Guest guest Posted October 12, 2011 Report Share Posted October 12, 2011 wasn't directed at anyone in particular, just the comment. Didn't know it was personal. Many on here, with normal diets, have said they wont DASH at various times. Thought that is what you meant. Subject: Re: failureTo: hyperaldosteronism Date: Wednesday, October 12, 2011, 12:33 PM Not sure if you're generalizing or directing the "we" at me, so let me start by saying my response is assuming the latter. So are you saying the fact that I was born with a metabolic disorder that prevents me from eating K-rich foods means I've "failed?"I've avoided salt all of my life - hate salty foods, hate junk foods, and have never eaten in a fast food restaurant. It's not that simple - "we" don't "all" love this stuff.The people who "love" this stuff are making a *choice* every time they reach for the junk/processed foods over something natural and low-sodium.But the fact that I can't eat a tomato without it resulting in severe vomiting and diarrhea (and potential future liver damage) isn't a *choice*. And neither is it a *failure*.Perhaps I'm being too literal. But the entire time I've been with this group, this whole "failure to DASH" thing has made me feel like a real loser every time those words have appeared in a response to one of my inquiries.> > >> > > Well if the medical team has documented that either has failed to DASH > > > and take meds as directed then I would also recommend surgery.> > > > > > You seem to leave out one of the key messages here. If you DASH and > > > fail to get to DASH GOALS and despite repeated urine testing that > > > shows you cant do this then I would also recommend surgery after AVS. > > > If AVS does not lateralize and BP cannot be controlled on meds and > > > DASH then one can also do bilateral adrenalectomy which I have > > > recommended and seen successful results but then medical management > > > becomes a real task for both the pt and the team including more > > > careful dietary management to prevent sudden death from Addision's.> > > > > > I have been there and done that and rarely recommend this now.> > > > > > CE Grim MD> > >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 12, 2011 Report Share Posted October 12, 2011 We know your story. Thought you were suggesting an over generalization - not just your case. Sorry. Subject: Re: failureTo: hyperaldosteronism Date: Wednesday, October 12, 2011, 12:33 PM Not sure if you're generalizing or directing the "we" at me, so let me start by saying my response is assuming the latter. So are you saying the fact that I was born with a metabolic disorder that prevents me from eating K-rich foods means I've "failed?"I've avoided salt all of my life - hate salty foods, hate junk foods, and have never eaten in a fast food restaurant. It's not that simple - "we" don't "all" love this stuff.The people who "love" this stuff are making a *choice* every time they reach for the junk/processed foods over something natural and low-sodium.But the fact that I can't eat a tomato without it resulting in severe vomiting and diarrhea (and potential future liver damage) isn't a *choice*. And neither is it a *failure*.Perhaps I'm being too literal. But the entire time I've been with this group, this whole "failure to DASH" thing has made me feel like a real loser every time those words have appeared in a response to one of my inquiries.> > >> > > Well if the medical team has documented that either has failed to DASH > > > and take meds as directed then I would also recommend surgery.> > > > > > You seem to leave out one of the key messages here. If you DASH and > > > fail to get to DASH GOALS and despite repeated urine testing that > > > shows you cant do this then I would also recommend surgery after AVS. > > > If AVS does not lateralize and BP cannot be controlled on meds and > > > DASH then one can also do bilateral adrenalectomy which I have > > > recommended and seen successful results but then medical management > > > becomes a real task for both the pt and the team including more > > > careful dietary management to prevent sudden death from Addision's.> > > > > > I have been there and done that and rarely recommend this now.> > > > > > CE Grim MD> > >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 12, 2011 Report Share Posted October 12, 2011 Failure to dash must be documented by urine testing For both Na and K. However the most important part is likely the low Na part in PA esp if Low blood K has not been a problem. If one cannot get K from food sources then tabs are available but they haves documented risk of GI upset and bleeding. Some also co contain Chloride which also may play a role in the increased BP caused by NaCl. Indeed inthe days before we could measure Na we measured ÇL in the urine. Dr Kempner started with this. One can even due this in the home buy using the Fantus test or by the dipsticks we have discussed here before bTiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension wasn't directed at anyone in particular, just the comment. Didn't know it was personal. Many on here, with normal diets, have said they wont DASH at various times. Thought that is what you meant. Subject: Re: failureTo: hyperaldosteronism Date: Wednesday, October 12, 2011, 12:33 PM Not sure if you're generalizing or directing the "we" at me, so let me start by saying my response is assuming the latter. So are you saying the fact that I was born with a metabolic disorder that prevents me from eating K-rich foods means I've "failed?"I've avoided salt all of my life - hate salty foods, hate junk foods, and have never eaten in a fast food restaurant. It's not that simple - "we" don't "all" love this stuff.The people who "love" this stuff are making a *choice* every time they reach for the junk/processed foods over something natural and low-sodium.But the fact that I can't eat a tomato without it resulting in severe vomiting and diarrhea (and potential future liver damage) isn't a *choice*. And neither is it a *failure*.Perhaps I'm being too literal. But the entire time I've been with this group, this whole "failure to DASH" thing has made me feel like a real loser every time those words have appeared in a response to one of my inquiries.> > >> > > Well if the medical team has documented that either has failed to DASH > > > and take meds as directed then I would also recommend surgery.> > > > > > You seem to leave out one of the key messages here. If you DASH and > > > fail to get to DASH GOALS and despite repeated urine testing that > > > shows you cant do this then I would also recommend surgery after AVS. > > > If AVS does not lateralize and BP cannot be controlled on meds and > > > DASH then one can also do bilateral adrenalectomy which I have > > > recommended and seen successful results but then medical management > > > becomes a real task for both the pt and the team including more > > > careful dietary management to prevent sudden death from Addision's.> > > > > > I have been there and done that and rarely recommend this now.> > > > > > CE Grim MD> > >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 12, 2011 Report Share Posted October 12, 2011 Well it may be a failure of the Dr to sell the importance of the diet. One way I have found useful is to have them buy or give then the DASH BOOK. This is a real eye-opener for some and they can make changes. ESP of they are the food preparer.Next I show them how to rad labels. Then I check the urine Na K before insee them and in the VA system I can sit with them and show the urine plots for feed back. I was amazed at how well some single vets were able to do if they got good guidance and monitoring. However if they do not have to eat out. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension That's a whole other story: if someone refuses to comply with dietary change just because they want their junk food, then yes, FAILURE is the only word for it > > > > > > > > Well if the medical team has documented that either has failed to DASH > > > > and take meds as directed then I would also recommend surgery. > > > > > > > > You seem to leave out one of the key messages here. If you DASH and > > > > fail to get to DASH GOALS and despite repeated urine testing that > > > > shows you cant do this then I would also recommend surgery after AVS. > > > > If AVS does not lateralize and BP cannot be controlled on meds and > > > > DASH then one can also do bilateral adrenalectomy which I have > > > > recommended and seen successful results but then medical management > > > > becomes a real task for both the pt and the team including more > > > > careful dietary management to prevent sudden death from Addision's. > > > > > > > > I have been there and done that and rarely recommend this now. > > > > > > > > CE Grim MD > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 12, 2011 Report Share Posted October 12, 2011 You can access the web at the VA COMPUTER to look things up. They do not have an automatic flag that says this pt has drug resistant HTN AND LOW K think PA. I think I sent in one of the updates abstracts from a VA in CA That searched for all drug resistant pts and tested them for PA WITH renin and Aldo. As I recall over 20% had prob PA. You AND SEE IF IT TURNS UP do a pub med on primary Aldo and VA Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension The VA system is only as good as the care provider wants it to be. I asked you this before but didn't get an answer. I have seem where the provider needed more information about what they thought was my problem within a very short time IE tooth infection they had the information on the screen. Does the VA system have this built into it or is it something the provider is looking at outside the VA? You would think if if the VA system has this information in it then would be very easy to find information about PA. > > > > > > > > > > > > Well if the medical team has documented that either has failed to DASH > > > > > > and take meds as directed then I would also recommend surgery. > > > > > > > > > > > > You seem to leave out one of the key messages here. If you DASH and > > > > > > fail to get to DASH GOALS and despite repeated urine testing that > > > > > > shows you cant do this then I would also recommend surgery after AVS. > > > > > > If AVS does not lateralize and BP cannot be controlled on meds and > > > > > > DASH then one can also do bilateral adrenalectomy which I have > > > > > > recommended and seen successful results but then medical management > > > > > > becomes a real task for both the pt and the team including more > > > > > > careful dietary management to prevent sudden death from Addision's. > > > > > > > > > > > > I have been there and done that and rarely recommend this now. > > > > > > > > > > > > CE Grim MD > > > > > > > > > > > > > > > > > > > > > > > Reply to sender | Reply to group | Reply via web post | Start a New Topic Messages in this topic (25) Recent Activity: New Members 3 New Files 1 Visit Your Group MARKETPLACE Stay on top of your group activity without leaving the page you're on - Get the Yahoo! Toolbar now. Switch to: Text-Only, Daily Digest • Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 12, 2011 Report Share Posted October 12, 2011 And why did they not act on this?Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension Wrong Answer! It said "Low-renin sodium/volume-mediated hypertension likely" and "Primary aldosteronism possible" right in my lab reports, not once but twice!(once in 2007 and again in 2010.) - 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): 125/73 Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD. Meds: Duloxetine hcl 80 MG, Mirtazapine 7.5 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG. > > > > > > > > > > > > > > > > Well if the medical team has documented that either has failed to DASH > > > > > > > > and take meds as directed then I would also recommend surgery. > > > > > > > > > > > > > > > > You seem to leave out one of the key messages here. If you DASH and > > > > > > > > fail to get to DASH GOALS and despite repeated urine testing that > > > > > > > > shows you cant do this then I would also recommend surgery after AVS. > > > > > > > > If AVS does not lateralize and BP cannot be controlled on meds and > > > > > > > > DASH then one can also do bilateral adrenalectomy which I have > > > > > > > > recommended and seen successful results but then medical management > > > > > > > > becomes a real task for both the pt and the team including more > > > > > > > > careful dietary management to prevent sudden death from Addision's. > > > > > > > > > > > > > > > > I have been there and done that and rarely recommend this now. > > > > > > > > > > > > > > > > CE Grim MD > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Reply to sender | Reply to group | Reply via web post | Start a New Topic > > Messages in this topic (25) > > RECENT ACTIVITY: New Members 3 New Files 1 > > Visit Your Group > > MARKETPLACE > > Stay on top of your group activity without leaving the page you're on - Get the Yahoo! Toolbar now. > > > > > > Switch to: Text-Only, Daily Digest • > Quote Link to comment Share on other sites More sharing options...
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