Guest guest Posted December 23, 2011 Report Share Posted December 23, 2011 We had mosquito nets and those bastards always found a way in! We had malaria pills and belly aches! > > > > > > > > > > > > > > > > > > > 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 I was drafted and enrolled in the Berry Plan which deferred service until advanced training was done. When done I was assigned to the USPHS for 2 years at the CDC. I RECEIVED an Honorable disch. But despite serving 2 years have no VA or other benefits. Still trying to track down why?May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension 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 8q21Ââ€"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 Let. Me know the feedback. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension 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 Do u get a refund?May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension 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 can get some information from this group. http://www.smcaf.org/History.htm#armedforces > > > > > > > > > > > > > > > > > > > > > > > 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 11ÃÆ'¢-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 11ÃÆ'¢-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 24, 2011 Report Share Posted December 24, 2011 Thanks for this info will lok at it over next few days. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension Maybe can get some information from this group. http://www.smcaf.org/History.htm#armedforces > > > > > > > > > > > > > > > > > > > > > > > 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 11ÃÆ'¢-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 11ÃÆ'¢-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 8q21Ââ€"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 24, 2011 Report Share Posted December 24, 2011 Will do. > > > > > > > > > > > > > > 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 24, 2011 Report Share Posted December 24, 2011 Yea, right! Probably get charged double for wasting his time! (I used to get a 4hr minimum if they called me in!) > > > >> > > > > > > >> > > > 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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