Re: Need to know what is the appropriate med. to go with Sprio

[Guest guest]

My BP is still running at 137/103.

 

Going to the Dr. in l l/2 hrs. time.

I am on 100 mg. of Spiro (50 mg. twice daily)

It has improved the BP somewhat but nowhere

near where it should be and my pulse is very

high. It usually is around 78 - 82 but it is

now running up to 111.

I think the Dr. indicated last time that he

thought my HBP was not all due to hyperaldosteronism.

He wants to add another medication.

I have been on all of them over the last 20 odd

years and they either don't work or I have terrible

side effects.

Diovan, Micardis & Cozaar (all from the same family)

seemed to be tolerated by me, but I don't think it

did much to reduce the BP.

I think he is going to want to add Micardis but I

read somewhere that it is counterproductive with the

Spiro.

Please.....let me know what are the no-nos to add

and what is the best one to add. Thanks for your

help.

-- Jan ShimanoHealth & Wellness Advocate

[Guest guest]

ARBs, ACEs and BB will not work if you have PA. Take your team my Evolution of PA article. Remind them I trained with Dr Conn.Trust you are DASHing as well.you can outsalt all Bp meds. Esp if you have PA.CE Grim MD Going to the Dr. in l l/2 hrs. time. I am on 100 mg. of Spiro (50 mg. twice daily) It has improved the BP somewhat but nowhere near where it should be and my pulse is very high. It usually is around 78 - 82 but it is now running up to 111. I think the Dr. indicated last time that he thought my HBP was not all due to hyperaldosteronism. He wants to add another medication. I have been on all of them over the last 20 odd years and they either don't work or I have terrible side effects. Diovan, Micardis & Cozaar (all from the same family) seemed to be tolerated by me, but I don't think it did much to reduce the BP. I think he is going to want to add Micardis but I read somewhere that it is counterproductive with the Spiro. Please.....let me know what are the no-nos to add and what is the best one to add. Thanks for your help.

[Guest guest]

Ignore the diastolic reading on your home device for now. Rapid heart rate likely due to BP decreasing and body getting used to it.CE Grim MD My BP is still running at 137/103. Going to the Dr. in l l/2 hrs. time. I am on 100 mg. of Spiro (50 mg. twice daily) It has improved the BP somewhat but nowhere near where it should be and my pulse is very high. It usually is around 78 - 82 but it is now running up to 111. I think the Dr. indicated last time that he thought my HBP was not all due to hyperaldosteronism. He wants to add another medication. I have been on all of them over the last 20 odd years and they either don't work or I have terrible side effects. Diovan, Micardis & Cozaar (all from the same family) seemed to be tolerated by me, but I don't think it did much to reduce the BP. I think he is going to want to add Micardis but I read somewhere that it is counterproductive with the Spiro. Please.....let me know what are the no-nos to add and what is the best one to add. Thanks for your help. -- Jan ShimanoHealth & Wellness Advocate

[Guest guest]

Ignore the diastolic reading on your home device for now. Rapid heart rate likely due to BP decreasing and body getting used to it.CE Grim MD My BP is still running at 137/103. Going to the Dr. in l l/2 hrs. time. I am on 100 mg. of Spiro (50 mg. twice daily) It has improved the BP somewhat but nowhere near where it should be and my pulse is very high. It usually is around 78 - 82 but it is now running up to 111. I think the Dr. indicated last time that he thought my HBP was not all due to hyperaldosteronism. He wants to add another medication. I have been on all of them over the last 20 odd years and they either don't work or I have terrible side effects. Diovan, Micardis & Cozaar (all from the same family) seemed to be tolerated by me, but I don't think it did much to reduce the BP. I think he is going to want to add Micardis but I read somewhere that it is counterproductive with the Spiro. Please.....let me know what are the no-nos to add and what is the best one to add. Thanks for your help. -- Jan ShimanoHealth & Wellness Advocate

[Guest guest]

Hopefully you are not out salting the spiro. If I go over 1400 a day my pressure

is up in spite of spiro. Remember out salting does not mean the salt shaker, but

what's in our food- especially packaged, canned, and processed foods. Salt

intake may be the answer insyead of just adding another med. Take inventory and

cut something higher sodium out. Bet it helps more.

Sent from my Palm Pre on the Now Network from Sprint

[Guest guest]

Hopefully you are not out salting the spiro. If I go over 1400 a day my pressure

is up in spite of spiro. Remember out salting does not mean the salt shaker, but

what's in our food- especially packaged, canned, and processed foods. Salt

intake may be the answer insyead of just adding another med. Take inventory and

cut something higher sodium out. Bet it helps more.

Sent from my Palm Pre on the Now Network from Sprint

[Guest guest]

I am reading your Evolution of PA right now and one page 489it is stated that for those patients whose BP cannot be comtrolledwith ......including spiro or eplerenone....you use a cocktail thatnearly always includes a combination of a BB with a diuretic,

an ACE or ARB and with a CCB and an aldosterone-blocking agent. " This has me confused because you said in your reply to methat ARBs, ACEs and BBs will not work if you have PA.What if I have PA but also my HBP is partly essential hypertension

also.What medication can be successfully added to my Spiro??

 

ARBs, ACEs and BB will not work if you have PA. Take your team my Evolution of PA article. Remind them I trained with Dr Conn.Trust you are DASHing as well.you can outsalt all Bp meds. Esp if you have PA.

CE Grim MD   Going to the Dr. in l l/2 hrs. time.

I am on 100 mg. of Spiro (50 mg. twice daily) It has improved the BP somewhat but nowhere near where it should be and my pulse is very high. It usually is around 78 - 82 but it is now running up to 111.

I think the Dr. indicated last time that he thought my HBP was not all due to hyperaldosteronism. He wants to add another medication. I have been on all of them over the last 20 odd years and they either don't work or I have terrible

side effects. Diovan, Micardis & Cozaar (all from the same family) seemed to be tolerated by me, but I don't think it did much to reduce the BP. I think he is going to want to add Micardis but I

read somewhere that it is counterproductive with the Spiro. Please.....let me know what are the no-nos to add and what is the best one to add. Thanks for your help.

-- Jan ShimanoHealth & Wellness Advocate

[Guest guest]

And don't forget the low Na V-8 for K.CE Grim MD Hopefully you are not out salting the spiro. If I go over 1400 a day my pressure is up in spite of spiro. Remember out salting does not mean the salt shaker, but what's in our food- especially packaged, canned, and processed foods. Salt intake may be the answer insyead of just adding another med. Take inventory and cut something higher sodium out. Bet it helps more. Sent from my Palm Pre on the Now Network from Sprint

[Guest guest]

And don't forget the low Na V-8 for K.CE Grim MD Hopefully you are not out salting the spiro. If I go over 1400 a day my pressure is up in spite of spiro. Remember out salting does not mean the salt shaker, but what's in our food- especially packaged, canned, and processed foods. Salt intake may be the answer insyead of just adding another med. Take inventory and cut something higher sodium out. Bet it helps more. Sent from my Palm Pre on the Now Network from Sprint

[Guest guest]

Love the low K V8 juice.  I don't wantto overdo it though.  What is the rightamount to drink each day?

 

And don't forget the low Na V-8 for K.CE Grim MD

  Hopefully you are not out salting the spiro. If I go over 1400 a day my pressure is up in spite of spiro. Remember out salting does not mean the salt shaker, but what's in our food- especially packaged, canned, and processed foods. Salt intake may be the answer insyead of just adding another med. Take inventory and cut something higher sodium out. Bet it helps more.

Sent from my Palm Pre on the Now Network from Sprint

-- Jan ShimanoHealth & Wellness Advocate

[Guest guest]

Love the low K V8 juice.  I don't wantto overdo it though.  What is the rightamount to drink each day?

 

And don't forget the low Na V-8 for K.CE Grim MD

  Hopefully you are not out salting the spiro. If I go over 1400 a day my pressure is up in spite of spiro. Remember out salting does not mean the salt shaker, but what's in our food- especially packaged, canned, and processed foods. Salt intake may be the answer insyead of just adding another med. Take inventory and cut something higher sodium out. Bet it helps more.

Sent from my Palm Pre on the Now Network from Sprint

-- Jan ShimanoHealth & Wellness Advocate

[Guest guest]

Thanks for the note and careful reading: I was referring to this mostly in pts with drug resistant HTN who may not clearly have PA and are not ready for AVS unitl they fail my cocktail which included spiro or eplerenone. If they fail this then consider AVS. This combination of combinations has been successful in PA pts but rarely needed once spiro or epler and DASH have been started and followed and documented with urine Na and K.Since this article was written I have been stressing DASH and checking urines and have not had to use that combo in PA patients. If they can DASH.Will make a note about this in my next revision.Thanks again.CE Grim MD I am reading your Evolution of PA right now and one page 489it is stated that for those patients whose BP cannot be comtrolledwith ......including spiro or eplerenone....you use a cocktail thatnearly always includes a combination of a BB with a diuretic, an ACE or ARB and with a CCB and an aldosterone-blocking agent."This has me confused because you said in your reply to methat ARBs, ACEs and BBs will not work if you have PA.What if I have PA but also my HBP is partly essential hypertension also.What medication can be successfully added to my Spiro?? ARBs, ACEs and BB will not work if you have PA. Take your team my Evolution of PA article. Remind them I trained with Dr Conn.Trust you are DASHing as well.you can outsalt all Bp meds. Esp if you have PA. CE Grim MD Going to the Dr. in l l/2 hrs. time. I am on 100 mg. of Spiro (50 mg. twice daily) It has improved the BP somewhat but nowhere near where it should be and my pulse is very high. It usually is around 78 - 82 but it is now running up to 111. I think the Dr. indicated last time that he thought my HBP was not all due to hyperaldosteronism. He wants to add another medication. I have been on all of them over the last 20 odd years and they either don't work or I have terrible side effects. Diovan, Micardis & Cozaar (all from the same family) seemed to be tolerated by me, but I don't think it did much to reduce the BP. I think he is going to want to add Micardis but I read somewhere that it is counterproductive with the Spiro. Please.....let me know what are the no-nos to add and what is the best one to add. Thanks for your help. -- Jan ShimanoHealth & Wellness Advocate

[Guest guest]

Thanks for the note and careful reading: I was referring to this mostly in pts with drug resistant HTN who may not clearly have PA and are not ready for AVS unitl they fail my cocktail which included spiro or eplerenone. If they fail this then consider AVS. This combination of combinations has been successful in PA pts but rarely needed once spiro or epler and DASH have been started and followed and documented with urine Na and K.Since this article was written I have been stressing DASH and checking urines and have not had to use that combo in PA patients. If they can DASH.Will make a note about this in my next revision.Thanks again.CE Grim MD I am reading your Evolution of PA right now and one page 489it is stated that for those patients whose BP cannot be comtrolledwith ......including spiro or eplerenone....you use a cocktail thatnearly always includes a combination of a BB with a diuretic, an ACE or ARB and with a CCB and an aldosterone-blocking agent."This has me confused because you said in your reply to methat ARBs, ACEs and BBs will not work if you have PA.What if I have PA but also my HBP is partly essential hypertension also.What medication can be successfully added to my Spiro?? ARBs, ACEs and BB will not work if you have PA. Take your team my Evolution of PA article. Remind them I trained with Dr Conn.Trust you are DASHing as well.you can outsalt all Bp meds. Esp if you have PA. CE Grim MD Going to the Dr. in l l/2 hrs. time. I am on 100 mg. of Spiro (50 mg. twice daily) It has improved the BP somewhat but nowhere near where it should be and my pulse is very high. It usually is around 78 - 82 but it is now running up to 111. I think the Dr. indicated last time that he thought my HBP was not all due to hyperaldosteronism. He wants to add another medication. I have been on all of them over the last 20 odd years and they either don't work or I have terrible side effects. Diovan, Micardis & Cozaar (all from the same family) seemed to be tolerated by me, but I don't think it did much to reduce the BP. I think he is going to want to add Micardis but I read somewhere that it is counterproductive with the Spiro. Please.....let me know what are the no-nos to add and what is the best one to add. Thanks for your help. -- Jan ShimanoHealth & Wellness Advocate

[Guest guest]

The right amount to drink is to drink when you are thirsty.Water does not wash salt out. The only way to get it out is to take less in than is needed until BP goes down. Then add back till BP goes up again, and then reduce again till you find your level of Na and K intake that keeps BP at goal.CE Grim MD Thanks :However, I am being very diligent about my salt. I am eating athome and preparing my food from scratch. If anything, I believethat I am way below the 1400 a day for the salt.Perhaps I am not drinking enough to wash the salt out of my system. If I drink what is considered the right amount, I am having to stayfairly close to a washroom. Hopefully you are not out salting the spiro. If I go over 1400 a day my pressure is up in spite of spiro. Remember out salting does not mean the salt shaker, but what's in our food- especially packaged, canned, and processed foods. Salt intake may be the answer insyead of just adding another med. Take inventory and cut something higher sodium out. Bet it helps more. Sent from my Palm Pre on the Now Network from Sprint -- Jan ShimanoHealth & Wellness Advocate

[Guest guest]

The right amount to drink is to drink when you are thirsty.Water does not wash salt out. The only way to get it out is to take less in than is needed until BP goes down. Then add back till BP goes up again, and then reduce again till you find your level of Na and K intake that keeps BP at goal.CE Grim MD Thanks :However, I am being very diligent about my salt. I am eating athome and preparing my food from scratch. If anything, I believethat I am way below the 1400 a day for the salt.Perhaps I am not drinking enough to wash the salt out of my system. If I drink what is considered the right amount, I am having to stayfairly close to a washroom. Hopefully you are not out salting the spiro. If I go over 1400 a day my pressure is up in spite of spiro. Remember out salting does not mean the salt shaker, but what's in our food- especially packaged, canned, and processed foods. Salt intake may be the answer insyead of just adding another med. Take inventory and cut something higher sodium out. Bet it helps more. Sent from my Palm Pre on the Now Network from Sprint -- Jan ShimanoHealth & Wellness Advocate

[Guest guest]

Thanks Dr. Grim:However, I still need to know what BP med. I should add to theSpiro and my DASHing as it is not bringing the BP down very much.This morning it was 144/98, which isn't bad considering it was

202/132 about three weeks or so ago.  Have only been on theSpiro for 3 weeks and am on 100 mg. a day.What drug can the Dr. add to it at this stage.Thanks.

 

Thanks for the note and careful reading:  I was referring to this mostly in pts with drug resistant HTN who may not clearly have PA and are not ready for AVS unitl they fail my cocktail which included spiro or eplerenone. If they fail this then consider AVS.   This combination of combinations has been successful in PA pts but rarely needed once spiro or epler and DASH have been started and followed and documented with urine Na and K.

Since this article was written I have been stressing DASH and checking urines and have not had to use that combo in PA patients. If they can DASH.Will make a note about this in my next revision.

Thanks again.CE Grim MD

  I am reading your Evolution of PA right now and one page 489it is stated that for those patients whose BP cannot be comtrolled

with ......including spiro or eplerenone....you use a cocktail thatnearly always includes a combination of a BB with a diuretic, an ACE or ARB and with a CCB and an aldosterone-blocking agent. " This has me confused because you said in your reply to me

that ARBs, ACEs and BBs will not work if you have PA.What if I have PA but also my HBP is partly essential hypertension also.What medication can be successfully added to my Spiro??

  ARBs, ACEs and BB will not work if you have PA. Take your team my Evolution of PA article. Remind them I trained with Dr Conn.

Trust you are DASHing as well.you can outsalt all Bp meds. Esp if you have PA. CE Grim MD

  Going to the Dr. in l l/2 hrs. time. I am on 100 mg. of Spiro (50 mg. twice daily) It has improved the BP somewhat but nowhere

near where it should be and my pulse is very high. It usually is around 78 - 82 but it is now running up to 111. I think the Dr. indicated last time that he thought my HBP was not all due to hyperaldosteronism.

He wants to add another medication. I have been on all of them over the last 20 odd years and they either don't work or I have terrible side effects. Diovan, Micardis & Cozaar (all from the same family)

seemed to be tolerated by me, but I don't think it did much to reduce the BP. I think he is going to want to add Micardis but I read somewhere that it is counterproductive with the Spiro. Please.....let me know what are the no-nos to add

and what is the best one to add. Thanks for your help.

-- Jan ShimanoHealth & Wellness Advocate

-- Jan ShimanoHealth & Wellness Advocate

[Guest guest]

Thanks Dr. Grim:However, I still need to know what BP med. I should add to theSpiro and my DASHing as it is not bringing the BP down very much.This morning it was 144/98, which isn't bad considering it was

202/132 about three weeks or so ago.  Have only been on theSpiro for 3 weeks and am on 100 mg. a day.What drug can the Dr. add to it at this stage.Thanks.

 

Thanks for the note and careful reading:  I was referring to this mostly in pts with drug resistant HTN who may not clearly have PA and are not ready for AVS unitl they fail my cocktail which included spiro or eplerenone. If they fail this then consider AVS.   This combination of combinations has been successful in PA pts but rarely needed once spiro or epler and DASH have been started and followed and documented with urine Na and K.

Since this article was written I have been stressing DASH and checking urines and have not had to use that combo in PA patients. If they can DASH.Will make a note about this in my next revision.

Thanks again.CE Grim MD

  I am reading your Evolution of PA right now and one page 489it is stated that for those patients whose BP cannot be comtrolled

with ......including spiro or eplerenone....you use a cocktail thatnearly always includes a combination of a BB with a diuretic, an ACE or ARB and with a CCB and an aldosterone-blocking agent. " This has me confused because you said in your reply to me

that ARBs, ACEs and BBs will not work if you have PA.What if I have PA but also my HBP is partly essential hypertension also.What medication can be successfully added to my Spiro??

  ARBs, ACEs and BB will not work if you have PA. Take your team my Evolution of PA article. Remind them I trained with Dr Conn.

Trust you are DASHing as well.you can outsalt all Bp meds. Esp if you have PA. CE Grim MD

  Going to the Dr. in l l/2 hrs. time. I am on 100 mg. of Spiro (50 mg. twice daily) It has improved the BP somewhat but nowhere

near where it should be and my pulse is very high. It usually is around 78 - 82 but it is now running up to 111. I think the Dr. indicated last time that he thought my HBP was not all due to hyperaldosteronism.

He wants to add another medication. I have been on all of them over the last 20 odd years and they either don't work or I have terrible side effects. Diovan, Micardis & Cozaar (all from the same family)

seemed to be tolerated by me, but I don't think it did much to reduce the BP. I think he is going to want to add Micardis but I read somewhere that it is counterproductive with the Spiro. Please.....let me know what are the no-nos to add

and what is the best one to add. Thanks for your help.

-- Jan ShimanoHealth & Wellness Advocate

-- Jan ShimanoHealth & Wellness Advocate

[Guest guest]

And I found some of the worst sneaky culprits are breads, dressings and condiments, and butter. High sodium in thoseSent from my Palm Pre on the Now Network from Sprint

Thanks :However, I am being very diligent about my salt. I am eating athome and preparing my food from scratch. If anything, I believethat I am way below the 1400 a day for the salt.Perhaps I am not drinking enough to wash the salt out of my system.

If I drink what is considered the right amount, I am having to stayfairly close to a washroom.

Hopefully you are not out salting the spiro. If I go over 1400 a day my pressure is up in spite of spiro. Remember out salting does not mean the salt shaker, but what's in our food- especially packaged, canned, and processed foods. Salt intake may be the answer insyead of just adding another med. Take inventory and cut something higher sodium out. Bet it helps more.

Sent from my Palm Pre on the Now Network from Sprint

-- Jan ShimanoHealth & Wellness Advocate

[Guest guest]

From 202/132 to 144/98 in 3 weeks? Are you dizzy or anything? I am

feeling dizzy with mine just dropping 20 points.

 

Thanks Dr. Grim:

However, I still need to know what BP med. I should add to

the

Spiro and my DASHing as it is not bringing the BP down

very much.

This morning it was 144/98, which isn't bad considering it

was

202/132 about three weeks or so ago.  Have only been on

the

Spiro for 3 weeks and am on 100 mg. a day.

What

drug can the Dr. add to it at this stage.

Thanks.

On Thu, Aug 25, 2011 at 9:38 AM,

Clarence Grim

wrote:

 

Thanks for the note and careful reading:  I

was referring to this mostly in pts with drug

resistant HTN who may not clearly have PA and

are not ready for AVS unitl they fail my

cocktail which included spiro or eplerenone.

If they fail this then consider AVS.   This

combination of combinations has been

successful in PA pts but rarely needed once

spiro or epler and DASH have been started and

followed and documented with urine Na and K.

Since this article was written I have

been stressing DASH and checking urines and

have not had to use that combo in PA

patients. If they can DASH.

Will make a note about this in my next

revision.

Thanks again.

CE Grim MD

On Aug 25, 2011, at 11:24 AM, Jan

Shimano wrote:

 

I am reading your Evolution

of PA right now and one page

489

it is stated that for those

patients whose BP cannot be

comtrolled

with ......including spiro or

eplerenone....you use a

cocktail that

nearly always includes a

combination of a BB with a

diuretic,

an ACE or ARB and with a CCB

and an aldosterone-

blocking agent."

This has me confused because

you said in your reply to me

that ARBs, ACEs and BBs will

not work if you have PA.

What if I have PA but also my

HBP is partly essential

hypertension

also.

What medication can be

successfully added to my

Spiro??

On Thu, Aug 25, 2011 at 9:12

AM, Clarence Grim

wrote:

 

ARBs, ACEs and BB

will not work if

you have PA. Take

your team my

Evolution of PA

article. Remind

them I trained

with Dr Conn.

Trust you are

DASHing as well.

you can outsalt

all Bp meds. Esp

if you have PA.

CE Grim MD

On Aug

25, 2011, at

11:07 AM,

Jeanette

wrote:

 

Going to

the Dr. in l

l/2 hrs. time.

I am on 100

mg. of Spiro

(50 mg. twice

daily)

It has

improved the

BP somewhat

but nowhere

near where it

should be and

my pulse is

very

high. It

usually is

around 78 - 82

but it is

now running up

to 111.

I think the

Dr. indicated

last time that

he

thought my HBP

was not all

due to

hyperaldosteronism.

He wants to

add another

medication.

I have been on

all of them

over the last

20 odd

years and they

either don't

work or I have

terrible

side effects.

Diovan,

Micardis &

Cozaar (all

from the same

family)

seemed to be

tolerated by

me, but I

don't think it

did much to

reduce the BP.

I think he is

going to want

to add

Micardis but I

read somewhere

that it is

counterproductive

with the

Spiro.

Please.....let

me know what

are the no-nos

to add

and what is

the best one

to add. Thanks

for your

help.

--

Jan Shimano

Health & Wellness Advocate

--

Jan Shimano

Health & Wellness Advocate

[Guest guest]

I have also had HBP for 18 years  averaging 180/100 even with meds. 

Mine is now 150/70 after 2 weeks and I am thrilled to death!!!

 

I hear you Phyllis.  I think I have been paying too much

attention

to how low other peoples BP has gone practically

overnight, and

I should remember that I am much older than most of the

people

on here and have had out of control high BP for well over

20 years.

You comments have brought me back to earth!! Thanks.

On Thu, Aug 25, 2011 at 10:00 AM,

Phyllis

wrote:

 

From 202/132 to 144/98 in 3 weeks? Are you

dizzy or anything? I am feeling dizzy with

mine just dropping 20 points.

 

Thanks Dr. Grim:

However, I still need to know what BP

med. I should add to the

Spiro and my DASHing as it is not

bringing the BP down very much.

This morning it was 144/98, which

isn't bad considering it was

202/132 about three weeks or so ago. 

Have only been on the

Spiro for 3 weeks and am on 100 mg. a

day.

What drug can the Dr. add

to it at this stage.

Thanks.

[Guest guest]

Hey " Old Lady " you are only as old as you think and you better not slow down

cause some of us are right behind you! (B 65 in a month and feeling better than

I have in 10 yrs!)

- 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.

> >>>

> >>>

> >>>

> >>> Going to the Dr. in l l/2 hrs. time.

> >>> I am on 100 mg. of Spiro (50 mg. twice daily)

> >>> It has improved the BP somewhat but nowhere

> >>> near where it should be and my pulse is very

> >>> high. It usually is around 78 - 82 but it is

> >>> now running up to 111.

> >>> I think the Dr. indicated last time that he

> >>> thought my HBP was not all due to hyperaldosteronism.

> >>> He wants to add another medication.

> >>> I have been on all of them over the last 20 odd

> >>> years and they either don't work or I have terrible

> >>> side effects.

> >>> Diovan, Micardis & Cozaar (all from the same family)

> >>> seemed to be tolerated by me, but I don't think it

> >>> did much to reduce the BP.

> >>> I think he is going to want to add Micardis but I

> >>> read somewhere that it is counterproductive with the

> >>> Spiro.

> >>> Please.....let me know what are the no-nos to add

> >>> and what is the best one to add. Thanks for your

> >>> help.

> >>>

> >>>

> >>>

> >>>

> >>

> >>

> >> --

> >>

> >> Jan Shimano

> >> Health & Wellness Advocate

> >>

> >>

> >>

> >>

> >>

> >>

> >>

> >

> >

> > --

> >

> > Jan Shimano

> > Health & Wellness Advocate

> >

> >

> >

> >

> >

> >

> >

>

>

>

> --

>

> Jan Shimano

> Health & Wellness Advocate

>

[Guest guest]

Well maybe 5yrs first, my son just came up from Boston and we are headed up in

the mtns to my remote camp. He says we are going for a hike and it will be the

first time for that in 4 yrs! Looking forward to it!

- 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.

> > > >>>

> > > >>>

> > > >>>

> > > >>> Going to the Dr. in l l/2 hrs. time.

> > > >>> I am on 100 mg. of Spiro (50 mg. twice daily)

> > > >>> It has improved the BP somewhat but nowhere

> > > >>> near where it should be and my pulse is very

> > > >>> high. It usually is around 78 - 82 but it is

> > > >>> now running up to 111.

> > > >>> I think the Dr. indicated last time that he

> > > >>> thought my HBP was not all due to hyperaldosteronism.

> > > >>> He wants to add another medication.

> > > >>> I have been on all of them over the last 20 odd

> > > >>> years and they either don't work or I have terrible

> > > >>> side effects.

> > > >>> Diovan, Micardis & Cozaar (all from the same family)

> > > >>> seemed to be tolerated by me, but I don't think it

> > > >>> did much to reduce the BP.

> > > >>> I think he is going to want to add Micardis but I

> > > >>> read somewhere that it is counterproductive with the

> > > >>> Spiro.

> > > >>> Please.....let me know what are the no-nos to add

> > > >>> and what is the best one to add. Thanks for your

> > > >>> help.

> > > >>>

> > > >>>

> > > >>>

> > > >>>

> > > >>

> > > >>

> > > >> --

> > > >>

> > > >> Jan Shimano

> > > >> Health & Wellness Advocate

> > > >>

> > > >>

> > > >>

> > > >>

> > > >>

> > > >>

> > > >>

> > > >

> > > >

> > > > --

> > > >

> > > > Jan Shimano

> > > > Health & Wellness Advocate

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > >

> > >

> > >

> > > --

> > >

> > > Jan Shimano

> > > Health & Wellness Advocate

> > >

> >

> >

> >

>

>

>

> --

>

> Jan Shimano

> Health & Wellness Advocate

>

[Guest guest]

What do you mean medS? I'll just put a couple extra Spiro in my pocket! That

will get me off the bblocker which in turn reduce my depression so I won't need

the psyco meds. (Actually that would be two factors that might increase my

mood! Now I'm qualified to make recommendations for the JNC study!) Almost

ready to tackle that issue when I get back!

- 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.

> > > > > >>>

> > > > > >>>

> > > > > >>>

> > > > > >>> Going to the Dr. in l l/2 hrs. time.

> > > > > >>> I am on 100 mg. of Spiro (50 mg. twice daily)

> > > > > >>> It has improved the BP somewhat but nowhere

> > > > > >>> near where it should be and my pulse is very

> > > > > >>> high. It usually is around 78 - 82 but it is

> > > > > >>> now running up to 111.

> > > > > >>> I think the Dr. indicated last time that he

> > > > > >>> thought my HBP was not all due to hyperaldosteronism.

> > > > > >>> He wants to add another medication.

> > > > > >>> I have been on all of them over the last 20 odd

> > > > > >>> years and they either don't work or I have terrible

> > > > > >>> side effects.

> > > > > >>> Diovan, Micardis & Cozaar (all from the same family)

> > > > > >>> seemed to be tolerated by me, but I don't think it

> > > > > >>> did much to reduce the BP.

> > > > > >>> I think he is going to want to add Micardis but I

> > > > > >>> read somewhere that it is counterproductive with the

> > > > > >>> Spiro.

> > > > > >>> Please.....let me know what are the no-nos to add

> > > > > >>> and what is the best one to add. Thanks for your

> > > > > >>> help.

> > > > > >>>

> > > > > >>>

> > > > > >>>

> > > > > >>>

> > > > > >>

> > > > > >>

> > > > > >> --

> > > > > >>

> > > > > >> Jan Shimano

> > > > > >> Health & Wellness Advocate

> > > > > >>

> > > > > >>

> > > > > >>

> > > > > >>

> > > > > >>

> > > > > >>

> > > > > >>

> > > > > >

> > > > > >

> > > > > > --

> > > > > >

> > > > > > Jan Shimano

> > > > > > Health & Wellness Advocate

> > > > > >

> > > > > >

> > > > > >

> > > > > >

> > > > > >

> > > > > >

> > > > > >

> > > > >

> > > > >

> > > > >

> > > > > --

> > > > >

> > > > > Jan Shimano

> > > > > Health & Wellness Advocate

> > > > >

> > > >

> > > >

> > > >

> > >

> > >

> > >

> > > --

> > >

> > > Jan Shimano

> > > Health & Wellness Advocate

> > >

> >

> >

> >

>

>

>

> --

>

> Jan Shimano

> Health & Wellness Advocate

>

[Guest guest]

I would add the drug of measuring the urine Na and K to see if you are DASHing to the max (more K that Na in your urine). If not the DASH. If so then increase Spiro. I used to go to 400 mg a day before DASH. if you read the Bravo article referred to in our intro you will not the pt who cut his Spiro from 600 mg a day to 12.5 by lowering is Na intake.So it is you and your Drs choice: Drug or DASH.CE Grim MD Thanks Dr. Grim:However, I still need to know what BP med. I should add to theSpiro and my DASHing as it is not bringing the BP down very much.This morning it was 144/98, which isn't bad considering it was 202/132 about three weeks or so ago. Have only been on theSpiro for 3 weeks and am on 100 mg. a day.What drug can the Dr. add to it at this stage.Thanks. Thanks for the note and careful reading: I was referring to this mostly in pts with drug resistant HTN who may not clearly have PA and are not ready for AVS unitl they fail my cocktail which included spiro or eplerenone. If they fail this then consider AVS. This combination of combinations has been successful in PA pts but rarely needed once spiro or epler and DASH have been started and followed and documented with urine Na and K. Since this article was written I have been stressing DASH and checking urines and have not had to use that combo in PA patients. If they can DASH.Will make a note about this in my next revision. Thanks again.CE Grim MD I am reading your Evolution of PA right now and one page 489it is stated that for those patients whose BP cannot be comtrolled with ......including spiro or eplerenone....you use a cocktail thatnearly always includes a combination of a BB with a diuretic, an ACE or ARB and with a CCB and an aldosterone-blocking agent."This has me confused because you said in your reply to me that ARBs, ACEs and BBs will not work if you have PA.What if I have PA but also my HBP is partly essential hypertension also.What medication can be successfully added to my Spiro?? ARBs, ACEs and BB will not work if you have PA. Take your team my Evolution of PA article. Remind them I trained with Dr Conn. Trust you are DASHing as well.you can outsalt all Bp meds. Esp if you have PA. CE Grim MD Going to the Dr. in l l/2 hrs. time. I am on 100 mg. of Spiro (50 mg. twice daily) It has improved the BP somewhat but nowhere near where it should be and my pulse is very high. It usually is around 78 - 82 but it is now running up to 111. I think the Dr. indicated last time that he thought my HBP was not all due to hyperaldosteronism. He wants to add another medication. I have been on all of them over the last 20 odd years and they either don't work or I have terrible side effects. Diovan, Micardis & Cozaar (all from the same family) seemed to be tolerated by me, but I don't think it did much to reduce the BP. I think he is going to want to add Micardis but I read somewhere that it is counterproductive with the Spiro. Please.....let me know what are the no-nos to add and what is the best one to add. Thanks for your help. -- Jan ShimanoHealth & Wellness Advocate -- Jan ShimanoHealth & Wellness Advocate

[Guest guest]

It does take time for DASH and MCB to reverse the damage done by aldo and excess salt. CE Grim MD I hear you Phyllis. I think I have been paying too much attentionto how low other peoples BP has gone practically overnight, andI should remember that I am much older than most of the peopleon here and have had out of control high BP for well over 20 years. You comments have brought me back to earth!! Thanks. From 202/132 to 144/98 in 3 weeks? Are you dizzy or anything? I am feeling dizzy with mine just dropping 20 points. Thanks Dr. Grim: However, I still need to know what BP med. I should add to the Spiro and my DASHing as it is not bringing the BP down very much. This morning it was 144/98, which isn't bad considering it was 202/132 about three weeks or so ago. Have only been on the Spiro for 3 weeks and am on 100 mg. a day. What drug can the Dr. add to it at this stage. Thanks. Thanks for the note and careful reading: I was referring to this mostly in pts with drug resistant HTN who may not clearly have PA and are not ready for AVS unitl they fail my cocktail which included spiro or eplerenone. If they fail this then consider AVS. This combination of combinations has been successful in PA pts but rarely needed once spiro or epler and DASH have been started and followed and documented with urine Na and K. Since this article was written I have been stressing DASH and checking urines and have not had to use that combo in PA patients. If they can DASH. Will make a note about this in my next revision. Thanks again. CE Grim MD I am reading your Evolution of PA right now and one page 489 it is stated that for those patients whose BP cannot be comtrolled with ......including spiro or eplerenone....you use a cocktail that nearly always includes a combination of a BB with a diuretic, an ACE or ARB and with a CCB and an aldosterone- blocking agent." This has me confused because you said in your reply to me that ARBs, ACEs and BBs will not work if you have PA. What if I have PA but also my HBP is partly essential hypertension also. What medication can be successfully added to my Spiro?? ARBs, ACEs and BB will not work if you have PA. Take your team my Evolution of PA article. Remind them I trained with Dr Conn. Trust you are DASHing as well. you can outsalt all Bp meds. Esp if you have PA. CE Grim MD Going to the Dr. in l l/2 hrs. time. I am on 100 mg. of Spiro (50 mg. twice daily) It has improved the BP somewhat but nowhere near where it should be and my pulse is very high. It usually is around 78 - 82 but it is now running up to 111. I think the Dr. indicated last time that he thought my HBP was not all due to hyperaldosteronism. He wants to add another medication. I have been on all of them over the last 20 odd years and they either don't work or I have terrible side effects. Diovan, Micardis & Cozaar (all from the same family) seemed to be tolerated by me, but I don't think it did much to reduce the BP. I think he is going to want to add Micardis but I read somewhere that it is counterproductive with the Spiro. Please.....let me know what are the no-nos to add and what is the best one to add. Thanks for your help. -- Jan Shimano Health & Wellness Advocate -- Jan Shimano Health & Wellness Advocate -- Jan ShimanoHealth & Wellness Advocate