Re: Question about medication

[Guest guest]

I started with 50 mg and it was doubled to 100 within 3 weeksPam

 

My doctor wants to prescribe Spiro 50mg day. He wants me to discontinue my ampodipine but stay on my metaprolol 100mg day until he sees what the Spiro does for my BP. Does this sound right? Shouldn't it be one or the other, not both? And isn't 50mg of Spiro too much to start with? I've been reading it should be 25mg to start until you get used to it.

- 44 yr old female/5'6 " / 140 lbs/ 2.2 cm adenoma on left adrenal gland descovered in March 2011. Two year history of high BP. Average BP 150/94. AVS in August determined bilaterial hyperplasia. Current medication Amlodipine 10mg/day, Metaprolol 100mg/day, Currently being tested for Diabetes due to high glucose on 3 fasting blood tests, no family history of diabetes. Also being tested for Vitamin D deficiency due to low calcium on blood tests. Began DASH diet 3 days ago.

[Guest guest]

I also started with 50 mg a day and two weeks later my Dr. increased itto 100 mg. a day.  That increase was just last Wednesday and I go backagain this Thursday for a check up to see how I am doing on it.

 

My doctor wants to prescribe Spiro 50mg day. He wants me to discontinue my ampodipine but stay on my metaprolol 100mg day until he sees what the Spiro does for my BP. Does this sound right? Shouldn't it be one or the other, not both? And isn't 50mg of Spiro too much to start with? I've been reading it should be 25mg to start until you get used to it.

- 44 yr old female/5'6 " / 140 lbs/ 2.2 cm adenoma on left adrenal gland descovered in March 2011. Two year history of high BP. Average BP 150/94. AVS in August determined bilaterial hyperplasia. Current medication Amlodipine 10mg/day, Metaprolol 100mg/day, Currently being tested for Diabetes due to high glucose on 3 fasting blood tests, no family history of diabetes. Also being tested for Vitamin D deficiency due to low calcium on blood tests. Began DASH diet 3 days ago.

-- Jan ShimanoHealth & Wellness Advocate

[Guest guest]

Thanks Pam and Jan, Were you also still taking your old BP meds with the Spiro at the same time? That just seems strange to me.

[Guest guest]

I had been off BP meds for many years because they were not workingfor me so I just lived with the very, very high BP.After doing my own research, I asked for the aldo/renin ratio test andit came back positive for PA.

However, now the Dr. is going to add a BP med. in (maybe not immediately....I am not sure) to get the BP down more.My BP was a high as 206/124 and yesterday it was down to 148/91.

 

Thanks Pam and Jan,  Were you also still taking your old BP meds with the Spiro at the same time? That just seems strange to me.

-- Jan ShimanoHealth & Wellness Advocate

[Guest guest]

As u note in my evol art BB will not have much of a BP EFFECT. DASH effect will max out by 2 weeks if following to the letter. Be sure you tell him u are DASHING. If meto only being given for BP I would taper it down after stopping amlodipine. 50 or 25 are ok starting doses but would see effect of DASHING first if having no other problems. Will look at 's story again and you may have sent me other info as I recAll. Is your dr willing to work with me? If so I am happy for him to contact me. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

My doctor wants to prescribe Spiro 50mg day. He wants me to discontinue my ampodipine but stay on my metaprolol 100mg day until he sees what the Spiro does for my BP. Does this sound right? Shouldn't it be one or the other, not both? And isn't 50mg of Spiro too much to start with? I've been reading it should be 25mg to start until you get used to it.

- 44 yr old female/5'6"/ 140 lbs/ 2.2 cm adenoma on left adrenal gland descovered in March 2011. Two year history of high BP. Average BP 150/94. AVS in August determined bilaterial hyperplasia. Current medication Amlodipine 10mg/day, Metaprolol 100mg/day, Currently being tested for Diabetes due to high glucose on 3 fasting blood tests, no family history of diabetes. Also being tested for Vitamin D deficiency due to low calcium on blood tests. Began DASH diet 3 days ago.

[Guest guest]

Again depends on want BP is and has been doing over last few months. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Thanks Pam and Jan, Were you also still taking your old BP meds with the Spiro at the same time? That just seems strange to me.

[Guest guest]

This is from posts by . To me this statement doesn't seem to make much sense

as it seems both glands are functional

in spite of the mass on the left

gland there is no lateralization, therefore the mass is non functional

Hi Everyone,

I finally received the numbers from my AVS. I plugged them into the AVS file and

posted them below. The IR's note just stated " in spite of the mass on the left

gland there is no lateralization, therefore the mass is non functional, and she

has bilateral hyperplasia. She is not likely to benefit from surgery " . For Dr.

Grim and those of you who've had AVS, do these numbers look the way they should?

I appreciate any feedback.

Right Adrenal

Aldosterone ng/dL 2412.0

Cortisol 587.7

Ratio 4.1

Left Adrenal

Aldosterone ng/dL 2408.0

Cortisol 407.8

Ratio 5.9

IVC

Aldosterone ng/dL 56.6

Cortisol 34.3

Ratio 1.7

>

> > My doctor wants to prescribe Spiro 50mg day. He wants me to discontinue my

ampodipine but stay on my metaprolol 100mg day until he sees what the Spiro does

for my BP. Does this sound right? Shouldn't it be one or the other, not both?

And isn't 50mg of Spiro too much to start with? I've been reading it should be

25mg to start until you get used to it.

> >

> > - 44 yr old female/5'6 " / 140 lbs/ 2.2 cm adenoma on left adrenal gland

descovered in March 2011. Two year history of high BP. Average BP 150/94. AVS in

August determined bilaterial hyperplasia. Current medication Amlodipine

10mg/day, Metaprolol 100mg/day, Currently being tested for Diabetes due to high

glucose on 3 fasting blood tests, no family history of diabetes. Also being

tested for Vitamin D deficiency due to low calcium on blood tests. Began DASH

diet 3 days ago.

> >

> >

>

[Guest guest]

Thank you Dr. Grim. After it was determined I wasn’t a candidate for surgery, I went back to my current Endocrinologist and asked a million questions. Don’t get me wrong, he’s a very good doctor and I have great respect for him, but his specialty is Diabetes. Because I’m still learning about all this, I think it’s important that I’m confident my doctor has a solid understanding of PA. The surgeon I met with called me, and he wants me to see a doctor in his group at the University of Penn. I looked her up, and she seems to have some very good experience with this. I’m waiting for her to call me to set up an appointment. Once I meet with her I’ll let you know if it may be beneficial to have you consult. My current doc is prescribing the Spiro today but I’m debating if I should start taking it. I’m thinking I should wait until I meet with the new doc and get her opinion as well. Why, I’m not sure. I can’t have surgery so the medication is inevitable right? I’ve just heard so many people talk about the bad side effects, I suppose I’m afraid to take it. Not that my PA symptoms haven’t been a complete nightmare already, but I’m afraid to have a whole new set of problems from the Spiro. For Francis, what didn’t make sense from my AVS results? I’m confused. Did something not look right?

[Guest guest]

I've read ahead and see Dr. G. has you in his sights so I'll only offer one

observation and my experience.

Assuming PA, the HTN Primer suggests: " Spirolactone is most commonly used in

doses of 25 to 200 mg daily, with titrations at 4- to 6-week intervals. "

My doctor started me at 25 mg along with a loop diuretic and increased spiro to

bid within a couple of weeks. He left the 7 BP meds asis for quite a while and

then we started eliminating them. (They were essentially not having any effect

on BP judging from the fact that it essentially didn't change as they were

removed!) I was one of the lucky ones where 50 mg/day resolved my BP issues

instantly and other symptoms eventially (it took another 10 mos. to get my NA

low enough.)

- 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): 123/69

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.

>

> My doctor wants to prescribe Spiro 50mg day. He wants me to discontinue my

ampodipine but stay on my metaprolol 100mg day until he sees what the Spiro does

for my BP. Does this sound right? Shouldn't it be one or the other, not both?

And isn't 50mg of Spiro too much to start with? I've been reading it should be

25mg to start until you get used to it.

>

>

>

> - 44 yr old female/5'6 " / 140 lbs/ 2.2 cm adenoma on left adrenal gland

descovered in March 2011. Two year history of high BP. Average BP 150/94. AVS

in August determined bilaterial hyperplasia. Current medication Amlodipine

10mg/day, Metaprolol 100mg/day, Currently being tested for Diabetes due to high

glucose on 3 fasting blood tests, no family history of diabetes. Also being

tested for Vitamin D deficiency due to low calcium on blood tests. Began DASH

diet 3 days ago.

>

[Guest guest]

My understanding of AVS results is limited so my answer may not be quite right.

If you have PA it means at least one of your Adrenal glands is making to much

aldosterone thus it is said to over functioning. When it is stated the gland is

non functional it means it is normal and doesn't make to much aldosterone. As

your AVS shows both glands are making to much aldosterone so both are over

functioning. So the statement in spite of the mass on the left gland there is

no lateralization, therefore the mass is non functional in your case doesn't fit

with your AVS results.

>

> Thank you Dr. Grim. After it was determined I wasn't a candidate for

> surgery, I went back to my current Endocrinologist and asked a million

> questions. Don't get me wrong, he's a very good doctor and I have great

> respect for him, but his specialty is Diabetes. Because I'm still learning

> about all this, I think it's important that I'm confident my doctor has a

> solid understanding of PA. The surgeon I met with called me, and he wants

> me to see a doctor in his group at the University of Penn. I looked her up,

> and she seems to have some very good experience with this. I'm waiting for

> her to call me to set up an appointment. Once I meet with her I'll let you

> know if it may be beneficial to have you consult. My current doc is

> prescribing the Spiro today but I'm debating if I should start taking it.

> I'm thinking I should wait until I meet with the new doc and get her opinion

> as well. Why, I'm not sure. I can't have surgery so the medication is

> inevitable right? I've just heard so many people talk about the bad side

> effects, I suppose I'm afraid to take it. Not that my PA symptoms haven't

> been a complete nightmare already, but I'm afraid to have a whole new set of

> problems from the Spiro.

>

>

>

> For Francis, what didn't make sense from my AVS results? I'm confused. Did

> something not look right?

>

[Guest guest]

Okay, bare with me while I try to process this J I was told that if the mass on the left was functioning (producing Aldosterone) that sample number would have been much higher than the right sample number. Because the two samples are almost exactly the same (2408 and 2412) it means that its not the mass that’s producing the Aldosterone (it didn’t lateralize to the left). It’s the gland itself that’s producing too much Aldosterone. And based on the numbers both glands are producing too much. Taking out the left gland with the mass, wouldn’t do anything to lower my BP or eliminate my symptoms because I’d still have the right gland producing too much Aldosterone. Does that sound correct? Not sure if I got it right. I did read a study though, that said even though both glands may be producing too much Aldosterone, removing the one with the mass could eliminate ‘Bulk’ and possibly lower your BP and symptoms. Has anyone else ever heard of that, or had that done? If so did it help at all?

[Guest guest]

Depending on SX mass could also be making to much corticosteroids, adrenalin and

noradrenaline or androgenic steroids. They should have tested you for this as

well.

>

> Okay, bare with me while I try to process this J I was told that if the

> mass on the left was functioning (producing Aldosterone) that sample number

> would have been much higher than the right sample number. Because the two

> samples are almost exactly the same (2408 and 2412) it means that its not

> the mass that's producing the Aldosterone (it didn't lateralize to the

> left). It's the gland itself that's producing too much Aldosterone. And

> based on the numbers both glands are producing too much. Taking out the

> left gland with the mass, wouldn't do anything to lower my BP or eliminate

> my symptoms because I'd still have the right gland producing too much

> Aldosterone. Does that sound correct? Not sure if I got it right.

>

>

>

> I did read a study though, that said even though both glands may be

> producing too much Aldosterone, removing the one with the mass could

> eliminate 'Bulk' and possibly lower your BP and symptoms. Has anyone else

> ever heard of that, or had that done? If so did it help at all?

>

[Guest guest]

I was tested for cortisol which I think is the corticosteroid? I believe I tested low on that at 1.8. I was tested for Metanephrines and Catecholamines. Is that what the other two things you referenced are? Still learning all the lingo.

[Guest guest]

Most with spiro do not have major side effects. If they get well they seem to leave our group. I would go ahead and start if your current Dr. Recommended it. My guess is that he has little experience in the powerful effect of DASH and spiro on BP so ask if you can start 1/2 dose and DASH DASH DASH. Did he recommend DASH even? Remind him that I trained with Dr. Conn.Always check with him.Is the person at Penn a Endo, Surgeon or HTN specialist. You want someone with lots of PA experience.Keep us posted. CE Grim MD Thank you Dr. Grim. After it was determined I wasn’t a candidate for surgery, I went back to my current Endocrinologist and asked a million questions. Don’t get me wrong, he’s a very good doctor and I have great respect for him, but his specialty is Diabetes. Because I’m still learning about all this, I think it’s important that I’m confident my doctor has a solid understanding of PA. The surgeon I met with called me, and he wants me to see a doctor in his group at the University of Penn. I looked her up, and she seems to have some very good experience with this. I’m waiting for her to call me to set up an appointment. Once I meet with her I’ll let you know if it may be beneficial to have you consult. My current doc is prescribing the Spiro today but I’m debating if I should start taking it. I’m thinking I should wait until I meet with the new doc and get her opinion as well. Why, I’m not sure. I can’t have surgery so the medication is inevitable right? I’ve just heard so many people talk about the bad side effects, I suppose I’m afraid to take it. Not that my PA symptoms haven’t been a complete nightmare already, but I’m afraid to have a whole new set of problems from the Spiro. For Francis, what didn’t make sense from my AVS results? I’m confused. Did something not look right?

[Guest guest]

There is no way to say the mass is not part of the problem. Most likely is part of a bilateral hyperplastic process.In my experience most with a big bump also have little bumps on both sides.CE Grim MDOn Aug 23, 2011, at 11:36 AM, Francis Bill SUSPECTED PA wrote: My understanding of AVS results is limited so my answer may not be quite right. If you have PA it means at least one of your Adrenal glands is making to much aldosterone thus it is said to over functioning. When it is stated the gland is non functional it means it is normal and doesn't make to much aldosterone. As your AVS shows both glands are making to much aldosterone so both are over functioning. So the statement in spite of the mass on the left gland there is no lateralization, therefore the mass is non functional in your case doesn't fit with your AVS results. > > Thank you Dr. Grim. After it was determined I wasn't a candidate for > surgery, I went back to my current Endocrinologist and asked a million > questions. Don't get me wrong, he's a very good doctor and I have great > respect for him, but his specialty is Diabetes. Because I'm still learning > about all this, I think it's important that I'm confident my doctor has a > solid understanding of PA. The surgeon I met with called me, and he wants > me to see a doctor in his group at the University of Penn. I looked her up, > and she seems to have some very good experience with this. I'm waiting for > her to call me to set up an appointment. Once I meet with her I'll let you > know if it may be beneficial to have you consult. My current doc is > prescribing the Spiro today but I'm debating if I should start taking it. > I'm thinking I should wait until I meet with the new doc and get her opinion > as well. Why, I'm not sure. I can't have surgery so the medication is > inevitable right? I've just heard so many people talk about the bad side > effects, I suppose I'm afraid to take it. Not that my PA symptoms haven't > been a complete nightmare already, but I'm afraid to have a whole new set of > problems from the Spiro. > > > > For Francis, what didn't make sense from my AVS results? I'm confused. Did > something not look right? >

[Guest guest]

Good sounds like your Dr is learning. Should not be so much of a big problem for her next patient.I think you are in VA? One of the abstracts I recently sent looked a drug resistant HTN in a VA on west coast and found about 30%? likley had PA but they did no imaging.Take it to your VA team so they can find all the ones in their system and get them under better control.CEGrim MD I've read ahead and see Dr. G. has you in his sights so I'll only offer one observation and my experience. Assuming PA, the HTN Primer suggests: "Spirolactone is most commonly used in doses of 25 to 200 mg daily, with titrations at 4- to 6-week intervals." My doctor started me at 25 mg along with a loop diuretic and increased spiro to bid within a couple of weeks. He left the 7 BP meds asis for quite a while and then we started eliminating them. (They were essentially not having any effect on BP judging from the fact that it essentially didn't change as they were removed!) I was one of the lucky ones where 50 mg/day resolved my BP issues instantly and other symptoms eventially (it took another 10 mos. to get my NA low enough.) - 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): 123/69 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. > > My doctor wants to prescribe Spiro 50mg day. He wants me to discontinue my ampodipine but stay on my metaprolol 100mg day until he sees what the Spiro does for my BP. Does this sound right? Shouldn't it be one or the other, not both? And isn't 50mg of Spiro too much to start with? I've been reading it should be 25mg to start until you get used to it. > > > > - 44 yr old female/5'6"/ 140 lbs/ 2.2 cm adenoma on left adrenal gland descovered in March 2011. Two year history of high BP. Average BP 150/94. AVS in August determined bilaterial hyperplasia. Current medication Amlodipine 10mg/day, Metaprolol 100mg/day, Currently being tested for Diabetes due to high glucose on 3 fasting blood tests, no family history of diabetes. Also being tested for Vitamin D deficiency due to low calcium on blood tests. Began DASH diet 3 days ago. >

[Guest guest]

You got it. Well almost. If both sides have bumps they cannot see then then you may still have bumps on both sides. Indeed most likely do. The size is likely below what we can see with today's imaging techniques.Also it is possible the vein they sampled was not draining the bump. Was it at top or bottom of the gland? CE Grim MD Okay, bare with me while I try to process this J I was told that if the mass on the left was functioning (producing Aldosterone) that sample number would have been much higher than the right sample number. Because the two samples are almost exactly the same (2408 and 2412) it means that its not the mass that’s producing the Aldosterone (it didn’t lateralize to the left). It’s the gland itself that’s producing too much Aldosterone. And based on the numbers both glands are producing too much. Taking out the left gland with the mass, wouldn’t do anything to lower my BP or eliminate my symptoms because I’d still have the right gland producing too much Aldosterone. Does that sound correct? Not sure if I got it right. I did read a study though, that said even though both glands may be producing too much Aldosterone, removing the one with the mass could eliminate ‘Bulk’ and possibly lower your BP and symptoms. Has anyone else ever heard of that, or had that done? If so did it help at all?

[Guest guest]

Usually don't do these during AVS. Its Aldo it sounds like to me.Get on with the Rx. CE Grim MDOn Aug 23, 2011, at 12:46 PM, Francis Bill SUSPECTED PA wrote: Depending on SX mass could also be making to much corticosteroids, adrenalin and noradrenaline or androgenic steroids. They should have tested you for this as well. > > Okay, bare with me while I try to process this J I was told that if the > mass on the left was functioning (producing Aldosterone) that sample number > would have been much higher than the right sample number. Because the two > samples are almost exactly the same (2408 and 2412) it means that its not > the mass that's producing the Aldosterone (it didn't lateralize to the > left). It's the gland itself that's producing too much Aldosterone. And > based on the numbers both glands are producing too much. Taking out the > left gland with the mass, wouldn't do anything to lower my BP or eliminate > my symptoms because I'd still have the right gland producing too much > Aldosterone. Does that sound correct? Not sure if I got it right. > > > > I did read a study though, that said even though both glands may be > producing too much Aldosterone, removing the one with the mass could > eliminate 'Bulk' and possibly lower your BP and symptoms. Has anyone else > ever heard of that, or had that done? If so did it help at all? >

[Guest guest]

When you hear hoofbeats think of horses not zebras. CE Grim MD I was tested for cortisol which I think is the corticosteroid? I believe I tested low on that at 1.8. I was tested for Metanephrines and Catecholamines. Is that what the other two things you referenced are? Still learning all the lingo.

[Guest guest]

VA = Yes, I'll go back and find it for her!

- 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): 123/69

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.

> > >

> > > My doctor wants to prescribe Spiro 50mg day. He wants me to

> > discontinue my ampodipine but stay on my metaprolol 100mg day until

> > he sees what the Spiro does for my BP. Does this sound right?

> > Shouldn't it be one or the other, not both? And isn't 50mg of Spiro

> > too much to start with? I've been reading it should be 25mg to start

> > until you get used to it.

> > >

> > >

> > >

> > > - 44 yr old female/5'6 " / 140 lbs/ 2.2 cm adenoma on left

> > adrenal gland descovered in March 2011. Two year history of high BP.

> > Average BP 150/94. AVS in August determined bilaterial hyperplasia.

> > Current medication Amlodipine 10mg/day, Metaprolol 100mg/day,

> > Currently being tested for Diabetes due to high glucose on 3 fasting

> > blood tests, no family history of diabetes. Also being tested for

> > Vitamin D deficiency due to low calcium on blood tests. Began DASH

> > diet 3 days ago.

> > >

> >

> >

>

[Guest guest]

Take your Dr my evolution article. You say you have been "living" with severe HTN FOR years when in fact your blood vessels, heart and kidneys have been progressively dying. Why have u not been places on a MCB?Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

I had been off BP meds for many years because they were not workingfor me so I just lived with the very, very high BP.After doing my own research, I asked for the aldo/renin ratio test andit came back positive for PA.

However, now the Dr. is going to add a BP med. in (maybe not immediately....I am not sure) to get the BP down more.My BP was a high as 206/124 and yesterday it was down to 148/91.

Thanks Pam and Jan, Were you also still taking your old BP meds with the Spiro at the same time? That just seems strange to me.

-- Jan ShimanoHealth & Wellness Advocate

[Guest guest]

Thanks Dr. Grim. To answer your question, I’m not sure where in the gland the bump is. No one has ever told me, I’ve never thought to ask, and it’s not written on the CAT scan report. I can ask where it is when I see the new doc. I’ve looked at the disk at home but I have no idea what I’m looking at. If they didn’t pull the blood from the bump does that mean the results were not truly accurate? I pulled Dr. Cohen’s profile off of Penn’s website. It says she’s in the Renal, Electrolyte and Hypertension Division at Penn Medicine. It sounds from her research below that she’s a hypertension specialist but she’s board certified in Nephrology and Internal Medicine. Undergraduate: University of the Witwatersrand, M.D.Medical: Degree: M.D.Residency: Albert Einstein Medical Center, PhiladelphiaFellowship: NephrologyInstitution: Hospital of the University of Pennsylvania, Philadelphia, PABoard Certification: Internal Medicine, Nephrology Research Interests:Dr. Cohen’s research interests are in hypertension with an emphasis on alternative methods of treating hypertension and in the field of pheochromocytoma and adrenal hypertension. She is the Principal Investigator on an NIH funded study looking at the effects of yoga on blood pressure reduction (www.limbs.cohenhtn.com). She is a Co-PI in the NIDDK Chronic Kidney Disease (CKD) “CRIC” cognitive cohort study. She is also the PI on a study investigating the changes on pulse wave velocity in chronic kidney disease patients with reduction in proteinuria.Clinical and Other Interests:Pheochromocytoma, Adrenal Hypertension, Renovascular Hypertension, Complex Resistant Hypertension

[Guest guest]

Sounds like an good expert. I man even know her as we did the quality control for the CRIC study and may have visited her site several years ago. So when do you see her? I can send her a email and a copy of my Evolution Article in case she has not seen it.The issue of sampling from and away from a bump has not been well studied but probably not a problem, just a consideration. We have reported it is a problem when sampling from the renal veins but that is a different issue. Will ask around about the adrenal.CE Grim MD Thanks Dr. Grim. To answer your question, I’m not sure where in the gland the bump is. No one has ever told me, I’ve never thought to ask, and it’s not written on the CAT scan report. I can ask where it is when I see the new doc. I’ve looked at the disk at home but I have no idea what I’m looking at. If they didn’t pull the blood from the bump does that mean the results were not truly accurate? I pulled Dr. Cohen’s profile off of Penn’s website. It says she’s in the Renal, Electrolyte and Hypertension Division at Penn Medicine. It sounds from her research below that she’s a hypertension specialist but she’s board certified in Nephrology and Internal Medicine. Undergraduate: University of the Witwatersrand, M.D.Medical: Degree: M.D.Residency: Albert Einstein Medical Center, PhiladelphiaFellowship: NephrologyInstitution: Hospital of the University of Pennsylvania, Philadelphia, PABoard Certification: Internal Medicine, Nephrology Research Interests:Dr. Cohen’s research interests are in hypertension with an emphasis on alternative methods of treating hypertension and in the field of pheochromocytoma and adrenal hypertension. She is the Principal Investigator on an NIH funded study looking at the effects of yoga on blood pressure reduction (www.limbs.cohenhtn.com). She is a Co-PI in the NIDDK Chronic Kidney Disease (CKD) “CRIC” cognitive cohort study. She is also the PI on a study investigating the changes on pulse wave velocity in chronic kidney disease patients with reduction in proteinuria.Clinical and Other Interests:Pheochromocytoma, Adrenal Hypertension, Renovascular Hypertension, Complex Resistant Hypertension

[Guest guest]

The surgeon I met with who recommended Dr. Cohen said he would send her an email to contact me about an appointment, but I haven’t heard from her office yet. That was a few days ago, so I may just call the office today. So far Penn has been EXCELLENT. When they were pulling the blood from the right adrenal I felt some pain but didn’t say anything about it. Then when it was over I started feeling pressure in my chest. Before I knew what was happening I had three cardiologists and two teams of nurses around me. Rather than send me to the ER, they sent me right to the cardiac ICU. Something about my T waves being off and they didn’t want me to wait around the ER. The T wave thing didn’t happen again, and after a ton of tests they let me go home the next afternoon, but I was completely taken care of. I was sort of an oddity in the ICU. The nurses kept saying “ you came in for what? And you ended up here??” As far as quality of care I’ve been very impressed with them!!

[Guest guest]

Another reason not to rush to AVS IMHO. Most likely related to low K I would guess.CE Grim MD The surgeon I met with who recommended Dr. Cohen said he would send her an email to contact me about an appointment, but I haven’t heard from her office yet. That was a few days ago, so I may just call the office today. So far Penn has been EXCELLENT. When they were pulling the blood from the right adrenal I felt some pain but didn’t say anything about it. Then when it was over I started feeling pressure in my chest. Before I knew what was happening I had three cardiologists and two teams of nurses around me. Rather than send me to the ER, they sent me right to the cardiac ICU. Something about my T waves being off and they didn’t want me to wait around the ER. The T wave thing didn’t happen again, and after a ton of tests they let me go home the next afternoon, but I was completely taken care of. I was sort of an oddity in the ICU. The nurses kept saying “ you came in for what? And you ended up here??” As far as quality of care I’ve been very impressed with them!!