Val's story (cont) ATTN Dr. Grim

[Guest guest]

Dr. Grim, could you please help me with this?

Started spiro 50 mg/d/split on 3/22/08

3/22/08: BP = 164/104 pulse 85 (but it was running up to mid 90's depending

on level of anxiety)

4/4/08: BP = 142/87 & 125/78, pulse 75. Average BP from 3/22 - 4/4 was

134/84 (including the few high readings) I had a couple of readings near

150 when having a " grip " (previously called anxiety episode).

4/4/08: Increased spiro to 75 mg/d/split

This morning's BP was 120/84 pulse 70, early morning sweats were

significantly less but still there.

The constant " heart gripping " has slowed down considerably compared to where

it was before spiro. I took no Ativan on Saturday and felt almost normal,

but had a rough Sunday with several " grips, " muscle spasms, bad early

morning sweats and BP at one time was 146/81 (during a " grip. " ). During the

" grips " my heart often pounds hard. Today I had a couple " grips " and took

1/2 mg Ativan. They are preceded by a sense of low blood sugar. They

resolved quickly after Ativan. Other than those, I feel almost normal. I

am stronger, can do light exercises and my ankle edema is 50% improved. I'm

assuming K is doing something good to my muscles. I have complained for

years that exercise seemed never to build any muscle.

In terms of the " heart grips, " I had them nearly non-stop for months and

months. I was nearly nuts and wondered how long my heart could stand it.

Sometimes, some V-8 would relieve them a little. Early on, estradiol seemed

to help a bit but by 2/25/08, every time I used it, I had terrible anxiety.

Valerian Root helped a tiny bit. Whey protein made them worse, and of

course, salt made them worse. Since 4/1/08 I've lost 6/10 lb. Nothing to

write home about but more than I've lost in a week ever before.

K test 4/3/08: 4.8 (3.5 - 5.2) (Yes, her office DID call today) I have

been averaging 3,900mg K and 780 mg Na according to FitDay. (You told me I

needed about 3,000 mg K based on my height and caloric intake).

QUESTION 1: I assume it is okay to continue the 75 mg spiro? I will clear

it with endo.

QUESTION 2: Would you agree that I've had a very good reaction to spiro?

QUESTION 3: If I decide I want to go to Mayo and have AVS, am I going to

have to go off spiro for six weeks?

Previous tests are below. Thank you forever and ever.

Val

________________________________________

12/23/07: In ER, K was at " bottom of the range. " I was on 25 mg HCTZ. BP

was ~210/114 to 180/100 to 157/95

1/7/08: K = 3.7 (3.5 - 5.5) I had been drinking LS V-8 (570 mg K) in

addition to regular food. Based on my current food diary, I was probably

getting 3,000 - 3,500K/day. I was on Triam/HCTZ 37.5/25 for two weeks.

Renin, plasma 1.35 (1.31 - 3.95 uGu/mol/hr)

Below are normal bands for different levels of salt excretion

Na = 0 - 30: (8.82 - 23.86)

Na = 30 - 75 (4.09 - 7.73)

Na = 75 - 150 (1.44 - 2.80)

Na = >150 (0.39 - 1.31)

Urine Na was not done

I had become aware (after my paralysis on 1/3/08) that salt hurt me badly

and was controlling it. I would guess at about 900 - 1200 mg/d but

sometimes ate some salty food (we were moving and working on the old house).

Aldosterone 25.7 HIGH (1.0 - 16.0)

Below it has a normal range for Upright of 4 - 31

1/28/08:

Urine aldo 15 (2.0 - 20.0 uGu/24h)

VMA, Cortisol, Metanephrines were all well within normal.