Re: Treating PA DASH and MCB Dr. Grim approach.

[Guest guest]

YOU MEAN YOU HAVE CHF NOW? I think not. i mean CHF when I first see the pt to get Rx started is what I mean. One wants to move faster if CHF present.When HTN/excess aldo/excess salt is the cause of the CHF (as in PA) the treatment is lowering the BP.One basic rule of treating heart disease. if you know the cause treat the cause, not the Sx. Esp in CHF. Treating the cause will stop the CHF usually.CE Grim MD Dr. Grim, why is there an exception to ppl with hx of cva, mi or CHF? I have CHF. Thanks. Phyllis Comments Corrections appreciated. The Grim approach to controlling PA. Goal Home BP less than 135/85 using a calibrated device correctly and our method of home BP taking. 1. Start DASH (14 day trial in book) and check urine after 2 weeks. Take BP daily and be prepared for a large fall if on other BP meds. Tell your team you are DASHING if the do not know it. Some may want to double the time between the recommendations below. 1 week: If BP better continue. If BP not better and urine not better work on DASH for another 2 weeks. 2 weeks; If urine at goal but BP not then start spiro--depending on BP. So if over 200 I would start at 100-200 mg a day, If over 180 75 and if over 160 50 and increase by doubling dose every 2 weeks. Assuming no Hx of CHF, renal disease, stroke, angina or Hx MI. If so I would increase every week till home BP less that 135/85 average. Also weigh your self daily. Should drop about 4 lbs when you have gotten enough DASH or MCB. Also nite peeing with decrease. If you are having no K symptoms no reason to check K after first 2 weeks. CE Grim MD How do they finally determine what the adequate dosage is to manage my PA? Is it simply doing a bp reading or will there be another blood test, or a pee test? And, in two weeks or so if nothing is regulated do they just keep adding a higher dose; wait a week or two and repeat the process? I began Spiro 2 weeks ago on a very lose dose, 12.5 mg. But last week my bp numbers were crazy high, the highest I have ever seen my bp. I returned that day to the doctors and they immediately put me up to 50 mg Spiro. In two days it will be a week on the 50 mg dose. A few days after they increased the Spiro they have since added back another bp med to try and get everything to calm down while giving Spiro a chance to get going. I go in tomorrow to the nephorologist for another check and perhaps more tweaking. How will I know 50 mg is enough? And, if it isn't what do I expect to be the next step? I would really like to be on one drug, not the cocktail they used to keep me on~~4 drugs at age 30~~13 years ago! So, spiro suppresses aldosterone. But, am I correct in understanding that it is getting the renin working again that brings the bp numbers down? If so, what gets renin back to normal working order, too? Just suppressing Aldosterone? How does the tricky balance of aldo to renin get back again to normal? Also, do I ask every time I'm in the doctors office for a k test too? Thanks for reading and any feedback is always appreciated! -

[Guest guest]

Oh I see I did have CHF when I first started treatment. EF was 22. It is now 50Sent from my Verizon Wireless BlackBerrySender: hyperaldosteronism Date: Thu, 20 Oct 2011 01:03:16 -0700To: <hyperaldosteronism >ReplyTo: hyperaldosteronism Subject: Re: Treating PA DASH and MCB Dr. Grim approach. YOU MEAN YOU HAVE CHF NOW? I think not. i mean CHF when I first see the pt to get Rx started is what I mean. One wants to move faster if CHF present.When HTN/excess aldo/excess salt is the cause of the CHF (as in PA) the treatment is lowering the BP.One basic rule of treating heart disease. if you know the cause treat the cause, not the Sx. Esp in CHF. Treating the cause will stop the CHF usually.CE Grim MD Dr. Grim, why is there an exception to ppl with hx of cva, mi or CHF? I have CHF. Thanks. Phyllis Comments Corrections appreciated. The Grim approach to controlling PA. Goal Home BP less than 135/85 using a calibrated device correctly and our method of home BP taking. 1. Start DASH (14 day trial in book) and check urine after 2 weeks. Take BP daily and be prepared for a large fall if on other BP meds. Tell your team you are DASHING if the do not know it. Some may want to double the time between the recommendations below. 1 week: If BP better continue. If BP not better and urine not better work on DASH for another 2 weeks. 2weeks; If urine at goal but BP not then start spiro--depending on BP. So if over 200 I would start at 100-200 mg a day, If over 180 75 and if over 160 50 and increase by doubling dose every 2 weeks. Assuming no Hx of CHF, renal disease, stroke, angina or Hx MI. If so I would increase every week till home BP less that 135/85 average. Also weigh your self daily. Should drop about 4 lbs when you have gotten enough DASH or MCB. Also nite peeing with decrease. If you are having no K symptoms no reason to check K after first 2 weeks. CE Grim MD How do they finally determine what the adequate dosage is to manage my PA? Is it simply doing a bp reading or will there be another blood test, or a pee test? And, in two weeks or so if nothing is regulated do they just keep adding a higher dose; wait a week or two and repeat the process? I began Spiro 2 weeks ago on a very lose dose, 12.5 mg. But last week my bp numbers were crazy high, the highest I have ever seen my bp. I returned that day to the doctors and they immediately put me up to 50 mg Spiro. In two days it will be a week on the 50 mg dose. A few days after they increased the Spiro they have since added back another bp med to try and get everything to calm down while giving Spiro a chance to get going. I go in tomorrow to the nephorologist for another check and perhaps more tweaking. How will I know 50 mg is enough? And, if it isn't what do I expect to be the next step? Iwould really like to be on one drug, not the cocktail they used to keep me on~~4 drugs at age 30~~13 years ago! So, spiro suppresses aldosterone. But, am I correct in understanding that it is getting the renin working again that brings the bp numbers down? If so, what gets renin back to normal working order, too? Just suppressing Aldosterone? How does the tricky balance of aldo to renin get back again to normal? Also, do I ask every time I'm in the doctors office for a k test too? Thanks for reading and any feedback is alwaysappreciated! -

[Guest guest]

My PPC referred me when he saw that I had an old infarct in my recent EKG. He wanted stress test, I declined.Natalia To: "hyperaldosteronism " <hyperaldosteronism >Sent: Saturday, October 22, 2011 11:44 PMSubject: Re: Re:

Treating PA DASH and MCB Dr. Grim approach.

Not sure why you need an echo? Well to many cards the indication for ANC e echo is a heart. Drhumor Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Oh, , many thanks. I will schedule echo on Monday, and this site is extremely helpful for me.Natalia To: hyperaldosteronism Sent: Saturday, October 22, 2011 5:53 PMSubject: Re: Treating PA DASH and MCB Dr. Grim approach.

Natalia, try this site for all you wanted to know about EF and your heart: http://www.chfpatients.com/faq/ef.htm

- 65 yo super ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank pain. Treating with Meds. And DASH. . Current BP(last week ave): 131/76 HR 60

Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD.

Meds: Duloxetine hcl 80 MG, Mirtazapine 7.5 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

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> > >>>>How do they finally determine what the adequate dosage is to manage my PA? Is it simply doing a bp reading or will there be another blood test, or a pee test? And, in two weeks or so if nothing is regulated do they just keep adding a higher dose; wait a week or two and repeat the process?

> > >>>>

> > >>>>I began Spiro 2 weeks ago on a very lose dose, 12.5 mg. But last week my bp numbers were crazy high, the highest I have ever seen my bp. I returned that day to the doctors and they immediately put me up to 50 mg Spiro. In two days it will be a week on the 50 mg dose. A few days after they increased the Spiro they have since added back another bp med to try and get everything to calm down while giving Spiro a chance to get going. I go in tomorrow to the nephorologist for another check and perhaps more tweaking.

> > >>>>

> > >>>>How will I know 50 mg is enough? And, if it isn't what do I expect to be the next step? I would really like to be on one drug, not the cocktail they used to keep me on~~4 drugs at age 30~~13 years ago!

> > >>>>

> > >>>>So, spiro suppresses aldosterone. But, am I correct in understanding that it is getting the renin working again that brings the bp numbers down? If so, what gets renin back to normal working order, too? Just suppressing Aldosterone? How does the tricky balance of aldo to renin get back again to normal?

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> > >>>>Also, do I ask every time I'm in the doctors office for a k test too?

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> > >>>>Thanks for reading and any feedback is always appreciated!

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