Re: Re: Missed PA in the practice of medicine: why does it happen?

[Guest guest]

Obesity is not really a cause of HTN once BP gets up to 140/90 it appears to not go up further with more weight gain in the population.CE Grim MD This needs to be done! I mainly blame the ease of prescribing SSRIs. How many people here were first "diagnosed" with a psych disorder the first time we presented in an ER with elevated BP? I certainly was. Another reason: because in med school they're still teaching that it's rare. So, none of us could *possibly* have such a *rare* condition. And, lastly: if untreated, PA makes most of us gain weight. By the we first present with HTN, if we're anything larger than emaciated, I'm convinced that the doctors blame the obesity for the HTN and refuse to consider anything else. --- In hyperaldosteronism , Clarence Grim > Maybe we should also do an abstract on Missed PA in the practice of medicine: why does it happen? > This would tabulate the reasons PA has been missed

[Guest guest]

Healthy living does cure alot of things. Many people do not have "something" because they lived healthy. In the grand scheme of things, and playing devils advocate is all, do we actually know why we have PA? Maybe one day we'll find out it is some thing common we all indulged in too much. Not likely, but just for example. I have said it before, but would I have known I had PA if I had followed a low sodium/high K diet naturally? Maybe, maybe not. If not, my last few years may have had a much better outcome and been a hell of a lot messy.

Patients get angry because as they say "all the doctor want to do is put you on pills", but then complain when he or she doesn't, and then complain when they talk abut getting healthier. Weight - especially morbid obesity - does have adverse consequences for many and most people see bad things just from being overweight - that is so well studied that it is not even debatable.

A bad diet has adverse consequences for many - does this even need to be told to us at this stage in our life? Yet we still aren't perfect in our diets and even those on here who may claim they always diet perfect likely do not.

Do we need to get into exercise? I think I may alive today because I was so aerobically active up until the PA got me too weak to even walk up the driveway (low K I am certain). But when I say I hit 160/120 every day for years I mean I hit that every day for years. My ticker is good, my brain.....well.......okay 1 out of 2 isn't bad.

But the doc doesn't know who does and who doesn't so it's going to be said. Sadly I am guessing you allude to the fact they ignore other things to preach about something else. Yes, it happens. Yet some, like my wife, are very motivated when the doc tells her to exercise more. She's more OCD like that. Me, I don't need to be told. Doesn't particularly motivate me. So some need the preachin.

And as a disclaimer, we know some CAN'T exercise or lose weight because of disabilities, or can't eat a certain diet because of dietary things, etc. but those are exceptions not the rule. I'd still put my money on a healthier diet, more exercise, weight loss, and even keeping one's mind healthy by continuing to learn and so on. Bumps come along, but if we have the rest in order maybe we can stay alive to fix it.

BTW exercise has been shown to be a better treatment for anxiety than ANY SSRI. Cognitive behavioral therapy also better than SSRI's.

Subject: Re: Missed PA in the practice of medicine: why does it happen?To: hyperaldosteronism Date: Saturday, November 5, 2011, 9:39 PM

But family doctors don't seem to get that. In the U.S. especially we have so much government-issued and AHA-issued dogma about weight and exercise being the cure-all for HTN and diabetes, but all of us here are proof that it's not that simple.> > > This needs to be done!> >> > I mainly blame the ease of prescribing SSRIs. How many people here > > were first "diagnosed" with a psych disorder the

first time we > > presented in an ER with elevated BP? I certainly was.> >> > Another reason: because in med school they're still teaching that > > it's rare. So, none of us could *possibly* have such a *rare* > > condition.> >> > And, lastly: if untreated, PA makes most of us gain weight. By the > > we first present with HTN, if we're anything larger than emaciated, > > I'm convinced that the doctors blame the obesity for the HTN and > > refuse to consider anything else.> >> > --- In hyperaldosteronism , Clarence Grim> > > Maybe we should also do an abstract on Missed PA in the practice > > of medicine: why does it

happen?> > > This would tabulate the reasons PA has been missed> >> >>

[Guest guest]

Certainly, and sadly, the first answer is THE answer in the tunnel our vision is in. Obesity is the easy one. But if it's not obesity, as I am not obese or really overweight, it is something - usually "stress" and anxiety. Or lack of physical exercise.

In some defense, many many many do go off BP meds when they lose weight. I have seen diabetes go bye bye when people eat better, exercise, and lose weight. SO it is right sometimes, wrong other times. Hard to know which is best when sometimes a patient refuses to try the natural things first though (and again, not defending bad care, but patients do have a habit, because they do not want to dissappoint, tell you they ALWAYS eat healthy, have tried every diet without cheating, or exercise perfectly, and so on so we are all part of the guilty party).

In our cases, we weren't just a one time visit to the doc or the ER's, but went again and again, and didn't respond to many many meds and all the signs were there, they just blew them off. I'd say were certainly not typical though. Maybe PA not as rare as they think, but probably not as common is PA as it might seem to us.

Subject: Re: Missed PA in the practice of medicine: why does it happen?To: hyperaldosteronism Date: Saturday, November 5, 2011, 9:23 PM

This needs to be done!I mainly blame the ease of prescribing SSRIs. How many people here were first "diagnosed" with a psych disorder the first time we presented in an ER with elevated BP? I certainly was.Another reason: because in med school they're still teaching that it's rare. So, none of us could *possibly* have such a *rare* condition.And, lastly: if untreated, PA makes most of us gain weight. By the we first present with HTN, if we're anything larger than emaciated, I'm convinced that the doctors blame the obesity for the HTN and refuse to consider anything else.--- In hyperaldosteronism , Clarence Grim > Maybe we should also do an abstract on Missed PA in the practice of medicine: why does it happen?> This

would tabulate the reasons PA has been missed

[Guest guest]

I'll do the writing if we get a good case study. I can certainly get it to the PA and NP journals and see if they will publish. Dr G has the credentials and resume to help, plus the publishing experience. This "when they miss the missing link" cause of HTN would be a good one too for the "pop" magazines like Womans Day or Readers Digest!

I am not a great case because I had complicating factors and think my own case would be too long, plus they made the dx based on the very vivid response to spiro and my history, but didn't take me off the spiro to get the labs right (risk was too high due to the severity of my BP) and failed to do labs before that the right way or at all . I so far only have a 1 cm cyst on the kidney, but nothing on adrenals that show up - they claim adrenals are clear on scans.

Maybe someone who had HTN for a long time, low K, didn't respond to meds, then was found to have the ARR high and the other labs to back it up?

Subject: Re: Missed PA in the practice of medicine: why does it happen?To: hyperaldosteronism Date: Saturday, November 5, 2011, 9:23 PM

This needs to be done!I mainly blame the ease of prescribing SSRIs. How many people here were first "diagnosed" with a psych disorder the first time we presented in an ER with elevated BP? I certainly was.Another reason: because in med school they're still teaching that it's rare. So, none of us could *possibly* have such a *rare* condition.And, lastly: if untreated, PA makes most of us gain weight. By the we first present with HTN, if we're anything larger than emaciated, I'm convinced that the doctors blame the obesity for the HTN and refuse to consider anything else.--- In hyperaldosteronism , Clarence Grim > Maybe we should also do an abstract on Missed PA in the practice of medicine: why does it happen?> This

would tabulate the reasons PA has been missed

[Guest guest]

Maybe you NEED the TV! I have to have my sports so I am keeping the TV. I admire those who can do without. I am not that disciplined. Now my wife , if the doc told her the TV is killing her it be gone as soon as she got home. For me it'd be the doc who was gone when I got home .

I think your point we agree with is that the holistic approach is needed. Don't sacrifice the real problem so the ego can be satisfied by telling someone else what to do. I think they do that too often

Subject: Re: Missed PA in the practice of medicine: why does it happen?To: hyperaldosteronism Date: Sunday, November 6, 2011, 12:44 PM

Sadly I am guessing you allude to the fact they ignore other things to preach about something else. Yes, this. I'm all for healthy living - been doing it most of my life save for my punk-rock teens and early twenties. But when I made it clear to a half-dozen doctors that I do yoga, eat healthy (meaning natural and organic and not in excess), walk everywhere I can, go hiking regularly, blah blah and they ignore these facts (or choose to not believe them, since so many Americans DO NOT live this way), then offer solutions such as "maybe you should join a gym" or "maybe you should take a pill that affects your brain chemistry," something in the system is clearly broken. I just think it's insane when a doctor gives this same advice to an otherwise healthy, thin woman such as myself, and gives the same advice to a morbidly-obese couch potato, as though it's a one-size-fits-all solution. Heck, I've never even owned a

television!We don't know why we have PA. I strongly believe it's environmental, caused by things that we once didn't know enough to control - a really messed up food supply, for one. BPA-containing plastic everywhere for most of our lives, which we now know contributes to metabolic disturbances. Stuff in the air and in the water. We'll probably never know.> > > > > This needs to be done!> > >> > > I mainly blame the ease of prescribing SSRIs. How many people here > > > were first "diagnosed" with a psych disorder the first time we > > > presented in an ER with elevated BP? I certainly was.> > >> > > Another reason: because in med school they're still teaching that > > > it's rare. So, none of us could *possibly* have such a *rare* > > > condition.> > >> > > And, lastly: if untreated, PA makes most of us gain weight. By the > > > we first present with HTN, if we're

anything larger than emaciated, > > > I'm convinced that the doctors blame the obesity for the HTN and > > > refuse to consider anything else.> > >> > > --- In hyperaldosteronism , Clarence Grim> > > > Maybe we should also do an abstract on Missed PA in the practice > > > of medicine: why does it happen?> > > > This would tabulate the reasons PA has been missed> > >> > >> >>

[Guest guest]

But most don't check urine to see if DASHING. MOST who lose at and Bp goes down are also eating less salt I suspect. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension

Certainly, and sadly, the first answer is THE answer in the tunnel our vision is in. Obesity is the easy one. But if it's not obesity, as I am not obese or really overweight, it is something - usually "stress" and anxiety. Or lack of physical exercise.

In some defense, many many many do go off BP meds when they lose weight. I have seen diabetes go bye bye when people eat better, exercise, and lose weight. SO it is right sometimes, wrong other times. Hard to know which is best when sometimes a patient refuses to try the natural things first though (and again, not defending bad care, but patients do have a habit, because they do not want to dissappoint, tell you they ALWAYS eat healthy, have tried every diet without cheating, or exercise perfectly, and so on so we are all part of the guilty party).

In our cases, we weren't just a one time visit to the doc or the ER's, but went again and again, and didn't respond to many many meds and all the signs were there, they just blew them off. I'd say were certainly not typical though. Maybe PA not as rare as they think, but probably not as common is PA as it might seem to us.

Subject: Re: Missed PA in the practice of medicine: why does it happen?To: hyperaldosteronism Date: Saturday, November 5, 2011, 9:23 PM

This needs to be done!I mainly blame the ease of prescribing SSRIs. How many people here were first "diagnosed" with a psych disorder the first time we presented in an ER with elevated BP? I certainly was.Another reason: because in med school they're still teaching that it's rare. So, none of us could *possibly* have such a *rare* condition.And, lastly: if untreated, PA makes most of us gain weight. By the we first present with HTN, if we're anything larger than emaciated, I'm convinced that the doctors blame the obesity for the HTN and refuse to consider anything else.--- In hyperaldosteronism , Clarence Grim > Maybe we should also do an abstract on Missed PA in the practice of medicine: why does it happen?> This

would tabulate the reasons PA has been missed

[Guest guest]

Your Ho cries for a good long term data base. As we are the largest group of PAs in the world we can help with this once we get a database set up. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension

Sadly I am guessing you allude to the fact they ignore other things to preach about something else. Yes, this. I'm all for healthy living - been doing it most of my life save for my punk-rock teens and early twenties. But when I made it clear to a half-dozen doctors that I do yoga, eat healthy (meaning natural and organic and not in excess), walk everywhere I can, go hiking regularly, blah blah and they ignore these facts (or choose to not believe them, since so many Americans DO NOT live this way), then offer solutions such as "maybe you should join a gym" or "maybe you should take a pill that affects your brain chemistry," something in the system is clearly broken. I just think it's insane when a doctor gives this same advice to an otherwise healthy, thin woman such as myself, and gives the same advice to a morbidly-obese couch potato, as though it's a one-size-fits-all solution. Heck, I've never even owned a television!We don't know why we have PA. I strongly believe it's environmental, caused by things that we once didn't know enough to control - a really messed up food supply, for one. BPA-containing plastic everywhere for most of our lives, which we now know contributes to metabolic disturbances. Stuff in the air and in the water. We'll probably never know.> > > > > This needs to be done!> > >> > > I mainly blame the ease of prescribing SSRIs. How many people here > > > were first "diagnosed" with a psych disorder the first time we > > > presented in an ER with elevated BP? I certainly was.> > >> > > Another reason: because in med school they're still teaching that > > > it's rare. So, none of us could *possibly* have such a *rare* > > > condition.> > >> > > And, lastly: if untreated, PA makes most of us gain weight. By the > > > we first present with HTN, if we're anything larger than emaciated, > > > I'm convinced that the doctors blame the obesity for the HTN and > > > refuse to consider anything else.> > >> > > --- In hyperaldosteronism , Clarence Grim> > > > Maybe we should also do an abstract on Missed PA in the practice > > > of medicine: why does it happen?> > > > This would tabulate the reasons PA has been missed> > >> > >> >>

[Guest guest]

What of these items do u not meet. + u r a health professional who was missed for way to long. If you were my student I would. Hew your ass out for missing the DX so long. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension

I'll do the writing if we get a good case study. I can certainly get it to the PA and NP journals and see if they will publish. Dr G has the credentials and resume to help, plus the publishing experience. This "when they miss the missing link" cause of HTN would be a good one too for the "pop" magazines like Womans Day or Readers Digest!

I am not a great case because I had complicating factors and think my own case would be too long, plus they made the dx based on the very vivid response to spiro and my history, but didn't take me off the spiro to get the labs right (risk was too high due to the severity of my BP) and failed to do labs before that the right way or at all . I so far only have a 1 cm cyst on the kidney, but nothing on adrenals that show up - they claim adrenals are clear on scans.

Maybe someone who had HTN for a long time, low K, didn't respond to meds, then was found to have the ARR high and the other labs to back it up?

Subject: Re: Missed PA in the practice of medicine: why does it happen?To: hyperaldosteronism Date: Saturday, November 5, 2011, 9:23 PM

This needs to be done!I mainly blame the ease of prescribing SSRIs. How many people here were first "diagnosed" with a psych disorder the first time we presented in an ER with elevated BP? I certainly was.Another reason: because in med school they're still teaching that it's rare. So, none of us could *possibly* have such a *rare* condition.And, lastly: if untreated, PA makes most of us gain weight. By the we first present with HTN, if we're anything larger than emaciated, I'm convinced that the doctors blame the obesity for the HTN and refuse to consider anything else.--- In hyperaldosteronism , Clarence Grim > Maybe we should also do an abstract on Missed PA in the practice of medicine: why does it happen?> This

would tabulate the reasons PA has been missed

[Guest guest]

Good so we have a lay person who figured it out before their team As well As a medical professional in which the Dx was missed for year's. We will need to compare the stories and the stories and reasons give for low K and poor BP control. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension

Maybe someone who had HTN for a long time, low K, didn't respond to meds, then was found to have the ARR high and the other labs to back it up?, this is me EXACTLY. If you want to collaborate on something like this, please include me in!> > > Subject: Re: Missed PA in the practice of medicine: why does it happen?> To: hyperaldosteronism > Date: Saturday, November 5, 2011, 9:23 PM> > > > Â > > > > This needs to be done!> > I mainly blame the ease of prescribing SSRIs. How many people here were first "diagnosed" with a psych disorder the first time we presented in an ER with elevated BP? I certainly was.> > Another reason: because in med school they're still teaching that it's rare. So, none of us could *possibly* have such a *rare* condition.> > And, lastly: if untreated, PA makes most of us gain weight. By the we first present with HTN, if we're anything larger than emaciated, I'm convinced that the doctors blame the obesity for the HTN and refuse to consider anything else.> > --- In hyperaldosteronism , Clarence Grim > > Maybe we should also do an abstract on Missed PA in the practice of medicine: why does it happen?> > This would tabulate the reasons PA has been missed>

[Guest guest]

I am afraid that the holistic approach may delay dx. So if one has DASH sensitive BP the BP should reach the max reduction in 2 weeks mostly. But unless the urine is to doc compliance then if BP is not at goal some may assume DASH did not work. Then the response would be now let's try exercise or stress reduction or at lose and the Dx is delayed again. Anytime it takes more than 2 drugs or ACES OR ARBS OR BB don't work or K is ever low test for PA. Which is what I and others have.been teaching for since about 1967 or so. And dr conn since 1964. In 2 years the message will have been out there for 50 years. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension

Maybe you NEED the TV! I have to have my sports so I am keeping the TV. I admire those who can do without. I am not that disciplined. Now my wife , if the doc told her the TV is killing her it be gone as soon as she got home. For me it'd be the doc who was gone when I got home .

I think your point we agree with is that the holistic approach is needed. Don't sacrifice the real problem so the ego can be satisfied by telling someone else what to do. I think they do that too often

Subject: Re: Missed PA in the practice of medicine: why does it happen?To: hyperaldosteronism Date: Sunday, November 6, 2011, 12:44 PM

Sadly I am guessing you allude to the fact they ignore other things to preach about something else. Yes, this. I'm all for healthy living - been doing it most of my life save for my punk-rock teens and early twenties. But when I made it clear to a half-dozen doctors that I do yoga, eat healthy (meaning natural and organic and not in excess), walk everywhere I can, go hiking regularly, blah blah and they ignore these facts (or choose to not believe them, since so many Americans DO NOT live this way), then offer solutions such as "maybe you should join a gym" or "maybe you should take a pill that affects your brain chemistry," something in the system is clearly broken. I just think it's insane when a doctor gives this same advice to an otherwise healthy, thin woman such as myself, and gives the same advice to a morbidly-obese couch potato, as though it's a one-size-fits-all solution. Heck, I've never even owned a

television!We don't know why we have PA. I strongly believe it's environmental, caused by things that we once didn't know enough to control - a really messed up food supply, for one. BPA-containing plastic everywhere for most of our lives, which we now know contributes to metabolic disturbances. Stuff in the air and in the water. We'll probably never know.> > > > > This needs to be done!> > >> > > I mainly blame the ease of prescribing SSRIs. How many people here > > > were first "diagnosed" with a psych disorder the first time we > > > presented in an ER with elevated BP? I certainly was.> > >> > > Another reason: because in med school they're still teaching that > > > it's rare. So, none of us could *possibly* have such a *rare* > > > condition.> > >> > > And, lastly: if untreated, PA makes most of us gain weight. By the > > > we first present with HTN, if we're

anything larger than emaciated, > > > I'm convinced that the doctors blame the obesity for the HTN and > > > refuse to consider anything else.> > >> > > --- In hyperaldosteronism , Clarence Grim> > > > Maybe we should also do an abstract on Missed PA in the practice > > > of medicine: why does it happen?> > > > This would tabulate the reasons PA has been missed> > >> > >> >>

[Guest guest]

I was referring to listening to all the patient has to say about their S/Sand history and not ignoring what we don't want to hear or just making a quick decision like it's just stress. And like putting low K with resistant HTN. I didn't mean holistic n the natural medicine sense.Sent from my Palm Pre on the Now Network from Sprint

I am afraid that the holistic approach may delay dx. So if one has DASH sensitive BP the BP should reach the max reduction in 2 weeks mostly. But unless the urine is to doc compliance then if BP is not at goal some may assume DASH did not work. Then the response would be now let's try exercise or stress reduction or at lose and the Dx is delayed again. Anytime it takes more than 2 drugs or ACES OR ARBS OR BB don't work or K is ever low test for PA. Which is what I and others have.been teaching for since about 1967 or so. And dr conn since 1964. In 2 years the message will have been out there for 50 years. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension

Maybe you NEED the TV! I have to have my sports so I am keeping the TV. I admire those who can do without. I am not that disciplined. Now my wife , if the doc told her the TV is killing her it be gone as soon as she got home. For me it'd be the doc who was gone when I got home .

I think your point we agree with is that the holistic approach is needed. Don't sacrifice the real problem so the ego can be satisfied by telling someone else what to do. I think they do that too often

Subject: Re: Missed PA in the practice of medicine: why does it happen?To: hyperaldosteronism Date: Sunday, November 6, 2011, 12:44 PM

Sadly I am guessing you allude to the fact they ignore other things to preach about something else. Yes, this. I'm all for healthy living - been doing it most of my life save for my punk-rock teens and early twenties. But when I made it clear to a half-dozen doctors that I do yoga, eat healthy (meaning natural and organic and not in excess), walk everywhere I can, go hiking regularly, blah blah and they ignore these facts (or choose to not believe them, since so many Americans DO NOT live this way), then offer solutions such as "maybe you should join a gym" or "maybe you should take a pill that affects your brain chemistry," something in the system is clearly broken. I just think it's insane when a doctor gives this same advice to an otherwise healthy, thin woman such as myself, and gives the same advice to a morbidly-obese couch potato, as though it's a one-size-fits-all solution. Heck, I've never even owned a

television!We don't know why we have PA. I strongly believe it's environmental, caused by things that we once didn't know enough to control - a really messed up food supply, for one. BPA-containing plastic everywhere for most of our lives, which we now know contributes to metabolic disturbances. Stuff in the air and in the water. We'll probably never know.> > > > > This needs to be done!> > >> > > I mainly blame the ease of prescribing SSRIs. How many people here > > > were first "diagnosed" with a psych disorder the first time we > > > presented in an ER with elevated BP? I certainly was.> > >> > > Another reason: because in med school they're still teaching that > > > it's rare. So, none of us could *possibly* have such a *rare* > > > condition.> > >> > > And, lastly: if untreated, PA makes most of us gain weight. By the > > > we first present with HTN, if we're

anything larger than emaciated, > > > I'm convinced that the doctors blame the obesity for the HTN and > > > refuse to consider anything else.> > >> > > --- In hyperaldosteronism , Clarence Grim> > > > Maybe we should also do an abstract on Missed PA in the practice > > > of medicine: why does it happen?> > > > This would tabulate the reasons PA has been missed> > >> > >> >>