Re: Francis - New PCP

October 28, 2011

Bill. As discussed in the Evolution Article. CE Grim MDOn Oct 28, 2011, at 6:01 PM, Francis Bill SUSPECTED PA wrote: 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

He will be dinged by the VA for not getting your BP to goal which should be less than 140/90. If that was the BP that went into your record.Can you do a excel spread sheets of you VA visits BP as far back as you can go. CE Grim MDOn Oct 28, 2011, at 6:14 PM, Francis Bill SUSPECTED PA wrote: 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 29, 2011

Will have to get his first name. He might have told me what it was but don't

recall. Once I have this I will see if he has Dartmouth email. Or can get his VA

email from my nephew. It seems he is at both the VA and Dartmouth. Didn't know

that one did residency in both places.

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

> > > >> >> > > > > > > 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 29, 2011

Marchelle, you don't have resistance to BP medications, you have PA and a low renin - it usual reaction for most of us to almost ANY BP medications, except spiro and Inspra :-)As for Francis, I was on lisinopril also. It did the same for me as for Marchelle. And, BTW, there are maybe 1000 more BP medications and they produce every year new ones, so calculate if you have enough time in your life to try all combinations of all of them:-) I am not trying to be mean, I am just trying to convince you, that you have to trust yourself, Dr. Grim and us, not your previous, current and future doctors:-) Natalia Kamneva To: "hyperaldosteronism " <hyperaldosteronism >Sent: Friday, October 28, 2011 7:57 PMSubject: Re: Re: Francis - New PCP

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 29, 2011

If it will not work, it's good! Bad if it's going to raise your BP. Watch it. To: hyperaldosteronism Sent: Friday, October 28, 2011 8:01 PMSubject: Re: Francis - New PCP

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 29, 2011

I just got back from g-daughter's so I'm doing a little catchup. Sorry for your

experience but must admit I'm not surprised. How far did he get thru the HX

before you mentioned PA? (Seconds or minutes?) Did he have alternate ideas? Do

you have another appt.? What's the plan?

I still suggest you have a referral to Dr. Luiz Kolankiewicz in Neprology. I

believe an adrenal adnoma would be in his field of expertese and he did all the

necessary tests to not only confirm PA but also rule out other issues I think.

(I reported all the tests so maybe someone smarter than I can confirm that) I

have a followup with him in a week or so and plan to discuss his qualifications

a little.

- 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 29, 2011

I see Dr. Grim has suggested my PCP is the " resident expert for PA " and while

she my have experience treating one PTN, it has come from a lot of coaching by

said PTN! I have had 8 months of unlimitted time to research and prepare for

our 30 minute sessions. I start every appt. with BP, BS and HR graphs. (On the

front is the last 30 days and the back is the last year.) Her comment last

time, " You sure spoil me with these! " We don't even discuss what they see in

the office anymore! I sometimes let her check it just to confirm her hearing is

still working! ;>)

In 8 months she has had > 2000 PTN appts and formed a new all female unit with

primary responsibility to service the female veterans. Is she ready and does

she want to become the resident PA expert. I doubt it but I never asked her and

don't plan to. I suspect if/when she gets another case she will refer it to

Nepr & Endo since those resources are available to her and they should be the

" experts " .

I still feel he needs to se a Neprologist with a " 2 cm tumor on left adrenal

gland and 2.2 cm exophytic low density lesion off the mid pole of the left

kidney " it seems to me a Neprologist is the logical step, eapecially since he is

most qualified IMHUPO to DX it!

- 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 29, 2011

If you discuss starting a MCB I would suggest you talk about Spirolactone since

Eplerenone is still nonformularly at the VA. I talked with Dr. Webster about it

and she said for that reason the request would have to come from Neperology. (I

already had an appt. with them scheduled for next week so will discuss it then.)

- 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 29, 2011

Francis, 143/80 is better than any reading I get at the VA. Did they take 3 and

average 2 after sitting etc, etc? This is also a lot lower than the 199/100

you've been reporting. If you assume the same range for renin at Dartmouth,

both your renin test are within range and aldo is also. I know Dr. Grim said

once you had PA but I'm not sure what he saw that made him come to that

conclusion. He usually requires a 24h urine as I recall.

Have you ever tried stopping the atenolol? Both it and lisinopril are ACE

inhibitors and if I understand it correctly work on angiotenisn which starts as

renin. Since my renin was .1 they didn't do anything but with yours being

within range they may be doing something!

What was the timeframe for your two tests?

- 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 29, 2011

So a good indication to use it is gynecomastia from Spiro despite good BP CONTROL ESP if urine Na and K documents dashing. May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

If you discuss starting a MCB I would suggest you talk about Spirolactone since Eplerenone is still nonformularly at the VA. I talked with Dr. Webster about it and she said for that reason the request would have to come from Neperology. (I already had an appt. with them scheduled for next week so will discuss it then.)

- 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.

> > >> >

> > >> > A basic metabolic panel has 6 analytes.

> > >> >

> > >> > So don't know how you are counting?

> > >> >

> > >> > CE Grim MD

> > >> > O

October 29, 2011

Actually if one calculates all the permutations and. Combinations of Bp drugs it is over a million so you will never live long enough to try them all. When inSee to lecture about this I would say if you treat HTN you can always say we have not tried everything yet. May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Marchelle, you don't have resistance to BP medications, you have PA and a low renin - it usual reaction for most of us to almost ANY BP medications, except spiro and Inspra :-)As for Francis, I was on lisinopril also. It did the same for me as for Marchelle. And, BTW, there are maybe 1000 more BP medications and they produce every year new ones, so calculate if you have enough time in your life to try all combinations of all of them:-) I am not trying to be mean, I am just trying to convince you, that you have to trust yourself, Dr. Grim and us, not your previous, current and future doctors:-) Natalia Kamneva To: "hyperaldosteronism " <hyperaldosteronism >Sent: Friday, October 28, 2011 7:57 PMSubject: Re: Re: Francis - New PCP

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 29, 2011

Ah but she does have resistance to the usual ones used today. It just happens to be do to PA. There Are a number of other causes of resistance as noted in JNC 7IMay your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Marchelle, you don't have resistance to BP medications, you have PA and a low renin - it usual reaction for most of us to almost ANY BP medications, except spiro and Inspra :-)As for Francis, I was on lisinopril also. It did the same for me as for Marchelle. And, BTW, there are maybe 1000 more BP medications and they produce every year new ones, so calculate if you have enough time in your life to try all combinations of all of them:-) I am not trying to be mean, I am just trying to convince you, that you have to trust yourself, Dr. Grim and us, not your previous, current and future doctors:-) Natalia Kamneva To: "hyperaldosteronism " <hyperaldosteronism >Sent: Friday, October 28, 2011 7:57 PMSubject: Re: Re: Francis - New PCP

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 29, 2011

She knows all about that and made comments in my record re gynecomastia and

diarreha if my 25mg doses aren't close to exactly 12 hours apart. Believe it or

not, the VA has rules and one of those apparently says the change must be RXed

by a Neprologist. She was even going to set up a consult until she saw I had an

appt in a week.

I just thought I would give Francis a headsup since he appears to have so much

trouble getting any satisfaction from the VA. (No need to start with a

formulary argument!)

- 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.

> > > > >> >

> > > > >> > A basic metabolic panel has 6 analytes.

> > > > >> >

> > > > >> > So don't know how you are counting?

> > > > >> >

> > > > >> > CE Grim MD

> > > > >> > O

>

October 30, 2011

Usually one may rotate thru VA as part of residency. But should be having work reviewed by a staff person if in a Residency Training program.On Oct 29, 2011, at 4:58 AM, Francis Bill SUSPECTED PA wrote: Will have to get his first name. He might have told me what it was but don't recall. Once I have this I will see if he has Dartmouth email. Or can get his VA email from my nephew. It seems he is at both the VA and Dartmouth. Didn't know that one did residency in both places. > > > >> >> > > > > > > > > >> >> > > > > > > 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 30, 2011

But all good internists and FP folks should really be hypertension experts as it is the most common chronic disease they will see or are seeing. Unfortunately most receive no special training in HTN and have probably not read any JNCs or the HTN Primer. Both can be certified in HTN by the Am SOC OF HTN by studying for an taking the exam. But hey! everyone knows how to treat HTN. Anyway some Nephs are also Boarded in HTN as are some Endos and some Cards. She knows all about that and made comments in my record re gynecomastia and diarreha if my 25mg doses aren't close to exactly 12 hours apart. Believe it or not, the VA has rules and one of those apparently says the change must be RXed by a Neprologist. She was even going to set up a consult until she saw I had an appt in a week. I just thought I would give Francis a headsup since he appears to have so much trouble getting any satisfaction from the VA. (No need to start with a formulary argument!) - 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. > > > > >> > > > > > >> > A basic metabolic panel has 6 analytes. > > > > >> > > > > > >> > So don't know how you are counting? > > > > >> > > > > > >> > CE Grim MD > > > > >> > O >

October 30, 2011

He didn't take much history He had read what was in my record. Did ask about the

recent ED visit and how my shortness of breath was doing. Got to see this a bit

as taking off my shoes was enough to bring it on. He also got to see the shaking

(Kinetic Activity) thing I get.

It was not very long into the visit when I asked about PA. He really has no

ideas except my weight. Have a B/P check on the 10th doing this to see how

changing meds are working.

Did have blood test for HbA1C no results yet. Wants me to talk with the behaver

modification person. Will see how this goes maybe I can get them to believe

there is really something wrong like PA. Next PCP appt will be in 4 months.

Not likely to get referral until Dr thinks PA.

> > > > >> > > > > >

> > > > >> > > > > > > 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 30, 2011

The B/P is the first reading. Nurse took it again and said the first one was

better so that is the one she put down. The set up

for nurses visit at least for the office I was in has changed. No longer sit at

desk. The automatic B/P device is a few feet

from desk does have are rest on it.

Before B/P was taking was given some hand outs. I am holding them in left hand

nurse put cuff right on arm over my shirt than

tells me she is going to take temp in my ear while the B/P is being taking.

Problem is I have a hearing aid in both ears she is

on my left side and asks me to take out the left aid. To do this I have to

change handouts to right hand. so I have papers in

same hand as the side B/P is and hearing aid in other side with my Temp being

taking in the ear. sounds like a good set up to

get bad B/P readings.

Dr did take B/P while I was sitting on table with legs handing and him holding

my arm.

Note what a said is B/P has been as high as 199/100.

I think I depends on what information Dr grim has to look at. A B/P reading of

199/100 by it's self can indicate PA the K drop

from 4.3 to 3.2 after being started 25 MG of HYDROCHLOROTHIAZIDE and the 2 cm

tumor on left adrenal gland would also indicate

PA. And Dr grim isn't a big believer in PRA of a certain amount Per posting in

the past two weeks. Just that low rennin and

somewhat high Aldo looks like PA to him. so he made an educated guess. Still

needs to be proved.

Beta blockers like atenolol can lower both aldo and renin. Diuretics can

increase both.

VA test Blood Drawn 12/24/2008 14:19. Dartmouth test Blood drawn 03/03/2009 at 3

PM.

> > > > >> > > > > >

> > > > >> > > > > > > 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 30, 2011

Every resident I have been treated by at the VA has had every treatment reviewed

by his/her supervisor. Often they have to consult with super before final DX.

The supervising eye doctor almost always personally examines my left eye which

is constantly a challenge.

- 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 30, 2011

You bet your Bippy I would get a referral to Neperology if I had an unexplained

tumor in my adrenal and another in my kidney! I would be surprised if on

desk 80 couldn't give you some direction (Dr. Robey called me within a half hour

after I told her I wasn't happy!) If she can't, I would be surprised if Dr.

Robey would ignore it if you told him you were not satisfied with what you are

being told about youe kidney problems and would like a second professional

opinion.

Now, if you go in and say, " I think I have PA and I want my tumors checked " , all

bets are off. Make them start at ground zero and tell you what is going on!

- 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 30, 2011

No Shit, your BP was higher the second time! You were already pissed since she

had done everything wrong! You need to become noncomplient when she asks you to

do something wrong like move, change hands, remove hearing aids, etc as she is

taking your BP! DON'T DO IT! What is she going to do about it if you just sit

there? When Kalie tries to take my temp. while taking BP and finds a hearing

aid she just steps back and says, " I'll wait " .

And she took it over your shirt? Who's fault is that? Why did you allow it?

" No problem baring my arm, I want an accurate bp reading! " If she comes back

with anything, ask her to see it in the operators manual! Wonder why your BP

was up for second reading, mine is up just thinking about it!

I did note you said " as high as 199/100 " and I asked what it was currently. Do

you remember what you said? (I have an issue so auto BP machines may not be

accurate. I have hearing aids so I can't use a manual cuff. I never saw a

different number!)

BTW, I once weighed 115 lbs.!

- 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 30, 2011

I would suggest that if BP is not at goal you would like to try spironolactone as you have been reading about its use in drug resistant HTN(uncontrolled on / meds) and you have an adrenal bump on CT. All good reasons to give Spiro a trial. Then ask for the reasons it should not be tried in your situation. Finally ask what does this Dr think the bump is doing?May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension

He didn't take much history He had read what was in my record. Did ask about the recent ED visit and how my shortness of breath was doing. Got to see this a bit as taking off my shoes was enough to bring it on. He also got to see the shaking (Kinetic Activity) thing I get.

It was not very long into the visit when I asked about PA. He really has no ideas except my weight. Have a B/P check on the 10th doing this to see how changing meds are working.

Did have blood test for HbA1C no results yet. Wants me to talk with the behaver modification person. Will see how this goes maybe I can get them to believe there is really something wrong like PA. Next PCP appt will be in 4 months.

Not likely to get referral until Dr thinks PA.

> > > > >> > > > > >

> > > > >> > > > > > > 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 30, 2011

If BP AT GOAL and you are feeling well then I would sit tight. Tell us about thur shaking. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension

He didn't take much history He had read what was in my record. Did ask about the recent ED visit and how my shortness of breath was doing. Got to see this a bit as taking off my shoes was enough to bring it on. He also got to see the shaking (Kinetic Activity) thing I get.

It was not very long into the visit when I asked about PA. He really has no ideas except my weight. Have a B/P check on the 10th doing this to see how changing meds are working.

Did have blood test for HbA1C no results yet. Wants me to talk with the behaver modification person. Will see how this goes maybe I can get them to believe there is really something wrong like PA. Next PCP appt will be in 4 months.

Not likely to get referral until Dr thinks PA.

> > > > >> > > > > >

> > > > >> > > > > > > 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 30, 2011

Francis, do you keep your own daily record of your BP? Mine always runs high when near a white coat. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Francis Bill SUSPECTED PA The B/P is the first reading. Nurse took it again and said the first one was better so that is the one she put down. The set up for nurses visit at least for the office I was in has changed. No longer sit at desk. The automatic B/P device is a few feet from desk does have are rest on it. Before B/P was taking was given some hand outs. I am holding them in left hand nurse put cuff right on arm over my shirt than tells me she is going to take temp in my ear while the B/P is being taking. Problem is I have a hearing aid in both ears she is on my left side and asks me to take out the left aid. To do this I have to change handouts to right hand. so I have papers in same hand as the side B/P is and hearing aid in other side with my Temp being taking in the ear. sounds like a good set up to get bad B/P readings. Dr did take B/P while I was sitting on table with legs handing and him holding my arm. Note what a said is B/P has been as high as 199/100. I think I depends on what information Dr grim has to look at. A B/P reading of 199/100 by it's self can indicate PA the K drop from 4.3 to 3.2 after being started 25 MG of HYDROCHLOROTHIAZIDE and the 2 cm tumor on left adrenal gland would also indicate PA. And Dr grim isn't a big believer in PRA of a certain amount Per posting in the past two weeks. Just that low rennin and somewhat high Aldo looks like PA to him. so he made an educated guess. Still needs to be proved. Beta blockers like atenolol can lower both aldo and renin. Diuretics can increase both. VA test Blood Drawn 12/24/2008 14:19. Dartmouth test Blood drawn 03/03/2009 at 3 PM. .

October 31, 2011

Don't know which arm is highest as it has never been checked.

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

> > > > > > >> > > > > > > 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 31, 2011

B/P has been recorded as low as 124/78 at VA. Who and what and when is taking

B/P it can very a lot. Since I have more higher then lower readings I can assume

It is high. Just how high is the question.

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

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