Guest guest Posted April 28, 2008 Report Share Posted April 28, 2008 Hello Dr Grim About a week after you sent your email to Dr Stowasser, I had an unexpected phone call from my specialist(cardiologist). He referred to my posting here and the comment linking spiro to the possibility of breast cancer. He said he wanted to clarify with me that he was referring to the possibility of breast lumps, not cancer. I will be seeing him again in a couple of weeks.... Anyway, the point for me is, what determines the dosage of spiro? Currently on 25mg spiro, my BP is now in the range of 140-150/ 80-90. I am a 61 yo female caucasion. If it is that aldosterone excess has harmful effects in addition to hypertension, does an increased dosage of spiro help to minimise those effects? A further question - my GP has put me on the diuretic furosomide. Val has commented recently this is not appropriate for PA patients. Is this so? I really value this group and all the comments - but I get pretty confused with the medical terminology, so please forgive any naive questions. Regards Carol (in Australia) Clarence Grim wrote: > > Be sure you are DASHing to the max to minimize the need for any drugs > to control your PA. > > See my next note on Breast CA lit search. > > The Brisbane group is one of the world class experts in PA and I > suggest you contact > > Recommend you contact Dr. Stowasser and get his groups opinion. Let us > know what they think. I am also forwarding this to him. > On Mar 26, 2008, at 3:03 AM, carolch58 wrote: > > > Hello everyone, > > I joined this group a few years ago - 'silent partner' you might say > > as I think I have only posted once. > > > > In 2004 I was diagnosed with primary aldosteronism at Greenslopes > > Hospital in Brisbane, Australia. I then had adrenal vein sampling, but > > the result was 'inconclusive'. So I have been treated medically since > > with verapamil, amiloride and spironalactone. Initially the dosage of > > spiro was 12.5 mg. Since last year it is 25mg, plus irbesartan and > > minus amiloride. I continue to see a cardiologist at Greenslopes. He > > said he was reluctant to prescribe a higher dosage of spiro because of > > breast cancer risk. (My mother has survived breast cancer.) > > > > While my BP is more acceptable, I still suffer many symptoms referred > > to by others in this group - constant fatigue, weak muscles, back > > pain, brain fogginess, reduced ability to organise/concentrate, sleep > > disturbance, breathlessness on exertion. > > > > I have sleep apnoea and use a CPAP machine. Blood tests indicate > > potassium levels at normal range. An echocardiogram has shown 'stiff > > heart'. > > > > Recently my general practice doctor diagnosed me as having chronic > > fatigue syndrome. And,of course, there is the usual diagnosis of > > depression for which I reluctantly take Lexapro. > > > > I find it tough to keep going, but am determined to do so. Thanks to > > all who share their stories and advice. > > Regards > > Carol > > > > > May your pressure be low! > > CE Grim BS, MS, MD > High Blood Pressure Consulting > Specializing in Difficult to Manage High Blood Pressure > Consult the following at for details > bloodpressureline > hyperaldosteronism > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2008 Report Share Posted April 28, 2008 Carol, it was not I who addressed furosemide. I don't know anything about it. If you are afraid of spiro, why not take Inspra? I'm on 200 mg of spiro now and my anxiety and sleep disturbances are still there. BP is down nicely. I'm sure Dr. Grim will check in. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Carol Christie Hello Dr Grim About a week after you sent your email to Dr Stowasser, I had an unexpected phone call from my specialist(cardiologist). He referred to my posting here and the comment linking spiro to the possibility of breast cancer. He said he wanted to clarify with me that he was referring to the possibility of breast lumps, not cancer. I will be seeing him again in a couple of weeks.... Anyway, the point for me is, what determines the dosage of spiro? Currently on 25mg spiro, my BP is now in the range of 140-150/ 80-90. I am a 61 yo female caucasion. If it is that aldosterone excess has harmful effects in addition to hypertension, does an increased dosage of spiro help to minimise those effects? A further question - my GP has put me on the diuretic furosomide. Val has commented recently this is not appropriate for PA patients. Is this so? I really value this group and all the comments - but I get pretty confused with the medical terminology, so please forgive any naive questions. Regards Carol (in Australia) Clarence Grim wrote: > > Be sure you are DASHing to the max to minimize the need for any drugs > to control your PA. > > See my next note on Breast CA lit search. > > The Brisbane group is one of the world class experts in PA and I > suggest you contact > > Recommend you contact Dr. Stowasser and get his groups opinion. Let us > know what they think. I am also forwarding this to him. > On Mar 26, 2008, at 3:03 AM, carolch58 wrote: > > > Hello everyone, > > I joined this group a few years ago - 'silent partner' you might say > > as I think I have only posted once. > > > > In 2004 I was diagnosed with primary aldosteronism at Greenslopes > > Hospital in Brisbane, Australia. I then had adrenal vein sampling, but > > the result was 'inconclusive'. So I have been treated medically since > > with verapamil, amiloride and spironalactone. Initially the dosage of > > spiro was 12.5 mg. Since last year it is 25mg, plus irbesartan and > > minus amiloride. I continue to see a cardiologist at Greenslopes. He > > said he was reluctant to prescribe a higher dosage of spiro because of > > breast cancer risk. (My mother has survived breast cancer.) > > > > While my BP is more acceptable, I still suffer many symptoms referred > > to by others in this group - constant fatigue, weak muscles, back > > pain, brain fogginess, reduced ability to organise/concentrate, sleep > > disturbance, breathlessness on exertion. > > > > I have sleep apnoea and use a CPAP machine. Blood tests indicate > > potassium levels at normal range. An echocardiogram has shown 'stiff > > heart'. > > > > Recently my general practice doctor diagnosed me as having chronic > > fatigue syndrome. And,of course, there is the usual diagnosis of > > depression for which I reluctantly take Lexapro. > > > > I find it tough to keep going, but am determined to do so. Thanks to > > all who share their stories and advice. > > Regards > > Carol > > > > > May your pressure be low! > > CE Grim BS, MS, MD > High Blood Pressure Consulting > Specializing in Difficult to Manage High Blood Pressure > Consult the following at for details > bloodpressureline > hyperaldosteronism > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2008 Report Share Posted April 28, 2008 Hello Val, I was referring to your comment to Helen: > I'd say your specialist hung himself on two hooks - once for being > intimidated by an informed patient, and second, trying to give a > diuretic to a PA. I'm prescribed Frusemide (sorry, incorrect spelling before) - a diuretic, 40mg twice a day. It's not that I'm afraid of spiro - my prescribing cardiologist advised against my having more than 25mg a day (linking it to potential breast issues). Inspra isn't available here for hypertension or PA. Carol (PS - thanks for sharing your research, and your personal struggle with us.) Valarie wrote: > > Carol, it was not I who addressed furosemide. I don't know anything > about it. > > If you are afraid of spiro, why not take Inspra? I'm on 200 mg of > spiro now and my anxiety and sleep disturbances are still there. > BP is down nicely. > > I'm sure Dr. Grim will check in. > > Val > > From: hyperaldosteronism > <mailto:hyperaldosteronism%40> > [mailto:hyperaldosteronism > <mailto:hyperaldosteronism%40>] On Behalf Of Carol Christie > > Hello Dr Grim > About a week after you sent your email to Dr Stowasser, I had an > unexpected phone call from my specialist(cardiologist). He referred to > my posting here and the comment linking spiro to the possibility of > breast cancer. He said he wanted to clarify with me that he was > referring to the possibility of breast lumps, not cancer. I will be > seeing him again in a couple of weeks.... > Anyway, the point for me is, what determines the dosage of spiro? > Currently on 25mg spiro, my BP is now in the range of 140-150/ 80-90. I > am a 61 yo female caucasion. > If it is that aldosterone excess has harmful effects in addition to > hypertension, does an increased dosage of spiro help to minimise those > effects? > A further question - my GP has put me on the diuretic furosomide. Val > has commented recently this is not appropriate for PA patients. Is > this so? > I really value this group and all the comments - but I get pretty > confused with the medical terminology, so please forgive any naive > questions. > Regards > Carol (in Australia) > > Clarence Grim wrote: > > > > Be sure you are DASHing to the max to minimize the need for any drugs > > to control your PA. > > > > See my next note on Breast CA lit search. > > > > The Brisbane group is one of the world class experts in PA and I > > suggest you contact > > > > Recommend you contact Dr. Stowasser and get his groups opinion. Let us > > know what they think. I am also forwarding this to him. > > On Mar 26, 2008, at 3:03 AM, carolch58 wrote: > > > > > Hello everyone, > > > I joined this group a few years ago - 'silent partner' you might say > > > as I think I have only posted once. > > > > > > In 2004 I was diagnosed with primary aldosteronism at Greenslopes > > > Hospital in Brisbane, Australia. I then had adrenal vein sampling, but > > > the result was 'inconclusive'. So I have been treated medically since > > > with verapamil, amiloride and spironalactone. Initially the dosage of > > > spiro was 12.5 mg. Since last year it is 25mg, plus irbesartan and > > > minus amiloride. I continue to see a cardiologist at Greenslopes. He > > > said he was reluctant to prescribe a higher dosage of spiro because of > > > breast cancer risk. (My mother has survived breast cancer.) > > > > > > While my BP is more acceptable, I still suffer many symptoms referred > > > to by others in this group - constant fatigue, weak muscles, back > > > pain, brain fogginess, reduced ability to organise/concentrate, sleep > > > disturbance, breathlessness on exertion. > > > > > > I have sleep apnoea and use a CPAP machine. Blood tests indicate > > > potassium levels at normal range. An echocardiogram has shown 'stiff > > > heart'. > > > > > > Recently my general practice doctor diagnosed me as having chronic > > > fatigue syndrome. And,of course, there is the usual diagnosis of > > > depression for which I reluctantly take Lexapro. > > > > > > I find it tough to keep going, but am determined to do so. Thanks to > > > all who share their stories and advice. > > > Regards > > > Carol > > > > > > > > May your pressure be low! > > > > CE Grim BS, MS, MD > > High Blood Pressure Consulting > > Specializing in Difficult to Manage High Blood Pressure > > Consult the following at for details > > bloodpressureline > > hyperaldosteronism > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2008 Report Share Posted April 28, 2008 Oh, now I see what you were referring to. The general theme here is that diuretics are not good for PA because you lose potassium and they don't improve BP. <http://www.bupa.co.uk/health_information/html/medicine/loop_diuretics.html> http://www.bupa.co.uk/health_information/html/medicine/loop_diuretics.html " One of the most common side effects with a loop diuretic is potassium deficiency, which can lead to abnormal heart rhythms, weakness and confusion " The problem is that, even if you can keep your potassium up someway, diuretics do not block the action of aldosterone and thus, do not block the cardiac injury. Your blood pressure is still too high. A simple answer to your question is that an adequate dose of spiro is that which will bring your blood pressure to normal. BTW, CFS is often misdiagnosed hypothyroidism. Val Walked in the wrong direction last night, fell on the ceramic tub steps and hurt my ribs pretty badly. The hurt cannot remotely compare to the hurt of PA, however. From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Carol Christie Hello Val, I was referring to your comment to Helen: > I'd say your specialist hung himself on two hooks - once for being > intimidated by an informed patient, and second, trying to give a > diuretic to a PA. I'm prescribed Frusemide (sorry, incorrect spelling before) - a diuretic, 40mg twice a day. It's not that I'm afraid of spiro - my prescribing cardiologist advised against my having more than 25mg a day (linking it to potential breast issues). Inspra isn't available here for hypertension or PA. Carol (PS - thanks for sharing your research, and your personal struggle with us.) Valarie wrote: > > Carol, it was not I who addressed furosemide. I don't know anything > about it. > > If you are afraid of spiro, why not take Inspra? I'm on 200 mg of > spiro now and my anxiety and sleep disturbances are still there. > BP is down nicely. > > I'm sure Dr. Grim will check in. > > Val > > From: hyperaldosteronism <mailto:hyperaldosteronism%40> > <mailto:hyperaldosteronism%40> > [mailto:hyperaldosteronism <mailto:hyperaldosteronism%40> > <mailto:hyperaldosteronism%40>] On Behalf Of Carol Christie > > Hello Dr Grim > About a week after you sent your email to Dr Stowasser, I had an > unexpected phone call from my specialist(cardiologist). He referred to > my posting here and the comment linking spiro to the possibility of > breast cancer. He said he wanted to clarify with me that he was > referring to the possibility of breast lumps, not cancer. I will be > seeing him again in a couple of weeks.... > Anyway, the point for me is, what determines the dosage of spiro? > Currently on 25mg spiro, my BP is now in the range of 140-150/ 80-90. I > am a 61 yo female caucasion. > If it is that aldosterone excess has harmful effects in addition to > hypertension, does an increased dosage of spiro help to minimise those > effects? > A further question - my GP has put me on the diuretic furosomide. Val > has commented recently this is not appropriate for PA patients. Is > this so? > I really value this group and all the comments - but I get pretty > confused with the medical terminology, so please forgive any naive > questions. > Regards > Carol (in Australia) > > Clarence Grim wrote: > > > > Be sure you are DASHing to the max to minimize the need for any drugs > > to control your PA. > > > > See my next note on Breast CA lit search. > > > > The Brisbane group is one of the world class experts in PA and I > > suggest you contact > > > > Recommend you contact Dr. Stowasser and get his groups opinion. Let us > > know what they think. I am also forwarding this to him. > > On Mar 26, 2008, at 3:03 AM, carolch58 wrote: > > > > > Hello everyone, > > > I joined this group a few years ago - 'silent partner' you might say > > > as I think I have only posted once. > > > > > > In 2004 I was diagnosed with primary aldosteronism at Greenslopes > > > Hospital in Brisbane, Australia. I then had adrenal vein sampling, but > > > the result was 'inconclusive'. So I have been treated medically since > > > with verapamil, amiloride and spironalactone. Initially the dosage of > > > spiro was 12.5 mg. Since last year it is 25mg, plus irbesartan and > > > minus amiloride. I continue to see a cardiologist at Greenslopes. He > > > said he was reluctant to prescribe a higher dosage of spiro because of > > > breast cancer risk. (My mother has survived breast cancer.) > > > > > > While my BP is more acceptable, I still suffer many symptoms referred > > > to by others in this group - constant fatigue, weak muscles, back > > > pain, brain fogginess, reduced ability to organise/concentrate, sleep > > > disturbance, breathlessness on exertion. > > > > > > I have sleep apnoea and use a CPAP machine. Blood tests indicate > > > potassium levels at normal range. An echocardiogram has shown 'stiff > > > heart'. > > > > > > Recently my general practice doctor diagnosed me as having chronic > > > fatigue syndrome. And,of course, there is the usual diagnosis of > > > depression for which I reluctantly take Lexapro. > > > > > > I find it tough to keep going, but am determined to do so. Thanks to > > > all who share their stories and advice. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2008 Report Share Posted April 28, 2008 Val, the GP prescribed the diuretic because of oedema in my ankles./ lower legs. I did follow up your suggestion in a previous post re hypothyroidism. The doctor had included those tests in a battery of diagnostic tests she ran. Nothing indicated there. Hope your ribs are OK. Carol Valarie wrote: > > Oh, now I see what you were referring to. The general theme here is > that diuretics are not good for PA because you lose potassium > and they don't improve BP. > > <http://www.bupa.co.uk/health_information/html/medicine/loop_diuretics.html > <http://www.bupa.co.uk/health_information/html/medicine/loop_diuretics.html>> > http://www.bupa.co.uk/health_information/html/medicine/loop_diuretics.html > <http://www.bupa.co.uk/health_information/html/medicine/loop_diuretics.html> > > " One of the most common side effects with a loop diuretic is potassium > deficiency, which can lead to abnormal heart rhythms, > weakness and confusion " > > The problem is that, even if you can keep your potassium up someway, > diuretics do not block the action of aldosterone and thus, do > not block the cardiac injury. Your blood pressure is still too high. A > simple answer to your question is that an adequate dose of > spiro is that which will bring your blood pressure to normal. > > BTW, CFS is often misdiagnosed hypothyroidism. > > Val > Walked in the wrong direction last night, fell on the ceramic tub > steps and hurt my ribs pretty badly. The hurt cannot remotely > compare to the hurt of PA, however. > > From: hyperaldosteronism > <mailto:hyperaldosteronism%40> > [mailto:hyperaldosteronism > <mailto:hyperaldosteronism%40>] On Behalf Of Carol Christie > > Hello Val, I was referring to your comment to Helen: > > I'd say your specialist hung himself on two hooks - once for being > > intimidated by an informed patient, and second, trying to give a > > diuretic to a PA. > I'm prescribed Frusemide (sorry, incorrect spelling before) - a > diuretic, 40mg twice a day. > > It's not that I'm afraid of spiro - my prescribing cardiologist advised > against my having more than 25mg a day (linking it to potential breast > issues). > Inspra isn't available here for hypertension or PA. > Carol > (PS - thanks for sharing your research, and your personal struggle > with us.) > > Valarie wrote: > > > > Carol, it was not I who addressed furosemide. I don't know anything > > about it. > > > > If you are afraid of spiro, why not take Inspra? I'm on 200 mg of > > spiro now and my anxiety and sleep disturbances are still there. > > BP is down nicely. > > > > I'm sure Dr. Grim will check in. > > > > Val > > > > From: hyperaldosteronism > <mailto:hyperaldosteronism%40> > <mailto:hyperaldosteronism%40> > > <mailto:hyperaldosteronism%40> > > [mailto:hyperaldosteronism > <mailto:hyperaldosteronism%40> > <mailto:hyperaldosteronism%40> > > <mailto:hyperaldosteronism%40>] On Behalf Of Carol > Christie > > > > Hello Dr Grim > > About a week after you sent your email to Dr Stowasser, I had an > > unexpected phone call from my specialist(cardiologist). He referred to > > my posting here and the comment linking spiro to the possibility of > > breast cancer. He said he wanted to clarify with me that he was > > referring to the possibility of breast lumps, not cancer. I will be > > seeing him again in a couple of weeks.... > > Anyway, the point for me is, what determines the dosage of spiro? > > Currently on 25mg spiro, my BP is now in the range of 140-150/ 80-90. I > > am a 61 yo female caucasion. > > If it is that aldosterone excess has harmful effects in addition to > > hypertension, does an increased dosage of spiro help to minimise those > > effects? > > A further question - my GP has put me on the diuretic furosomide. Val > > has commented recently this is not appropriate for PA patients. Is > > this so? > > I really value this group and all the comments - but I get pretty > > confused with the medical terminology, so please forgive any naive > > questions. > > Regards > > Carol (in Australia) > > > > Clarence Grim wrote: > > > > > > Be sure you are DASHing to the max to minimize the need for any drugs > > > to control your PA. > > > > > > See my next note on Breast CA lit search. > > > > > > The Brisbane group is one of the world class experts in PA and I > > > suggest you contact > > > > > > Recommend you contact Dr. Stowasser and get his groups opinion. Let us > > > know what they think. I am also forwarding this to him. > > > On Mar 26, 2008, at 3:03 AM, carolch58 wrote: > > > > > > > Hello everyone, > > > > I joined this group a few years ago - 'silent partner' you might say > > > > as I think I have only posted once. > > > > > > > > In 2004 I was diagnosed with primary aldosteronism at Greenslopes > > > > Hospital in Brisbane, Australia. I then had adrenal vein > sampling, but > > > > the result was 'inconclusive'. So I have been treated medically > since > > > > with verapamil, amiloride and spironalactone. Initially the > dosage of > > > > spiro was 12.5 mg. Since last year it is 25mg, plus irbesartan and > > > > minus amiloride. I continue to see a cardiologist at Greenslopes. He > > > > said he was reluctant to prescribe a higher dosage of spiro > because of > > > > breast cancer risk. (My mother has survived breast cancer.) > > > > > > > > While my BP is more acceptable, I still suffer many symptoms > referred > > > > to by others in this group - constant fatigue, weak muscles, back > > > > pain, brain fogginess, reduced ability to organise/concentrate, > sleep > > > > disturbance, breathlessness on exertion. > > > > > > > > I have sleep apnoea and use a CPAP machine. Blood tests indicate > > > > potassium levels at normal range. An echocardiogram has shown 'stiff > > > > heart'. > > > > > > > > Recently my general practice doctor diagnosed me as having chronic > > > > fatigue syndrome. And,of course, there is the usual diagnosis of > > > > depression for which I reluctantly take Lexapro. > > > > > > > > I find it tough to keep going, but am determined to do so. Thanks to > > > > all who share their stories and advice. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2008 Report Share Posted April 28, 2008 I know its not supposed to happen, but my edema is about 75% less in my ankles since being on spiro. I've been on it just over a month and am up to 200 mg/d. I'm almost thinking the spiro is making my anxiety worse. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Carol Christie Val, the GP prescribed the diuretic because of oedema in my ankles./ lower legs. I did follow up your suggestion in a previous post re hypothyroidism. The doctor had included those tests in a battery of diagnostic tests she ran. Nothing indicated there. Hope your ribs are OK. Carol Valarie wrote: > > Oh, now I see what you were referring to. The general theme here is > that diuretics are not good for PA because you lose potassium > and they don't improve BP. > > <http://www.bupa.co.uk/health_information/html/medicine/loop_diuretics.html > <http://www.bupa.co.uk/health_information/html/medicine/loop_diuretics.html>> > http://www.bupa.co.uk/health_information/html/medicine/loop_diuretics.html > <http://www.bupa.co.uk/health_information/html/medicine/loop_diuretics.html> > > " One of the most common side effects with a loop diuretic is potassium > deficiency, which can lead to abnormal heart rhythms, > weakness and confusion " > > The problem is that, even if you can keep your potassium up someway, > diuretics do not block the action of aldosterone and thus, do > not block the cardiac injury. Your blood pressure is still too high. A > simple answer to your question is that an adequate dose of > spiro is that which will bring your blood pressure to normal. > > BTW, CFS is often misdiagnosed hypothyroidism. > > Val > Walked in the wrong direction last night, fell on the ceramic tub > steps and hurt my ribs pretty badly. The hurt cannot remotely > compare to the hurt of PA, however. > > From: hyperaldosteronism <mailto:hyperaldosteronism%40> > <mailto:hyperaldosteronism%40> > [mailto:hyperaldosteronism <mailto:hyperaldosteronism%40> > <mailto:hyperaldosteronism%40>] On Behalf Of Carol Christie > > Hello Val, I was referring to your comment to Helen: > > I'd say your specialist hung himself on two hooks - once for being > > intimidated by an informed patient, and second, trying to give a > > diuretic to a PA. > I'm prescribed Frusemide (sorry, incorrect spelling before) - a > diuretic, 40mg twice a day. > > It's not that I'm afraid of spiro - my prescribing cardiologist advised > against my having more than 25mg a day (linking it to potential breast > issues). > Inspra isn't available here for hypertension or PA. > Carol > (PS - thanks for sharing your research, and your personal struggle > with us.) > > Valarie wrote: > > > > Carol, it was not I who addressed furosemide. I don't know anything > > about it. > > > > If you are afraid of spiro, why not take Inspra? I'm on 200 mg of > > spiro now and my anxiety and sleep disturbances are still there. > > BP is down nicely. > > > > I'm sure Dr. Grim will check in. > > > > Val > > > > From: hyperaldosteronism <mailto:hyperaldosteronism%40> > <mailto:hyperaldosteronism%40> > <mailto:hyperaldosteronism%40> > > <mailto:hyperaldosteronism%40> > > [mailto:hyperaldosteronism <mailto:hyperaldosteronism%40> > <mailto:hyperaldosteronism%40> > <mailto:hyperaldosteronism%40> > > <mailto:hyperaldosteronism%40>] On Behalf Of Carol > Christie > > > > Hello Dr Grim > > About a week after you sent your email to Dr Stowasser, I had an > > unexpected phone call from my specialist(cardiologist). He referred to > > my posting here and the comment linking spiro to the possibility of > > breast cancer. He said he wanted to clarify with me that he was > > referring to the possibility of breast lumps, not cancer. I will be > > seeing him again in a couple of weeks.... > > Anyway, the point for me is, what determines the dosage of spiro? > > Currently on 25mg spiro, my BP is now in the range of 140-150/ 80-90. I > > am a 61 yo female caucasion. > > If it is that aldosterone excess has harmful effects in addition to > > hypertension, does an increased dosage of spiro help to minimise those > > effects? > > A further question - my GP has put me on the diuretic furosomide. Val > > has commented recently this is not appropriate for PA patients. Is > > this so? > > I really value this group and all the comments - but I get pretty > > confused with the medical terminology, so please forgive any naive > > questions. > > Regards > > Carol (in Australia) > > > > Clarence Grim wrote: > > > > > > Be sure you are DASHing to the max to minimize the need for any drugs > > > to control your PA. > > > > > > See my next note on Breast CA lit search. > > > > > > The Brisbane group is one of the world class experts in PA and I > > > suggest you contact > > > > > > Recommend you contact Dr. Stowasser and get his groups opinion. Let us > > > know what they think. I am also forwarding this to him. > > > On Mar 26, 2008, at 3:03 AM, carolch58 wrote: > > > > > > > Hello everyone, > > > > I joined this group a few years ago - 'silent partner' you might say > > > > as I think I have only posted once. > > > > > > > > In 2004 I was diagnosed with primary aldosteronism at Greenslopes > > > > Hospital in Brisbane, Australia. I then had adrenal vein > sampling, but > > > > the result was 'inconclusive'. So I have been treated medically > since > > > > with verapamil, amiloride and spironalactone. Initially the > dosage of > > > > spiro was 12.5 mg. Since last year it is 25mg, plus irbesartan and > > > > minus amiloride. I continue to see a cardiologist at Greenslopes. He > > > > said he was reluctant to prescribe a higher dosage of spiro > because of > > > > breast cancer risk. (My mother has survived breast cancer.) > > > > > > > > While my BP is more acceptable, I still suffer many symptoms > referred > > > > to by others in this group - constant fatigue, weak muscles, back > > > > pain, brain fogginess, reduced ability to organise/concentrate, > sleep > > > > disturbance, breathlessness on exertion. > > > > > > > > I have sleep apnoea and use a CPAP machine. Blood tests indicate > > > > potassium levels at normal range. An echocardiogram has shown 'stiff > > > > heart'. > > > > > > > > Recently my general practice doctor diagnosed me as having chronic > > > > fatigue syndrome. And,of course, there is the usual diagnosis of > > > > depression for which I reluctantly take Lexapro. > > > > > > > > I find it tough to keep going, but am determined to do so. Thanks to > > > > all who share their stories and advice. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2008 Report Share Posted April 28, 2008 Val, so while spiro can bring BP to normal, does it have any effect on the " constellation of cardiovascular, renal and metabolic sequelae which make it far from benign and that these are not merely effects of blood pressure elevation " (from quote below)? > A simple answer to your question is that an adequate dose of > spiro is that which will bring your blood pressure to normal. > Trends Endocrinol Metab. 2008 Apr;19(3):88- > > 90. Epub 2008 Mar 7. > Primary aldosteronism: cardiovascular, renal and metabolic implications. > Rossi GP, et. al > DMCS - Clinica Medica 4 and University of Padua, 35126, Padua, Italy. > For many years primary aldosteronism was considered a relatively > benign form of hypertension. This assumption reflects the primacy > accorded to elevated levels of angiotensin in terms of deleterious > cardiovascular effects, and the fact that in primary > aldosteronism renin and angiotensin levels are low. We now know that > primary aldosteronism causes a constellation of cardiovascular, > renal and metabolic sequelae which make it far from benign and that > these are not merely effects of blood pressure elevation. In > primary aldosteronism, tissue damage, on several indices, is higher > than in age-, sex- and blood pressure-matched controls, > reflecting the ability of inappropriately elevated aldosterone for > salt status to produce structural and functional changes over and > above those produced by high blood pressure. > PMID: 18314347 [PubMed - in process] > Regards Carol Valarie wrote: > > Oh, now I see what you were referring to. The general theme here is > that diuretics are not good for PA because you lose potassium > and they don't improve BP. > > <http://www.bupa.co.uk/health_information/html/medicine/loop_diuretics.html > <http://www.bupa.co.uk/health_information/html/medicine/loop_diuretics.html>> > http://www.bupa.co.uk/health_information/html/medicine/loop_diuretics.html > <http://www.bupa.co.uk/health_information/html/medicine/loop_diuretics.html> > > " One of the most common side effects with a loop diuretic is potassium > deficiency, which can lead to abnormal heart rhythms, > weakness and confusion " > > The problem is that, even if you can keep your potassium up someway, > diuretics do not block the action of aldosterone and thus, do > not block the cardiac injury. Your blood pressure is still too high. A > simple answer to your question is that an adequate dose of > spiro is that which will bring your blood pressure to normal. > > BTW, CFS is often misdiagnosed hypothyroidism. > > Val > Walked in the wrong direction last night, fell on the ceramic tub > steps and hurt my ribs pretty badly. The hurt cannot remotely > compare to the hurt of PA, however. > > From: hyperaldosteronism > <mailto:hyperaldosteronism%40> > [mailto:hyperaldosteronism > <mailto:hyperaldosteronism%40>] On Behalf Of Carol Christie > > Hello Val, I was referring to your comment to Helen: > > I'd say your specialist hung himself on two hooks - once for being > > intimidated by an informed patient, and second, trying to give a > > diuretic to a PA. > I'm prescribed Frusemide (sorry, incorrect spelling before) - a > diuretic, 40mg twice a day. > > It's not that I'm afraid of spiro - my prescribing cardiologist advised > against my having more than 25mg a day (linking it to potential breast > issues). > Inspra isn't available here for hypertension or PA. > Carol > (PS - thanks for sharing your research, and your personal struggle > with us.) > > Valarie wrote: > > > > Carol, it was not I who addressed furosemide. I don't know anything > > about it. > > > > If you are afraid of spiro, why not take Inspra? I'm on 200 mg of > > spiro now and my anxiety and sleep disturbances are still there. > > BP is down nicely. > > > > I'm sure Dr. Grim will check in. > > > > Val > > > > From: hyperaldosteronism > <mailto:hyperaldosteronism%40> > <mailto:hyperaldosteronism%40> > > <mailto:hyperaldosteronism%40> > > [mailto:hyperaldosteronism > <mailto:hyperaldosteronism%40> > <mailto:hyperaldosteronism%40> > > <mailto:hyperaldosteronism%40>] On Behalf Of Carol > Christie > > > > Hello Dr Grim > > About a week after you sent your email to Dr Stowasser, I had an > > unexpected phone call from my specialist(cardiologist). He referred to > > my posting here and the comment linking spiro to the possibility of > > breast cancer. He said he wanted to clarify with me that he was > > referring to the possibility of breast lumps, not cancer. I will be > > seeing him again in a couple of weeks.... > > Anyway, the point for me is, what determines the dosage of spiro? > > Currently on 25mg spiro, my BP is now in the range of 140-150/ 80-90. I > > am a 61 yo female caucasion. > > If it is that aldosterone excess has harmful effects in addition to > > hypertension, does an increased dosage of spiro help to minimise those > > effects? > > A further question - my GP has put me on the diuretic furosomide. Val > > has commented recently this is not appropriate for PA patients. Is > > this so? > > I really value this group and all the comments - but I get pretty > > confused with the medical terminology, so please forgive any naive > > questions. > > Regards > > Carol (in Australia) > > > > Clarence Grim wrote: > > > > > > Be sure you are DASHing to the max to minimize the need for any drugs > > > to control your PA. > > > > > > See my next note on Breast CA lit search. > > > > > > The Brisbane group is one of the world class experts in PA and I > > > suggest you contact > > > > > > Recommend you contact Dr. Stowasser and get his groups opinion. Let us > > > know what they think. I am also forwarding this to him. > > > On Mar 26, 2008, at 3:03 AM, carolch58 wrote: > > > > > > > Hello everyone, > > > > I joined this group a few years ago - 'silent partner' you might say > > > > as I think I have only posted once. > > > > > > > > In 2004 I was diagnosed with primary aldosteronism at Greenslopes > > > > Hospital in Brisbane, Australia. I then had adrenal vein > sampling, but > > > > the result was 'inconclusive'. So I have been treated medically > since > > > > with verapamil, amiloride and spironalactone. Initially the > dosage of > > > > spiro was 12.5 mg. Since last year it is 25mg, plus irbesartan and > > > > minus amiloride. I continue to see a cardiologist at Greenslopes. He > > > > said he was reluctant to prescribe a higher dosage of spiro > because of > > > > breast cancer risk. (My mother has survived breast cancer.) > > > > > > > > While my BP is more acceptable, I still suffer many symptoms > referred > > > > to by others in this group - constant fatigue, weak muscles, back > > > > pain, brain fogginess, reduced ability to organise/concentrate, > sleep > > > > disturbance, breathlessness on exertion. > > > > > > > > I have sleep apnoea and use a CPAP machine. Blood tests indicate > > > > potassium levels at normal range. An echocardiogram has shown 'stiff > > > > heart'. > > > > > > > > Recently my general practice doctor diagnosed me as having chronic > > > > fatigue syndrome. And,of course, there is the usual diagnosis of > > > > depression for which I reluctantly take Lexapro. > > > > > > > > I find it tough to keep going, but am determined to do so. Thanks to > > > > all who share their stories and advice. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2008 Report Share Posted April 28, 2008 It is supposed to do all that. However, I have read that it does not correct impaired glucose tolerance. I don't think there is enough research on Inspra to know if it will do a different job. And, of course, I imagine articles counter to the one below could be found. Dr. Grim can probably address that better than I. Curr Hypertens Rep. 2003 Apr;5(2):106-9. The effect of aldosterone on glucose metabolism. Corry DB, Tuck ML. Olive View-UCLA Medical Center, Sylmar, CA 91342, USA. dbcorry@... " In general adrenal surgery in cases of aldosterone-producing adenoma will correct the metabolic abnormalities, but it is less sure if treatment with spironolactone in cases of idiopathic hyperplasia will correct impaired glucose tolerance. " PMID: 12642008 There is one woman on this board who had serious congestive heart failure. One year on spiro turned it around. Have you thought of having AVS again and see if you can get some " conslusive " results? Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Carol Christie Val, so while spiro can bring BP to normal, does it have any effect on the " constellation of cardiovascular, renal and metabolic sequelae which make it far from benign and that these are not merely effects of blood pressure elevation " (from quote below)? > A simple answer to your question is that an adequate dose of > spiro is that which will bring your blood pressure to normal. > Trends Endocrinol Metab. 2008 Apr;19(3):88- > > 90. Epub 2008 Mar 7. > Primary aldosteronism: cardiovascular, renal and metabolic implications. > Rossi GP, et. al > DMCS - Clinica Medica 4 and University of Padua, 35126, Padua, Italy. > For many years primary aldosteronism was considered a relatively > benign form of hypertension. This assumption reflects the primacy > accorded to elevated levels of angiotensin in terms of deleterious > cardiovascular effects, and the fact that in primary > aldosteronism renin and angiotensin levels are low. We now know that > primary aldosteronism causes a constellation of cardiovascular, > renal and metabolic sequelae which make it far from benign and that > these are not merely effects of blood pressure elevation. In > primary aldosteronism, tissue damage, on several indices, is higher > than in age-, sex- and blood pressure-matched controls, > reflecting the ability of inappropriately elevated aldosterone for > salt status to produce structural and functional changes over and > above those produced by high blood pressure. > PMID: 18314347 [PubMed - in process] > Regards Carol Valarie wrote: > > Oh, now I see what you were referring to. The general theme here is > that diuretics are not good for PA because you lose potassium > and they don't improve BP. > > <http://www.bupa.co.uk/health_information/html/medicine/loop_diuretics.html > <http://www.bupa.co.uk/health_information/html/medicine/loop_diuretics.html>> > http://www.bupa.co.uk/health_information/html/medicine/loop_diuretics.html > <http://www.bupa.co.uk/health_information/html/medicine/loop_diuretics.html> > > " One of the most common side effects with a loop diuretic is potassium > deficiency, which can lead to abnormal heart rhythms, > weakness and confusion " > > The problem is that, even if you can keep your potassium up someway, > diuretics do not block the action of aldosterone and thus, do > not block the cardiac injury. Your blood pressure is still too high. A > simple answer to your question is that an adequate dose of > spiro is that which will bring your blood pressure to normal. > > BTW, CFS is often misdiagnosed hypothyroidism. > > Val > Walked in the wrong direction last night, fell on the ceramic tub > steps and hurt my ribs pretty badly. The hurt cannot remotely > compare to the hurt of PA, however. > > From: hyperaldosteronism <mailto:hyperaldosteronism%40> > <mailto:hyperaldosteronism%40> > [mailto:hyperaldosteronism <mailto:hyperaldosteronism%40> > <mailto:hyperaldosteronism%40>] On Behalf Of Carol Christie > > Hello Val, I was referring to your comment to Helen: > > I'd say your specialist hung himself on two hooks - once for being > > intimidated by an informed patient, and second, trying to give a > > diuretic to a PA. > I'm prescribed Frusemide (sorry, incorrect spelling before) - a > diuretic, 40mg twice a day. > > It's not that I'm afraid of spiro - my prescribing cardiologist advised > against my having more than 25mg a day (linking it to potential breast > issues). > Inspra isn't available here for hypertension or PA. > Carol > (PS - thanks for sharing your research, and your personal struggle > with us.) > > Valarie wrote: > > > > Carol, it was not I who addressed furosemide. I don't know anything > > about it. > > > > If you are afraid of spiro, why not take Inspra? I'm on 200 mg of > > spiro now and my anxiety and sleep disturbances are still there. > > BP is down nicely. > > > > I'm sure Dr. Grim will check in. > > > > Val > > > > From: hyperaldosteronism <mailto:hyperaldosteronism%40> > <mailto:hyperaldosteronism%40> > <mailto:hyperaldosteronism%40> > > <mailto:hyperaldosteronism%40> > > [mailto:hyperaldosteronism <mailto:hyperaldosteronism%40> > <mailto:hyperaldosteronism%40> > <mailto:hyperaldosteronism%40> > > <mailto:hyperaldosteronism%40>] On Behalf Of Carol > Christie > > > > Hello Dr Grim > > About a week after you sent your email to Dr Stowasser, I had an > > unexpected phone call from my specialist(cardiologist). He referred to > > my posting here and the comment linking spiro to the possibility of > > breast cancer. He said he wanted to clarify with me that he was > > referring to the possibility of breast lumps, not cancer. I will be > > seeing him again in a couple of weeks.... > > Anyway, the point for me is, what determines the dosage of spiro? > > Currently on 25mg spiro, my BP is now in the range of 140-150/ 80-90. I > > am a 61 yo female caucasion. > > If it is that aldosterone excess has harmful effects in addition to > > hypertension, does an increased dosage of spiro help to minimise those > > effects? > > A further question - my GP has put me on the diuretic furosomide. Val > > has commented recently this is not appropriate for PA patients. Is > > this so? > > I really value this group and all the comments - but I get pretty > > confused with the medical terminology, so please forgive any naive > > questions. > > Regards > > Carol (in Australia) > > > > Clarence Grim wrote: > > > > > > Be sure you are DASHing to the max to minimize the need for any drugs > > > to control your PA. > > > > > > See my next note on Breast CA lit search. > > > > > > The Brisbane group is one of the world class experts in PA and I > > > suggest you contact > > > > > > Recommend you contact Dr. Stowasser and get his groups opinion. Let us > > > know what they think. I am also forwarding this to him. > > > On Mar 26, 2008, at 3:03 AM, carolch58 wrote: > > > > > > > Hello everyone, > > > > I joined this group a few years ago - 'silent partner' you might say > > > > as I think I have only posted once. > > > > > > > > In 2004 I was diagnosed with primary aldosteronism at Greenslopes > > > > Hospital in Brisbane, Australia. I then had adrenal vein > sampling, but > > > > the result was 'inconclusive'. So I have been treated medically > since > > > > with verapamil, amiloride and spironalactone. Initially the > dosage of > > > > spiro was 12.5 mg. Since last year it is 25mg, plus irbesartan and > > > > minus amiloride. I continue to see a cardiologist at Greenslopes. He > > > > said he was reluctant to prescribe a higher dosage of spiro > because of > > > > breast cancer risk. (My mother has survived breast cancer.) > > > > > > > > While my BP is more acceptable, I still suffer many symptoms > referred > > > > to by others in this group - constant fatigue, weak muscles, back > > > > pain, brain fogginess, reduced ability to organise/concentrate, > sleep > > > > disturbance, breathlessness on exertion. > > > > > > > > I have sleep apnoea and use a CPAP machine. Blood tests indicate > > > > potassium levels at normal range. An echocardiogram has shown 'stiff > > > > heart'. > > > > > > > > Recently my general practice doctor diagnosed me as having chronic > > > > fatigue syndrome. And,of course, there is the usual diagnosis of > > > > depression for which I reluctantly take Lexapro. > > > > > > > > I find it tough to keep going, but am determined to do so. Thanks to > > > > all who share their stories and advice. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2008 Report Share Posted April 28, 2008 BTW, I was on a diuretic for 6 years and it didn't touch the edema (non-pitting). The only thing that ever decreased it before spiro, was some T3 thyroid. I have found docs incredibly inept at diagnosing hypothyroidism. Too many stick to old, outmoded normal bands, and too many don't test the correct hormones. Do you get copies of every test you've ever had? If you have thyroid results, I'd like you to post them here. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Carol Christie Val, the GP prescribed the diuretic because of oedema in my ankles./ lower legs. I did follow up your suggestion in a previous post re hypothyroidism. The doctor had included those tests in a battery of diagnostic tests she ran. Nothing indicated there. Hope your ribs are OK. Carol Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2008 Report Share Posted April 28, 2008 I don't have copies of any test results. I'll try to get them and post them. Thanks, Val. Carol Valarie wrote: > > BTW, I was on a diuretic for 6 years and it didn't touch the edema > (non-pitting). The only thing that ever decreased it before > spiro, was some T3 thyroid. > > I have found docs incredibly inept at diagnosing hypothyroidism. Too > many stick to old, outmoded normal bands, and too many don't > test the correct hormones. Do you get copies of every test you've ever > had? If you have thyroid results, I'd like you to post them > here. > > Val > > From: hyperaldosteronism > <mailto:hyperaldosteronism%40> > [mailto:hyperaldosteronism > <mailto:hyperaldosteronism%40>] On Behalf Of Carol Christie > > Val, the GP prescribed the diuretic because of oedema in my ankles./ > lower legs. I did follow up your suggestion in a previous post re > hypothyroidism. The doctor had included those tests in a battery of > diagnostic tests she ran. Nothing indicated there. > Hope your ribs are OK. > Carol > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2008 Report Share Posted April 28, 2008 Its very important to get copies of your tests and keep your own file. In collecting my data lately, I got a copy of my ER visit in December and learned there was an abnormal EKG. Nothing was said to me at the time. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Carol Christie I don't have copies of any test results. I'll try to get them and post them. Thanks, Val. Carol Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2008 Report Share Posted April 28, 2008 Yes, I've thought about having another AVS. It seems, though, from reading and elsewhere that aldosterone can be produced from various parts of the body. If AVS indicated adrenolectomy, I guess it's worth the risk of surgery to get a better quality of life. In two minds about it though. Carol > There is one woman on this board who had serious congestive heart > failure. One year on spiro turned it around. > > Have you thought of having AVS again and see if you can get some > " conslusive " results? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2008 Report Share Posted April 28, 2008 My thinking is there. My BP is well-controlled, K is good, heart is not skipping so much on spiro + Toprol, but the constant buzz/anxiety/sweats are still there. I told my doc Friday I want to go to Mayo. She said she'd set it up but no telling how long it will take her to get around to it. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Carol Christie Yes, I've thought about having another AVS. It seems, though, from reading and elsewhere that aldosterone can be produced from various parts of the body. If AVS indicated adrenolectomy, I guess it's worth the risk of surgery to get a better quality of life. In two minds about it though. Carol > There is one woman on this board who had serious congestive heart > failure. One year on spiro turned it around. > > Have you thought of having AVS again and see if you can get some > " conslusive " results? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2008 Report Share Posted April 28, 2008 It amazes me that you can have two AVS in Australia but no Inspra. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Carol Christie Yes, I've thought about having another AVS. It seems, though, from reading and elsewhere that aldosterone can be produced from various parts of the body. If AVS indicated adrenolectomy, I guess it's worth the risk of surgery to get a better quality of life. In two minds about it though. Carol > Have you thought of having AVS again and see if you can get some > " conslusive " results? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2008 Report Share Posted April 28, 2008 Yes and an AVS will tell if its coming from the adrenal or not. That is the major reason to do it. Aldo from other sources is so rare I have never see it, but know it has been reported in the ovary. If the is the case the AVS should show not aldo from either adrenal. On Apr 28, 2008, at 8:44 PM, Valarie wrote: > My thinking is there. My BP is well-controlled, K is good, heart is > not skipping so much on spiro + Toprol, but the constant > buzz/anxiety/sweats are still there. I told my doc Friday I want to > go to Mayo. She said she'd set it up but no telling how long > it will take her to get around to it. > > Val > > From: hyperaldosteronism > [mailto:hyperaldosteronism ] On Behalf Of Carol > Christie > > Yes, I've thought about having another AVS. It seems, though, from > reading and elsewhere that aldosterone can be produced from various > parts of the body. If AVS indicated adrenolectomy, I guess it's worth > the risk of surgery to get a better quality of life. > In two minds about it though. > > Carol > > > There is one woman on this board who had serious congestive heart > > failure. One year on spiro turned it around. > > > > Have you thought of having AVS again and see if you can get some > > " conslusive " results? > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2008 Report Share Posted April 28, 2008 I just reread one of the first art on long term Rx with spiro and sweating was one of the side effects they reported. I have never seen it and I have treated more than they had at the time. But if if is a 1/1000 occurence I would have not likely seen it. I also just found a pdf of re DASH and Calcium metabolism (CA, PTH etc) that should be in our files. The study documents that low sodium diet DASH improves bone and CA metabolism. Thus high salt diet is likely a cause of osteoporosis (some have said this before). This suggests that PA which mimicks high salt diet should also mess up CA metabolism. I am attaching this to a note to Val separtely-she may have sent it to me originally anyway. On Apr 28, 2008, at 8:44 PM, Valarie wrote: > My thinking is there. My BP is well-controlled, K is good, heart is > not skipping so much on spiro + Toprol, but the constant > buzz/anxiety/sweats are still there. I told my doc Friday I want to > go to Mayo. She said she'd set it up but no telling how long > it will take her to get around to it. > > Val > > From: hyperaldosteronism > [mailto:hyperaldosteronism ] On Behalf Of Carol > Christie > > Yes, I've thought about having another AVS. It seems, though, from > reading and elsewhere that aldosterone can be produced from various > parts of the body. If AVS indicated adrenolectomy, I guess it's worth > the risk of surgery to get a better quality of life. > In two minds about it though. > > Carol > > > There is one woman on this board who had serious congestive heart > > failure. One year on spiro turned it around. > > > > Have you thought of having AVS again and see if you can get some > > " conslusive " results? > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2008 Report Share Posted April 28, 2008 need to add CHF due to uncontrolled HTN from PA. On Apr 28, 2008, at 7:00 PM, Carol Christie wrote: > There is one woman on this board who had serious congestive heart > > failure. One year on spiro turned it around. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2008 Report Share Posted April 28, 2008 Yes, it makes no sense to me, either. Under the Pharmaceutical Benefits Scheme which operates here, the following restrictions apply to Inspra: > Heart failure with a left ventricular ejection fraction of 40% or less > occurring within 3 to 14 days following an acute myocardial > infarction. Treatment with eplerenone must be commenced within 14 days > of an acute myocardial infarction. > The date of the acute myocardial infarction and the date of initiation > of eplerenone treatment must be documented in the patient's medical > records when PBS-subsidised treatment is initiated. Generally speaking, it is a great system, subsidising medicine costs for the whole population. Operated by the national government. Carol Valarie wrote: > > It amazes me that you can have two AVS in Australia but no Inspra. > > Val > > From: hyperaldosteronism > <mailto:hyperaldosteronism%40> > [mailto:hyperaldosteronism > <mailto:hyperaldosteronism%40>] On Behalf Of Carol Christie > > Yes, I've thought about having another AVS. It seems, though, from > reading and elsewhere that aldosterone can be produced from various > parts of the body. If AVS indicated adrenolectomy, I guess it's worth > the risk of surgery to get a better quality of life. > In two minds about it though. > > Carol > > > Have you thought of having AVS again and see if you can get some > > " conslusive " results? > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2008 Report Share Posted April 28, 2008 Yes yes yes always get copies of all your labs, xrays etc. as you are very likely to change Drs and you need to have them when the new Dr does not!! On Apr 28, 2008, at 6:54 PM, Valarie wrote: > Its very important to get copies of your tests and keep your own file. > > In collecting my data lately, I got a copy of my ER visit in > December and learned there was an abnormal EKG. Nothing was said to me > at the time. > > Val > > From: hyperaldosteronism > [mailto:hyperaldosteronism ] On Behalf Of Carol > Christie > > I don't have copies of any test results. I'll try to get them and post > them. Thanks, Val. > > Carol > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2008 Report Share Posted April 28, 2008 It seems to reverse them all and I think we have paper in files from English group on first long term results with spiro. It was published over 30 years ago and I know some of the people on the paper and ask about 30 year follow up. Recall that DASH may do all spiro can do without the side effects in many. Esp when PA is early. On Apr 28, 2008, at 6:04 PM, Carol Christie wrote: > Val, so while spiro can bring BP to normal, does it have any effect on > the " constellation of cardiovascular, > renal and metabolic sequelae which make it far from benign and that > these are not merely effects of blood pressure elevation " (from > quote below)? > > > A simple answer to your question is that an adequate dose of > > spiro is that which will bring your blood pressure to normal. > > > Trends Endocrinol Metab. 2008 Apr;19(3):88- > > > > 90. Epub 2008 Mar 7. > > Primary aldosteronism: cardiovascular, renal and metabolic > implications. > > Rossi GP, et. al > > DMCS - Clinica Medica 4 and University of Padua, 35126, Padua, > Italy. > > For many years primary aldosteronism was considered a relatively > > benign form of hypertension. This assumption reflects the primacy > > accorded to elevated levels of angiotensin in terms of deleterious > > cardiovascular effects, and the fact that in primary > > aldosteronism renin and angiotensin levels are low. We now know that > > primary aldosteronism causes a constellation of cardiovascular, > > renal and metabolic sequelae which make it far from benign and that > > these are not merely effects of blood pressure elevation. In > > primary aldosteronism, tissue damage, on several indices, is higher > > than in age-, sex- and blood pressure-matched controls, > > reflecting the ability of inappropriately elevated aldosterone for > > salt status to produce structural and functional changes over and > > above those produced by high blood pressure. > > PMID: 18314347 [PubMed - in process] > > > Regards > Carol > > Valarie wrote: > > > > Oh, now I see what you were referring to. The general theme here is > > that diuretics are not good for PA because you lose potassium > > and they don't improve BP. > > > > <http://www.bupa.co.uk/health_information/html/medicine/ > loop_diuretics.html > > <http://www.bupa.co.uk/health_information/html/medicine/ > loop_diuretics.html>> > >http://www.bupa.co.uk/health_information/html/medicine/ > loop_diuretics.html > > <http://www.bupa.co.uk/health_information/html/medicine/ > loop_diuretics.html> > > > > " One of the most common side effects with a loop diuretic is > potassium > > deficiency, which can lead to abnormal heart rhythms, > > weakness and confusion " > > > > The problem is that, even if you can keep your potassium up someway, > > diuretics do not block the action of aldosterone and thus, do > > not block the cardiac injury. Your blood pressure is still too > high. A > > simple answer to your question is that an adequate dose of > > spiro is that which will bring your blood pressure to normal. > > > > BTW, CFS is often misdiagnosed hypothyroidism. > > > > Val > > Walked in the wrong direction last night, fell on the ceramic tub > > steps and hurt my ribs pretty badly. The hurt cannot remotely > > compare to the hurt of PA, however. > > > > From: hyperaldosteronism > > <mailto:hyperaldosteronism%40> > > [mailto:hyperaldosteronism > > <mailto:hyperaldosteronism%40>] On Behalf Of Carol > Christie > > > > Hello Val, I was referring to your comment to Helen: > > > I'd say your specialist hung himself on two hooks - once for being > > > intimidated by an informed patient, and second, trying to give a > > > diuretic to a PA. > > I'm prescribed Frusemide (sorry, incorrect spelling before) - a > > diuretic, 40mg twice a day. > > > > It's not that I'm afraid of spiro - my prescribing cardiologist > advised > > against my having more than 25mg a day (linking it to potential > breast > > issues). > > Inspra isn't available here for hypertension or PA. > > Carol > > (PS - thanks for sharing your research, and your personal struggle > > with us.) > > > > Valarie wrote: > > > > > > Carol, it was not I who addressed furosemide. I don't know > anything > > > about it. > > > > > > If you are afraid of spiro, why not take Inspra? I'm on 200 mg of > > > spiro now and my anxiety and sleep disturbances are still there. > > > BP is down nicely. > > > > > > I'm sure Dr. Grim will check in. > > > > > > Val > > > > > > From: hyperaldosteronism > > <mailto:hyperaldosteronism%40> > > <mailto:hyperaldosteronism%40> > > > <mailto:hyperaldosteronism%40> > > > [mailto:hyperaldosteronism > > <mailto:hyperaldosteronism%40> > > <mailto:hyperaldosteronism%40> > > > <mailto:hyperaldosteronism%40>] On Behalf Of Carol > > Christie > > > > > > Hello Dr Grim > > > About a week after you sent your email to Dr Stowasser, I had an > > > unexpected phone call from my specialist(cardiologist). He > referred to > > > my posting here and the comment linking spiro to the > possibility of > > > breast cancer. He said he wanted to clarify with me that he was > > > referring to the possibility of breast lumps, not cancer. I > will be > > > seeing him again in a couple of weeks.... > > > Anyway, the point for me is, what determines the dosage of spiro? > > > Currently on 25mg spiro, my BP is now in the range of 140-150/ > 80-90. I > > > am a 61 yo female caucasion. > > > If it is that aldosterone excess has harmful effects in > addition to > > > hypertension, does an increased dosage of spiro help to > minimise those > > > effects? > > > A further question - my GP has put me on the diuretic > furosomide. Val > > > has commented recently this is not appropriate for PA patients. Is > > > this so? > > > I really value this group and all the comments - but I get pretty > > > confused with the medical terminology, so please forgive any naive > > > questions. > > > Regards > > > Carol (in Australia) > > > > > > Clarence Grim wrote: > > > > > > > > Be sure you are DASHing to the max to minimize the need for > any drugs > > > > to control your PA. > > > > > > > > See my next note on Breast CA lit search. > > > > > > > > The Brisbane group is one of the world class experts in PA and I > > > > suggest you contact > > > > > > > > Recommend you contact Dr. Stowasser and get his groups > opinion. Let us > > > > know what they think. I am also forwarding this to him. > > > > On Mar 26, 2008, at 3:03 AM, carolch58 wrote: > > > > > > > > > Hello everyone, > > > > > I joined this group a few years ago - 'silent partner' you > might say > > > > > as I think I have only posted once. > > > > > > > > > > In 2004 I was diagnosed with primary aldosteronism at > Greenslopes > > > > > Hospital in Brisbane, Australia. I then had adrenal vein > > sampling, but > > > > > the result was 'inconclusive'. So I have been treated > medically > > since > > > > > with verapamil, amiloride and spironalactone. Initially the > > dosage of > > > > > spiro was 12.5 mg. Since last year it is 25mg, plus > irbesartan and > > > > > minus amiloride. I continue to see a cardiologist at > Greenslopes. He > > > > > said he was reluctant to prescribe a higher dosage of spiro > > because of > > > > > breast cancer risk. (My mother has survived breast cancer.) > > > > > > > > > > While my BP is more acceptable, I still suffer many symptoms > > referred > > > > > to by others in this group - constant fatigue, weak > muscles, back > > > > > pain, brain fogginess, reduced ability to organise/ > concentrate, > > sleep > > > > > disturbance, breathlessness on exertion. > > > > > > > > > > I have sleep apnoea and use a CPAP machine. Blood tests > indicate > > > > > potassium levels at normal range. An echocardiogram has > shown 'stiff > > > > > heart'. > > > > > > > > > > Recently my general practice doctor diagnosed me as having > chronic > > > > > fatigue syndrome. And,of course, there is the usual > diagnosis of > > > > > depression for which I reluctantly take Lexapro. > > > > > > > > > > I find it tough to keep going, but am determined to do so. > Thanks to > > > > > all who share their stories and advice. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2008 Report Share Posted April 28, 2008 Swelling is always caused by eating more salt than your body can get rid of. No salt no swelling. On Apr 28, 2008, at 6:35 PM, Valarie wrote: > BTW, I was on a diuretic for 6 years and it didn't touch the edema > (non-pitting). The only thing that ever decreased it before > spiro, was some T3 thyroid. > > I have found docs incredibly inept at diagnosing hypothyroidism. > Too many stick to old, outmoded normal bands, and too many don't > test the correct hormones. Do you get copies of every test you've > ever had? If you have thyroid results, I'd like you to post them > here. > > Val > > From: hyperaldosteronism > [mailto:hyperaldosteronism ] On Behalf Of Carol > Christie > > Val, the GP prescribed the diuretic because of oedema in my ankles./ > lower legs. I did follow up your suggestion in a previous post re > hypothyroidism. The doctor had included those tests in a battery of > diagnostic tests she ran. Nothing indicated there. > Hope your ribs are OK. > Carol > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2008 Report Share Posted April 28, 2008 spiro makes edema go away. edema in PA is rare due to what is called aldosterone escape. What other drugs have you been taking when the edema developed. On Apr 28, 2008, at 5:50 PM, Valarie wrote: > I know its not supposed to happen, but my edema is about 75% less > in my ankles since being on spiro. I've been on it just over a > month and am up to 200 mg/d. I'm almost thinking the spiro is > making my anxiety worse. > > Val > > From: hyperaldosteronism > [mailto:hyperaldosteronism ] On Behalf Of Carol > Christie > > Val, the GP prescribed the diuretic because of oedema in my ankles./ > lower legs. I did follow up your suggestion in a previous post re > hypothyroidism. The doctor had included those tests in a battery of > diagnostic tests she ran. Nothing indicated there. > Hope your ribs are OK. > Carol > Valarie wrote: > > > > Oh, now I see what you were referring to. The general theme here is > > that diuretics are not good for PA because you lose potassium > > and they don't improve BP. > > > > <http://www.bupa.co.uk/health_information/html/medicine/ > loop_diuretics.html > > <http://www.bupa.co.uk/health_information/html/medicine/ > loop_diuretics.html>> > >http://www.bupa.co.uk/health_information/html/medicine/ > loop_diuretics.html > > <http://www.bupa.co.uk/health_information/html/medicine/ > loop_diuretics.html> > > > > " One of the most common side effects with a loop diuretic is > potassium > > deficiency, which can lead to abnormal heart rhythms, > > weakness and confusion " > > > > The problem is that, even if you can keep your potassium up someway, > > diuretics do not block the action of aldosterone and thus, do > > not block the cardiac injury. Your blood pressure is still too > high. A > > simple answer to your question is that an adequate dose of > > spiro is that which will bring your blood pressure to normal. > > > > BTW, CFS is often misdiagnosed hypothyroidism. > > > > Val > > Walked in the wrong direction last night, fell on the ceramic tub > > steps and hurt my ribs pretty badly. The hurt cannot remotely > > compare to the hurt of PA, however. > > > > From: hyperaldosteronism <mailto:hyperaldosteronism > %40> > > <mailto:hyperaldosteronism%40> > > > [mailto:hyperaldosteronism <mailto:hyperaldosteronism > %40> > > <mailto:hyperaldosteronism%40>] On Behalf Of Carol > Christie > > > > Hello Val, I was referring to your comment to Helen: > > > I'd say your specialist hung himself on two hooks - once for being > > > intimidated by an informed patient, and second, trying to give a > > > diuretic to a PA. > > I'm prescribed Frusemide (sorry, incorrect spelling before) - a > > diuretic, 40mg twice a day. > > > > It's not that I'm afraid of spiro - my prescribing cardiologist > advised > > against my having more than 25mg a day (linking it to potential > breast > > issues). > > Inspra isn't available here for hypertension or PA. > > Carol > > (PS - thanks for sharing your research, and your personal struggle > > with us.) > > > > Valarie wrote: > > > > > > Carol, it was not I who addressed furosemide. I don't know > anything > > > about it. > > > > > > If you are afraid of spiro, why not take Inspra? I'm on 200 mg of > > > spiro now and my anxiety and sleep disturbances are still there. > > > BP is down nicely. > > > > > > I'm sure Dr. Grim will check in. > > > > > > Val > > > > > > From: > hyperaldosteronism <mailto:hyperaldosteronism% > 40> > > <mailto:hyperaldosteronism%40> > > <mailto:hyperaldosteronism%40> > > > <mailto:hyperaldosteronism%40> > > > > [mailto:hyperaldosteronism <mailto:hyperaldosteronism > %40> > > <mailto:hyperaldosteronism%40> > > <mailto:hyperaldosteronism%40> > > > <mailto:hyperaldosteronism%40>] On Behalf Of Carol > > Christie > > > > > > Hello Dr Grim > > > About a week after you sent your email to Dr Stowasser, I had an > > > unexpected phone call from my specialist(cardiologist). He > referred to > > > my posting here and the comment linking spiro to the > possibility of > > > breast cancer. He said he wanted to clarify with me that he was > > > referring to the possibility of breast lumps, not cancer. I > will be > > > seeing him again in a couple of weeks.... > > > Anyway, the point for me is, what determines the dosage of spiro? > > > Currently on 25mg spiro, my BP is now in the range of 140-150/ > 80-90. I > > > am a 61 yo female caucasion. > > > If it is that aldosterone excess has harmful effects in > addition to > > > hypertension, does an increased dosage of spiro help to > minimise those > > > effects? > > > A further question - my GP has put me on the diuretic > furosomide. Val > > > has commented recently this is not appropriate for PA patients. Is > > > this so? > > > I really value this group and all the comments - but I get pretty > > > confused with the medical terminology, so please forgive any naive > > > questions. > > > Regards > > > Carol (in Australia) > > > > > > Clarence Grim wrote: > > > > > > > > Be sure you are DASHing to the max to minimize the need for > any drugs > > > > to control your PA. > > > > > > > > See my next note on Breast CA lit search. > > > > > > > > The Brisbane group is one of the world class experts in PA and I > > > > suggest you contact > > > > > > > > Recommend you contact Dr. Stowasser and get his groups > opinion. Let us > > > > know what they think. I am also forwarding this to him. > > > > On Mar 26, 2008, at 3:03 AM, carolch58 wrote: > > > > > > > > > Hello everyone, > > > > > I joined this group a few years ago - 'silent partner' you > might say > > > > > as I think I have only posted once. > > > > > > > > > > In 2004 I was diagnosed with primary aldosteronism at > Greenslopes > > > > > Hospital in Brisbane, Australia. I then had adrenal vein > > sampling, but > > > > > the result was 'inconclusive'. So I have been treated > medically > > since > > > > > with verapamil, amiloride and spironalactone. Initially the > > dosage of > > > > > spiro was 12.5 mg. Since last year it is 25mg, plus > irbesartan and > > > > > minus amiloride. I continue to see a cardiologist at > Greenslopes. He > > > > > said he was reluctant to prescribe a higher dosage of spiro > > because of > > > > > breast cancer risk. (My mother has survived breast cancer.) > > > > > > > > > > While my BP is more acceptable, I still suffer many symptoms > > referred > > > > > to by others in this group - constant fatigue, weak > muscles, back > > > > > pain, brain fogginess, reduced ability to organise/ > concentrate, > > sleep > > > > > disturbance, breathlessness on exertion. > > > > > > > > > > I have sleep apnoea and use a CPAP machine. Blood tests > indicate > > > > > potassium levels at normal range. An echocardiogram has > shown 'stiff > > > > > heart'. > > > > > > > > > > Recently my general practice doctor diagnosed me as having > chronic > > > > > fatigue syndrome. And,of course, there is the usual > diagnosis of > > > > > depression for which I reluctantly take Lexapro. > > > > > > > > > > I find it tough to keep going, but am determined to do so. > Thanks to > > > > > all who share their stories and advice. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2008 Report Share Posted April 28, 2008 What else were you taking at the time. CCB? On Apr 28, 2008, at 5:10 PM, Carol Christie wrote: > Val, the GP prescribed the diuretic because of oedema in my ankles./ > lower legs. I did follow up your suggestion in a previous post re > hypothyroidism. The doctor had included those tests in a battery of > diagnostic tests she ran. Nothing indicated there. > Hope your ribs are OK. > Carol > Valarie wrote: > > > > Oh, now I see what you were referring to. The general theme here is > > that diuretics are not good for PA because you lose potassium > > and they don't improve BP. > > > > <http://www.bupa.co.uk/health_information/html/medicine/ > loop_diuretics.html > > <http://www.bupa.co.uk/health_information/html/medicine/ > loop_diuretics.html>> > >http://www.bupa.co.uk/health_information/html/medicine/ > loop_diuretics.html > > <http://www.bupa.co.uk/health_information/html/medicine/ > loop_diuretics.html> > > > > " One of the most common side effects with a loop diuretic is > potassium > > deficiency, which can lead to abnormal heart rhythms, > > weakness and confusion " > > > > The problem is that, even if you can keep your potassium up someway, > > diuretics do not block the action of aldosterone and thus, do > > not block the cardiac injury. Your blood pressure is still too > high. A > > simple answer to your question is that an adequate dose of > > spiro is that which will bring your blood pressure to normal. > > > > BTW, CFS is often misdiagnosed hypothyroidism. > > > > Val > > Walked in the wrong direction last night, fell on the ceramic tub > > steps and hurt my ribs pretty badly. The hurt cannot remotely > > compare to the hurt of PA, however. > > > > From: hyperaldosteronism > > <mailto:hyperaldosteronism%40> > > [mailto:hyperaldosteronism > > <mailto:hyperaldosteronism%40>] On Behalf Of Carol > Christie > > > > Hello Val, I was referring to your comment to Helen: > > > I'd say your specialist hung himself on two hooks - once for being > > > intimidated by an informed patient, and second, trying to give a > > > diuretic to a PA. > > I'm prescribed Frusemide (sorry, incorrect spelling before) - a > > diuretic, 40mg twice a day. > > > > It's not that I'm afraid of spiro - my prescribing cardiologist > advised > > against my having more than 25mg a day (linking it to potential > breast > > issues). > > Inspra isn't available here for hypertension or PA. > > Carol > > (PS - thanks for sharing your research, and your personal struggle > > with us.) > > > > Valarie wrote: > > > > > > Carol, it was not I who addressed furosemide. I don't know > anything > > > about it. > > > > > > If you are afraid of spiro, why not take Inspra? I'm on 200 mg of > > > spiro now and my anxiety and sleep disturbances are still there. > > > BP is down nicely. > > > > > > I'm sure Dr. Grim will check in. > > > > > > Val > > > > > > From: hyperaldosteronism > > <mailto:hyperaldosteronism%40> > > <mailto:hyperaldosteronism%40> > > > <mailto:hyperaldosteronism%40> > > > [mailto:hyperaldosteronism > > <mailto:hyperaldosteronism%40> > > <mailto:hyperaldosteronism%40> > > > <mailto:hyperaldosteronism%40>] On Behalf Of Carol > > Christie > > > > > > Hello Dr Grim > > > About a week after you sent your email to Dr Stowasser, I had an > > > unexpected phone call from my specialist(cardiologist). He > referred to > > > my posting here and the comment linking spiro to the > possibility of > > > breast cancer. He said he wanted to clarify with me that he was > > > referring to the possibility of breast lumps, not cancer. I > will be > > > seeing him again in a couple of weeks.... > > > Anyway, the point for me is, what determines the dosage of spiro? > > > Currently on 25mg spiro, my BP is now in the range of 140-150/ > 80-90. I > > > am a 61 yo female caucasion. > > > If it is that aldosterone excess has harmful effects in > addition to > > > hypertension, does an increased dosage of spiro help to > minimise those > > > effects? > > > A further question - my GP has put me on the diuretic > furosomide. Val > > > has commented recently this is not appropriate for PA patients. Is > > > this so? > > > I really value this group and all the comments - but I get pretty > > > confused with the medical terminology, so please forgive any naive > > > questions. > > > Regards > > > Carol (in Australia) > > > > > > Clarence Grim wrote: > > > > > > > > Be sure you are DASHing to the max to minimize the need for > any drugs > > > > to control your PA. > > > > > > > > See my next note on Breast CA lit search. > > > > > > > > The Brisbane group is one of the world class experts in PA and I > > > > suggest you contact > > > > > > > > Recommend you contact Dr. Stowasser and get his groups > opinion. Let us > > > > know what they think. I am also forwarding this to him. > > > > On Mar 26, 2008, at 3:03 AM, carolch58 wrote: > > > > > > > > > Hello everyone, > > > > > I joined this group a few years ago - 'silent partner' you > might say > > > > > as I think I have only posted once. > > > > > > > > > > In 2004 I was diagnosed with primary aldosteronism at > Greenslopes > > > > > Hospital in Brisbane, Australia. I then had adrenal vein > > sampling, but > > > > > the result was 'inconclusive'. So I have been treated > medically > > since > > > > > with verapamil, amiloride and spironalactone. Initially the > > dosage of > > > > > spiro was 12.5 mg. Since last year it is 25mg, plus > irbesartan and > > > > > minus amiloride. I continue to see a cardiologist at > Greenslopes. He > > > > > said he was reluctant to prescribe a higher dosage of spiro > > because of > > > > > breast cancer risk. (My mother has survived breast cancer.) > > > > > > > > > > While my BP is more acceptable, I still suffer many symptoms > > referred > > > > > to by others in this group - constant fatigue, weak > muscles, back > > > > > pain, brain fogginess, reduced ability to organise/ > concentrate, > > sleep > > > > > disturbance, breathlessness on exertion. > > > > > > > > > > I have sleep apnoea and use a CPAP machine. Blood tests > indicate > > > > > potassium levels at normal range. An echocardiogram has > shown 'stiff > > > > > heart'. > > > > > > > > > > Recently my general practice doctor diagnosed me as having > chronic > > > > > fatigue syndrome. And,of course, there is the usual > diagnosis of > > > > > depression for which I reluctantly take Lexapro. > > > > > > > > > > I find it tough to keep going, but am determined to do so. > Thanks to > > > > > all who share their stories and advice. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2008 Report Share Posted April 28, 2008 Transdermal estradiol Oral Prometrium Spiro Synthroid Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Clarence Grim spiro makes edema go away. edema in PA is rare due to what is called aldosterone escape. What other drugs have you been taking when the edema developed. On Apr 28, 2008, at 5:50 PM, Valarie wrote: > I know its not supposed to happen, but my edema is about 75% less > in my ankles since being on spiro. I've been on it just over a > month and am up to 200 mg/d. I'm almost thinking the spiro is > making my anxiety worse. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2008 Report Share Posted April 28, 2008 I've been averaging 654 mg sodium. Maybe that's the reason. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Clarence Grim Swelling is always caused by eating more salt than your body can get rid of. No salt no swelling. On Apr 28, 2008, at 6:35 PM, Valarie wrote: > BTW, I was on a diuretic for 6 years and it didn't touch the edema > (non-pitting). The only thing that ever decreased it before > spiro, was some T3 thyroid. Quote Link to comment Share on other sites More sharing options...
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