Guest guest Posted December 22, 2011 Report Share Posted December 22, 2011 I did not see the dose of spiro or the effects when on spiro for 1 years. or studies on the effects of Na intake on the response. I would not pay attention to this small study that is not relevant to PA. But only my opinion.The study is likely true, the results true but not related to PA.CE Grim MD 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-bilingual-042710.pdf http://www.hormone.org/Resources/Patient_Guides/upload/androgen-deficiency-syndromes-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 Depends if you liver is fatty to start with as it is in many obese folks who drink a bit.CE Grim 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 23, 2011 Report Share Posted December 23, 2011 According to the protocol the dose was 200mg. You may very well be right that it MAY NOT be related to a normal PA PTN, if there is such an animal, but don't ever call me normal! The major point of this study was a PTN w/MDD (Major Depressive Disorder). PA came into play only because we chose to treat it with Spironolactone! Elevated cortisol for an extended time apparently exersabates MDD, an assumption I will be verifying with my Psychiatrist on Jan. 12. I wonder is anyone else w/PA suffers w/depression! - 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 23, 2011 Report Share Posted December 23, 2011 It's easier for him to assume it is as he is primarily working on obese people. (He did explain this to me and required it even though I don't drink.) If he finds the liver is fatty he simply closes the hole and your time on the table is done! > >> > > > > >> > > > 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 23, 2011 Report Share Posted December 23, 2011 Maybe you have never been in the military, let me explain. You don't go doctor shopping, they assign them. In my experience they usually have an experienced doctor assisting if there is likely to be issues or problems. (In my case it was the Col. in charge of dental operations! And before you ask, Yes I was an A-Hole when I was 20, too!) Let me ask a stupid question. If everyone always requests/requires the best of the best do we eventually end up with only 75yo surgeons with shaky hands? To bring it closer to home, if you needed an OT and always wanted one with 10+yrs experience would my daughter be unemployed and I paying her college bills? - 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 23, 2011 Report Share Posted December 23, 2011 As his CURRICULUM VITAE states he was in the military. Military Service: 1967-69: Lt. Commander JG, Epidemiology Intelligence Service Officer, Director, Hypertension Laboratory, NCDC, USPHS, Laboratory Branch, National Communicable Disease Center, Atlanta, Georgia > > > > > > > > > > > > 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 23, 2011 Report Share Posted December 23, 2011 I didn't want to insult his memory! (Besides it might be different for a doctor looking for a doctor.) " National Cummunicable Disease Center " Wonder if he is the SOB that approved spraying me w/Agent Orange! > > > > > > > > > > > > > > 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 23, 2011 Report Share Posted December 23, 2011 Not sure who aproved the use of AO but was approved well before Dr Grim's service. A bit of history on it. Nice that the US runined so much farm land. http://en.wikipedia.org/wiki/Agent_Orange > > > > > > > > > > > > > > > > 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 23, 2011 Report Share Posted December 23, 2011 My duty in the CDC for my military service 67-69 was to set up a National Laboratory Standard for Renin measurements. Could not get done as at that time chronic disease was not a major CDC interest. I can assure I had nothing to do with agent orange.It is interesting that despite my 2 years CDC service which I was assigned to under the Berry plan as my 2 years of military service does not allow me toOn get VA benefits of any kind. Nor any other benefits from my 2 years of service. One event I do recall was the mysterious death of 100s of sheep near the Dugway Proving Grounds. Thought to be some new infections disease until one of our team found a molecule in the sheep that looked exactly like a nerve gas that was being tested at Diugway. When finally identifed the Army admitted that maybe it have come from their palce as best I recall. Clarence Grimlowerbp2@...Seasons Greetings and I didn't want to insult his memory! (Besides it might be different for a doctor looking for a doctor.) "National Cummunicable Disease Center" Wonder if he is the SOB that approved spraying me w/Agent Orange! > > > > > > > > > > > > > > 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 23, 2011 Report Share Posted December 23, 2011 If you had no or little active duty time then you would not get VA benefits. > > > > > > > > > > > > > > > > > > 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 23, 2011 Report Share Posted December 23, 2011 , did you mean for your list to be empty? There is no alternative to Medicare if you're over 65. Only retired government employees get that plan. What's been happening to me is that the service is provided and then Medicare refuses to pay for it. There is no pre-authorization. They are very explicit that I am not to pay it, and want me to tell them if the provider tries to collect. In other words, they want me to stiff the provider and then sick the government on him/her. If this continues, there will be no " providers " for those on Medicare. I won't stiff anyone and will end up depriving myself to pay those who used their facilities and manpower to help me. Medicare be damned! I have no insurance company to which I can complain. I don't see Medicare doctors either so I have no insurance company to which I can turn in the bills, no matter how catastrophic they get. Only government doctors get to secure payment from my " insurance. " Before anyone tries to foist socialized medicine on you, think about it. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Thanks Val, here is a list of the providers in Vermont! Individual and Family Health Insurance Companies in VermontMVP....>Hyperaldosteronism , " Valarie " wrote:>> Go to www.ehealthinsurance.com and see how much private insurance you can buy if you're 65.> > 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 23, 2011 Report Share Posted December 23, 2011 There was one provider and I thought it was MVP (tht's all your site returned also) Does it make a difference if you are coming from CIGNA? MVP and CIGNA appear to be in bed together! I suspect there will be none if the Vermont State Legislature and the governor continue on their socialist path, IMHO!!! > > > > Go to www.ehealthinsurance.com and see how much private insurance you can > buy if you're 65. > > > > From: hyperaldosteronism > <mailto:hyperaldosteronism%40yahoogroups.com> > [mailto:hyperaldosteronism > <mailto:hyperaldosteronism%40yahoogroups.com> ] 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. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 23, 2011 Report Share Posted December 23, 2011 I do hope you realize I was kidding. I knew you were too young and not stupid enough to think something strong enough to defoliate trees wouldn't hurt people and their food supply! The sad part is I never realized they were poisioning me until years later hence just now getting the registery exam! I was on a base and now find it is still 30 times above standards as of a couple years ago! Thinking about it, DaNang was the northern most major air base so they probably flew most of the northern missions out of there. My bunk mate worked the line in POL (Petroleum Oil & Lubricants) so he probably loaded the planes and hung his shirt on the end of the bunks when he got done! I do have one question Dr. Grim. What were they doing with " 100's of Sheep " on an Army Base? (Hope hazing wasn't involved!) , > > > > > > > > > > > > > > > > > > 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 23, 2011 Report Share Posted December 23, 2011 But DOW made a lot of money. Intersting it the CORP> that make all the money But it is the tax payer that pays for the harm that is done. > > > > > > > > > > > > > > > > > > > > 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 23, 2011 Report Share Posted December 23, 2011 Dow wasn't stupid enough to spray it just like whiskey makers don't make you drive drunk and guns don't kill people! This is probably not the right forum to get me strted! > > > > > > > > > > > > > > > > > > > > > > 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 23, 2011 Report Share Posted December 23, 2011 you can buy medgap or so forth, but you can still buy health insurance if you can afford it. "Can" is not the same as "able to" though and like life insurance, the older you are the more you'll pay and most can't pay for their own insurance. It's kind of a joke like COBRA was. BUT..... If you have enough money you can get anything. If you have no assets and no income many do get medicaid on top of medicare too, but once again it is back to those that have something - for example, like they worked their whole life for their home and still have their 1980 Cadillac Seville in the garage, even though zero income now, will still be punished for having and will not qualify for medicaid, even over 65. The nice house and nice car may be seen by others as they are rich, when in reality they are not, but were hard workers who's retirement savings didnt keep up with inflation. But if they are not in subsidised housing they won't get medicaid on top of medicare. Many of them just go without a lot of medications because they can't buy them. >> Go to www.ehealthinsurance.com and see how much private insurance you can buy if you're 65.> > 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 23, 2011 Report Share Posted December 23, 2011 , go to https://www.ehealthinsurance.com  and try to buy health insurance if you're 65. All you can buy is supplements. If you're 65 and don't have VA (government) or the federal employees health plan, you have no choice but Medicare (government) if you want any insurance. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Bingham you can buy medgap or so forth, but you can still buy health insurance if you can afford it. " Can " is not the same as " able to " though and like life insurance, the older you are the more you'll pay and most can't pay for their own insurance. It's kind of a joke like COBRA was. BUT..... If you have enough money you can get anything. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 23, 2011 Report Share Posted December 23, 2011 Did you remember to give the horse extra oats now that it's winter? Now that was good transportation, always started and the brakes never failed! Let me point out I am persuing the only other option according to Bravo since Elperenone wouldn't be developed for another 4 years! I was only able to find one Bravo article in our files and that looks like it was done in 1973! If that is the one, when did you start " hanging your hat " on a study of 14? And maybe you should reread the last sentence where they recommend Spiro for preopertive treatment AND THOSE NOT SUITABLE FOR SURGERY (emphasis is mine). Maybe we should research how many trials recommend surgery where appropriate vs MCB's. I think all I have seen said something like " for those not a candidate for surgery or those that refuse " . If I had persued that avenue I would have reported my first anniversary a couple months ago! (But I would certainly be a lot less informed!) - 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 23, 2011 Report Share Posted December 23, 2011 But they will still get special ins when they retire?May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension There was one provider and I thought it was MVP (tht's all your site returned also) Does it make a difference if you are coming from CIGNA? MVP and CIGNA appear to be in bed together! I suspect there will be none if the Vermont State Legislature and the governor continue on their socialist path, IMHO!!! > > > > Go to www.ehealthinsurance.com and see how much private insurance you can > buy if you're 65. > > > > From: hyperaldosteronism > <mailto:hyperaldosteronism%40yahoogroups.com> > [mailto:hyperaldosteronism > <mailto:hyperaldosteronism%40yahoogroups.com> ] 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. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 23, 2011 Report Share Posted December 23, 2011 I have Blue Cross for my supplement and I am 73. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension , go to https://www.ehealthinsurance.com and try to buy health insurance if you're 65. All you can buy is supplements. If you're 65 and don't have VA (government) or the federal employees health plan, you have no choice but Medicare (government) if you want any insurance. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Bingham you can buy medgap or so forth, but you can still buy health insurance if you can afford it. "Can" is not the same as "able to" though and like life insurance, the older you are the more you'll pay and most can't pay for their own insurance. It's kind of a joke like COBRA was. BUT..... If you have enough money you can get anything. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 23, 2011 Report Share Posted December 23, 2011 What do u mean active duty? We were in sewer pipes trapping Mosquitos to see if they had encephalitis virus. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension If you had no or little active duty time then you would not get VA benefits. > > > > > > > > > > > > > > > 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 o Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 23, 2011 Report Share Posted December 23, 2011 They were down wind of the proving grounds. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension I do hope you realize I was kidding. I knew you were too young and not stupid enough to think something strong enough to defoliate trees wouldn't hurt people and their food supply! The sad part is I never realized they were poisioning me until years later hence just now getting the registery exam! I was on a base and now find it is still 30 times above standards as of a couple years ago! Thinking about it, DaNang was the northern most major air base so they probably flew most of the northern missions out of there. My bunk mate worked the line in POL (Petroleum Oil & Lubricants) so he probably loaded the planes and hung his shirt on the end of the bunks when he got done! I do have one question Dr. Grim. What were they doing with "100's of Sheep" on an Army Base? (Hope hazing wasn't involved!) , > > > > > > > > > > > > > > > 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 p Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 23, 2011 Report Share Posted December 23, 2011 Dr Conn only studied 1 patient and that was before u could measure renin and aldosterone had not yet been reported. Very good inductive reasoning based on his prior work with US Army on the metabic effects of heat exposure in healthy men. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension Did you remember to give the horse extra oats now that it's winter? Now that was good transportation, always started and the brakes never failed! Let me point out I am persuing the only other option according to Bravo since Elperenone wouldn't be developed for another 4 years! I was only able to find one Bravo article in our files and that looks like it was done in 1973! If that is the one, when did you start "hanging your hat" on a study of 14? And maybe you should reread the last sentence where they recommend Spiro for preopertive treatment AND THOSE NOT SUITABLE FOR SURGERY (emphasis is mine). Maybe we should research how many trials recommend surgery where appropriate vs MCB's. I think all I have seen said something like "for those not a candidate for surgery or those that refuse". If I had persued that avenue I would have reported my first anniversary a couple months ago! (But I would certainly be a lot less informed!) - 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 > > > > > > > > Reply to sender | Reply to group | Reply via web post | Start a New Topic Messages in this topic (46) Recent Activity: New Members 4 Visit Your Group MARKETPLACE Stay on top of your group activity without leaving the page you're on - Get the Yahoo! Toolbar now. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 23, 2011 Report Share Posted December 23, 2011 Were you full time military. > > > > > > > > > > > > > > > > > > > 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 o > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 23, 2011 Report Share Posted December 23, 2011 J What do u mean active duty? We were in sewer pipes trapping Mosquitos to see if they had encephalitis virus. Quote Link to comment Share on other sites More sharing options...
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