Re: Re: So here is something that is bugging me a bit

[Guest guest]

When I express some kind concern about possibility of an illness, my doc

immediately writes lab requisition for necessary tests and the matter is

sorted out in no time. This way he I covered and I am satisfied. I even

asked him to replace my medications with what I wanted and he did although

once complained as though I was challenging his intelligence! This was years

before he finally suspects I have PA and he was just shuffling medication

combos and I also joined in to find info on drugs and make my suggestions.

After Spiro and finally control of BP no longer I needed to make such

suggestions.

Max.

|My upfront test was borderline, but the salt ýloading test left no doubt.

Couldn't

|someone ask a doctor to do a confirmation test of some sort? ý

|

|

|

[Guest guest]

We need a politician or sports figure or celebrity to have PA so we can get some headlines. So every one keep our eyes and ears open. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension

It sounds like getting tested, in and of itself, is the problem for some people - their docs refuse to order the tests.

When I showed up at my last (now fired) doctor's office asking him to order the blood test for the ARR, he refused. I was incredibly fortunate in that I was able to go doctor-shopping until I found one who would order the tests; some people here, depending on the type of insurance they have, do not have this freedom.

And that's a crying shame.

-msmith1928

Nulliparous female, 46, 5'3", 115 lbs, CT showed 1cm left adrenal nodule, AVS determined disease is unilateral, had left laparoscopic adrenalectomy on 10/13/2011. Low sodium, fructose- and grain-free diet due to hereditary fructose intolerance, lactose intolerance, gluten intolerance (probable celiac).

>

> Many people on here seem to argue with each other regarding whether or not they actually have PA. It occurred to me today that all the mystery is taken out of diagnosis with simple confirmation tests. There seem to be plenty of tests such as salt loading etc. that could either diagnose or rule out PA. I know when I was diagnosed the salt loading test confirmed my PA. My endo was a skeptic at Mayo until the salt loading results. There is now no doubt that I have PA. Why wouldn't one get confirmation testing of some sort. I know that salt loading can be torturous, but there are other tests that are easier on the body. I guess I just don't get all of the arguing over something that seems like it would be so simple. Get tested and you either have PA or you don't.

>

> What am I missing?

>

[Guest guest]

Depends on what one calls borderline. Again my approach is to, even in boring folks to recommend DASH and MCB trial. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension

It is a shame! Personally I would call every doctor allowed in my network and ask their office point blank if they are willing to test me for PA if I was in their shoes.

I know how challenging it can be. My doc at Mayo told me he would be shocked if I had PA. He agreed to test me to get me to shut up about it for the most part. My upfront test was borderline, but the salt loading test left no doubt. Couldn't someone ask a doctor to do a confirmation test of some sort?

> >

> > Many people on here seem to argue with each other regarding whether or not they actually have PA. It occurred to me today that all the mystery is taken out of diagnosis with simple confirmation tests. There seem to be plenty of tests such as salt loading etc. that could either diagnose or rule out PA. I know when I was diagnosed the salt loading test confirmed my PA. My endo was a skeptic at Mayo until the salt loading results. There is now no doubt that I have PA. Why wouldn't one get confirmation testing of some sort. I know that salt loading can be torturous, but there are other tests that are easier on the body. I guess I just don't get all of the arguing over something that seems like it would be so simple. Get tested and you either have PA or you don't.

> >

> > What am I missing?

> >

>

[Guest guest]

My story is just like yours given the spiro worked right away (and should say each time I gave in and tried HCTZ I was in the hospital). They did do the labs, but didn't take me off the spiro due to the 180/140 on 5 meds the very day they started the spiro and it wasn't worth risking driving the pressure up again to stop the spiro. So the dx is made. But I don't have an adrenal anything - they say - on CT, but I do have a 1 cm cyst on the kidney, but they don't say if it's dense, hypodense, etc. and no talk of looking furhter at the cyst so far.

Subject: Re: So here is something that is bugging me a bitTo: hyperaldosteronism Date: Thursday, November 3, 2011, 7:26 PM

In my case the Neprologist used a 25mg of Spiro as his first test. (There was a 3 1/2 year old lab test of extremely low renin.) When BP dove down to normal he was satisfied and labeled it PA. Another Neper ordered more tests to satisfy himself that nothing else was going on because I was still considering surgery. I never had salt loading or anything else because whatever you want to call it, it responds very well to Spiro and DASH! the only thing I still need to consider if the tumor is growing. It was "unchanged" at 3 1/2 years so I guess I need to check again in 5 years, if I remember! :>) - 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.

>> Many people on here seem to argue with each other regarding whether or not they actually have PA. It occurred to me today that all the mystery is taken out of diagnosis with simple confirmation tests. There seem to be plenty of tests such as salt loading etc. that could either diagnose or rule out PA. I know when I was diagnosed the salt loading test confirmed my PA. My endo was a skeptic at Mayo until the salt loading results. There is now no doubt that I have PA. Why wouldn't one get confirmation testing of some sort. I know that salt loading can be torturous, but there are other tests that are easier on the body. I guess I just don't get all of the arguing over something

that seems like it would be so simple. Get tested and you either have PA or you don't.> > What am I missing?>

[Guest guest]

I personally cannot and will not understand this. Why they refuse, if there is no danger to the patient, to order a very reasonable request eludes me. Only ego is in the way as far as I can see

Subject: Re: So here is something that is bugging me a bitTo: hyperaldosteronism Date: Thursday, November 3, 2011, 6:47 PM

It sounds like getting tested, in and of itself, is the problem for some people - their docs refuse to order the tests.When I showed up at my last (now fired) doctor's office asking him to order the blood test for the ARR, he refused. I was incredibly fortunate in that I was able to go doctor-shopping until I found one who would order the tests; some people here, depending on the type of insurance they have, do not have this freedom.And that's a crying shame.-msmith1928Nulliparous female, 46, 5'3", 115 lbs, CT showed 1cm left adrenal nodule, AVS determined disease is unilateral, had left laparoscopic adrenalectomy on 10/13/2011. Low sodium, fructose- and grain-free diet due to hereditary fructose intolerance, lactose intolerance, gluten intolerance (probable celiac).>> Many people on here seem to argue with each other regarding whether or not they actually have PA. It occurred to me today that all the mystery is taken out of diagnosis with simple confirmation tests. There seem to be plenty of tests such as salt loading etc. that could either diagnose or rule out PA. I know when I was diagnosed the salt loading test confirmed my PA. My endo was a skeptic at Mayo until the salt loading results. There is now no doubt that I have PA. Why wouldn't one get confirmation testing of some sort. I know that salt loading can be torturous, but there are other tests that are easier on the body. I guess I just don't get all of the arguing over something that seems like it would be so simple. Get tested and you either have PA or you don't.> > What am I

missing?>

[Guest guest]

You most likely have either an adrenal adenoma too small to see or bilateral hyperplasia. I have seen them smaller than 1 mm in adrenals removed from pts with stage 1 or 2 PA. CE Grim MD My story is just like yours given the spiro worked right away (and should say each time I gave in and tried HCTZ I was in the hospital). They did do the labs, but didn't take me off the spiro due to the 180/140 on 5 meds the very day they started the spiro and it wasn't worth risking driving the pressure up again to stop the spiro. So the dx is made. But I don't have an adrenal anything - they say - on CT, but I do have a 1 cm cyst on the kidney, but they don't say if it's dense, hypodense, etc. and no talk of looking furhter at the cyst so far. Subject: Re: So here is something that is bugging me a bitTo: hyperaldosteronism Date: Thursday, November 3, 2011, 7:26 PM In my case the Neprologist used a 25mg of Spiro as his first test. (There was a 3 1/2 year old lab test of extremely low renin.) When BP dove down to normal he was satisfied and labeled it PA. Another Neper ordered more tests to satisfy himself that nothing else was going on because I was still considering surgery. I never had salt loading or anything else because whatever you want to call it, it responds very well to Spiro and DASH! the only thing I still need to consider if the tumor is growing. It was "unchanged" at 3 1/2 years so I guess I need to check again in 5 years, if I remember! :>) - 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. >> Many people on here seem to argue with each other regarding whether or not they actually have PA. It occurred to me today that all the mystery is taken out of diagnosis with simple confirmation tests. There seem to be plenty of tests such as salt loading etc. that could either diagnose or rule out PA. I know when I was diagnosed the salt loading test confirmed my PA. My endo was a skeptic at Mayo until the salt loading results. There is now no doubt that I have PA. Why wouldn't one get confirmation testing of some sort. I know that salt loading can be torturous, but there are other tests that are easier on the body. I guess I just don't get all of the arguing over something that seems like it would be so simple. Get tested and you either have PA or you don't.> > What am I missing?>

[Guest guest]

Because u are now feeling much better I would talk to psych re depression meds May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension

The answer is simple, it keeps the PTN "pissed off" which raises the BP which causes more BP meds to be dispensed which keeps the drug companies happy. If totally effective it will cause Clinical Depression which keeps the "Psyco Docs" employed and my Cymbalta costs $796/qtr which makes the drug companies really happy! See, everybody is happy (well almost everyone!) IMHO

- 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.

> >

> > Many people on here seem to argue with each other regarding whether or not they actually have PA. It occurred to me today that all the mystery is taken out of diagnosis with simple confirmation tests. There seem to be plenty of tests such as salt loading etc. that could either diagnose or rule out PA. I know when I was diagnosed the salt loading test confirmed my PA. My endo was a skeptic at Mayo until the salt loading results. There is now no doubt that I have PA. Why wouldn't one get confirmation testing of some sort. I know that salt loading can be torturous, but there are other tests that are easier on the body. I guess I just don't get all of the arguing over something that seems like it would be so simple. Get tested and you either have PA or you don't.

> >

> > What am I missing?

> >

>

[Guest guest]

It has an indication for chronic back pain now too. Not sure I can recall anyone on it for that, but wonder if it really helps

Subject: Re: So here is something that is bugging me a bitTo: hyperaldosteronism Date: Friday, November 4, 2011, 10:52 PM

I reported the elimination of Mirtazpine a few weeks ago. struggled a little with that one and decided to hold tight on the Cymbalta for now. PTSD claim is coming to a close with physical scheduled for Monday. Then starting a "Cognitive Processing Therapy" session later this month. Also, since it is used for DM neuropathy so need to figure out how that fits in. Probably not the right time to make too many changes until I find out how I handle some of this! - 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. > > > >> > > > Many people on here seem to argue with each other regarding whether or not they actually have

PA. It occurred to me today that all the mystery is taken out of diagnosis with simple confirmation tests. There seem to be plenty of tests such as salt loading etc. that could either diagnose or rule out PA. I know when I was diagnosed the salt loading test confirmed my PA. My endo was a skeptic at Mayo until the salt loading results. There is now no doubt that I have PA. Why wouldn't one get confirmation testing of some sort. I know that salt loading can be torturous, but there are other tests that are easier on the body. I guess I just don't get all of the arguing over something that seems like it would be so simple. Get tested and you either have PA or you don't.> > > > > > > > What am I missing?> > > >> > >> > > >>

[Guest guest]

Right. Suspect low K may have aggravated Neuropathy. Keep us posted. . . May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension

I reported the elimination of Mirtazpine a few weeks ago. struggled a little with that one and decided to hold tight on the Cymbalta for now. PTSD claim is coming to a close with physical scheduled for Monday. Then starting a "Cognitive Processing Therapy" session later this month. Also, since it is used for DM neuropathy so need to figure out how that fits in. Probably not the right time to make too many changes until I find out how I handle some of this!

- 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.

> > > >

> > > > Many people on here seem to argue with each other regarding whether or not they actually have PA. It occurred to me today that all the mystery is taken out of diagnosis with simple confirmation tests. There seem to be plenty of tests such as salt loading etc. that could either diagnose or rule out PA. I know when I was diagnosed the salt loading test confirmed my PA. My endo was a skeptic at Mayo until the salt loading results. There is now no doubt that I have PA. Why wouldn't one get confirmation testing of some sort. I know that salt loading can be torturous, but there are other tests that are easier on the body. I guess I just don't get all of the arguing over something that seems like it would be so simple. Get tested and you either have PA or you don't.

> > > >

> > > > What am I missing?

> > > >

> > >

> >

> >

>

[Guest guest]

As I recall metformin has been implicated in hyponat. CE Grim MD They did a urine test but apparently missed the request for for Na and K so I didn't get those numbers. Plasma K was 4.6 (3.5-5.0) if that makes any difference. (It's usually 4.8.) I have NEVER had any indication of Low K. - 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. > > > > > > > > > > > > Many people on here seem to argue with each other regarding whether or not they actually have PA. It occurred to me today that all the mystery is taken out of diagnosis with simple confirmation tests. There seem to be plenty of tests such as salt loading etc. that could either diagnose or rule out PA. I know when I was diagnosed the salt loading test confirmed my PA. My endo was a skeptic at Mayo until the salt loading results. There is now no doubt that I have PA. Why wouldn't one get confirmation testing of some sort. I know that salt loading can be torturous, but there are other tests that are easier on the body. I guess I just don't get all of the arguing over something that seems like it would be so simple. Get tested and you either have PA or you don't. > > > > > > > > > > > > What am I missing? > > > > > > > > > > > > > > > > > > > > > > > > > > >