outcome could have been!

On to your question, I had 4 blood tests after DX last year and 5 thru June of

this year (PCP was being very watchful of K as Nepr. added ACEI in June!) The

good thing at the VA is if I get labs done 1/2 hr. before my appt the results

will be available for that appt! That was the number (137-138) that I was

quoting that works best for my Spiro to work. I've only found a couple urine NA

test and don't have them in a table yet.

We talked a little about REM Sleep and I just happened by a record of my bi-pap

numbers from Feb, 2010, before DX. In 217 days of use my average use was 2hr

and 12min and the % that got into REM was 6.6%! I checked my machine and in the

last 30 days I averaged 7.37 hrs/night and got into REM 28 of the 30! That's a

heck of a change in 18 months and Thank God, it sure feels good!

I can't close without one more thought on Spiro. My understanding is it will

NOT work until he/you get your NA low enough. He may need to ignore what is

" acceptable " to the people that set up the ranges and keep attacking it until he

finds out what is " acceptable " to your body and Spiro.! A lab test, Dr. Grim

likes urine, will prove you are headed in the right direction! I've included a

quote from " MedlinePlus " that shows why my Neprologist RXed it: " Furosemide, a

'water pill,' is used to reduce the swelling and fluid retention caused by

various medical problems, including heart or liver disease. It is also used to

treat high blood pressure. It causes the kidneys to get rid of unneeded water

and salt from the body into the urine. " I can't emphasize enough that I didn't

see any gradual changes (you haven't either as much as I can see)! When

everything changed it was litterly overnight like turning a light switch on (or

closing it depending where you live!) Don't know if that is the way it always

works.

I won't stress you out anymore, Good Luck with your appt. tomorrow and I look

foward to your summary!

- 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(last week ave): 124/61

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

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

81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

> > > > > > > >

> > > > > > > > I have been waiting a month for the results of my Aldo and Renin

> > > > > tests to

> > > > > > > come in. I just picked them up at the doctors and notice that it

> > > says

> > > > > at the

> > > > > > > bottom that it is an " Interim Report " . Not sure what that means!

> > > > > > > >

> > > > > > > > These are the results:

> > > > > > > >

> > > > > > > > Random Aldosterone - 473 pmol/L

> > > > > > > > The screen for aldosteronism is positive. The aldosterone

exceeds

> > > the

> > > > > > > minimum threshold concentration (250 pmol/L for supine collections

> > > and

> > > > > 300

> > > > > > > pmol/L for upright collections) and the ratio is >2500 pmol/L per

> > > > > ng/L/s.

> > > > > > > >

> > > > > > > > Consistent with but not diagnostic for primary

> > > hyperaldosteronism.

> > > > > > > Generally, diagnosis requires confirmation by means of a saline

> > > > > suppression,

> > > > > > > fludrocortisone suppression, or oral salt loading test.

> > > > > > > >

> > > > > > > > Dr. Andre Mattman, MD

> > > > > > > >

> > > > > > > > New Method. Performed by Mass Spectrometry at St. 's

> > > Hospital.

> > > > > > > >

> > > > > > > > Aldosterone/Renin Ratio --- >9460 [<1500]

> > > > > > > >

> > > > > > > > Renin Random --- <0.05 ng/L/s

> > > > > > > >

> > > > > > > > Reference interval for plasma renin

> > > > > > > > activity are: upright: 0.05 to 0.55 ng/L/s

> > > > > > > > and supine: <0.28 ng/L/s.

> > > > > > > >

> > > > > > > > Sodium 141 Reference range 135-145

> > > > > > > > Potassium 4.0 Reference range 3.5 - 5.0

> > > > > > > > Urea 5.4 Reference range 3.0 - 7.5

> > > > > > > >

> > > > > > > > Creatinine 54 umol/L Reference 50 - 90

> > > > > > > > Estimated GFR 98 mL/min/l.73 sq m

> > > > > > > >

> > > > > > > > Observation Notes: eGFR within accepted reference interval.

Diet,

> > > > > drugs,

> > > > > > > and clinical state may affect calculation. See

> > > > > > > www.bcguidelines.ca/gpac/pdf/ckd.pdf

> > > > > > > >

> > > > > > > >

> > > > > > > > So, those are my results. My doctor was not in today but I made

> > > an

> > > > > > > appointment to see him on Wednesday to go over these results and I

> > > > > presume

> > > > > > > he will order one of the other diagnostic tests. Which do you

think

> > > is

> > > > > the

> > > > > > > best one to do now.

> > > > > > > >

> > > > > > > > I am thinking that my aldo/renin ratio at >9460 is probably

quite

> > > > > high.

> > > > > > > What are your thoughts.

> > > > > > > >

> > > > > > > > Also, do you think it is a good idea to start of one of the two

> > > > > > > medications that are used the PA along with going on the DASH

diet.

> > > I

> > > > > have

> > > > > > > just received the Dash Diet Book by Dr. .

> > > > > > > >

> > > > > > > > Thanks for your input.

> > > > > > > >

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> > > > > >

> > > > > > Jan Shimano

> > > > > > Health & Wellness Advocate

> > > > > >

> > > > >

> > > > >

> > > > >

> > > >

> > > >

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> > > >

> > > > Jan Shimano

> > > > Health & Wellness Advocate

> > > >

> > >

> > >

> > >

> >

> >

> >

> > --

> >

> > Jan Shimano

> > Health & Wellness Advocate

> >

>

[Guest guest]

I certainly agree with you long term Dr. Grim but I think my Neprologist used

furosemide to jump-start the process. I wish He was still around so I could

thank him and discuss his process with him. I'm assuming 40 mg of F. lowered my

NA some and diet did the rest but after 11 months I was ready to call it a

failure and have the adnoma removed! Had that happened I would have declaired

you full of poopoo when MCBs did Not resolve the pain but surgery did! I have

replaced the furosemide with DASH now and reduced Spironlactone by 25mg but do

you think it might be appropriate to prove it might be possible? (I might not

be from MO but us Vermonters are a pretty independent group and you need to show

us sometimes also!

- 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(last week ave): 124/61

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

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

81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

> > > > > > >

> > > > > > > I have been waiting a month for the results of my Aldo and Renin

> > > > tests to

> > > > > > come in. I just picked them up at the doctors and notice that it

says

> > > > at the

> > > > > > bottom that it is an " Interim Report " . Not sure what that means!

> > > > > > >

> > > > > > > These are the results:

> > > > > > >

> > > > > > > Random Aldosterone - 473 pmol/L

> > > > > > > The screen for aldosteronism is positive. The aldosterone exceeds

the

> > > > > > minimum threshold co

>

[Guest guest]

In unfortunately many used Furos only once a day. It is a piss poor BP med once a day a you pee for 4 hrs then retain Na like crazy the rest of the day so you end up not making much progress. Always use it bid if for BP. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Looks like Francis took the words right out of my mouth! Mom always said, "Opinions are like noses, everyone has one!" I would point blank ask your doctor what he is basing his on.. I'm not saying he doesn't have a valid position but he should lay it on the table for review by some of the professionals here. If he is just guessing, some call it "the shotgun approach", he is just wasting your time and suffering of more side effects. As I learn more and more about LVH I get madder and madder as I realize how seriously it was affecting me and how different the outcome could have been!

On to your question, I had 4 blood tests after DX last year and 5 thru June of this year (PCP was being very watchful of K as Nepr. added ACEI in June!) The good thing at the VA is if I get labs done 1/2 hr. before my appt the results will be available for that appt! That was the number (137-138) that I was quoting that works best for my Spiro to work. I've only found a couple urine NA test and don't have them in a table yet.

We talked a little about REM Sleep and I just happened by a record of my bi-pap numbers from Feb, 2010, before DX. In 217 days of use my average use was 2hr and 12min and the % that got into REM was 6.6%! I checked my machine and in the last 30 days I averaged 7.37 hrs/night and got into REM 28 of the 30! That's a heck of a change in 18 months and Thank God, it sure feels good!

I can't close without one more thought on Spiro. My understanding is it will NOT work until he/you get your NA low enough. He may need to ignore what is "acceptable" to the people that set up the ranges and keep attacking it until he finds out what is "acceptable" to your body and Spiro.! A lab test, Dr. Grim likes urine, will prove you are headed in the right direction! I've included a quote from "MedlinePlus" that shows why my Neprologist RXed it: "Furosemide, a 'water pill,' is used to reduce the swelling and fluid retention caused by various medical problems, including heart or liver disease. It is also used to treat high blood pressure. It causes the kidneys to get rid of unneeded water and salt from the body into the urine." I can't emphasize enough that I didn't see any gradual changes (you haven't either as much as I can see)! When everything changed it was litterly overnight like turning a light switch on (or closing it depending

where you live!) Don't know if that is the way it always works.

I won't stress you out anymore, Good Luck with your appt. tomorrow and I look foward to your summary!

- 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(last week ave): 124/61

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

Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

> > > >

> > > > > **

> > > > >

> > > > >

> > > > > Jan, a few questions: Other meds. you are on? Do you know what your

> > > urine

> > > > > NA (sodium) is? Are you taking your BP according to Dr. Grim's

> > > perscribed

> > > > > method? (Take 3, average last 2.) Titrating Spiro up in only 2 weeks

> > > may be

> > > > > too soon, HTN Primer recommends 4-6 weeks.

> > > > >

> > > > > When I started Spiro the doctor also started me on a loop diutetic

> > > > > (furosemide) to control fluid and NA. I saw some immediate benefit to

> > > my BP

> > > > > but other symptoms didn't change for 10 mos! (Dr. Grim told me I

> > > FINALLY got

> > > > > my NA under control!) Once that happened the changes have been dramatic

> > > and

> > > > > amazing!

> > > > >

> > > > > Update us and somebody will have some suggestions (I'm not a doctor but

> > > > > love to read and research!) (My questions are some of the standard

> > > info.

> > > > >

[Guest guest]

I HAVE no rational for the blood level of Na would Affect MCB RESPONSES. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

I certainly agree with you long term Dr. Grim but I think my Neprologist used furosemide to jump-start the process. I wish He was still around so I could thank him and discuss his process with him. I'm assuming 40 mg of F. lowered my NA some and diet did the rest but after 11 months I was ready to call it a failure and have the adnoma removed! Had that happened I would have declaired you full of poopoo when MCBs did Not resolve the pain but surgery did! I have replaced the furosemide with DASH now and reduced Spironlactone by 25mg but do you think it might be appropriate to prove it might be possible? (I might not be from MO but us Vermonters are a pretty independent group and you need to show us sometimes also!

- 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(last week ave): 124/61

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

Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

> > > > > > >

> > > > > > > I have been waiting a month for the results of my Aldo and Renin

> > > > tests to

> > > > > > come in. I just picked them up at the doctors and notice that it says

> > > > at the

> > > > > > bottom that it is an "Interim Report". Not sure what that means!

> > > > > > >

> > > > > > > These are the results:

> > > > > > >

> > > > > > > Random Aldosterone - 473 pmol/L

> > > > > > > The screen for aldosteronism is positive. The aldosterone exceeds the

> > > > > > minimum threshold co

>

[Guest guest]

I wish we had picked up on that a year or so ago, I might have only been on O2

for 6 mos! Oh well, never look back except to learn! May be a good

explaination as to why it took so long for Spiro to take full effect!

- 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(last week ave): 124/61

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

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

81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

> > > > > >

> > > > > > > **

> > > > > > >

> > > > > > >

> > > > > > > Jan, a few questions: Other meds. you are on? Do you know what

your

> > > > > urine

> > > > > > > NA (sodium) is? Are you taking your BP according to Dr. Grim's

> > > > > perscribed

> > > > > > > method? (Take 3, average last 2.) Titrating Spiro up in only 2

weeks

> > > > > may be

> > > > > > > too soon, HTN Primer recommends 4-6 weeks.

> > > > > > >

> > > > > > > When I started Spiro the doctor also started me on a loop diutetic

> > > > > > > (furosemide) to control fluid and NA. I saw some immediate benefit

to

> > > > > my BP

> > > > > > > but other symptoms didn't change for 10 mos! (Dr. Grim told me I

> > > > > FINALLY got

> > > > > > > my NA under control!) Once that happened the changes have been

dramatic

> > > > > and

> > > > > > > amazing!

> > > > > > >

> > > > > > > Update us and somebody will have some suggestions (I'm not a

doctor but

> > > > > > > love to read and research!) (My questions are some of the standard

> > > > > info.

> > > > > > >

>

[Guest guest]

Every Dr who treats HTN should know this but most dont.CE Grim MD I wish we had picked up on that a year or so ago, I might have only been on O2 for 6 mos! Oh well, never look back except to learn! May be a good explaination as to why it took so long for Spiro to take full effect! - 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(last week ave): 124/61 Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and PTSD. Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG. > > > > > > > > > > > > > ** > > > > > > > > > > > > > > > > > > > > > Jan, a few questions: Other meds. you are on? Do you know what your > > > > > urine > > > > > > > NA (sodium) is? Are you taking your BP according to Dr. Grim's > > > > > perscribed > > > > > > > method? (Take 3, average last 2.) Titrating Spiro up in only 2 weeks > > > > > may be > > > > > > > too soon, HTN Primer recommends 4-6 weeks. > > > > > > > > > > > > > > When I started Spiro the doctor also started me on a loop diutetic > > > > > > > (furosemide) to control fluid and NA. I saw some immediate benefit to > > > > > my BP > > > > > > > but other symptoms didn't change for 10 mos! (Dr. Grim told me I > > > > > FINALLY got > > > > > > > my NA under control!) Once that happened the changes have been dramatic > > > > > and > > > > > > > amazing! > > > > > > > > > > > > > > Update us and somebody will have some suggestions (I'm not a doctor but > > > > > > > love to read and research!) (My questions are some of the standard > > > > > info. > > > > > > > >

[Guest guest]

I suffered terrible swelling with my urine Na " too low to quantitate. " Once I got Lyme treatment, the swelling stopped and I've lost 40 pounds. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Clarence Grim Swelling means you are eAting too much salt.