Guest guest Posted July 13, 2011 Report Share Posted July 13, 2011 No ace and MCBs work by entirely different methodsIf no renin(as in PA ace will not work. Possible that renin will increase with low Na and Spiro and ace may have some effect. When was the last time they had u collect a 24 hr urine. That is the most reliable way to stage renal disease but most drs believe that most pts can't do this right and use faulty formula Cockcroft Gault to est from PCr Wikipedia has a good discussion of this as I recall. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank & testicle pain. I have decided against an adrenalectomy at this time since Meds. are working so well. Current BP: 130/77 Other Issues/Opportunities: COPD w/ft Oxygen, OSA w Bi-Pap settings 13/19, DM2. and PTSD Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, Metformin 2000MG, Lisinopril 2.5MG and Spironolactone 75 MG. SORRY DR. GRIM - THE ONE TIME I FORGET MY SIGNATURE BLOCK AND YOU CAUGHT ME!!! As you can now see, BP is 130/77 Close enough for a PTN with DM2! (There has been little to no change since adding ACEI as we suspected!) I have no reason to ask her to reread Evo of PA because she is solidly in our court. She only added ACEI at the insistance of the Neph. I saw in Apr. (I wouldn't let him change anything and told him I wanted her to control ALL my meds.) They were DXing CKD Stage 3 and wanted me on it to control vasiodilation around my kidney. (Before you ask I have an outstanding question with Nepherology asking if they are double dipping with Spiro and ACEI performing same function!) As an aside, I am in the process of preparing to set up a meeting with the VA Nephology Dept. They found enough fault with my treatment that they set RTC for 6months instead of the customary 3mos., that is totally unacceptable to me! If nothing else they will learn how to take a proper BP reading and the way to DX HTN and how to run an effective meeting! They'll also need to prove to me they know how to treat a PTN with DM2 and PA and whatever else I think they might be responsibe for. (Yes, they will also receive a copy of Evo. of PA!) She doesn't need to read Dr. Kemper, you and I have already taught her that! (You just saved a beer so now you can drink two, mine would have been a tea, iced and unsweetened anyway, haven't had a beer since atleast 2005!) Trust me, she is really eating this journey up - a case of "you never forget your first one - PA PTN that is!" I do need to point out that I need to attempt to follow their wishes providing it won't hurt me if I am going to go back and prove they missed the boat in 2007 and where I might be today if I had been properly DXed 3 1/2 years earlier! Oh yes, I need to tell you the Linisopril test ended this morning when I called them to report another 3day bout with diarrhea - you could say I "flushed it"! I told the nurse what I was doing and she could add that I wasn't starting another until I got some answers! Stay tuned! > > > Just received an update from PCP with latest labs. (She has had me > > on a 2week recall for 3 recalls to keep track of K as we add an > > ACEI. I had expressed my concerns!) > > > > GLUCOSE: 96! (2nd consecutive time in range since 2007!) > > UREA NITROGEN: 20 > > CREATININE: 0.98 > > SODIUM: 136 > > POTASSIUM: 4.8 > > CHLORIDE: 107 > > CO2: 16L (I had been experiencing diarrhea) > > ANION GAP 13 > > eGFR: 77 > > > > SIGNED LYNN WEBSTER, 7/7/2011 5:04PM > > (I know she had Fri. off so she must have worked late Thurs. to get > > her week completed!) > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 13, 2011 Report Share Posted July 13, 2011 I suspect they meant in kidney for vasodilation. Of the efferent arteries of omerus to decrease pressure in glom. The best indicator this is a problem is urine protein. What has yours been?Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank & testicle pain. I have decided against an adrenalectomy at this time since Meds. are working so well. Current BP: 130/77 Other Issues/Opportunities: COPD w/ft Oxygen, OSA w Bi-Pap settings 13/19, DM2. and PTSD Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, Metformin 2000MG, Lisinopril 2.5MG and Spironolactone 75 MG. SORRY DR. GRIM - THE ONE TIME I FORGET MY SIGNATURE BLOCK AND YOU CAUGHT ME!!! As you can now see, BP is 130/77 Close enough for a PTN with DM2! (There has been little to no change since adding ACEI as we suspected!) I have no reason to ask her to reread Evo of PA because she is solidly in our court. She only added ACEI at the insistance of the Neph. I saw in Apr. (I wouldn't let him change anything and told him I wanted her to control ALL my meds.) They were DXing CKD Stage 3 and wanted me on it to control vasiodilation around my kidney. (Before you ask I have an outstanding question with Nepherology asking if they are double dipping with Spiro and ACEI performing same function!) As an aside, I am in the process of preparing to set up a meeting with the VA Nephology Dept. They found enough fault with my treatment that they set RTC for 6months instead of the customary 3mos., that is totally unacceptable to me! If nothing else they will learn how to take a proper BP reading and the way to DX HTN and how to run an effective meeting! They'll also need to prove to me they know how to treat a PTN with DM2 and PA and whatever else I think they might be responsibe for. (Yes, they will also receive a copy of Evo. of PA!) She doesn't need to read Dr. Kemper, you and I have already taught her that! (You just saved a beer so now you can drink two, mine would have been a tea, iced and unsweetened anyway, haven't had a beer since atleast 2005!) Trust me, she is really eating this journey up - a case of "you never forget your first one - PA PTN that is!" I do need to point out that I need to attempt to follow their wishes providing it won't hurt me if I am going to go back and prove they missed the boat in 2007 and where I might be today if I had been properly DXed 3 1/2 years earlier! Oh yes, I need to tell you the Linisopril test ended this morning when I called them to report another 3day bout with diarrhea - you could say I "flushed it"! I told the nurse what I was doing and she could add that I wasn't starting another until I got some answers! Stay tuned! > > > Just received an update from PCP with latest labs. (She has had me > > on a 2week recall for 3 recalls to keep track of K as we add an > > ACEI. I had expressed my concerns!) > > > > GLUCOSE: 96! (2nd consecutive time in range since 2007!) > > UREA NITROGEN: 20 > > CREATININE: 0.98 > > SODIUM: 136 > > POTASSIUM: 4.8 > > CHLORIDE: 107 > > CO2: 16L (I had been experiencing diarrhea) > > ANION GAP 13 > > eGFR: 77 > > > > SIGNED LYNN WEBSTER, 7/7/2011 5:04PM > > (I know she had Fri. off so she must have worked late Thurs. to get > > her week completed!) > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 15, 2011 Report Share Posted July 15, 2011 Did he not mention that one of the more effective ways to lower protein is to lower Na intake? Shame in him is he did not. Needs to get boards in HTN. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension Dr. Grim, thanks so much fo clearing up the difference between ACE and Spiro. When I spoke with Dr. Robey, the chair of the Nepr. Dept, on 5/11 he spoke of Proteinuria that I have "variably exhibited in the past, w/ most recent result neg." He went on to explain that he too would RX an ACEI IF (enphasis mine) proteinuria was cearly documented & attributed to DN. He went on to state that I was unhappy with his concurrence with the original Dr. I'm still trying to conquer the english language but I don't think his explaination was consistant with his conclusion, ie. he said ACEI IF while Dr. said ACEI NOW! I'm simply not interested in taking meds. that do nothing but produce side effects, those days are over! I will discuss this with them at my meeting. Thanks again. - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank & testicle pain. I have decided against an adrenalectomy at this time since Meds. are working so well. Current BP: 130/77 Other Issues/Opportunities: COPD w/ft Oxygen, OSA w Bi-Pap settings 13/19, DM2. and PTSD Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, Metformin 2000MG and Spironolactone 75 MG. > > > > > > > Just received an update from PCP with latest labs. (She has had me > > > > on a 2week recall for 3 recalls to keep track of K as we add an > > > > ACEI. I had expressed my concerns!) > > > > > > > > GLUCOSE: 96! (2nd consecutive time in range since 2007!) > > > > UREA NITROGEN: 20 > > > > CREATININE: 0.98 > > > > SODIUM: 136 > > > > POTASSIUM: 4.8 > > > > CHLORIDE: 107 > > > > CO2: 16L (I had been experiencing diarrhea) > > > > ANION GAP 13 > > > > eGFR: 77 > > > > > > > > SIGNED LYNN WEBSTER, 7/7/2011 5:04PM > > > > (I know she had Fri. off so she must have worked late Thurs. to get > > > > her week completed!) > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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