Re: B is for Bureaucrats, also RANT

[Guest guest]

Oh, , I'm so sorry you're a victim of this type of panel. Time to go higher. We should expect more of this. You're 65; can you get Medicare? At least with Medicare you could go to a center with a good history of doing AVS properly. Mayo Clinic, however, is out; they don't accept Medicare. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of I spoke with telephone advice this morning an found out Elperone has been denied again. Since Spiro is not working satisfactorly it looks like AVS and ADx are my only options!I am so happy because it appears they are predicting I will live to over 92! (AVS = $25,000 + ADx = $40,000) = $65,000 / Elper @$200 per month = 27+ years! (Of course I could alway take the other position and assume I will die on the operating table and look at the money they save!)Waiting for a call from PCP and hope that comes today since it would be nice th hear mammogram results before the w/e! - 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 60Other 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.

[Guest guest]

Some VA are better then others. Or that is what I have seen. Seem there is about

70 miles from me that is reported as being one of the better ones. My problem is

many times I have problems driving to the one that is 15 miles from me.

From what I see about this VA S. Middleton Memorial Veterans

Madison, WI. They are very up to speed on PA. They have teaching programs on it.

Would seem that the VA Dr should be able to talk between centers.

Might be worth asking Walmart what there cost is for Elperone is.

>

> Oh, , I'm so sorry you're a victim of this type of panel. Time to go

> higher. We should expect more of this. You're 65; can you get Medicare?

> At least with Medicare you could go to a center with a good history of doing

> AVS properly. Mayo Clinic, however, is out; they don't accept Medicare.

>

> Val

>

> From: hyperaldosteronism

> [mailto:hyperaldosteronism ] On Behalf Of

> I spoke with telephone advice this morning an found out Elperone has been

> denied again. Since Spiro is not working satisfactorly it looks like AVS and

> ADx are my only options!

>

> I am so happy because it appears they are predicting I will live to over 92!

> (AVS = $25,000 + ADx = $40,000) = $65,000 / Elper @$200 per month = 27+

> years! (Of course I could alway take the other position and assume I will

> die on the operating table and look at the money they save!)

>

> Waiting for a call from PCP and hope that comes today since it would be nice

> th hear mammogram results before the w/e!

>

> - 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.

>

[Guest guest]

Dr.Ted Goodfriend has been there for 40 years-good friend of mine and bp and aldo expert. I will send him an email. re the VA problems elsewhere. Some VA are better then others. Or that is what I have seen. Seem there is about 70 miles from me that is reported as being one of the better ones. My problem is many times I have problems driving to the one that is 15 miles from me. From what I see about this VA S. Middleton Memorial Veterans Madison, WI. They are very up to speed on PA. They have teaching programs on it. Would seem that the VA Dr should be able to talk between centers. Might be worth asking Walmart what there cost is for Elperone is. > > Oh, , I'm so sorry you're a victim of this type of panel. Time to go > higher. We should expect more of this. You're 65; can you get Medicare? > At least with Medicare you could go to a center with a good history of doing > AVS properly. Mayo Clinic, however, is out; they don't accept Medicare. > > Val > > From: hyperaldosteronism > [mailto:hyperaldosteronism ] On Behalf Of > I spoke with telephone advice this morning an found out Elperone has been > denied again. Since Spiro is not working satisfactorly it looks like AVS and > ADx are my only options! > > I am so happy because it appears they are predicting I will live to over 92! > (AVS = $25,000 + ADx = $40,000) = $65,000 / Elper @$200 per month = 27+ > years! (Of course I could alway take the other position and assume I will > die on the operating table and look at the money they save!) > > Waiting for a call from PCP and hope that comes today since it would be nice > th hear mammogram results before the w/e! > > - 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. >

[Guest guest]

Who is denying? Appeal again. I will be with VA in a week or 2 in Minden, NV and can write letter perhaps.No good reason to deny that I can figure out. HTN responded well to spiro, but disabling gyneco. CE Grim MD I spoke with telephone advice this morning an found out Elperone has been denied again. Since Spiro is not working satisfactorly it looks like AVS and ADx are my only options! I am so happy because it appears they are predicting I will live to over 92! (AVS = $25,000 + ADx = $40,000) = $65,000 / Elper @$200 per month = 27+ years! (Of course I could alway take the other position and assume I will die on the operating table and look at the money they save!) Waiting for a call from PCP and hope that comes today since it would be nice th hear mammogram results before the w/e! - 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.

[Guest guest]

Ask him if he ever uses Inspra and if so how does he get it approved!

Thanks

- 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.

> > >

> > > Oh, , I'm so sorry you're a victim of this type of panel. Time

> > to go

> > > higher. We should expect more of this. You're 65; can you get

> > Medicare?

> > > At least with Medicare you could go to a center with a good

> > history of doing

> > > AVS properly. Mayo Clinic, however, is out; they don't accept

> > Medicare.

> > >

> > > Val

> > >

> > > From: hyperaldosteronism

> > > [mailto:hyperaldosteronism ] On Behalf Of

> > > I spoke with telephone advice this morning an found out Elperone

> > has been

> > > denied again. Since Spiro is not working satisfactorly it looks

> > like AVS and

> > > ADx are my only options!

> > >

> > > I am so happy because it appears they are predicting I will live

> > to over 92!

> > > (AVS = $25,000 + ADx = $40,000) = $65,000 / Elper @$200 per month

> > = 27+

> > > years! (Of course I could alway take the other position and assume

> > I will

> > > die on the operating table and look at the money they save!)

> > >

> > > Waiting for a call from PCP and hope that comes today since it

> > would be nice

> > > th hear mammogram results before the w/e!

> > >

> > > - 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.

> > >

> >

> >

>

[Guest guest]

The triage nurse used some acronym but didn't know what it ment. Not important

tonight since I have an appointment with an Endocrolgist monday and plan to

discuss that. I will come out with a better answer or someone's head!

I will also discuss Spironolactone and my reaction to it. Give them a chance

earn some of that big money!

- 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 spoke with telephone advice this morning an found out Elperone has

> > been denied again. Since Spiro is not working satisfactorly it looks

> > like AVS and ADx are my only options!

> >

> > I am so happy because it appears they are predicting I will live to

> > over 92! (AVS = $25,000 + ADx = $40,000) = $65,000 / Elper @$200 per

> > month = 27+ years! (Of course I could alway take the other position

> > and assume I will die on the operating table and look at the money

> > they save!)

> >

> > Waiting for a call from PCP and hope that comes today since it would

> > be nice th hear mammogram results before the w/e!

> >

> > - 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.

> >

> >

>

[Guest guest]

Done. Ask him if he ever uses Inspra and if so how does he get it approved! Thanks - 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. > > > > > > Oh, , I'm so sorry you're a victim of this type of panel. Time > > to go > > > higher. We should expect more of this. You're 65; can you get > > Medicare? > > > At least with Medicare you could go to a center with a good > > history of doing > > > AVS properly. Mayo Clinic, however, is out; they don't accept > > Medicare. > > > > > > Val > > > > > > From: hyperaldosteronism > > > [mailto:hyperaldosteronism ] On Behalf Of > > > I spoke with telephone advice this morning an found out Elperone > > has been > > > denied again. Since Spiro is not working satisfactorly it looks > > like AVS and > > > ADx are my only options! > > > > > > I am so happy because it appears they are predicting I will live > > to over 92! > > > (AVS = $25,000 + ADx = $40,000) = $65,000 / Elper @$200 per month > > = 27+ > > > years! (Of course I could alway take the other position and assume > > I will > > > die on the operating table and look at the money they save!) > > > > > > Waiting for a call from PCP and hope that comes today since it > > would be nice > > > th hear mammogram results before the w/e! > > > > > > - 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. > > > > > > > >

[Guest guest]

Be sure to ask if you still need metoprolol and metformin now that PA is doing better.,CE Grim, MD The triage nurse used some acronym but didn't know what it ment. Not important tonight since I have an appointment with an Endocrolgist monday and plan to discuss that. I will come out with a better answer or someone's head! I will also discuss Spironolactone and my reaction to it. Give them a chance earn some of that big money! - 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 spoke with telephone advice this morning an found out Elperone has > > been denied again. Since Spiro is not working satisfactorly it looks > > like AVS and ADx are my only options! > > > > I am so happy because it appears they are predicting I will live to > > over 92! (AVS = $25,000 + ADx = $40,000) = $65,000 / Elper @$200 per > > month = 27+ years! (Of course I could alway take the other position > > and assume I will die on the operating table and look at the money > > they save!) > > > > Waiting for a call from PCP and hope that comes today since it would > > be nice th hear mammogram results before the w/e! > > > > - 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. > > > > >

[Guest guest]

I've had the discussion re: metoprolol, twice. I'm on half the dose I used to

be. She won't let me go lower, guess she likes a HR of 58-62! She said that

they treat me as if I had a MI even though I didn't! You and said you had

never heard of such a thing!

They will have a MI if I mention reducing metformin, I'm one of the few PTN's

w/T2DM that can consistently hit goal!

- 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 spoke with telephone advice this morning an found out Elperone

> > has

> > > > been denied again. Since Spiro is not working satisfactorly it

> > looks

> > > > like AVS and ADx are my only options!

> > > >

> > > > I am so happy because it appears they are predicting I will live

> > to

> > > > over 92! (AVS = $25,000 + ADx = $40,000) = $65,000 / Elper @$200

> > per

> > > > month = 27+ years! (Of course I could alway take the other

> > position

> > > > and assume I will die on the operating table and look at the money

> > > > they save!)

> > > >

> > > > Waiting for a call from PCP and hope that comes today since it

> > would

> > > > be nice th hear mammogram results before the w/e!

> > > >

> > > > - 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.

> > > >

> > > >

> > >

> >

> >

>

[Guest guest]

Remind her about the concept of step down plan. If doing well and have made significant life style improvements you may well not need these any more. So when did Type 2 get to goal. Related to K getting better and DASHing?Nearly all Type 2 is related to eating more than your genome can handle. So you have control. Met has a number of side effects including fatigue, slowing down the head, hands turn white, then blue, then red when exposed to cold.Ask for the evidence that treating you as if you have had a heart attack when you have not is beneficial over the long haul. I've had the discussion re: metoprolol, twice. I'm on half the dose I used to be. She won't let me go lower, guess she likes a HR of 58-62! She said that they treat me as if I had a MI even though I didn't! You and said you had never heard of such a thing! They will have a MI if I mention reducing metformin, I'm one of the few PTN's w/T2DM that can consistently hit goal! - 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 spoke with telephone advice this morning an found out Elperone > > has > > > > been denied again. Since Spiro is not working satisfactorly it > > looks > > > > like AVS and ADx are my only options! > > > > > > > > I am so happy because it appears they are predicting I will live > > to > > > > over 92! (AVS = $25,000 + ADx = $40,000) = $65,000 / Elper @$200 > > per > > > > month = 27+ years! (Of course I could alway take the other > > position > > > > and assume I will die on the operating table and look at the money > > > > they save!) > > > > > > > > Waiting for a call from PCP and hope that comes today since it > > would > > > > be nice th hear mammogram results before the w/e! > > > > > > > > - 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. > > > > > > > > > > > > > > > >

[Guest guest]

What do you think DASH is the answer to everything!?! Well it appears you might

be right, again! MyhealthEVet is not graphing today so I did it the old fashion

way, I looked at the numbers.

Prior to knowing I had PA on 500mg metformin bid I was w/i range usually but

wide ranging. At times I needed glucose tabs. Started spiro in June 2010 and

BP dropped but BS appears about the same. In late April 2011 I attribute Spiro

to be fully working but BS tells me differently. BS started an upward trend and

varying widely in late Feb and by the end of April was declaired " Out of

Control " and they doubled Metformin to 1000mg bid. It's been very well

controlled since July, much more stable and no real wide swings. They want my

hbA1C to be between 6.0 & 6.5 - it was 6.3 a couple weeks ago when we

recertified my meter!

Oh yea, DASHing seriously started in mid July!

Meter averages tonight: 7day = 132, 14day = 135, 30day = 136. Goal is 140 or

less!

I have never identified a K issue so I don't think that was factor. (4.8

except for one 5.0 last Dec. Latest was 4.6 last month.)

- 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 spoke with telephone advice this morning an found out

> > Elperone

> > > > has

> > > > > > been denied again. Since Spiro is not working satisfactorly it

> > > > looks

> > > > > > like AVS and ADx are my only options!

> > > > > >

> > > > > > I am so happy because it appears they are predicting I will

> > live

> > > > to

> > > > > > over 92! (AVS = $25,000 + ADx = $40,000) = $65,000 / Elper @

> > $200

> > > > per

> > > > > > month = 27+ years! (Of course I could alway take the other

> > > > position

> > > > > > and assume I will die on the operating table and look at the

> > money

> > > > > > they save!)

> > > > > >

> > > > > > Waiting for a call from PCP and hope that comes today since it

> > > > would

> > > > > > be nice th hear mammogram results before the w/e!

> > > > > >

> > > > > > - 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.

> > > > > >

> > > > > >

> > > > >

> > > >

> > > >

> > >

> >

> >

>

[Guest guest]

I've had a couple " chats " regarding bblockers. I haven't given up but with my

current battles it is on hold until I have time to gather and layout my

position. I'll make a HTN specialist out of her yet!

- 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 spoke with telephone advice this morning an found out

> > Elperone

> > > > has

> > > > > > been denied again. Since Spiro is not working satisfactorly it

> > > > looks

> > > > > > like AVS and ADx are my only options!

> > > > > >

> > > > > > I am so happy because it appears they are predicting I will

> > live

> > > > to

> > > > > > over 92! (AVS = $25,000 + ADx = $40,000) = $65,000 / Elper @

> > $200

> > > > per

> > > > > > month = 27+ years! (Of course I could alway take the other

> > > > position

> > > > > > and assume I will die on the operating table and look at the

> > money

> > > > > > they save!)

> > > > > >

> > > > > > Waiting for a call from PCP and hope that comes today since it

> > > > would

> > > > > > be nice th hear mammogram results before the w/e!

> > > > > >

> > > > > > - 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.

> > > > > >

> > > > > >

> > > > >

> > > >

> > > >

> > >

> >

> >

>

[Guest guest]

Isn't Dr. Luiz Kolankiewicz the HTN specialist. Is he has a lot of work to do.

Need to start a teaching program on how not to take B/P. Maybe even see how lab

draws K and have them

stop sending the blood through system.

> > > > > >

> > > > > > > I spoke with telephone advice this morning an found out

> > > Elperone

> > > > > has

> > > > > > > been denied again. Since Spiro is not working satisfactorly it

> > > > > looks

> > > > > > > like AVS and ADx are my only options!

> > > > > > >

> > > > > > > I am so happy because it appears they are predicting I will

> > > live

> > > > > to

> > > > > > > over 92! (AVS = $25,000 + ADx = $40,000) = $65,000 / Elper @

> > > $200

> > > > > per

> > > > > > > month = 27+ years! (Of course I could alway take the other

> > > > > position

> > > > > > > and assume I will die on the operating table and look at the

> > > money

> > > > > > > they save!)

> > > > > > >

> > > > > > > Waiting for a call from PCP and hope that comes today since it

> > > > > would

> > > > > > > be nice th hear mammogram results before the w/e!

> > > > > > >

> > > > > > > - 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.

> > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > > >

> > > >

> > >

> > >

> >

>

[Guest guest]

This site seems to have current information on Dr. Luiz Kolankiewicz.

Nephrologist at Dartmouth Medical School and WRJ-VAMC.

http://www.linkedin.com/pub/luiz-kolankiewicz/6/262/632

> > > > > > >

> > > > > > > > I spoke with telephone advice this morning an found out

> > > > Elperone

> > > > > > has

> > > > > > > > been denied again. Since Spiro is not working satisfactorly it

> > > > > > looks

> > > > > > > > like AVS and ADx are my only options!

> > > > > > > >

> > > > > > > > I am so happy because it appears they are predicting I will

> > > > live

> > > > > > to

> > > > > > > > over 92! (AVS = $25,000 + ADx = $40,000) = $65,000 / Elper @

> > > > $200

> > > > > > per

> > > > > > > > month = 27+ years! (Of course I could alway take the other

> > > > > > position

> > > > > > > > and assume I will die on the operating table and look at the

> > > > money

> > > > > > > > they save!)

> > > > > > > >

> > > > > > > > Waiting for a call from PCP and hope that comes today since it

> > > > > > would

> > > > > > > > be nice th hear mammogram results before the w/e!

> > > > > > > >

> > > > > > > > - 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.

> > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > >

> > > > > >

> > > > >

> > > >

> > > >

> > >

> >

>

[Guest guest]

To the best of my knowledge he is a Nephrologist and that is what he has

primarily seen me for. I presume he could be dual certified but I have no

reason to suspect that. I saw him as a follow up to the Neperologist that DXed

me w/PA but he was following Dr.Yousfi's lead so he knew what he was looking at.

(I did think he asked the right questions and ran the right tests.) Of course

adrenals are probably considered part of the kidney because of where they

reside!

I do not know if any one individual has responsibility for HTN at the VA.

Suggest if you want to know if it is that department Dr. Robey, the chair, would

be the one to ask.

- 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 spoke with telephone advice this morning an found out

> > > > Elperone

> > > > > > has

> > > > > > > > been denied again. Since Spiro is not working satisfactorly it

> > > > > > looks

> > > > > > > > like AVS and ADx are my only options!

> > > > > > > >

> > > > > > > > I am so happy because it appears they are predicting I will

> > > > live

> > > > > > to

> > > > > > > > over 92! (AVS = $25,000 + ADx = $40,000) = $65,000 / Elper @

> > > > $200

> > > > > > per

> > > > > > > > month = 27+ years! (Of course I could alway take the other

> > > > > > position

> > > > > > > > and assume I will die on the operating table and look at the

> > > > money

> > > > > > > > they save!)

> > > > > > > >

> > > > > > > > Waiting for a call from PCP and hope that comes today since it

> > > > > > would

> > > > > > > > be nice th hear mammogram results before the w/e!

> > > > > > > >

> > > > > > > > - 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.

> > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > >

> > > > > >

> > > > >

> > > >

> > > >

> > >

> >

>

[Guest guest]

The job posting that they had for the WRJ Nephrologist also stated they were to

be a HTN specialist. In fact they were to set this up is a new department.

This job is no longer posted so can't state what was in it but the information

may be in one of group the posting. Since it is no longer opened I would think

that is what Dr.Yousfi's was hired to do.

> > > > > > > >

> > > > > > > > > I spoke with telephone advice this morning an found out

> > > > > Elperone

> > > > > > > has

> > > > > > > > > been denied again. Since Spiro is not working satisfactorly it

> > > > > > > looks

> > > > > > > > > like AVS and ADx are my only options!

> > > > > > > > >

> > > > > > > > > I am so happy because it appears they are predicting I will

> > > > > live

> > > > > > > to

> > > > > > > > > over 92! (AVS = $25,000 + ADx = $40,000) = $65,000 / Elper @

> > > > > $200

> > > > > > > per

> > > > > > > > > month = 27+ years! (Of course I could alway take the other

> > > > > > > position

> > > > > > > > > and assume I will die on the operating table and look at the

> > > > > money

> > > > > > > > > they save!)

> > > > > > > > >

> > > > > > > > > Waiting for a call from PCP and hope that comes today since it

> > > > > > > would

> > > > > > > > > be nice th hear mammogram results before the w/e!

> > > > > > > > >

> > > > > > > > > - 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.

> > > > > > > > >

> > > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > > >

> > > >

> > >

> >

>

[Guest guest]

This is what was stated in that job posting

The successful applicant will be a fully competent Internist and Nephrologist

capable of evaluating and managing the full spectrum of acute and chronic kidney

disease, including fluid and electrolyte disorders, urolithiasis, resistant

hypertension, and transplantation. He/she will also be competent to provide both

inpatient and outpatient renal consultation services, renal replacement therapy,

temporary dialysis catheter insertion, and percutaneous renal biopsy. The

incumbent will oversee and develop a new Nephrology & Hypertension program.

Participation in the shared teaching mission of the VA and Dartmouth Medical

School is expected. The ideal candidate will qualify for an academic appointment

at Dartmouth Medical School and a corresponding staff appointment at

Dartmouth-Hitchcock Medical Center and will be both competent and eligible to

supervise affiliated trainees.

> > > > > > > > >

> > > > > > > > > > I spoke with telephone advice this morning an found out

> > > > > > Elperone

> > > > > > > > has

> > > > > > > > > > been denied again. Since Spiro is not working satisfactorly

it

> > > > > > > > looks

> > > > > > > > > > like AVS and ADx are my only options!

> > > > > > > > > >

> > > > > > > > > > I am so happy because it appears they are predicting I will

> > > > > > live

> > > > > > > > to

> > > > > > > > > > over 92! (AVS = $25,000 + ADx = $40,000) = $65,000 / Elper @

> > > > > > $200

> > > > > > > > per

> > > > > > > > > > month = 27+ years! (Of course I could alway take the other

> > > > > > > > position

> > > > > > > > > > and assume I will die on the operating table and look at the

> > > > > > money

> > > > > > > > > > they save!)

> > > > > > > > > >

> > > > > > > > > > Waiting for a call from PCP and hope that comes today since

it

> > > > > > > > would

> > > > > > > > > > be nice th hear mammogram results before the w/e!

> > > > > > > > > >

> > > > > > > > > > - 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.

> > > > > > > > > >

> > > > > > > > > >

> > > > > > > > >

> > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

[Guest guest]

don't know when the posting went away but Dr. Yousfi left about a year ago. If

you saw it in a posting you know more about it than I but I do remember Dr.

Webster said somethig about a HTN specialist before I ment Dr. Yousfi. Again,

Dr. Robey should know his plans, probably on desk 80 really is the one who

knows what is going on!

New Question. Do you know a female PCP doctor, other than the two on team 4?

Her name may start with " B " .

.....

> > > > > > > > >

> > > > > > > > > > I spoke with telephone advice this morning an found out

> > > > > > Elperone

> > > > > > > > has

> > > > > > > > > > been denied again. Since Spiro is not working satisfactorly

it

> > > > > > > > looks

> > > > > > > > > > like AVS and ADx are my only options!

> > > > > > > > > >

> > > > > > > > > > I am so happy because it appears they are predicting I will

> > > > > > live

> > > > > > > > to

> > > > > > > > > > over 92! (AVS = $25,000 + ADx = $40,000) = $65,000 / Elper @

> > > > > > $200

> > > > > > > > per

> > > > > > > > > > month = 27+ years! (Of course I could alway take the other

> > > > > > > > position

> > > > > > > > > > and assume I will die on the operating table and look at the

> > > > > > money

> > > > > > > > > > they save!)

> > > > > > > > > >

> > > > > > > > > > Waiting for a call from PCP and hope that comes today since

it

> > > > > > > > would

> > > > > > > > > > be nice th hear mammogram results before the w/e!

> > > > > > > > > >

> > > > > > > > > > - 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.

> > > > > > > > > >

> > > > > > > > > >

> > > > > > > > >

> > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

[Guest guest]

There you have it!

> > > > > > > > > >

> > > > > > > > > > > I spoke with telephone advice this morning an found out

> > > > > > > Elperone

> > > > > > > > > has

> > > > > > > > > > > been denied again. Since Spiro is not working

satisfactorly it

> > > > > > > > > looks

> > > > > > > > > > > like AVS and ADx are my only options!

> > > > > > > > > > >

> > > > > > > > > > > I am so happy because it appears they are predicting I

will

> > > > > > > live

> > > > > > > > > to

> > > > > > > > > > > over 92! (AVS = $25,000 + ADx = $40,000) = $65,000 / Elper

@

> > > > > > > $200

> > > > > > > > > per

> > > > > > > > > > > month = 27+ years! (Of course I could alway take the other

> > > > > > > > > position

> > > > > > > > > > > and assume I will die on the operating table and look at

the

> > > > > > > money

> > > > > > > > > > > they save!)

> > > > > > > > > > >

> > > > > > > > > > > Waiting for a call from PCP and hope that comes today

since it

> > > > > > > > > would

> > > > > > > > > > > be nice th hear mammogram results before the w/e!

> > > > > > > > > > >

> > > > > > > > > > > - 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.

> > > > > > > > > > >

> > > > > > > > > > >

> > > > > > > > > >

> > > > > > > > >

> > > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

[Guest guest]

You can search here

http://www.va.gov/providerinfo/WHITERIVER/

> > > > > > > > > > >

> > > > > > > > > > > > I spoke with telephone advice this morning an found out

> > > > > > > > Elperone

> > > > > > > > > > has

> > > > > > > > > > > > been denied again. Since Spiro is not working

satisfactorly it

> > > > > > > > > > looks

> > > > > > > > > > > > like AVS and ADx are my only options!

> > > > > > > > > > > >

> > > > > > > > > > > > I am so happy because it appears they are predicting I

will

> > > > > > > > live

> > > > > > > > > > to

> > > > > > > > > > > > over 92! (AVS = $25,000 + ADx = $40,000) = $65,000 /

Elper @

> > > > > > > > $200

> > > > > > > > > > per

> > > > > > > > > > > > month = 27+ years! (Of course I could alway take the

other

> > > > > > > > > > position

> > > > > > > > > > > > and assume I will die on the operating table and look at

the

> > > > > > > > money

> > > > > > > > > > > > they save!)

> > > > > > > > > > > >

> > > > > > > > > > > > Waiting for a call from PCP and hope that comes today

since it

> > > > > > > > > > would

> > > > > > > > > > > > be nice th hear mammogram results before the w/e!

> > > > > > > > > > > >

> > > > > > > > > > > > - 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.

> > > > > > > > > > > >

> > > > > > > > > > > >

> > > > > > > > > > >

> > > > > > > > > >

> > > > > > > > > >

> > > > > > > > >

> > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

[Guest guest]

Thanks, guess my mind wasn't functioning t 6:45 the other morning!

> > > > > > > > > > > >

> > > > > > > > > > > > > I spoke with telephone advice this morning an found

out

> > > > > > > > > Elperone

> > > > > > > > > > > has

> > > > > > > > > > > > > been denied again. Since Spiro is not working

satisfactorly it

> > > > > > > > > > > looks

> > > > > > > > > > > > > like AVS and ADx are my only options!

> > > > > > > > > > > > >

> > > > > > > > > > > > > I am so happy because it appears they are predicting I

will

> > > > > > > > > live

> > > > > > > > > > > to

> > > > > > > > > > > > > over 92! (AVS = $25,000 + ADx = $40,000) = $65,000 /

Elper @

> > > > > > > > > $200

> > > > > > > > > > > per

> > > > > > > > > > > > > month = 27+ years! (Of course I could alway take the

other

> > > > > > > > > > > position

> > > > > > > > > > > > > and assume I will die on the operating table and look

at the

> > > > > > > > > money

> > > > > > > > > > > > > they save!)

> > > > > > > > > > > > >

> > > > > > > > > > > > > Waiting for a call from PCP and hope that comes today

since it

> > > > > > > > > > > would

> > > > > > > > > > > > > be nice th hear mammogram results before the w/e!

> > > > > > > > > > > > >

> > > > > > > > > > > > > - 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.

> > > > > > > > > > > > >

> > > > > > > > > > > > >

> > > > > > > > > > > >

> > > > > > > > > > >

> > > > > > > > > > >

> > > > > > > > > >

> > > > > > > > >

> > > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

[Guest guest]

Changes in DM Rx should be based on HbA1c. Feeding your genome wrong causes most of the following.HtnDMCadStrokeRenal failureObesityCHFHIGH blood lipids. Metabolic syndromeTo mention a few. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension

What do you think DASH is the answer to everything!?! Well it appears you might be right, again! MyhealthEVet is not graphing today so I did it the old fashion way, I looked at the numbers.

Prior to knowing I had PA on 500mg metformin bid I was w/i range usually but wide ranging. At times I needed glucose tabs. Started spiro in June 2010 and BP dropped but BS appears about the same. In late April 2011 I attribute Spiro to be fully working but BS tells me differently. BS started an upward trend and varying widely in late Feb and by the end of April was declaired "Out of Control" and they doubled Metformin to 1000mg bid. It's been very well controlled since July, much more stable and no real wide swings. They want my hbA1C to be between 6.0 & 6.5 - it was 6.3 a couple weeks ago when we recertified my meter!

Oh yea, DASHing seriously started in mid July!

Meter averages tonight: 7day = 132, 14day = 135, 30day = 136. Goal is 140 or less!

I have never identified a K issue so I don't think that was factor. (4.8 except for one 5.0 last Dec. Latest was 4.6 last month.)

- 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 spoke with telephone advice this morning an found out

> > Elperone

> > > > has

> > > > > > been denied again. Since Spiro is not working satisfactorly it

> > > > looks

> > > > > > like AVS and ADx are my only options!

> > > > > >

> > > > > > I am so happy because it appears they are predicting I will

> > live

> > > > to

> > > > > > over 92! (AVS = $25,000 + ADx = $40,000) = $65,000 / Elper @

> > $200

> > > > per

> > > > > > month = 27+ years! (Of course I could alway take the other

> > > > position

> > > > > > and assume I will die on the operating table and look at the

> > money

> > > > > > they save!)

> > > > > >

> > > > > > Waiting for a call from PCP and hope that comes today since it

> > > > would

> > > > > > be nice th hear mammogram results before the w/e!

> > > > > >

> > > > > > - 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.

> > > > > >

> > > > > >

> > > > >

> > > >

> > > >

> > >

> >

> >

>

[Guest guest]

You might want to read the UK position on BB for HTN. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension

I've had a couple "chats" regarding bblockers. I haven't given up but with my current battles it is on hold until I have time to gather and layout my position. I'll make a HTN specialist out of her yet!

- 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 spoke with telephone advice this morning an found out

> > Elperone

> > > > has

> > > > > > been denied again. Since Spiro is not working satisfactorly it

> > > > looks

> > > > > > like AVS and ADx are my only options!

> > > > > >

> > > > > > I am so happy because it appears they are predicting I will

> > live

> > > > to

> > > > > > over 92! (AVS = $25,000 + ADx = $40,000) = $65,000 / Elper @

> > $200

> > > > per

> > > > > > month = 27+ years! (Of course I could alway take the other

> > > > position

> > > > > > and assume I will die on the operating table and look at the

> > money

> > > > > > they save!)

> > > > > >

> > > > > > Waiting for a call from PCP and hope that comes today since it

> > > > would

> > > > > > be nice th hear mammogram results before the w/e!

> > > > > >

> > > > > > - 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.

> > > > > >

> > > > > >

> > > > >

> > > >

> > > >

> > >

> >

> >

>

[Guest guest]

Ah but is he Board Certified in HTN. CHECK Am Soc htn list of specialist. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension

This site seems to have current information on Dr. Luiz Kolankiewicz. Nephrologist at Dartmouth Medical School and WRJ-VAMC.

http://www.linkedin.com/pub/luiz-kolankiewicz/6/262/632

> > > > > > >

> > > > > > > > I spoke with telephone advice this morning an found out

> > > > Elperone

> > > > > > has

> > > > > > > > been denied again. Since Spiro is not working satisfactorly it

> > > > > > looks

> > > > > > > > like AVS and ADx are my only options!

> > > > > > > >

> > > > > > > > I am so happy because it appears they are predicting I will

> > > > live

> > > > > > to

> > > > > > > > over 92! (AVS = $25,000 + ADx = $40,000) = $65,000 / Elper @

> > > > $200

> > > > > > per

> > > > > > > > month = 27+ years! (Of course I could alway take the other

> > > > > > position

> > > > > > > > and assume I will die on the operating table and look at the

> > > > money

> > > > > > > > they save!)

> > > > > > > >

> > > > > > > > Waiting for a call from PCP and hope that comes today since it

> > > > > > would

> > > > > > > > be nice th hear mammogram results before the w/e!

> > > > > > > >

> > > > > > > > - 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.

> > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > >

> > > > > >

> > > > >

> > > >

> > > >

> > >

> >

>

[Guest guest]

So time to discuss step down in about 6 months I would think. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension

What do you think DASH is the answer to everything!?! Well it appears you might be right, again! MyhealthEVet is not graphing today so I did it the old fashion way, I looked at the numbers.

Prior to knowing I had PA on 500mg metformin bid I was w/i range usually but wide ranging. At times I needed glucose tabs. Started spiro in June 2010 and BP dropped but BS appears about the same. In late April 2011 I attribute Spiro to be fully working but BS tells me differently. BS started an upward trend and varying widely in late Feb and by the end of April was declaired "Out of Control" and they doubled Metformin to 1000mg bid. It's been very well controlled since July, much more stable and no real wide swings. They want my hbA1C to be between 6.0 & 6.5 - it was 6.3 a couple weeks ago when we recertified my meter!

Oh yea, DASHing seriously started in mid July!

Meter averages tonight: 7day = 132, 14day = 135, 30day = 136. Goal is 140 or less!

I have never identified a K issue so I don't think that was factor. (4.8 except for one 5.0 last Dec. Latest was 4.6 last month.)

- 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 spoke with telephone advice this morning an found out

> > Elperone

> > > > has

> > > > > > been denied again. Since Spiro is not working satisfactorly it

> > > > looks

> > > > > > like AVS and ADx are my only options!

> > > > > >

> > > > > > I am so happy because it appears they are predicting I will

> > live

> > > > to

> > > > > > over 92! (AVS = $25,000 + ADx = $40,000) = $65,000 / Elper @

> > $200

> > > > per

> > > > > > month = 27+ years! (Of course I could alway take the other

> > > > position

> > > > > > and assume I will die on the operating table and look at the

> > money

> > > > > > they save!)

> > > > > >

> > > > > > Waiting for a call from PCP and hope that comes today since it

> > > > would

> > > > > > be nice th hear mammogram results before the w/e!

> > > > > >

> > > > > > - 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.

> > > > > >

> > > > > >

> > > > >

> > > >

> > > >

> > >

> >

> >

>