VA EMR excellent.

[Guest guest]

Just my 2 ¢ worth. The VA EMR is the best I have seen. Would love to see it adopted as a national play but may not be able to handle the load. AND ....VA docs won't get it or qualify. They're in a system already. Subject: RE: Endocrinologist Appt. UpdateTo: hyperaldosteronism Date: Monday, December 12, 2011, 9:59 PM I'm glad you are advocating for yourself. Perhaps they will understand that it is either AVS or epler. Yeah, and that expensive computer record is really valuable, eh? Did you know every doc just got $44,000 to help create a national medical record on each of us? Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of I had my Endo appt this afternoon. I started by asking if she knew why I was there. Answer, NO and she pulled up my record on the computer. I then asked her how many PTN's she had treated w/PA. Answer, treated some with Cortisol problems. Me. "Can I take that as a none?" Answer, "That's what you have? It is very rare!"Then she took control with, "I'm supposed to ask the questions, Who's the Doctor here?" Me, "I guess in this case I'd better be, I obviously know more what is going on!" Good thing she had a sense of humor, she smiled! I guess I can conclude from that they are still living in the '80's with their teaching as she couldn't have been out of school more than a year or two!I then explained I was getting off Spiro and she needed to decide if I was going onto Epler or getting an AVS. We talked about Gynecomastia and she thought I should have a mammogram and I told her, been there/done that - should be in my record. When she found out it was done in Boston she didn't think it would be on file. I explained the nurse referenced it last Friday! She then started a good HX until I started to answer the questions before she asked! (No T2DM in family, Mom 1 kidney & HTN, Brother w/poly kidney and transplant, atleast 2 out of 3 children w/HTN, etc.) I explained that had all been gone over many times and was in my file and we really needed to decide how we were going to proceed.She said, "So, you want to get off Spiro." I explained I said "I AM going to get off Spiro and I only knew of two choices." She said she would RX Epler but would need to run it by her department chair who she called in. He arrived and was quite sure he could get it approved. If I hadn't seen it or heard anything in a week to give him a call and he would "kick ass!"They then tried to figure out the dosing. His comment, "I don't use Spironolactone very often so we will have to look this up." I said the usual dose of epler was about double spiro so since I was on 50mg/day I would suggest starting at 100mg of epler! Dr. Grim, with his comment I think it would be safe to assume they don't Identify PA very often at the White River Jct., VT VA!GOD, I FEEL LIKE I'M IN GOOD HANDS! - 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]

They still don't get $44,000 either way. And that system has been around a while as I used it 10 years ago at the SLC VA. It certainly made things so much easier - even routine stuff such as labs and xrays - pictures and reports - were right there.

Subject: RE: Endocrinologist Appt. UpdateTo: hyperaldosteronism Date: Monday, December 12, 2011, 9:59 PM

I'm glad you are advocating for yourself. Perhaps they will understand that it is either AVS or epler. Yeah, and that expensive computer record is really valuable, eh? Did you know every doc just got $44,000 to help create a national medical record on each of us?

Val

From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of

I had my Endo appt this afternoon. I started by asking if she knew why I was there. Answer, NO and she pulled up my record on the computer. I then asked her how many PTN's she had treated w/PA. Answer, treated some with Cortisol problems. Me. "Can I take that as a none?" Answer, "That's what you have? It is very rare!"Then she took control with, "I'm supposed to ask the questions, Who's the Doctor here?" Me, "I guess in this case I'd better be, I obviously know more what is going on!" Good thing she had a sense of humor, she smiled! I guess I can conclude from that they are still living in the '80's with their teaching as she couldn't have been out of school more than a year or two!I then explained I was getting off Spiro and she needed to decide if I was going onto Epler or getting an AVS. We talked about Gynecomastia and she thought I should have a mammogram and I told her, been there/done that - should

be in my record. When she found out it was done in Boston she didn't think it would be on file. I explained the nurse referenced it last Friday! She then started a good HX until I started to answer the questions before she asked! (No T2DM in family, Mom 1 kidney & HTN, Brother w/poly kidney and transplant, atleast 2 out of 3 children w/HTN, etc.) I explained that had all been gone over many times and was in my file and we really needed to decide how we were going to proceed.She said, "So, you want to get off Spiro." I explained I said "I AM going to get off Spiro and I only knew of two choices." She said she would RX Epler but would need to run it by her department chair who she called in. He arrived and was quite sure he could get it approved. If I hadn't seen it or heard anything in a week to give him a call and he would "kick ass!"They then tried to figure out the dosing. His comment, "I don't use Spironolactone very often so we

will have to look this up." I said the usual dose of epler was about double spiro so since I was on 50mg/day I would suggest starting at 100mg of epler! Dr. Grim, with his comment I think it would be safe to assume they don't Identify PA very often at the White River Jct., VT VA!GOD, I FEEL LIKE I'M IN GOOD HANDS! - 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.