Guest guest Posted January 27, 2005 Report Share Posted January 27, 2005 Pam, you have asked the $64,001.00 question. Limbic system fans unite! Bring back the term parasympathetic! Sleep apnea pts w/10 or more years at 100 or more apneas (chokings) per our during sleep before treatment usually have it. It can mimic other diseases, in inconsistent ways. Sleep medicien theory posits zillions of hypoxias slowly forming calcium (or salt) metabolic irregularities. These may, one article said " involve the condition known as hyperaldosteronism, possibly producing subclinical or palpable begnign tumors of the adrenal system. . . or elctrolyte imbalances in . . ..metabolic attempts to replace lost elements fro improper cyto-oxygenation. . . " As you can imagine, clinicians LOVE that reality (once they look at the articles and studies published by Dement, Guineillmault, Vaughan, et. al. and know you're not making it up) almost as much as quietly thinking (or noisily declaring) that you have panic disorder and should just go see a psychiatrist. They usually give you tranquilizers & SSRI's, making it worse. The electrolyte metabolism is intimately involved, and the terms " cholinergia " and " anticholinergia " are bandied often. PA pts like us may produce the systemic functional problems because of our salts going out of balance, and/or their may be some neuro structural changes, both of which are turning up in research. But what is known is it happens. If it's apnea, sleep debt will do it. If PA, well, you know. I have fooled a university G.I. dept into thinking I had some rare tropical organism, cardiologists into " seeing " MCI markers in my bloodwork, a dentist into certainty I had a 12cm abcess and a bone guy thinking I had spur arthritis and a heel spur. Only one problem: —all disappeared in as few as 48 hours. But it's hard to argue with the scans and bloodwork. Nobody likes this. I have some articles, but have to retrieve them. Soon. Dave On Jan 27, 2005, at 5:31 PM, Pamela s wrote: > > Hi, Dr. Grim and All: > > Can anyone give me some ideas about autonomic > dysfunction? > > I came across this little syndrome while reading up on > 24-hour ambulatory blood pressure monitoring, and it > seems possible I have some similar traits. > > Do we know what causes it? Might it be secondary to a > significant virus, like Epstein-Barr or Hepatitis B? > > How is it diagnosed? > > Is there any reason that a diagnosis of aldosteronism > would exclude the diagnosis of autonomic dysfunction? > > Just wondering. > > Warmly, > > Pam > > ===== > " I'd rather learn from one bird how to sing, than to teach ten > thousand stars how not to dance. " > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2005 Report Share Posted January 28, 2005 Dave, this is great! I'd wondered if one might be secondary to the other. And so far, my aldosteronism is totally idiopathic. This would explain a lot. I only have mild apnea, but I have had a couple of serious viruses which I think may have led to such a problem. This would explain my blood pressure bouncing around like crazy, and a few other mysterious things, I think. What tests are definitive? Diagnostic criteria? Sounds like there are lots of differential diagnoses. Any articles you have will be most useful. Warmly, Pam --- DP <dp@...> wrote: > > Pam, you have asked the $64,001.00 question. Limbic > system fans unite! > Bring back the term parasympathetic! > > Sleep apnea pts w/10 or more years at 100 or more > apneas (chokings) per > our during sleep before treatment usually have it. > It can mimic other > diseases, in inconsistent ways. Sleep medicien > theory posits zillions > of hypoxias slowly forming calcium (or salt) > metabolic irregularities. > These may, one article said " involve the > condition known as > hyperaldosteronism, possibly producing subclinical > or palpable begnign > tumors of the adrenal system. . . or elctrolyte > imbalances in . . > .metabolic attempts to replace lost elements fro > improper > cyto-oxygenation. . . " As you can imagine, > clinicians LOVE that > reality (once they look at the articles and studies > published by > Dement, Guineillmault, Vaughan, et. al. and know > you're not making it > up) almost as much as quietly thinking (or noisily > declaring) that you > have panic disorder and should just go see a > psychiatrist. They > usually give you tranquilizers & SSRI's, making it > worse. > > The electrolyte metabolism is intimately involved, > and the terms > " cholinergia " and " anticholinergia " are bandied > often. PA pts like us > may produce the systemic functional problems because > of our salts going > out of balance, and/or their may be some neuro > structural changes, both > of which are turning up in research. But what is > known is it happens. > If it's apnea, sleep debt will do it. If PA, > well, you know. > > I have fooled a university G.I. dept into thinking I > had some rare > tropical organism, cardiologists into " seeing " MCI > markers in my > bloodwork, a dentist into certainty I had a 12cm > abcess and a bone guy > thinking I had spur arthritis and a heel spur. Only > one problem: > > —all disappeared in as few as 48 hours. But it's > hard to argue with > the scans and bloodwork. Nobody likes this. > > I have some articles, but have to retrieve them. > Soon. > > Dave > > > On Jan 27, 2005, at 5:31 PM, Pamela s wrote: > > > > > Hi, Dr. Grim and All: > > > > Can anyone give me some ideas about autonomic > > dysfunction? > > > > I came across this little syndrome while reading > up on > > 24-hour ambulatory blood pressure monitoring, and > it > > seems possible I have some similar traits. > > > > Do we know what causes it? Might it be secondary > to a > > significant virus, like Epstein-Barr or Hepatitis > B? > > > > How is it diagnosed? > > > > Is there any reason that a diagnosis of > aldosteronism > > would exclude the diagnosis of autonomic > dysfunction? > > > > Just wondering. > > > > Warmly, > > > > Pam > > > > ===== > > " I'd rather learn from one bird how to sing, than > to teach ten > > thousand stars how not to dance. " > > > > __________________________________________________ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2005 Report Share Posted January 28, 2005 Hi, Dave I lost the thread of our conversation about decumbiture, I'm afraid. Do let me know if you need any more information! I suppose you can see parallels to the endocrine system, cholinergic and anticholinergic, etc. I'm really interested in this find about autonomic dysfunction. My astrological chart indicates a neuropathy is primary to my health problems, but with all my diagnoses Western medicine has yet to discover it. Now we have a direction to explore. Warmly, Pam --- DP <dp@...> wrote: > > Pam, you have asked the $64,001.00 question. Limbic > system fans unite! > Bring back the term parasympathetic! > > Sleep apnea pts w/10 or more years at 100 or more > apneas (chokings) per > our during sleep before treatment usually have it. > It can mimic other > diseases, in inconsistent ways. Sleep medicien > theory posits zillions > of hypoxias slowly forming calcium (or salt) > metabolic irregularities. > These may, one article said " involve the > condition known as > hyperaldosteronism, possibly producing subclinical > or palpable begnign > tumors of the adrenal system. . . or elctrolyte > imbalances in . . > .metabolic attempts to replace lost elements fro > improper > cyto-oxygenation. . . " As you can imagine, > clinicians LOVE that > reality (once they look at the articles and studies > published by > Dement, Guineillmault, Vaughan, et. al. and know > you're not making it > up) almost as much as quietly thinking (or noisily > declaring) that you > have panic disorder and should just go see a > psychiatrist. They > usually give you tranquilizers & SSRI's, making it > worse. > > The electrolyte metabolism is intimately involved, > and the terms > " cholinergia " and " anticholinergia " are bandied > often. PA pts like us > may produce the systemic functional problems because > of our salts going > out of balance, and/or their may be some neuro > structural changes, both > of which are turning up in research. But what is > known is it happens. > If it's apnea, sleep debt will do it. If PA, > well, you know. > > I have fooled a university G.I. dept into thinking I > had some rare > tropical organism, cardiologists into " seeing " MCI > markers in my > bloodwork, a dentist into certainty I had a 12cm > abcess and a bone guy > thinking I had spur arthritis and a heel spur. Only > one problem: > > —all disappeared in as few as 48 hours. But it's > hard to argue with > the scans and bloodwork. Nobody likes this. > > I have some articles, but have to retrieve them. > Soon. > > Dave > > > On Jan 27, 2005, at 5:31 PM, Pamela s wrote: > > > > > Hi, Dr. Grim and All: > > > > Can anyone give me some ideas about autonomic > > dysfunction? > > > > I came across this little syndrome while reading > up on > > 24-hour ambulatory blood pressure monitoring, and > it > > seems possible I have some similar traits. > > > > Do we know what causes it? Might it be secondary > to a > > significant virus, like Epstein-Barr or Hepatitis > B? > > > > How is it diagnosed? > > > > Is there any reason that a diagnosis of > aldosteronism > > would exclude the diagnosis of autonomic > dysfunction? > > > > Just wondering. > > > > Warmly, > > > > Pam > > > > ===== > > " I'd rather learn from one bird how to sing, than > to teach ten > > thousand stars how not to dance. " > > > > __________________________________________________ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2005 Report Share Posted January 28, 2005 Hi, Dave They have not yet learned the cause of my aldosteronism. Nothing seems to be really wrong with my adrenals; no GRA or other genetic cause. >Only one problem: > —all disappeared in as few as 48 hours. But it's > hard to argue with > the scans and bloodwork. Nobody likes this. So, do they tell you that because all of your symptoms abated with treatment for aldosteronism, that you don't have autonomic dysfunction? Or are some of your doctors more enlightened? Perhaps your experience has been that doctors want to give you so many different diagnoses (structurally based, these modern doctors!) . . . yet this one covers so much. When I was testing my blood pressure, I became dizzy after eating breakfast (but while still seated). I found within minutes that my blood pressure had dropped by 23 points. I went to sleep on the couch with my feet up on the armrest (gets more blood to my head than just lying down when I feel woozy) and woke up an hour and a half later. If not for the ambulatory monitoring, I would have assumed that I just got sleepy from eating breakfast and being up so much the night before. I often sleep after meals--such a lazy person! But I'm starting to see a different picture now that I know more about my blood pressure patterns. My blood pressure was also not much different at night than it was during the day: several 120s, a few 110s, the occasional 100. (I'm a light sleeper and kept checking the darn monitor!). It did go higher during the day, but not with excercise; more with stress (waiting in the doctor's office). I did not get in any great exercise experiments, though. I spent a lot of time driving and the weather was way too cool to take a walk. My blood pressure never got as high at home as it did in the doctor's office the other day. I think the highest reading at home was in the 120's, and the highest overall was in the waiting room (I did not see the doctor while I was wearing the monitor, though--just had to show up to get them to take it off). Would anxiety provoke high blood pressure sometimes with this condition? Does this condition sometimes cause a disrupted sleep pattern? What sort of a specialist deals with this condition? If SSRI's don't help, is there anything that does? I see a tilt table in my future, and a lot of sitting around in packed offices downtown to get back on Medicaid and get this sort of testing paid for. I have digestive problems, but they are intermittent and at this time are not troubling me. I wonder if I'm seeing improvement over time because of treatment for aldosteronism. Or possibly some of the symptoms of autonomic dysfunction could come and go? Dr. Grim, can aldosteronism be primary to digestive problems (intermittent constipation/diarrhea?). Perhaps the salt/water balance in the body being thrown off from time to time? Thanks for your thoughts! Bless the sympathetic and parasympathetic nervous systems! Warmly, Pam --- DP <dp@...> wrote: > > Pam, you have asked the $64,001.00 question. Limbic > system fans unite! > Bring back the term parasympathetic! > > Sleep apnea pts w/10 or more years at 100 or more > apneas (chokings) per > our during sleep before treatment usually have it. > It can mimic other > diseases, in inconsistent ways. Sleep medicien > theory posits zillions > of hypoxias slowly forming calcium (or salt) > metabolic irregularities. > These may, one article said " involve the > condition known as > hyperaldosteronism, possibly producing subclinical > or palpable begnign > tumors of the adrenal system. . . or elctrolyte > imbalances in . . > .metabolic attempts to replace lost elements fro > improper > cyto-oxygenation. . . " As you can imagine, > clinicians LOVE that > reality (once they look at the articles and studies > published by > Dement, Guineillmault, Vaughan, et. al. and know > you're not making it > up) almost as much as quietly thinking (or noisily > declaring) that you > have panic disorder and should just go see a > psychiatrist. They > usually give you tranquilizers & SSRI's, making it > worse. > > The electrolyte metabolism is intimately involved, > and the terms > " cholinergia " and " anticholinergia " are bandied > often. PA pts like us > may produce the systemic functional problems because > of our salts going > out of balance, and/or their may be some neuro > structural changes, both > of which are turning up in research. But what is > known is it happens. > If it's apnea, sleep debt will do it. If PA, > well, you know. > > I have fooled a university G.I. dept into thinking I > had some rare > tropical organism, cardiologists into " seeing " MCI > markers in my > bloodwork, a dentist into certainty I had a 12cm > abcess and a bone guy > thinking I had spur arthritis and a heel spur. > > I have some articles, but have to retrieve them. > Soon. > > Dave > > > On Jan 27, 2005, at 5:31 PM, Pamela s wrote: > > > > > Hi, Dr. Grim and All: > > > > Can anyone give me some ideas about autonomic > > dysfunction? > > > > I came across this little syndrome while reading > up on > > 24-hour ambulatory blood pressure monitoring, and > it > > seems possible I have some similar traits. > > > > Do we know what causes it? Might it be secondary > to a > > significant virus, like Epstein-Barr or Hepatitis > B? > > > > How is it diagnosed? > > > > Is there any reason that a diagnosis of > aldosteronism > > would exclude the diagnosis of autonomic > dysfunction? > > > > Just wondering. > > > > Warmly, > > > > Pam > > > > ===== > > " I'd rather learn from one bird how to sing, than > to teach ten > > thousand stars how not to dance. " > > > > __________________________________________________ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2005 Report Share Posted January 28, 2005 In a message dated 1/28/05 3:57:52 AM, spirlhelix@... writes: Or possibly some of the symptoms of autonomic dysfunction could come and go? Dr. Grim, can aldosteronism be primary to digestive problems (intermittent constipation/diarrhea?). Perhaps the salt/water balance in the body being thrown off from time to time? The renin AND aldo would be high. Remind me about why they dont think you have PA-as I recall the severe HTN, CHF, leaky heart valves and low K all got better with spiro. Pretty good presumtive evidence to me. Also I recall you son had HTN and low K. How do they explain that? May your pressure be low! Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD, FACP, FACC, FAHACHBPR Charter member of American Society of Hypertension(ASH) and the International Society for Hypertension in Blacks (ISHIB). Clinical Professor of Medicine and Epidemiology Director, Hypertension Diagnosis and Treatment Center Board Certified in Internal Medicine, Geriatrics and Hypertension Published over 220 scientific papers, book chapters and 220 abstracts in the area of high blood pressure epidemiology, physiology, endocrinology, measurement, treatment and how to detect curable causes. Listed in Best Doctors in America Specializing in Difficult to Control High Blood Pressure and the History and Physiology of High Blood pressure in the African Diaspora Member of the Board of Directors, ISHIB Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2005 Report Share Posted January 28, 2005 In a message dated 1/28/05 3:17:31 AM, spirlhelix@... writes: My astrological chart indicates a neuropathy is primary to my health problems, but with all my diagnoses Western medicine has yet to discover it. Now we have a direction to explore. I can assure you that your astro chart will be of no help in trying to figure out what is wrong with you. May your pressure be low! Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD, FACP, FACC, FAHACHBPR Charter member of American Society of Hypertension(ASH) and the International Society for Hypertension in Blacks (ISHIB). Clinical Professor of Medicine and Epidemiology Director, Hypertension Diagnosis and Treatment Center Board Certified in Internal Medicine, Geriatrics and Hypertension Published over 220 scientific papers, book chapters and 220 abstracts in the area of high blood pressure epidemiology, physiology, endocrinology, measurement, treatment and how to detect curable causes. Listed in Best Doctors in America Specializing in Difficult to Control High Blood Pressure and the History and Physiology of High Blood pressure in the African Diaspora Member of the Board of Directors, ISHIB Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2005 Report Share Posted January 28, 2005 In a message dated 1/28/05 21:23:29, dp@... writes: My son has HTN and LVH, but he is normokalemic. They >> are beginning to look into his sleep apnea, which >> again may cause aldosteronism, I believe. ALL primary aldosteronism starts off as normokalemic. . We report the first normokalemic. family-2 boys (6 and 9)-about 30 years ago- and a father with HTN, LVH and nommal K. One of the sons stopped his BP meds at 21 and suffered a disabling stroke. This is characteristic of men in GRA families. Please get your son tested for PA with a renin and aldo. LVH means he has advanced HTN disease. I trust he is DASHING and if the BP is not less than what it should be for his age, gender and height meds are being used to get it there. May your pressure be low! Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD, FACP, FACC, FAHS Clinical Professor of Medicine and Epidemiology Director, Hypertension Diagnosis and Treatment Center Board Certified in Internal Medicine, Geriatrics and Hypertension Published over 220 scientific papers, book chapters and 220 abstracts in the area of high blood pressure epidemiology, physiology, endocrinology measurement, treatment and how to detect curable causes. Listed in Best Doctors in America Specializing in Difficult to Control High Blood Pressure and the History and Physiology of High Blood pressure in the African Diaspora Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2005 Report Share Posted January 28, 2005 In a message dated 1/28/05 21:23:29, dp@... writes: >> Where do I go from here? Measure your BP every am as we recommend and use that fryer BP. I you want you can do it am and PM. I dont know what to do with the other pressures. I do ow what to do with the average BP. May your pressure be low! Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD, FACP, FACC, FAHS Clinical Professor of Medicine and Epidemiology Direactor, Hypertension Diagnosis and Treatment Center Board Certified in Internal Medicine, Geriatrics and Hypertension Published over 220 scientific papers, book chapters and 220 abstracts in the area of high blood pressure epidemiology, physiology, endocrinology measurement, treatment and how to detect curable causes. Listed in Best Doctors in America Specializing in Difficult to Control High Blood Pressure and the History and Physiology of High Blood pressure in the African Diaspora Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2005 Report Share Posted January 28, 2005 Hi, Dr. Grim Sorry, this message was not meant for the list. I confess I have studied medical astrology, to some degree. And I think I can probably say with Sir Issac Newton, " Sir, I have studied the matter; you have not. " No offense meant. Grin. Warmly, Pam --- lowerbp2@... wrote: > > In a message dated 1/28/05 3:17:31 AM, > spirlhelix@... writes: > > > > My astrological chart indicates a > > neuropathy is primary to my health problems, but > with > > all my diagnoses Western medicine has yet to > discover > > it. Now we have a direction to explore. > > > > I can assure you that your astro chart will be of no > help in trying to figure > out what is wrong with you. > > > > May your pressure be low! > > Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD, > FACP, FACC, FAHACHBPR > Charter member of American Society of > Hypertension(ASH) and the International > Society for Hypertension in Blacks (ISHIB). > Clinical Professor of Medicine and Epidemiology > Director, Hypertension Diagnosis and Treatment > Center > Board Certified in Internal Medicine, Geriatrics and > Hypertension > > Published over 220 scientific papers, book chapters > and 220 abstracts > in the area of high blood pressure epidemiology, > physiology, endocrinology, > measurement, treatment and how to detect curable > causes. > Listed in Best Doctors in America > Specializing in Difficult to Control High Blood > Pressure and the > History and Physiology of High Blood pressure in the > African Diaspora > Member of the Board of Directors, ISHIB > > ===== " I'd rather learn from one bird how to sing, than to teach ten thousand stars how not to dance. " __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2005 Report Share Posted January 28, 2005 Hi, Dr. Grim My renin:aldo was never clearly indicative of primary aldosteronism, but that may be because I was unable to stay off spironolactone for more than two weeks because my blood pressure shot up. So yes, my aldosterone was high. . . I think my renin was, too, but I don't remember exactly. When I read about autonomic dysfunction, it is actually listed as a possible cause of aldosteronism. There is speculation that it ultimately leads to the formation of calcium deposits which lead to adrenal tumors. I don't have such tumors, but on the other hand I don't have any clear explanation for the etiology of my aldosteronism that I know of. So I found this correlation with autonomic dysfunction interesting, although I readily admit you would know more about the causal relationship than I do. My son has HTN and LFV, but he is normokalemic. They are beginning to look into his sleep apnea, which again may cause aldosteronism, I believe. Please let me know your thoughts. Why do you think my blood pressure would be so unstable despite fairly rigorous Spironolactone therapy? At night, my lowest blood pressure was 122/60, while my highest was 123/80. In the daytime, my lowest blood pressure was 100/60, while my highest was 168/146. This was all in one 24-hour period. The highest reading happened while I was on the phone with the water company paying a bill--evidently I had lower blood pressure readings while I was exercising. Where do I go from here? Warmly, Pam --- lowerbp2@... wrote: > > In a message dated 1/28/05 3:57:52 AM, > spirlhelix@... writes: > > > > Or possibly some of the symptoms > > of autonomic dysfunction could come and go? Dr. > Grim, > > can aldosteronism be primary to digestive problems > > (intermittent constipation/diarrhea?). Perhaps > the > > salt/water balance in the body being thrown off > from > > time to time? > > > > The renin AND aldo would be high. > Remind me about why they dont think you have PA-as I > recall the severe HTN, > CHF, leaky heart valves and low K all got better > with spiro. Pretty good > presumtive evidence to me. Also I recall you son > had HTN and low K. How do > they explain that? > > > > May your pressure be low! > > Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD, > FACP, FACC, FAHACHBPR > Charter member of American Society of > Hypertension(ASH) and the International > Society for Hypertension in Blacks (ISHIB). > Clinical Professor of Medicine and Epidemiology > Director, Hypertension Diagnosis and Treatment > Center > Board Certified in Internal Medicine, Geriatrics and > Hypertension > > Published over 220 scientific papers, book chapters > and 220 abstracts > in the area of high blood pressure epidemiology, > physiology, endocrinology, > measurement, treatment and how to detect curable > causes. > Listed in Best Doctors in America > Specializing in Difficult to Control High Blood > Pressure and the > History and Physiology of High Blood pressure in the > African Diaspora > Member of the Board of Directors, ISHIB > > ===== " I'd rather learn from one bird how to sing, than to teach ten thousand stars how not to dance. " __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2005 Report Share Posted January 28, 2005 > > I don't mean to be a pest, but the Stanford, UCSF and California > Center for Sleep Disorders clinics, as well as all of St Louis > (ultimately Stanford-derived) practices speak of both these theories > commonly as pretty well founded, but still creeping through the ICD > process (calcium, other mineral foundations for adrenal masses, and > autonomic compromise-as-organ-system-malfunction). So, not > well-known outside of their preceincts. Their conferences go into it > every time. More and more cases; more and more tracing of the > structures & chemical tracks to causation. So, autonomic regulation, > a poorly understood phenomenon, is implicated in anything, but with > the longterm (10 yrs +) severe (100 + a/h/r per hr.) apnea cases w/no > treatment, it is expected. Odd if such a pt does NOT show signs of > it. > > Dave > > On Jan 28, 2005, at 6:23 PM, Pamela s wrote: > >> >> Hi, Dr. Grim >> >> My renin:aldo was never clearly indicative of primary >> aldosteronism, but that may be because I was unable to >> stay off spironolactone for more than two weeks >> because my blood pressure shot up. So yes, my >> aldosterone was high. . . I think my renin was, too, >> but I don't remember exactly. >> >> When I read about autonomic dysfunction, it is >> actually listed as a possible cause of aldosteronism. >> There is speculation that it ultimately leads to the >> formation of calcium deposits which lead to adrenal >> tumors. I don't have such tumors, but on the other >> hand I don't have any clear explanation for the >> etiology of my aldosteronism that I know of. So I >> found this correlation with autonomic dysfunction >> interesting, although I readily admit you would know >> more about the causal relationship than I do. >> >> My son has HTN and LFV, but he is normokalemic. They >> are beginning to look into his sleep apnea, which >> again may cause aldosteronism, I believe. >> >> Please let me know your thoughts. Why do you think my >> blood pressure would be so unstable despite fairly >> rigorous Spironolactone therapy? >> >> At night, my lowest blood pressure was 122/60, while >> my highest was 123/80. >> >> In the daytime, my lowest blood pressure was 100/60, >> while my highest was 168/146. >> >> This was all in one 24-hour period. The highest >> reading happened while I was on the phone with the >> water company paying a bill--evidently I had lower >> blood pressure readings while I was exercising. >> >> Where do I go from here? >> >> >> Warmly, >> >> Pam >> >> >> --- lowerbp2@... wrote: >> >>> >>> In a message dated 1/28/05 3:57:52 AM, >>> spirlhelix@... writes: >>> >>> >>>> Or possibly some of the symptoms >>>> of autonomic dysfunction could come and go? Dr. >>> Grim, >>>> can aldosteronism be primary to digestive problems >>>> (intermittent constipation/diarrhea?). Perhaps >>> the >>>> salt/water balance in the body being thrown off >>> from >>>> time to time? >>>> >>> >>> The renin AND aldo would be high. >>> Remind me about why they dont think you have PA-as I >>> recall the severe HTN, >>> CHF, leaky heart valves and low K all got better >>> with spiro. Pretty good >>> presumtive evidence to me. Also I recall you son >>> had HTN and low K. How do >>> they explain that? >>> >>> >>> >>> May your pressure be low! >>> >>> Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD, >>> FACP, FACC, FAHACHBPR >>> Charter member of American Society of >>> Hypertension(ASH) and the International >>> Society for Hypertension in Blacks (ISHIB). >>> Clinical Professor of Medicine and Epidemiology >>> Director, Hypertension Diagnosis and Treatment >>> Center >>> Board Certified in Internal Medicine, Geriatrics and >>> Hypertension >>> >>> Published over 220 scientific papers, book chapters >>> and 220 abstracts >>> in the area of high blood pressure epidemiology, >>> physiology, endocrinology, >>> measurement, treatment and how to detect curable >>> causes. >>> Listed in Best Doctors in America >>> Specializing in Difficult to Control High Blood >>> Pressure and the >>> History and Physiology of High Blood pressure in the >>> African Diaspora >>> Member of the Board of Directors, ISHIB >>> >>> >> >> >> ===== >> " I'd rather learn from one bird how to sing, than to teach ten >> thousand stars how not to dance. " >> >> __________________________________________________ >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2005 Report Share Posted January 29, 2005 In a message dated 1/29/05 2:51:27, spirlhelix@... writes: Hi, Dr. Grim My cardiologist insists that my blood pressure must be kept to a certain low level at all times because of my history of dilated cardiomyopathy, heart failure, etc. In a sense, I feel she is fighting with me about beta blockers here. Which are not an option for me, because I become suicidally depressed when using them even at low doses. But I am anticipating her reaction here. She will probably look at my test results on Monday, and we will see what her intention will be then. Warmly, Pam You treat heart failure but treating the cause, in your case primary aldosteronism is the cause it appears. How else does she explain the regression of all of your BP, K and echo abnormalites with spiro? There ain't no other way that I can see. May your pressure be low! Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD, FACP, FACC, FAHS Clinical Professor of Medicine and Epidemiology Director, Hypertension Diagnosis and Treatment Center Board Certified in Internal Medicine, Geriatrics and Hypertension Published over 220 scientific papers, book chapters and 220 abstracts in the area of high blood pressure epidemiology, physiology, endocrinology measurement, treatment and how to detect curable causes. Listed in Best Doctors in America Specializing in Difficult to Control High Blood Pressure and the History and Physiology of High Blood pressure in the African Diaspora Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2005 Report Share Posted January 29, 2005 In a message dated 1/28/05 20:25:14, spirlhelix@... writes: When I read about autonomic dysfunction, it is actually listed as a possible cause of aldosteronism. There is speculation that it ultimately leads to the formation of calcium deposits which lead to adrenal tumors. I don't have such tumors, but on the other hand I don't have any clear explanation for the etiology of my aldosteronism that I know of. So I found this correlation with autonomic dysfunction interesting, although I readily admit you would know more about the causal relationship than I do. I have never heard that aut dys causes primary aldosteronism or adrenal calcificatiaon. There is an excleent AD group in Minniapolis as I recall. Google it and see whatyhou find AD support groups. Thereis aperson on bloodpressureline that has a big problem with it and is an expert patient as well. Dont recall her name. May your pressure be low! Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD, FACP, FACC, FAHS Clinical Professor of Medicine and Epidemiology Director, Hypertension Diagnosis and Treatment Center Board Certified in Internal Medicine, Geriatrics and Hypertension Published over 220 scientific papers, book chapters and 220 abstracts in the area of high blood pressure epidemiology, physiology, endocrinology measurement, treatment and how to detect curable causes. Listed in Best Doctors in America Specializing in Difficult to Control High Blood Pressure and the History and Physiology of High Blood pressure in the African Diaspora Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2005 Report Share Posted January 29, 2005 If the BP is not controlled with aldo blockers alone the other drugs should be added and this is an individual experiment. Your prev BB problems would steer me awayh from them but the one I try in such people would bre Carvediolol or bisoprolol-have you been tried on these. Is you heart rate rapid all the time.? May your pressure be low! Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD, FACP, FACC, FAHS Clinical Professor of Medicine and Epidemiology Director, Hypertension Diagnosis and Treatment Center Board Certified in Internal Medicine, Geriatrics and Hypertension Published over 220 scientific papers, book chapters and 220 abstracts in the area of high blood pressure epidemiology, physiology, endocrinology measurement, treatment and how to detect curable causes. Listed in Best Doctors in America Specializing in Difficult to Control High Blood Pressure and the History and Physiology of High Blood pressure in the African Diaspora Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2005 Report Share Posted January 29, 2005 In a message dated 1/28/05 19:56:49, spirlhelix@... writes: I confess I have studied medical astrology, to some degree. And I think I can probably say with Sir Issac Newton, "Sir, I have studied the matter; you have not." I bet he had some good comments on astrology as well. IT would be something to the effect that a theory based on garbage can only produce garbage. May your pressure be low! Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD, FACP, FACC, FAHS Clinical Professor of Medicine and Epidemiology Director, Hypertension Diagnosis and Treatment Center Board Certified in Internal Medicine, Geriatrics and Hypertension Published over 220 scientific papers, book chapters and 220 abstracts in the area of high blood pressure epidemiology, physiology, endocrinology measurement, treatment and how to detect curable causes. Listed in Best Doctors in America Specializing in Difficult to Control High Blood Pressure and the History and Physiology of High Blood pressure in the African Diaspora Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2005 Report Share Posted January 30, 2005 In a message dated 1/29/05 23:48:09, spirlhelix@... writes: Hi, Dr. Grim Carvedilol is a beta blocker, I believe. The "ol" on Bisoprolo sounds like one, too. I don't care to try more beta blockers. I have had suicidal reactions on labetalol, nadolol, and atenolol. Enough is enough. My heart rate used to be better controlled over the past year (I think!), but in the past few days as it has been measured frequently, it hovers in the 95's. It goes over 100 when I am having high blood pressure surges. Warmly, Pam Understand Carvde is a n alpha and BB May your pressure be low! Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD, FACP, FACC, FAHS Clinical Professor of Medicine and Epidemiology Director, Hypertension Diagnosis and Treatment Center Board Certified in Internal Medicine, Geriatrics and Hypertension Published over 220 scientific papers, book chapters and 220 abstracts in the area of high blood pressure epidemiology, physiology, endocrinology measurement, treatment and how to detect curable causes. Listed in Best Doctors in America Specializing in Difficult to Control High Blood Pressure and the History and Physiology of High Blood pressure in the African Diaspora Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 1, 2005 Report Share Posted February 1, 2005 But he reason they were on BB in the first place is that you live longer if you have a heart attack. The question was how long should you be on them. It looks like the longer the better. This is not the case when BB are used for HTN. Maybe you should let your pharmacist prescribe your meds rather than your Dr. In a message dated 2/1/05 13:49:30, spirlhelix@... writes: Hi, Dr. Grim There are a number of cardiologists who won't let you off carvedilol if you start. I think it has to do with an older study that showed a high percentage of patients who were taken off a beta blocker died within the next year. At any rate, I'm more than a little hesitant. My pharmacy assures me that if I react so consistently to beta blockers, I will have the same reaction to Carvedilol. Warmly, Pam May your pressure be low! Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD, FACP, FACC, FAHS Clinical Professor of Medicine and Epidemiology Director, Hypertension Diagnosis and Treatment Center Board Certified in Internal Medicine, Geriatrics and Hypertension Published over 220 scientific papers, book chapters and 220 abstracts in the area of high blood pressure epidemiology, physiology, endocrinology measurement, treatment and how to detect curable causes. Listed in Best Doctors in America Specializing in Difficult to Control High Blood Pressure and the History and Physiology of High Blood pressure in the African Diaspora Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 2, 2008 Report Share Posted November 2, 2008 Hi Kim. I'm very sorry to hear of the hard time you're having. Do you know why they did the sweat test? Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of kimsstay It has been awhile since I posted last, or have kept up with posts as I have been ill with vomiting and fainting. Went to the Mayo for an eval after my local doc said I needed a specialist. After a billion tests, it seems I have something not right with my Autonomic system. Not sure exactly what as I don't meet with the specialist until Nov 28th. My catacholimenes were high (norepinephrine 2965 upright and 1364 supine -- normal is 70-750), and dopamine 131 up and 61 sup -- normal is <30). I also 'failed' the tilt table and sweat tests, but i don't understand the results enough to report -- will have to wait until I see the doc. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 2, 2008 Report Share Posted November 2, 2008 Depends on which sweat test they did? Tell us how it was done. Some Auto Failures dont sweat right. High cats suggest suggests you do not have autonomic failure from the secretion point of view.-usually but will wait for the expert interpretation. What drugs are you on or were you on when tested. Some give false + for cats depending on assay used. CE Grim MD On Nov 2, 2008, at 11:42 AM, Valarie wrote: > Hi Kim. I'm very sorry to hear of the hard time you're having. Do > you know > why they did the sweat test? > > Val > > From: hyperaldosteronism > [mailto:hyperaldosteronism ] On Behalf Of kimsstay > > It has been awhile since I posted last, or have kept up with posts as > I have been ill with vomiting and fainting. Went to the Mayo for an > eval after my local doc said I needed a specialist. After a billion > tests, it seems I have something not right with my Autonomic system. > Not sure exactly what as I don't meet with the specialist until Nov > 28th. My catacholimenes were high (norepinephrine 2965 upright and > 1364 supine -- normal is 70-750), and dopamine 131 up and 61 sup -- > normal is <30). I also 'failed' the tilt table and sweat tests, but i > don't understand the results enough to report -- will have to wait > until I see the doc. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2008 Report Share Posted November 4, 2008 I had a " Autonomic Reflex Screen " which included tilt table, valsalva & QSART - Quantitative Sudomotor Axon Reflex Test. During the tilt, my HR increased during the tilt. Conclusion reads " Abnormal study. Thee was cardiovagal & distal postganglionic sympathetic sudomotor abnormality with normal cardiovascular adrenergic function. Results were compatable with a limited autonomic (small fiber) neuropathy. In addition, I had a Thermoregulatory Sweat Test. Don't have the results on this one. In this test, they coat your body with a powder that reacts to sweat then put you in a 'sweat' chamber for an hour and measure the sweat patterns. I was on lisinopril, verapamil, toprol, zofran, zocor. But, because of vomiting repeatedly, not sure just how much of anything was actually on board. thanks for you input, kim > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 9, 2008 Report Share Posted November 9, 2008 Vomiting may have lowered your K and changed adrenergic function. Was your K low at the time? CE Grim MD On Nov 4, 2008, at 8:11 AM, kimsstay wrote: > I had a " Autonomic Reflex Screen " which included tilt table, valsalva > & QSART - Quantitative Sudomotor Axon Reflex Test. During the tilt, my > HR increased during the tilt. Conclusion reads " Abnormal study. Thee > was cardiovagal & distal postganglionic sympathetic sudomotor > abnormality with normal cardiovascular adrenergic function. Results > were compatable with a limited autonomic (small fiber) neuropathy. > > In addition, I had a Thermoregulatory Sweat Test. Don't have the > results on this one. In this test, they coat your body with a powder > that reacts to sweat then put you in a 'sweat' chamber for an hour and > measure the sweat patterns. > > I was on lisinopril, verapamil, toprol, zofran, zocor. But, because of > vomiting repeatedly, not sure just how much of anything was actually > on board. > > thanks for you input, > > kim > > > > > > > > May your pressure be low!  CE Grim BS, MS, MD High Blood Pressure Consulting Senior Consultant to Shared Care Research and Education Consulting Inc.(sharedcareinc.com) Clinical Professor of Internal Medicine Medical and Cardiology Medical College of Wisconsin Board certified in Internal Med, Geriatrics and Hypertension. Interests: 1. Difficult to control high blood pressure. 2. The effect of recent evolutionary forces on high blood pressure in human populations. 3. Improving blood pressure measurement in the office and out. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 10, 2008 Report Share Posted November 10, 2008 > My K was lower than it has been, but still within normal limits (4.2). Dr. Grim, one thing I noticed that may or may not just be a fluke -- they had me go off the spiro (I was taking 100 mg 2x day) until I stop vomiting because I was volume depleted. I did not faint at all while off the Spiro, now I am slowly going back on (50 mg 2x day) and am starting to get lightheaded again...Of note, while off the spiro and added lisonipril, my BP was running lowest ever, often lower that 120/80. Now, it is up again (150-160/95-110). Go figure... Also, my GFR (est.) was 43...hopefully will get better if I can get vomiting under control and re-hydrate. Kim in MN Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 10, 2008 Report Share Posted November 10, 2008 did you ever take your BP after vomiting. You may have been having low BP episodes. I suspect your BP is being lowered too much. Most would be happy with BP less than 135/85 at home and not lower. Esp if you are fainting. Was it related to taking the pills themselves. It is ok to split spiro up to 4 x a day if you have GI problems. Recall that lisinopril does not work very well in PA. Has your Dr tried adding triampterene or amiloride. This combo with spiro seems to be helpful in some. On Nov 10, 2008, at 5:47 AM, kimsstay wrote: > > > My K was lower than it has been, but still within normal limits > (4.2). > > Dr. Grim, one thing I noticed that may or may not just be a fluke -- > they had me go off the spiro (I was taking 100 mg 2x day) until I stop > vomiting because I was volume depleted. I did not faint at all while > off the Spiro, now I am slowly going back on (50 mg 2x day) and am > starting to get lightheaded again...Of note, while off the spiro and > added lisonipril, my BP was running lowest ever, often lower that > 120/80. Now, it is up again (150-160/95-110). Go figure... > > Also, my GFR (est.) was 43...hopefully will get better if I can get > vomiting under control and re-hydrate. > > Kim in MN > > > May your pressure be low!  CE Grim BS, MS, MD High Blood Pressure Consulting Senior Consultant to Shared Care Research and Education Consulting Inc.(sharedcareinc.com) Clinical Professor of Internal Medicine Medical and Cardiology Medical College of Wisconsin Board certified in Internal Med, Geriatrics and Hypertension. Interests: 1. Difficult to control high blood pressure. 2. The effect of recent evolutionary forces on high blood pressure in human populations. 3. Improving blood pressure measurement in the office and out. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2008 Report Share Posted November 11, 2008 When I took my BP after vomiting it was high, altho I did not do this very often. Hypertension doc at Mayo, in his opinion letter, said following: - History of resistant hypertension with inappropriate hyperaldosteronism. - Poorly-controlled hypertension, presumably related to vomiting of meds - Evidence of hypertensive target organ damage including aortic dilation & microalbuminuria - Dyslipidemia, treatment recommended. He said that because of #3, my target BP should be 120/80 or less. What do you think? Vomiting often happens after I take pills, altho with reglan it is a bit better (maybe 50%). Fainting never. I will try splitting my spiro dose up more, thanks for the tip. I am allergic to triamterine, makes me vomit. Again, thanks for input, Kim in MN Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2008 Report Share Posted November 11, 2008 I would ask your Dr to do a 24 hr urine sodium if you think you are DASHing to the max to see if this will help the BP. There is a new report from AHA showing DASHing works very well in drug resis HTN esp with early primary aldo. aka inappropriate hyperaldo On Nov 11, 2008, at 6:19 AM, kimsstay wrote: > When I took my BP after vomiting it was high, altho I did not do this > very often. > > Hypertension doc at Mayo, in his opinion letter, said following: > - History of resistant hypertension with inappropriate > hyperaldosteronism. > - Poorly-controlled hypertension, presumably related to vomiting of > meds > - Evidence of hypertensive target organ damage including aortic > dilation & microalbuminuria > - Dyslipidemia, treatment recommended. > > He said that because of #3, my target BP should be 120/80 or less. > What do you think? > > Vomiting often happens after I take pills, altho with reglan it is a > bit better (maybe 50%). Fainting never. > > I will try splitting my spiro dose up more, thanks for the tip. > > I am allergic to triamterine, makes me vomit. > > Again, thanks for input, > Kim in MN > > > May your pressure be low!  CE Grim BS, MS, MD High Blood Pressure Consulting Senior Consultant to Shared Care Research and Education Consulting Inc.(sharedcareinc.com) Clinical Professor of Internal Medicine Medical and Cardiology Medical College of Wisconsin Board certified in Internal Med, Geriatrics and Hypertension. Interests: 1. Difficult to control high blood pressure. 2. The effect of recent evolutionary forces on high blood pressure in human populations. 3. Improving blood pressure measurement in the office and out. Quote Link to comment Share on other sites More sharing options...
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