update

February 2, 2012

Your ER experience is biased because u do not know the denominator. Most phaemacies now give out a review of the drug prescribed. Pts should read it but suspect most don't. What I say is the med we are going to try has a number of side effects. Read the info and let me know if ANYTHING changes. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Feb 2, 2012, at 18:14, Phyllis <phylisrn@...> wrote:

a, I kind of agree and disagree. As a nurse, don't you think

more patients should be aware of their side effects. Like the pt who

comes to the Er with a pulse of 30 and still taking his beta

blockers or his digoxin? Or how about the ones that come in with

repeated glucose < 60 and continues to take his metformin or

glucophage?

What if a pt. was prescribed Imdur and he wasn't warned about the

bad headaches- which actually means it is working?

I have a better one- the ppl who weren't warned about Ace Inhibitors

and angioedema and they come into the ER thinking they ate something

bad. Or the pt coming in with GI bleeding and still taking their ASA

and NSAIDS and on and on.

I always, always, always warn/tell pt's about side effects/adverse

side effects. Some side effects can be fatal. I have never had

anyone say they won't take a med cause I told

them about the side effects. In fact, most thank me.

Phyllis

On 2/2/2012 8:17 PM, a Hall wrote:

,

The point of my other post was that maybe we

should tone down stressing the "adverse side effects"

of spiro because not everyone gets them. If I were a

new member of the group and read some of the posts on

spiro there is no way I would take it, although I am

one of the persons that have no problems with it. I

could not tolerate Inspra. Several years ago the endo

I was going to at the time insisted I try it although

I was having no problems with spiro. I had a raging

headache for one month that never went away so back on

spiro I went. Some people may have insurance

that won't pay for Inspra and can't afford to pay for

it themselves and have no choice of medications,

others may have problems with Inspra. Auto-suggestion

is very strong in some people. I'm from the time

fram when nurses could give placebos for pain if they

felt it was warranted. More than 50% of the people I

gave them to had miraculous pain relief from 2 ml of

normal saline IM and a "this is a very strong pain

medication, it should take away your pain and make you

sleepy in just a few minutes." Maybe it would be

better not to stress possible adverse effects of spiro

(every drug has them) and let each person find out

whether they will have side effects from it or not.

Just sayin'......

From:

<jclark24p@...>

To:

hyperaldosteronism

Sent:

Thursday, February 2, 2012 7:15 PM

Subject:

Re: Update

Barb, I totally agree with your assessment and

decision as long as you keep a close eye on adverse

side effects! I was well controlled on 25mg bid but

developed gynecomastia early. No recommendation from

anyone to change because it "was not painful". My PCP

was estatic and not willing to change anything until I

developed 6 bumps in my rt. breast and she had to

convince me that I was going to Boston (400+ miles

R/T) for a mammogram! I considered Eplerenone but it

took 3 trys to get it approved by the VA. I did a lot

of research and found enough unanswered questions and

the fact that there was limited research and finlly

decided now was the time to persue an AVS and know all

my options!

As a postmenopusal female many of my concerns will not

apply. I do have an outstanding question with my

Psyco Staff regarding how it might affect MDD

treatment. (There is apprently an effect on gene

CYP11B1 and CYP11B2, cortisol and androgen, because

they are neighbors on the channel. You surely know

more about it than I!)

- 65 yo super ob., fastidious male - 12mm X 13mm

rt. a.adnoma with previous rt. flank pain. Treating

with DASH. Stats w/o meds = BP 175/90 HR 59 BS 125.

D/C Spironolactone 12/20/2011 due to adverse SX.

Other Issues/Opportunities: OSA w Bi-Pap settings

13/19, DM2, Gynecomastia, MDD and PTSD.

Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200

MG, AmlodipineBesylate 5mg, 81mg aspirin and

Metformin 2000MG. Started washing Spironolactone

12/20/11 to prepare for AVS.

>

> Briefly, my adrenal history includes a right

adenoma dx'd in 2000 and a left adenoma dx'd in 2009

and drug-resistant HTN for 25 years. My right renal

artery is 70% stenosed (US dx) and the right kidney is

atrophic. I had some basic lab work done 2 weeks ago.

Aldosterone was 25 (high). Renin 9.3 (high normal).

Started Spiro 25mg daily after labs were drawn. I have

been on the Spiro for 2 weeks now. After one dose, the

brain fog lifted, my lungs were much more clear, the

trace LE peripheral edema started to diminish and my

blood pressure began to decrease.

>

> The second week on Spiro, I felt generally

horrible and my BPs were improving but not good. At

the end of the second week, BP normalizing and K+

maintained on 20mEq BID (had been taking 40 BID and

supplementing when the low K+ PVCs cycled in - usually

160mEq over 24 hrs). The sum: I am feeling much

better.

>

> I was referred to endo. Saw him today. Super doc

with a great big brain. He says there is so much going

on with me, now and historically, he is not sure if it

is primary or secondary aldosteronism because of the

renal artery stenosis or the long-term NSAID therapy

(800mg BID for the issues with my lumbar vertebrae and

left hip). Based on the numbers and diagnostics, he is

leaning toward secondary. He ordered labs to check for

Pheo, Cushing's, etc., and I will see him in one

month. He also wants a repeat CT because the last one

was 3 years ago. I won't do that until Medicare kicks

in July 1. He's okay with that.

>

> He said it was up to me if I wanted to purge the

drugs, do a salt loading and then retest. He also said

he would refer me to a university setting for an AVS

if I wanted a definitive diagnosis. The way I view

it... I am 65, retired, and Spiro is working. Kind of

a no brainer.

>

> Any thoughts?

>

> Barb

>

------------------------------------

February 2, 2012

Hmm did the VA NOT give you a drug info on Spiro when u first got it. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Feb 2, 2012, at 18:57, <jclark24p@...> wrote:

I disagree and had you told me what androgen was and the possible side effects I would have known what was causing my breasts, I might have had a hint as to why I was loosing all my body hair from the neck down, I might have known why I now have to sit down to pee so I don't wet myself (It's not a problem sexually since libido is zero), and maybe just maybe I would have figured out why I am reduced to tears at times because of the CPY11B1/CPY11B2 conflict causing the cortisol problems! Speaking of headaches, I have had one for over 2 months now. The first month as my body was rebelling to spironolactone and the last 6 week as I have been washing it from my system! So if you have any extra placebos, send few my way - it will save me breaking out the oxycodone and methadone!

Hopefully you did notice I lent my support to Barb for the treatment she had been suggested. I bet I didn't scare her since she is a retired ICU nurse I believe with a dual major maybe. Bet she knows more about side effects than I! As for the cortisol and MDD issue I felt it important because I seem to remember a nervous breakdown and some tramatic issues in the past which hopefully are IN THE PAST but she should be aware if they start to resurface, forgive me if I have the wrong person, Barb! She may even have a professional opinion!

I feel strongly that they have the order of MCBs reversed and that should be obvious if you have been following the discussion. The DX should be for HTN and that kid reviewing it should be told to "pound sand". We have a "Banking and Insurnce" committee here in Vermont that might like to hear my story and they just might if I can get a doctor or two to agree!

I was reading "Case Detection, Diagnosis, and Treatment of Patients with Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline". source:

http://jcem.endojournals.org/content/93/9/3266.full

From the Abstract:

Objective: Our objective was to develop clinical practice guidelines for the diagnosis and treatment of patients with primary aldosteronism.

Participants: The Task Force comprised a chair, selected by the Clinical Guidelines Subcommittee (CGS) of The Endocrine Society, six additional experts, one methodologist, and a medical writer. The Task Force received no corporate funding or remuneration.

I found this statement, among others, particularly interesting: "The use of eplerenone may be preferred in the case of affected children, in whom there may be concerns with respect to growth retardation and antiandrogenic effects of glucocorticoids and spironolactone, respectively." Now if I was in charge that is the group I would use Spiro on, the boys until they were 25 and the girls until half the plastic surgeons were less rich!

I consider my healthcare providers a team and I am the most important part of that team, without me they are unemployed! I don't keep secrets from my team and expect them not to keep secrets from me! Others join this group for informtion and we are not doing our job if we keep secrets from them. It is up to the reader to determine if it applies to them and how important it is to them.

> >

> > Briefly, my adrenal history includes a right adenoma dx'd in 2000 and a left adenoma dx'd in 2009 and drug-resistant HTN for 25 years. My right renal artery is 70% stenosed (US dx) and the right kidney is atrophic. I had some basic lab work done 2 weeks ago. Aldosterone was 25 (high). Renin 9.3 (high normal). Started Spiro 25mg daily after labs were drawn. I have been on the Spiro for 2 weeks now. After one dose, the brain fog lifted, my lungs were much more clear, the trace LE peripheral edema started to diminish and my blood pressure began to decrease.

> >

> > The second week on Spiro, I felt generally horrible and my BPs were improving but not good. At the end of the second week, BP normalizing and K+ maintained on 20mEq BID (had been taking 40 BID and supplementing when the low K+ PVCs cycled in - usually 160mEq over 24 hrs). The sum: I am feeling much better.

> >

> > I was referred to endo. Saw him today. Super doc with a great big brain. He says there is so much going on with me, now and historically, he is not sure if it is primary or secondary aldosteronism because of the renal artery stenosis or the long-term NSAID therapy (800mg BID for the issues with my lumbar vertebrae and left hip). Based on the numbers and diagnostics, he is leaning toward secondary. He ordered labs to check for Pheo, Cushing's, etc., and I will see him in one month. He also wants a repeat CT because the last one was 3 years ago. I won't do that until Medicare kicks in July 1. He's okay with that.

> >

> > He said it was up to me if I wanted to purge the drugs, do a salt loading and then retest. He also said he would refer me to a university setting for an AVS if I wanted a definitive diagnosis. The way I view it... I am 65, retired, and Spiro is working. Kind of a no brainer.

> >

> > Any thoughts?

> >

> > Barb

> >

>

> ------------------------------------

>

February 2, 2012

It is. OT appropriate to give meds for appropriate depression such as when the rabbit croaks. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Feb 2, 2012, at 20:58, Bingham <jlkbbk2003@...> wrote:

It sems more on this list have issues with anxiety and not depression in this regards. I realize that modern medicine erroneously lumps the two together, and even treats anxiety with SSRI's (which is off-label), but they are different emotions that need different treatments (but don't get it of course). But then again in society we are apparently supposed to be smiling and skipping 24/7 and any emotion to the otherwise has a medicine for it. Hell, the psych community now even wants grief listed as a disorder. Grief!!! Should we not be sad at a death in the family. Even the shortest verse in the Bible is "Jesus Wept." Maybe if he was put on prozac he would have been stronger

And while some tend to post on this list daily and much more than others it may appear that depression is a common thread, but it doesn't seem to be all that common. Anxiety seems to have more commonality among us with PA than depression does, but then again if I went to my doc tomorrow and said I was sad because my rabbit died I could get a depression label and a brand new SSRI. So who knows who's really depressed and who isn't.

Just my 2 cents but there are millions upon millions who have suffered abuse, been through war(s), watched people get shot, pulled burned children out of houses, lost family members, and so on, who don't have depression or PTSD. You write like it is an expectation, but millions of us, even when put in situations that are so gruesome and abnormal, and tragic, that defy any and all explanation as to why or how someone could do that to someone else, and while we can still hate it, despise it, cringe at it, cry over it, can still at the days end put it in a box I call perspective. Never to forget it, but also never to let it drive our life. There are horrible sides to life, some that happens directly to us, but some can put in the abnormal perspective box and let it go, and go on. So it is all relative. But when we think we are the only ones who suffered something, or are the island, keep in mind that the person sitting

next to you often has too, they just deal with it differently, keep it tucked away, or are built inherently emotionally different.

From: Barb Tatro <rainbowdayz@...>Subject: Re: Re: Update [1 Attachment]hyperaldosteronism Date: Thursday, February 2, 2012, 9:01 PM

Hey homeboy,

Thanks for the feedback. Right out of the chute, allow me to apologize for hammering you the other day. What appears to be rude and uncalled for, is normal 'speak' in my family and the ICU circles I've called home. We're a brassy lot and filter-free. Sometimes a good thing. Sometimes it came with a security escort to my car. Been fired more than a few times... a Barb-ism I wear with pride. It nearly always had to do with patient or nurse advocacy. Truth be told, you're a good man who is more than willing to educate others as you learn through the wrong that's been done to you. So, , good on you.

At the risk of perhaps offending again, I say this in humor and with caution. You know those smart phones out now that you speak into it in English, it translates into the desired language and speaks it back? So... I was wondering... do they have one that translates , cause sometimes it would be helpful <grin>? Please translate the following:

(are we still smiling?)

1) The postmenopausal women would be ____________________?

2) I do have an outstanding psych question regarding how ____________________ might effect MDD treatment.

3) I'm not sure I'm grasping your commentary/question regarding CYP11B(1/2). So... I will tell you what I know (usually not much). I did teach A & P and Micro labs at Indiana University, adjunct faculty for 12 years. Stopped doing that when I relocated to Houston to work for DeBakey (Google him) in 2001.

Therefore, it is my belief that one can never understand pathophysiology unless one understands normal anatomy/physiology. That said, it is necessary to look at the structure of the adrenal gland to 'get' why and how it goes on the blink.

The adrenal gland, histologically, is divided into 2 general layers: 1) cortex, 2) medulla

The medulla (deepest tissue of the gland) is easy - makes/secretes catecholamines (epi/norepi ---> adrenaline)

The cortex has 3 layers and each makes/secretes a separate type of hormone. From outermost to innermost:

1) zona glomerulosa - mineralcorticoids (aldosterone)

2) zona fasiculata - glucocorticoids (cortisol)

3) zona reticularis - androgens (estrogen, testosterone)

All of the adrenal hormones start out as cholesterol and then are changed into specific layer (zona) hormones through the action of enzymes. Enzymes cause a change in the shape of the molecule and it becomes a different hormone (just like the enzymatic changes in the production of aldosterone---> renin -> angiotensin I -> angiotensin II -> aldosterone). Each of those steps require a specific enzyme to create the new 'shape' of the hormone molecule.

Actually, CYP11B1 and CYP11B2 aren't really genes at all. They are enzymes (B1 = b-hydroxylase, B2 = aldosterone synthase) (Aside - words with 'ase' suffix are generally enzymes). I think they call them genes because they code for these enzymes, but it is confusing. They should call B1 and B2 and say that and are mucking up the hormone factory, but I'm pretty sure that's not gonna' happen.

So... the CYP11B1 acts on the zona fasiculata and impacts the enzyme action on glucocorticoids. CYP11B2 acts on the cells of the zona glomerulosa and impacts the enzyme action on mineralcorticoids. Because both are mutants, what comes out the other end are hormones that secrete and behave inappropriately.

The mutant enzymatic changes end up chronically resetting the relationship between the pituitary gland secretion of ACTH (adreocorticotropic hormone, which stimulates the adrenal cortex to secrete), creating upregulation (excessive mineral and glucocorticoids).

So... back to your question... what you are saying is that CYP11B1/2 can also alter enzymatic changes in the zona reticularis androgens? I don't see the correlation, because that's a whole different set of enzymes. Because enzymes are target tissue specific, it's not likely that enzymes that are mineral/glucocorticoid specific are capable of causing changes in androgens. I'll attach a picture here if it will let me to show you the different layers, hormones and enzymes. If not I'll post it to the group with a call out. You know what they say a picture is worth.

Finally, I find your MDD interesting. I have the same diagnosis for likely the same reason - PTSD. I have never been diagnosed with PTSD but you can't spend your childhood being molested and abused and not come out like a returning vet. Also, many on this site admit to a life filled with depression. Perhaps we're assigning the MDD to events that are unrelated. Perhaps the relationship has everything to do with adrenal abnormalities and nothing at all to do with the hardships of our life. I find that more plausible because you and I are both survivors, stuffed full of piss and vinegar. I'm thinkin' that maybe and are f-ing with my mood ring too.

Hugs,

Barb

Re: Update

Barb, I totally agree with your assessment and decision as long as you keep a close eye on adverse side effects! I was well controlled on 25mg bid but developed gynecomastia early. No recommendation from anyone to change because it "was not painful". My PCP was estatic and not willing to change anything until I developed 6 bumps in my rt. breast and she had to convince me that I was going to Boston (400+ miles R/T) for a mammogram! I considered Eplerenone but it took 3 trys to get it approved by the VA. I did a lot of research and found enough unanswered questions and the fact that there was limited research and finlly decided now was the time to persue an AVS and know all my options! As a postmenopusal female many of my concerns will not apply. I do have an outstanding question with my Psyco Staff regarding how it might affect MDD treatment. (There is apprently an effect on gene CYP11B1 and CYP11B2, cortisol and androgen, because they are

neighbors on the channel. You surely know more about it than I!) - 65 yo super ob., fastidious male - 12mm X 13mm rt. a.adnoma with previous rt. flank pain. Treating with DASH. Stats w/o meds = BP 175/90 HR 59 BS 125. D/C Spironolactone 12/20/2011 due to adverse SX.Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, Gynecomastia, MDD and PTSD.Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, AmlodipineBesylate 5mg, 81mg aspirin and Metformin 2000MG. Started washing Spironolactone 12/20/11 to prepare for AVS.>> Briefly, my adrenal history includes a right adenoma dx'd in 2000 and a

left adenoma dx'd in 2009 and drug-resistant HTN for 25 years. My right renal artery is 70% stenosed (US dx) and the right kidney is atrophic. I had some basic lab work done 2 weeks ago. Aldosterone was 25 (high). Renin 9.3 (high normal). Started Spiro 25mg daily after labs were drawn. I have been on the Spiro for 2 weeks now. After one dose, the brain fog lifted, my lungs were much more clear, the trace LE peripheral edema started to diminish and my blood pressure began to decrease. > > The second week on Spiro, I felt generally horrible and my BPs were improving but not good. At the end of the second week, BP normalizing and K+ maintained on 20mEq BID (had been taking 40 BID and supplementing when the low K+ PVCs cycled in - usually 160mEq over 24 hrs). The sum: I am feeling much better.> > I was referred to endo. Saw him today. Super doc with a great big brain. He says there is so much going on with me, now and

historically, he is not sure if it is primary or secondary aldosteronism because of the renal artery stenosis or the long-term NSAID therapy (800mg BID for the issues with my lumbar vertebrae and left hip). Based on the numbers and diagnostics, he is leaning toward secondary. He ordered labs to check for Pheo, Cushing's, etc., and I will see him in one month. He also wants a repeat CT because the last one was 3 years ago. I won't do that until Medicare kicks in July 1. He's okay with that.> > He said it was up to me if I wanted to purge the drugs, do a salt loading and then retest. He also said he would refer me to a university setting for an AVS if I wanted a definitive diagnosis. The way I view it... I am 65, retired, and Spiro is working. Kind of a no brainer. > > Any thoughts?> > Barb>

February 2, 2012

Barb, thanks for the apology, I appreciate it but your comments really didn't

bother me much because I've known Dr. Grim for a year and we respect each other

and you might find us rather direct and to the point. It did accomplish one

thing, I got to know you from reading your story a couple times! (BTW you might

change the name of your file, it reads as " Dr. Grim's Story " !)

I'm always smiling, people might think I was sane if I didn't! It's late and I

will share my thoughts on the rest of your messge tomorrow....

> >

> > Briefly, my adrenal history includes a right adenoma dx'd in 2000 and a

left adenoma dx'd in 2009 and drug-resistant HTN for 25 years. My right renal

artery is 70% stenosed (US dx) and the right kidney is atrophic. I had some

basic lab work done 2 weeks ago. Aldosterone was 25 (high). Renin 9.3 (high

normal). Started Spiro 25mg daily after labs were drawn. I have been on the

Spiro for 2 weeks now. After one dose, the brain fog lifted, my lungs were much

more clear, the trace LE peripheral edema started to diminish and my blood

pressure began to decrease.

> >

> > The second week on Spiro, I felt generally horrible and my BPs were

improving but not good. At the end of the second week, BP normalizing and K+

maintained on 20mEq BID (had been taking 40 BID and supplementing when the low

K+ PVCs cycled in - usually 160mEq over 24 hrs). The sum: I am feeling much

better.

> >

> > I was referred to endo. Saw him today. Super doc with a great big brain.

He says there is so much going on with me, now and historically, he is not sure

if it is primary or secondary aldosteronism because of the renal artery stenosis

or the long-term NSAID therapy (800mg BID for the issues with my lumbar

vertebrae and left hip). Based on the numbers and diagnostics, he is leaning

toward secondary. He ordered labs to check for Pheo, Cushing's, etc., and I will

see him in one month. He also wants a repeat CT because the last one was 3 years

ago. I won't do that until Medicare kicks in July 1. He's okay with that.

> >

> > He said it was up to me if I wanted to purge the drugs, do a salt loading

and then retest. He also said he would refer me to a university setting for an

AVS if I wanted a definitive diagnosis. The way I view it... I am 65, retired,

and Spiro is working. Kind of a no brainer.

> >

> > Any thoughts?

> >

> > Barb

> >

>

February 2, 2012

ï»¿

Yo ,

I think you're spot on. There is a payoff to everything all of us do all day and all night long or we wouldn't do it. Name one thing, anything you've ever done that a payoff was NOT included. For years I the angriest person I've ever known. I was mad as hell for the cards I was dealt and I wanted some payback. But, no one ever saw this anger. I held it all inside because if I showed these emotions, the person that saw them had the upper hand. I kept my buttons well disguise. But, the body cannot stand up to that indefinitely. Hans Selye taught us that. The depression became my timeout to rebuild so I could hate again.

And within that framework, I had children, earned a BSN, most of a double master's degree (MSN/MBA), put 4 kids through college, worked two jobs, wrote a book, painted, sculpted, played piano and violin, taught myself to use a computer and tons of software, bought a Nikon and became an amateur photographer, cared for my patients, taught at a university, was a clinical educator and presented at several consortiums. Not the profile of someone with MDD or PTSD according to my psych classes.

So, yes, we all deal with it our own way. And, more times than not, I am the person sitting next to you who, outwardly, gives no indication that anything at all is wrong.

Barb

Re: Update

Barb, I totally agree with your assessment and decision as long as you keep a close eye on adverse side effects! I was well controlled on 25mg bid but developed gynecomastia early. No recommendation from anyone to change because it "was not painful". My PCP was estatic and not willing to change anything until I developed 6 bumps in my rt. breast and she had to convince me that I was going to Boston (400+ miles R/T) for a mammogram! I considered Eplerenone but it took 3 trys to get it approved by the VA. I did a lot of research and found enough unanswered questions and the fact that there was limited research and finlly decided now was the time to persue an AVS and know all my options! As a postmenopusal female many of my concerns will not apply. I do have an outstanding question with my Psyco Staff regarding how it might affect MDD treatment. (There is apprently an effect on gene CYP11B1 and CYP11B2, cortisol and androgen, because they are neighbors on the channel. You surely know more about it than I!) - 65 yo super ob., fastidious male - 12mm X 13mm rt. a.adnoma with previous rt. flank pain. Treating with DASH. Stats w/o meds = BP 175/90 HR 59 BS 125. D/C Spironolactone 12/20/2011 due to adverse SX.Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, Gynecomastia, MDD and PTSD.Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, AmlodipineBesylate 5mg, 81mg aspirin and Metformin 2000MG. Started washing Spironolactone 12/20/11 to prepare for AVS.>> Briefly, my adrenal history includes a right adenoma dx'd in 2000 and a left adenoma dx'd in 2009 and drug-resistant HTN for 25 years. My right renal artery is 70% stenosed (US dx) and the right kidney is atrophic. I had some basic lab work done 2 weeks ago. Aldosterone was 25 (high). Renin 9.3 (high normal). Started Spiro 25mg daily after labs were drawn. I have been on the Spiro for 2 weeks now. After one dose, the brain fog lifted, my lungs were much more clear, the trace LE peripheral edema started to diminish and my blood pressure began to decrease. > > The second week on Spiro, I felt generally horrible and my BPs were improving but not good. At the end of the second week, BP normalizing and K+ maintained on 20mEq BID (had been taking 40 BID and supplementing when the low K+ PVCs cycled in - usually 160mEq over 24 hrs). The sum: I am feeling much better.> > I was referred to endo. Saw him today. Super doc with a great big brain. He says there is so much going on with me, now and historically, he is not sure if it is primary or secondary aldosteronism because of the renal artery stenosis or the long-term NSAID therapy (800mg BID for the issues with my lumbar vertebrae and left hip). Based on the numbers and diagnostics, he is leaning toward secondary. He ordered labs to check for Pheo, Cushing's, etc., and I will see him in one month. He also wants a repeat CT because the last one was 3 years ago. I won't do that until Medicare kicks in July 1. He's okay with that.> > He said it was up to me if I wanted to purge the drugs, do a salt loading and then retest. He also said he would refer me to a university setting for an AVS if I wanted a definitive diagnosis. The way I view it... I am 65, retired, and Spiro is working. Kind of a no brainer. > > Any thoughts?> > Barb>

February 3, 2012

Wait a minute, stop the press. Yes, the VA does provide drug info, not only when

first Rxed but every time it is refilled! (I have a copy of each med I take on

a clipboard that my wife can reference if necessary, she doesn't use the

computer.) It also provides a link to Medline Plus where this information is

published. I have read it many times and just reviewed it again and pulled the

side effects that I reported to my doctor, most if not all of which I reported

here.

Let's review, here are the ones I reported:

Spironolactone may cause side effects. Tell your doctor if any of these symptoms

are severe or do not go away:

diarrhea

dry mouth

thirst

unsteadiness

headache

enlarged or painful breasts in men or women

difficulty maintaining or achieving an erection

tiredness

Notice nowhere does it define the word " androgen " or " testosterone " ! You have

to play detective to figure out what actually is going on. Nobody, including

you, recommended I switch until I developed bumps in my right breast, about 16

months after I started Spiro! Then everybody thought I should switch, well,

everyone except those that approve requests for nonformula meds (it took 3 trys

to convince them!)

- 65 yo super ob., fastidious male - 12mm X 13mm rt. a.adnoma with

previous rt. flank pain. Treating with DASH. Stats w/o meds = BP 175/90 HR 59

BS 125. D/C Spironolactone 12/20/2011 due to adverse SX.

Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, Gynecomastia, MDD

and PTSD.

Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, AmlodipineBesylate

5mg, 81mg aspirin and Metformin 2000MG. Started washing Spironolactone 12/20/11

to prepare for AVS.

> > > >

> > > > Briefly, my adrenal history includes a right adenoma dx'd in 2000 and a

left adenoma dx'd in 2009 and drug-resistant HTN for 25 years. My right renal

artery is 70% stenosed (US dx) and the right kidney is atrophic. I had some

basic lab work done 2 weeks ago. Aldosterone was 25 (high). Renin 9.3 (high

normal). Started Spiro 25mg daily after labs were drawn. I have been on the

Spiro for 2 weeks now. After one dose, the brain fog lifted, my lungs were much

more clear, the trace LE peripheral edema started to diminish and my blood

pressure began to decrease.

> > > >

> > > > The second week on Spiro, I felt generally horrible and my BPs were

improving but not good. At the end of the second week, BP normalizing and K+

maintained on 20mEq BID (had been taking 40 BID and supplementing when the low

K+ PVCs cycled in - usually 160mEq over 24 hrs). The sum: I am feeling much

better.

> > > >

> > > > I was referred to endo. Saw him today. Super doc with a great big brain.

He says there is so much going on with me, now and historically, he is not sure

if it is primary or secondary aldosteronism because of the renal artery stenosis

or the long-term NSAID therapy (800mg BID for the issues with my lumbar

vertebrae and left hip). Based on the numbers and diagnostics, he is leaning

toward secondary. He ordered labs to check for Pheo, Cushing's, etc., and I will

see him in one month. He also wants a repeat CT because the last one was 3 years

ago. I won't do that until Medicare kicks in July 1. He's okay with that.

> > > >

> > > > He said it was up to me if I wanted to purge the drugs, do a salt

loading and then retest. He also said he would refer me to a university setting

for an AVS if I wanted a definitive diagnosis. The way I view it... I am 65,

retired, and Spiro is working. Kind of a no brainer.

> > > >

> > > > Any thoughts?

> > > >

> > > > Barb

> > > >

> > >

> > > ------------------------------------

> > >

February 3, 2012

Right on, Dr. Grim. Of course I believe people should be aware of the side effects of their medications, most today are very aware and educated consumers. I do not think the side effects need to be repeated frequently or stressed. From: Clarence Grim <lowerbp2@...> "hyperaldosteronism " <hyperaldosteronism > Sent: Friday, February 3, 2012 12:13 AM Subject: Re: Re: Update

Your ER experience is biased because u do not know the denominator. Most phaemacies now give out a review of the drug prescribed. Pts should read it but suspect most don't. What I say is the med we are going to try has a number of side effects. Read the info and let me know if ANYTHING changes. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Feb 2, 2012, at 18:14, Phyllis <phylisrn@...> wrote:

a, I kind of agree and disagree. As a nurse, don't you think

more patients should be aware of their side effects. Like the pt who

comes to the Er with a pulse of 30 and still taking his beta

blockers or his digoxin? Or how about the ones that come in with

repeated glucose < 60 and continues to take his metformin or

glucophage?

What if a pt. was prescribed Imdur and he wasn't warned about the

bad headaches- which actually means it is working?

I have a better one- the ppl who weren't warned about Ace Inhibitors

and angioedema and they come into the ER thinking they ate something

bad. Or the pt coming in with GI bleeding and still taking their ASA

and NSAIDS and on and on.

I always, always, always warn/tell pt's about side effects/adverse

side effects. Some side effects can be fatal. I have never had

anyone say they won't take a med cause I told

them about the side effects. In fact, most thank me.

Phyllis

On 2/2/2012 8:17 PM, a Hall wrote:

,

The point of my other post was that maybe we

should tone down stressing the "adverse side effects"

of spiro because not everyone gets them. If I were a

new member of the group and read some of the posts on

spiro there is no way I would take it, although I am

one of the persons that have no problems with it. I

could not tolerate Inspra. Several years ago the endo

I was going to at the time insisted I try it although

I was having no problems with spiro. I had a raging

headache for one month that never went away so back on

spiro I went. Some people may have insurance

that won't pay for Inspra and can't afford to pay for

it themselves and have no choice of medications,

others may have problems with Inspra. Auto-suggestion

is very strong in some people. I'm from the time

fram when nurses could give placebos for pain if they

felt it was warranted. More than 50% of the people I

gave them to had miraculous pain relief from 2 ml of

normal saline IM and a "this is a very strong pain

medication, it should take away your pain and make you

sleepy in just a few minutes." Maybe it would be

better not to stress possible adverse effects of spiro

(every drug has them) and let each person find out

whether they will have side effects from it or not.

Just sayin'......

From:

<jclark24p@...>

To:

hyperaldosteronism

Sent:

Thursday, February 2, 2012 7:15 PM

Subject:

Re: Update

Barb, I totally agree with your assessment and

decision as long as you keep a close eye on adverse

side effects! I was well controlled on 25mg bid but

developed gynecomastia early. No recommendation from

anyone to change because it "was not painful". My PCP

was estatic and not willing to change anything until I

developed 6 bumps in my rt. breast and she had to

convince me that I was going to Boston (400+ miles

R/T) for a mammogram! I considered Eplerenone but it

took 3 trys to get it approved by the VA. I did a lot

of research and found enough unanswered questions and

the fact that there was limited research and finlly

decided now was the time to persue an AVS and know all

my options!

As a postmenopusal female many of my concerns will not

apply. I do have an outstanding question with my

Psyco Staff regarding how it might affect MDD

treatment. (There is apprently an effect on gene

CYP11B1 and CYP11B2, cortisol and androgen, because

they are neighbors on the channel. You surely know

more about it than I!)

- 65 yo super ob., fastidious male - 12mm X 13mm

rt. a.adnoma with previous rt. flank pain. Treating

with DASH. Stats w/o meds = BP 175/90 HR 59 BS 125.

D/C Spironolactone 12/20/2011 due to adverse SX.

Other Issues/Opportunities: OSA w Bi-Pap settings

13/19, DM2, Gynecomastia, MDD and PTSD.

Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200

MG, AmlodipineBesylate 5mg, 81mg aspirin and

Metformin 2000MG. Started washing Spironolactone

12/20/11 to prepare for AVS.

>

> Briefly, my adrenal history includes a right

adenoma dx'd in 2000 and a left adenoma dx'd in 2009

and drug-resistant HTN for 25 years. My right renal

artery is 70% stenosed (US dx) and the right kidney is

atrophic. I had some basic lab work done 2 weeks ago.

Aldosterone was 25 (high). Renin 9.3 (high normal).

Started Spiro 25mg daily after labs were drawn. I have

been on the Spiro for 2 weeks now. After one dose, the

brain fog lifted, my lungs were much more clear, the

trace LE peripheral edema started to diminish and my

blood pressure began to decrease.

>

> The second week on Spiro, I felt generally

horrible and my BPs were improving but not good. At

the end of the second week, BP normalizing and K+

maintained on 20mEq BID (had been taking 40 BID and

supplementing when the low K+ PVCs cycled in - usually

160mEq over 24 hrs). The sum: I am feeling much

better.

>

> I was referred to endo. Saw him today. Super doc

with a great big brain. He says there is so much going

on with me, now and historically, he is not sure if it

is primary or secondary aldosteronism because of the

renal artery stenosis or the long-term NSAID therapy

(800mg BID for the issues with my lumbar vertebrae and

left hip). Based on the numbers and diagnostics, he is

leaning toward secondary. He ordered labs to check for

Pheo, Cushing's, etc., and I will see him in one

month. He also wants a repeat CT because the last one

was 3 years ago. I won't do that until Medicare kicks

in July 1. He's okay with that.

>

> He said it was up to me if I wanted to purge the

drugs, do a salt loading and then retest. He also said

he would refer me to a university setting for an AVS

if I wanted a definitive diagnosis. The way I view

it... I am 65, retired, and Spiro is working. Kind of

a no brainer.

>

> Any thoughts?

>

> Barb

>

------------------------------------

February 3, 2012

Barb,Placebos aren't given any more and this isn't an appropriate place for a discussion of them, but I will say that I occasionally gave them 30 year ago and with certain frequent fliers they worked very well. From: amazingkeltic <rainbowdayz@...> To:

hyperaldosteronism Sent: Thursday, February 2, 2012 10:22 PM Subject: Re: Update a,Just a question. In what specific situation did you feel that it was acceptable to treat a patient's pain with salt water? I was ICU for 25 years. I worked when pain placebos were often listed on the MAR and I never once chose to give it. Back then we were giving Demerol IM in the leg. Those injections created great big knots that would hurt for weeks or even months later. The way I saw it... if I'm going to give you pain later, I'll take it away now. It was never my place to dissect the reason for a patient's pain. It was, however, my job to treat it. If a pain medication was ordered, they got it. Outside the area of research in which the patient knows that a percentage will receive a

placebo, they have no place in medicine. It is equal to emotional and psychological game playing.However, life is a circle and karma's a given.Barb> >> > Briefly, my adrenal history includes a right adenoma dx'd in 2000 and a left adenoma dx'd in 2009 and drug-resistant HTN for 25 years. My right renal artery is 70% stenosed (US dx) and the right kidney is atrophic. I had some basic lab work done 2 weeks ago. Aldosterone was 25 (high). Renin 9.3 (high normal). Started Spiro 25mg daily after labs were drawn. I have been on the Spiro for 2 weeks now. After one dose, the brain fog lifted, my lungs were much more clear, the trace LE peripheral edema started to diminish and my blood pressure began to decrease. > > > > The second week on Spiro, I felt generally horrible and my BPs were improving but not good. At the end of the second week,

BP normalizing and K+ maintained on 20mEq BID (had been taking 40 BID and supplementing when the low K+ PVCs cycled in - usually 160mEq over 24 hrs). The sum: I am feeling much better.> > > > I was referred to endo. Saw him today. Super doc with a great big brain. He says there is so much going on with me, now and historically, he is not sure if it is primary or secondary aldosteronism because of the renal artery stenosis or the long-term NSAID therapy (800mg BID for the issues with my lumbar vertebrae and left hip). Based on the numbers and diagnostics, he is leaning toward secondary. He ordered labs to check for Pheo, Cushing's, etc., and I will see him in one month. He also wants a repeat CT because the last one was 3 years ago. I won't do that until Medicare kicks in July 1. He's okay with that.> > > > He said it was up to me if I wanted to purge the drugs, do a salt loading and then retest. He also said he

would refer me to a university setting for an AVS if I wanted a definitive diagnosis. The way I view it... I am 65, retired, and Spiro is working. Kind of a no brainer. > > > > Any thoughts?> > > > Barb> >> > > > > ------------------------------------> >

February 3, 2012

If u read the complete drug insert you may find the word androgen but not sure. Drugs.com may have it?May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Feb 3, 2012, at 3:32, <jclark24p@...> wrote:

Wait a minute, stop the press. Yes, the VA does provide drug info, not only when first Rxed but every time it is refilled! (I have a copy of each med I take on a clipboard that my wife can reference if necessary, she doesn't use the computer.) It also provides a link to Medline Plus where this information is published. I have read it many times and just reviewed it again and pulled the side effects that I reported to my doctor, most if not all of which I reported here.

Let's review, here are the ones I reported:

Spironolactone may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

diarrhea

dry mouth

thirst

unsteadiness

headache

enlarged or painful breasts in men or women

difficulty maintaining or achieving an erection

tiredness

Notice nowhere does it define the word "androgen" or "testosterone"! You have to play detective to figure out what actually is going on. Nobody, including you, recommended I switch until I developed bumps in my right breast, about 16 months after I started Spiro! Then everybody thought I should switch, well, everyone except those that approve requests for nonformula meds (it took 3 trys to convince them!)

- 65 yo super ob., fastidious male - 12mm X 13mm rt. a.adnoma with previous rt. flank pain. Treating with DASH. Stats w/o meds = BP 175/90 HR 59 BS 125. D/C Spironolactone 12/20/2011 due to adverse SX.

Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, Gynecomastia, MDD and PTSD.

Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, AmlodipineBesylate 5mg, 81mg aspirin and Metformin 2000MG. Started washing Spironolactone 12/20/11 to prepare for AVS.

> > > >

> > > > Briefly, my adrenal history includes a right adenoma dx'd in 2000 and a left adenoma dx'd in 2009 and drug-resistant HTN for 25 years. My right renal artery is 70% stenosed (US dx) and the right kidney is atrophic. I had some basic lab work done 2 weeks ago. Aldosterone was 25 (high). Renin 9.3 (high normal). Started Spiro 25mg daily after labs were drawn. I have been on the Spiro for 2 weeks now. After one dose, the brain fog lifted, my lungs were much more clear, the trace LE peripheral edema started to diminish and my blood pressure began to decrease.

> > > >

> > > > The second week on Spiro, I felt generally horrible and my BPs were improving but not good. At the end of the second week, BP normalizing and K+ maintained on 20mEq BID (had been taking 40 BID and supplementing when the low K+ PVCs cycled in - usually 160mEq over 24 hrs). The sum: I am feeling much better.

> > > >

> > > > I was referred to endo. Saw him today. Super doc with a great big brain. He says there is so much going on with me, now and historically, he is not sure if it is primary or secondary aldosteronism because of the renal artery stenosis or the long-term NSAID therapy (800mg BID for the issues with my lumbar vertebrae and left hip). Based on the numbers and diagnostics, he is leaning toward secondary. He ordered labs to check for Pheo, Cushing's, etc., and I will see him in one month. He also wants a repeat CT because the last one was 3 years ago. I won't do that until Medicare kicks in July 1. He's okay with that.

> > > >

> > > > He said it was up to me if I wanted to purge the drugs, do a salt loading and then retest. He also said he would refer me to a university setting for an AVS if I wanted a definitive diagnosis. The way I view it... I am 65, retired, and Spiro is working. Kind of a no brainer.

> > > >

> > > > Any thoughts?

> > > >

> > > > Barb

> > > >

> > >

> > > ------------------------------------

> > >

February 3, 2012

Dr Kempner of rice diet fame used them all the time. A god lesson in side effects patients experience. There is good research that documents that the color of the placeo affects side effects reported. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Feb 3, 2012, at 6:57, a Hall <shahall@...> wrote:

Barb,Placebos aren't given any more and this isn't an appropriate place for a discussion of them, but I will say that I occasionally gave them 30 year ago and with certain frequent fliers they worked very well. From: amazingkeltic <rainbowdayz@...> To:

hyperaldosteronism Sent: Thursday, February 2, 2012 10:22 PM Subject: Re: Update a,Just a question. In what specific situation did you feel that it was acceptable to treat a patient's pain with salt water? I was ICU for 25 years. I worked when pain placebos were often listed on the MAR and I never once chose to give it. Back then we were giving Demerol IM in the leg. Those injections created great big knots that would hurt for weeks or even months later. The way I saw it... if I'm going to give you pain later, I'll take it away now. It was never my place to dissect the reason for a patient's pain. It was, however, my job to treat it. If a pain medication was ordered, they got it. Outside the area of research in which the patient knows that a percentage will receive a

placebo, they have no place in medicine. It is equal to emotional and psychological game playing.However, life is a circle and karma's a given.Barb> >> > Briefly, my adrenal history includes a right adenoma dx'd in 2000 and a left adenoma dx'd in 2009 and drug-resistant HTN for 25 years. My right renal artery is 70% stenosed (US dx) and the right kidney is atrophic. I had some basic lab work done 2 weeks ago. Aldosterone was 25 (high). Renin 9.3 (high normal). Started Spiro 25mg daily after labs were drawn. I have been on the Spiro for 2 weeks now. After one dose, the brain fog lifted, my lungs were much more clear, the trace LE peripheral edema started to diminish and my blood pressure began to decrease. > > > > The second week on Spiro, I felt generally horrible and my BPs were improving but not good. At the end of the second week,

BP normalizing and K+ maintained on 20mEq BID (had been taking 40 BID and supplementing when the low K+ PVCs cycled in - usually 160mEq over 24 hrs). The sum: I am feeling much better.> > > > I was referred to endo. Saw him today. Super doc with a great big brain. He says there is so much going on with me, now and historically, he is not sure if it is primary or secondary aldosteronism because of the renal artery stenosis or the long-term NSAID therapy (800mg BID for the issues with my lumbar vertebrae and left hip). Based on the numbers and diagnostics, he is leaning toward secondary. He ordered labs to check for Pheo, Cushing's, etc., and I will see him in one month. He also wants a repeat CT because the last one was 3 years ago. I won't do that until Medicare kicks in July 1. He's okay with that.> > > > He said it was up to me if I wanted to purge the drugs, do a salt loading and then retest. He also said he

would refer me to a university setting for an AVS if I wanted a definitive diagnosis. The way I view it... I am 65, retired, and Spiro is working. Kind of a no brainer. > > > > Any thoughts?> > > > Barb> >> > > > > ------------------------------------> >

February 3, 2012

You are missing my point, " androgen " is not a word generally known or used in

everyday conversation unless you are in the medical profession. Many more know

the word testosterone and would be able to relate the information to what was

going on with them.

When I was responsible for technical writers we had a goal to write at " the 5th

grade level " because that is the level that the average American can read at and

understand. (It may be higher now, this was back in the '80's.) Maybe that

should be the policy for the insert writers!

In fact what if we decided we wanted to stay with Spironolactone but wanted to

reduce side effects as much as possible. Maybe we could recommend something

like this:

" The incidence of gynecomastia with spironolactone therapy is dose related, with

one study reporting an incidence after 6 months of 6.9% at a dose of less than

50 mg/d and 52% at a dose of more than 150 mg/d (132). The exact incidence of

menstrual disturbances in premenopausal women with spironolactone therapy is

unknown. Where available, canrenone (an active metabolite of spironolactone) or

potassium canrenoate, its open E-ring water-soluble congener, might be

considered, in that they possibly have fewer sex steroid-related side effects.

In addition, a small dose of a thiazide diuretic, triamterine, or amiloride can

be added to attempt to avoid a higher dose of spironolactone, which may cause

side effects. " (With the DASH Eating Plan of course!) Might that be a better

option?

> > > > > >

> > > > > > Briefly, my adrenal history includes a right adenoma dx'd in 2000

and a left adenoma dx'd in 2009 and drug-resistant HTN for 25 years. My right

renal artery is 70% stenosed (US dx) and the right kidney is atrophic. I had

some basic lab work done 2 weeks ago. Aldosterone was 25 (high). Renin 9.3 (high

normal). Started Spiro 25mg daily after labs were drawn. I have been on the

Spiro for 2 weeks now. After one dose, the brain fog lifted, my lungs were much

more clear, the trace LE peripheral edema started to diminish and my blood

pressure began to decrease.

> > > > > >

> > > > > > The second week on Spiro, I felt generally horrible and my BPs were

improving but not good. At the end of the second week, BP normalizing and K+

maintained on 20mEq BID (had been taking 40 BID and supplementing when the low

K+ PVCs cycled in - usually 160mEq over 24 hrs). The sum: I am feeling much

better.

> > > > > >

> > > > > > I was referred to endo. Saw him today. Super doc with a great big

brain. He says there is so much going on with me, now and historically, he is

not sure if it is primary or secondary aldosteronism because of the renal artery

stenosis or the long-term NSAID therapy (800mg BID for the issues with my lumbar

vertebrae and left hip). Based on the numbers and diagnostics, he is leaning

toward secondary. He ordered labs to check for Pheo, Cushing's, etc., and I will

see him in one month. He also wants a repeat CT because the last one was 3 years

ago. I won't do that until Medicare kicks in July 1. He's okay with that.

> > > > > >

> > > > > > He said it was up to me if I wanted to purge the drugs, do a salt

loading and then retest. He also said he would refer me to a university setting

for an AVS if I wanted a definitive diagnosis. The way I view it... I am 65,

retired, and Spiro is working. Kind of a no brainer.

> > > > > >

> > > > > > Any thoughts?

> > > > > >

> > > > > > Barb

> > > > > >

> > > > >

> > > > > ------------------------------------

> > > > >

February 3, 2012

a,

I didn't bring it up for discussion. You did.

Barb

Re: Updatea,Just a question. In what specific situation did you feel that it was acceptable to treat a patient's pain with salt water? I was ICU for 25 years. I worked when pain placebos were often listed on the MAR and I never once chose to give it. Back then we were giving Demerol IM in the leg. Those injections created great big knots that would hurt for weeks or even months later. The way I saw it... if I'm going to give you pain later, I'll take it away now. It was never my place to dissect the reason for a patient's pain. It was, however, my job to treat it. If a pain medication was ordered, they got it. Outside the area of research in which the patient knows that a percentage will receive a placebo, they have no place in medicine. It is equal to emotional and psychological game playing.However, life is a circle and karma's a given.Barb> >> > Briefly, my adrenal history includes a right adenoma dx'd in 2000 and a left adenoma dx'd in 2009 and drug-resistant HTN for 25 years. My right renal artery is 70% stenosed (US dx) and the right kidney is atrophic. I had some basic lab work done 2 weeks ago. Aldosterone was 25 (high). Renin 9.3 (high normal). Started Spiro 25mg daily after labs were drawn. I have been on the Spiro for 2 weeks now. After one dose, the brain fog lifted, my lungs were much more clear, the trace LE peripheral edema started to diminish and my blood pressure began to decrease. > > > > The second week on Spiro, I felt generally horrible and my BPs were improving but not good. At the end of the second week, BP normalizing and K+ maintained on 20mEq BID (had been taking 40 BID and supplementing when the low K+ PVCs cycled in - usually 160mEq over 24 hrs). The sum: I am feeling much better.> > > > I was referred to endo. Saw him today. Super doc with a great big brain. He says there is so much going on with me, now and historically, he is not sure if it is primary or secondary aldosteronism because of the renal artery stenosis or the long-term NSAID therapy (800mg BID for the issues with my lumbar vertebrae and left hip). Based on the numbers and diagnostics, he is leaning toward secondary. He ordered labs to check for Pheo, Cushing's, etc., and I will see him in one month. He also wants a repeat CT because the last one was 3 years ago. I won't do that until Medicare kicks in July 1. He's okay with that.> > > > He said it was up to me if I wanted to purge the drugs, do a salt loading and then retest. He also said he would refer me to a university setting for an AVS if I wanted a definitive diagnosis. The way I view it... I am 65, retired, and Spiro is working. Kind of a no brainer. > > > > Any thoughts?> > > > Barb> >> > > > > ------------------------------------> >

February 3, 2012

I mentioned it in relation to something else. If you misinterpreted and thought I brought the subject up for discussion then my bad. From: Barb Tatro <rainbowdayz@...> hyperaldosteronism Sent: Friday,

February 3, 2012 12:59 PM Subject: Re: Re: Update

a,

I didn't bring it up for discussion. You did.

Barb

Re: Updatea,Just a question. In what specific situation did you feel that it was acceptable to treat a patient's pain with salt water? I was ICU for 25 years. I worked when pain placebos were often listed on the MAR and I never once chose to give it. Back then we were giving Demerol IM in the leg. Those injections created great big knots that would hurt for weeks or even months later. The way I saw it... if I'm going to give you pain later, I'll take it away now. It was never my place to dissect the reason for a patient's pain. It was, however, my job to treat it. If a pain medication was ordered, they got it. Outside the area of research in which the patient knows that a percentage will receive a placebo, they have no place in medicine. It is equal to emotional and psychological game playing.However, life is a circle and karma's a given.Barb> >> > Briefly, my adrenal history includes a right adenoma dx'd in 2000 and a left adenoma dx'd in 2009 and drug-resistant HTN for 25 years. My right renal artery is 70% stenosed (US dx) and the right kidney is atrophic. I had some basic lab work done 2 weeks ago. Aldosterone was 25 (high). Renin 9.3 (high normal). Started Spiro 25mg daily after labs were drawn. I have been on the Spiro for 2 weeks now. After one dose, the brain fog lifted, my lungs were much more clear, the trace LE peripheral edema started to diminish and my blood pressure began to decrease. > > > > The second week on Spiro, I felt generally horrible and my BPs were improving but not good. At the end of the second week, BP normalizing and K+ maintained on 20mEq BID (had been taking 40 BID and supplementing when the low K+ PVCs cycled in - usually 160mEq over 24 hrs). The sum: I am feeling much better.> > > > I was referred to endo. Saw him today. Super doc with a great big brain. He says there is so much going on with me, now and historically, he is not sure if it is primary or secondary aldosteronism because of the renal artery stenosis or the long-term NSAID therapy (800mg BID for the issues with my lumbar vertebrae and left hip). Based on the numbers and diagnostics, he is leaning toward secondary. He ordered labs to check for Pheo, Cushing's, etc., and I will see him in one month. He also wants a repeat CT because the last one was 3 years ago. I won't do that until Medicare kicks in July 1. He's okay with that.> > > > He said it was up to me if I wanted to purge the drugs, do a salt loading and then retest. He also said he would refer me to a university setting for an AVS if I wanted a definitive diagnosis. The way I view it... I am 65, retired, and Spiro is working. Kind of a no brainer. > > > > Any thoughts?> > > > Barb> >> > > > > ------------------------------------> >

February 3, 2012

Barb, I'm back. Short intro, I am still studying at " The School of Hard

Knocks " ! Formal education beyond H.S. includes a 5-week computer operator class

in the Air Force and one college course, Intro to Poly Sci, which was an online

course I took to see what was " current " when I was on the local H.S. School

Board. (Computer Science majors were on the " short list " in 1968 and funds were

limited with 5 brothers and sisters!)

I once took a week long course explaining different personalities and what makes

people think to prepare me for middle management. I learned there were 2 basic

types, thinkers (type and doers(type A) (at least that is what I remember)

As a programmer I was a thinker. A good example of a doer is salesman, they

need you to make a decision so they can get to their next victim! As an ICU/ER

Nurse I would expect you to be a doer because getting it done is often the

difference between life and death! BUT, " it " better be right so you would also

need to be a thinker and that would make you an AB. I would be BA after much

work since in management you often need to make an instant decision. ( " Let me

think about it " is a real comfortable phrase for me!) How often do you hear a

doctor say, " let me think about it and I'll get back to you tomorrow " ? If

unsure they'll say, " Take 2 aspirin and call me in the morning " to do something

and still give them time to think!

Is this what you mean? : lavatory, chamber pot, commode, urinal, latrine,

privy (informal) W.C., bathroom, restroom, washroom, john (US, informal),

lavatory, ladies, gents, powder room, water closet, public convenience! ;>)

1) The postmenopausal women would be ____________________?

By this statement I only mean I assume you are beyond childbearing age and your

hormonal issues are different than when you were younger. Many meds, including

spiro, make this distinction. (I make that distinction because my research is

generally focused on the male gender although most of the time it applies to

both!) I'll never understand a woman and after 44 years of marriage I know

better than to try!

I will save questions 2 and 3 for another post. (They are the same and I need

to look up couple studies to set the stage.)

So that leaves PTSD and MDD, I consider them two different items. You have been

Dxed w/PTSD, maybe just not professionally! Your description is classical and

understandable as I understand it from my doctors. They would be concerned with

the way it cycles, I just hope you have it conquered!

You told me you had MDD for probably 18 years and then was formally Dxed. I was

pushed to a DX by my sister-in-law, a nurse practitioner.

.....