Re: Francis - New PCP

October 25, 2011

2 labs would have made him tunnel visioned. 12 labs made him more thorough

Subject: Re: Francis - New PCPTo: hyperaldosteronism Date: Tuesday, October 25, 2011, 2:08 PM

I figured he must be a "Quack" since I had 12 different labs done at that visit! Why would anyone need that many for a simple DX? What is aldosterone and urine NA and K good for in that situation!A while back I said I wasn't sure about him but decided maybe he did know what he was doing when I saw what he was checking. - 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 60Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD.Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG. > > >> > > > Are you getting a real doctor this time or another resident?> > > >> > > > I was at the VA today and found out the new Neprologist was as I > > hoped, Dr. Luiz Kolankiewicz. He was the one I saw back in December > > and seemed to know about PA. I thought asked the right questions. > > You might suggest a referral if appropriate!> > > >> > > > I also heard Dr. , Chief - Pulmonary Section, passed away > > from a massive heart attack! 46 y/o, great shape and exersized every > > day! I told Dr. Webster that was it, I was going to

remain fat, dumb > > and happy!> > > >> > > > - 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, Metoprolol Tartrate 200 MG, 81mg > > asprin, Metformin 2000MG and Spironolactone 50 MG.> > > >> > > >> > >> >> >>

October 25, 2011

A basic metabolic panel has 6 analytes. So don't know how you are counting?CE Grim MD I figured he must be a "Quack" since I had 12 different labs done at that visit! Why would anyone need that many for a simple DX? What is aldosterone and urine NA and K good for in that situation! A while back I said I wasn't sure about him but decided maybe he did know what he was doing when I saw what he was checking. - 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, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG. > > > > > > > Are you getting a real doctor this time or another resident? > > > > > > > > I was at the VA today and found out the new Neprologist was as I > > hoped, Dr. Luiz Kolankiewicz. He was the one I saw back in December > > and seemed to know about PA. I thought asked the right questions. > > You might suggest a referral if appropriate! > > > > > > > > I also heard Dr. , Chief - Pulmonary Section, passed away > > from a massive heart attack! 46 y/o, great shape and exersized every > > day! I told Dr. Webster that was it, I was going to remain fat, dumb > > and happy! > > > > > > > > - 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, Metoprolol Tartrate 200 MG, 81mg > > asprin, Metformin 2000MG and Spironolactone 50 MG. > > > > > > > > > > > > > > > >

October 25, 2011

Depends on the lab IMHO and the situation.CE Grim MD 2 labs would have made him tunnel visioned. 12 labs made him more thorough Subject: Re: Francis - New PCPTo: hyperaldosteronism Date: Tuesday, October 25, 2011, 2:08 PM I figured he must be a "Quack" since I had 12 different labs done at that visit! Why would anyone need that many for a simple DX? What is aldosterone and urine NA and K good for in that situation!A while back I said I wasn't sure about him but decided maybe he did know what he was doing when I saw what he was checking. - 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 60Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD.Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG. > > >> > > > Are you getting a real doctor this time or another resident?> > > >> > > > I was at the VA today and found out the new Neprologist was as I > > hoped, Dr. Luiz Kolankiewicz. He was the one I saw back in December > > and seemed to know about PA. I thought asked the right questions. > > You might suggest a referral if appropriate!> > > >> > > > I also heard Dr. , Chief - Pulmonary Section, passed away > > from a massive heart attack! 46 y/o, great shape and exersized every > > day! I told Dr. Webster that was it, I was going to remain fat, dumb > > and happy!> > > >> > > > - 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, Metoprolol Tartrate 200 MG, 81mg > > asprin, Metformin 2000MG and Spironolactone 50 MG.> > > >> > > >> > >> >> >>

October 27, 2011

In reviewing my lab records in the VA Chemistry/Hematology Personal Health

Record of JOHN M. CLARK on 12/29/2010 and found 12 entries (I know because I had

to take my shoe off and use one toe!) Here is what was reported, maybe you can

point out the duplicates!

Here is what Dr. KOLANKIEWICZ saw:

ALANINE AMINOTRANSFERASE 31 U/L 7-52 Details

ALKALINE PHOSPHATASE 59 U/L 40-150 Details

ASPARTATE AMINOTRANSFERASE 20 U/L 5-40 BILIRUBIN 0.5 mg/dL 0.2-1.2 Details

CALCIUM 9.7 mg/dL 8.5-10.5 Details

CARBON DIOXIDE 24 mmol/L 20-30 Details

CHLORIDE 102 mmol/L 100-110 Details

CREATININE 1.04 mg/dl 0.5-1.5 Details

GAMMA GLUTAMYL TRANSFERASE 53 U/L 10-65 GLOMERULAR FILTRATION RATE.PREDICTED

72 mL/min >60 GLUCOSE 130 High mg/dL 65-100 Details

MAGNESIUM 2.5 High mg/dL 1.8-2.4 Details

PHOSPHATE 3.6 mg/dL 2.5-5.0 Details

POTASSIUM 5.0 mmol/L 3.5-5.0 Details

SODIUM 135 mmol/L 135-145 Details

UREA NITROGEN 26 High mg/dL 7-25 Details

BASOPHILS/100 LEUKOCYTES 0.7 % 0-2.0 Details

EOSINOPHILS/100 LEUKOCYTES 1.7 % 0-7.0

ERYTHROCYTE DISTRIBUTION WIDTH 13.7 % 11.5-14.5 ERYTHROCYTE MEAN CORPUSCULAR

HEMOGLOBIN 30.0 27-34 ERYTHROCYTE MEAN CORPUSCULAR HEMOGLOBIN CONCENTRATION

33.7 g/dl 32-37 Details

ERYTHROCYTES 4.76 M/cmm 4.7-6.1 Details

GRANULOCYTES/100 LEUKOCYTES 59.1 % 40-75

HEMATOCRIT 42.3 % 40-52 Details

HEMOGLOBIN 14.3 g/dl 14-18 Details

LEUKOCYTES 6.6 K/cmm 4.5-11.0 Details

LYMPHOCYTES/100 LEUKOCYTES 27.0 % 10-55

MEAN CORPUSCULAR VOLUME 88.8 fl 80-98 Details

MONOCYTES/100 LEUKOCYTES 11.5 % 2-12 Details

PLATELET MEAN VOLUME 7.6 fl 7.4-10.4 Details

PLATELETS 245 K/cmm 130-450 Details

CREATININE 27.15 mg/dL Details

PROTEIN <2.6 mg/dL Details

APPEARANCE CLEAR Clear Details

BILIRUBIN NEG NEG Details

COLOR Light-Yellow YELLOW Details

GLUCOSE NEG mg/dL NEG Details

HEMOGLOBIN NEG NEG Details

KETONES NEG mg/dL NEG Details

LEUKOCYTES NEG NEG Details

NITRITE NEG NEG Details

PH 5.0 5-9 Details

PROTEIN NEG mg/dL NEG Details

SPECIFIC GRAVITY 1.005 Low 1.016-1.022 UROBILINOGEN <2.0 mg/dL ><2.0 Details

CHLORIDE (URINE,RANDOM) 140 Details

POTASSIUM (URINE,RANDOM) 40.6 Details

SODIUM 104 mmol/l Details

CORTICOTROPIN 10 pg/mL Details

CORTISOL~MORNING 7.29 ug/dL 6-28 Details

OSMOLALITY 298 High mOsm/Kg 280-295 Details

OSMOLALITY 369 mOsm/kg 50-1400 Details

METANEPHRINES <25 pg/mL 0-57 Details

METANEPHRINES 117 pg/mL 0-205 Details

NORMETANEPHRINE 117 pg/mL 0-148 Details

Test Name Result Units Reference Range Test Amended ALDOSTERONE comment

mcg/24hr 2.3-21.0 Details

Test Name: ALDOSTERONE

Result: comment

Units: mcg/24hr

Reference Range: 2.3-21.0

Lab Test: Aldosterone

Ordering Provider: KOLANKIEWICZ, LUIZ

Ordering Location: WHITE RIVER JCT VAMROC

Performing Location: QUEST 14225 NEWBROOK DRIVE , CHANTILLY, VA 20153

Status: Amended

Interpretation: Reference Ranges: Random Sodium diet

Age_________mcg/24 h

_2-_7 years______5.7 or less

_8-11 years_____10.2 or less

12-16 years_____15.6 or less

_Adults_____2.3-21.0

Post Florinef or IV saline suppression____5 mcg/24 h

or less

Creatinine, 24-Hour Urine

Age (yrs)__g/24 hours

___<3_____Not

established

_3-_8______0.11-0.68

_9-12______0.17-1.41

13-17______0.29-1.87

_Adults____0.63-2.50

Reference Range prior to 11/22/2005 was: 6-25 ug/24 hrs

This 24 hr urine range applies to patients on normal salt diet. Low salt

diet: 17-44 ug/24hr. High salt diet: 0-6 ug/24hr

Comments: ALDOSTERONE, SERUM= 12 ng/dL

REFERENCE RANGE (SERUM): Upright 8:00-10:00am < or = 28ng/dL

Upright 4:00-6:00pm < or = 21ng/dL

Supine 8:00-10:00am 3-16ng/dL

TV=2400 (24 HR URINE COLLECTION)

ALDOSTERONE,URINE: 12.7 mcg/24h

Test performed at Quest Diag. Lab.

CREATININE 1734.48c mg/24hrs 600-2000 Details SPECIMEN VOLUME 2400 ml. Details

What did he miss?

- 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, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin

2000MG and Spironolactone 50 MG.

> > > > >

> > > > > > Are you getting a real doctor this time or another resident?

> > > > > >

> > > > > > I was at the VA today and found out the new Neprologist was

> > as I

> > > > hoped, Dr. Luiz Kolankiewicz. He was the one I saw back in

> > December

> > > > and seemed to know about PA. I thought asked the right questions.

> > > > You might suggest a referral if appropriate!

> > > > > >

> > > > > > I also heard Dr. , Chief - Pulmonary Section, passed away

> > > > from a massive heart attack! 46 y/o, great shape and exersized

> > every

> > > > day! I told Dr. Webster that was it, I was going to remain fat,

> > dumb

> > > > and happy!

> > > > > >

> > > > > > - 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, Metoprolol Tartrate 200 MG, 81mg

> > > > asprin, Metformin 2000MG and Spironolactone 50 MG.

> > > > > >

> > > > >

> > > >

> > >

> >

>

October 27, 2011

Don't see a renin but every thing else looks good. If you are trying to DASH can see you are getting too much salt and need more K. Goal is to have the K in urine higher than Na May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

In reviewing my lab records in the VA Chemistry/Hematology Personal Health Record of JOHN M. CLARK on 12/29/2010 and found 12 entries (I know because I had to take my shoe off and use one toe!) Here is what was reported, maybe you can point out the duplicates!

Here is what Dr. KOLANKIEWICZ saw:

ALANINE AMINOTRANSFERASE 31 U/L 7-52 Details

ALKALINE PHOSPHATASE 59 U/L 40-150 Details

ASPARTATE AMINOTRANSFERASE 20 U/L 5-40 BILIRUBIN 0.5 mg/dL 0.2-1.2 Details

CALCIUM 9.7 mg/dL 8.5-10.5 Details

CARBON DIOXIDE 24 mmol/L 20-30 Details

CHLORIDE 102 mmol/L 100-110 Details

CREATININE 1.04 mg/dl 0.5-1.5 Details

GAMMA GLUTAMYL TRANSFERASE 53 U/L 10-65 GLOMERULAR FILTRATION RATE.PREDICTED 72 mL/min >60 GLUCOSE 130 High mg/dL 65-100 Details

MAGNESIUM 2.5 High mg/dL 1.8-2.4 Details

PHOSPHATE 3.6 mg/dL 2.5-5.0 Details

POTASSIUM 5.0 mmol/L 3.5-5.0 Details

SODIUM 135 mmol/L 135-145 Details

UREA NITROGEN 26 High mg/dL 7-25 Details

BASOPHILS/100 LEUKOCYTES 0.7 % 0-2.0 Details

EOSINOPHILS/100 LEUKOCYTES 1.7 % 0-7.0

ERYTHROCYTE DISTRIBUTION WIDTH 13.7 % 11.5-14.5 ERYTHROCYTE MEAN CORPUSCULAR HEMOGLOBIN 30.0 27-34 ERYTHROCYTE MEAN CORPUSCULAR HEMOGLOBIN CONCENTRATION 33.7 g/dl 32-37 Details

ERYTHROCYTES 4.76 M/cmm 4.7-6.1 Details

GRANULOCYTES/100 LEUKOCYTES 59.1 % 40-75

HEMATOCRIT 42.3 % 40-52 Details

HEMOGLOBIN 14.3 g/dl 14-18 Details

LEUKOCYTES 6.6 K/cmm 4.5-11.0 Details

LYMPHOCYTES/100 LEUKOCYTES 27.0 % 10-55

MEAN CORPUSCULAR VOLUME 88.8 fl 80-98 Details

MONOCYTES/100 LEUKOCYTES 11.5 % 2-12 Details

PLATELET MEAN VOLUME 7.6 fl 7.4-10.4 Details

PLATELETS 245 K/cmm 130-450 Details

CREATININE 27.15 mg/dL Details

PROTEIN <2.6 mg/dL Details

APPEARANCE CLEAR Clear Details

BILIRUBIN NEG NEG Details

COLOR Light-Yellow YELLOW Details

GLUCOSE NEG mg/dL NEG Details

HEMOGLOBIN NEG NEG Details

KETONES NEG mg/dL NEG Details

LEUKOCYTES NEG NEG Details

NITRITE NEG NEG Details

PH 5.0 5-9 Details

PROTEIN NEG mg/dL NEG Details

SPECIFIC GRAVITY 1.005 Low 1.016-1.022 UROBILINOGEN <2.0 mg/dL ><2.0 Details

CHLORIDE (URINE,RANDOM) 140 Details

POTASSIUM (URINE,RANDOM) 40.6 Details

SODIUM 104 mmol/l Details

CORTICOTROPIN 10 pg/mL Details

CORTISOL~MORNING 7.29 ug/dL 6-28 Details

OSMOLALITY 298 High mOsm/Kg 280-295 Details

OSMOLALITY 369 mOsm/kg 50-1400 Details

METANEPHRINES <25 pg/mL 0-57 Details

METANEPHRINES 117 pg/mL 0-205 Details

NORMETANEPHRINE 117 pg/mL 0-148 Details

Test Name Result Units Reference Range Test Amended ALDOSTERONE comment mcg/24hr 2.3-21.0 Details

Test Name: ALDOSTERONE

Result: comment

Units: mcg/24hr

Reference Range: 2.3-21.0

Lab Test: Aldosterone

Ordering Provider: KOLANKIEWICZ, LUIZ

Ordering Location: WHITE RIVER JCT VAMROC

Performing Location: QUEST 14225 NEWBROOK DRIVE , CHANTILLY, VA 20153

Status: Amended

Interpretation: Reference Ranges: Random Sodium diet

Age_________mcg/24 h

_2-_7 years______5.7 or less

_8-11 years_____10.2 or less

12-16 years_____15.6 or less

_Adults_____2.3-21.0

Post Florinef or IV saline suppression____5 mcg/24 h

or less

Creatinine, 24-Hour Urine

Age (yrs)__g/24 hours

___<3_____Not

established

_3-_8______0.11-0.68

_9-12______0.17-1.41

13-17______0.29-1.87

_Adults____0.63-2.50

Reference Range prior to 11/22/2005 was: 6-25 ug/24 hrs

This 24 hr urine range applies to patients on normal salt diet. Low salt

diet: 17-44 ug/24hr. High salt diet: 0-6 ug/24hr

Comments: ALDOSTERONE, SERUM= 12 ng/dL

REFERENCE RANGE (SERUM): Upright 8:00-10:00am < or = 28ng/dL

Upright 4:00-6:00pm < or = 21ng/dL

Supine 8:00-10:00am 3-16ng/dL

TV=2400 (24 HR URINE COLLECTION)

ALDOSTERONE,URINE: 12.7 mcg/24h

Test performed at Quest Diag. Lab.

CREATININE 1734.48c mg/24hrs 600-2000 Details SPECIMEN VOLUME 2400 ml. Details

What did he miss?

- 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, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

> > > > >

> > > > > > Are you getting a real doctor this time or another resident?

> > > > > >

> > > > > > I was at the VA today and found out the new Neprologist was

> > as I

> > > > hoped, Dr. Luiz Kolankiewicz. He was the one I saw back in

> > December

> > > > and seemed to know about PA. I thought asked the right questions.

> > > > You might suggest a referral if appropriate!

> > > > > >

> > > > > > I also heard Dr. , Chief - Pulmonary Section, passed away

> > > > from a massive heart attack! 46 y/o, great shape and exersized

> > every

> > > > day! I told Dr. Webster that was it, I was going to remain fat,

> > dumb

> > > > and happy!

> > > > > >

> > > > > > - 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, Metoprolol Tartrate 200 MG, 81mg

> > > > asprin, Metformin 2000MG and Spironolactone 50 MG.

> > > > > >

> > > > >

> > > >

> > >

> >

>

October 27, 2011

I didn't know we were doing a history check on my labs, I thought we were

checking to see if Dr. K might know what he is doing and proving that I can

count to 12! I'm glad to know that my numbers show I wasn't DASHing too well

since these labs were ~7months prior to starting!

He probably didn't redo renin after seeing this lab which was on file:

VA Chemistry/Hematology

Personal Health Record of JOHN M. CLARK

Information last updated in My HealtheVet on 10/27/2011 at 11:20.

User Guide | Help | Printer Friendly

Plasma Specimen

Collected on 08 Jul 2010 @ 1442 at WHITE RIVER JCT VAMROC

Test results slightly outside the reference range are not unusual. Your provider

has reviewed your test results and will contact you for any important issues. If

you have further questions, please do not hesitate to contact your primary care

provider. If you have an amended test and you want to see the history, go to the

Comments on the Details page.

Test Name Result Units Reference Range Test Details

RENIN 0.51 Low ng/mL/hr 0.65-5.0 Details

I believe he was confirming PA and making sure there were no other issues.

- 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, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin

2000MG and Spironolactone 50 MG.

> > > > > > >

> > > > > > > > Are you getting a real doctor this time or another resident?

> > > > > > > >

> > > > > > > > I was at the VA today and found out the new Neprologist was

> > > > as I

> > > > > > hoped, Dr. Luiz Kolankiewicz. He was the one I saw back in

> > > > December

> > > > > > and seemed to know about PA. I thought asked the right questions.

> > > > > > You might suggest a referral if appropriate!

> > > > > > > >

> > > > > > > > I also heard Dr. , Chief - Pulmonary Section, passed away

> > > > > > from a massive heart attack! 46 y/o, great shape and exersized

> > > > every

> > > > > > day! I told Dr. Webster that was it, I was going to remain fat,

> > > > dumb

> > > > > > and happy!

> > > > > > > >

> > > > > > > > - 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, Metoprolol Tartrate 200 MG, 81mg

> > > > > > asprin, Metformin 2000MG and Spironolactone 50 MG.

> > > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

October 27, 2011

Ah I was thinking these were new tests sorry. He did not miss anything. What was your previous Aldo?Good reason to have these in a spread sheet over time. May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

I didn't know we were doing a history check on my labs, I thought we were checking to see if Dr. K might know what he is doing and proving that I can count to 12! I'm glad to know that my numbers show I wasn't DASHing too well since these labs were ~7months prior to starting!

He probably didn't redo renin after seeing this lab which was on file:

VA Chemistry/Hematology

Personal Health Record of JOHN M. CLARK

Information last updated in My HealtheVet on 10/27/2011 at 11:20.

User Guide | Help | Printer Friendly

Plasma Specimen

Collected on 08 Jul 2010 @ 1442 at WHITE RIVER JCT VAMROC

Test results slightly outside the reference range are not unusual. Your provider has reviewed your test results and will contact you for any important issues. If you have further questions, please do not hesitate to contact your primary care provider. If you have an amended test and you want to see the history, go to the Comments on the Details page.

Test Name Result Units Reference Range Test Details

RENIN 0.51 Low ng/mL/hr 0.65-5.0 Details

I believe he was confirming PA and making sure there were no other issues.

- 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, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

> > > > > > >

> > > > > > > > Are you getting a real doctor this time or another resident?

> > > > > > > >

> > > > > > > > I was at the VA today and found out the new Neprologist was

> > > > as I

> > > > > > hoped, Dr. Luiz Kolankiewicz. He was the one I saw back in

> > > > December

> > > > > > and seemed to know about PA. I thought asked the right questions.

> > > > > > You might suggest a referral if appropriate!

> > > > > > > >

> > > > > > > > I also heard Dr. , Chief - Pulmonary Section, passed away

> > > > > > from a massive heart attack! 46 y/o, great shape and exersized

> > > > every

> > > > > > day! I told Dr. Webster that was it, I was going to remain fat,

> > > > dumb

> > > > > > and happy!

> > > > > > > >

> > > > > > > > - 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, Metoprolol Tartrate 200 MG, 81mg

> > > > > > asprin, Metformin 2000MG and Spironolactone 50 MG.

> > > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

October 27, 2011

If you don't mind my asking, are your levels indicative of someone with PA? I am trying to decipher my most recent blood work. Thanks!27 y/o , 115 lb at 5'6, female with 4+ year history of hypertension (Avg 135/95). Recently taken off of all bp meds because of resistance to them. Currently awaiting a second Nephrology appointment and up-to-date blood work. Last Aldosterone Level was 88. No known underlying illnesses other than systemic hypertension. To: hyperaldosteronism Sent: Thursday, October 27, 2011 11:49 AMSubject: Re: Francis - New PCP

In reviewing my lab records in the VA Chemistry/Hematology Personal Health Record of JOHN M. CLARK on 12/29/2010 and found 12 entries (I know because I had to take my shoe off and use one toe!) Here is what was reported, maybe you can point out the duplicates!

Here is what Dr. KOLANKIEWICZ saw:

ALANINE AMINOTRANSFERASE 31 U/L 7-52 Details

ALKALINE PHOSPHATASE 59 U/L 40-150 Details

ASPARTATE AMINOTRANSFERASE 20 U/L 5-40 BILIRUBIN 0.5 mg/dL 0.2-1.2 Details

CALCIUM 9.7 mg/dL 8.5-10.5 Details

CARBON DIOXIDE 24 mmol/L 20-30 Details

CHLORIDE 102 mmol/L 100-110 Details

CREATININE 1.04 mg/dl 0.5-1.5 Details

GAMMA GLUTAMYL TRANSFERASE 53 U/L 10-65 GLOMERULAR FILTRATION RATE.PREDICTED 72 mL/min >60 GLUCOSE 130 High mg/dL 65-100 Details

MAGNESIUM 2.5 High mg/dL 1.8-2.4 Details

PHOSPHATE 3.6 mg/dL 2.5-5.0 Details

POTASSIUM 5.0 mmol/L 3.5-5.0 Details

SODIUM 135 mmol/L 135-145 Details

UREA NITROGEN 26 High mg/dL 7-25 Details

BASOPHILS/100 LEUKOCYTES 0.7 % 0-2.0 Details

EOSINOPHILS/100 LEUKOCYTES 1.7 % 0-7.0

ERYTHROCYTE DISTRIBUTION WIDTH 13.7 % 11.5-14.5 ERYTHROCYTE MEAN CORPUSCULAR HEMOGLOBIN 30.0 27-34 ERYTHROCYTE MEAN CORPUSCULAR HEMOGLOBIN CONCENTRATION 33.7 g/dl 32-37 Details

ERYTHROCYTES 4.76 M/cmm 4.7-6.1 Details

GRANULOCYTES/100 LEUKOCYTES 59.1 % 40-75

HEMATOCRIT 42.3 % 40-52 Details

HEMOGLOBIN 14.3 g/dl 14-18 Details

LEUKOCYTES 6.6 K/cmm 4.5-11.0 Details

LYMPHOCYTES/100 LEUKOCYTES 27.0 % 10-55

MEAN CORPUSCULAR VOLUME 88.8 fl 80-98 Details

MONOCYTES/100 LEUKOCYTES 11.5 % 2-12 Details

PLATELET MEAN VOLUME 7.6 fl 7.4-10.4 Details

PLATELETS 245 K/cmm 130-450 Details

CREATININE 27.15 mg/dL Details

PROTEIN <2.6 mg/dL Details

APPEARANCE CLEAR Clear Details

BILIRUBIN NEG NEG Details

COLOR Light-Yellow YELLOW Details

GLUCOSE NEG mg/dL NEG Details

HEMOGLOBIN NEG NEG Details

KETONES NEG mg/dL NEG Details

LEUKOCYTES NEG NEG Details

NITRITE NEG NEG Details

PH 5.0 5-9 Details

PROTEIN NEG mg/dL NEG Details

SPECIFIC GRAVITY 1.005 Low 1.016-1.022 UROBILINOGEN <2.0 mg/dL ><2.0 Details

CHLORIDE (URINE,RANDOM) 140 Details

POTASSIUM (URINE,RANDOM) 40.6 Details

SODIUM 104 mmol/l Details

CORTICOTROPIN 10 pg/mL Details

CORTISOL~MORNING 7.29 ug/dL 6-28 Details

OSMOLALITY 298 High mOsm/Kg 280-295 Details

OSMOLALITY 369 mOsm/kg 50-1400 Details

METANEPHRINES <25 pg/mL 0-57 Details

METANEPHRINES 117 pg/mL 0-205 Details

NORMETANEPHRINE 117 pg/mL 0-148 Details

Test Name Result Units Reference Range Test Amended ALDOSTERONE comment mcg/24hr 2.3-21.0 Details

Test Name: ALDOSTERONE

Result: comment

Units: mcg/24hr

Reference Range: 2.3-21.0

Lab Test: Aldosterone

Ordering Provider: KOLANKIEWICZ, LUIZ

Ordering Location: WHITE RIVER JCT VAMROC

Performing Location: QUEST 14225 NEWBROOK DRIVE , CHANTILLY, VA 20153

Status: Amended

Interpretation: Reference Ranges: Random Sodium diet

Age_________mcg/24 h

_2-_7 years______5.7 or less

_8-11 years_____10.2 or less

12-16 years_____15.6 or less

_Adults_____2.3-21.0

Post Florinef or IV saline suppression____5 mcg/24 h

or less

Creatinine, 24-Hour Urine

Age (yrs)__g/24 hours

___<3_____Not

established

_3-_8______0.11-0.68

_9-12______0.17-1.41

13-17______0.29-1.87

_Adults____0.63-2.50

Reference Range prior to 11/22/2005 was: 6-25 ug/24 hrs

This 24 hr urine range applies to patients on normal salt diet. Low salt

diet: 17-44 ug/24hr. High salt diet: 0-6 ug/24hr

Comments: ALDOSTERONE, SERUM= 12 ng/dL

REFERENCE RANGE (SERUM): Upright 8:00-10:00am < or = 28ng/dL

Upright 4:00-6:00pm < or = 21ng/dL

Supine 8:00-10:00am 3-16ng/dL

TV=2400 (24 HR URINE COLLECTION)

ALDOSTERONE,URINE: 12.7 mcg/24h

Test performed at Quest Diag. Lab.

CREATININE 1734.48c mg/24hrs 600-2000 Details SPECIMEN VOLUME 2400 ml. Details

What did he miss?

- 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, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

> > > > >

> > > > > > Are you getting a real doctor this time or another resident?

> > > > > >

> > > > > > I was at the VA today and found out the new Neprologist was

> > as I

> > > > hoped, Dr. Luiz Kolankiewicz. He was the one I saw back in

> > December

> > > > and seemed to know about PA. I thought asked the right questions.

> > > > You might suggest a referral if appropriate!

> > > > > >

> > > > > > I also heard Dr. , Chief - Pulmonary Section, passed away

> > > > from a massive heart attack! 46 y/o, great shape and exersized

> > every

> > > > day! I told Dr. Webster that was it, I was going to remain fat,

> > dumb

> > > > and happy!

> > > > > >

> > > > > > - 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, Metoprolol Tartrate 200 MG, 81mg

> > > > asprin, Metformin 2000MG and Spironolactone 50 MG.

> > > > > >

> > > > >

> > > >

> > >

> >

>

October 27, 2011

I'm trying to see how diplomatically I can answer this! These numbers are

indicative of a fat old man w/PA who had BP controlled with 25mg of Spirolactone

but other symptoms of PA were still ongoing. I would expect a young lady would

see many different numbers! I had/have other issue that contribute to these

numbers like T2DM, OSA and COPD requiring supplemental oxygen (later determined

it was LVH that was causing the need for oxygen.)

My aldostrone was never really high (5 & 15 as I recall) but my renin was low,

low (0.1 & 0.51). I also never experienced low K which is the case in ~30% of

people w/PA.

What BP meds were you on? What happened to BP when you stopped them? If you

post your numbers many here will help you understand them! Let us know how we

can help.

- 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, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin

2000MG and Spironolactone 50 MG.

> > > > > >

> > > > > > > Are you getting a real doctor this time or another resident?

> > > > > > >

> > > > > > > I was at the VA today and found out the new Neprologist was

> > > as I

> > > > > hoped, Dr. Luiz Kolankiewicz. He was the one I saw back in

> > > December

> > > > > and seemed to know about PA. I thought asked the right questions.

> > > > > You might suggest a referral if appropriate!

> > > > > > >

> > > > > > > I also heard Dr. , Chief - Pulmonary Section, passed away

> > > > > from a massive heart attack! 46 y/o, great shape and exersized

> > > every

> > > > > day! I told Dr. Webster that was it, I was going to remain fat,

> > > dumb

> > > > > and happy!

> > > > > > >

> > > > > > > - 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, Metoprolol Tartrate 200 MG, 81mg

> > > > > asprin, Metformin 2000MG and Spironolactone 50 MG.

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

October 27, 2011

Okay, here we go. I copied these down as accurately as I could:Blood Workup 5/26/10Glucose: 85 BUN 11 Creat: 1.2 NA+: 137 K: 5.0 CL-: 102 CO2: 31 CA: 9.4Protein Total: 7.5 Albumin: 3.8 ALKPHOS 68 ALT: 25AST: 14 TBILI: 0.46 Aldo: 88ng/dLBlood Workup 6/29/11Glucose: 67 BUN: 11 Creat: .87 Sodium Serum: 139K: 4.2 Carbon Dioxide: 22 Norepinephrine: 191Epinephrine: 40 Renin Plasma: .65 Aldo: 18.8ng/dLNormetanephrine: 29 Metanephrine: <10On 3/22/10 CT scan of abdomen looking for renal artery stenosis with IV and enteric contrast was performed. Findings: No evidence for renal artery stenosis. No renal masses identified. Delayed imaging demonstrates excretion of contrast material from both kidneys. The adrenal glands are not enlarged. A normal celiac and superior mesenteric artery are also visualized. Multiple tiny hypodensities are seen within the liver which do not demonstrate contrast enhancement and probably represents tiny cysts. However, they measure less than 1 cm in greatest dimension and are too small to characterize. Not currently on any BP meds. Have previously tried lisinopril-10mg, hydrochlorothiazide, Micardis-80mg, Telmisartan-40mg, without a decrease in

bp. I just had another aldosterone test done and will get results in a week hopefully. I'm also being sent to another nephrologist for a second opinion. Any ideas? I'm somewhat stumped because my aldosterone was at 88 for one lab, then 18.8 for another! 27 y/o , 115 lb at 5'6, female with 4+ year history of hypertension (Avg 135/95). Recently taken off of all bp meds because of resistance to them. Currently awaiting a second Nephrology appointment and up-to-date blood work. Last Aldosterone Level was 88. No known underlying illnesses other than systemic hypertensionTo: hyperaldosteronism Sent: Thursday, October 27, 2011 5:56 PMSubject: Re: Francis - New PCP

I'm trying to see how diplomatically I can answer this! These numbers are indicative of a fat old man w/PA who had BP controlled with 25mg of Spirolactone but other symptoms of PA were still ongoing. I would expect a young lady would see many different numbers! I had/have other issue that contribute to these numbers like T2DM, OSA and COPD requiring supplemental oxygen (later determined it was LVH that was causing the need for oxygen.)

My aldostrone was never really high (5 & 15 as I recall) but my renin was low, low (0.1 & 0.51). I also never experienced low K which is the case in ~30% of people w/PA.

What BP meds were you on? What happened to BP when you stopped them? If you post your numbers many here will help you understand them! Let us know how we can help.

- 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, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

> > > > > >

> > > > > > > Are you getting a real doctor this time or another resident?

> > > > > > >

> > > > > > > I was at the VA today and found out the new Neprologist was

> > > as I

> > > > > hoped, Dr. Luiz Kolankiewicz. He was the one I saw back in

> > > December

> > > > > and seemed to know about PA. I thought asked the right questions.

> > > > > You might suggest a referral if appropriate!

> > > > > > >

> > > > > > > I also heard Dr. , Chief - Pulmonary Section, passed away

> > > > > from a massive heart attack! 46 y/o, great shape and exersized

> > > every

> > > > > day! I told Dr. Webster that was it, I was going to remain fat,

> > > dumb

> > > > > and happy!

> > > > > > >

> > > > > > > - 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, Metoprolol Tartrate 200 MG, 81mg

> > > > > asprin, Metformin 2000MG and Spironolactone 50 MG.

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

October 27, 2011

You have very low renin but not low aldo. You have primary aldosteoronims.If you and your nephro read my evolution of PA article it will be clear.It will also be clear why ACEs and ARBs did not affect your BP.Why was HCTZ stopped?What were you taking and what was your Na intake when each aldo was done.With out a 24 hr urine done on the same day as the renin and aldo it is not possible to interpret renin and aldo.CE Grim MD . Okay, here we go. I copied these down as accurately as I could:Blood Workup 5/26/10Glucose: 85 BUN 11 Creat: 1.2 NA+: 137 K: 5.0 CL-: 102 CO2: 31 CA: 9.4Protein Total: 7.5 Albumin: 3.8 ALKPHOS 68 ALT: 25AST: 14 TBILI: 0.46 Aldo: 88ng/dLBlood Workup 6/29/11Glucose: 67 BUN: 11 Creat: .87 Sodium Serum: 139K: 4.2 Carbon Dioxide: 22 Norepinephrine: 191Epinephrine: 40 Renin Plasma: .65 Aldo: 18.8ng/dLNormetanephrine: 29 Metanephrine: <10On 3/22/10 CT scan of abdomen looking for renal artery stenosis with IV and enteric contrast was performed. Findings: No evidence for renal artery stenosis. No renal masses identified. Delayed imaging demonstrates excretion of contrast material from both kidneys. The adrenal glands are not enlarged. A normal celiac and superior mesenteric artery are also visualized. Multiple tiny hypodensities are seen within the liver which do not demonstrate contrast enhancement and probably represents tiny cysts. However, they measure less than 1 cm in greatest dimension and are too small to characterize. Not currently on any BP meds. Have previously tried lisinopril-10mg, hydrochlorothiazide, Micardis-80mg, Telmisartan-40mg, without a decrease in bp. I just had another aldosterone test done and will get results in a week hopefully. I'm also being sent to another nephrologist for a second opinion. Any ideas? I'm somewhat stumped because my aldosterone was at 88 for one lab, then 18.8 for another! 27 y/o , 115 lb at 5'6, female with 4+ year history of hypertension (Avg 135/95). Recently taken off of all bp meds because of resistance to them. Currently awaiting a second Nephrology appointment and up-to-date blood work. Last Aldosterone Level was 88. No known underlying illnesses other than systemic hypertensionTo: hyperaldosteronism Sent: Thursday, October 27, 2011 5:56 PMSubject: Re: Francis - New PCP I'm trying to see how diplomatically I can answer this! These numbers are indicative of a fat old man w/PA who had BP controlled with 25mg of Spirolactone but other symptoms of PA were still ongoing. I would expect a young lady would see many different numbers! I had/have other issue that contribute to these numbers like T2DM, OSA and COPD requiring supplemental oxygen (later determined it was LVH that was causing the need for oxygen.) My aldostrone was never really high (5 & 15 as I recall) but my renin was low, low (0.1 & 0.51). I also never experienced low K which is the case in ~30% of people w/PA. What BP meds were you on? What happened to BP when you stopped them? If you post your numbers many here will help you understand them! Let us know how we can help. - 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, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG. > > > > > > > > > > > > > Are you getting a real doctor this time or another resident? > > > > > > > > > > > > > > I was at the VA today and found out the new Neprologist was > > > as I > > > > > hoped, Dr. Luiz Kolankiewicz. He was the one I saw back in > > > December > > > > > and seemed to know about PA. I thought asked the right questions. > > > > > You might suggest a referral if appropriate! > > > > > > > > > > > > > > I also heard Dr. , Chief - Pulmonary Section, passed away > > > > > from a massive heart attack! 46 y/o, great shape and exersized > > > every > > > > > day! I told Dr. Webster that was it, I was going to remain fat, > > > dumb > > > > > and happy! > > > > > > > > > > > > > > - 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, Metoprolol Tartrate 200 MG, 81mg > > > > > asprin, Metformin 2000MG and Spironolactone 50 MG. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

October 27, 2011

Do you know, what, : we have very similar condition. I never had high aldo either, and never low K, but my renin was 0.1. And I also have diabetes and take 2000 mg of metformin. And I am also on two BP medications. And my BP is controlled by 87.5 mg of eplerenon + 80 mg of micardis very well, but I still have other symptoms of PA. Very, very similar to your condition, is not it? Natalia Kamneva 67 Russian F with 2 cm left adrenal adenoma, recently diagnosed with PA; diabetic; on 87.5 mg eplerenone, 80 mg Micardis, 2000 mg metformin, 60 mg Dexilant and 1mg Lorazepam; Dashing; on private consultation with Dr Grim.To: hyperaldosteronism Sent: Thursday, October 27, 2011 5:56 PMSubject: Re: Francis - New PCP

I'm trying to see how diplomatically I can answer this! These numbers are indicative of a fat old man w/PA who had BP controlled with 25mg of Spirolactone but other symptoms of PA were still ongoing. I would expect a young lady would see many different numbers! I had/have other issue that contribute to these numbers like T2DM, OSA and COPD requiring supplemental oxygen (later determined it was LVH that was causing the need for oxygen.)

My aldostrone was never really high (5 & 15 as I recall) but my renin was low, low (0.1 & 0.51). I also never experienced low K which is the case in ~30% of people w/PA.

What BP meds were you on? What happened to BP when you stopped them? If you post your numbers many here will help you understand them! Let us know how we can help.

- 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, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

> > > > > >

> > > > > > > Are you getting a real doctor this time or another resident?

> > > > > > >

> > > > > > > I was at the VA today and found out the new Neprologist was

> > > as I

> > > > > hoped, Dr. Luiz Kolankiewicz. He was the one I saw back in

> > > December

> > > > > and seemed to know about PA. I thought asked the right questions.

> > > > > You might suggest a referral if appropriate!

> > > > > > >

> > > > > > > I also heard Dr. , Chief - Pulmonary Section, passed away

> > > > > from a massive heart attack! 46 y/o, great shape and exersized

> > > every

> > > > > day! I told Dr. Webster that was it, I was going to remain fat,

> > > dumb

> > > > > and happy!

> > > > > > >

> > > > > > > - 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, Metoprolol Tartrate 200 MG, 81mg

> > > > > asprin, Metformin 2000MG and Spironolactone 50 MG.

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

October 27, 2011

You both have an aldo that is not zero when you renin is nearly zero. You have inappropriate aldo for your renin which is early PA in the Grim Hypothesis. See the Evolution of PA article. CE Grim MD Do you know, what, : we have very similar condition. I never had high aldo either, and never low K, but my renin was 0.1. And I also have diabetes and take 2000 mg of metformin. And I am also on two BP medications. And my BP is controlled by 87.5 mg of eplerenon + 80 mg of micardis very well, but I still have other symptoms of PA. Very, very similar to your condition, is not it? Natalia Kamneva 67 Russian F with 2 cm left adrenal adenoma, recently diagnosed with PA; diabetic; on 87.5 mg eplerenone, 80 mg Micardis, 2000 mg metformin, 60 mg Dexilant and 1mg Lorazepam; Dashing; on private consultation with Dr Grim.To: hyperaldosteronism Sent: Thursday, October 27, 2011 5:56 PMSubject: Re: Francis - New PCP I'm trying to see how diplomatically I can answer this! These numbers are indicative of a fat old man w/PA who had BP controlled with 25mg of Spirolactone but other symptoms of PA were still ongoing. I would expect a young lady would see many different numbers! I had/have other issue that contribute to these numbers like T2DM, OSA and COPD requiring supplemental oxygen (later determined it was LVH that was causing the need for oxygen.) My aldostrone was never really high (5 & 15 as I recall) but my renin was low, low (0.1 & 0.51). I also never experienced low K which is the case in ~30% of people w/PA. What BP meds were you on? What happened to BP when you stopped them? If you post your numbers many here will help you understand them! Let us know how we can help. - 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, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG. > > > > > > > > > > > > > Are you getting a real doctor this time or another resident? > > > > > > > > > > > > > > I was at the VA today and found out the new Neprologist was > > > as I > > > > > hoped, Dr. Luiz Kolankiewicz. He was the one I saw back in > > > December > > > > > and seemed to know about PA. I thought asked the right questions. > > > > > You might suggest a referral if appropriate! > > > > > > > > > > > > > > I also heard Dr. , Chief - Pulmonary Section, passed away > > > > > from a massive heart attack! 46 y/o, great shape and exersized > > > every > > > > > day! I told Dr. Webster that was it, I was going to remain fat, > > > dumb > > > > > and happy! > > > > > > > > > > > > > > - 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, Metoprolol Tartrate 200 MG, 81mg > > > > > asprin, Metformin 2000MG and Spironolactone 50 MG. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

October 27, 2011

Got it. Thank you. Natalia To: hyperaldosteronism Sent: Thursday, October 27, 2011 10:34 PMSubject: Re: Re: Francis - New PCP

You both have an aldo that is not zero when you renin is nearly zero. You have inappropriate aldo for your renin which is early PA in the Grim Hypothesis. See the Evolution of PA article. CE Grim MD Do you know, what, : we have very similar condition. I never had high aldo either, and never low K, but my renin was 0.1. And I also have diabetes and take 2000 mg of metformin. And I am also on two BP

medications. And my BP is controlled by 87.5 mg of eplerenon + 80 mg of micardis very well, but I still have other symptoms of PA. Very, very similar to your condition, is not it? Natalia Kamneva 67 Russian F with 2 cm left adrenal adenoma, recently diagnosed with PA; diabetic; on 87.5 mg eplerenone, 80 mg Micardis, 2000 mg metformin, 60 mg Dexilant and 1mg Lorazepam; Dashing; on private consultation with Dr Grim.To: hyperaldosteronism Sent: Thursday, October 27, 2011 5:56 PMSubject: Re: Francis - New PCP I'm trying to see how diplomatically I can answer this! These numbers are indicative of a fat old man w/PA who had BP controlled with 25mg of Spirolactone but other symptoms of PA were still ongoing. I would expect a young lady would see many different numbers! I had/have other issue that contribute to these numbers like T2DM, OSA and COPD requiring supplemental oxygen (later determined it was LVH that was causing the need for oxygen.) My aldostrone was never really high (5 &

15 as I recall) but my renin was low, low (0.1 & 0.51). I also never experienced low K which is the case in ~30% of people w/PA. What BP meds were you on? What happened to BP when you stopped them? If you post your numbers many here will help you understand them! Let us know how we can help. - 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, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG. > > > > > > > > > > > > > Are you getting a real doctor this time or another resident? > > > > > > > > > > > > > > I was at the VA today and found out the new

Neprologist was > > > as I > > > > > hoped, Dr. Luiz Kolankiewicz. He was the one I saw back in > > > December > > > > > and seemed to know about PA. I thought asked the right questions. > > > > > You might suggest a referral if appropriate! > > > > > > > > > > > > > > I also heard Dr. , Chief - Pulmonary Section, passed away > > > > > from a massive heart attack! 46 y/o, great shape and exersized > > > every > > > > > day! I told Dr. Webster that was it, I was going to remain fat, > > > dumb > > > > > and happy! > > > > > > > > > > > > > > - 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, Metoprolol Tartrate 200 MG, 81mg > > > > > asprin, Metformin 2000MG and Spironolactone 50 MG. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

October 28, 2011

Had my visit with my new PCP at the VA Think at this point believe it was just a

waste of time. When I told him I thought I had PA he told me PA is very rare

That My B/P wasn't high enough nor my K low enough to have it. Tried to tell him

Pa wasn't so rare and my B/P has been close to 199/100 and my K had been 3.2.

Told me low K was due to being on diuretics and my B/P was a bit higher then it

should be wasn't high enough for PA. When I asked about the adrenal tumor said

it is a very common finding on CT It became point less to try to get him to

think I might have PA.

64 y old N.H. Vet with possible PA BP readings as high 199/100 K drop from 4.3

to 3.2 after being started 25 MG of HYDROCHLOROTHIAZIDE fluid retention

Dizziness Fatigue Tachycardia PVC shortness of breath brain fog Not sure how to

describe this but to say Kinetic Activity 2 cm tumor on left adrenal gland 2.2

cm exophytic low density lesion off the mid pole of the left kidney which

measures 34 HU, greater than expected for a simple cyst.

3 NEG stress tests 2 NEG ECHO

meds I now take and was on for the two PRA ratio test. PAR ratio wasn't high to

DX PA

ATENOLOL 25MG TRIAMTERENE 50MG POTASSIUM CHLORIDE 20MEQ

FUROSEMIDE 60MG TAB.

Information from first Test done at the VA and quest labs. RENIN: 1.8 ng/mL/hr

Current Range 0.65-5.0 ng/mL/hr

SERUM ALDOS: 16 ng/dL Current adult reference range:

Upright 8:00-10:00 am < or = 28 ng/dL

Upright 4:00-6:00 pm < or = 21 ng/dL

Supine 8:00-10:00 am 3-16 ng/dL

Test done At Dartmouth RENIN ACTIVITY .8 no range given

ALDOSTERONE 5.5 range <=21

> >> > > > > >

> >> > > > > > > Are you getting a real doctor this time or another resident?

> >> > > > > > >

> >> > > > > > > I was at the VA today and found out the new Neprologist was

> >> > > as I

> >> > > > > hoped, Dr. Luiz Kolankiewicz. He was the one I saw back in

> >> > > December

> >> > > > > and seemed to know about PA. I thought asked the right questions.

> >> > > > > You might suggest a referral if appropriate!

> >> > > > > > >

> >> > > > > > > I also heard Dr. , Chief - Pulmonary Section, passed away

> >> > > > > from a massive heart attack! 46 y/o, great shape and exersized

> >> > > every

> >> > > > > day! I told Dr. Webster that was it, I was going to remain fat,

> >> > > dumb

> >> > > > > and happy!

> >> > > > > > >

> >> > > > > > > - 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, Metoprolol Tartrate 200 MG, 81mg

> >> > > > > asprin, Metformin 2000MG and Spironolactone 50 MG.

> >> > > > > > >

> >> > > > > >

> >> > > > >

> >> > > >

> >> > >

> >> >

> >>

> >

>

October 28, 2011

Francis, Your experience with the VA sounds like a frustrating ordeal. Do you

any recourse? ~Lucy

Sent from my Verizon Wireless Phone

Francis Bill SUSPECTED PA wrote:

>Had my visit with my new PCP at the VA Think at this point believe it was just

a waste of time. When I told him I thought I had PA he told me PA is very rare

That My B/P wasn't high enough nor my K low enough to have it. Tried to tell him

Pa wasn't so rare and my B/P has been close to 199/100 and my K had been 3.2.

Told me low K was due to being on diuretics and my B/P was a bit higher then it

should be wasn't high enough for PA. When I asked about the adrenal tumor said

it is a very common finding on CT It became point less to try to get him to

think I might have PA.

>

>64 y old N.H. Vet with possible PA BP readings as high 199/100 K drop from 4.3

to 3.2 after being started 25 MG of HYDROCHLOROTHIAZIDE fluid retention

Dizziness Fatigue Tachycardia PVC shortness of breath brain fog Not sure how to

describe this but to say Kinetic Activity 2 cm tumor on left adrenal gland 2.2

cm exophytic low density lesion off the mid pole of the left kidney which

measures 34 HU, greater than expected for a simple cyst.

>3 NEG stress tests 2 NEG ECHO

>

>meds I now take and was on for the two PRA ratio test. PAR ratio wasn't high to

DX PA

>ATENOLOL 25MG TRIAMTERENE 50MG POTASSIUM CHLORIDE 20MEQ

>FUROSEMIDE 60MG TAB.

>

>Information from first Test done at the VA and quest labs. RENIN: 1.8 ng/mL/hr

>Current Range 0.65-5.0 ng/mL/hr

>

>SERUM ALDOS: 16 ng/dL Current adult reference range:

>Upright 8:00-10:00 am < or = 28 ng/dL

>Upright 4:00-6:00 pm < or = 21 ng/dL

>Supine 8:00-10:00 am 3-16 ng/dL

>

>Test done At Dartmouth RENIN ACTIVITY .8 no range given

>

>ALDOSTERONE 5.5 range <=21

>

>> >> > > > > >

>> >> > > > > > > Are you getting a real doctor this time or another resident?

>> >> > > > > > >

>> >> > > > > > > I was at the VA today and found out the new Neprologist was

>> >> > > as I

>> >> > > > > hoped, Dr. Luiz Kolankiewicz. He was the one I saw back in

>> >> > > December

>> >> > > > > and seemed to know about PA. I thought asked the right questions.

>> >> > > > > You might suggest a referral if appropriate!

>> >> > > > > > >

>> >> > > > > > > I also heard Dr. , Chief - Pulmonary Section, passed away

>> >> > > > > from a massive heart attack! 46 y/o, great shape and exersized

>> >> > > every

>> >> > > > > day! I told Dr. Webster that was it, I was going to remain fat,

>> >> > > dumb

>> >> > > > > and happy!

>> >> > > > > > >

>> >> > > > > > > - 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, Metoprolol Tartrate 200 MG, 81mg

>> >> > > > > asprin, Metformin 2000MG and Spironolactone 50 MG.

>> >> > > > > > >

>> >> > > > > >

>> >> > > > >

>> >> > > >

>> >> > >

>> >> >

>> >>

>> >

>>

>

October 28, 2011

Hate to keep harping on the incompetence of your VA doc. 1. PA is not rare. 2. There is no BP that allows one to Dx or exclude PA. Even some have normal BP.3. Most PAs do not have low K.4. Getting a low K on a diuretic is a classic tip off for PA.I think you need to write a formal letter to the VA there and see if you can see someone else who is up to date on high blood pressure do to PA in the VA system. I recall one of our other folks here goes to the same VA and has a pcp who understands this.And what does he think the adrenal bump is doing? IMHO in the face of HTN and low K it is likely that it is involved in a uni or bilateral process related to your BP proven otherwise. A simple trial of spiro or eplere is clearly indicated. If BP does not get better and you are not able to stop other BP drugs then you do not have PA. If it does lower BP/improve K metabolism then you will likely feel better.Lets see what we can do by contacting the VA. I many have another CBOC locum coming up and then I can contact them directly. CE Grim MD On Oct 28, 2011, at 3:45 PM, Francis Bill SUSPECTED PA wrote: Had my visit with my new PCP at the VA Think at this point believe it was just a waste of time. When I told him I thought I had PA he told me PA is very rare That My B/P wasn't high enough nor my K low enough to have it. Tried to tell him Pa wasn't so rare and my B/P has been close to 199/100 and my K had been 3.2. Told me low K was due to being on diuretics and my B/P was a bit higher then it should be wasn't high enough for PA. When I asked about the adrenal tumor said it is a very common finding on CT It became point less to try to get him to think I might have PA. 64 y old N.H. Vet with possible PA BP readings as high 199/100 K drop from 4.3 to 3.2 after being started 25 MG of HYDROCHLOROTHIAZIDE fluid retention Dizziness Fatigue Tachycardia PVC shortness of breath brain fog Not sure how to describe this but to say Kinetic Activity 2 cm tumor on left adrenal gland 2.2 cm exophytic low density lesion off the mid pole of the left kidney which measures 34 HU, greater than expected for a simple cyst. 3 NEG stress tests 2 NEG ECHO meds I now take and was on for the two PRA ratio test. PAR ratio wasn't high to DX PA ATENOLOL 25MG TRIAMTERENE 50MG POTASSIUM CHLORIDE 20MEQ FUROSEMIDE 60MG TAB. Information from first Test done at the VA and quest labs. RENIN: 1.8 ng/mL/hr Current Range 0.65-5.0 ng/mL/hr SERUM ALDOS: 16 ng/dL Current adult reference range: Upright 8:00-10:00 am < or = 28 ng/dL Upright 4:00-6:00 pm < or = 21 ng/dL Supine 8:00-10:00 am 3-16 ng/dL Test done At Dartmouth RENIN ACTIVITY .8 no range given ALDOSTERONE 5.5 range <=21 > >> > > > > > > >> > > > > > > Are you getting a real doctor this time or another resident? > >> > > > > > > > >> > > > > > > I was at the VA today and found out the new Neprologist was > >> > > as I > >> > > > > hoped, Dr. Luiz Kolankiewicz. He was the one I saw back in > >> > > December > >> > > > > and seemed to know about PA. I thought asked the right questions. > >> > > > > You might suggest a referral if appropriate! > >> > > > > > > > >> > > > > > > I also heard Dr. , Chief - Pulmonary Section, passed away > >> > > > > from a massive heart attack! 46 y/o, great shape and exersized > >> > > every > >> > > > > day! I told Dr. Webster that was it, I was going to remain fat, > >> > > dumb > >> > > > > and happy! > >> > > > > > > > >> > > > > > > - 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, Metoprolol Tartrate 200 MG, 81mg > >> > > > > asprin, Metformin 2000MG and Spironolactone 50 MG. > >> > > > > > > > >> > > > > > > > >> > > > > > > >> > > > > > >> > > > > > >> > > > > >> > > > >> > > > >> > > >> > > > > > > > > > > > > >

October 28, 2011

So, what are you doing now? What was your BP during the visit? Did you ask him to try eplerenone? As we discussed here, it's for BP, not even approved for PA. Natalia To: hyperaldosteronism Sent: Friday, October 28, 2011 5:45 PMSubject: Re:

Francis - New PCP

Had my visit with my new PCP at the VA Think at this point believe it was just a waste of time. When I told him I thought I had PA he told me PA is very rare That My B/P wasn't high enough nor my K low enough to have it. Tried to tell him Pa wasn't so rare and my B/P has been close to 199/100 and my K had been 3.2. Told me low K was due to being on diuretics and my B/P was a bit higher then it should be wasn't high enough for PA. When I asked about the adrenal tumor said it is a very common finding on CT It became point less to try to get him to think I might have PA.

64 y old N.H. Vet with possible PA BP readings as high 199/100 K drop from 4.3 to 3.2 after being started 25 MG of HYDROCHLOROTHIAZIDE fluid retention Dizziness Fatigue Tachycardia PVC shortness of breath brain fog Not sure how to describe this but to say Kinetic Activity 2 cm tumor on left adrenal gland 2.2 cm exophytic low density lesion off the mid pole of the left kidney which measures 34 HU, greater than expected for a simple cyst.

3 NEG stress tests 2 NEG ECHO

meds I now take and was on for the two PRA ratio test. PAR ratio wasn't high to DX PA

ATENOLOL 25MG TRIAMTERENE 50MG POTASSIUM CHLORIDE 20MEQ

FUROSEMIDE 60MG TAB.

Information from first Test done at the VA and quest labs. RENIN: 1.8 ng/mL/hr

Current Range 0.65-5.0 ng/mL/hr

SERUM ALDOS: 16 ng/dL Current adult reference range:

Upright 8:00-10:00 am < or = 28 ng/dL

Upright 4:00-6:00 pm < or = 21 ng/dL

Supine 8:00-10:00 am 3-16 ng/dL

Test done At Dartmouth RENIN ACTIVITY .8 no range given

ALDOSTERONE 5.5 range <=21

> >> > > > > >

> >> > > > > > > Are you getting a real doctor this time or another resident?

> >> > > > > > >

> >> > > > > > > I was at the VA today and found out the new Neprologist was

> >> > > as I

> >> > > > > hoped, Dr. Luiz Kolankiewicz. He was the one I saw back in

> >> > > December

> >> > > > > and seemed to know about PA. I thought asked the right questions.

> >> > > > > You might suggest a referral if appropriate!

> >> > > > > > >

> >> > > > > > > I also heard Dr. , Chief - Pulmonary Section, passed away

> >> > > > > from a massive heart attack! 46 y/o, great shape and exersized

> >> > > every

> >> > > > > day! I told Dr. Webster that was it, I was going to remain fat,

> >> > > dumb

> >> > > > > and happy!

> >> > > > > > >

> >> > > > > > > - 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, Metoprolol Tartrate 200 MG, 81mg

> >> > > > > asprin, Metformin 2000MG and Spironolactone 50 MG.

> >> > > > > > >

> >> > > > > >

> >> > > > >

> >> > > >

> >> > >

> >> >

> >>

> >

>

October 28, 2011

I think part of the problem is Dartmouth Med school.

Possable Clack has the only PCP at this VA that is now understanding PA.

Because of my breathing problem they want to stop atenolol and start lisinopril.

> > > >> > > > > >

> > > >> > > > > > > Are you getting a real doctor this time or another

> > resident?

> > > >> > > > > > >

> > > >> > > > > > > I was at the VA today and found out the new

> > Neprologist was

> > > >> > > as I

> > > >> > > > > hoped, Dr. Luiz Kolankiewicz. He was the one I saw back

> > in

> > > >> > > December

> > > >> > > > > and seemed to know about PA. I thought asked the right

> > questions.

> > > >> > > > > You might suggest a referral if appropriate!

> > > >> > > > > > >

> > > >> > > > > > > I also heard Dr. , Chief - Pulmonary Section,

> > passed away

> > > >> > > > > from a massive heart attack! 46 y/o, great shape and

> > exersized

> > > >> > > every

> > > >> > > > > day! I told Dr. Webster that was it, I was going to

> > remain fat,

> > > >> > > dumb

> > > >> > > > > and happy!

> > > >> > > > > > >

> > > >> > > > > > > - 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, Metoprolol Tartrate 200

> > MG, 81mg

> > > >> > > > > asprin, Metformin 2000MG and Spironolactone 50 MG.

> > > >> > > > > > >

> > > >> > > > > >

> > > >> > > > >

> > > >> > > >

> > > >> > >

> > > >> >

> > > >>

> > > >

> > >

> >

>

October 28, 2011

I hope lisinopril works better for you than it did me! It didn't lower my bp and gave me severe arthritis symptoms. My knee and elbow joints hurt so bad when taking even a small dosage of lisinopril. 27 y/o , 114 lb at 5'6, female with 4+ year history of hypertension (Avg 135/95). Recently taken off of all bp meds because of resistance to them. Currently awaiting a second Nephrology appointment and up-to-date blood work. Last Aldosterone Level was 88, Renin: 0.65. No known underlying illnesses other than systemic hypertensionTo: hyperaldosteronism Sent: Friday, October 28, 2011 7:53 PMSubject: Re: Francis - New PCP

I think part of the problem is Dartmouth Med school.

Possable Clack has the only PCP at this VA that is now understanding PA.

Because of my breathing problem they want to stop atenolol and start lisinopril.

> > > >> > > > > >

> > > >> > > > > > > Are you getting a real doctor this time or another

> > resident?

> > > >> > > > > > >

> > > >> > > > > > > I was at the VA today and found out the new

> > Neprologist was

> > > >> > > as I

> > > >> > > > > hoped, Dr. Luiz Kolankiewicz. He was the one I saw back

> > in

> > > >> > > December

> > > >> > > > > and seemed to know about PA. I thought asked the right

> > questions.

> > > >> > > > > You might suggest a referral if appropriate!

> > > >> > > > > > >

> > > >> > > > > > > I also heard Dr. , Chief - Pulmonary Section,

> > passed away

> > > >> > > > > from a massive heart attack! 46 y/o, great shape and

> > exersized

> > > >> > > every

> > > >> > > > > day! I told Dr. Webster that was it, I was going to

> > remain fat,

> > > >> > > dumb

> > > >> > > > > and happy!

> > > >> > > > > > >

> > > >> > > > > > > - 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, Metoprolol Tartrate 200

> > MG, 81mg

> > > >> > > > > asprin, Metformin 2000MG and Spironolactone 50 MG.

> > > >> > > > > > >

> > > >> > > > > >

> > > >> > > > >

> > > >> > > >

> > > >> > >

> > > >> >

> > > >>

> > > >

> > >

> >

>

October 28, 2011

I can always change to VA'S. would be about 1 and 1/2 hours from me have heard

they anr better then the one I now go to that is 15 min from me.

> >> >> > > > > >

> >> >> > > > > > > Are you getting a real doctor this time or another resident?

> >> >> > > > > > >

> >> >> > > > > > > I was at the VA today and found out the new Neprologist was

> >> >> > > as I

> >> >> > > > > hoped, Dr. Luiz Kolankiewicz. He was the one I saw back in

> >> >> > > December

> >> >> > > > > and seemed to know about PA. I thought asked the right

questions.

> >> >> > > > > You might suggest a referral if appropriate!

> >> >> > > > > > >

> >> >> > > > > > > I also heard Dr. , Chief - Pulmonary Section, passed

away

> >> >> > > > > from a massive heart attack! 46 y/o, great shape and exersized

> >> >> > > every

> >> >> > > > > day! I told Dr. Webster that was it, I was going to remain fat,

> >> >> > > dumb

> >> >> > > > > and happy!

> >> >> > > > > > >

> >> >> > > > > > > - 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, Metoprolol Tartrate 200 MG, 81mg

> >> >> > > > > asprin, Metformin 2000MG and Spironolactone 50 MG.

> >> >> > > > > > >

> >> >> > > > > >

> >> >> > > > >

> >> >> > > >

> >> >> > >

> >> >> >

> >> >>

> >> >

> >>

> >

>

October 28, 2011

If I have PA it will not work.

> > > > >> > > > > >

> > > > >> > > > > > > Are you getting a real doctor this time or another

> > > resident?

> > > > >> > > > > > >

> > > > >> > > > > > > I was at the VA today and found out the new

> > > Neprologist was

> > > > >> > > as I

> > > > >> > > > > hoped, Dr. Luiz Kolankiewicz. He was the one I saw back

> > > in

> > > > >> > > December

> > > > >> > > > > and seemed to know about PA. I thought asked the right

> > > questions.

> > > > >> > > > > You might suggest a referral if appropriate!

> > > > >> > > > > > >

> > > > >> > > > > > > I also heard Dr. , Chief - Pulmonary Section,

> > > passed away

> > > > >> > > > > from a massive heart attack! 46 y/o, great shape and

> > > exersized

> > > > >> > > every

> > > > >> > > > > day! I told Dr. Webster that was it, I was going to

> > > remain fat,

> > > > >> > > dumb

> > > > >> > > > > and happy!

> > > > >> > > > > > >

> > > > >> > > > > > > - 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, Metoprolol Tartrate 200

> > > MG, 81mg

> > > > >> > > > > asprin, Metformin 2000MG and Spironolactone 50 MG.

> > > > >> > > > > > >

> > > > >> > > > > >

> > > > >> > > > >

> > > > >> > > >

> > > > >> > >

> > > > >> >

> > > > >>

> > > > >

> > > >

> > >

> >

>

October 28, 2011

B/P was something like 143/80 Unsure of what I will do next. Since Dr wasn't

understanding things I kind of gave up on asking him any thing.

> > >> > > > > >

> > >> > > > > > > Are you getting a real doctor this time or another resident?

> > >> > > > > > >

> > >> > > > > > > I was at the VA today and found out the new Neprologist was

> > >> > > as I

> > >> > > > > hoped, Dr. Luiz Kolankiewicz. He was the one I saw back in

> > >> > > December

> > >> > > > > and seemed to know about PA. I thought asked the right questions.

> > >> > > > > You might suggest a referral if appropriate!

> > >> > > > > > >

> > >> > > > > > > I also heard Dr. , Chief - Pulmonary Section, passed

away

> > >> > > > > from a massive heart attack! 46 y/o, great shape and exersized

> > >> > > every

> > >> > > > > day! I told Dr. Webster that was it, I was going to remain fat,

> > >> > > dumb

> > >> > > > > and happy!

> > >> > > > > > >

> > >> > > > > > > - 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, Metoprolol Tartrate 200 MG, 81mg

> > >> > > > > asprin, Metformin 2000MG and Spironolactone 50 MG.

> > >> > > > > > >

> > >> > > > > >

> > >> > > > >

> > >> > > >

> > >> > >

> > >> >

> > >>

> > >

> >

>

October 28, 2011

Lisin does not work in PA. Some data it may even increase BP.CE Grim MD I hope lisinopril works better for you than it did me! It didn't lower my bp and gave me severe arthritis symptoms. My knee and elbow joints hurt so bad when taking even a small dosage of lisinopril. 27 y/o , 114 lb at 5'6, female with 4+ year history of hypertension (Avg 135/95). Recently taken off of all bp meds because of resistance to them. Currently awaiting a second Nephrology appointment and up-to-date blood work. Last Aldosterone Level was 88, Renin: 0.65. No known underlying illnesses other than systemic hypertensionTo: hyperaldosteronism Sent: Friday, October 28, 2011 7:53 PMSubject: Re: Francis - New PCP I think part of the problem is Dartmouth Med school. Possable Clack has the only PCP at this VA that is now understanding PA. Because of my breathing problem they want to stop atenolol and start lisinopril. > > > >> > > > > > > > > >> > > > > > > Are you getting a real doctor this time or another > > resident? > > > >> > > > > > > > > > >> > > > > > > I was at the VA today and found out the new > > Neprologist was > > > >> > > as I > > > >> > > > > hoped, Dr. Luiz Kolankiewicz. He was the one I saw back > > in > > > >> > > December > > > >> > > > > and seemed to know about PA. I thought asked the right > > questions. > > > >> > > > > You might suggest a referral if appropriate! > > > >> > > > > > > > > > >> > > > > > > I also heard Dr. , Chief - Pulmonary Section, > > passed away > > > >> > > > > from a massive heart attack! 46 y/o, great shape and > > exersized > > > >> > > every > > > >> > > > > day! I told Dr. Webster that was it, I was going to > > remain fat, > > > >> > > dumb > > > >> > > > > and happy! > > > >> > > > > > > > > > >> > > > > > > - 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, Metoprolol Tartrate 200 > > MG, 81mg > > > >> > > > > asprin, Metformin 2000MG and Spironolactone 50 MG. > > > >> > > > > > > > > > >> > > > > > > > > > >> > > > > > > > > >> > > > > > > > >> > > > > > > > >> > > > > > > >> > > > > > >> > > > > > >> > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

October 28, 2011

Need to get the local one up to speed. I could write a letter to your pcp recommending a trail of MCB?CE Grim MDOn Oct 28, 2011, at 5:59 PM, Francis Bill SUSPECTED PA wrote: I can always change to VA'S. would be about 1 and 1/2 hours from me have heard they anr better then the one I now go to that is 15 min from me. > >> >> > > > > > > >> >> > > > > > > Are you getting a real doctor this time or another resident? > >> >> > > > > > > > >> >> > > > > > > I was at the VA today and found out the new Neprologist was > >> >> > > as I > >> >> > > > > hoped, Dr. Luiz Kolankiewicz. He was the one I saw back in > >> >> > > December > >> >> > > > > and seemed to know about PA. I thought asked the right questions. > >> >> > > > > You might suggest a referral if appropriate! > >> >> > > > > > > > >> >> > > > > > > I also heard Dr. , Chief - Pulmonary Section, passed away > >> >> > > > > from a massive heart attack! 46 y/o, great shape and exersized > >> >> > > every > >> >> > > > > day! I told Dr. Webster that was it, I was going to remain fat, > >> >> > > dumb > >> >> > > > > and happy! > >> >> > > > > > > > >> >> > > > > > > - 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, Metoprolol Tartrate 200 MG, 81mg > >> >> > > > > asprin, Metformin 2000MG and Spironolactone 50 MG. > >> >> > > > > > > > >> >> > > > > > > > >> >> > > > > > > >> >> > > > > > >> >> > > > > > >> >> > > > > >> >> > > > >> >> > > > >> >> > > >> >> > >> > > >> > > >> > > >> > > >> > > >> > > >> > > > > >

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