Re: Dash vs Surgery and Dr. Grim

[Guest guest]

The only problem with this thinking is this: Dr. Grim does not see us as the

individuals that we are. Nor should he, if we aren't paying him - I certainly

don't expect that level of personal care for free.

However, knowing the INDIVIDUAL needs to be part of the process of giving sound

medical advice.

Take two patients who have a medical condition: let's say, hyperaldosteronism.

Patient A has a tumor and has had AVS that has shown it is lateralized. She is

(relatively) young, active, and otherwise healthy. She has tried MCBs and they

make her feel terrible and detract enormously from her quality of life.

Patient B does not show lateralization. She has other health issues, already

takes medication, and has higher risk factors for surgery than Patient A does.

Maybe she admits that her diet is not the best. She has tried MCBs and finds the

side effects tolerable.

Is the same treatment really the best approach to both patients?

 

> Doesnt Dr. Grim have alot of insight as to how best to deal with this disease?

I mean, who else has spent their career studying it? Seriously, is there anyone

else?

> If his recommendations are based on his lifes work, can we really argue it?

[Guest guest]

All very logical, and I would agree with the general premise except for one

thing: the professional literature all says that the longer one has had PA, the

more chance there is that surgery will not be successful. So, if this is a

concern, perhaps Patient A may not want to take the time to try MCBs and DASH if

she really does appear to be a good surgical candidate.

> > 

> >> Doesnt Dr. Grim have alot of insight as to how best to deal with this

disease? I mean, who else has spent their career studying it? Seriously, is

there anyone else?

> >> If his recommendations are based on his lifes work, can we really argue it?

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[Guest guest]

Point in question, does it say has had PA or has had UNCONTROLLED PA? I ask

this before looking but wonder if my heart is better today than a year ago. I

suspect we may also see improvement in other systems if I can convince the VA to

test but it may still be early.

I don't see how many studies can offer surgery or meds as being the same if Pa

continues to progress but that is just logic which sometimes fails me in

medicine!

- 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.

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> > >> Doesnt Dr. Grim have alot of insight as to how best to deal with this

disease? I mean, who else has spent their career studying it? Seriously, is

there anyone else?

> > >> If his recommendations are based on his lifes work, can we really argue

it?

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[Guest guest]

Thanks for the feedback. I get my kicks out of this group because I am able to help many folks in with my expertise and experience.Would be better if I could get paid for it and a few do consult with me personally. Until that keeps me so busy I cant do this I will keep doing this. I suspect thru this group I have interacted with more pts with PA than almost anyone else in the world. That is a kick.Now lets do some pulling together of the experience and publish it for the world to see.CE Grim MD I saw alot of comments about bias on the site against surgery lately, and I have to ask a few questions: Doesnt Dr. Grim have alot of insight as to how best to deal with this disease? I mean, who else has spent their career studying it? Seriously, is there anyone else?If his recommendations are based on his lifes work, can we really argue it? I dont see how he can be thrown under the bus when he has no financial gain to blame for his recommendation seemingly bias toward DASH. What does he have to gain by recommending medication and lifestyle changes vs risking your life under the knife?My endo thinks Dr grim is very generous with his knowledge sharing when he isnt gaining financially. Most would not do that. What really is a worthy question of Dr Grim is to simply ask, what makes him give a crap about any of us? And why does he do it for nothing? I am probably not a canidate to risk AVS/Surgery becuase I dont have a visable tumor, and my BP is well controlled using MCBs and low sodium diet.I have been reflecting on this for sometime. I would take the gyno over the risk of a failed surgery any day. I am not going to die from gyno. And since it sounds like alot of those who choose surgery end up back on meds anyway, why take that risk? I dont like the DASH prescription, but since Dr Grim has spent his lifes work on this subject, and isnt benefiting financially from his recommendation, I cant find fault it it. It just makes logical sense to me to heed that advice as best I can. I wont pursue surgery option unless diet and MCBs fail. I dont see that as a bias, I see it as a good course of action recommended to me by someone who knows a heck of alot more about the subject than i ever will. But...that is just me. We all have to make our choices. ============================================================================45-Male-Caucasian, 5'9"- 242lbs, PA Diagnosed 2007 Suspected Hyperplasia-No tumors on CT - No AVS.Meds: 50mg Inspra, 40meq Potassium, 2400mg Calcium, 1000mg Magnesium, 100,000UI Vit D (weekly), 20mg OmeprazoleSide effects: Gynecomastia, stomach inflammation (from potassium citrate)Other Diags: GERD, Hiatal Hernia, Metabolic Syndrome - PreDiabetic, Secondary Hyperparathyroidism caused by Renal calcium leak, Bone Cyct in left Femoral Head and Pelvis. Benign Lung Nodules, Fibromyalgia, Scarring on Right Kidney Lower Pole, Right Flank PainDASH: Started "sort of" DASHing 5/3/2011Status: Last Urine K/Na ratio was 1.1. But total of Na high alsoInitial Presenting Symptom: Muscle twitching all over body with low normal K, Mg, Ca, Low Ionized Ca, High PTH, low Vitamin D

[Guest guest]

1) While possibly outdated, you'll find charts on the internet that recommend

Adrenalectomy without AVS for people under 40.

2) While I agree that AVS and Adrenalectomy are not without risks, I think that

we are not considering the risks of the MCBs. There are risks for both

Spironolactone and Eplerenone; including: hyperkalemia, misc drug interactions,

risk of bleeding from stomach and duodenum, ED, rashes, suspected

carcinogenicity. So it's not just Gynecomastia.

In fact I bet if you ask most doctors weather they are more likely to trust a

physical cure (i.e. removing a redundant organ) vs. a medicinal cure, the would

probably trust the physical. Who knows what sort of undocumented side effects

these MCBs have? i.e. Actos pulled of the market for links with bladder cancer.

fen/phen for Mitral valve malfunction. The list goes on.

3) Lastly, while I'm sure everybody here appreciates and respects Dr. Grims

experience and knowledge, (I certainly do) I for one object to your contention

that unless you have a lifetimes worth of experience on PA that you have nothing

to say/contribute on the matter.

> > 

> >> Doesnt Dr. Grim have alot of insight as to how best to deal with this

disease? I mean, who else has spent their career studying it? Seriously, is

there anyone else?

> >> If his recommendations are based on his lifes work, can we really argue it?

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[Guest guest]

Many do not take meds as directed. Some do it do to cost. Some because of side

effects. Some just forget.

There are some big risks that come with surgery Some of the tools they use for

keyhole surgery can malfunction and cause a lot of damage.

If I was less then 40 and AVS showed there was a chance of cure with surgery I

most likey would have it.

It is not easy to to DASH for any one. I am not there yet. Sodium hides every

where. I also have problems shopping becomes very frustrated when idem isn't

where I think it is. Also supper size stores can be overwhelming.

This didn't used to be a problem for me until I got brain fog.

> >

> > 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

> >

>

[Guest guest]

AFAIR, they say PA - straight out whether controlled by drugs or not. Becuase

actually the meds just mask the effect of PA on BP (as does DASH). That little

tumour is still there churning out its aldosterone and underproducing renin. And

I couldn't find anything about what else these hormones do in your body - what

is the impact beyond BP? BUT the issues associated with BP are fine if your BP

is fine - and hopefully your heart is great ;-)

So in may case I most definitely didn't wait until meds and DASH had failed - my

BP was under control. But the PubMed literature that I found (also published by

people with a lifetime of experience in PA, even if that professional life is

somewhat shorter than Dr.Grim to date) indicated that the sooner, the better, as

far as the prognosis of surgery was concerned. If you wait until it is no longer

controlled by meds, the outcome is less likely to be successful. And the older

you are and the iller you are, the greater the risks of surgery. So I couldn't

see any reason to wait. If surgery had not succeeded, I'd have had to take meds

for life - but I was going to have to do that anyway.

So I completely agree with msmith (again) that it has to be tailored to the

individual. There are many on here who are not good candidates for surgery -

either because surgery itself would be a threat or because the disease has not

lateralised - and for sure the knowledge of DASH and meds is life saving. But

there are some for whom surgery CAN cure. And in those cases, it could actually

be the wrong advice (based on the research I've read) to keep DASHing and

medication until it fails.

H

> > > > 

> > > >> Doesnt Dr. Grim have alot of insight as to how best to deal with this

disease? I mean, who else has spent their career studying it? Seriously, is

there anyone else?

> > > >> If his recommendations are based on his lifes work, can we really argue

it?

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[Guest guest]

From the research I've done on PA it seems to me:

For hypovolemic rather than hypertensive PA: (yes this does exist - I have it!)

DASH = makes it worse

For hypertensive (*normal*) PA:

DASH = better than nothing/misdiagnosis

DASH + Spiro/Eplerone = better and might be enough

DASH + meds if no good then surgery = compromise

DASH + meds + surgery and tumour returns = a genetic susceptibility to tumours

NOT THE MEDS MAKING THEM RETURN whatever the research on rodents says

Bottomline is: listen to everyone's opinion, even the 'experts' and then at the

end of the day do what works for YOU - since you may have an unusual form of PA

that so far has not come up and you may need tailor made treatment.

> > >

> > > 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

> > >

> >

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[Guest guest]

Hi, sorry I have been meaning to come back and post more but have been on the

phone for the past 3 days trying to chase up my case with my endos. Will

describe what I mean by this and the other stuff I talked about as soon as get

off the phone...

> > > > >

> > > > > 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

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