Re: Re: post-AVS report

August 20, 2011

Excellent we may want to put this site on our list of good places for AVS?The singnature was in case they needed to do general anesthesia as an emergency I might guess.With HH the chance of regurgitating is greater and if that happened they might need to intubate.But all worked out well. CE Grim MD Pretty sure I wasn't intubated; at least if I was they didn't mention it. All I know is I had to sign a general anesthesia consent form and that an anesthesiologist put me out. Ordinarily it's a nurse who does some sort of light sedation, but because I have a hiatal hernia they thought this was better. They used Cosyntropin - the IR made a big deal of making sure I had a dedicated IV line for it. > > > I had my second AVS yesterday and it went much like the first - no > > pain, no problems, other than my K crashing and having to have one > > of those awful infusions. Not much else to tell as I don't remember > > much of anything, because like the first time, they had me under > > general anesthesia (propofol, fentanyl and versed). After reading > > others' accounts of pain and discomfort during the procedure, it > > makes me wonder why this isn't standard protocol. > > > > This time around they expect to have results back and interpreted > > within two weeks - well see about that. Originally my nephro wanted > > me to start eplerenone today, but we came to an agreement to wait > > until the results come back because if it's inconclusive again, I'll > > be repeating the procedure ASAP. Here's hoping it doesn't come to > > that though Because of the imaging obtained the first time > > around, the IR team thinks that chances of accuracy were improved > > the second time. > > > > --msmith1928 > > Nulliparous female, 46, 5'3", 120 lbs, polymenorrhea, > > hyperinsulinemia, hereditary fructose intolerance, lactose > > intolerance, probable gluten intolerance. Current meds are K 20 MEQ > > 4x/day, singulair 10mg, norethindrone .35mg to regulate > > polymenorrhea, cyclobenzaprine 5-10mg when needed, fexofenadine > > 180mg as needed. Low sodium, fructose- and grain-free diet. Known > > drug allergies include PCN, sulfa, tetracycline. 1cm left adrenal > > nodule, supine aldosterone 28.5/renin 0.2, potassium <2.9 (when not > > taking supplements); spiro caused gynecomastia and polymenorrhea > > > > >

August 20, 2011

msmith, I've learned that the perception of pain is a very personal thing, what one person considers to be tolerable pain-wise, another person may percieve as unbearable. Every day I work I ask people if they're having any pain and if they are, have them rate it on a scale of 1 to 10, with 10 being the worst pain they can imagine. More often than you'd believe I have a person rate their pain 9-10 while they appear very comfortable and are having a very relaxed appearing conversation with me. For me personally to identify pain as 9-10 I would have to be screaming or crying and not be able to carry on a conversation with anyone. Labor was a definite 10+ for me and AVS was a 1, but that's my personal perception. I had 1 mg versed and 50 mcg

of Fentanyl, was awake but very mellow during my AVS. I probably could have done it with no meds but would definitely have had a higher anxiety level during it. I've also read other peoples' accounts of their AVS in which they describe it as excrutiatingly painful. Unless something went wrong, like a perforated adrenal gland that they're not mentioning, I'd have to guess they just have a very low tolerance for pain or their perception of pain is very different from ours.

Conscious sedation can be given by an RN who has taken special classes. Most often it consists of IV versed and/or fentanyl. Patient is sedated but is able to respond to verbal commands and maintains protective reflexes and a patent airway on his own. Depending on amount of versed given, patient may think they were totally asleep due to amnesiac effect of the drug.

MAC (Monitored Anesthesia Care) is usually given by an MDA or CRNA but in a few states RNs who have been credentialed in propofol administration can give. Usually consists of IV propofol alone or one or more of versed /fentanyl/ketamine and can be given in conjunction with a local or block, such as during a C-section or some cosmetic surgeries. The patient is usually asleep but should respond to painful stimulus and maintains a patent airway. MAC should wear off fairly fast and is usually quite safe but there are different levels of MAC. Propofol is Juice and requires continuous monitoring, as his cardiologist found out. When someone in our unit stays sedated for a longer period than usual after a procedure, we say he's had a Big MAC ;-)

General Anesthesia is given by an MDA in conjunction with a CRNA and causes a total loss of consciousness, loss of pain sensation and can cause loss of protective reflexes. Induction is usually via an IV anesthetic and maintained by an inhaled gas via endotracheal tube.

If you're having any kind of sedation/anesthesia you will be required to sign a general anesthesia consent form, just in case, since anything can happen. I have a great respect for any kind of anesthetic agent and have always said I fear anesthesia more than I fear a surgical procedure.

To: hyperaldosteronism Sent: Saturday, August 20, 2011 2:33 PMSubject: Re: Re: post-AVS report

Excellent we may want to put this site on our list of good places for AVS?

The singnature was in case they needed to do general anesthesia as an emergency I might guess.

With HH the chance of regurgitating is greater and if that happened they might need to intubate.

But all worked out well.

CE Grim MD

Pretty sure I wasn't intubated; at least if I was they didn't mention it. All I know is I had to sign a general anesthesia consent form and that an anesthesiologist put me out. Ordinarily it's a nurse who does some sort of light sedation, but because I have a hiatal hernia they thought this was better.They used Cosyntropin - the IR made a big deal of making sure I had a dedicated IV line for it. > > > I had my second AVS yesterday and it went much like the first - no > > pain, no problems, other than my K crashing and having to have one > > of those awful infusions. Not much else to tell as I don't remember > > much of anything, because like the first time, they had me under > > general anesthesia (propofol, fentanyl and versed). After reading > > others' accounts of pain and discomfort during the procedure, it > > makes me wonder why this isn't standard protocol.> >> > This time around they expect to have results back and interpreted > > within two weeks - well see about that. Originally my nephro wanted > > me to start eplerenone today, but we came to an agreement to wait > > until the results come back because if it's inconclusive again, I'll > > be

repeating the procedure ASAP. Here's hoping it doesn't come to > > that though Because of the imaging obtained the first time > > around, the IR team thinks that chances of accuracy were improved > > the second time.> >> > --msmith1928> > Nulliparous female, 46, 5'3", 120 lbs, polymenorrhea, > > hyperinsulinemia, hereditary fructose intolerance, lactose > > intolerance, probable gluten intolerance. Current meds are K 20 MEQ > > 4x/day, singulair 10mg, norethindrone .35mg to regulate > > polymenorrhea, cyclobenzaprine 5-10mg when needed, fexofenadine > > 180mg as needed. Low sodium, fructose- and grain-free diet. Known > > drug allergies include PCN, sulfa, tetracycline. 1cm left adrenal > > nodule, supine aldosterone 28.5/renin 0.2, potassium <2.9 (when not > > taking supplements); spiro caused gynecomastia

and polymenorrhea> >> >>

August 20, 2011

Glad to hear you got through AVS again without any complications. Hopefully this time they will not botch the results. Makes me less nervous about having one someday. Although, I am not sure they ever will. I still have no visable tumor after 3 years between CTs.

I am very tough to get blood out of. I end up getting alot of needles inthe hand. I remember at Mayo when I had my DEX suppresion test, they had to draw it out of the top of my hand cause they couldnt find a vein. That is something I didnt find to painful...which is good becuase I get alot of hand sticking.

a, thanks for the explanation. From your description, it sounds like it was Monitored Anesthesia Care that I was under. What I do remember is hearing the medical team discussing getting an anesthesiologist at the last minute, which of course made me worry that they wouldn't be able to and I'd get sent home! I got the impression that ordinarily they do the procedure under conscious sedation with an RN, and that's what they had scheduled; after reviewing my file the doctor changed her mind and called in the anesthesiologist. There was also some debate about whether or not to intubate but I think they said they could do it during the procedure if there was a need. For all I know I imagined all or part of this, by then I was really out of it!

I was surprised at how much pain the potassium drip caused when they tried to put it in through the IV in the back of my hand (as opposed to higher up the arm). I'm fortunate that I still can't say I've ever experienced pain that was a " 10 " but that was probably an 8, and definitely the worst part of the day.

> >>

> >> > I had my second AVS yesterday and it went much like the first - no

> >> > pain, no problems, other than my K crashing and having to have one

> >> > of those awful infusions. Not much else to tell as I don't remember

> >> > much of anything, because like the first time, they had me under

> >> > general anesthesia (propofol, fentanyl and versed). After reading

> >> > others' accounts of pain and discomfort during the procedure, it

> >> > makes me wonder why this isn't standard protocol.

> >> >

> >> > This time around they expect to have results back and interpreted

> >> > within two weeks - well see about that. Originally my nephro wanted

> >> > me to start eplerenone today, but we came to an agreement to wait

> >> > until the results come back because if it's inconclusive again, I'll

> >> > be repeating the procedure ASAP. Here's hoping it doesn't come to

> >> > that though Because of the imaging obtained the first time

> >> > around, the IR team thinks that chances of accuracy were improved

> >> > the second time.

> >> >

> >> > --msmith1928

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

> >> > hyperinsulinemia, hereditary fructose intolerance, lactose

> >> > intolerance, probable gluten intolerance. Current meds are K 20 MEQ

> >> > 4x/day, singulair 10mg, norethindrone .35mg to regulate

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

> >> > 180mg as needed. Low sodium, fructose- and grain-free diet. Known

> >> > drug allergies include PCN, sulfa, tetracycline. 1cm left adrenal

> >> > nodule, supine aldosterone 28.5/renin 0.2, potassium <2.9 (when not

> >> > taking supplements); spiro caused gynecomastia and polymenorrhea

> >> >

> >>

> >

>

-- ============================================================================45-Male-Caucasian, 5'9 " - 234lbs, PA Diagnosed 2007 Suspected Hyperplasia-No tumors on CT - No AVS.

Meds: 100mg Spiro, 1800mg Calcium, 1000mg Magnesium, 100,000UI Vit D (weekly), 20mg OmeprazoleSide effects: Gynecomastia, stomach inflammationOther Diags: GERD, Hiatal Hernia, Metabolic Syndrome - PreDiabetic, Secondary Hyperparathyroidism caused by Renal calcium leak, Bone Cyct in left Femoral Head and Pelvis. Benign Lung Nodules, Fibromyalgia, Scarring on Right Kidney Lower Pole, Right Flank Pain

DASH: Started " sort of " DASHing 5/3/2011

August 20, 2011

This means that your K values are likely falsely high. Has ur K ever been low?Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Glad to hear you got through AVS again without any complications. Hopefully this time they will not botch the results. Makes me less nervous about having one someday. Although, I am not sure they ever will. I still have no visable tumor after 3 years between CTs.

I am very tough to get blood out of. I end up getting alot of needles inthe hand. I remember at Mayo when I had my DEX suppresion test, they had to draw it out of the top of my hand cause they couldnt find a vein. That is something I didnt find to painful...which is good becuase I get alot of hand sticking.

a, thanks for the explanation. From your description, it sounds like it was Monitored Anesthesia Care that I was under. What I do remember is hearing the medical team discussing getting an anesthesiologist at the last minute, which of course made me worry that they wouldn't be able to and I'd get sent home! I got the impression that ordinarily they do the procedure under conscious sedation with an RN, and that's what they had scheduled; after reviewing my file the doctor changed her mind and called in the anesthesiologist. There was also some debate about whether or not to intubate but I think they said they could do it during the procedure if there was a need. For all I know I imagined all or part of this, by then I was really out of it!

I was surprised at how much pain the potassium drip caused when they tried to put it in through the IV in the back of my hand (as opposed to higher up the arm). I'm fortunate that I still can't say I've ever experienced pain that was a "10" but that was probably an 8, and definitely the worst part of the day.

> >>

> >> > I had my second AVS yesterday and it went much like the first - no

> >> > pain, no problems, other than my K crashing and having to have one

> >> > of those awful infusions. Not much else to tell as I don't remember

> >> > much of anything, because like the first time, they had me under

> >> > general anesthesia (propofol, fentanyl and versed). After reading

> >> > others' accounts of pain and discomfort during the procedure, it

> >> > makes me wonder why this isn't standard protocol.

> >> >

> >> > This time around they expect to have results back and interpreted

> >> > within two weeks - well see about that. Originally my nephro wanted

> >> > me to start eplerenone today, but we came to an agreement to wait

> >> > until the results come back because if it's inconclusive again, I'll

> >> > be repeating the procedure ASAP. Here's hoping it doesn't come to

> >> > that though Because of the imaging obtained the first time

> >> > around, the IR team thinks that chances of accuracy were improved

> >> > the second time.

> >> >

> >> > --msmith1928

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