Guest guest Posted April 28, 2008 Report Share Posted April 28, 2008 My other medications are verapamil(240mg), irbesartan(150mg), spiro(25mg), plus lexapro(20mg). Carol Clarence Grim wrote: > > 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/ > <http://www.bupa.co.uk/health_information/html/medicine/> > > loop_diuretics.html > > > <http://www.bupa.co.uk/health_information/html/medicine/ > <http://www.bupa.co.uk/health_information/html/medicine/> > > loop_diuretics.html>> > > >http://www.bupa.co.uk/health_information/html/medicine/ > <http://www.bupa.co.uk/health_information/html/medicine/> > > loop_diuretics.html > > > <http://www.bupa.co.uk/health_information/html/medicine/ > <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 As it costs 10x as much as spiro you can see why it is expensive to provide all meds to everyone. I should be available for those with PA who fail spiro I would think. On Apr 28, 2008, at 10:33 PM, Carol Christie wrote: > 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 Verap causes swelling, irbesartan does not work in PA. On Apr 29, 2008, at 12:00 AM, Carol Christie wrote: > My other medications are verapamil(240mg), irbesartan(150mg), > spiro(25mg), plus lexapro(20mg). > Carol Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2008 Report Share Posted April 28, 2008 did you gain wt on transdermal est or Oral Prometrium? On Apr 28, 2008, at 11:38 PM, Valarie wrote: > 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 29, 2008 Report Share Posted April 29, 2008 Does verapamil work in PA? Could that cause the lower leg oedema? Is it likely that I would be better served by a higher dosage of spiro? I was also taking amiloride until last year when the cardio said to stop taking it - can't recall any reason. Many thanks Carol Clarence Grim wrote: > > Verap causes swelling, irbesartan does not work in PA. > > On Apr 29, 2008, at 12:00 AM, Carol Christie wrote: > > > My other medications are verapamil(240mg), irbesartan(150mg), > > spiro(25mg), plus lexapro(20mg). > > Carol > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 2008 Report Share Posted April 29, 2008 Verap has not been well tested in PA. It will cause leg edema in many persons (presumably with and without PA but not well studied. In general it does not seem to work will in PA and that is the reason so many are now called drug resistant (PA). See my article. On Apr 29, 2008, at 1:02 AM, Carol Christie wrote: > Does verapamil work in PA? Could that cause the lower leg oedema? > Is it likely that I would be better served by a higher dosage of > spiro? > I was also taking amiloride until last year when the cardio said to > stop > taking it - can't recall any reason. > Many thanks > Carol > > Clarence Grim wrote: > > > > Verap causes swelling, irbesartan does not work in PA. > > > > On Apr 29, 2008, at 12:00 AM, Carol Christie wrote: > > > > > My other medications are verapamil(240mg), irbesartan(150mg), > > > spiro(25mg), plus lexapro(20mg). > > > Carol > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 2008 Report Share Posted April 29, 2008 I went from 96 lbs to 155 lbs over 9 years of being treated for ankylosing spondylitis instead of hypothyroidism. E and P never seemed to make much difference either way. I stopped hormones on 2/25/08 because estrogen made the anxiety (gripping) worse. Since on spiro (3/21), I've lost 5.9 lb. Water or what, I don't know. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Clarence Grim did you gain wt on transdermal est or Oral Prometrium? On Apr 28, 2008, at 11:38 PM, Valarie wrote: > Transdermal estradiol > Oral Prometrium > Spiro > Synthroid > > Val > > From: hyperaldosteronism <mailto:hyperaldosteronism%40> > [mailto:hyperaldosteronism <mailto:hyperaldosteronism%40> ] 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 29, 2008 Report Share Posted April 29, 2008 Dr. Grim: I find this interesting. I usually try to only mention my primary symptoms to docs, because if I offer the entire constellation, it tends to confuse things and/or sound like a nut. However, one thing that I can not take is calcium. It worsens my anxiety and gives me a funny feeling in the head. I took ergocalciferol (Vit D2) 50,000 u's/week for a while fine..but eventually also suffered the same symptoms and thyroid level changes/severe depression. Without calcium supplementation, my Ca stays right of normal, sometimes borderline high (serum ionized at 5.4, serum Ca as high as 10.2..now 9.1). Is there a connection with the early PA? Thank you, Angie > > 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. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 2008 Report Share Posted April 29, 2008 You need both PTH and CA measurements if Ca is highish. On Apr 29, 2008, at 8:19 AM, aviano237 wrote: > Dr. Grim: > I find this interesting. I usually try to only mention my primary > symptoms to docs, because if I offer the entire constellation, it > tends to confuse things and/or sound like a nut. However, one thing > that I can not take is calcium. It worsens my anxiety and gives me a > funny feeling in the head. I took ergocalciferol (Vit D2) 50,000 > u's/week for a while fine..but eventually also suffered the same > symptoms and thyroid level changes/severe depression. Without > calcium supplementation, my Ca stays right of normal, sometimes > borderline high (serum ionized at 5.4, serum Ca as high as 10.2..now > 9.1). Is there a connection with the early PA? > Thank you, > Angie > > > > > 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. > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 2008 Report Share Posted April 29, 2008 Not well studied. How excessive is Vid D 50000 u per week. There is such a thing as Vit D toxicity. On Apr 29, 2008, at 8:19 AM, aviano237 wrote: > Dr. Grim: > I find this interesting. I usually try to only mention my primary > symptoms to docs, because if I offer the entire constellation, it > tends to confuse things and/or sound like a nut. However, one thing > that I can not take is calcium. It worsens my anxiety and gives me a > funny feeling in the head. I took ergocalciferol (Vit D2) 50,000 > u's/week for a while fine..but eventually also suffered the same > symptoms and thyroid level changes/severe depression. Without > calcium supplementation, my Ca stays right of normal, sometimes > borderline high (serum ionized at 5.4, serum Ca as high as 10.2..now > 9.1). Is there a connection with the early PA? > Thank you, > Angie > > > > > 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. > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 30, 2008 Report Share Posted April 30, 2008 Dr. Grim: My PTH was 23, twice. Left of normal, but still persistent irrespective of Ca levels. Angie > > > > > > 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. > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 1, 2008 Report Share Posted May 1, 2008 Like one needs both renin and aldo to interpret this problem one needs both PTH and Ca++ to interpret the status of the parathyroid function. On Apr 30, 2008, at 10:32 AM, aviano237 wrote: > Dr. Grim: > My PTH was 23, twice. Left of normal, but still persistent > irrespective of Ca levels. > Angie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 5, 2008 Report Share Posted May 5, 2008 Dr. Grim: I don't want to clutter up the hyperaldo board with PTH/Ca issues unless you specifically direct me to do so..Suffice it to say that my Ca and PTH..when measured together..were HN Ca (both serum and serum ionized measured) have been borderline high with PTH not moving (lowest 21, highest 23). Thank you for your response. Angie > > > Dr. Grim: > > My PTH was 23, twice. Left of normal, but still persistent > > irrespective of Ca levels. > > Angie > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 5, 2008 Report Share Posted May 5, 2008 If you read out PTH files I think there is something there about PA affecting PTH issues. Certainly the hypokalemic alkalosis typical of advanced PA will affect bone metabolism. On May 5, 2008, at 7:49 AM, aviano237 wrote: > Dr. Grim: > I don't want to clutter up the hyperaldo board with PTH/Ca issues > unless you specifically direct me to do so..Suffice it to say that my > Ca and PTH..when measured together..were HN Ca (both serum and serum > ionized measured) have been borderline high with PTH not moving > (lowest 21, highest 23). > Thank you for your response. > Angie > > > > > > Dr. Grim: > > > My PTH was 23, twice. Left of normal, but still persistent > > > irrespective of Ca levels. > > > Angie > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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