Re: protocol for testing low aldo

January 3, 2012

Beleive this is what you are looking for Endocrine_Society_PA_Guidelines.pdf

It is low renin and high aldo that causes PA.

>

> I've been searching for the file/info regarding the protocol for testing for

low aldo. Will you please direct me to it?

>

> thanks,

> Ashlee

>

January 3, 2012

Thanks for posting that Francis!

I didn't find what I need there. Mainly I need to know how long I need to be

off licorice and if it's the third day of my menses cycle or ovulation cycle

that I'm supposed to be testing at.

I have super low BP and have a lab slip for testing cortisol, renin, aldo,

potasium, (and few others i don't remember at present time).

Thanks!

Ashlee

January 3, 2012

Don't think we have that information in our files. Dr Grim can give more about

this.

>

> Thanks for posting that Francis!

>

> I didn't find what I need there. Mainly I need to know how long I need to be

off licorice and if it's the third day of my menses cycle or ovulation cycle

that I'm supposed to be testing at.

>

> I have super low BP and have a lab slip for testing cortisol, renin, aldo,

potasium, (and few others i don't remember at present time).

>

> Thanks!

> Ashlee

>

January 3, 2012

Thanks for posting that Francis!

I didn't find what I need there. Mainly I need to know how long I need to be

off licorice and if it's the third day of my menses cycle or ovulation cycle

that I'm supposed to be testing at.

I have super low BP and have a lab slip for testing cortisol, renin, aldo,

potasium, (and few others i don't remember at present time).

Thanks!

Ashlee

January 3, 2012

Thanks for posting that Francis!

I didn't find what I need there. Mainly I need to know how long I need to be

off licorice and if it's the third day of my menses cycle or ovulation cycle

that I'm supposed to be testing at.

I have super low BP and have a lab slip for testing cortisol, renin, aldo,

potasium, (and few others i don't remember at present time).

Thanks!

Ashlee

January 3, 2012

I'm not sure it is necessarily high aldo. I was dxed w/aldo = 5 and renin 0.1.

Dr. Grim also called it " low renin HTN " which he explained was early PA.

- 65 yo super ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank

pain. Treating with DASH. 2-Day ave w/o meds = BP 133/77 HR 61 BS 132. D/C

Spironolactone 12/20/2011 due to adverse SX.

Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, Gynecomastia, MDD

and PTSD.

Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and

Metformin 2000MG. Started washing Spironolactone 12/20/11 to prepare for AVS.

> >

> > I've been searching for the file/info regarding the protocol for testing for

low aldo. Will you please direct me to it?

> >

> > thanks,

> > Ashlee

> >

>

January 3, 2012

Your aldo was 50 time higher then renin. That is PA.

> > >

> > > I've been searching for the file/info regarding the protocol for testing

for low aldo. Will you please direct me to it?

> > >

> > > thanks,

> > > Ashlee

> > >

> >

>

January 3, 2012

Yep which is ARR that is high, not aldo. I know you know that, just trying to

not confuse the new people. Hypertension Primer says " some experts also require

a minimum plasma aldosterone > 12 ng per dL. " That might cause some to fail to

get a PA DX which is when Dr. G. tells us to ask them what is going on with the

renin. Call it what you what, just treat it with DASH and spiro if your body

will tolerate it!

> > > >

> > > > I've been searching for the file/info regarding the protocol for testing

for low aldo. Will you please direct me to it?

> > > >

> > > > thanks,

> > > > Ashlee

> > > >

> > >

> >

>

January 3, 2012

From her newer posting they may be testing her for addison's disease. This would

be reason for testing low aldo.

> > > > >

> > > > > I've been searching for the file/info regarding the protocol for

testing for low aldo. Will you please direct me to it?

> > > > >

> > > > > thanks,

> > > > > Ashlee

> > > > >

> > > >

> > >

> >

>

January 3, 2012

Same as testing for high aldo to start. See item 6 below.What do you know so far about renin and aldo and 24 hr urine Na and K?CE Grim MD Welcome to the exciting world of Hyperaldosteronism You are in the right place! I am Dr. CE Grim a retired Professor of Medicine and Endocrinology. I have had a long standing interest is Primary Aldosteronism since medical school days when I saw my first patient with Primary Aldosteronism in 1963 as a 4th year medical student. I did a Nephrology Fellowship at Duke and an Endocrinology and Metabolism Fellowship with Dr. Conn (1969-70). I have been on the faculty of the University of MO, Indiana Univ, UCLA/ R. Drew, and the Medical College of Wisconsin in Divisions of Nephrology, Endocrinology, Hypertension, Cardiology and Epidemiology. I have published over 240 papers and book chapters in most areas of the broad discipline of High Blood Pressure. My CV is in our files for details. The GOAL of our group is to teach you and your health care team about the ins and outs of the causes, diagnosis and control of the many forms of hyperaldosteronism. The steps below will introduce you into the fascinating world of high blood pressure, salt and potassium and the role of the adrenal hormone aldosterone in health and disease. Doing these in sequence will save you time and effort in getting up to speed in taking control of you health and educating your own health care team. While we can’t make you a doctor we will make you into a pretty good BP doctor-a skill that you will have for life. 1. Overview: Read my article in our files on the evolution of PA (Evolution_of_PA-Grim.pdf ) and take to all members of health care team. Tell us what stage you believe you are in. This is a brief review of most causes of hyperaldosteronism, high blood pressure, low potassium (K). Be certain that you and your health care team understand the key role of excess diet salt in HTN and especially in PA. Go to: http://www.worldactiononsalt.com/evidence/treatment_trials.htm For a state of the art and science discussion of salt and health. 2. Other patients with hyperaldosteronism (Conn’s syndrome). Read our Conn's stories in our files and then give us your own in as much detail as you can. Dr. Conn was the first to describe this disease process and the syndrome is named after him. To see others' stories, on the Hyperaldosteronism home page, go to Files/Conn’s Stories. You'll find instructions in "A - How to put your story here.doc "Then send us your story in an email and then we will likely ask more questions and make suggestions before you upload it to our files. 3. Hyperaldosteronism and Salt: The deadly Duo. Eating Plan to control high blood pressure due to hyperaldosteronism and most others with high blood pressure. This will reduce your need for medications and in many will get your BP and K to goal without meds.. Get the DASH diet book by T. et al, read it and use it: $8 in paperback at your local bookstore. If they don’t have it ask them to order it for you. Learning to eat the DASH way will play a major role in your road to good BP and K control and, in many of our folks here, will revolutionize your life. Go to chapter 9 and do the 14 day challenge. Tell your Dr you are doing this as your BP may plummet if you are on other meds in only 2-3 days. or go to http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf download this 64 page booklet free and do the Week on the DASH Diet for 2 weeks. If you are on BP meds be prepared for a large fall in BP and let your Dr. know you are doing this. Or go to (but costs money) DASH Diet for Health ProgramThe DASH Diet for Health Program is designed to help you improve your eating and exercise habits. Twice each week we will provide you with information on our website about food, food preparation, eating out, losing weight, getting fit and much more. In addition to providing new information each week on our website, we create a web page specially for you where you can track progress in areas such as your weight, blood pressure, and exercise.http://www.dashforhealth.com/ I strongly recommend you get the book and read it now! 4. Measure your BP: Measure your BP daily so you can see if it is getting better. If you are taking meds be sure to tell your health care team you are doing this as your BP may plummet to normal quickly. We recommend you use a device you listen to and will help you learn how to do this. If this is not something you want to do we can teach a significant other how to do it. See sharedcareinc.com or email to sharedcare@... to order a video on how to do this. If you already have one we will teach you how to teach your health care team how to validate your device. Your life and health depends on accurate BP measurements. Go to the amricanheart.org and download the Guidelines for Human Blood Pressure Measurement. Insist the your health care team do BP the AHA way. Your life is in the hands of those who measure your BP. Never trust your life to an automatic BP machine unless you know it is accurate on YOU. 5. Genetics and your BP: Go to familyhistory.hhs.gov and do your detailed family medical history so we can review with you to help Dx familial causes of high blood pressure and heart disease. If BP runs in your family you may save lives in your family by checking their BP yourself. There is a brief discussion of this in my Evolution Article. 6. How to DX and treat PA: Go to our file/Conn's Articles of Note/Medications/Bravo spir 1973.pdf and read this article and take to your health care team. It is old but still one of the best in the medical management of PA. Also see our file from the Endocrine Society Guidelines on PA. Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a high salt diet for 2 weeks-at least 4000 mg of Na a day.2. No BP meds in last 4-12 weeks depending on meds and Drs advice.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 1-4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. I call this Dr. Grim’s “Quick Pee Test” for PA. Our PA Registry: If you have been Dxed with PA already and are on Rx or have had surgery please go to http://www.kwiksurveys.com/online-survey.php?surveyID=HIJIO_f2685379 and complete our survey with as much information as you know. If there is some information you don't know ask us and we will help. If you need to update this as you journey thru the diagnostic/treatment process you can add another entry but label it as Nameyymmdd. For example today 4/20/11 for me would be Grim110420. This way of writing the date is an ever increasing number and will allow us and you to sort your multiple entries into a dated order. We are working on a more extensive database. 8. Learn the language: If you are new to medical lingo then download the acroyms from http://health.groups.yahoo.com/group/bloodpressureline/message/291869. Salt and high blood pressure: To learn the state of the science of salt and blood pressure please spend some time looking at http://www.worldactiononsalt.com/evidence/treatment_trials.htm10. Become a HBP expert consumer: Expect that it will take at least several weeks to get all this digested and to learn the new language of high blood pressure health care. As most doctors and nurses in practice have had very little training in high blood pressure you must become an expert yourself. For example most have never had anyone listen with them with a double stethoscope to verify that they can hear BP sounds. We cannot make you a doctor but we will make you a pretty good BP doctor.11. How High Blood Pressure should be managed: Go to nih.gov and download and read the Joint National Commission (JNC) Report 7 to get an overview on current guidelines. I ask all my secretaries to read this so they can communicate the importance of high blood pressure to my patients. JNC 8 will be out soon.Then: get (and study) the Hypertension Primer from americanheart.org. This is the most up-to-date compendium of what is known about high blood pressure and what every Dr. should know when they graduate from Medical School. Every chapter is only 2-3 pages. Read one chapter every week-night and you will finish it in about a year. I am working on a reading guide for lay people for the Primer. Stay tuned.12. Ask us questions: Ask any questions about high blood pressure you want answered. That is what we are here for.13. One-on-one Consulting: I can provide individual consulting if you do not want to go public. If you want individual one-on-one consulting for you and your Doctor contract me directly at lowerbp2@....May your pressure be low!Clarence E. Grim BS, MS, MD, FACP, FACCBoard Certified in Internal Medicine, Geriatrics, and High Blood Pressure Specializing in Primary Aldosteronism and Difficult to Control High Blood Pressure. I've been searching for the file/info regarding the protocol for testing for low aldo. Will you please direct me to it? thanks, Ashlee

January 3, 2012

It is high aldo that causes PA and lower renin.CE Grim MD> > It is low renin and high aldo that causes PA.

January 3, 2012

Ashlee: How much licorice do you eat and for how long?CE Grim MD Thanks for posting that Francis! I didn't find what I need there. Mainly I need to know how long I need to be off licorice and if it's the third day of my menses cycle or ovulation cycle that I'm supposed to be testing at. I have super low BP and have a lab slip for testing cortisol, renin, aldo, potasium, (and few others i don't remember at present time). Thanks! Ashlee

January 4, 2012

Im not currently taking any and never have. I would like to start to see if I

may feel a bit better. I was thinking of trying the licorice root to see if I

felt a benefit, but I will be testing at my next cycle (was out of town for the

last one), but haven't because I'm uncertain about how long I would need to

discontinue before testing so have not started the licorice.

I have worsening symptoms. Or so it seems. (waking every night about 3:30. If I

can't get back to sleep the following day I have nausea diarrhea, intestinal

cramping, increased dizziness, increased fatigue throughout the day. I've also

lost 8 pounds in about a two week period of time without exercising or eating

differently (not that I'm complaining) I'm also waking with chest congestion

which I only am having in the middle of the night. I know some of this can be

explained other ways especially with the cold and flu season upon us, but it

also looks like more (addition symptoms then I previously had) for 's

maybe? The two nights I was able to get good sleep I didn't have the severity of

the above " new " symptoms. This will only be my 2nd menses in many years due to

being pregnant and nursing babies. I was thinking of trying the licorice root

to see if I felt a benefit, but I will be testing at my next cycle (was out of

town for the last one).

Thanks so much for responding!

Ashlee

>

> > Thanks for posting that Francis!

> >

> > I didn't find what I need there. Mainly I need to know how long I

> > need to be off licorice and if it's the third day of my menses cycle

> > or ovulation cycle that I'm supposed to be testing at.

> >

> > I have super low BP and have a lab slip for testing cortisol, renin,

> > aldo, potasium, (and few others i don't remember at present time).

> >

> > Thanks!

> > Ashlee

> >

>

January 4, 2012