Re: Re: BP going up

August 31, 2011

In your case what would be the reason for the metoprolol?

Subject: Re: BP going upTo: hyperaldosteronism Date: Wednesday, August 31, 2011, 2:42 PM

Hi , during the three weeks I took spiro a few months back my BP went up from an average of 140s/90s to 160s/100s, and did not come back down until 4 weeks after I had discontinued the spiro. I never did get a concrete explanation for it, but my nephrologist believed it was nothing to worry about and that when the dosage was right, it would come down. (He had me increase the dose in 12.5 mg increments rather than starting at a normal therapeutic dose; I never got past 37.5mg as the side effects were intolerable.) On this board and over at the NORD rare disease board, a few people suggested that it was happening because the dose was not yet high enough.Since this happened to me but does not seem to be the norm, I'd be really curious to hear your doc's explanation, if you wouldn't mind reporting back. Thanks in advance!>> I've been dashing for almost two weeks and started taking Spiro 50mg day on Saturday. My doc said I should stay on the Metoprol 100mg day but discontinue the Amlodipine. Since Saturday my BP has started to go up. I'm averaging 155/102 over the last three days. I have a call out to my doc but wanted to see if anyone else has experienced this. Why is this happening? Is it the Spiro?> > - 44 yr old female/5'6"/ 140 lbs/ 2.2 cm adenoma on left adrenal gland discovered in March 2011. Two year history of high BP. Average BP 150/94. AVS in August determined bilaterial hyperplasia. Current medication Spiro 50mg/day, Metoprolol 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 DASHING 8/21.>

August 31, 2011

Interactions between your selected drugs

metoprolol â†” hydrochlorothiazide

Applies to:metoprolol and Aldactazide (hydrochlorothiazide/spironolactone)

MONITOR: Although they are often combined in clinical practice, diuretics and beta-blockers may increase the risk of hyperglycemia and hypertriglyceridemia in some patients, especially in patients with diabetes or latent diabetes. In addition, the risk of QT interval prolongation and arrhythmias (e.g. torsades de pointes) due to sotalol may be increased by potassium-depleting diuretics.MANAGEMENT: Monitoring of serum potassium levels, blood pressure, and blood glucose is recommended during coadministration. Patients should be advised to seek medical assistance if they experience dizziness, weakness, fainting, fast or irregular heartbeats, or loss of blood glucose control.

Subject: Re: BP going upTo: hyperaldosteronism Date: Wednesday, August 31, 2011, 2:42 PM

Hi , during the three weeks I took spiro a few months back my BP went up from an average of 140s/90s to 160s/100s, and did not come back down until 4 weeks after I had discontinued the spiro. I never did get a concrete explanation for it, but my nephrologist believed it was nothing to worry about and that when the dosage was right, it would come down. (He had me increase the dose in 12.5 mg increments rather than starting at a normal therapeutic dose; I never got past 37.5mg as the side effects were intolerable.) On this board and over at the NORD rare disease board, a few people suggested that it was happening because the dose was not yet high enough.Since this happened to me but does not seem to be the norm, I'd be really curious to hear your doc's explanation, if you wouldn't mind reporting back. Thanks in advance!>> I've been dashing for almost two weeks and started taking Spiro 50mg day on Saturday. My doc said I should stay on the Metoprol 100mg day but discontinue the Amlodipine. Since Saturday my BP has started to go up. I'm averaging 155/102 over the last three days. I have a call out to my doc but wanted to see if anyone else has experienced this. Why is this happening? Is it the Spiro?> > - 44 yr old female/5'6"/ 140 lbs/ 2.2 cm adenoma on left adrenal gland discovered in March 2011. Two year history of high BP. Average BP 150/94. AVS in August determined bilaterial hyperplasia. Current medication Spiro 50mg/day, Metoprolol 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 DASHING 8/21.>

August 31, 2011

and they're absolutely positive it's PA?

Subject: Re: BP going upTo: hyperaldosteronism Date: Wednesday, August 31, 2011, 3:12 PM

Thanks for the feedback! What you said about the side effects, thatâ€™s interesting. Iâ€™ve noticed my anxiety level has been even higher than it normally is for the last few days, and my legs feel like Iâ€™ve run a mile. I ask myself, is that the Spiro or just the PA getting worse? My husband asked me, if the medicine is going to make you feel just as crappy as the PA whatâ€™s the point of taking it? The way I feel right now I tend to agree with him J Iâ€™ll check in after my doc calls back and let you know what he says.

August 31, 2011

hey DASHing really takes a knack to get I right for YOU. I did it and was

way too low on the BP side so I have to be in the middle. Too extreme and I go

one way or the other. So don't get discouraged as so long as they have your

diagnosis right as PA then you may juggle a few things to fit you best. Most of

us are on consensus that decreasing the salt is one of those for all of us. As

Dr G has said aldosterone appears relatively harmless until the sodium gets to

it. So in some way our problem IS salt, not aldosterone.

>Hi , during the three weeks I took spiro a few months back my BP went up

from an average of 140s/90s to 160s/100s, and did not come back down until 4

weeks after I had discontinued the spiro. I never did get a concrete explanation

for it, but my nephrologist believed it was nothing to worry about and that when

the dosage was right, it would come down. (He had me increase the dose in 12.5

mg increments rather than starting at a normal therapeutic dose; I never got

past 37.5mg as the side effects were intolerable.) On this board and over at the

NORD rare disease board, a few people suggested that it was happening because

the dose was not yet high enough.

>

>Since this happened to me but does not seem to be the norm, I'd be really

curious to hear your doc's explanation, if you wouldn't mind reporting back.

Thanks in advance!

>

>>

>> I've been dashing for almost two weeks and started taking Spiro 50mg day on

Saturday. My doc said I should stay on the Metoprol 100mg day but discontinue

the Amlodipine. Since Saturday my BP has started to go up. I'm averaging 155/102

over the last three days. I have a call out to my doc but wanted to see if

anyone else has experienced this. Why is this happening? Is it the Spiro?

>>

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

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

August determined bilaterial hyperplasia. Current medication Spiro 50mg/day,

Metoprolol 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 DASHING 8/21.

>>

>

September 1, 2011

No correction needed. Every single time I tried HCTZ I was in the ER too. Never an explanation or any attempt to try and figure out why my K was low and my BP was 160/130for the 10th time at the same ER!

Subject: Re: BP going upTo: hyperaldosteronism Date: Thursday, September 1, 2011, 9:17 PM

I took HCTZ for about a month before I landed in the ER and hospital about 5 times with severe hypokalemia! I couldn't move my arms and legs - much less walk, talk, or function. I don't seem to have primary Conn's but still......If you have a doctor who is prescribing this medication to you (which is VERY WELL KNOWN to cause hypokalemia in ALL patients) you need to question him/her carefully about their knowledge of Conn's......

Dr. Grim, , and Bill - please correct me if I am wrong!

Also, I seem to be one of the few in the group who is on strictly alpha blockers?? Is this anyone else out there? They work great for me along with the potassium supplements, dashing, and Spironolactone. I realize we are all different but the trends of the low potassiums seem to all be the same.

Why don't more of us get more potassium supplements? (I am lucky I talked my PCP into it by going up and down and ending up in the ER and showing her the results and she got it) but.... I still question this at length. I have to admit - I had spaghetti for dinner tonight (easy and quick) and I am now tingling in the face and arms and my hand and foot starting cramping - so I am going to take 10 more meq of K - I DO realize the SIDE EFFECT of too much potassium is DEATH however, when was the last time any of us had a high potassium?

For me, it was when I was on 40 meq per day.

Okay, enough from the Maine peanut gallery tonight. I am fighting the Lyme with a vengeance thanks to a friend on here named Val - thanks Val - and to the Naturopath I found in Wolfeboro NH who is quite well versed in Lyme - Dr. Steve , Wolfeboro NH.

God Bless all and have a Happy Labor Day!

M

p.s. I was proud my pressure was 116/74 this am - pulse still 84 though

September 1, 2011

You had a classic Conn's response to HCTZ. Most likely u have Conn's ESP if Spiro has helped. Have your dr check ur urine Na And K so you can see how well u are DASHing. How can a naturopath treat with antibiotics for Lyme?Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

I took HCTZ for about a month before I landed in the ER and hospital about 5 times with severe hypokalemia! I couldn't move my arms and legs - much less walk, talk, or function. I don't seem to have primary Conn's but still......If you have a doctor who is prescribing this medication to you (which is VERY WELL KNOWN to cause hypokalemia in ALL patients) you need to question him/her carefully about their knowledge of Conn's......

Dr. Grim, , and Bill - please correct me if I am wrong!

Also, I seem to be one of the few in the group who is on strictly alpha blockers?? Is this anyone else out there? They work great for me along with the potassium supplements, dashing, and Spironolactone. I realize we are all different but the trends of the low potassiums seem to all be the same.

Why don't more of us get more potassium supplements? (I am lucky I talked my PCP into it by going up and down and ending up in the ER and showing her the results and she got it) but.... I still question this at length. I have to admit - I had spaghetti for dinner tonight (easy and quick) and I am now tingling in the face and arms and my hand and foot starting cramping - so I am going to take 10 more meq of K - I DO realize the SIDE EFFECT of too much potassium is DEATH however, when was the last time any of us had a high potassium?

For me, it was when I was on 40 meq per day.

Okay, enough from the Maine peanut gallery tonight. I am fighting the Lyme with a vengeance thanks to a friend on here named Val - thanks Val - and to the Naturopath I found in Wolfeboro NH who is quite well versed in Lyme - Dr. Steve , Wolfeboro NH.

God Bless all and have a Happy Labor Day!

M

p.s. I was proud my pressure was 116/74 this am - pulse still 84 though

September 1, 2011

Ahh but your were being treated by a PA?;-)Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

No correction needed. Every single time I tried HCTZ I was in the ER too. Never an explanation or any attempt to try and figure out why my K was low and my BP was 160/130for the 10th time at the same ER!

Subject: Re: BP going upTo: hyperaldosteronism Date: Thursday, September 1, 2011, 9:17 PM

I took HCTZ for about a month before I landed in the ER and hospital about 5 times with severe hypokalemia! I couldn't move my arms and legs - much less walk, talk, or function. I don't seem to have primary Conn's but still......If you have a doctor who is prescribing this medication to you (which is VERY WELL KNOWN to cause hypokalemia in ALL patients) you need to question him/her carefully about their knowledge of Conn's......

Dr. Grim, , and Bill - please correct me if I am wrong!

Also, I seem to be one of the few in the group who is on strictly alpha blockers?? Is this anyone else out there? They work great for me along with the potassium supplements, dashing, and Spironolactone. I realize we are all different but the trends of the low potassiums seem to all be the same.

Why don't more of us get more potassium supplements? (I am lucky I talked my PCP into it by going up and down and ending up in the ER and showing her the results and she got it) but.... I still question this at length. I have to admit - I had spaghetti for dinner tonight (easy and quick) and I am now tingling in the face and arms and my hand and foot starting cramping - so I am going to take 10 more meq of K - I DO realize the SIDE EFFECT of too much potassium is DEATH however, when was the last time any of us had a high potassium?

For me, it was when I was on 40 meq per day.

Okay, enough from the Maine peanut gallery tonight. I am fighting the Lyme with a vengeance thanks to a friend on here named Val - thanks Val - and to the Naturopath I found in Wolfeboro NH who is quite well versed in Lyme - Dr. Steve , Wolfeboro NH.

God Bless all and have a Happy Labor Day!

M

p.s. I was proud my pressure was 116/74 this am - pulse still 84 though

September 1, 2011

The body regulates blood sodium VERY tightly and few things will change it much.Therefore it tells us almost nothing about body Na.CE Grim MD I once posted a question regarding urine vs blood NA and don't believe I ever got an answer: Logic tells me that blood NA would be an indicator of the NA circulating at that point-in-time within your body. Urine NA on the other hand would be the amount of NA being excreated from your body at that point-in-time. If that logic is correct then wouldn't it be blood NA that impacts whether and how effective Spironlactone will work? I can understand where Urine NA would tell you how compliant a PTN is with diet, assuming the salt excretion/retention system is working correctly (which I presume would be validated by the blood NA!) Where did I go wrong? - 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. > > >Thanks ! My doc just called. He wants me to start the Amplodipine again > >and see if that helps. He feels he may have made too many changes at once. > >If my BP doesn't start going back down within a week he suggested increasing > >the Spiro. I'm being tested for Diabetes so the article you sent was > >interesting. I've never had high glucose until now and there is no history > >of it in my family so I'm eager to see what the outcome of the blood work > >is. Every doctor I've seen has confirmed PA. As for salt intake, I've > >always been very anti salt and I'm normally far below the daily requirement. > >I had to retake the sodium loading test three times before I met the minimum > >required level even after taking the salt pills. Boy was that a horrible > >experience! I'm also a part time caterer and food is a bit of a passion. > >Very limited packaged or pre-cooked food in this house and never any salt on > >the table. Anything I have to buy pre-packaged or pre made is never more > >than 4% of your daily sodium. I just looked at the labs I had done in the > >hospital when this all started with heart palpitations and elevated BP in > >March (Before I ever knew what an adrenal gland did) and looked at my > >sodium. I was at the bottom of the range at 139 so I think that's not too > >bad?? > > >

September 1, 2011

works in the body by blocking aldo salt retaining effects. Also works in gut and sweat glands and saliva to so same.CE Grim MD Maybe a little but without about 7 years of med school or an interpreter, like Dr.Grim, I don't think I will arrive at an answer! I get as far as activating the RAS which as I understand works on Renin which we have little of so I'm not sure how that causes vasodilation which would theroetically lower blood pressure! Is it the lowered BP that you get when you finally get your NA depleated enough that allows the Spiro to work? It seems like I have hit a brick wall here so let me rephrase my question! Does Spirolactone work in the body or the potty? If it is the body, how does it know how much NA is hitting the potty? I think I am back at my original question! Thanks. - 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. > > > > > > >Thanks ! My doc just called. He wants me to start the Amplodipine again > > > >and see if that helps. He feels he may have made too many changes at once. > > > >If my BP doesn't start going back down within a week he suggested increasing > > > >the Spiro. I'm being tested for Diabetes so the article you sent was > > > >interesting. I've never had high glucose until now and there is no history > > > >of it in my family so I'm eager to see what the outcome of the blood work > > > >is. Every doctor I've seen has confirmed PA. As for salt intake, I've > > > >always been very anti salt and I'm normally far below the daily requirement. > > > >I had to retake the sodium loading test three times before I met the minimum > > > >required level even after taking the salt pills. Boy was that a horrible > > > >experience! I'm also a part time caterer and food is a bit of a passion. > > > >Very limited packaged or pre-cooked food in this house and never any salt on > > > >the table. Anything I have to buy pre-packaged or pre made is never more > > > >than 4% of your daily sodium. I just looked at the labs I had done in the > > > >hospital when this all started with heart palpitations and elevated BP in > > > >March (Before I ever knew what an adrenal gland did) and looked at my > > > >sodium. I was at the bottom of the range at 139 so I think that's not too > > > >bad?? > > > > > > > > > >

September 2, 2011

Unless you have kidney disease, you dont have to worry much about too much potassium. And you say you're on spironolactone, so why do you think its alpha blocker and why do think THATS the thing working great for you? And if you have Conn's then it's likely the spironolactone and potassium supplements thats working and while the alpha blocker is not harming you or causing side effects, it may just be tagging along. Unless you need your prostate shrunk too

Now if you're going to eat a big sodium diet like spaghettis than you may just keep spinning your wheels. Some of the symptoms, like tingling, that they may attribute to Lymes may be nothing more than a diet that's bad for you and you over and over again are the reason you keep knocking your potassium down by what you eat.

If they siad tomorrow your 100% gluten intolerant would you stop the gluten in your diet? Likely yes, and you'd be shopping tomorrow for some new food. But with Conn's salt will kill you as combined with your elevated aldosterone it is causing HTN and the silent killers that HTN leads to (like kidney disease) heart issues, etc.....so why do you not stop the salt? A gluten allergy will cause a bunch of discomforts, but not usually any kind of killer.......salt is. The reality is you're the reason you have the issues if you continue to ignore the high sodium warning. And no one has to stop it, just bring it to the level that keeps the hyperaldosterone inert. Taking a potassium pill after a meal is not the answer.

And even if your naturopath thinks you have Lyme DZ I am guessing they still have you on the DASH diet and a high potassium rich diet? Yes? And a GREAT exercise routine?

and BTW too much of anything except love and money can cause death...and money's debatable, and I also guess it depends on who's loving you too........

Subject: Re: BP going upTo: hyperaldosteronism Date: Friday, September 2, 2011, 7:24 AM

Why do say you don't have primary Conn's? >> I took HCTZ for about a month before I landed in the ER and hospital about > 5 times with severe hypokalemia! I couldn't move my arms and legs - much > less walk, talk, or function. I don't seem to have primary Conn's but > still......If you have a doctor who is prescribing this medication to you (which > is VERY WELL KNOWN to cause hypokalemia in ALL patients) you need to > question him/her carefully about their knowledge of Conn's......> > Dr. Grim, , and Bill - please correct me if I am wrong!> > Also, I seem to be one of the few in the group who is on strictly alpha >

blockers?? Is this anyone else out there? They work great for me along with > the potassium supplements, dashing, and Spironolactone. I realize we are all > different but the trends of the low potassiums seem to all be the same.> > Why don't more of us get more potassium supplements? (I am lucky I talked > my PCP into it by going up and down and ending up in the ER and showing her > the results and she got it) but.... I still question this at length. I > have to admit - I had spaghetti for dinner tonight (easy and quick) and I am > now tingling in the face and arms and my hand and foot starting cramping - so > I am going to take 10 more meq of K - I DO realize the SIDE EFFECT of too > much potassium is DEATH however, when was the last time any of us had a > high potassium?> > For me, it was when I was on 40 meq per day.> > Okay, enough from the Maine

peanut gallery tonight. I am fighting the Lyme > with a vengeance thanks to a friend on here named Val - thanks Val - and to > the Naturopath I found in Wolfeboro NH who is quite well versed in Lyme - > Dr. Steve , Wolfeboro NH.> > God Bless all and have a Happy Labor Day!> M> p.s. I was proud my pressure was 116/74 this am - pulse still 84 though >

September 2, 2011

Then how can Adlo/Salt impact organs? It gets there through the blood right? It would seem to me that low blood NA would be a goal. ============================================================================45-Male-Caucasian, 5'9"- 242lbs, PA Diagnosed 2007 Suspected Hyperplasia-No tumors on CT - No AVS.Meds: 100mg Spiro, 40meq Potassium, 1800mg Calcium, 500mg 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

PainDASH: Started "sort of" DASHing 5/3/2011To: hyperaldosteronism Sent: Friday, September 2, 2011 12:46 AMSubject: Re: Re: BP going up

The body regulates blood sodium VERY tightly and few things will change it much.Therefore it tells us almost nothing about body Na.CE Grim MD I once posted a question regarding urine vs blood NA and don't believe I ever got an answer: Logic tells me that blood NA would be an indicator of the NA circulating at that point-in-time within your body. Urine NA on the other hand would be the amount of NA being excreated from your body at that point-in-time. If that logic is correct then wouldn't it be blood NA that impacts whether and how effective Spironlactone will work? I can understand where Urine NA would tell you how compliant a PTN is with diet, assuming the salt

excretion/retention system is working correctly (which I presume would be validated by the blood NA!) Where did I go wrong? - 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. > > >Thanks ! My doc just called. He wants me to start the Amplodipine again > >and see if that helps. He feels he may have made too many changes at once. > >If my BP doesn't start going back down within a week he suggested increasing > >the Spiro. I'm being tested for Diabetes so the article you sent was > >interesting. I've never had high glucose until now and there is no history > >of it in my family so I'm eager to see what the outcome of the blood work > >is. Every doctor I've seen has confirmed PA. As for salt intake, I've > >always been very anti salt and I'm normally far below the daily requirement. > >I had to retake the sodium loading test three times before I met the minimum > >required level even after taking the salt pills. Boy was that a

horrible > >experience! I'm also a part time caterer and food is a bit of a passion. > >Very limited packaged or pre-cooked food in this house and never any salt on > >the table. Anything I have to buy pre-packaged or pre made is never more > >than 4% of your daily sodium. I just looked at the labs I had done in the > >hospital when this all started with heart palpitations and elevated BP in > >March (Before I ever knew what an adrenal gland did) and looked at my > >sodium. I was at the bottom of the range at 139 so I think that's not too > >bad?? > > >

September 2, 2011

Again, if you have low blood NA then where is Aldo putting the salt? ============================================================================45-Male-Caucasian, 5'9"- 242lbs, PA Diagnosed 2007 Suspected Hyperplasia-No tumors on CT - No AVS.Meds: 100mg Spiro, 40meq Potassium, 1800mg Calcium, 500mg 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 PainDASH:

Started "sort of" DASHing 5/3/2011To: hyperaldosteronism Sent: Friday, September 2, 2011 12:49 AMSubject: Re: Re: BP going

up

works in the body by blocking aldo salt retaining effects. Also works in gut and sweat glands and saliva to so same.CE Grim MD Maybe a little but without about 7 years of med school or an interpreter, like Dr.Grim, I don't think I will arrive at an answer! I get as far as activating the RAS which as I understand works on Renin which we have little of so I'm not sure how that causes vasodilation which would theroetically lower blood pressure! Is it the lowered BP that you get when you finally get your NA depleated enough that allows the Spiro to work? It seems like I have hit a brick wall here so let me rephrase my question! Does Spirolactone work in the body

or the potty? If it is the body, how does it know how much NA is hitting the potty? I think I am back at my original question! Thanks. - 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. > > > > > > >Thanks ! My doc just called. He wants me to start the Amplodipine again > > > >and see if that helps. He feels he may have made too many changes at once. > > > >If my BP doesn't start going back down within a week he suggested increasing > > > >the Spiro. I'm being tested for Diabetes so the article you sent was > > > >interesting. I've never had high glucose until now and there is no history > > > >of it in my family so I'm eager to see what the outcome of the blood work > > > >is. Every doctor I've seen has confirmed PA. As for salt intake, I've > > > >always been very anti salt and I'm normally far

below the daily requirement. > > > >I had to retake the sodium loading test three times before I met the minimum > > > >required level even after taking the salt pills. Boy was that a horrible > > > >experience! I'm also a part time caterer and food is a bit of a passion. > > > >Very limited packaged or pre-cooked food in this house and never any salt on > > > >the table. Anything I have to buy pre-packaged or pre made is never more > > > >than 4% of your daily sodium. I just looked at the labs I had done in the > > > >hospital when this all started with heart palpitations and elevated BP in > > > >March (Before I ever knew what an adrenal gland did) and looked at my > > > >sodium. I was at the bottom of the range at 139 so I think that's not too > > > >bad?? > > > > > >

> > > >

September 2, 2011

The body's serum sodium is tightly regulated with a very thin margin of error. It tends to remain failry consistent until we get into more serious trouble. Even the labs for serum sodium have a little window for change. Our urinary sodium though, where the real control of it takes place and BP control essentially is happening, is a good indicator of how much sodium we are taking in - the serum (plasma) sodium is not because it's staying in a narrow control range - for now. The serum/blood sodium can change dramatically OVER TIME, the urinary sodium tells us what's happening NOW AND TODAY. Thus in our situation of Conn's it is very important.

Our major blood pressure control system is renal and urinary. The circulatory system has baroreceptors and our brain has tools to help us maintain pressure (our body has many many backup systems) but our fluid balance is renal and urinary.

So yes, our issue with Conns is occuring in the renal/urinary system. We have a flaw and overproduce aldosterone. Not an issue unless too much salt comes by - about 1400 as Dr G says seems to be the threshhold (and it's almost spot on in my case - 1400 and I am over and BP up).

But since we - meaning, as my oldest college age daughter says who's been raised in Oklahoma and Texas, "ALL'YALL" with PA release excess aldosterone, which in general tells the renal/urinary system to falsely retain sodium, but in our case we don't need it to, as the reason it is doing so is to raise blood pressure - or does do that anyway. Now, our electrolyte balance is messed up because we retained sodium we didnt need. And excess sodium sort of thickens the filtrate (not like cholesterol does exactly, but kind of like viscosity in motor oil) and this in turn leads the body to sense it needs to pump harder (not sure thats EXACT but sort of like that) and it decides it means it has to jack up blood pressure.

And remember the body is very very particular about the ph balance - very aggressive at keeping the serum level stable - that is maintaining us from being too acidic or too alkaline (base). BUT now, since this positive ion (Na+) of sodium is throwing off the balance in our body, it says it has to dump some other positive ions since it has way too many positive ones (which makes us acidic) and the balance is off. It will also put in some negative ions too to help the balance, like bicarbonate (HC3O-) but this isn't enough to get balanced again.

So since this positive sodium is messing the balance up, the body dumps our K+ first, and then Magnesium (Mg+), and it also tells the powers that be to NOT take in any more calcium either (Ca+). Thus we see low K and it's signs and symptoms (sodium and K are #1 and 2 in cellular function, one inside the cell, one outside and the switching places of the two of them wherein one goes in one goes out is kind of the "motor" or energy cell of our body as that action is where the power for function of everything in our body is- so one can see why when they aren't right we get cramps, low energy, etc) as the motor is broken.

Now ALL BECAUSE OF TOO MUCH SODIUM that's also now due to excess aldosterone and us getting over the sodium threshhold (remember the body dealt with the extra aldosterone and "ignored" it (simplicistic I know) until the sodium level jumped up, then it overrode everything and saw our pressure spike, we lost K, Mg, Ca and also have bicarbonate in the mix now leading to a metabolic alkalosis, which has some problems of it's own. But since those electrolytes got messed up we will pay in the form of fatigue, cramps, headaches, brain fog, peeing all day and/or night, and well.....we all know too well the sympoms.

All this, most of it i talked about, is occuring in the kidney, specifically in the nephron of the kidney, and happening NOW every second, so how our sodium is doing NOW is best observed in the urine and we will know better how much we took in. Serum/blood fought to hard to keep it balanced up in the circulatory system so it's not the best indicator.

Maybe a little but without about 7 years of med school or an interpreter, like Dr.Grim, I don't think I will arrive at an answer! I get as far as activating the RAS which as I understand works on Renin which we have little of so I'm not sure how that causes vasodilation which would theroetically lower blood pressure! Is it the lowered BP that you get when you finally get your NA depleated enough that allows the Spiro to work? It seems like I have hit a brick wall here so let me rephrase my question!Does Spirolactone work in the body or the potty? If it is the body, how does it know how much NA is hitting the potty? I think I am back at my original question! Thanks. - 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): 123/69Other 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. > > > > > > >Thanks ! My doc just called. He wants me to start the Amplodipine again> > > >and see if that

helps. He feels he may have made too many changes at once.> > > >If my BP doesn't start going back down within a week he suggested increasing> > > >the Spiro. I'm being tested for Diabetes so the article you sent was> > > >interesting. I've never had high glucose until now and there is no history> > > >of it in my family so I'm eager to see what the outcome of the blood work> > > >is. Every doctor I've seen has confirmed PA. As for salt intake, I've> > > >always been very anti salt and I'm normally far below the daily requirement.> > > >I had to retake the sodium loading test three times before I met the minimum> > > >required level even after taking the salt pills. Boy was that a horrible> > > >experience! I'm also a part time caterer and food is a bit of a passion.> > > >Very limited packaged

or pre-cooked food in this house and never any salt on> > > >the table. Anything I have to buy pre-packaged or pre made is never more> > > >than 4% of your daily sodium. I just looked at the labs I had done in the> > > >hospital when this all started with heart palpitations and elevated BP in> > > >March (Before I ever knew what an adrenal gland did) and looked at my> > > >sodium. I was at the bottom of the range at 139 so I think that's not too> > > >bad??> > > >> > >> >>

September 2, 2011

AND....in the RAS our aldosterone is again falsely too high (we dont need it to be is what I mean) and it is the aldosterone telling the body to retain more salt. Seems the body is cool with a little excess, but once the aldosterone senses the upper level sodium coming in it retains the extra salt, which raises BP and so on. If there is no aldosterone, thenno extra sodium is retained and no BP rise - that is, IF PA was the cause of our HTN (of course there could be other reasons for HTN).

So...........we block the aldosterone release with spironolactone. It is occuring in renal system, in the kidney's nephron, so it's kind of both body and urinary in essence, but by blocking the aldosterone we no longer have the salt issue per se, because it won't be retained and cause HTN. Sadly, there seems to be that threshhold of sodium though wherein we hit 1400 a day then it overrides the aldosterone blockade and decides to address this bigger sodium issue and senses it and retains it. Seems we can't totally "outspiro" the sodium completely. Just stay below the threshhold. Normal people can go way up on sodium, like say 5000 a day which is unhealthy, but the body deals with it and it's peed out. But add in abnormally high aldosterone in there, in which in Conn's is hanging out for no reason (well it is because of an adenoma or hyperplasia), and it will say "Hey, keep that sodium. Not sure why I want it,

but I guess I need it since I have all this aldosterone here" and the bypoduct is that HTN.

Dear God....I have messed that up somewhere but the urinary sodium is better.............

Maybe a little but without about 7 years of med school or an interpreter, like Dr.Grim, I don't think I will arrive at an answer! I get as far as activating the RAS which as I understand works on Renin which we have little of so I'm not sure how that causes vasodilation which would theroetically lower blood pressure! Is it the lowered BP that you get when you finally get your NA depleated enough that allows the Spiro to work? It seems like I have hit a brick wall here so let me rephrase my question!Does Spirolactone work in the body or the potty? If it is the body, how does it know how much NA is hitting the potty? I think I am back at my original question! Thanks. - 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): 123/69Other 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. > > > > > > >Thanks ! My doc just called. He wants me to start the Amplodipine again> > > >and see if that

helps. He feels he may have made too many changes at once.> > > >If my BP doesn't start going back down within a week he suggested increasing> > > >the Spiro. I'm being tested for Diabetes so the article you sent was> > > >interesting. I've never had high glucose until now and there is no history> > > >of it in my family so I'm eager to see what the outcome of the blood work> > > >is. Every doctor I've seen has confirmed PA. As for salt intake, I've> > > >always been very anti salt and I'm normally far below the daily requirement.> > > >I had to retake the sodium loading test three times before I met the minimum> > > >required level even after taking the salt pills. Boy was that a horrible> > > >experience! I'm also a part time caterer and food is a bit of a passion.> > > >Very limited packaged

or pre-cooked food in this house and never any salt on> > > >the table. Anything I have to buy pre-packaged or pre made is never more> > > >than 4% of your daily sodium. I just looked at the labs I had done in the> > > >hospital when this all started with heart palpitations and elevated BP in> > > >March (Before I ever knew what an adrenal gland did) and looked at my> > > >sodium. I was at the bottom of the range at 139 so I think that's not too> > > >bad??> > > >> > >> >>

September 2, 2011

It's the HTN and all of it's sequelae, not the sodium that is affecting the organs.

The sodium started the chain of events, but isn't the exact thing doing the damage. Higher pressure in organs enlarges our hearts, messes up the small arterioles in the organs like the kidneys, pushes through too much filtrate befire the kidneys are ready for it, etc. It's like having way too much power running through and electronic item - it might work for a while but then it will kill it early.

I once posted a question regarding urine vs blood NA and don't believe I ever got an answer: Logic tells me that blood NA would be an indicator of the NA circulating at that point-in-time within your body. Urine NA on the other hand would be the amount of NA being excreated from your body at that point-in-time. If that logic is correct then wouldn't it be blood NA that impacts whether and how effective Spironlactone will work? I can understand where Urine NA would tell you how compliant a PTN is with diet, assuming the salt excretion/retention system is working correctly (which I presume would be validated by the blood NA!)Where did I go wrong? - 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): 123/69Other 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. > > >Thanks ! My doc just called. He wants me to start the Amplodipine again> >and see if that helps. He feels he may have made too many changes at once.> >If my BP doesn't start going back down within a week he suggested increasing> >the Spiro. I'm being tested for

Diabetes so the article you sent was> >interesting. I've never had high glucose until now and there is no history> >of it in my family so I'm eager to see what the outcome of the blood work> >is. Every doctor I've seen has confirmed PA. As for salt intake, I've> >always been very anti salt and I'm normally far below the daily requirement.> >I had to retake the sodium loading test three times before I met the minimum> >required level even after taking the salt pills. Boy was that a horrible> >experience! I'm also a part time caterer and food is a bit of a passion.> >Very limited packaged or pre-cooked food in this house and never any salt on> >the table. Anything I have to buy pre-packaged or pre made is never more> >than 4% of your daily sodium. I just looked at the labs I had done in the> >hospital when this all started with heart palpitations

and elevated BP in> >March (Before I ever knew what an adrenal gland did) and looked at my> >sodium. I was at the bottom of the range at 139 so I think that's not too> >bad??> >>

September 2, 2011

Probably not that lucky

Subject: Re: BP going upTo: hyperaldosteronism Date: Thursday, September 1, 2011, 9:17 PM

I took HCTZ for about a month before I landed in the ER and hospital about 5 times with severe hypokalemia! I couldn't move my arms and legs - much less walk, talk, or function. I don't seem to have primary Conn's but still......If you have a doctor who is prescribing this medication to you (which is VERY WELL KNOWN to cause hypokalemia in ALL patients) you need to question him/her carefully about their knowledge of Conn's......

Dr. Grim, , and Bill - please correct me if I am wrong!

Also, I seem to be one of the few in the group who is on strictly alpha blockers?? Is this anyone else out there? They work great for me along with the potassium supplements, dashing, and Spironolactone. I realize we are all different but the trends of the low potassiums seem to all be the same.

Why don't more of us get more potassium supplements? (I am lucky I talked my PCP into it by going up and down and ending up in the ER and showing her the results and she got it) but.... I still question this at length. I have to admit - I had spaghetti for dinner tonight (easy and quick) and I am now tingling in the face and arms and my hand and foot starting cramping - so I am going to take 10 more meq of K - I DO realize the SIDE EFFECT of too much potassium is DEATH however, when was the last time any of us had a high potassium?

For me, it was when I was on 40 meq per day.

Okay, enough from the Maine peanut gallery tonight. I am fighting the Lyme with a vengeance thanks to a friend on here named Val - thanks Val - and to the Naturopath I found in Wolfeboro NH who is quite well versed in Lyme - Dr. Steve , Wolfeboro NH.

God Bless all and have a Happy Labor Day!

M

p.s. I was proud my pressure was 116/74 this am - pulse still 84 though

September 2, 2011

Great explanation and kinda tells me then, unless your BP is elevated, the sodium/aldo isnt damaging the heart/veins, etc. It hasnt make it past the kidney at that point, right? ============================================================================45-Male-Caucasian, 5'9"- 242lbs, PA Diagnosed 2007 Suspected Hyperplasia-No tumors on CT - No AVS.Meds: 100mg Spiro, 40meq Potassium, 1800mg Calcium, 500mg 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 PainDASH: Started "sort of" DASHing 5/3/2011To: hyperaldosteronism Sent: Friday, September 2, 2011 8:49

AMSubject: Re: Re: BP going up