RE: Spiro Dosage - upper limit of 50mg?

[Guest guest]

In using the term " PA episode " , I mean a period of time when symptoms

are more concentrated and pronounced. It usually begins for me with a

sensation in my head that feels like a wash is moving through my brain.

My head feels heavy, and my thought processes start to slow. I start to

'shut down', and need to lie down as weakness and fatigue increase. The

sleep at these times is usually filled with vivid frightening dreams.

Anxiety increases.

1. What brings it on if anything/

Don't know

2. How long does it last?

Varies from a few hours to a couple of days

3. Can you stop it if you catch it early?

No

4. What can you do to make it go away?

Nothing

5. What has been the past role of BP meds or diuretics on the spells?

Don't know

6. What do blood tests reveal during or after a spell?

Unknown, untested

Carol

Clarence Grim wrote:

>

> We need to be sure each person spells out exactly what they mean by a

> PA episode.

>

> Also:

>

> 1. What brings it on if anything/

> 2. How long does it last?

> 3. Can you stop it if you catch it early?

> 4. What can you do to make it go away?

> 5. What has been the past role of BP meds or diuretics on the spells?

> 6. What do blood tests reveal during or after a spell?

>

> Same for the " anxiety episode "

>

> On May 26, 2008, at 7:50 PM, Valarie wrote:

>

> > Over and over we hear about " the anxiety that comes on with a PA

> > episode, "

> > but there is little to nothing in the literature about this issue.

> > I guess

> > it can't be measured very well.

> >

> > Val

> >

> > From: hyperaldosteronism

> <mailto:hyperaldosteronism%40>

> > [mailto:hyperaldosteronism

> <mailto:hyperaldosteronism%40>] On Behalf Of Carol

> > Christie

> >

> > Val, I feel better using Efexor than I did using Lexapro. It doesn't

> > help, though, with the anxiety that comes on with a PA episode. I'm

> > hoping that if I can feel better with increased dosage of spiro that I

> > can come off Efexor. Time will tell...

> > Carol

> >

> >

[Guest guest]

I saw my GP today as I have been having heart palpitations and feeling

weak in a different way. A blood test taken 5 days ago showed potassium

at 5. ECG didn't show any irregularities but dr's physical examination

of me convinced her that I must be hyperkalaemic as a result of the

100mg of spiro daily. For now she said to cease the spiro and to take 40

mg furosemide daily. Am to have another blood test in two days. If I

have any chest pain to go to hospital immediately. All a bit scary and

frustrating really as I felt at last I was getting somewhere with PA

treatment.

Carol

Clarence Grim wrote:

>

> He sent me a note saying he thought he knew your Dr (the surgeon who

> was worried about side effects of sprio that have not been reported)

> and was going to talk to him.

>

> He did not come to the Am Soc of HTN meeting 2 weeks ago as he is

> prob going to the Int Soc HTN meeting in Berlin in June. I am not

> going to that one.

>

> On Jun 3, 2008, at 9:02 AM, Carol Christie wrote:

>

> > Dr Grim, I spoke with my GP about spiro dosage, your comments and my

> > cardiologist's management of my PA. She has agreed that the dosage of

> > spiro is too low, and is monitoring my increase in dosage. For a

> > week I

> > took 50mg per day and am now on 100mg(2x50mg). I had been feeling much

> > better until yesterday when I felt very weak in the legs and very

> > fatigued.

> > I have been wondering if you have heard anything from Dr Stowasser.

> > Carol

> >

> > Clarence Grim wrote:

> > >

> > > I am certain that Prof Gordon did not say 50 unless he was talking

> > > about men.

> > >

> > > I gave a talk there in 1983 when I was the Aust Heart Foundations

> > > international visiting fellow for a year. I talked about early

> > > primary aldo even then and used the same slides I have in my most

> > > recent review which is in our files.

> > >

> > > Maybe he misunderstood it as 50 and not 500 as we still go to 400 mg

> > > here if it can be tolerated. If pts can restrict salt it is not

> > > necessary to go so high.

> > >

> > > On May 26, 2008, at 1:25 AM, Carol Christie wrote:

> > >

> > > > Hello Dr Grim

> > > > Yes I am the same person you contacted Dr Stowasser about

> > before. The

> > > > cardiologist is Dr Nik Nikwan at Greenslopes Hospital. Dr

> > Stowasser

> > > > did

> > > > contact Nikwan after your last email to him re breast cancer and

> > > > spiro.

> > > > Nikwan has worked with Stowasser and Prof Gordon, I understand. In

> > > > fact

> > > > he referred to some research done by Prof Gordon in saying that

> > 50mg

> > > > should be the maximum dosage. It would be good to get some

> > > > clarification

> > > > about this.

> > > > Thank you

> > > > Carol

> > >

> > >

[Guest guest]

Be sure you read our files on cautions about how to draw blood to get

an accurate K. Be certain your lab followed these guidelines such

as not pumping your fist.

I know of no way to examine a patient and decide the K is high. Ask

him how he does this.

CE Grim MD

On Jun 4, 2008, at 9:18 AM, Carol Christie wrote:

> I saw my GP today as I have been having heart palpitations and feeling

> weak in a different way. A blood test taken 5 days ago showed

> potassium

> at 5. ECG didn't show any irregularities but dr's physical examination

> of me convinced her that I must be hyperkalaemic as a result of the

> 100mg of spiro daily. For now she said to cease the spiro and to

> take 40

> mg furosemide daily. Am to have another blood test in two days. If I

> have any chest pain to go to hospital immediately. All a bit scary and

> frustrating really as I felt at last I was getting somewhere with PA

> treatment.

> Carol

[Guest guest]

If you have not given us Carol's Story please do so and insert this

into your PA episode description.

What do you mean by a wash?

Are you saying you have never taken any BP meds?

What does your health care team think it is?

Have you ever had migraines?

On Jun 4, 2008, at 9:05 AM, Carol Christie wrote:

> In using the term " PA episode " , I mean a period of time when symptoms

> are more concentrated and pronounced. It usually begins for me with a

> sensation in my head that feels like a wash is moving through my

> brain.

> My head feels heavy, and my thought processes start to slow. I

> start to

> 'shut down', and need to lie down as weakness and fatigue increase.

> The

> sleep at these times is usually filled with vivid frightening dreams.

> Anxiety increases.

> 1. What brings it on if anything/

> Don't know

> 2. How long does it last?

> Varies from a few hours to a couple of days

> 3. Can you stop it if you catch it early?

> No

> 4. What can you do to make it go away?

> Nothing

> 5. What has been the past role of BP meds or diuretics on the spells?

> Don't know

> 6. What do blood tests reveal during or after a spell?

> Unknown, untested

> Carol

>

> Clarence Grim wrote:

> >

> > We need to be sure each person spells out exactly what they mean

> by a

> > PA episode.

> >

> > Also:

> >

> > 1. What brings it on if anything/

> > 2. How long does it last?

> > 3. Can you stop it if you catch it early?

> > 4. What can you do to make it go away?

> > 5. What has been the past role of BP meds or diuretics on the

> spells?

> > 6. What do blood tests reveal during or after a spell?

> >

> > Same for the " anxiety episode "

> >

> > On May 26, 2008, at 7:50 PM, Valarie wrote:

> >

> > > Over and over we hear about " the anxiety that comes on with a PA

> > > episode, "

> > > but there is little to nothing in the literature about this issue.

> > > I guess

> > > it can't be measured very well.

> > >

> > > Val

> > >

> > > From: hyperaldosteronism

> > <mailto:hyperaldosteronism%40>

> > > [mailto:hyperaldosteronism

> > <mailto:hyperaldosteronism%40>] On Behalf Of Carol

> > > Christie

> > >

> > > Val, I feel better using Efexor than I did using Lexapro. It

> doesn't

> > > help, though, with the anxiety that comes on with a PA episode.

> I'm

> > > hoping that if I can feel better with increased dosage of spiro

> that I

> > > can come off Efexor. Time will tell...

> > > Carol

> > >

> > >

[Guest guest]

Dr Grim, Thanks, I will write it up. To answer your questions,

> What do you mean by a wash?

I think the closest analogy would be a dripping of water on a sponge,

where the moisture gradually permeates the whole sponge.

> Are you saying you have never taken any BP meds?

No, I also take verapamil and irbesartan.

> What does your health care team think it is?

When I first tried to talk about this, I got blank looks, and general

disbelief.

> Have you ever had migraines?

No

Carol

Clarence Grim wrote:

>

> If you have not given us Carol's Story please do so and insert this

> into your PA episode description.

>

> What do you mean by a wash?

>

> Are you saying you have never taken any BP meds?

>

> What does your health care team think it is?

>

> Have you ever had migraines?

>

> On Jun 4, 2008, at 9:05 AM, Carol Christie wrote:

>

> > In using the term " PA episode " , I mean a period of time when symptoms

> > are more concentrated and pronounced. It usually begins for me with a

> > sensation in my head that feels like a wash is moving through my

> > brain.

> > My head feels heavy, and my thought processes start to slow. I

> > start to

> > 'shut down', and need to lie down as weakness and fatigue increase.

> > The

> > sleep at these times is usually filled with vivid frightening dreams.

> > Anxiety increases.

> > 1. What brings it on if anything/

> > Don't know

> > 2. How long does it last?

> > Varies from a few hours to a couple of days

> > 3. Can you stop it if you catch it early?

> > No

> > 4. What can you do to make it go away?

> > Nothing

> > 5. What has been the past role of BP meds or diuretics on the spells?

> > Don't know

> > 6. What do blood tests reveal during or after a spell?

> > Unknown, untested

> > Carol

> >

> > Clarence Grim wrote:

> > >

> > > We need to be sure each person spells out exactly what they mean

> > by a

> > > PA episode.

> > >

> > > Also:

> > >

> > > 1. What brings it on if anything/

> > > 2. How long does it last?

> > > 3. Can you stop it if you catch it early?

> > > 4. What can you do to make it go away?

> > > 5. What has been the past role of BP meds or diuretics on the

> > spells?

> > > 6. What do blood tests reveal during or after a spell?

> > >

> > > Same for the " anxiety episode "

> > >

> > > On May 26, 2008, at 7:50 PM, Valarie wrote:

> > >

> > > > Over and over we hear about " the anxiety that comes on with a PA

> > > > episode, "

> > > > but there is little to nothing in the literature about this issue.

> > > > I guess

> > > > it can't be measured very well.

> > > >

> > > > Val

> > > >

> > > > From: hyperaldosteronism

> <mailto:hyperaldosteronism%40>

> > > <mailto:hyperaldosteronism%40>

> > > > [mailto:hyperaldosteronism

> <mailto:hyperaldosteronism%40>

> > > <mailto:hyperaldosteronism%40>] On Behalf Of Carol

> > > > Christie

> > > >

> > > > Val, I feel better using Efexor than I did using Lexapro. It

> > doesn't

> > > > help, though, with the anxiety that comes on with a PA episode.

> > I'm

> > > > hoping that if I can feel better with increased dosage of spiro

> > that I

> > > > can come off Efexor. Time will tell...

> > > > Carol

> > > >

> > > >

[Guest guest]

ever had any seizures?

I forgot if you have any warning that an attack is coming on?

Flasing lights or wavy lines in vision?

On Jun 5, 2008, at 7:11 AM, Carol Christie wrote:

> Dr Grim, Thanks, I will write it up. To answer your questions,

> > What do you mean by a wash?

> I think the closest analogy would be a dripping of water on a sponge,

> where the moisture gradually permeates the whole sponge.

> > Are you saying you have never taken any BP meds?

> No, I also take verapamil and irbesartan.

> > What does your health care team think it is?

> When I first tried to talk about this, I got blank looks, and general

> disbelief.

> > Have you ever had migraines?

> No

>

> Carol

>

> Clarence Grim wrote:

> >

> > If you have not given us Carol's Story please do so and insert this

> > into your PA episode description.

> >

> > What do you mean by a wash?

> >

> > Are you saying you have never taken any BP meds?

> >

> > What does your health care team think it is?

> >

> > Have you ever had migraines?

> >

> > On Jun 4, 2008, at 9:05 AM, Carol Christie wrote:

> >

> > > In using the term " PA episode " , I mean a period of time when

> symptoms

> > > are more concentrated and pronounced. It usually begins for me

> with a

> > > sensation in my head that feels like a wash is moving through my

> > > brain.

> > > My head feels heavy, and my thought processes start to slow. I

> > > start to

> > > 'shut down', and need to lie down as weakness and fatigue

> increase.

> > > The

> > > sleep at these times is usually filled with vivid frightening

> dreams.

> > > Anxiety increases.

> > > 1. What brings it on if anything/

> > > Don't know

> > > 2. How long does it last?

> > > Varies from a few hours to a couple of days

> > > 3. Can you stop it if you catch it early?

> > > No

> > > 4. What can you do to make it go away?

> > > Nothing

> > > 5. What has been the past role of BP meds or diuretics on the

> spells?

> > > Don't know

> > > 6. What do blood tests reveal during or after a spell?

> > > Unknown, untested

> > > Carol

> > >

> > > Clarence Grim wrote:

> > > >

> > > > We need to be sure each person spells out exactly what they mean

> > > by a

> > > > PA episode.

> > > >

> > > > Also:

> > > >

> > > > 1. What brings it on if anything/

> > > > 2. How long does it last?

> > > > 3. Can you stop it if you catch it early?

> > > > 4. What can you do to make it go away?

> > > > 5. What has been the past role of BP meds or diuretics on the

> > > spells?

> > > > 6. What do blood tests reveal during or after a spell?

> > > >

> > > > Same for the " anxiety episode "

> > > >

> > > > On May 26, 2008, at 7:50 PM, Valarie wrote:

> > > >

> > > > > Over and over we hear about " the anxiety that comes on with

> a PA

> > > > > episode, "

> > > > > but there is little to nothing in the literature about this

> issue.

> > > > > I guess

> > > > > it can't be measured very well.

> > > > >

> > > > > Val

> > > > >

> > > > > From: hyperaldosteronism

> > <mailto:hyperaldosteronism%40>

> > > > <mailto:hyperaldosteronism%40>

> > > > > [mailto:hyperaldosteronism

> > <mailto:hyperaldosteronism%40>

> > > > <mailto:hyperaldosteronism%40>] On Behalf Of

> Carol

> > > > > Christie

> > > > >

> > > > > Val, I feel better using Efexor than I did using Lexapro. It

> > > doesn't

> > > > > help, though, with the anxiety that comes on with a PA

> episode.

> > > I'm

> > > > > hoping that if I can feel better with increased dosage of

> spiro

> > > that I

> > > > > can come off Efexor. Time will tell...

> > > > > Carol

> > > > >

> > > > >

[Guest guest]

No seizures. No warning that I am aware of. I sometimes get wavy lines

in my vision.

Carol

Clarence Grim wrote:

>

> ever had any seizures?

>

> I forgot if you have any warning that an attack is coming on?

> Flasing lights or wavy lines in vision?

>

> On Jun 5, 2008, at 7:11 AM, Carol Christie wrote:

>

> > Dr Grim, Thanks, I will write it up. To answer your questions,

> > > What do you mean by a wash?

> > I think the closest analogy would be a dripping of water on a sponge,

> > where the moisture gradually permeates the whole sponge.

> > > Are you saying you have never taken any BP meds?

> > No, I also take verapamil and irbesartan.

> > > What does your health care team think it is?

> > When I first tried to talk about this, I got blank looks, and general

> > disbelief.

> > > Have you ever had migraines?

> > No

> >

> > Carol

> >

> > Clarence Grim wrote:

> > >

> > > If you have not given us Carol's Story please do so and insert this

> > > into your PA episode description.

> > >

> > > What do you mean by a wash?

> > >

> > > Are you saying you have never taken any BP meds?

> > >

> > > What does your health care team think it is?

> > >

> > > Have you ever had migraines?

> > >

> > > On Jun 4, 2008, at 9:05 AM, Carol Christie wrote:

> > >

> > > > In using the term " PA episode " , I mean a period of time when

> > symptoms

> > > > are more concentrated and pronounced. It usually begins for me

> > with a

> > > > sensation in my head that feels like a wash is moving through my

> > > > brain.

> > > > My head feels heavy, and my thought processes start to slow. I

> > > > start to

> > > > 'shut down', and need to lie down as weakness and fatigue

> > increase.

> > > > The

> > > > sleep at these times is usually filled with vivid frightening

> > dreams.

> > > > Anxiety increases.

> > > > 1. What brings it on if anything/

> > > > Don't know

> > > > 2. How long does it last?

> > > > Varies from a few hours to a couple of days

> > > > 3. Can you stop it if you catch it early?

> > > > No

> > > > 4. What can you do to make it go away?

> > > > Nothing

> > > > 5. What has been the past role of BP meds or diuretics on the

> > spells?

> > > > Don't know

> > > > 6. What do blood tests reveal during or after a spell?

> > > > Unknown, untested

> > > > Carol

> > > >

> > > > Clarence Grim wrote:

> > > > >

> > > > > We need to be sure each person spells out exactly what they mean

> > > > by a

> > > > > PA episode.

> > > > >

> > > > > Also:

> > > > >

> > > > > 1. What brings it on if anything/

> > > > > 2. How long does it last?

> > > > > 3. Can you stop it if you catch it early?

> > > > > 4. What can you do to make it go away?

> > > > > 5. What has been the past role of BP meds or diuretics on the

> > > > spells?

> > > > > 6. What do blood tests reveal during or after a spell?

> > > > >

> > > > > Same for the " anxiety episode "

> > > > >

> > > > > On May 26, 2008, at 7:50 PM, Valarie wrote:

> > > > >

> > > > > > Over and over we hear about " the anxiety that comes on with

> > a PA

> > > > > > episode, "

> > > > > > but there is little to nothing in the literature about this

> > issue.

> > > > > > I guess

> > > > > > it can't be measured very well.

> > > > > >

> > > > > > 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

> > > > > >

> > > > > > Val, I feel better using Efexor than I did using Lexapro. It

> > > > doesn't

> > > > > > help, though, with the anxiety that comes on with a PA

> > episode.

> > > > I'm

> > > > > > hoping that if I can feel better with increased dosage of

> > spiro

> > > > that I

> > > > > > can come off Efexor. Time will tell...

> > > > > > Carol

> > > > > >

> > > > > >