Guest guest Posted November 12, 2008 Report Share Posted November 12, 2008 I am Dashing, have been for a couple of years now. My 24 hr sodium (urine) was 100, range 40-217. > > > 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...
Guest guest Posted November 13, 2008 Report Share Posted November 13, 2008 DASH's low sodium in about 20% lower 80 mM/24 hr. Yours is getting there and lowering it more may help more with the BP. Only way to tell is to do it and see. You will know in 2 weeks. CE Grim MD On Nov 12, 2008, at 8:14 AM, kimsstay wrote: > I am Dashing, have been for a couple of years now. My 24 hr sodium > (urine) was 100, range 40-217. > > > > > > > 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...
Guest guest Posted November 19, 2008 Report Share Posted November 19, 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 19, 2008 Report Share Posted November 19, 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 19, 2008 Report Share Posted November 19, 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...
Guest guest Posted June 9, 2009 Report Share Posted June 9, 2009 My assessment is that you may have an early form that some do not yet recognize. You need to remember that for aldo to cause high blood pressure and low K and all the other symptoms and complications it must be enabled by a high salt diet. You may be out " salting " the spiro or the Inspra! They can only do so much. If your urine is full of sodium your MC receptors will keep on pumping in Na and out K no matter how much you block the MCs. Is it possible that you have not tried to severely limit your salt intake and increase K intake by DASHing to the max? If you have not I recommend you do so and have your local Dr order a 24 hr urine for Na and K and creatinine to document you are on the diet after 2 weeks. If you think you are DASHing now then do the urine now and then I recommend using the chapter in the book (to the letter) called the 14 day challenge and then check your BP and your urine.. How were you taking the Spiro? GI problems may be less it taken 3-4 x a day with meals esp if on 400/day. What is causing the gatroparesis? Clarence E. Grim, BS, MS, MD Specializing in Difficult High Blood Pressure and recent evolutionary forces on high blood pressure in population's today. On Tuesday, June 09, 2009, at 01:12PM, " kimsstay " <kimshannons@...> wrote: >Have recently been diagnosed with this and seem to remember another member of this group with this problem? If so, I would really like to hear from you as to treatment options that are working for you... > >I was up to 300 mg Spiro (split into 2 doses) and it really was not doing much - they have me off of it now due to low blood volume/dehydration issues due to gastroparesis. Am on clonidine .3mg due to hyperadrenergic state and it does seem to be helping a bit this week, only getting sick every other day instead of every day and BP is edging back into OK status (running avg of high 140's over low 100's) after being way too high. I started at .1 mg patch and am working my way up. When 1st diagnosed in 2006 I was given Inspra and my BP came down immediately. Switched to Spiro in 2007 due to insurance and it seemed to work ok for awhile, then my BP just got plain stubborn and I kept upping the dose hoping for relief, but never received any. I have with interest read on this site where members say they receive relief from not just high BP, but the 'other' PA symptoms -- but I never felt any relief of my other symptoms at all from Inspra or Spiro (muscle pain, joint pain, daily headache/migraines, mental fog, memory problems, general malaise) which does make me wonder about if I really do have PA. > >This last time at Mayo, both the hypertension guy and the endo both expressed doubt as to whether I have PA or not...the endo wanted me to come back for 'comprehensive' testing when I stopped vomiting and I think I may do so. I really liked him (Dr. Abboud) and do respect his opinion so probably will do this, if I ever stop vomiting!! > >Last tested Aldo/serum was 43 ng/dl (ref <=21) and renin 1.9 ng/mL/h (no ref given) -- was still on Spiro and BB at time. Also pretty severely dehydrated. Tested off spiro 10/06 and results were Aldo 18 ng/dl (<32) and Renin <0.5 ng/mL/hr (<3.4). Any thoughts on if I really do have PA or ?? > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 9, 2009 Report Share Posted June 9, 2009 My assessment is that you may have an early form that some do not yet recognize. You need to remember that for aldo to cause high blood pressure and low K and all the other symptoms and complications it must be enabled by a high salt diet. You may be out " salting " the spiro or the Inspra! They can only do so much. If your urine is full of sodium your MC receptors will keep on pumping in Na and out K no matter how much you block the MCs. Is it possible that you have not tried to severely limit your salt intake and increase K intake by DASHing to the max? If you have not I recommend you do so and have your local Dr order a 24 hr urine for Na and K and creatinine to document you are on the diet after 2 weeks. If you think you are DASHing now then do the urine now and then I recommend using the chapter in the book (to the letter) called the 14 day challenge and then check your BP and your urine.. How were you taking the Spiro? GI problems may be less it taken 3-4 x a day with meals esp if on 400/day. What is causing the gatroparesis? Clarence E. Grim, BS, MS, MD Specializing in Difficult High Blood Pressure and recent evolutionary forces on high blood pressure in population's today. On Tuesday, June 09, 2009, at 01:12PM, " kimsstay " <kimshannons@...> wrote: >Have recently been diagnosed with this and seem to remember another member of this group with this problem? If so, I would really like to hear from you as to treatment options that are working for you... > >I was up to 300 mg Spiro (split into 2 doses) and it really was not doing much - they have me off of it now due to low blood volume/dehydration issues due to gastroparesis. Am on clonidine .3mg due to hyperadrenergic state and it does seem to be helping a bit this week, only getting sick every other day instead of every day and BP is edging back into OK status (running avg of high 140's over low 100's) after being way too high. I started at .1 mg patch and am working my way up. When 1st diagnosed in 2006 I was given Inspra and my BP came down immediately. Switched to Spiro in 2007 due to insurance and it seemed to work ok for awhile, then my BP just got plain stubborn and I kept upping the dose hoping for relief, but never received any. I have with interest read on this site where members say they receive relief from not just high BP, but the 'other' PA symptoms -- but I never felt any relief of my other symptoms at all from Inspra or Spiro (muscle pain, joint pain, daily headache/migraines, mental fog, memory problems, general malaise) which does make me wonder about if I really do have PA. > >This last time at Mayo, both the hypertension guy and the endo both expressed doubt as to whether I have PA or not...the endo wanted me to come back for 'comprehensive' testing when I stopped vomiting and I think I may do so. I really liked him (Dr. Abboud) and do respect his opinion so probably will do this, if I ever stop vomiting!! > >Last tested Aldo/serum was 43 ng/dl (ref <=21) and renin 1.9 ng/mL/h (no ref given) -- was still on Spiro and BB at time. Also pretty severely dehydrated. Tested off spiro 10/06 and results were Aldo 18 ng/dl (<32) and Renin <0.5 ng/mL/hr (<3.4). Any thoughts on if I really do have PA or ?? > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 10, 2009 Report Share Posted June 10, 2009 Thanks for you assessment, it is really helpful. I have been Dashing for a couple of years now, altho I do occasionally eat out and then go off, but by occasionally, I mean only a couple of times a year (my hubby hates to eat out). I was growing my own vegies until I got too sick, now it irritates me to have to purchase them!! Don't eat processed foods unless labels no or low-salt, and not many of those either. My last 24-hr sodium was 100 (range 40-217) at the Mayo. With the gastroparesis, I have had to eat more low fiber (think 'mushy' or 'watery') which sucks but is the only way to keep food down, or at least it was until this increased clonidine patch dose has helped. I am still eating low salt. The gastroparesis is caused by the autonomic dysfunction. > >Have recently been diagnosed with this and seem to remember another member of this group with this problem? If so, I would really like to hear from you as to treatment options that are working for you... > > > >I was up to 300 mg Spiro (split into 2 doses) and it really was not doing much - they have me off of it now due to low blood volume/dehydration issues due to gastroparesis. Am on clonidine .3mg due to hyperadrenergic state and it does seem to be helping a bit this week, only getting sick every other day instead of every day and BP is edging back into OK status (running avg of high 140's over low 100's) after being way too high. I started at .1 mg patch and am working my way up. When 1st diagnosed in 2006 I was given Inspra and my BP came down immediately. Switched to Spiro in 2007 due to insurance and it seemed to work ok for awhile, then my BP just got plain stubborn and I kept upping the dose hoping for relief, but never received any. I have with interest read on this site where members say they receive relief from not just high BP, but the 'other' PA symptoms -- but I never felt any relief of my other symptoms at all from Inspra or Spiro (muscle pain, joint pain, daily headache/migraines, mental fog, memory problems, general malaise) which does make me wonder about if I really do have PA. > > > >This last time at Mayo, both the hypertension guy and the endo both expressed doubt as to whether I have PA or not...the endo wanted me to come back for 'comprehensive' testing when I stopped vomiting and I think I may do so. I really liked him (Dr. Abboud) and do respect his opinion so probably will do this, if I ever stop vomiting!! > > > >Last tested Aldo/serum was 43 ng/dl (ref <=21) and renin 1.9 ng/mL/h (no ref given) -- was still on Spiro and BB at time. Also pretty severely dehydrated. Tested off spiro 10/06 and results were Aldo 18 ng/dl (<32) and Renin <0.5 ng/mL/hr (<3.4). Any thoughts on if I really do have PA or ?? > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 10, 2009 Report Share Posted June 10, 2009 If you are DASHing your urine sodium should be below 80 mM/day thus 100 is excessive. Some need to get down to 20 to get BP response. That can only be done with the ricefruit diet which I may have mentioned before. See ricediet.com Clarence E. Grim, BS, MS, MD Specializing in Difficult High Blood Pressure and recent evolutionary forces on high blood pressure in population's today. On Wednesday, June 10, 2009, at 08:50AM, " kimsstay " <kimshannons@...> wrote: >Thanks for you assessment, it is really helpful. I have been Dashing for a couple of years now, altho I do occasionally eat out and then go off, but by occasionally, I mean only a couple of times a year (my hubby hates to eat out). I was growing my own vegies until I got too sick, now it irritates me to have to purchase them!! Don't eat processed foods unless labels no or low-salt, and not many of those either. My last 24-hr sodium was 100 (range 40-217) at the Mayo. > >With the gastroparesis, I have had to eat more low fiber (think 'mushy' or 'watery') which sucks but is the only way to keep food down, or at least it was until this increased clonidine patch dose has helped. I am still eating low salt. The gastroparesis is caused by the autonomic dysfunction. > > > >> >Have recently been diagnosed with this and seem to remember another member of this group with this problem? If so, I would really like to hear from you as to treatment options that are working for you... >> > >> >I was up to 300 mg Spiro (split into 2 doses) and it really was not doing much - they have me off of it now due to low blood volume/dehydration issues due to gastroparesis. Am on clonidine .3mg due to hyperadrenergic state and it does seem to be helping a bit this week, only getting sick every other day instead of every day and BP is edging back into OK status (running avg of high 140's over low 100's) after being way too high. I started at .1 mg patch and am working my way up. When 1st diagnosed in 2006 I was given Inspra and my BP came down immediately. Switched to Spiro in 2007 due to insurance and it seemed to work ok for awhile, then my BP just got plain stubborn and I kept upping the dose hoping for relief, but never received any. I have with interest read on this site where members say they receive relief from not just high BP, but the 'other' PA symptoms -- but I never felt any relief of my other symptoms at all from Inspra or Spiro (muscle pain, joint pain, daily headache/migraines, mental fog, memory problems, general malaise) which does make me wonder about if I really do have PA. >> > >> >This last time at Mayo, both the hypertension guy and the endo both expressed doubt as to whether I have PA or not...the endo wanted me to come back for 'comprehensive' testing when I stopped vomiting and I think I may do so. I really liked him (Dr. Abboud) and do respect his opinion so probably will do this, if I ever stop vomiting!! >> > >> >Last tested Aldo/serum was 43 ng/dl (ref <=21) and renin 1.9 ng/mL/h (no ref given) -- was still on Spiro and BB at time. Also pretty severely dehydrated. Tested off spiro 10/06 and results were Aldo 18 ng/dl (<32) and Renin <0.5 ng/mL/hr (<3.4). Any thoughts on if I really do have PA or ?? >> > >> > >> > >> > >> > >> > >> > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 15, 2012 Report Share Posted July 15, 2012 Are there any alternative tests (safer) than the Tilt Table Test for Autonomic Dysfunction. I know about lying down, taking BP ten minutes later, then standing up and repeat. This is not adequate for disability because tests fluctuates. Thanks, Kookie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 15, 2012 Report Share Posted July 15, 2012 Hi Kookie, I don't know what it is called but Dr. Enlander in NYC has a way to take blood pressure and heart rate lying down, sitting and standing all without a tilt table. It was painless and one did not feel like passing out. You could call their office and ask about it. They are only there on Tues, Wed and Thurs. The office is in NYC. 212-794-2000. Peace, Love and Harmony, Bev > > > > Are there any alternative tests (safer) > than the Tilt Table Test for Autonomic > Dysfunction. I know about lying down, > taking BP ten minutes later, then standing > up and repeat. This is not adequate for disability > because tests fluctuates. > > Thanks, > > Kookie > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 16, 2012 Report Share Posted July 16, 2012 I know several people who worsened considerably after the TTT, and one died!! Its not that safe. I am extremely ill and frail, I can't even pick up something on the floor, nor can I look up, down etc, I also suffer from vestibular dysfunction and other nasty, serious symptoms. Anyway, I need to find an accessible test, which is safe for me. From: Teewinot <teewinot13@...> Subject: Re: Autonomic Dysfunction Date: Sunday, July 15, 2012, 7:00 PM Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 16, 2012 Report Share Posted July 16, 2012 I've heard this also, and the same can be said for quite a number of tests, even if not " invasive. " Ellen >I know several people who worsened considerably after the TTT, and one died!! Its not that safe. < Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 17, 2012 Report Share Posted July 17, 2012 Hi EveryOne, The test I took at Dr, Enlander's had an automatic printed readout which would provide a record but did not involve a tilt table. It servers the purpose without the risk. Whether or not the printout would be " legal " I can't say but I am sure the doctors office would know. 212-794-2000. Peace, Love and Harmony, Bev > > > > > > > > Are there any alternative tests (safer) > > than the Tilt Table Test for Autonomic > > Dysfunction. I know about lying down, > > taking BP ten minutes later, then standing > > up and repeat. This is not adequate for disability > > because tests fluctuates. > > > > Thanks, > > > > Kookie > > > Quote Link to comment Share on other sites More sharing options...
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