Guest guest Posted December 21, 2011 Report Share Posted December 21, 2011 After seriously pondering the sitution for two days and a lot research over the last week or so I have decided to suspend the MCB/DASH method of treatment and persue AVS/ADx/DASH. Since I have to get off Spironolactone if I want to return to being a man it seems like a good time to do a wash and see if I am a candidate. I called the VA Tele. Advice line yesterday afternoon and told them to let Drs. Webster nd Bauman know and invite them to call me back if they wanted to participate in my BP management! BTW Francis, you are right I'm afraid. I have not heard back from Dr. Bauman since Monday afternoon when he told triage he would call me back! I'll be doing a QOL study of 1, stay tuned! - 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): 133/74 HR 58 BS 123 Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD. Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 21, 2011 Report Share Posted December 21, 2011 If you are going outside the VA could see what Burlington has to offer. I know you like DHMC but PA doesn't seem one of the top things they do. > > After seriously pondering the sitution for two days and a lot research over the last week or so I have decided to suspend the MCB/DASH method of treatment and persue AVS/ADx/DASH. Since I have to get off Spironolactone if I want to return to being a man it seems like a good time to do a wash and see if I am a candidate. > > I called the VA Tele. Advice line yesterday afternoon and told them to let Drs. Webster nd Bauman know and invite them to call me back if they wanted to participate in my BP management! BTW Francis, you are right I'm afraid. I have not heard back from Dr. Bauman since Monday afternoon when he told triage he would call me back! > > I'll be doing a QOL study of 1, stay tuned! > > - 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): 133/74 HR 58 BS 123 > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD. > Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 21, 2011 Report Share Posted December 21, 2011 I got a call from GiGi, team 4 nurse, informing me Elperenone had been approved, Surprise, SURPRISE! I told her that plans have changed and to cancel the order. Told her that I needed to know if Dr. Webster or Dr. Bauman needed to order the AVS. (I also pointed out Dr. Bauman had not called me back in 3 days!) I gave her a brief summary of PA and treatment options. She was very impressed with my knowledge and wanted " to hire me " as a doctor at the VA! Told her I had enough trouble getting thru H.S.! Maybe I should offer to be consultant, they make more money and don't need a license! I sent her an e-mail nd it and her response follows: (BTW, she is the nurse Dr. Grim and I awarded dark chocolate to for taking BP correctly.) Here's i's the message: This is one of the best summaries I have seen for Hyper Aldosteronism. Now you are the EX/SPURT! (Suitable for every doctor at the VA! Please teach them the correct method of taking BP while you are at it!) http://www.hormone.org/Resources/upload/primary-aldosteronism-bilingual-070709.p\ df Regards... Thank you you made my day. I really love learning new things and I feel if I don't something new I didn't have an eventful day. This is my something new that I learned Thank you! Have a Merry Christmas and a Happy New Year or Happy Holidays! Not sure which would be the correct term. It was a pleasure talking with you on the phone. Georgina merrill, LPN Team 4 Nurse - 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): 133/74 HR 58 BS 123 Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD. Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin, Metformin 2000MG and Spironolactone 50 MG. > > After seriously pondering the sitution for two days and a lot research over the last week or so I have decided to suspend the MCB/DASH method of treatment and persue AVS/ADx/DASH. Since I have to get off Spironolactone if I want to return to being a man it seems like a good time to do a wash and see if I am a candidate. > > I called the VA Tele. Advice line yesterday afternoon and told them to let Drs. Webster nd Bauman know and invite them to call me back if they wanted to participate in my BP management! BTW Francis, you are right I'm afraid. I have not heard back from Dr. Bauman since Monday afternoon when he told triage he would call me back! > > I'll be doing a QOL study of 1, stay tuned! > > - 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): 133/74 HR 58 BS 123 > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD. > Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 21, 2011 Report Share Posted December 21, 2011 I will persue thru the VA as private insurance went away when I turned 65. I like DHMH because I was raised in Woodstock and my wife's family, a 5th generation Vermonter, is from the Woodstock/Quechee area. Fletcher/, another teaching hospital, in Burlington has transistioned into another good hospital after they merged two a number of years ago. The local hospital, Central VT Medical Center, has recently chnged their affiliation to Fletcher/. - 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): 133/74 HR 58 BS 123 Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD. Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin, Metformin 2000MG and Spironolactone 50 MG. > > > > After seriously pondering the sitution for two days and a lot research over the last week or so I have decided to suspend the MCB/DASH method of treatment and persue AVS/ADx/DASH. Since I have to get off Spironolactone if I want to return to being a man it seems like a good time to do a wash and see if I am a candidate. > > > > I called the VA Tele. Advice line yesterday afternoon and told them to let Drs. Webster nd Bauman know and invite them to call me back if they wanted to participate in my BP management! BTW Francis, you are right I'm afraid. I have not heard back from Dr. Bauman since Monday afternoon when he told triage he would call me back! > > > > I'll be doing a QOL study of 1, stay tuned! > > > > - 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): 133/74 HR 58 BS 123 > > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD. > > Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 21, 2011 Report Share Posted December 21, 2011 Surprise, SURPRISE, I just heard from Dr. Bauman, Chief of Endo, and Inspra has been approved! He didn't seem surprised when I told him to put it on hold. Do you think GiGi " spilled the beans " ? He said he would arrange for the AVS. I reminded him to give me 6 weeks to wash Spiro and his response was he would see what the lab needed. I assured him it was at least 6 week! He asked when I stopped Spiro and I told him this morning. He asked wht BP was this morning. He thought 137/80 w/BS of 83 was " great " and I didn't have the heart to remind him that was the last reading with the full effect of Spiro! (See , I'm learning!) He also wanted to know if I had lost weight. Instead of telling him I had gained 282 lbs., I was respectful and responded " maybe a pound or two " . God, I've mellowed! - 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): 133/74 HR 58 BS 123 Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD. Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin, Metformin 2000MG and Spironolactone 50 MG. > > > > After seriously pondering the sitution for two days and a lot research over the last week or so I have decided to suspend the MCB/DASH method of treatment and persue AVS/ADx/DASH. Since I have to get off Spironolactone if I want to return to being a man it seems like a good time to do a wash and see if I am a candidate. > > > > I called the VA Tele. Advice line yesterday afternoon and told them to let Drs. Webster nd Bauman know and invite them to call me back if they wanted to participate in my BP management! BTW Francis, you are right I'm afraid. I have not heard back from Dr. Bauman since Monday afternoon when he told triage he would call me back! > > > > I'll be doing a QOL study of 1, stay tuned! > > > > - 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): 133/74 HR 58 BS 123 > > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD. > > Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 21, 2011 Report Share Posted December 21, 2011 Keep us posted. It will be an educational experience I am sure. Weigh the risks and benefits of each step. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension After seriously pondering the sitution for two days and a lot research over the last week or so I have decided to suspend the MCB/DASH method of treatment and persue AVS/ADx/DASH. Since I have to get off Spironolactone if I want to return to being a man it seems like a good time to do a wash and see if I am a candidate. I called the VA Tele. Advice line yesterday afternoon and told them to let Drs. Webster nd Bauman know and invite them to call me back if they wanted to participate in my BP management! BTW Francis, you are right I'm afraid. I have not heard back from Dr. Bauman since Monday afternoon when he told triage he would call me back! I'll be doing a QOL study of 1, stay tuned! - 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): 133/74 HR 58 BS 123 Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD. Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 21, 2011 Report Share Posted December 21, 2011 I would recommend a trial of eplerenone first but it is always up to u. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension I got a call from GiGi, team 4 nurse, informing me Elperenone had been approved, Surprise, SURPRISE! I told her that plans have changed and to cancel the order. Told her that I needed to know if Dr. Webster or Dr. Bauman needed to order the AVS. (I also pointed out Dr. Bauman had not called me back in 3 days!) I gave her a brief summary of PA and treatment options. She was very impressed with my knowledge and wanted "to hire me" as a doctor at the VA! Told her I had enough trouble getting thru H.S.! Maybe I should offer to be consultant, they make more money and don't need a license! I sent her an e-mail nd it and her response follows: (BTW, she is the nurse Dr. Grim and I awarded dark chocolate to for taking BP correctly.) Here's i's the message: This is one of the best summaries I have seen for Hyper Aldosteronism. Now you are the EX/SPURT! (Suitable for every doctor at the VA! Please teach them the correct method of taking BP while you are at it!) http://www.hormone.org/Resources/upload/primary-aldosteronism-bilingual-070709.pdf Regards... Thank you you made my day. I really love learning new things and I feel if I don't something new I didn't have an eventful day. This is my something new that I learned Thank you! Have a Merry Christmas and a Happy New Year or Happy Holidays! Not sure which would be the correct term. It was a pleasure talking with you on the phone. Georgina merrill, LPN Team 4 Nurse - 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): 133/74 HR 58 BS 123 Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD. Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin, Metformin 2000MG and Spironolactone 50 MG. > > After seriously pondering the sitution for two days and a lot research over the last week or so I have decided to suspend the MCB/DASH method of treatment and persue AVS/ADx/DASH. Since I have to get off Spironolactone if I want to return to being a man it seems like a good time to do a wash and see if I am a candidate. > > I called the VA Tele. Advice line yesterday afternoon and told them to let Drs. Webster nd Bauman know and invite them to call me back if they wanted to participate in my BP management! BTW Francis, you are right I'm afraid. I have not heard back from Dr. Bauman since Monday afternoon when he told triage he would call me back! > > I'll be doing a QOL study of 1, stay tuned! > > - 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): 133/74 HR 58 BS 123 > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD. > Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 21, 2011 Report Share Posted December 21, 2011 I was thinking you could still get "private" insurance after 65. So no one will sell you insurance?May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension I will persue thru the VA as private insurance went away when I turned 65. I like DHMH because I was raised in Woodstock and my wife's family, a 5th generation Vermonter, is from the Woodstock/Quechee area. Fletcher/, another teaching hospital, in Burlington has transistioned into another good hospital after they merged two a number of years ago. The local hospital, Central VT Medical Center, has recently chnged their affiliation to Fletcher/. - 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): 133/74 HR 58 BS 123 Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD. Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin, Metformin 2000MG and Spironolactone 50 MG. > > > > After seriously pondering the sitution for two days and a lot research over the last week or so I have decided to suspend the MCB/DASH method of treatment and persue AVS/ADx/DASH. Since I have to get off Spironolactone if I want to return to being a man it seems like a good time to do a wash and see if I am a candidate. > > > > I called the VA Tele. Advice line yesterday afternoon and told them to let Drs. Webster nd Bauman know and invite them to call me back if they wanted to participate in my BP management! BTW Francis, you are right I'm afraid. I have not heard back from Dr. Bauman since Monday afternoon when he told triage he would call me back! > > > > I'll be doing a QOL study of 1, stay tuned! > > > > - 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): 133/74 HR 58 BS 123 > > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD. > > Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 22, 2011 Report Share Posted December 22, 2011 You need to be off some other meds two weeks before AVS. > > > > > > After seriously pondering the sitution for two days and a lot research over the last week or so I have decided to suspend the MCB/DASH method of treatment and persue AVS/ADx/DASH. Since I have to get off Spironolactone if I want to return to being a man it seems like a good time to do a wash and see if I am a candidate. > > > > > > I called the VA Tele. Advice line yesterday afternoon and told them to let Drs. Webster nd Bauman know and invite them to call me back if they wanted to participate in my BP management! BTW Francis, you are right I'm afraid. I have not heard back from Dr. Bauman since Monday afternoon when he told triage he would call me back! > > > > > > I'll be doing a QOL study of 1, stay tuned! > > > > > > - 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): 133/74 HR 58 BS 123 > > > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD. > > > Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 22, 2011 Report Share Posted December 22, 2011 You can pay for anything. Most companies or people do drop private insurance when they get medicare because they can't afford both. Medicare still has plenty of costs associated with it. But anyone can buy their own insurance - it's just too expensive anymore. The only "good" insurance in this day is medicaid - no copay (or a $2 one), all scripts free, all services free like MRI's (not under medicare though) , CT's, treatments, and so on (but like any insurance it is not endless in their coverage - still I never had any trouble getting something approved). And those who qualify do not have to pay a single penny in. Everyone who doesn't qualify pays in to medicaid. Of course people still complain - even though they are getting it 100% free - that it doesn't cover dental or that the free medicaid taxi won't also take them to the store on the way to their appointments. All insurance stinks in this age otherwise, in my opinion, at least it's not like it used to be. I will persue thru the VA as private insurance went away when I turned 65. I like DHMH because I was raised in Woodstock and my wife's family, a 5th generation Vermonter, is from the Woodstock/Quechee area.Fletcher/, another teaching hospital, in Burlington has transistioned into another good hospital after they merged two a number of years ago. The local hospital, Central VT Medical Center, has recently chnged their affiliation to Fletcher/. - 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): 133/74 HR 58 BS 123Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD.Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin, Metformin 2000MG and Spironolactone 50 MG. > >> > After seriously pondering the sitution for two days and a lot research over the last week or so I have decided to suspend the MCB/DASH method of treatment and persue AVS/ADx/DASH. Since I have to get off Spironolactone if I want to return to being a man it seems like a good time to do a wash and see if I am a candidate.> > > > I called the VA Tele. Advice line yesterday afternoon and told them to let Drs. Webster nd Bauman know and invite them to call me back if they wanted to participate in my BP management! BTW Francis, you are right I'm afraid. I have not heard back from Dr. Bauman since Monday afternoon when he told triage he would call me back! > > > > I'll be doing a QOL study of 1, stay tuned!> > > > - 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): 133/74 HR 58 BS 123> > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD.> > Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000.> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 22, 2011 Report Share Posted December 22, 2011 Oh no, you can. The price goes from $139/Qtr to $756/Mo, a little rich for my blood since I get all my care at the VA! > > > > > > > > After seriously pondering the sitution for two days and a lot research over the last week or so I have decided to suspend the MCB/DASH method of treatment and persue AVS/ADx/DASH. Since I have to get off Spironolactone if I want to return to being a man it seems like a good time to do a wash and see if I am a candidate. > > > > > > > > I called the VA Tele. Advice line yesterday afternoon and told them to let Drs. Webster nd Bauman know and invite them to call me back if they wanted to participate in my BP management! BTW Francis, you are right I'm afraid. I have not heard back from Dr. Bauman since Monday afternoon when he told triage he would call me back! > > > > > > > > I'll be doing a QOL study of 1, stay tuned! > > > > > > > > - 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): 133/74 HR 58 BS 123 > > > > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD. > > > > Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000. > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 22, 2011 Report Share Posted December 22, 2011 I was going to explain that to him but I didn't want to confuse him! 6 weeks was the longest lead time he needed! > > > > > > > > After seriously pondering the sitution for two days and a lot research over the last week or so I have decided to suspend the MCB/DASH method of treatment and persue AVS/ADx/DASH. Since I have to get off Spironolactone if I want to return to being a man it seems like a good time to do a wash and see if I am a candidate. > > > > > > > > I called the VA Tele. Advice line yesterday afternoon and told them to let Drs. Webster nd Bauman know and invite them to call me back if they wanted to participate in my BP management! BTW Francis, you are right I'm afraid. I have not heard back from Dr. Bauman since Monday afternoon when he told triage he would call me back! > > > > > > > > I'll be doing a QOL study of 1, stay tuned! > > > > > > > > - 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): 133/74 HR 58 BS 123 > > > > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD. > > > > Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000. > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 22, 2011 Report Share Posted December 22, 2011 I'm well aware what you recommend and seriously considered it as one of my options. I even made sure it was avilable to me but when the approval took over a month I decided I needed to look at all alternatives. Let me assure you I have approached this decision with my eyes and ears wide open. I weighed the risk of surgery with a team of experienced professionals against thousands of miles for numerous appointments (assume 40 trips * 100 miles at ~80 mph!) Yes, my PCP has pointed out I could slow down but I don't buy a car that rides on air to drive it like Yogo! I also considered the adverse side effects of years of medicinal therapy. The decision became clear when I discovered the association of MCBs to the increase in Cortisol and what that increase may be doing. I also considered that Eplerenone has not been approved for the treatment of PA nor did I find many controlled studies. I did find many studies that recommend removal of unilateral aldosterone producing tumors. IMHO The MCB/DASH trial is too uncontrolled. Instead of understanding and testing for adverse side effects we wait until SX appear and then change course and try to fix the problems we created. Dosing is determined by trial and error. I decided I wasn't ready psychologically for another year or more of that! The short list of major input factors, the first two are repeats regarding Cortisol: A picture is worth a thousand words: http://archpsyc.ama-assn.org/cgi/content/full/60/1/24/FIGYOA20492F1 I lifted it from here: http://archpsyc.ama-assn.org/cgi/content/full/60/1/24 This 2008 article from the UK provides good review. I'm way beyond my comfort zone explaining it so the only hint I will give is that I understand CYP11B1 converts to Cortisol and CYP11B2 to Aldosterone. Read it twice and draw your own conclusion! Source: http://edrv.endojournals.org/content/29/2/133.full A Lifetime of Aldosterone Excess: Long-Term Consequences of Altered Regulation of Aldosterone Production for Cardiovascular Function M. C. Connell, M. MacKenzie, E. Marie Freel, Fraser and Eleanor Davies E. Aldosterone synthase " The conversion of DOC to aldosterone involves three consecutive reactions catalyzed by a single enzyme, aldosterone synthase. It performs 11â-hydroxylation of DOC to form corticosterone, an 18-hydroxylation step providing 18-hydroxycorticosterone and finally 18-methyloxidation to produce aldosterone. Aldosterone synthase is located on the inner mitochondrial membrane and is encoded by the CYP11B2 gene. DOC is the preferred substrate of aldosterone synthase and remains bound to the active site throughout these reactions, whereas corticosterone and 18-hydroxycorticosterone are only released as by-products (21). Aldosterone synthase is approximately 93% homologous to 11â-hydroxylase, the product of the CYP11B1 gene, which catalyzes the conversion of 11-deoxycortisol to the main glucocorticoid, cortisol (in rodents, it converts DOC to the principal glucocorticoid, corticosterone). The CYP11B1 and CYP11B2 genes are located in tandem on human chromosome 8q21–22 (22, 23, 24) but are not coexpressed in the adrenal cortex; CYP11B2 expression is confined to the ZG, whereas CYP11B1 is expressed in the ZF and ZR. This zonal pattern of expression is accounted for by major differences in the regulatory regions of the two genes. CYP11B2 expression is mainly controlled by AngII and potassium, whereas CYP11B1 is regulated by ACTH. " IMHO this should be reviewed by all who treat w/MCBs even if they have no choice. Somebody needs to know the possibilities and the PTN should be aware of them! - 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): 133/74 HR 58 BS 123 Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD. Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000MG. > > > > > > After seriously pondering the sitution for two days and a lot research over the last week or so I have decided to suspend the MCB/DASH method of treatment and persue AVS/ADx/DASH. Since I have to get off Spironolactone if I want to return to being a man it seems like a good time to do a wash and see if I am a candidate. > > > > > > I called the VA Tele. Advice line yesterday afternoon and told them to let Drs. Webster nd Bauman know and invite them to call me back if they wanted to participate in my BP management! BTW Francis, you are right I'm afraid. I have not heard back from Dr. Bauman since Monday afternoon when he told triage he would call me back! > > > > > > I'll be doing a QOL study of 1, stay tuned! > > > > > > - 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): 133/74 HR 58 BS 123 > > > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD. > > > Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000. > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 22, 2011 Report Share Posted December 22, 2011 Go to www.ehealthinsurance.com and see how much private insurance you can buy if you're 65. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Bingham You can pay for anything. Most companies or people do drop private insurance when they get medicare because they can't afford both. Medicare still has plenty of costs associated with it. But anyone can buy their own insurance - it's just too expensive anymore. The only " good " insurance in this day is medicaid - no copay (or a $2 one), all scripts free, all services free like MRI's (not under medicare though) , CT's, treatments, and so on (but like any insurance it is not endless in their coverage - still I never had any trouble getting something approved). And those who qualify do not have to pay a single penny in. Everyone who doesn't qualify pays in to medicaid. Of course people still complain - even though they are getting it 100% free - that it doesn't cover dental or that the free medicaid taxi won't also take them to the store on the way to their appointments. All insurance stinks in this age otherwise, in my opinion, at least it's not like it used to be. I was thinking you could still get " private " insurance after 65. So no one will sell you insurance?__ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 22, 2011 Report Share Posted December 22, 2011 If we are going to examine insurance we need to look at the whole picture. When I was growing up and was sick a lot of time the doctor showed up in his big Pontiac convertible. His assistant was his dog, a big airdale, who often entertained the kids, sick or well he didn't care! More than once his pay was a fresh baked strawberry/rhubarb pie. (We had the best rhubarb and Mom was the best cook in town!) He then dispensed those little black pills (in those " child proof paper envelopes " and that was it, no trip to the drug store even! He needed enough money for the car and the dog food! Oh yea, he had an office, it was his living room! (BTW, he had a convertible because the dog objected to his smoke, he was a chain smoker!) How does that compare to running a practice today ? > > > > > > After seriously pondering the sitution for two days and a lot research over the last week or so I have decided to suspend the MCB/DASH method of treatment and persue AVS/ADx/DASH. Since I have to get off Spironolactone if I want to return to being a man it seems like a good time to do a wash and see if I am a candidate. > > > > > > I called the VA Tele. Advice line yesterday afternoon and told them to let Drs. Webster nd Bauman know and invite them to call me back if they wanted to participate in my BP management! BTW Francis, you are right I'm afraid. I have not heard back from Dr. Bauman since Monday afternoon when he told triage he would call me back! > > > > > > I'll be doing a QOL study of 1, stay tuned! > > > > > > - 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): 133/74 HR 58 BS 123 > > > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD. > > > Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 22, 2011 Report Share Posted December 22, 2011 I still don't envy people on Medicaid providing they are 'TRULY QUALIFIED FOR MEDICAID" Phyllis You can pay for anything. Most companies or people do drop private insurance when they get medicare because they can't afford both. Medicare still has plenty of costs associated with it. But anyone can buy their own insurance - it's just too expensive anymore. The only "good" insurance in this day is medicaid - no copay (or a $2 one), all scripts free, all services free like MRI's (not under medicare though) , CT's, treatments, and so on (but like any insurance it is not endless in their coverage - still I never had any trouble getting something approved). And those who qualify do not have to pay a single penny in. Everyone who doesn't qualify pays in to medicaid. Of course people still complain - even though they are getting it 100% free - that it doesn't cover dental or that the free medicaid taxi won't also take them to the store on the way to their appointments. All insurance stinks in this age otherwise, in my opinion, at least it's not like it used to be. I will persue thru the VA as private insurance went away when I turned 65. I like DHMH because I was raised in Woodstock and my wife's family, a 5th generation Vermonter, is from the Woodstock/Quechee area. Fletcher/, another teaching hospital, in Burlington has transistioned into another good hospital after they merged two a number of years ago. The local hospital, Central VT Medical Center, has recently chnged their affiliation to Fletcher/. - 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): 133/74 HR 58 BS 123 Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD. Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin, Metformin 2000MG and Spironolactone 50 MG. > > > > After seriously pondering the sitution for two days and a lot research over the last week or so I have decided to suspend the MCB/DASH method of treatment and persue AVS/ADx/DASH. Since I have to get off Spironolactone if I want to return to being a man it seems like a good time to do a wash and see if I am a candidate. > > > > I called the VA Tele. Advice line yesterday afternoon and told them to let Drs. Webster nd Bauman know and invite them to call me back if they wanted to participate in my BP management! BTW Francis, you are right I'm afraid. I have not heard back from Dr. Bauman since Monday afternoon when he told triage he would call me back! > > > > I'll be doing a QOL study of 1, stay tuned! > > > > - 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): 133/74 HR 58 BS 123 > > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD. > > Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 22, 2011 Report Share Posted December 22, 2011 Thanks Val, here is a list of the providers in Vermont! Individual and Family Health Insurance Companies in Vermont MVP ..... >Hyperaldosteronism , " Valarie " wrote: > > Go to www.ehealthinsurance.com and see how much private insurance you can buy if you're 65. > > Val > > From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Bingham > > > You can pay for anything. Most companies or people do drop private insurance when they get medicare because they can't afford both. Medicare still has plenty of costs associated with it. But anyone can buy their own insurance - it's just too expensive anymore. > > The only " good " insurance in this day is medicaid - no copay (or a $2 one), all scripts free, all services free like MRI's (not under medicare though) , CT's, treatments, and so on (but like any insurance it is not endless in their coverage - still I never had any trouble getting something approved). And those who qualify do not have to pay a single penny in. Everyone who doesn't qualify pays in to medicaid. > > Of course people still complain - even though they are getting it 100% free - that it doesn't cover dental or that the free medicaid taxi won't also take them to the store on the way to their appointments. > > All insurance stinks in this age otherwise, in my opinion, at least it's not like it used to be. > > > > > I was thinking you could still get " private " insurance after 65. So no one will sell you insurance? > __ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 22, 2011 Report Share Posted December 22, 2011 Your memory may be starting to let you down (or maybe it's the stress of moving!) I posted one two dys ago and here it is with your response: Re: MCB vs Surgery I would like to see 5 and 10 year results. And they will have them eventually. I know they do not Include DASH as part of the MT and have written to Stowasser a out this. They are " working on it " so we really have the best long ter DASH MCB data set in the world. If everyone would update their progress every 6 months in our data base we could make a real contribution. May your pressure be low! CE Grim MS, MD Specializing in Difficult Hypertension I came across two recent studies done in Australia. They look beyond only BP resolution, read for yourself..... Improved Quality of Life, Blood Pressure, and Biochemical Status Following Laparoscopic Adrenalectomy for Unilateral Primary Aldosteronism Norlela Sukor, Kogovsek, D. Gordon, Dianne Robson and Stowasser Source: http://jcem.endojournals.org/content/95/3/1360.long Abstract Context: In 22 patients with unilateral primary aldosteronism (UPA), unilateral laparoscopic adrenalectomy (ADX) not only corrected hypokalemia and led to cure or improvement of hypertension, but also significantly improved quality of life (QOL). Conclusion: Unilateral adrenalectomy had positive impacts not only on blood pressure and biochemical parameters, but also on QOL, which was impaired preoperatively but significantly improved by 3 months postoperatively. Quality of Life in Patients with Bilateral Primary Aldosteronism before and during Treatment with Spironolactone and/or Amiloride, Including a Comparison with Our Previously Published Results in Those with Unilateral Disease Treated Surgically Ashraf H. Ahmed, D. Gordon, Norlela Sukor, Pimenta and Stowasser Source: http://jcem.endojournals.org/content/96/9/2904.abstract Background: Measurement of quality of life (QOL) allows assessment of the impact of a disease or treatment from the patient's perspective, including need for social, emotional, or physical support. We are not aware of any published QOL assessment in patients with bilateral primary aldosteronism (BPA), before or after commencing medical treatment (MT) with spironolactone and/or amiloride. Conclusion: Subnormal QOL scores were improved after 6 months of MT in 21 patients with BPA, but more slowly and to a lesser degree than surgical treatment had previously been shown to improve QOL scores in 22 patients with UPA. Address all correspondence and requests for reprints to: Prof. Stowasser, Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Princess andra Hospital, Ipswich Road, Woolloongabba, Brisbane 4102,Australia. E-mail: m.stowasser@.... - 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. > > > > > > I would recommend a trial of eplerenone first but it is always up to u > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 22, 2011 Report Share Posted December 22, 2011 I have not reviewed the Bravo article because I consider it a history lesson since it is 13 years old. I am more concerned with what they are doing today. - 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): 133/74 HR 58 BS 123 Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD. Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000MG. > > > > > > I would recommend a trial of eplerenone first but it is always up to u > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 22, 2011 Report Share Posted December 22, 2011 The surgeon I spoke with, Dr. Lacock, was not the least bit concerned by my small size. He does ~15 lproscopic adrenal surgeries a year and the rest of the time it is mostly gastric banding. (Most of those are not done on small people he assured me!) He actually has a strict diet that you must adhere to for two weeks to soften your liver so he can get to the right adrenal. He makes the first incision and validates your compliance before proceeding! He will probably not be doing the surgery but I will be certainly checking the one that does once I get it planned. - 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): 133/74 HR 58 BS 123 Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD. Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000MG. > > > > > > I would recommend a trial of eplerenone first but it is always up to u > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 22, 2011 Report Share Posted December 22, 2011 You didn't happen to talk with him about what happens to the CYP11B1 when you antagonize the CYP11B2 did you? Did you discuss the extended elevated cortisol as depicted in the 3 graphs I sent you? Did you you happen to ask how the pituitary gland likes and reacts when you drastically reduce testosterone in men? Here is a couple of items from the Endocrine website that every man who is taking Spironolactone might want to consider (Sorry ladies, I haven't had time to research the effects on you): http://www.hormone.org/Resources/upload/low-testosterone-and-mens-health-bilingu\ al-042710.pdf http://www.hormone.org/Resources/Patient_Guides/upload/androgen-deficiency-syndr\ omes-in-men-070609.pdf - 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): 133/74 HR 58 BS 123 Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD. Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000MG. > > > > > > I would recommend a trial of eplerenone first but it is always up to u > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 22, 2011 Report Share Posted December 22, 2011 What diet softens your liver? Phyllis The surgeon I spoke with, Dr. Lacock, was not the least bit concerned by my small size. He does ~15 lproscopic adrenal surgeries a year and the rest of the time it is mostly gastric banding. (Most of those are not done on small people he assured me!) He actually has a strict diet that you must adhere to for two weeks to soften your liver so he can get to the right adrenal. He makes the first incision and validates your compliance before proceeding! He will probably not be doing the surgery but I will be certainly checking the one that does once I get it planned. - 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): 133/74 HR 58 BS 123 Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD. Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000MG. > > > > > > I would recommend a trial of eplerenone first but it is always up to u > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 22, 2011 Report Share Posted December 22, 2011 It was a very special he had developed or found that allowed the liver to soften enough to allow him to muniplate it to allow for surgery. I think I still have it but not looked for it recently. ..... > > > > > > > > > > I would recommend a trial of eplerenone first but it is always > > up to u > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 22, 2011 Report Share Posted December 22, 2011 Good data never goes bad!CE Grim MD I have not reviewed the Bravo article because I consider it a history lesson since it is 13 years old. I am more concerned with what they are doing today. - 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): 133/74 HR 58 BS 123 Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD. Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000MG. > > > > > > I would recommend a trial of eplerenone first but it is always up to u > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 22, 2011 Report Share Posted December 22, 2011 The adrenal is not easy to get to. I have watched perhaps 50 procedures myself. and good to have an experienced person. Why not have him do the surgery? or someone with more experience?CE Grim MD The surgeon I spoke with, Dr. Lacock, was not the least bit concerned by my small size. He does ~15 lproscopic adrenal surgeries a year and the rest of the time it is mostly gastric banding. (Most of those are not done on small people he assured me!) He actually has a strict diet that you must adhere to for two weeks to soften your liver so he can get to the right adrenal. He makes the first incision and validates your compliance before proceeding! He will probably not be doing the surgery but I will be certainly checking the one that does once I get it planned. - 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): 133/74 HR 58 BS 123 Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD. Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000MG. > > > > > > I would recommend a trial of eplerenone first but it is always up to u > Quote Link to comment Share on other sites More sharing options...
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