Re: Neperologist Appt. Update

[Guest guest]

Thanks, Francis....

> > > > >

> > > > > > Had a " Francis Experience " when tech wanted to take temp while

> > > taking BP! She started to head for my ear and I shook my head no.

> > > Continued and ran into hearing aid. Asked me to remove it and I shook

> > > head No again and held up 1 finger (index not middle). She got the

> > > message and waited!

> > > > > >

> > > > > > Saw Dr. K., the new Nepr. and you will never guess what his first

> > > question was: " So, have you got some BP charts for me? " Now there is a

> > > doctor that reviews the chart and obviously hasn't read the VA SOP

> > > manual! He thought he " could live with those numbers " and smiled when I

> > > asked if he thought I could!

> > > > > >

> > > > > > He then proceded to latest lab and said his only concern was my

> > > Carbon Dioxide numbers were going down (June 7=23, June 24=16, Oct 24=18

> > > range=20 - 30). He drew a picture and blamed it on low sodium causing

> > > excess acid (blood bicarbonate level HC03). Said he wasn't making

> > > changes today but wanted me to be aware since he would be making

> > > recomendations for a new med if the trend continues. Guess I've got some

> > > researching to do!

> > > > > >

> > > > > > We talked about switching from Spiro to Epler and he saiid that

> > > would have to come from an Endo! Love the runaround! He cautioned me

> > > that it might not resolve the Gynecomastia and did I know what the next

> > > step was. I asked if it was I shave my beard and buy a dress! I then

> > > told him as far as I know it was AVS and removal or live with it. He

> > > made an endo referral!

> > > > > >

> > > > > > In the 6months he's been gone he gained alot of people skills. I

> > > thought we had a good appt. and he seemed to know about the ACCORD study

> > > and had an understanding where JNC8 is headed.

> > > > > >

> > > > > > - 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.

> > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

[Guest guest]

This appears to be why the VA requires an Endo to RX Epler:

Eplerenone

Eplerenone is non-formulary, restricted to the following criteria:

(1) For essential hypertension, highly restricted to only those patients who

require treatment with an aldosterone blocker and cannot tolerate spironolactone

due to endocrine-related adverse events;

(2) For treatment of post-MI CHF, reserved for patients who are maximally

treated with all other medications known to affect the outcome of CHF (ACEIs,

ARBs, Beta-blockers, diuretics) and are unable to tolerate spironolactone due to

documented endocrine adverse events; and

(3) eplerenone may be considered as an alternative for a patient who develops

adverse events on spironolactone, who has a hyperaldosterone state such as

primary hyperaldosteronism or liver disease syndromes, and has intolerance to

amiloride with or without a diuretic.

January 2005 VISN 20 P & T

Looks like they stop reading at step 1! Dr. G., is step 3 a possible option? I

don't recall it being discussed here.

- 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.

> > > > >

> > > > > > Had a " Francis Experience " when tech wanted to take temp while

> > > taking BP! She started to head for my ear and I shook my head no.

> > > Continued and ran into hearing aid. Asked me to remove it and I shook

> > > head No again and held up 1 finger (index not middle). She got the

> > > message and waited!

> > > > > >

> > > > > > Saw Dr. K., the new Nepr. and you will never guess what his first

> > > question was: " So, have you got some BP charts for me? " Now there is a

> > > doctor that reviews the chart and obviously hasn't read the VA SOP

> > > manual! He thought he " could live with those numbers " and smiled when I

> > > asked if he thought I could!

> > > > > >

> > > > > > He then proceded to latest lab and said his only concern was my

> > > Carbon Dioxide numbers were going down (June 7=23, June 24=16, Oct 24=18

> > > range=20 - 30). He drew a picture and blamed it on low sodium causing

> > > excess acid (blood bicarbonate level HC03). Said he wasn't making

> > > changes today but wanted me to be aware since he would be making

> > > recomendations for a new med if the trend continues. Guess I've got some

> > > researching to do!

> > > > > >

> > > > > > We talked about switching from Spiro to Epler and he saiid that

> > > would have to come from an Endo! Love the runaround! He cautioned me

> > > that it might not resolve the Gynecomastia and did I know what the next

> > > step was. I asked if it was I shave my beard and buy a dress! I then

> > > told him as far as I know it was AVS and removal or live with it. He

> > > made an endo referral!

> > > > > >

> > > > > > In the 6months he's been gone he gained alot of people skills. I

> > > thought we had a good appt. and he seemed to know about the ACCORD study

> > > and had an understanding where JNC8 is headed.

> > > > > >

> > > > > > - 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.

> > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

[Guest guest]

Yes 3 is a good plan but no mention of DASH is curious.May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension

This appears to be why the VA requires an Endo to RX Epler:

Eplerenone

Eplerenone is non-formulary, restricted to the following criteria:

(1) For essential hypertension, highly restricted to only those patients who require treatment with an aldosterone blocker and cannot tolerate spironolactone due to endocrine-related adverse events;

(2) For treatment of post-MI CHF, reserved for patients who are maximally treated with all other medications known to affect the outcome of CHF (ACEIs, ARBs, Beta-blockers, diuretics) and are unable to tolerate spironolactone due to documented endocrine adverse events; and

(3) eplerenone may be considered as an alternative for a patient who develops adverse events on spironolactone, who has a hyperaldosterone state such as primary hyperaldosteronism or liver disease syndromes, and has intolerance to amiloride with or without a diuretic.

January 2005 VISN 20 P & T

Looks like they stop reading at step 1! Dr. G., is step 3 a possible option? I don't recall it being discussed here.

- 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.

> > > > >

> > > > > > Had a "Francis Experience" when tech wanted to take temp while

> > > taking BP! She started to head for my ear and I shook my head no.

> > > Continued and ran into hearing aid. Asked me to remove it and I shook

> > > head No again and held up 1 finger (index not middle). She got the

> > > message and waited!

> > > > > >

> > > > > > Saw Dr. K., the new Nepr. and you will never guess what his first

> > > question was: "So, have you got some BP charts for me?" Now there is a

> > > doctor that reviews the chart and obviously hasn't read the VA SOP

> > > manual! He thought he "could live with those numbers" and smiled when I

> > > asked if he thought I could!

> > > > > >

> > > > > > He then proceded to latest lab and said his only concern was my

> > > Carbon Dioxide numbers were going down (June 7=23, June 24=16, Oct 24=18

> > > range=20 - 30). He drew a picture and blamed it on low sodium causing

> > > excess acid (blood bicarbonate level HC03). Said he wasn't making

> > > changes today but wanted me to be aware since he would be making

> > > recomendations for a new med if the trend continues. Guess I've got some

> > > researching to do!

> > > > > >

> > > > > > We talked about switching from Spiro to Epler and he saiid that

> > > would have to come from an Endo! Love the runaround! He cautioned me

> > > that it might not resolve the Gynecomastia and did I know what the next

> > > step was. I asked if it was I shave my beard and buy a dress! I then

> > > told him as far as I know it was AVS and removal or live with it. He

> > > made an endo referral!

> > > > > >

> > > > > > In the 6months he's been gone he gained alot of people skills. I

> > > thought we had a good appt. and he seemed to know about the ACCORD study

> > > and had an understanding where JNC8 is headed.

> > > > > >

> > > > > > - 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.

> > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

[Guest guest]

That quote is from the formulary table which probably explains no DASH. My

question was specifically this: " and has intolerance to amiloride with or

without a diuretic. " Is this a possible RX in lieu of Spiro or Epler?

- 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.

> > > > > > >

> > > > > > > > Had a " Francis Experience " when tech wanted to take temp while

> > > > > taking BP! She started to head for my ear and I shook my head no.

> > > > > Continued and ran into hearing aid. Asked me to remove it and I shook

> > > > > head No again and held up 1 finger (index not middle). She got the

> > > > > message and waited!

> > > > > > > >

> > > > > > > > Saw Dr. K., the new Nepr. and you will never guess what his

first

> > > > > question was: " So, have you got some BP charts for me? " Now there is a

> > > > > doctor that reviews the chart and obviously hasn't read the VA SOP

> > > > > manual! He thought he " could live with those numbers " and smiled when

I

> > > > > asked if he thought I could!

> > > > > > > >

> > > > > > > > He then proceded to latest lab and said his only concern was my

> > > > > Carbon Dioxide numbers were going down (June 7=23, June 24=16, Oct

24=18

> > > > > range=20 - 30). He drew a picture and blamed it on low sodium causing

> > > > > excess acid (blood bicarbonate level HC03). Said he wasn't making

> > > > > changes today but wanted me to be aware since he would be making

> > > > > recomendations for a new med if the trend continues. Guess I've got

some

> > > > > researching to do!

> > > > > > > >

> > > > > > > > We talked about switching from Spiro to Epler and he saiid that

> > > > > would have to come from an Endo! Love the runaround! He cautioned me

> > > > > that it might not resolve the Gynecomastia and did I know what the

next

> > > > > step was. I asked if it was I shave my beard and buy a dress! I then

> > > > > told him as far as I know it was AVS and removal or live with it. He

> > > > > made an endo referral!

> > > > > > > >

> > > > > > > > In the 6months he's been gone he gained alot of people skills. I

> > > > > thought we had a good appt. and he seemed to know about the ACCORD

study

> > > > > and had an understanding where JNC8 is headed.

> > > > > > > >

> > > > > > > > - 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.

> > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

> >

>

[Guest guest]

If you want to find out what the VA has for information go to VA home page and

use the search on top right side.

> > > > > >

> > > > > > > Had a " Francis Experience " when tech wanted to take temp while

> > > > taking BP! She started to head for my ear and I shook my head no.

> > > > Continued and ran into hearing aid. Asked me to remove it and I shook

> > > > head No again and held up 1 finger (index not middle). She got the

> > > > message and waited!

> > > > > > >

> > > > > > > Saw Dr. K., the new Nepr. and you will never guess what his first

> > > > question was: " So, have you got some BP charts for me? " Now there is a

> > > > doctor that reviews the chart and obviously hasn't read the VA SOP

> > > > manual! He thought he " could live with those numbers " and smiled when I

> > > > asked if he thought I could!

> > > > > > >

> > > > > > > He then proceded to latest lab and said his only concern was my

> > > > Carbon Dioxide numbers were going down (June 7=23, June 24=16, Oct 24=18

> > > > range=20 - 30). He drew a picture and blamed it on low sodium causing

> > > > excess acid (blood bicarbonate level HC03). Said he wasn't making

> > > > changes today but wanted me to be aware since he would be making

> > > > recomendations for a new med if the trend continues. Guess I've got some

> > > > researching to do!

> > > > > > >

> > > > > > > We talked about switching from Spiro to Epler and he saiid that

> > > > would have to come from an Endo! Love the runaround! He cautioned me

> > > > that it might not resolve the Gynecomastia and did I know what the next

> > > > step was. I asked if it was I shave my beard and buy a dress! I then

> > > > told him as far as I know it was AVS and removal or live with it. He

> > > > made an endo referral!

> > > > > > >

> > > > > > > In the 6months he's been gone he gained alot of people skills. I

> > > > thought we had a good appt. and he seemed to know about the ACCORD study

> > > > and had an understanding where JNC8 is headed.

> > > > > > >

> > > > > > > - 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.

> > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

[Guest guest]

Not likely to see Endo for CHF. Not sure but I think non-formulary means that VA

do not have this the drug in stock.

> > > > > >

> > > > > > > Had a " Francis Experience " when tech wanted to take temp while

> > > > taking BP! She started to head for my ear and I shook my head no.

> > > > Continued and ran into hearing aid. Asked me to remove it and I shook

> > > > head No again and held up 1 finger (index not middle). She got the

> > > > message and waited!

> > > > > > >

> > > > > > > Saw Dr. K., the new Nepr. and you will never guess what his first

> > > > question was: " So, have you got some BP charts for me? " Now there is a

> > > > doctor that reviews the chart and obviously hasn't read the VA SOP

> > > > manual! He thought he " could live with those numbers " and smiled when I

> > > > asked if he thought I could!

> > > > > > >

> > > > > > > He then proceded to latest lab and said his only concern was my

> > > > Carbon Dioxide numbers were going down (June 7=23, June 24=16, Oct 24=18

> > > > range=20 - 30). He drew a picture and blamed it on low sodium causing

> > > > excess acid (blood bicarbonate level HC03). Said he wasn't making

> > > > changes today but wanted me to be aware since he would be making

> > > > recomendations for a new med if the trend continues. Guess I've got some

> > > > researching to do!

> > > > > > >

> > > > > > > We talked about switching from Spiro to Epler and he saiid that

> > > > would have to come from an Endo! Love the runaround! He cautioned me

> > > > that it might not resolve the Gynecomastia and did I know what the next

> > > > step was. I asked if it was I shave my beard and buy a dress! I then

> > > > told him as far as I know it was AVS and removal or live with it. He

> > > > made an endo referral!

> > > > > > >

> > > > > > > In the 6months he's been gone he gained alot of people skills. I

> > > > thought we had a good appt. and he seemed to know about the ACCORD study

> > > > and had an understanding where JNC8 is headed.

> > > > > > >

> > > > > > > - 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.

> > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

[Guest guest]

You are partially right in the fact that they have a limited supply in stock if

any. The other side as I understand it is that an RX has to go thru a review

process or can only be RXed by certain doctors. Cymbalta is or atleast was

non-formulary when I was RXed. My therapist, a Nurse Practioner, was denied the

first time because the wanted me off the narcotics because they thought I

wouldn't need them. I refused unless I KNEW Cymbalta would take care of the

pain. The NP, Barbra Bonney, agreed with me and took it to some commitee and

they reversed the decision. (Barbra formed the " new " in-home care program and

is in charge of it!)

I believe the Endo is involved to determine this, " to documented endocrine

adverse events " . Apparently a regular doctor can't recognize " man-boobs " - GO

FIGURE! Oh I just figured it out, they want me to pay another $50 copay!

- 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.

> > > > > > >

> > > > > > > > Had a " Francis Experience " when tech wanted to take temp while

> > > > > taking BP! She started to head for my ear and I shook my head no.

> > > > > Continued and ran into hearing aid. Asked me to remove it and I shook

> > > > > head No again and held up 1 finger (index not middle). She got the

> > > > > message and waited!

> > > > > > > >

> > > > > > > > Saw Dr. K., the new Nepr. and you will never guess what his

first

> > > > > question was: " So, have you got some BP charts for me? " Now there is a

> > > > > doctor that reviews the chart and obviously hasn't read the VA SOP

> > > > > manual! He thought he " could live with those numbers " and smiled when

I

> > > > > asked if he thought I could!

> > > > > > > >

> > > > > > > > He then proceded to latest lab and said his only concern was my

> > > > > Carbon Dioxide numbers were going down (June 7=23, June 24=16, Oct

24=18

> > > > > range=20 - 30). He drew a picture and blamed it on low sodium causing

> > > > > excess acid (blood bicarbonate level HC03). Said he wasn't making

> > > > > changes today but wanted me to be aware since he would be making

> > > > > recomendations for a new med if the trend continues. Guess I've got

some

> > > > > researching to do!

> > > > > > > >

> > > > > > > > We talked about switching from Spiro to Epler and he saiid that

> > > > > would have to come from an Endo! Love the runaround! He cautioned me

> > > > > that it might not resolve the Gynecomastia and did I know what the

next

> > > > > step was. I asked if it was I shave my beard and buy a dress! I then

> > > > > told him as far as I know it was AVS and removal or live with it. He

> > > > > made an endo referral!

> > > > > > > >

> > > > > > > > In the 6months he's been gone he gained alot of people skills. I

> > > > > thought we had a good appt. and he seemed to know about the ACCORD

study

> > > > > and had an understanding where JNC8 is headed.

> > > > > > > >

> > > > > > > > - 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.

> > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

[Guest guest]

Thanks, you'll make a research analyst out of me yet!

> > > > > > >

> > > > > > > > Had a " Francis Experience " when tech wanted to take temp while

> > > > > taking BP! She started to head for my ear and I shook my head no.

> > > > > Continued and ran into hearing aid. Asked me to remove it and I shook

> > > > > head No again and held up 1 finger (index not middle). She got the

> > > > > message and waited!

> > > > > > > >

> > > > > > > > Saw Dr. K., the new Nepr. and you will never guess what his

first

> > > > > question was: " So, have you got some BP charts for me? " Now there is a

> > > > > doctor that reviews the chart and obviously hasn't read the VA SOP

> > > > > manual! He thought he " could live with those numbers " and smiled when

I

> > > > > asked if he thought I could!

> > > > > > > >

> > > > > > > > He then proceded to latest lab and said his only concern was my

> > > > > Carbon Dioxide numbers were going down (June 7=23, June 24=16, Oct

24=18

> > > > > range=20 - 30). He drew a picture and blamed it on low sodium causing

> > > > > excess acid (blood bicarbonate level HC03). Said he wasn't making

> > > > > changes today but wanted me to be aware since he would be making

> > > > > recomendations for a new med if the trend continues. Guess I've got

some

> > > > > researching to do!

> > > > > > > >

> > > > > > > > We talked about switching from Spiro to Epler and he saiid that

> > > > > would have to come from an Endo! Love the runaround! He cautioned me

> > > > > that it might not resolve the Gynecomastia and did I know what the

next

> > > > > step was. I asked if it was I shave my beard and buy a dress! I then

> > > > > told him as far as I know it was AVS and removal or live with it. He

> > > > > made an endo referral!

> > > > > > > >

> > > > > > > > In the 6months he's been gone he gained alot of people skills. I

> > > > > thought we had a good appt. and he seemed to know about the ACCORD

study

> > > > > and had an understanding where JNC8 is headed.

> > > > > > > >

> > > > > > > > - 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.

> > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

[Guest guest]

Non formulary just means your insurance requires special approval to get it, if at all, and that they don't deem it necessary enough, or cheap enough, for common use. Alot on medicaid in AZ is non-formulary, but is pretty easy to get approval for (advair is one).

Off label is the term like we used for Cymbalta and neuropathic pain, or used to be off label for that as it is now official I believe. It now has a low back pain indication too.

I know Effexor, another SSRI, is structurally and chemically related to tramadol, but not sure about Cymbalta. I find this interesting since tramadol has been shown especially to help neuropathic like pain and has been studied with good results for depression, though it's not even used off label for that - probably the opioid effects though. And many of my patients through the years have reported they have much more stable moods on tramadol. But effexor - it's one of those years back they asked me to "please try it" for my invisible depression and stress related HTN (sarcasm implied there) that they were certain I had because it couldn't have been PA....(MORE SARCASM), actually gave me month of withdrawals. The worst ever. Not a fan of SSRI's in general - I know I have said that a million times, but they seem to work in some, like you, and I am glad there is something out there to help. I just se so little effect with SSRI's.

BTW they are the class that I think the pharm companies maintain the biggest fraud against the people as study after study either can't validate their efficacy, shows them to be less effective then CBT, or they conveniently started saying years ago, when they knew that their efficacy is seriously questioned, that they take up to 3 months to work so don't stop taking them. 2 cycles of a prescription and it becomes a habit and/or a dependency, whether it is working or not. How convenient uh? The reps, out of the blue, when they brought samples, just started telling us that, but had no real research to back it up.

Scary......

Subject: Re: Neperologist Appt. UpdateTo: hyperaldosteronism Date: Monday, November 7, 2011, 9:40 AM

You are partially right in the fact that they have a limited supply in stock if any. The other side as I understand it is that an RX has to go thru a review process or can only be RXed by certain doctors. Cymbalta is or atleast was non-formulary when I was RXed. My therapist, a Nurse Practioner, was denied the first time because the wanted me off the narcotics because they thought I wouldn't need them. I refused unless I KNEW Cymbalta would take care of the pain. The NP, Barbra Bonney, agreed with me and took it to some commitee and they reversed the decision. (Barbra formed the "new" in-home care program and is in charge of it!)I believe the Endo is involved to determine this, "to documented endocrine adverse events". Apparently a regular doctor can't recognize "man-boobs" - GO FIGURE! Oh I just figured it out, they want me to pay another $50 copay! - 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. > > > > > > >> > > > > > > > Had a "Francis Experience" when tech wanted to take temp while> > > > > taking BP! She started to head for my ear and I shook my head no.> > > > > Continued and ran into hearing aid. Asked me to remove it and I shook> > > > > head

No again and held up 1 finger (index not middle). She got the> > > > > message and waited!> > > > > > > >> > > > > > > > Saw Dr. K., the new Nepr. and you will never guess what his first> > > > > question was: "So, have you got some BP charts for me?" Now there is a> > > > > doctor that reviews the chart and obviously hasn't read the VA SOP> > > > > manual! He thought he "could live with those numbers" and smiled when I> > > > > asked if he thought I could!> > > > > > > >> > > > > > > > He then proceded to latest lab and said his only concern was my> > > > > Carbon Dioxide numbers were going down (June 7=23, June 24=16, Oct 24=18> > > > > range=20 - 30). He drew a picture and blamed it on low sodium

causing> > > > > excess acid (blood bicarbonate level HC03). Said he wasn't making> > > > > changes today but wanted me to be aware since he would be making> > > > > recomendations for a new med if the trend continues. Guess I've got some> > > > > researching to do!> > > > > > > >> > > > > > > > We talked about switching from Spiro to Epler and he saiid that> > > > > would have to come from an Endo! Love the runaround! He cautioned me> > > > > that it might not resolve the Gynecomastia and did I know what the next> > > > > step was. I asked if it was I shave my beard and buy a dress! I then> > > > > told him as far as I know it was AVS and removal or live with it. He> > > > > made an endo referral!> > > > > >

> >> > > > > > > > In the 6months he's been gone he gained alot of people skills. I> > > > > thought we had a good appt. and he seemed to know about the ACCORD study> > > > > and had an understanding where JNC8 is headed.> > > > > > > >> > > > > > > > - 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.> > > > > > >

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

[Guest guest]

Health care via government committee? Nice! Doctors are becoming nothing more than " fill in the box " robots. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of You are partially right in the fact that they have a limited supply in stock if any. The other side as I understand it is that an RX has to go thru a review process or can only be RXed by certain doctors. Cymbalta is or atleast was non-formulary when I was RXed. My therapist, a Nurse Practioner, was denied the first time because the wanted me off the narcotics because they thought I wouldn't need them. I refused unless I KNEW Cymbalta would take care of the pain. The NP, Barbra Bonney, agreed with me and took it to some commitee and they reversed the decision. (Barbra formed the " new " in-home care program and is in charge of it!).

[Guest guest]

It will only get worse. Wait til they start deciding that even 10years to live with a cancer dx isn't good enough to merit some treatments or that being buried in a coffin isn't environmentally friendly anymore and that everyone has to cremated - except they will make an exception for Muslims and ignore Christians wishes to avoid church and state involvement.

Subject: RE: Re: Neperologist Appt. UpdateTo: hyperaldosteronism Date: Monday, November 7, 2011, 1:49 PM

Health care via government committee? Nice! Doctors are becoming nothing more than "fill in the box" robots.

Val

From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of

You are partially right in the fact that they have a limited supply in stock if any. The other side as I understand it is that an RX has to go thru a review process or can only be RXed by certain doctors. Cymbalta is or atleast was non-formulary when I was RXed. My therapist, a Nurse Practioner, was denied the first time because the wanted me off the narcotics because they thought I wouldn't need them. I refused unless I KNEW Cymbalta would take care of the pain. The NP, Barbra Bonney, agreed with me and took it to some commitee and they reversed the decision. (Barbra formed the "new" in-home care program and is in charge of it!)

..

[Guest guest]

will do.

> > > > > > > > >

> > > > > > > > > > Had a " Francis Experience " when tech wanted to take

> > temp while

> > > > > > > taking BP! She started to head for my ear and I shook my

> > head no.

> > > > > > > Continued and ran into hearing aid. Asked me to remove it

> > and I shook

> > > > > > > head No again and held up 1 finger (index not middle). She

> > got the

> > > > > > > message and waited!

> > > > > > > > > >

> > > > > > > > > > Saw Dr. K., the new Nepr. and you will never guess

> > what his first

> > > > > > > question was: " So, have you got some BP charts for me? "

> > Now there is a

> > > > > > > doctor that reviews the chart and obviously hasn't read

> > the VA SOP

> > > > > > > manual! He thought he " could live with those numbers " and

> > smiled when I

> > > > > > > asked if he thought I could!

> > > > > > > > > >

> > > > > > > > > > He then proceded to latest lab and said his only

> > concern was my

> > > > > > > Carbon Dioxide numbers were going down (June 7=23, June

> > 24=16, Oct 24=18

> > > > > > > range=20 - 30). He drew a picture and blamed it on low

> > sodium causing

> > > > > > > excess acid (blood bicarbonate level HC03). Said he wasn't

> > making

> > > > > > > changes today but wanted me to be aware since he would be

> > making

> > > > > > > recomendations for a new med if the trend continues. Guess

> > I've got some

> > > > > > > researching to do!

> > > > > > > > > >

> > > > > > > > > > We talked about switching from Spiro to Epler and he

> > saiid that

> > > > > > > would have to come from an Endo! Love the runaround! He

> > cautioned me

> > > > > > > that it might not resolve the Gynecomastia and did I know

> > what the next

> > > > > > > step was. I asked if it was I shave my beard and buy a

> > dress! I then

> > > > > > > told him as far as I know it was AVS and removal or live

> > with it. He

> > > > > > > made an endo referral!

> > > > > > > > > >

> > > > > > > > > > In the 6months he's been gone he gained alot of

> > people skills. I

> > > > > > > thought we had a good appt. and he seemed to know about

> > the ACCORD study

> > > > > > > and had an understanding where JNC8 is headed.

> > > > > > > > > >

> > > > > > > > > > - 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.

> > > > > > > > > >

> > > > > > > > > >

> > > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > >

> > > >

> > >

> >

> >

>

[Guest guest]

The plane pine box seems like the best solution to me. Cremation gets mercury into the air from fillings and what was stored in the body.CE Grim MD It will only get worse. Wait til they start deciding that even 10years to live with a cancer dx isn't good enough to merit some treatments or that being buried in a coffin isn't environmentally friendly anymore and that everyone has to cremated - except they will make an exception for Muslims and ignore Christians wishes to avoid church and state involvement. Subject: RE: Re: Neperologist Appt. UpdateTo: hyperaldosteronism Date: Monday, November 7, 2011, 1:49 PM Health care via government committee? Nice! Doctors are becoming nothing more than "fill in the box" robots. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of You are partially right in the fact that they have a limited supply in stock if any. The other side as I understand it is that an RX has to go thru a review process or can only be RXed by certain doctors. Cymbalta is or atleast was non-formulary when I was RXed. My therapist, a Nurse Practioner, was denied the first time because the wanted me off the narcotics because they thought I wouldn't need them. I refused unless I KNEW Cymbalta would take care of the pain. The NP, Barbra Bonney, agreed with me and took it to some commitee and they reversed the decision. (Barbra formed the "new" in-home care program and is in charge of it!) .

[Guest guest]

Since this is VA, no insurance involved but I'm sure the same concept.

I look forward to more withdrawal!

- 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.

> > > > > > > >

> > > > > > > > > Had a " Francis Experience " when tech wanted to take temp while

> > > > > > taking BP! She started to head for my ear and I shook my head no.

> > > > > > Continued and ran into hearing aid. Asked me to remove it and I

shook

> > > > > > head No again and held up 1 finger (index not middle). She got the

> > > > > > message and waited!

> > > > > > > > >

> > > > > > > > > Saw Dr. K., the new Nepr. and you will never guess what his

first

> > > > > > question was: " So, have you got some BP charts for me? " Now there is

a

> > > > > > doctor that reviews the chart and obviously hasn't read the VA SOP

> > > > > > manual! He thought he " could live with those numbers " and smiled

when I

> > > > > > asked if he thought I could!

> > > > > > > > >

> > > > > > > > > He then proceded to latest lab and said his only concern was

my

> > > > > > Carbon Dioxide numbers were going down (June 7=23, June 24=16, Oct

24=18

> > > > > > range=20 - 30). He drew a picture and blamed it on low sodium

causing

> > > > > > excess acid (blood bicarbonate level HC03). Said he wasn't making

> > > > > > changes today but wanted me to be aware since he would be making

> > > > > > recomendations for a new med if the trend continues. Guess I've got

some

> > > > > > researching to do!

> > > > > > > > >

> > > > > > > > > We talked about switching from Spiro to Epler and he saiid

that

> > > > > > would have to come from an Endo! Love the runaround! He cautioned me

> > > > > > that it might not resolve the Gynecomastia and did I know what the

next

> > > > > > step was. I asked if it was I shave my beard and buy a dress! I then

> > > > > > told him as far as I know it was AVS and removal or live with it. He

> > > > > > made an endo referral!

> > > > > > > > >

> > > > > > > > > In the 6months he's been gone he gained alot of people skills.

I

> > > > > > thought we had a good appt. and he seemed to know about the ACCORD

study

> > > > > > and had an understanding where JNC8 is headed.

> > > > > > > > >

> > > > > > > > > - 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.

> > > > > > > > >

> > > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

[Guest guest]

You are not excluded from playing this game, it's just the insurance companies

until you get old enough for medicare, hence the government, to take over!

>

> Health care via government committee? Nice! Doctors are becoming nothing

> more than " fill in the box " robots.

>

> Val

>

> From: hyperaldosteronism

> [mailto:hyperaldosteronism ] On Behalf Of

>

>

> You are partially right in the fact that they have a limited supply in stock

> if any. The other side as I understand it is that an RX has to go thru a

> review process or can only be RXed by certain doctors. Cymbalta is or

> atleast was non-formulary when I was RXed. My therapist, a Nurse Practioner,

> was denied the first time because the wanted me off the narcotics because

> they thought I wouldn't need them. I refused unless I KNEW Cymbalta would

> take care of the pain. The NP, Barbra Bonney, agreed with me and took it to

> some commitee and they reversed the decision. (Barbra formed the " new "

> in-home care program and is in charge of it!)

>

>

> .

> Web Bug from

> http://geo.yahoo.com/serv?s=97359714/grpId=7299303/grpspId=1705132763/msgId=

> 37921/stime=1320680452/nc1=5191951/nc2=5191947/nc3=3848640

> <http://www.mailscanner.tv/1x1spacer.gif>

>

[Guest guest]

Well if all health care providers knew everything about everything they we would not need any fill in the box. But most of us do not know everything about everything. So I am happy with fill in the Box for a lot of stuff. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension

Health care via government committee? Nice! Doctors are becoming nothing more than "fill in the box" robots. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of You are partially right in the fact that they have a limited supply in stock if any. The other side as I understand it is that an RX

has to go thru a review process or can only be RXed by certain doctors. Cymbalta is or atleast was non-formulary when I was RXed. My therapist, a Nurse Practioner, was denied the first time because the wanted me off the narcotics because they thought I wouldn't need them. I refused unless I KNEW Cymbalta would take care of the pain. The NP, Barbra Bonney, agreed with me and took it to some commitee and they reversed the decision. (Barbra formed the "new" in-home care program and is in charge of it!).

[Guest guest]

It appears that the government wants you to develop CHF before you are allowed proper medication. And, they use information that is seven years old and don't understand that amiloride will probably not stop the left ventricular thickening. You are in good hands. Val> > > > This appears to be why the VA requires an Endo to RX Epler:> > > > Eplerenone> > Eplerenone is non-formulary, restricted to the following criteria: > > > > (1) For essential hypertension, highly restricted to only those patients who require treatment with an aldosterone blocker and cannot tolerate spironolactone due to endocrine-related adverse events; > > > > (2) For treatment of post-MI CHF, reserved for patients who are maximally treated with all other medications known to affect the outcome of CHF (ACEIs, ARBs, Beta-blockers, diuretics) and are unable to tolerate spironolactone due to documented endocrine adverse events; and > > > > (3) eplerenone may be considered as an alternative for a patient who develops adverse events on spironolactone, who has a hyperaldosterone state such as primary hyperaldosteronism or liver disease syndromes, and has intolerance to amiloride with or without a diuretic. > > > > January 2005 VISN 20 P & T> > > > Looks like they stop reading at step 1! Dr. G., is step 3 a possible option? I don't recall it being discussed here.

[Guest guest]

Val, in fairness to the VA that info was lifted from the section that deals

directly w/CHF, a 71 page document. We were specifically investigating " the

hoops to jump through " to switch from S. to E. since that process is normally

the same. I fully expect to switch to Eplerenone and just like to be prepared!

[PDF] THE PHARMACOLOGIC MANAGEMENT OF CHRONIC HEART FAILURE

PBM-MAP Clinical Practice Guideline for the Pharma PBM-MAP Clinical Practice

Guideline for the Pharmacologic Management of Chronic Heart Failure in Primary

Care Practice Pharmacy Benefits Management Strategic Healthcare Group and

Medical Advisory

www.pbm.va.gov/guidelines/PBM-MAP%20HF%20CPG%20Update%202007.pdf | Search This

Site

Aldosterone Antagonists (Eplerenone, Spironolactone) in Heart Failure,

Recommendations for Use

therapy early after

- 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.

> >

> > > This appears to be why the VA requires an Endo to RX Epler:

> > >

> > > Eplerenone

> > > Eplerenone is non-formulary, restricted to the following criteria:

> > >

> > > (1) For essential hypertension, highly restricted to only those patients

> who require treatment with an aldosterone blocker and cannot tolerate

> spironolactone due to endocrine-related adverse events;

> > >

> > > (2) For treatment of post-MI CHF, reserved for patients who are

> maximally treated with all other medications known to affect the outcome of

> CHF (ACEIs, ARBs, Beta-blockers, diuretics) and are unable to tolerate

> spironolactone due to documented endocrine adverse events; and

> > >

> > > (3) eplerenone may be considered as an alternative for a patient who

> develops adverse events on spironolactone, who has a hyperaldosterone state

> such as primary hyperaldosteronism or liver disease syndromes, and has

> intolerance to amiloride with or without a diuretic.

> > >

> > > January 2005 VISN 20 P & T

> > >

> > > Looks like they stop reading at step 1! Dr. G., is step 3 a possible

> option? I don't recall it being discussed here.

>

[Guest guest]

On the check the box robot dr my guess most would not be here soars in the process if the boxes had been checked years ago. But hey we do not want to interfere with a Drs right to do what s/he wants without being a boxer. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension

Val, in fairness to the VA that info was lifted from the section that deals directly w/CHF, a 71 page document. We were specifically investigating "the hoops to jump through" to switch from S. to E. since that process is normally the same. I fully expect to switch to Eplerenone and just like to be prepared!

[PDF] THE PHARMACOLOGIC MANAGEMENT OF CHRONIC HEART FAILURE

PBM-MAP Clinical Practice Guideline for the Pharma PBM-MAP Clinical Practice Guideline for the Pharmacologic Management of Chronic Heart Failure in Primary Care Practice Pharmacy Benefits Management Strategic Healthcare Group and Medical Advisory

www.pbm.va.gov/guidelines/PBM-MAP%20HF%20CPG%20Update%202007.pdf | Search This Site

Aldosterone Antagonists (Eplerenone, Spironolactone) in Heart Failure, Recommendations for Use

therapy early after

- 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.

> >

> > > This appears to be why the VA requires an Endo to RX Epler:

> > >

> > > Eplerenone

> > > Eplerenone is non-formulary, restricted to the following criteria:

> > >

> > > (1) For essential hypertension, highly restricted to only those patients

> who require treatment with an aldosterone blocker and cannot tolerate

> spironolactone due to endocrine-related adverse events;

> > >

> > > (2) For treatment of post-MI CHF, reserved for patients who are

> maximally treated with all other medications known to affect the outcome of

> CHF (ACEIs, ARBs, Beta-blockers, diuretics) and are unable to tolerate

> spironolactone due to documented endocrine adverse events; and

> > >

> > > (3) eplerenone may be considered as an alternative for a patient who

> develops adverse events on spironolactone, who has a hyperaldosterone state

> such as primary hyperaldosteronism or liver disease syndromes, and has

> intolerance to amiloride with or without a diuretic.

> > >

> > > January 2005 VISN 20 P & T

> > >

> > > Looks like they stop reading at step 1! Dr. G., is step 3 a possible

> option? I don't recall it being discussed here.

>

[Guest guest]

Do not count on Medicare being any different. It is government and is erratic. I had to have an EKG before my last surgery. Disallowed. Had I gone to the hospital to get it (at considerably more cost), it would have been covered without question. Now, I need some gyn help. Medicare won't allow it and without it, I will have to have a $200,000 hysterectomy. When I had private insurance, at least I could appeal decisions. How does one talk to the government? Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Sent: Monday, November 07, 2011 7:10 PMTo: hyperaldosteronism Subject: Re: Neperologist Appt. Update You are not excluded from playing this game, it's just the insurance companies until you get old enough for medicare, hence the government, to take over!>> Health care via government committee? Nice! Doctors are becoming nothing> more than " fill in the box " robots.> > Val> > From: hyperaldosteronism > [mailto:hyperaldosteronism ] On Behalf Of > > > You are partially right in the fact that they have a limited supply in stock> if any. The other side as I understand it is that an RX has to go thru a> review process or can only be RXed by certain doctors. Cymbalta is or> atleast was non-formulary when I was RXed. My therapist, a Nurse Practioner,> was denied the first time because the wanted me off the narcotics because> they thought I wouldn't need them. I refused unless I KNEW Cymbalta would> take care of the pain. The NP, Barbra Bonney, agreed with me and took it to> some commitee and they reversed the decision. (Barbra formed the " new " > in-home care program and is in charge of it!)> > > .> Web Bug from> http://geo.yahoo.com/serv?s=97359714/grpId=7299303/grpspId=1705132763/msgId=> 37921/stime=1320680452/nc1=5191951/nc2=5191947/nc3=3848640> <http://www.mailscanner.tv/1x1spacer.gif>>

[Guest guest]

Fill-in-the-box medicine has nearly killed a bunch of us.  As I look back at those who joined this list back in 2002 and from whom we no longer hear, I am left to wonder how many succumbed to fill-in-the-box. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Clarence Grim Well if all health care providers knew everything about everything they we would not need any fill in the box. But most of us do not know everything about everything. So I am happy with fill in the Box for a lot of stuff. From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of You are partially right in the fact that they have a limited supply in stock if any. The other side as I understand it is that an RX has to go thru a review process or can only be RXed by certain doctors. Cymbalta is or atleast was non-formulary when I was RXed. My therapist, a Nurse Practioner, was denied the first time because the wanted me off the narcotics because they thought I wouldn't need them. I refused unless I KNEW Cymbalta would take care of the pain. The NP, Barbra Bonney, agreed with me and took it to some commitee and they reversed the decision. (Barbra formed the " new " in-home care program and is in charge of it!).

[Guest guest]

Ahh, but the PA boxes are still not there to check.  To dx PA, doctors have to think + have attended class that day. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Clarence Grim On the check the box robot dr my guess most would not be here soars in the process if the boxes had been checked years ago. But hey we do not want to interfere with a Drs right to do what s/he wants without being a boxer.

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That must be the best hysterectomy money can buy?$200,000?May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension

Do not count on Medicare being any different. It is government and is erratic. I had to have an EKG before my last surgery. Disallowed. Had I gone to the hospital to get it (at considerably more cost), it would have been covered without question. Now, I need some gyn help. Medicare won't allow it and without it, I will have to have a $200,000 hysterectomy. When I had private insurance, at least I could appeal decisions. How does one talk to the government? Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Sent: Monday, November 07, 2011 7:10 PMTo: hyperaldosteronism Subject: Re: Neperologist Appt. Update You are not excluded from playing this game, it's just the insurance companies until you get old enough for medicare, hence the government, to take over!>> Health care via government committee? Nice! Doctors are becoming nothing> more than

"fill in the box" robots.> > Val> > From: hyperaldosteronism > [mailto:hyperaldosteronism ] On Behalf Of > > > You are partially right in the fact that they have a limited supply in stock> if any. The other side as I understand it is that an RX has to go thru a> review process or can only be RXed by certain doctors. Cymbalta is or> atleast was non-formulary when I was RXed. My therapist, a Nurse Practioner,> was denied the first time because the wanted me off the narcotics because> they thought I wouldn't need them. I refused unless I KNEW Cymbalta would> take care of the pain. The NP, Barbra Bonney, agreed with me and took it to> some commitee and they reversed the decision. (Barbra formed the

"new"> in-home care program and is in charge of it!)> > > .> Web Bug from> http://geo.yahoo.com/serv?s=97359714/grpId=7299303/grpspId=1705132763/msgId=> 37921/stime=1320680452/nc1=5191951/nc2=5191947/nc3=3848640> <http://www.mailscanner.tv/1x1spacer.gif>>

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Not as we have written for about 40 years. Box 1: htn before age 40 consider/test for PABox 2: low K-test for PA Box 3. Difficult to control HTN? Test for PABox 4: nocturia-test for PA?Box 5: HTN MUSCLE cramps WEAKNESS -test for PABox 6: Htn FH EARLY stroke in men: test for PA. BOX 7: + trousseau's when taking BP-test for PA Some more tomorrow. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionFill-in-the-box medicine has nearly killed a bunch of us. As I look back at those who joined this list back in 2002 and from whom we no longer hear, I am left to wonder how many succumbed to fill-in-the-box. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Clarence Grim Well if all health care providers knew everything about everything they we would not need any fill in the box. But most of us do not know everything about everything. So I am happy with fill in the Box for a lot of stuff. From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of You are partially right in the fact that they have a limited supply in stock if any. The other side as I understand it is that an RX has to go thru a review process or can only be RXed by certain doctors. Cymbalta is or atleast was non-formulary when I was RXed. My therapist, a Nurse Practioner, was denied the first time because the wanted me off the narcotics because they thought I wouldn't need them. I refused unless I KNEW Cymbalta would take care of the pain. The NP, Barbra Bonney, agreed with me and took it to some commitee and they reversed the decision. (Barbra formed the "new" in-home care program and is in charge of it!).

[Guest guest]

Or have their computer do it for them. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension

Ahh, but the PA boxes are still not there to check. To dx PA, doctors have to think + have attended class that day. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Clarence Grim On the check the box robot dr my guess most would not be here soars in the process if the boxes had been checked years ago. But hey we do not want to interfere with a Drs right to do what s/he wants without being a boxer.